How the Covid-19 Vaccine Works: amazing!

It is amazing how the COVID-19 vaccine works (the mRNA vaccines, especially)

It intrigues me how the COVID-19 vaccine works! How effective it is, and how safe it is.

I got mine, #1, as of 12/29/20, and I got my 2nd shot a few weeks later. Update as of 9/7/21: I plan on getting my booster this or next week!

Dr. Donald Thomas gets the COVID-19 vaccine

Dr. Don Thomas, MD getting his COVID-19 vaccine
First: If you have an autoimmune disorder, please consider getting the vaccine when it is your turn

Read my previous post on why lupus patients should get the COVID-19 vaccination

I got my Moderna COVID-19 vaccine on 12/29/20. I’ll post how I do day by day below at the bottom of this post. However, 1st, I’ll go over how this interesting vaccine works!

How the COVID-19 vaccine works “in a nutshell”

​This is fascinating!

– The 2 COVID-19 vaccines available now (Pfizer and Moderna) are RNA vaccines

– It helps to know how RNA works (specifically mRNA)
– Look at the cell above
– We are all born with DNA that codes everything our cells produce. It is responsible for our having blue eyes instead of brown, or black hair instead of blond, or, yes… having funny smelling pee after eating asparagus (or not)
– Our DNA is “transcribed” (think it is as being translated) into RNA, and eventually messenger RNA (mRNA)
– Then, a part of our cells called ribosomes can read this mRNA like a food recipe and produce a particular protein (such as the one responsible for your 2nd toe being shorter, instead of longer, than your big toe)

COVID-19 vaccine contains the COVID-19 mRNA that codes for those spikes
– The COVID-19 vaccines are NOT live virus vaccines. They CANNOT give you COVID-19 (impossible)
– Ingeniously, they contain the virus’ mRNA that codes for those spikes you see on the outside in all the pics
– These spikes look somewhat like a crown. Latin for “crown” is corona, hence, coronavirus
mRNA injected into our bodies as a vaccine: tricks our bodies into producing the spikes, but not the entire virus
– Fascinating!
– The mRNA of the virus (in the vaccine) is injected into your muscle
– It spreads quickly throughout your blood stream and body
– The mRNA is absorbed into our own cells
– Our own cells mistakenly think this mRNA came from our own DNA and instructs those cells to produce this protein
– The protein is the same one found in the spikes of the SARS-CoV-2 coronavirus responsible for COVID-19
– In other words, our cells produce just those pink spikes you see in the pic below, not the entire virus
– The viral spike protein ends up on the surfaces of our cells
– Our very smart T-cells of the immune system actually DO recognize these as being foreign
– They say, “we need to fight this off and protect us”
– They summon other players of the immune system as well to the battle

DaOur B-cells then learn to produce antibodies that quickly recognize those COVID-19 spikes

– The booster shot you get a few weeks later strengthens this memory
– If you were to actually get infected with COVID-19 in the future, your B-cells would recognize those tell-tale spikes
– Those smart B-cells would say, “This is a foreign invader we must destroy”
– They summon the rest of the immune system to attack the virus and protect us

– Note that many people will get a very sore arm, redness, swelling, aches, pains, fever for a few days after the vaccine
– This is actually the immune system learning to mount an attack. Think of it as a sign of the vaccine working
Day #1:
It has just been a few hours since my vaccine
I took some Tylenol and Advil to decrease my chances for the above side effects
If you get the vaccine (which I hope you do), ask your doctor before you consider taking Tylenol and/or Advil or Aleve

Day #2: Woke up with a sore upper arm muscle (deltoid) in the area of the shot. However, I expected this as usual with a good, strong vaccine.  I’ll just take Tylenol plus Advil around the clock today to lower the risk of pain and to lower my risk of a flu-like syndrome reaction.

Day #3: Mild, tolerable arm soreness. I feel great! I am optimistic about getting vaccinated and feeling safer.


Don Thomas, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Research Results in Dealing with Autoimmune Disease Fatigue Now

The causes of fatigue and dealing with autoimmune disease fatigue.

Tips on how to improve energy with Sjogren’s, lupus, and related disorders

Woman with Sjogren's and lupus with autoimmune disease fatigue

Fatigue is common in lupus
This video discusses the causes of autoimmune disease fatigue and gives practical tips on how to improve fatigue. Malaise means “not feeling well” and commonly accompanies fatigue. Malaise is often the first symptom of inflammation, so it not surprising that they (fatigue and malaise) are common in autoimmune diseases.

Thank you to the Sjogren’s Foundation for producing this video as a part of their “Town Hall” series during the COVID-19 pandemic of 2020.Although this was directed towards people who have the autoimmune disorders, Sjogren’s, it also pertains to other  autoimmune disorders, such as lupus, rheumatoid arthritis, scleroderma, polymyositis, and dermatomyositis.

Some facts about fatigue in lupus and other autoimmune diseases:

  • It is one of the most common problems
  • It is one of the most difficult symptoms to treat
  • Hydroxychloroquine and belimumab (Benlysta) can help some systemic lupus erythematosus (SLE) patients with fatigue that is due to active inflammatory disease
  • SLE patients with high anti-dsDNA, low C3, low C4, or high EC4d who have fatigue may improve with belimumab
  • Surprisingly, the one treatment found to benefit more patients with autoimmune diseases than any other treatment is exercise!
  • If you get less than 8 hours of good quality sleep each night, it is imperative to work on getting enough sleep. Taking a course in CBT-I is one of the best ways to learn to sleep well
Go to the Sjogren’s Foundation’s Town Hall series for more informative videosIf you have Sjogren’s, become a member of the Foundation. You get so much out of being a member to include an educational magazine every few months with great articles on how to deal with the complications of Sjogren’s, such as fatigue, pain, memory problems, sleep problems, the dryness, etc. They also share with their members the latest in research.

Also, get a copy of my in depth talk about autoimmune disease fatigue from the Sjogren’s Foundation on their website:

How do you deal with your fatigue? Do you have your own tips and advice? Please share by clicking on COMMENT above.
Please share with others by clicking the Facebook and other icons on the side of the blog page


Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Lupus and Taking Probiotics: Learn the truth here [Updated]

Lupus and taking probiotics: Should you take probiotics if you have lupus, and what are the best probiotics for autoimmune disease?

Lupus and taking probiotics: My answer in short: “No” to pills; “Yes” to probiotic and prebiotic-rich foods! Lupus Question of the Day:
Probiotic supplements seem to be a real trend these days. Is gut bacteria linked to lupus? If so, is there value in taking probiotic supplements?
My answer:

There are good bacteria in the microbiome that improve our health and bad bacteria that harm us. The microbiome includes all the living organisms inside and on our body (but good ones and bad ones). Probiotics are made up of bacteria that when you consume them in food or supplements, you “hope” that they enter your gut and improve your gut microbiome.

Several bacteria in our microbiome have been shown to be bad for lupus and other autoimmune diseases. They have been linked with making the immune system more active and are associated with inducing the immune system to produce autoantibodies (like anti-SSA) that can attack our body. Others have been shown to protect us and decrease lupus disease activity. Most of these studies have been in lupus mice. However, there are also human studies as well.

I do not recommend taking a probiotic supplement if you have lupus and taking probiotics. Why? Animal studies show that some bacteria in these supplements actually make some autoimmune diseases worse, while improving others. I recommend the following (instead of taking probiotic pills or capsules). My recommendations regarding lupus and probiotics are below. I also recommend this regarding probiotics for autoimmune disorders such as Sjogren’s and rheumatoid arthritis:

– Eat foods rich in healthy probiotics regularly.

Examples include fermented sauerkraut, live-culture yogurt (I love Siggi’s), kim chee, miso, kombucha, and fermented pickles. Kombucha and lupus have not been studied together. However, I do not see any problems with it theoretically.

– Eat foods rich in prebiotics as well. Particularly “resistant starches” may be beneficial. A lupus mouse study showed decreased lupus disease activity in lupus mice fed a “resistant starch” diet. Examples of resistant starch foods = cooled potatoes that are cold, potatoes starch, cold oatmeal, beans, legumes.

Sea moss and lupus: some of my patients ask me about sea moss. It may provide prebiotics and it appears to be healthy.

Thank you to Kelli of “More than Lupus” for producing the “Ask Dr. T” series!
Go to her blog and Facebook page and join the lupus community!

What are your favorite probiotic and prebiotic foods?
Click COMMENTS above


Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Lupus and Stress Management: How to lessen stress life

Lupus and Stress Management: The Science of Stress and the Immune System

The video below goes over lupus and stress management, while also discussing how stress affects the immune system adversely.The Lupus Foundation of America filed this video of me during their Living and Learning series December 2020 at the height of the COVID-19 epidemic and during the holiday season. Stress can increase lupus onset and lupus flares. Learnhow to lower stress can possibly help decrease the effects of lupus.

– The 1st part of the video goes over some of the science behind how stress abnormally affects the immune system. stress worsens cancer, autoimmune diseases, and cause increased death. Why is it that optimistic people who deal with stress well tend to live longer than pessimistic people who are easily stressed? Stress does have bad effects on our immune systems.

– Then I go over how people who are genetically predisposed to having lupus have a greater chance of developing lupus if they have had major stressors in their life (child abuse, physical abuse, sexual abuse, etc.)

– Then I go over how stress can cause lupus flares.

– Interestingly, easily stressed people can learn to deal with stress better. Some habits are easy and incredibly healthy in many other ways. Examples include exercising regularly, and practicing mindfulness daily.

​- I end the video with practical pointers on how to decrease stress.

Download my free stress management handout from my Lupus Secrets

SHARE with everyone who has an autoimmune disease

COMMENT above: how do you deal with and prevent stress?

​What advice do you have for others?


Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Covid-19 Vaccine for Lupus Patients: Please get your vaccine

Should We be Recommending the COVID-19 Vaccine for Lupus Patients?: Yes!

What I tell my systemic lupus patients as of 12/18/20: 4:00 PM regarding getting a COVID-19 vaccine for lupus patients

The Advisory Committee on Immunization Practices (ACIP) of the CDC made the following recommendations on 12/18/20 regarding vaccination in patients with autoimmune disorders. I’ll first put in verbatim what was said (courtesy of the RheumNow website), then give my recommendations in a nutshell.

The ACIP of the CDC states:
< > = is wording that I inserted

Persons with underlying medical conditions <such as lupus and other autoimmune disorders>:

… the vaccine may be administered to persons with underlying medical conditions who have no contraindications to vaccination. Phase 2/3 clinical trials demonstrated similar safety and efficacy profiles in persons with some underlying medical conditions, including those that place them at increased risk for severe COVID-19, compared to persons without comorbidities.

Immunocompromised persons: Persons with HIV infection, other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data are not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in phase 2/3 clinical trials, though data specific to this group are not yet available. Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19.” 

What I will tell my patients:

If you have lupus and just take an antimalarial such as Plaquenil:
– In the clinical trials, patients with underlying medical conditions with no contraindications to vaccines did as well with the COVID-19 vaccine as healthy people.
– This would apply to lupus patients who take hydroxychloroquine (Plaquenil). Plaquenil does not suppress the immune system.

If you take an immunosuppressant:
– Patients who take immunosuppressants (such as prednisone > 7.5 mg a day, mycophenolate, CellCept, azathioprine, Imuran, methotrexate, leflunomide, cyclophosphamide, cyclosporine, tacrolimus, Benlysta, and Rituxan) may get vaccinated if you do not have a contraindication to getting vaccines. However, the safety and effectiveness is unknown. There is always the chance that the vaccine may not work as well (in other words, not 95% effective). Therefore, you can never let your guard down. You must continue to practice strict infection prevention measures (washing hands, disinfecting, mask wearing, social distancing).

The Lupus Foundation of America put out additional information below:


The photo above of Covid vaccine comes from the LFA website

How about you? Are you going to get the vaccine?

Share your opinions and comments by clicking “COMMENT” above


Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

FDA approves Benlysta for lupus nephritis!

1st drug ever FDA-approved to treat lupus nephritis

​Historic mile-stone!

December 16, 2020: The FDA approved on Wednesday DEC 16, 2020…  Benlysta for lupus nephritis as the first drug ever FDA-approved to treat lupus nephritis (inflammation of the kidneys).
What should lupus patients know about lupus nephritis?

It is common
Lupus nephritis (LN) occurs in approximately 40% – 45% of people who have systemic lupus erythematosus (SLE). It occurs in some ethnicities more than others. For example, while 30% of Caucasian women with SLE will have LN, close to 80% of Caribbean women of African ancestry with SLE will develop LN.  

It can occur at any time 
When we look at people with LN, 1 out of 3 have LN when first diagnosed with SLE. It most commonly develops within the 1st 5 years. However, it can occur at any time, including after having SLE for many years.

It is why rheumatologists ask you for a urine sample every 3 months
It is diagnosed most commonly by finding an increased amount of protein in the urine. We want to catch it at the earliest stages possible when it is easiest to treat. Identifying it quickly increases the chances for remission.

The most common symptoms of lupus nephritis = you feel perfectly normal
Yes, that is correct. Early on with LN, there are no symptoms what-so-ever. By the time you feel any, you already have some significant kidney damage going on. Symptoms of LN once it gets to that more advanced stage include fatigue, swelling of the ankles that gets worse later on in the day (edema), weight gain (fluid retention), urinating more often at night time when in bed, foamy urine (from the increased protein in the urine).

We want to catch it when you feel completely normal. That is why it is so important to see your rheumatologist regularly when you feel great and give us that cup of urine.

Remission can and does happen! Here are the tricks to achieve remission:
– Help your rheumatologist catch it quickly by giving us a urine sample every 3 months.
– Get a kidney biopsy as quick as possible, and begin treatment as soon as possible if the urine sample is abnormal.
– Work hard on maintaining normal body weight.
– Do not smoke cigarettes. (Follow everything else in the Lupus Secrets)
– Take hydroxychloroquine (Plaquenil) religiously. It makes you 3-times more likely to go into remission.
– Take other prescribed medicines religiously (such as mycophenolate and azathioprine)
– If not on an ACE inhibitor or ARB blood pressure medicine, ask your doctor if you should, especially if you have increased protein in your urine.
– Ask your doctor to help you get your BP perfect. Have the top number (systolic) around 110 mmHg; have the bottom number less than 80 mmHg
– Keep your cholesterol perfect (take a statin if it is high)
– Exercise regularly
– Consider eating an anti-inflammatory diet (it has not been proven to put nephritis into remission because it has not been studied. However, there is good data that it can help decrease lupus inflammation in non-renal lupus.)
– Follow-up with your rheumatologist or nephrologist (kidney doctor) regularly. Your goal is to get your urine protein to creatinine ratio below 0.7 g/g (or < 700 mg:mg).

How effective is Benlysta for lupus nephritis?

In the phase III clinical trials, Benlysta IV (intravenous form) was added to the medicines we normally use to treat lupus nephritis (called standard of care, SOC).  Some patients in the study got Benlysta + mycophenolate +/- hydroxychloroquine + steroids, some got Benlysta + cyclophosphamide + steroids +/- hydroxychloroquine, while others got Placebo plus mycophenolate or cyclophosphamide ( plus steroids +/- HCQ).

Results were remarkable. The most important of which is the “complete renal response” meaning marked reduction of protein in the urine close to normal (<0.5 g/g) by week 100 and no worsening of kidney function.

Complete renal response rates at week 100 (bottom left graph):

Placebo + standard of care = 20% complete response
Benlysta + standard of care = 30% complete response

Note that this is a 50% higher amount of complete responses compared to standard of care (30% is 50% greater than 20% mathematically).

That is remarkable. (However, a caveat… we still need better treatments for that other 70% who did not go into complete remission! … read my comments at the bottom of this article for a possibility)

Graphs above come from the BLISS-LN trial published in the NEJM referenced below

How safe was Benlysta?

Benlysta continues to be one of our safest options for treating systemic lupus! There was not any statistically significant differences among side effects between the Benlysta group and the placebo group.

The most common side effects seen in the research studies were infections. However, it is important to remember that all patients were also treated with high dose steroids plus either mycophenolate or cyclophosphamide, which are strong immunosuppressant drugs. Interestingly, 0.7% of the patients who got Benlysta had infections while 1% of those on placebo did. (in other words, the other drugs, such as steroids, played the largest role in this).

Allergic reactions were seen as with any medication, but not common. For example, 0.9% of patients who received the placebo infusion had an infusion reaction, while 1.6% of those who got Benlysta did.

How is Benlysta dosed for lupus nephritis?

The IV form is the same as for other lupus problems (10mg/kg given 3 times in the first month; then 1 infusion monthly after that)

Interestingly, the self injectable subcutaneous form is different than for other types of lupus. It is recommended to do 2 injections weekly of 200 mg each (total of 400 mg) for the 1st four weeks. After that, it is just one injection weekly.

My prediction for the near future for lupus nephritis treatments

Voclosporin will probably be the next FDA-approved drug to treat lupus nephritis, and it will probably happen soon. It is a pill taken once a day.

How well did it do?
In the phase III clinical trial:
41% of the voclosporin + standard of care group had a complete response!
23% of the placebo + SOC group had a complete response

That is pretty close to twice as many patients going into remission compared to standard of care.

And voclosporin was safe! It is in the same group of drugs called calcineurin inhibitors (cyclosporine and tacrolimus) and it is safer than those two.

And what would happen if we were to use both voclosporin and Benlysta both together? They work through different mechanisms. We could potentially see even great remission rates.

As you can probably tell. I am pretty excited about the future of better therapies for lupus! They are not possibilities… they are actually happening right now.


Don Thomas, MD, author of The Lupus Encyclopedia and The Lupus Secrets


Furie R, Rovin BH, Houssiau F, Malvar A, Teng YKO, Contreras G, Amoura Z, Yu X, Mok CC, Santiago MB, Saxena A, Green Y, Ji B, Kleoudis C, Burriss SW, Barnett C, Roth DA. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med. 2020 Sep 17;383(12):1117-1128. doi: 10.1056/NEJMoa2001180. PMID: 32937045.

Lupus and Sleep: Strategies to Sleep Better!

Lupus and Sleep Problems are Common! Here are simple, effective strategies to improve your sleep

Tips on better sleep

Lupus and sleep problems are real. The lack of sleep has been associated with numerous problems such as fatigue, memory and concentration problems (lupus fog), gaining weight, and even lupus flares!
Learn to see better using the “sleep hygiene” techniques below.

How to use:
Sit down, read the list, use a yellow highlighter on anything you are not doing regularly.
Work faithfully on incorporating every single thing into your life.
If you then still have trouble sleeping, talk to your doctor. Ask if you should get a sleep study to figure out if you have a treatable sleep disorder

Get other advice for living better with lupus from “The Lupus Secrets

Thank you Kelli of “More than Lupus” for posting the Ask Dr. T question

Sleep Hygiene Techniques

​- Maintain a regular sleep schedule; get up and go to bed the same time daily even on non-work days and holidays.
– Reduce stress in your life.
– Get exposure to light first thing in the morning to set your biological clock. Consider using a non-UV source of light exposure such as the Philips goLITE or the Miroco non-UV light.
– Exercise daily; mornings and afternoons are best. Don’t exercise right before bedtime.
– Avoid naps late in the afternoon or evening.
– Finish eating two to three hours before bed; a light snack is fine, but avoid foods containing sugar as it can stimulate the mind and interfere with falling asleep.
– Limit fluids before bed to keep from getting up to urinate throughout the night.
– Avoid caffeine six hours before bed.
– Do not smoke; if you do, don’t smoke for two hours before bed; nicotine is a stimulant.
– Avoid alcohol two to five hours before bed; alcohol disrupts the sleep cycle.
– Avoid medicines that are stimulating (ask your doctor).
– Avoid stimulating mind activities for a few hours before bed (reading technical articles, listing tasks to do, trouble-shooting, paying bills, etc.).
– Have a hot bath one to two hours before bed; it raises your body temperature and you will get sleepy as your temperature decreases again afterward.
– Keep indoor lighting low for a few hours before bed.
– Establish a regular, relaxing bedtime regimen (aroma therapy, drink warm milk, read, listen to soft music, meditate, pray, do relaxation/breathing exercises).
– Ensure your sleeping environment is quiet and comfortable (comfortable mattress and pillows; white noise like a fan; pleasant, light smells).
– If pets ever wake you, keep them outside of the bedroom.
– Use the bedroom only for sleep and sex; never eat, read, or watch TV in bed.
– Never keep a TV, computer, or work materials in your bedroom.
– Go to bed only when sleepy.
– If you can’t go to sleep within fifteen to twenty minutes in bed, go to another room and read something boring under low light, meditate, pray, listen to soft music, or do relaxation/breathing exercises until sleepy.
– If you have dry mouth problems, use a mouth lubricant such as Biotene Mouth Spray before you go to bed.

What is the Best Non-Drug Treatment for Insomnia?

The experts recommend “Cognitive Behavioral Therapy for Insomnia” (abbreviated as CBT-I)
It is very easy to find many online CBT-I courses with high success rates


Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

Lupus Lifestyle Changes Advice: In the anti-Inflammatory diet

Lupus Lifestyle Changes are Important: Read here to learn about important dietary changes

There is more and more evidence that healthy lupus lifestyle changes do make a difference. Read below for practical information regarding diet. 

Lupus lifestyle changes as an anti-inflammatory diet for lupus and autoimmune diseases
There is growing evidence that eating an anti-inflammatory diet benefits lupus patients

​Anti-Inflammatory Diet for Autoimmune diseases

This is the latest handout I give to my own patients. It has information from some of the latest medical research regarding foods to eat and avoid in order to hopefully decrease inflammation in the body. It talks about anti-inflammatory foods to eat, which to avoid, intermittent fasting, prebiotics (such as resistant starches), and probiotics. As per the Lupus Secrets, do this along with taking your medications, exercising regularly, getting at least 8 hours of sleep each night, and protecting yourself from ultraviolet light.

If you find this helpful, please share with others.

There is growing evidence that eating a diet high in foods that decrease inflammation, while avoiding, or minimizing foods that increase inflammation, can help autoimmune diseases such as lupus and rheumatoid arthritis. One of the latest studies from the University of California, San Diego Medical Center showed that rheumatoid arthritis patients had significantly better disease control when sticking to this type of diet. Lupus studies show that diets rich in omega-3 fatty acids and low in omega-6 fatty acids can help disease activity in people with lupus as well as mice with lupus. Lupus mice also have better disease control when they eat a diet rich in “resistant starches.” Resistant starches as discussed in the probiotics section below.  Note that the Mediterranean diet has many of these anti-inflammatory recommendations. You can find information on the internet or ask your doctor for a copy of our Mediterranean diet.

oatmeal and yogurt probiotic foods for lupus lifestyle changes diet
Berries and nuts are high in anti-oxidants; oatmeal is an excellent prebiotic

Eat omega-3 fatty acids. Limit omega-6 fatty acids

Increase intake of:
Omega-3 fatty acids (walnuts, flaxseed, chia seed, salmon, tuna, mackerel, sardines, avocado, sesame seeds, tahini seeds)
Green leaf vegetables (such as arugula, broccoli, cabbage, zucchini, brussel sprouts)
Anti-inflammatory vegetables (onion, carrots, pumpkin; eat garlic in moderation)
Enzymatic fruits (pineapples, mangos, papaya)
Anti-inflammatory spices (turmeric, black pepper)

Decrease intake of:
Omega-6 fatty acids (reduce meat intake to turkey or chicken twice weekly; eat more fish as noted above; avoid or at least limit red meats, fried foods, butter)

Nightshade foods and lupus? Avoid gluten?

Controversial diet changes

Do nightshade foods and lupus mix. Some experts recommend the following changes, while others do not due to insufficient data). Nightshade foods are probably fine to eat when you have lupus. At our 2020 American College of Rheumatology meeting, an anti-inflammatory diet research study was presented that did include nightshades. For example, tomatoes are rich in lycopenes, a strong anti-oxidant (so, it seems like they should be healthy rather than harmful). This is one of those areas that needs more study.:

Decrease the intake of nightshade (solanaceae) vegetables (tomatoes, eggplant, potatoes) if you believe this. Personally, I would still eat them. However, like with any foods, if you predictably flare by eating them, then you should avoid them.

Decrease the intake of gluten products (instead of wheat bread and pasta, switch to rye bread, corn tortillas, quinoa/beet/bean/ or chickpea pasta). However, most experts recommend avoiding gluten only if you truly have celiac sprue (gluten hypersensitivity).
*** NOTE: These recommendations are not for people who have celiac sprue, gluten-sensitive enteropathy, or gluten sensitivity. Though these are lower in gluten than wheat breads and pastas, some (such as rye) can contain gluten.

Intermittent Fasting

Fasting has been shown to decrease inflammation in the body in numerous studies.  Some lupus mice studies also show that fasting decreases lupus disease activity. Numerous animal models show that animals that eat a highly restricted diet live longer.

One easy way to fast is to do something called intermittent fasting. This form of fasting also lowers insulin spikes (so may decrease the risk of diabetes), causes weight loss, and may help extend life span. 
An easy way to do intermittent fasting is to only start eating in the late afternoon, then stop when you go to bed. You only want to eat 8 or less hours a day, complete fasting for at least 16 hours (including your 8 hours of sleep). You are only allowed water, black tea, and black coffee while fasting. Go to YouTube to watch some helpful videos about intermittent fasting.

If you have diabetes, discuss with your doctor before doing intermittent fasting (especially if you are on insulin).
You should also exercise regularly to get the full benefits of intermittent fasting. 
The microbiome in autoimmune diseases:

We have trillions of bacteria living on and inside of us; all together it is called our “microbiome.” The insides of our intestines and gastrointestinal tract contain the largest immune system organ of our body, and the constant interactions of the microbiome bacteria and our immune system can either cause beneficial effects when we have good (beneficial) bacteria in our microbiome, or abnormal effects that can actually cause increase autoimmune disease. Studies of the microbiome and autoimmune diseases such as RA and lupus are in its infancy. Many studies have been performed in animals with lupus and RA, and smaller studies have been done in humans. We have so much to learn, but we do realize that having good bacteria that decrease autoimmunity, and getting rid of bad bacteria that increase autoimmunity are very important. Here are some recommended practices that you can do that may help you.

1. Take great care of your oral health! Poor dental health can actually cause RA and make it worse, and now there is evidence that it can do the same with lupus (in fact, one study showed that treatment of periodontal disease in lupus patients improved their lupus disease activity significantly.  Make sure and do the following:
     – Floss every day (flossing picks are very handy to use)
     – Brush twice a day
     – If you have dry mouth, talk to your doctor about how to improve the much needed saliva in your mouth to increase good bacteria and decrease the bad.
     – DO NOT SMOKE! (this is why smokers lose their teeth at a much younger age than nonsmokers)
     – Chew on gum that contains xylitol (or use Xylimelts, or use mouth wash that contains xylitol eg TheraBreath Maximum Strength)
     – Get your teeth cleaned every 6 months (every 3-4 months if you have dry mouth)

2. Improving the microbiome in the gut has less medical evidence behind it. It is probably important to do, but we lack good large studies in humans. However, increasing the amount of resistant starches in your diet may be beneficial.
– Resistant starches include cold oat meal (eg overnight oats), potato starch, green banana starch, potatoes that are cold after being cooked, and lentils
     – These types of starches aren’t digested well until the get into the large intestine where they begin to ferment. Then beneficial bacteria use these starches for food and interact favorably with the immune system and also decrease the numbers of bacteria that cause immune system problems
     – Including a serving of resistant starches in your diet daily is probably a good idea.

​Probiotics in autoimmune diseases:

Probiotics are live bacteria, touted to have beneficial effects by living within our intestinal system and interacting with our immune system. While probiotic supplements have been shown to have some benefit for gastrointestinal problems (such as irritable bowel syndrome), no human studies have proven benefit for autoimmune disorders yet. In fact, in animal research, some autoimmune disorders improve with some probiotic organisms while others actually worsen. Therefore, we do not recommend any probiotic supplements.  Probiotics may be beneficial for the microbiome as above.

However, many foods are rich in natural probiotics, and thus far, there are no studies suggesting that any of these foods make autoimmune disorders worse. Therefore, you may want to consider the possibility of consuming a daily portion of any of the following probiotic rich foods:

Probiotic rich foods
Greek yogurt
Kimchi (fermented, nonpasteurized)
Kombucha tea
Miso soup (warm, not boilded)
Sauerkraut, fermented, nonpasteurized (warm, not cooked too hot)
Fermented, nonpasteurized pickles
Dark chocolate (just a little, and NOT milk chocolate)
Cold green peas on salads
Natto (very healthy, but takes an acquired taste)
Beet kvass
Fermented beets
Cottage cheese containing live cultures (eg “Good Culture” and “Horizon organic”)
Soft, aged cheeses (especially gouda; but also parmesan, cheddar and swiss; the longer the aging, the higher the probiotic content)

Bustamante MF, et al. Contemp Clin Trials Commun 2020
Guma M, et al. Trial of diet to improve RA and impact on the microbiome. Presented at ACR Convergence 11/9/2020.
Zegarra-Ruiz DF, El Beidaq A, Iñiguez AJ, et al. A Diet-Sensitive Commensal Lactobacillus Strain Mediates TLR7-Dependent Systemic Autoimmunity. Cell Host Microbe. 2019;25(1):113-127.e6. doi:10.1016/j.chom.2018.11.009


written by Donald Thomas, MD
author of “The Lupus Encyclopedia
Arthritis and Pain Associates of PG County

Lupus and Vegetarian Diet: What is the best medical evidence?

Ask Dr. T Question about lupus diet and vegetarians

Anti-inflammatory diet for lupus patients

Lupus and Vegetarian Diet?

Eating a Vegetarian Diet can be Part of an Autoimmune Protocol (AI Protocol)

There are studies showing that diets rich in omega-3 fatty acids may reduce lupus inflammation and disease activity. Food examples are fatty fishes (salmon, mackerel, tuna, sardines), chia seed, flaxseed, walnuts. The Mediterranean diet is probably beneficial. At the same time, lowering inflammatory foods (omega-6 FAs) such as red meats, butter, etc (i.e. typical Western and American diet). I include these types of food recommendations in my “Lupus Secrets” as they are so important.

A lupus mouse study looked at “resistant starches.” Examples include potato starch, cold potatoes after cooking, oatmeal. These starches resist digestion, go to the large intestine where beneficial bacteria thrive on them. Studies showed positive immune system effects, so they looked at it for lupus mice. The mice who ate a diet rich in resistant starches were healthier, lived longer, and had less lupus disease activity.

A study in rheumatoid arthritis patients (closely related to lupus) had patients earth an anti-inflammatory diet containing more omega-3 fatty acids, more fruits and veggies (like your question: esp onion, carrots, pumpkin, zucchini, etc.), eat probiotic and prebiotics (eg yogurt with live cultures, and dark chocolate) while eliminating “Solanaceae vegetables (potatoes, eggplant, tomatoes), dairy products (replace it with almond, rice, coconut), greatly reduce all meats. After the study, there was significantly less inflammatory disease in the patients on this diet. (preliminary study data presented at ACR meeting NOV 2020 by principal investigator, Dr. Monica Guma, UCSD)

For more detailed information regarding an anti-inflammatory diet see my other blog on DIET
Thank you to Kelli Roseta of “More Than Lupus” for producing “Ask Dr. T”


Coras R, Martino C, Gauglitz J, Tripathi A, Jarmusch A, Cedola F, Fernandez Bustamante M, Agustín-Perez M, Alharthi M, Lee S, Singh A, Choi S, Rivera T, Nguyen K, Shekhtman T, Holt T, Golshan S, Knight R, Dorrestein P, Guma M. Rheumatoid Arthritis Improvement After Exposure to an Anti-Inflammatory “ITIS” Diet Is Associated with Changes of Gut Microbiome and Systemic Metabolome [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). Accessed September 17, 2021.