Lifestyle Medicine Week: Day 4 – Avoiding Risky Substances 🚫
Welcome to Lifestyle Medicine Week!
Each day this week, I’ve been sharing a short post focused on one of the six pillars of lifestyle medicine and how it might support your health if you're living with a rheumatic or chronic condition.
Today’s post focuses on substances like tobacco, alcohol, and cannabis. These are questions I often get in clinic, and I want to share what we know from the evidence so far.
🚬 Smoking
Cigarette smoking is strongly linked to worse outcomes in autoimmune diseases.
In lupus (SLE), smoking increases disease activity and reduces how well medications like hydroxychloroquine and belimumab work.
In rheumatoid arthritis (RA), smoking is tied to the development of anti-citrullinated protein antibodies (ACPAs), which are linked to more severe disease.
Smoking also worsens pain, fatigue, and long-term disability.
If you smoke, quitting is one of the most powerful changes you can make to improve your health and treatment response.
🍷 Alcohol
The effects of alcohol depend on the amount.
Moderate alcohol use may offer some protection in RA and SLE, possibly because of its immune-modulating effects.
Some studies show better function and lower disease activity in people who drink modestly.
However, heavy drinking can worsen inflammation, interfere with immune function, and make symptoms worse.
This is a good conversation to have with your healthcare team so that choices are tailored to your health and your medications. I would not recommend drinking overall but I do think that (in specific cases) having one drink every now and then won’t impact disease activity as much.
🌿 Cannabis
Many of my patients ask me about cannabis, both in smoked and edible forms. At this point, we do not have enough strong clinical evidence to recommend it for autoimmune rheumatic diseases.
Some lab studies suggest cannabinoids might have anti-inflammatory properties.
But there is limited data on how cannabis affects disease activity, long-term outcomes, or treatment response in RA, lupus, or related conditions.
I let my patients know that while it is understandable to look for options to help manage pain or inflammation, we simply do not have the evidence yet to recommend cannabis use confidently in this setting.
💬 Final Thought
If you're living with a chronic autoimmune disease, it is important to be thoughtful about what you put into your body.
Smoking is harmful and quitting can improve both disease activity and medication response.
Moderate alcohol use may be okay for some people, but it is important to discuss with your doctor.
Cannabis may hold potential, but right now we just do not have enough information.
🌿 You deserve information you can trust. I hope this helps guide you in making the best decisions for your health.
Just a kind reminder: This post is for educational purposes only and is not medical advice. Please talk to your healthcare team before making changes. These are my personal views and not those of my employer.
📚 References
Parisis D, et al. Autoimmun Rev. 2019;18(11):102393
Cozier YC, et al. Arthritis Care Res. 2019;71(5):671–677
Takvorian SU, et al. Lupus. 2014;23(6):537–544
Lu B, et al. J Rheumatol. 2014;41(1):24–30
Terracina S, et al. Int J Mol Sci. 2025;26(2):845
Azizov V, et al. Nutrients. 2021;13(4):1324
Katz-Talmor D, et al. Nat Rev Rheumatol. 2018;14(8):488–498
Holloman BL, et al. Int J Mol Sci. 2021;22(14):7302