Diet, Exercise and Drugs for Autoimmune Diseases

Usually, our immune systems protect us from all kinds of outside invaders like the bacteria that causes strep throat and the virus that causes COVID, but what happens when our immune system’s highly-specialized antibodies, white blood cells, and inflammatory molecules glitch and turn against us, attacking our body’s own tissues and organs? We get autoimmune diseases. 

There are 80 types of autoimmune diseases, and they’re often difficult to diagnose. The symptoms of autoimmune diseases can vary widely based on the parts of the body that are affected.

Often, the symptoms of autoimmune diseases, like painful swelling and inflammation, change from day to day. Certain triggers like food and stress might aggravate your autoimmune disease. When symptoms worsen, you’re experiencing what’s called a “disease flare.” 

What Causes Autoimmune Diseases?

In many cases, scientists don’t know what causes an autoimmune disease. Some have hereditary components. Others might be triggered by exposure to certain infections, medications or even chemicals in the environment. In many cases, if you have one autoimmune disease, you may be at higher risk of developing another. 

Are Autoimmune Diseases Genetic?

Researchers have found that many genes can raise or lower your risk of developing an autoimmune disease, and these diseases often run in families. However, genes don’t explain all of your risk. Exposures to infections or unknown environmental triggers likely also play a role.

Women and Autoimmune Disease

Overall, autoimmune disease tends to be more common in women than in men, though there are some caveats. Type I diabetes and Crohn’s disease affect men and women equally, for example. Researchers are still working to understand why women are so much more likely than men to experience autoimmune disease, but they suspect it may have to do with how hormones interact with the immune system, the immune-related genes present on the X chromosome and even sex-based differences in the gut microbiome.

About 90% of lupus diagnoses are in women. And of those, the disease is far more common in women of color, especially Black women, than white women, according to the Centers for Disease Control and Prevention (CDC). Three times as many women are diagnosed with MS than men. Rheumatoid arthritis and Hashimoto’s are also significantly more likely to affect women than men. 

Hives, Hair Loss and Autoimmune Disease

Having an autoimmune disease can make you more prone to hives. About 20% of people with rheumatoid arthritis develop chronic hives, raised red welts on the skin that can itch and last for six weeks or more. Autoimmune disease can also cause you to develop acute hives that start to fade within a day of appearing, often as a reaction to a recent viral infection or exposure to something you’re allergic to. Antihistamines can help treat hives.

In one specific autoimmune disease, alopecia areata, your immune cells attack your hair follicles causing hair loss (made famous by Jada Pinkett Smith’s alopecia areata and the famous Oscars ceremony slap by Will Smith). But many other autoimmune diseases, such as lupus, psoriatic arthritis and crohn’s, may also cause you to lose hair.

Types of Autoimmune Diseases

Lupus

When you have lupus, your body produces too many “B cells,” a type of immune cell. These cells can go on to attack your healthy tissue. The disease can be particularly difficult to diagnose because the symptoms vary widely depending on which tissues your B cells end up attacking. For example, Madeleine Shonka told MedShadow that it took doctors seven years to discover that lupus was the cause of her joint pain, but if lupus attacks your skin, you’ll likely experience rashes or sun sensitivity. If it attacks your heart, you could experience cardiovascular symptoms.

If you have rashes or skin irritation with lupus, it may help to limit your exposure to sunlight. 

Some symptoms of lupus include:

• Rashes
• Fevers
• Fatigue
• Joint pain
• Arthritis
• Sun sensitivity
• Heart and kidney problems
• Seizures
• Psychosis
• Respiratory problems

If you’re diagnosed with Lupus, your doctors may prescribe: 

• Nonsteroidal anti-inflammatories
• Corticosteroids
• BLyS-specific inhibitors
• Hydroxychloroquine
• Anticoagulants, because lupus can cause blood clots.
• Immunosuppressants such as methotrexate

Some lifestyle modifications that may ease all types of lupus symptoms are: 

• Tracking symptoms and triggers
• Exercise
• Reducing stress

Autoimmune Hepatitis

Autoimmune hepatitis is a rare form of hepatitis in which your immune system attacks your healthy liver.

Symptoms of Autoimmune Hepatitis

The symptoms of autoimmune hepatitis are the same as those of other types of liver disease. To confirm the diagnosis, your physician will likely need to rule out other potential causes of liver damage.

Those symptoms typically include:

• Jaundice (yellowing of the skin or eyes)
• Fatigue
• Rashes
• Joint Pain
• Abdominal discomfort
• Dark-colored urine
• Nausea and weight loss

If you’re diagnosed with autoimmune hepatitis, your healthcare provider may prescribe:

• Corticosteroids
• Azathioprine, an immunosuppressant

Juvenile, Rheumatoid and Psoriatic Arthritis 

In juvenile and rheumatoid arthritis, inflammation caused by your immune system attacks the cartilage in your joints, causing pain, swelling, and limited range of motion. These symptoms may improve or worsen day to day. Joints in your hands, wrists and knees are most commonly affected, but in some cases, arthritis can damage tissue throughout your body such as your lungs and eyes. 

Psoriatic arthritis attacks the skin and causes scaly, itchy, and painful rashes on the body.

Your healthcare provider may recommend these treatments:

• Increasing low impact exercise or mobility exercises to help you maintain range of motion
• NSAIDs 
• Corticosteroid injections
• Disease Modifying Drugs (DMARD) such as Methotrexate (Rheumatrex, Trexall) to slow further inflammation
• Janus Kinase (JAK) inhibitors, another type of DMARD, such as Xeljanz (tofacitinib)
• Biologic DMARDs such as Humira (adalimumab)
• Otezla (apremilast) which controls inflammation by blocking an enzyme inside cells

Does Psoriasis Cause Psoriatic Arthritis?

Psoriasis is an autoimmune skin condition that gives you thick patches of reddened or scaly skin that can be itchy and painful. About 10-20% of people with psoriasis go on to develop psoriatic arthritis. To learn more about psoriasis treatments and side effects, see MedShadow’s article: Psoriasis Drugs.

Crohn’s and Colitis

Both crohn’s and colitis fall under the category of inflammatory bowel disease. Your immune system attacks parts of your digestive tract. 

Symptoms of Crohn’s and Colitis typically include:

• Abdominal pain
• Diarrhea
• Vomiting
• Malnutrition
• Fatigue
• Weight loss

If you have inflammatory bowel disease, your physician may prescribe: 

• Corticosteroids
• Aminosalicylates to treat inflammation and prevent flares
• Immunosuppressants such as methotrexate
• Biologic DMARDs such as Humira (adalimumab)

Type 1 Diabetes

Often starting in childhood, diabetes type 1 is caused by your immune system attacking cells in your pancreas that are responsible for producing the hormone insulin. You need insulin to extract energy from glucose. If left untreated, diabetes can lead to serious complications such as nerve damage, kidney damage, skin and mouth infections, or a dangerous condition called ketoacidosis. 

Symptoms of type 1 diabetes include:

• Fatigue
• Unexplained weight loss
• Excessive hunger and thirst
• Excessive urination
• Mood changes
• Blurry vision

If you’re diagnosed with type 1 diabetes, your physician will likely recommend that you monitor your blood sugar, and in some cases, take insulin. In some cases, you may be prescribed drugs like metformin, which are more commonly used to treat type 2 diabetes, if your doctor thinks it will help control your blood sugar.

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease in which your immune system attacks the myelin sheath—an insulating coating, like the rubber around a wire, that protects your neurons. This makes it harder for your neurons to communicate with each other. In some people, MS is primarily progressive, meaning symptoms gradually worsens over time. For others, with relapsing-remitting MS, symptoms may flare up and die down throughout their lifetime. Flare ups can cause lesions, or wounds on your organs, that cause long-term damage or disability.

Symptoms of MS include: 

• An unsteady gait
• Tingling sensations 
• Limb numbness or weakness
• Loss of vision
• Blurry vision or double vision
• Slurred speech
• Cognitive or mood disturbances
• Lack of balance or coordination

If you are diagnosed with MS, your doctor is likely to prescribe 

• Corticosteroids to treat flares
• Disease-modifying injections of interferon beta, Copaxone or Glatopa (glatiramer acetate)
• Disease-modifying infusions of Ocrevus (ocrelizumab), Lemtrada (alemtuzumab) or Tysabri (natalizumab)
• Disease-modifying oral medications such as Mavenclad (cladribine), Tecfidera (dimethyl fumarate), Vumerity (diroximel fumarate), Gilenya (fingolimod), Zeposia (ozanimod), Mayzent (siponimod), Aubagio (teriflunomide) 

Hashimoto’s Thyroiditis and Grave’s Disease

Autoimmune diseases are one of the main causes of thyroid problems. When your immune cells attack your thyroid, it can cause your thyroid to produce too much or too little thyroid hormone. Hashimoto’s can cause an underactive thyroid, leading to hypothyroidism. 

Symptoms of hypothyroidism include:

• Fatigue
• Cold sensitivity
• Muscle and joint pain and stiffness
• Changes in menstruation
• Depression and difficulty concentrating
• A swollen thyroid and puffy face
• Brittle nails and hair loss
• Swollen tongue

Grave’s disease can cause the opposite, hyperthyroidism or an overactive thyroid. 

Symptoms of hyperthyroidism include:

• Anxiety 
• Tremors
• Unexplained weight loss
• Fatigue
• Frequent bowel movements
• Changes in menstrual cycle
• Sexual dysfunction 
• Insomnia 
• Skin thickening or redness, especially on the legs and feet
• Heat sensitivity
• Rapid heart rate

If you have hypothyroidism, your physician may prescribe thyroid hormone replacement therapy, such as Synthroid (levothyroxine).

If you have hyperthyroidism, your doctor may prescribe:

• Anti-thyroid hormone therapies (propylthiouracil, methimazole)
• Beta blockers, to treat symptoms like rapid heart rate

Side Effects of Treatments Commonly Used for Autoimmune Diseases

Nonsteroidal Anti-inflammatories for Lupus, Arthritis, Crohn’s and Colitis

You may take NSAIDs as needed to treat autoimmune disease flares. NSAIDs are common painkillers such as ibuprofen, naproxen, and aspirin. These drugs are known for their potential to cause gastrointestinal issues by irritating the lining of your stomach. 

In rarer cases, NSAIDs could cause swelling, bloody urine, liver damage, light sensitivity, high blood pressure, and more. The longer you take the drugs and the higher the dose, the greater your risk will be.

Make sure you don’t take more than the recommended dose, and stick with the smallest dose you can for the least amount of time. A 2018 study, conducted by the manufacturer of Tylenol, a competitor of NSAIDs, suggested that up to 15% of people take more than the recommended dose of NSAIDs. 

While rare, it is possible to overdose on NSAIDs. Symptoms of an NSAID overdose include blurry vision, headaches, sweating, seizures, low blood pressure, dizziness, diarrhea,vomiting and loss of consciousness. If you are experiencing these symptoms, call 9-11 immediately.

Corticosteroids for Lupus, Autoimmune Hepatitis, Arthritis, or MS

The most common side effects of oral corticosteroids are:

• weight gain
• reflux
• swelling 
• mood changes.

Over time, these drugs can cause weakening of your bones, high blood sugar, slowed wound healing, an increased risk of infections, and hormone imbalances. 

When lupus patient Madeleine Shonka was prescribed corticosteroids, she told MedShadow she gained weight, and had to adjust her diet to mitigate the side effect. She also felt more angry and irritable than usual. 

Shonka wasn’t the only one to tell MedShadow she experienced mood changes on corticosteroids.

“When I completed my course of prednisone without any other side effects, I thought I was in the clear. I was wrong,” writes Shawna De La Rosa, explaining that she started experiencing panic attacks severe enough that she thought she was having a heart attack.

Read Shawna De Le Rosa’s first-hand account of the rare but serious psychological side effects of corticosteroids here.

BLyS-specific inhibitors for Lupus

Your provider administers this drug either as an injection under the skin or an infusion directly into your veins. The drugs work by preventing your body from making too many immune cells. According to the clinical trials, the most common side effects of BLyS-specific inhibitors (belimumab) were:

• Gastrointestinal symptoms (diarrhea, nausea)
• Fevers
• Bronchitis
• Insomnia
• Depression
• Migraines
• Sore throats Injection-site reactions.

Early clinical trials suggested that the drug may not be as effective for Black lupus patients as it was for others, leaving patients and doctors to make their best guess as to whether or not to use it in this population. Finally, 10 years after its approval, new research shows it is effective in Black patients. Read more about the ordeal in MedShadow’s article: Does the Lupus Drug Benlysta Work for Black Patients?

Hydroxychloroquine for Lupus

Hydroxychloroquine (yes, this is the controversial drug that the FDA did not approve for use with COVID, but some doctors still do) is an antimalarial that works by lowering the levels of antibodies in your blood that attack healthy tissues. It can also help with pain, inflammation, and skin irritation. Some people with lupus are prescribed antimalarials long term.

Common side effects include:

• Nausea
• Vomiting
• Rash and hyperpigmentation of the skin

Of the various treatments Shonka was prescribed for lupus, for example, antimalarials seemed to cause the least intense side effects. She says she experienced about three months of mild nausea on the treatment.

Coumadin and Other Anticoagulants for Lupus

Lupus can raise your risk of forming blood clots. Anticoagulants are blood thinners prescribed to prevent that from happening.

Some common anticoagulants are:

• Coumadin (warfarin)
• Pradaxa (dabigatran)
• Xarelto (rivaroxaban)
• Eliquis (apixaban)
• Savaysa (edoxaban)

These drugs can interact with foods that contain vitamin K, so your healthcare provider may recommend that you monitor your intake of green, leafy vegetables, which contain this vitamin. They also interact with many other drugs, so be sure to carry a complete list of anything you take, including over-the-counter drugs and supplements to review with your provider.

Rarely, these drugs can cause shortness of breath by constricting your blood vessels, or bleeding because they prevent you from forming blood clots. The risk of major bleeding events on warfarin, such as hemorrhages or bleeding that requires hospitalization, ranges from 0.4% to 7.2%.

Methotrexate, Immunosuppressants for Lupus, Arthritis, Crohn’s or Colitis

Rheumatrex and Trexall (forms of methotrexate) is one of the most commonly prescribed drugs for a variety of autoimmune conditions because it can suppress immune activity and reduce damaging inflammation, helping to prevent disease flares over time.

The most common side effects of these drugs are: 

• Nausea and vomiting
• Increased risk of serious infections.

Over time, these drugs can irritate your liver. Your physician will likely monitor your liver enzymes using frequent blood tests. If these enzymes appear to be elevated, your healthcare provider may suggest stopping or changing your medications so your liver can heal.

When Angela, a rheumatoid arthritis patient, started taking methotrexate, her rheumatoid arthritis symptoms remained debilitating, but she also started feeling side effects of methotrexate like nausea. Blood tests showed her liver function had declined. Because methotrexate was both ineffective and intolerable due to side effects, her doctor took her off the medicine, but claimed it was only temporary, while her liver healed. Instead of starting to take the drug again, Angela found that changes to her diet could help.

Read Angela’s story here about how she used her diet to keep her rheumatoid arthritis symptoms at bay. And see her talk a bit about it below.

@medshadow_foundation Angela Christine tells Power to the Patient about her battle with arthritis, the side effects of the medication used to treat it, and how she overcame the condition. #arthritis #arthritisrelief #arthritispainrelief #arthritislife #rheumatoidarthritis #rheumatology #rheumatologist #rheumatoidarthritiswarrior #inflammation #mediterraneandiet #glutenfree #glutenfreelife #arthritisdiet #arthritistiktok #health #healthy #healthyliving #medshadow #medshadowfoundation ♬ original sound – MedShadow Foundation

When a doctor prescribed methotrexate to help treat Shonka’s lupus, she says she was only able to take it for six months. She was regularly vomiting up to three times a day.

JAK Inhibitors and Apremilast for Arthritis

JAK Inhibitors are also DMARDs (Disease Modifying Antirheumatic Drugs). Some of the most common JAK inhibitors are:

• Tofacitinib (Xeljanz)
• Baricitinib (Olumiant) 
• Upadacitinib (Rinvoq)

JAK inhibitors may raise your risk of developing blood clots. Tofacitinib currently carries a black box warning (the most serious warning for side effects that can cause death or significant harm) from the FDA regarding blood clots and an increased risk for certain cancers. A trial published in 2022 clarified the risk of developing cancer. For every 55 people aged 50 or over who took the drug for five years, one additional person might develop cancer. Lymphoma, lung cancer, and skin cancers occurred most often.

Otezla (apremilast) is used specifically for psoriatic arthritis. 

The most common side effects of apremilast are: 

• Nausea and diarrhea
• Respiratory infections
• Headaches

Aminosalicylates for Crohn’s or Colitis

These drugs can ease inflammation in the intestines. They can be prescribed temporarily for acute flare ups or continuously to reduce the risk of future flares. Some types are oral medications whereas others can be administered rectally via a suppository. Experts say that swallowing the pills may allow you to take larger doses while limiting the drug’s exposure to parts of the body outside of the intestines.

Some examples of aminosalicylates include:

• Sulfasalazine (Azulfidine) 
• Mesalamine (Pentasa, Lialda, Apriso, Delzicol, Asacol, Canasa or Rowasa)
• Olsalazine (Dipentum) 
• Balsalazide (Colazal)

The most common side effects of aminosalicylates are: 

• Additional gastrointestinal distress (nausea, cramping)
• Headaches 
• Rash 
• Fever
• Lowered sperm count (sulfasalazine in particular)

Disease-Modifying Pills, Injections or Infusions for Multiple Sclerosis

MS flares can be debilitating, and the scar tissue they leave behind can cause longer term damage so your physician may prescribe a disease-modifying treatment for you to take regularly to help prevent them. These drugs, which come in the form of injections, infusions, and pills dampen your immune system to prevent it from attacking your nervous system.

Disease-modifying injections of interferon beta for MS include:

• Copaxone (glatiramer acetate)
• Glatopa (glatiramer acetate)

Disease modifying therapies (DMTs) are some of the oldest drugs for MS. They were approved in the early 1990s. Often, they are the first drug you’ll be prescribed, but you may eventually need to move to a new treatment if your body stops responding to them or they start to irritate your liver. 

The most common side effect is injection site reactions. When Vickie Hadge, an MS patient who described her experience to MedShadow, first started taking glatiramer acetate, she got large, painful welts after each injection that lasted a few days, but after four months of taking the medication, she says the welts became smaller and less troublesome.

Disease-modifying infusions for MS include:

• Ocrevus (ocrelizumab)
• Lemtrada (alemtuzumab)
• Tysabri (natalizumab)

Infusion treatments are administered by a healthcare professional regularly. Depending on the drug, you may need to visit the doctor once every few weeks to once a year. These more recently approved drugs are monoclonal antibodies designed to prevent your immune system from attacking healthy tissues. Like injections, they can cause infusion-site reactions, but some of these drugs also raise your risk for other diseases down the line.

Disease-modifying pills for MS include:

• Mavenclad (cladribine)
• Tecfidera (dimethyl fumarate)
• Vumerity (diroximel fumarate)
• Gilenya (fingolimod)
• Zeposia (ozanimod)
• Mayzent (siponimod)
• Aubagio (teriflunomide)

The oral treatments for MS come as pills taken regularly. Many of them raise your risk for serious infections, liver problems and the rare brain infection PML. Mavenclad, gilenya and aubagio can cause birth defects.To read more about the serious effects of specific treatments, and how long you should wait before trying to get pregnant, read our article on MS treatments and side effects.

Drugs to Treat Thyroid Disorders

• Synthetic thyroid hormones (Synthroid) 
• Anti-thyroid hormone therapies (propylthiouracil, methimazole)
• Beta blockers, to treat symptoms like rapid heart rate

Diets for Autoimmune Disease

Autoimmune disease tends to be characterized by excessive inflammation in your body. Certain foods, including red meats and foods that are highly processed, are known to promote low levels of inflammation and may raise your risk of experiencing flares. Some patients report fewer symptoms when they change their diets to focus on fruits, vegetables and other foods thought to be more likely to reduce inflammation. 

Check out MedShadow’s anti-inflammatory diet tips and Instagram for tips on how to incorporate more anti-inflammatory foods, including herbs and spices, into your diet.

The Mediterranean Diet is a popular type of anti-inflammatory diet that has been studied for decades. Researchers say the diet, which focuses on vegetables, fruits, fish, lean meats and healthy fats, can reduce your risk for heart disease, macular degeneration, dementia and more. 

Another diet, the autoimmune protocol diet, may also help people with autoimmune diseases. The diet is similar to the paleolithic diet which includes lean meats, fruits, vegetables, nuts and very few grains. One of the main differences is that early on, you remove many food groups from your diet, such as gluten, dairy, nightshade vegetables, eggs, nuts, certain oils and more, then gradually add them back in to see how you feel. The diet has not been tested as thoroughly as the Mediterranean diet, but a small study of people with inflammatory bowel diseases such as Crohn’s and Colitis suggested it can reduce symptoms and increase quality of life.

Exercise for Autoimmune Disease

Exercise can be a double-edged sword for some people with autoimmune diseases. Exercise can be challenging or impossible on days when you’re experiencing flare ups. On other days, exercise that is too intense may cause inflammation and temporarily worsen your symptoms. Day-to-day, however, patients and doctors agree that careful exercise can play an important role in disease management. Be sure to discuss any plans to start a new exercise regimen with your healthcare provider first to make sure it’s safe for you.

For people with arthritis, exercise can help maintain flexibility and range of motion in their joints. Small trials suggest that physical activity may be helpful for people with inflammatory bowel diseases as well, though recommendations for specific regimen are not yet available.

Hadge, one of the MS patients who shared her experience with MedShadow, uses yoga to help ease her MS symptoms. Doctors say that regular exercise not only prevents comorbidities such as heart disease in people with MS, but also can help them maintain their ability to walk. Many people with MS struggle with overheating when they exercise, which can make symptoms worse. If this is a problem for you, you might consider water aerobics.

Shonka, the lupus patient who shared her story with MedShadow, tailors her exercise to how she feels each day. On days she feels a lot of pain, just a brief walk is enough to help. On days when she feels up to it, she might try more intense exercises. 

Read MedShadow’s Tips for Exercising with an Autoimmune Disorder.