Lupus and Taking Probiotics/Prebiotics: The truth [Updated JUL ’23]

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), kimchee, 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, and legumes.

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

Make sure to avoid any supplement that touts it boosts the immune system. Lupus is a disease where the immune system is already over active. Effective treatments calm it down. Boosting the immune system further can worsen lupus. An example is Echinacea. Echinacea has caused severe lupus flares in some Johns Hopkins lupus patients.

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!