Metabolism & Autoimmunity

What is offered

Typically there is a detailed initial assessment with lab values, followed by a program of dietary change, exercise, targeted micronutrient supplementation and complementary procedures. Frequently mentioned are intermittent hypoxia-hyperoxia training, in which you breathe alternately oxygen-poor and oxygen-rich air through a mask, and whole-body hyperthermia, that is, controlled overheating of the body. The aim is to influence inflammation, metabolism and the immune system at the same time.

The concerns behind this are legitimate. Hashimoto’s, rheumatoid arthritis, insulin resistance and overweight are chronic, and many of those affected want more than a pill. What matters is which component is supported for which disease.

Metabolism: the strongest part

With elevated blood sugar, lifestyle is not an add-on but a therapy backed by trials. The Diabetes Prevention Program showed that a structured program with weight loss and regular exercise clearly prevents new cases, even more so than metformin. An offer that supports you with diet and exercise over months is therefore aimed at the right point.

Autoimmunity: individual good findings

For vitamin D there is a remarkable finding from a large randomized trial in older adults: fewer newly occurring autoimmune diseases over about five years. In Hashimoto’s, selenium lowers antibodies against the thyroid in randomized trials. Both speak for a well-considered approach to micronutrients, ideally with measurement and in consultation with the treating physician.

Cost and insurance

Statutory health insurance pays for the diagnosis and treatment of Hashimoto’s, rheumatic disease and diabetes. Complementary programs with hypoxia training, hyperthermia or micronutrient profiles are self-pay services. For diet-related diseases, many insurers subsidize nutritional therapy if a physician’s certificate of necessity is provided.

How to recognize a reputable offer

A reputable program works with your general practitioner, endocrinologist or rheumatologist, not against them. It does not promise to cure autoimmune diseases, never advises stopping thyroid hormone or rheumatism medication, and tells you for each component how well it is supported.

What the studies show

Diabetes Prevention Program

Randomized trial with 3,234 people with prediabetes. The goals of the lifestyle program were at least 7 percent weight loss and at least 150 minutes of exercise per week. The primary endpoint, new-onset diabetes, was clearly met: minus 58 percent compared with placebo.

VITAL: vitamin D and autoimmune diseases

Double-blind randomized trial with 25,871 men aged 50 and over and women aged 55 and over, 2,000 IU of vitamin D per day against placebo. Confirmed autoimmune diseases such as rheumatoid arthritis, thyroid autoimmunity or psoriasis occurred less often, a hazard ratio of 0.78. Omega-3 showed no significant effect.

Selenium in Hashimoto’s

Meta-analysis of 21 randomized trials with 1,610 patients. Selenium lowered TPO antibodies after 3 and after 6 months, and the TSH level slightly after 6 months. Whether this changes the course of the disease was not measured.

Hypoxia-hyperoxia in metabolic syndrome

Randomized trial with 65 patients on optimal medication. Training for 45 minutes on 5 days a week for 3 weeks, against room air through the same mask. Blood pressure, cholesterol and fatty liver improved considerably. A single center, short duration.

Where the data stop

No randomized trial was found for hypoxia training and whole-body hyperthermia in autoimmune diseases such as Hashimoto’s, rheumatic disease or allergies. The claim that these procedures modulate the immune system has not been tested for these diseases.

In an open randomized pilot study in type 2 diabetes, the overall concept of root-cause medicine did no better than standard care: 15.8 versus 11.1 percent reached the main goal. For arthritis there is only a retrospective analysis with 54 patients. With selenium, antibodies go down; whether the disease takes a milder course is open, and a large observational study even found unfavorable associations, though without knowledge of selenium status at baseline.

Status, approval and legal

The treatment of Hashimoto’s, rheumatoid arthritis and diabetes is covered by statutory health insurance. Additional programs with hypoxia training, hyperthermia or extensive micronutrient profiles are offered as self-pay services. Vitamin D and selenium are freely available as dietary supplements; at higher doses they belong under medical supervision.

Safety

Never stop or change thyroid hormones, rheumatism medication or diabetes drugs on your own. Caution is warranted with selenium: a large observational study in Hashimoto’s found more autoimmune diseases and higher mortality under selenium without a measured deficiency, which still needs to be confirmed. In VITAL, vitamin D was given at 2,000 IU per day. Hypoxia training and hyperthermia strain the circulation and breathing; contraindications should be clarified with a physician beforehand.

Sources

• Knowler WC et al., N Engl J Med 2002 (Diabetes Prevention Program)
• Hahn J et al., BMJ 2022 (VITAL autoimmunity)
• Zhang H et al., Medicine (Baltimore) 2025
• Toraih EA et al., Endocrinol Diabetes Metab 2026
• Bestavashvili A et al., Biomedicines 2022
• Eldib M et al., J Clin Transl Endocrinol 2026
• Droz N et al., PLoS One 2020
• Verbraucherzentrale (German consumer advice center): looking for nutrition counseling, 2025