The Role of Lifestyle Factors in Autoimmune Disease Management

We are at a critical inflection point for autoimmune diseases. The increasing prevalence over the last few decades has left patients and clinicians grappling with how to support this complex collection of symptoms. Autoimmune conditions affect about 1 in 10 individuals, with 80% of those being women. It is hypothesized that autoimmune conditions such as rheumatoid arthritis and Sjogren’s syndrome occur more in women due to the hormonal changes they experience. 

Lifestyle management is vitally important when addressing autoimmune conditions and requires a comprehensive approach. Each disease presents uniquely in every individual and deserves a personalized perspective. Some foundational lifestyle modifications can improve everyone’s quality of life even if they are not diagnosed with an autoimmune condition(s). This article will build upon that foundation of specific recommendations that autoimmune patients can implement, which may prevent disease progression over time. 

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What Are Autoimmune Diseases?

The immune system is a complex web of cells that protects against pathogens and toxins that can cause disease. It also helps to move excess fluid (lymph) from our tissues so that we don’t accumulate toxins. We have two main arms of our immune system: innate and adaptive. Our innate immune system works like the first responders: as soon as we get exposed to a pathogen, they come running immediately when our internal environment is threatened. Our adaptive immune system is more delayed as it responds to a specific foreign substance and creates an antibody response.

Autoimmune disease is, by definition, when our adaptive immune system turns on itself. The most common conditions include lupus, Hashimoto's thyroiditis, multiple sclerosis, Sjogren's syndrome, and rheumatoid arthritis. The symptoms can vary widely depending on which organ system is attacking itself, but each condition responds well to holistic management with or without medication.

Functional Medicine Testing in Autoimmune Diseases

Proactive functional medicine testing is critical to early diagnosis and interventions. The quicker you can diagnose an autoimmune condition, the less likely it is to progress to a severe state. Measuring and tracking specific biomarkers can determine where your clinician needs to focus to create a personalized care plan for you. 

Below are the functional medicine test options to prioritize for the identification of potential autoimmune triggers and imbalances.

Immune Biomarkers

These include ANA+ reflex, CBC with differential, and hsCRP. These labs will help identify the severity of immune dysfunction, if you need to refer to an endocrinologist, and the level of overall inflammation in the body. 

Gut Microbiome Analysis

Since 70-80% of our immune system resides in our GI system, identifying imbalances in this organ system is key to the long term management of autoimmune conditions. Genova Diagnostic's GI Effects Comprehensive Profile has a one-day stool test that identifies inflammation, immune system function, dysbiosis, and intestinal permeability. The GI-MAP by Diagnostic Solutions is another example of a thorough stool test requiring only one sample as well.

Food Intolerance Testing

The Array 10 – Multiple Food Immune Reactivity Screen by Cyrex Laboratories has the most comprehensive testing to diagnose food intolerances including spices, herbs, beverages, and gums. This testing can be helpful if a patient has already removed the top seven inflammatory foods (gluten, dairy, corn, soy, eggs, peanuts, sugar) and are still experiencing symptoms.

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Diet and Nutrition in Autoimmune Disease Management

Nutrition for autoimmune disease management can often feel like the blind leading the blind. Research shows that the AIP (Autoimmune Paleo) diet can help to modulate the immune response. Every patient is different, so once common inflammatory foods like gluten and dairy are eliminated, the AIP diet must be tailored to the individual’s tolerance of specific foods. If they are willing, I typically recommend an elimination diet with the support of a health coach. This way, they can identify their personal food triggers.

Completing a food intolerance test can be a good starting point if a health coach is not an option. Discussing with the patient that it is not supposed to be a ‘forever diet’ goes a long way to reducing food fear and the potential for disordered eating in the future.

I have seen the most significant impact of the AIP diet on Hashimoto’s thyroiditis, largely due to the reduction/ elimination of gluten. The gliadin protein is similar to the thyroid hormone chemical structure and can significantly impact its function. Seemingly overnight, patients feel better because of the positive impact on gut health.

Since 70-80% of our immune system is in our gut, decreasing the intake of inflammatory foods can also aid in reducing autoimmune symptoms. The epithelial lining of our intestines repairs itself every 3-5 days if we feed it the right balance of foods and reduce our stress.

Physical Activity and Exercise for Autoimmune Management

Physical activity often falls by the wayside when patients are not feeling well due to autoimmune disease. Fatigue and exhaustion are two of the most common symptoms and can prevent a consistent exercise routine. This can be frustrating for clinicians as they try to push past patient resistance, especially when they know that increasing physical activity can greatly enhance a patient’s quality of life, reduce inflammation, and improve energy.

Recommending specific guidelines and writing an exercise prescription can significantly increase compliance. Consider inviting the patient to do a morning check-in on how their body feels and their capacity for movement that day. The outcomes improve when you make movement non-negotiable yet allow patients to choose the activity level and duration. Once that baseline has been established, you can support them in slowly increasing movement goals as their autoimmune condition improves.

Stress Management and Mental Health for Autoimmune Diseases

The mental stress load for an autoimmune patient can weigh heavy. Often, it takes years to get diagnosed because symptoms can be vague and often brushed off as “nothing to worry about.” Hence, it is important to diagnose subclinical autoimmune conditions, which can have a profoundly positive effect on patients’ outlook and quality of life.

The experience of being seen and heard by a medical professional is enough to activate the parasympathetic (rest and digest) nervous system. Once a level of trust is established, that in and of itself can have a placebo effect on the personalized treatment approach. The placebo effect is often seen as negative, but our mindset is integral to the healing process. 

Furthermore, when you layer on stress management techniques like meditation, breathwork, and other mindfulness practices, the patient begins to believe they can feel like themselves again. This also empowers them so they can access these tools at any time if they have a flare.

Sleep Quality and Autoimmune Diseases

Improving sleep in autoimmune patients should be one of the top priorities to support recovery and lasting health. It is often the primary lever that helps to move other interventions the patient is already incorporating. However, if they are not sleeping well, no diet or supplement is an adequate replacement over the long term.

When we go to sleep, the glymphatic system in our brain wakes up. This is a vital part of our immune system that is often overlooked. The glymphatic system's primary role is to remove proteins and metabolites from our central nervous system. It literally cleans out the cobwebs on our brain and supports the body’s overall immune health. Given patients often complain about brain fog, getting at least 7-9 hours of sleep each night can improve this symptom immensely. 

Having an open discussion about potential barriers to sleep helps identify where to focus the most support. Having a cool temperature (68F) in the bedroom, blackout curtains or sleep mask, a warm bath if accessible, and an evening meditation can set the foundation for a restful night of sleep. These small changes to an evening routine support the glymphatic system to more effectively remove waste products and prevent them from accumulating in the nervous system. A more restorative sleep leads to increased morning energy to implement other changes you may ask your patients to incorporate into their daily habits. This leads to greater compliance with specific protocols like supplements and nutrition changes that ultimately support their autoimmune conditions.

Environmental Factors and Autoimmune Diseases

Environmental factors and toxin exposure can also contribute to developing autoimmune diseases. We increasingly live in a world where new synthetic compounds are produced daily. This daily exposure to toxic chemicals found in our food, water supply, and even air is foreign to our immune systems. It increases what is known as oxidative stress on our systems, which can cause dysregulation of T cells and immune messenger systems.

We live in a modern world where new chemicals and compounds are added to daily products like food and beauty products. This aspect of health is often overlooked during an initial visit with a provider. Adding an environmental section to your intake form can be a starting place to have that conversation with patients. Once you identify how often they dry clean their clothes, eat out with plastic food containers, or if they live in a moldy home, then you know where to focus detoxification efforts. Even simple changes like only microwaving in glass containers or filtering their drinking water at home can make a big difference.

If you are concerned about more severe toxin exposure, comprehensive testing from companies like RTL Tox Complete can help identify toxin overload, including mycotoxins and environmental pollutants.

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Key Takeaways

When suspecting an autoimmune condition in a patient, the first step is acknowledging how their symptoms have negatively impacted their lives. Once someone feels seen and heard, they can trust in your therapeutic relationship as you walk them through the steps outlined above.

Adopting a multimodal holistic approach emphasizing lifestyle modifications leads to the best long-term patient outcomes. This may include medical treatment using a comprehensive treatment plan that prevents disease progression and improves quality of life.