4 Diets To Try if You Have an Autoimmune Disease

There's no one accepted definition of an "autoimmune diet," one that can help quell the symptoms of autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and lupus. However, some research suggests that certain foods may benefit people with an autoimmune condition, which occurs when your immune system mistakenly attacks your body.

"In general, most autoimmune diseases show a response to some changes in diet, whether [the disease is] Hashimoto's, rheumatoid arthritis, celiac disease, or Crohn's," Sonya Angelone, RDN, a spokesperson for the Academy of Nutrition and Dietetics and a nutritionist in private practice in the San Francisco Bay Area, told Health.

Although there are common threads to so-called autoimmune diets—for example, most include anti-inflammatory foods—specific dietary changes need to be tailored to the person.

"There will be generalizations that always require individualization," Alicia Romano, RD, a registered clinical dietitian at the Frances Stern Nutrition Center at Tufts Medical Center in Boston, told Health.

Here's a snapshot of some of the more popular autoimmune diets, what they are, and what we know about them.

The Autoimmune Protocol Diet

The autoimmune protocol diet (AIP) is an extreme version of the popular Paleo diet, which advocates a return to the types of foods our Paleolithic ancestors ate.

Foods to avoid include grains, legumes, dairy, processed foods, refined sugars, industrial seed oils, eggs, nuts, seeds, nightshade vegetables, gum, alternative sweeteners, emulsifiers, and food thickeners, said Romano.

The AIP follows an elimination protocol where different food groups that might contribute to inflammation are taken out of the diet, then slowly added back in.

"We don't have a reliable marker or test [for which foods are best], so we have to work with the patient, starting with the cleanest diet and slowly adding things back," Zhaoping Li, MD, PhD, professor of medicine and director of the Center for Human Nutrition at UCLA's David Geffen School of Medicine, told Health. "Everyone is different. We have to live and learn."

There's no standard about implementing these elimination protocols—some protocols are severe, pulling out multiple food groups at one time, said Romano.

Such a restrictive approach may not be helpful for all people with autoimmune diseases, who, as a group, tend to be at risk for nutritional deficiencies and malnutrition, said Romano. But a small study published in Inflammatory Bowel Diseases in November 2017 showed that for folks with inflammatory bowel disease (IBD)—which is thought to be an autoimmune or at least immune-related disorder—this diet can improve symptoms and inflammation in the gut. That inflammation is a hallmark of Crohn's disease and ulcerative colitis, the two conditions that IBD includes.

The Anti-Inflammatory Diet

The Anti-Inflammatory Diet is similar to the much-touted Mediterranean diet, which has been shown to lower the risk of chronic disease and extend lifespan. This finding was reported in a study published in the journal Current Opinion in Clinical Nutrition and Metabolic Care in November 2018. And another study published in June 2020 in the American Journal of Clinical Nutrition found that an anti-inflammatory diet had positive effects on disease activity in people with rheumatoid arthritis.

This diet focuses on anti-inflammatory foods like fish, olive oil, fruits, vegetables, legumes, nuts, and seeds. The Arthritis Foundation lists food groups from the Mediterranean, including reasons why each group may be able to help people with arthritis.

Foods should be as natural as possible, such as ocean-caught fish, said Dr. Li. And homemade meals are even better because you know all the ingredients used.

Some people also find dairy products to be problematic. "I would recommend limiting dairy to start. It can be added in later on," said Dr. Li. Some people with autoimmune diseases may react to lactose, a sugar in dairy products, or proteins in dairy, added Angelone.

A Plant-Based Diet

There is evidence that plant-based diets can benefit people with autoimmune diseases, as shown in a 2019 study on rheumatoid arthritis published in Frontiers in Nutrition and a 2022 study on lupus published in the journal Lupus. The AIP and anti-inflammatory diets also focus strongly on fruits and vegetables.

If you have an autoimmune disease, you might tolerate vegetables better when cooked. "Large molecules can provoke the immune system, but when cooking, you're breaking the molecules down," explained Dr. Li.

A Gluten-Free Diet

Gluten is the name for proteins in wheat, rye, and barley, and it damages the small intestine of people with celiac disease, another autoimmune condition. "Gluten is [another] large molecule that can provoke an immune response," said Dr. Li.

The only way to manage celiac disease is to avoid gluten, which is found not just in bread but also in pasta, soups, sauces, salad dressing, and a range of other products.

Going gluten-free helps people with celiac disease who also have other autoimmune diseases. A gluten-free diet may benefit people with an autoimmune condition other than celiac. "I have found that more people [in addition to those with celiac disease] do well without gluten," said Angelone. One small study published in Experimental and Clinical Endocrinology & Diabetes in 2019 found benefits to a gluten-free diet in women with autoimmune thyroid issues, for example.

In some cases, said Romano, simply improving the overall quality of someone's diet may help. Then, "if patients have a strong suspicion that foods may be triggers, I will typically have them keep food and symptom logs, so we can get a better idea of patterns," said Romano.

The Takeaway

While the autoimmune diet that works will be different for each patient, said Romano, "the patients that are willing to take the time to investigate their symptoms and improve their overall diet quality seem to do the best."

"Lots of time people use the terms 'autoimmune' or 'anti-inflammatory' diets to mean lots of different things with a varying degree on how restrictive the diet is," Kathryn Fitzgerald, ScD, of Johns Hopkins University, and a former National Multiple Sclerosis Society fellow, told Health. "However, a lot of the time, there are many aspects of these diets that are common to a generally healthy diet like high intakes of fruits and vegetables and low intake of processed food. It may be that these aspects are the critical component rather than adhering to stricter dietary protocol."