Lupus
Fighting Off an Immune System Attack
A painful and potentially life-threatening illness, lupus occurs when the immune system turns renegade and attacks the body’s own tissues, causing inflammation and damage. Skin, kidneys, blood vessels, eyes, lungs, nerves, joints—just about any part of the body can be involved.
At the same time, in severe cases the immune system sometimes shirks its normal protective duties, making infections of all sorts more likely. “No one knows what sets off the immune system in the first place, but a genetic tendency and exposure to some sort of outside trigger, perhaps a virus, may be involved,” explains Sheldon Paul Blau, M.D., clinical professor of medicine at the State University of New York at Stony Brook and co-author of Living with Lupus.
Lupus affects about 1 in 2,000 people, mostly women between puberty and menopause (ages 13 to 48) and, more frequently, African-American women. Some get the more common form of the disease, systemic lupus erythematosus, which affects the entire body. Another form of the disease, discoid lupus erythematosus, can cause disfiguring skin problems. Both conditions can flare up, then subside.
Lupus may be treated with corticosteroid drugs, such as prednisone (Deltasone), which reduce inflammation and suppress the immune response. “But most people newly diagnosed with lupus don’t need steroids,” Dr. Blau says. “They may do well on nonsteroidal anti-inflammatory drugs such as aspirin or with some dietary changes.”
It’s still important to see a doctor, preferably a rheumatologist (one who specializes in arthritis and autoimmune diseases), for assessment and long-term follow-up, Dr. Blau says. One good reason: People with lupus can develop inflammation in their kidneys, blood vessels and other organs but have no obvious symptoms until damage is severe. Your doctor can periodically check your kidneys with blood and urine tests.
Nutritional therapy for lupus involves correcting drug-induced deficiencies and eating a balanced diet to help prevent heart disease. Women with lupus are much more likely than normal to develop heart disease. People with kidney disease also need to follow special protein restriction guidelines.
In addition, some doctors recommend so-called antioxidant nutrients that may help reduce inflammation and protect against heart disease. “There’s good evidence that vitamins C and E can help prevent heart disease, and since that’s such a big risk, even in these young women, I feel these vitamins are essential,” Dr. Blau says.
Some doctors also recommend fish oil, which helps fight inflammation.
Here are the nutrients that may help the symptoms of this disease.
Revamping your eating habits can go a long way toward controlling the symptoms of lupus and warding off heart problems and kidney damage, its worst side effects, says Sheldon Paul Blau, M.D., clinical professor of medicine at the State University of New York at Stony Brook and co-author of Living with Lupus.
Don't chew the fat. Saturated fat, that is. "Evidence that this fat contributes to inflammation and promotes heart disease is a good reason to keep the fat out of your diet as much as possible," Dr. Blau says. One way to do that: Stick to small servings of lean meats and reduced-fat salad dressings and cheeses and load up on whole grains, fruits and vegetables.
Avoid alfalfa. According to Dr. Blau, alfalfa sprouts, tablets and tea all contain an immune systemstimulating compound called canavanine. In large amounts, this compound can trigger immune problems, says Dr. Blau.
Only two cases have been reported of people whose symptoms flared in response to alfalfa. One took 15 tablets a day for nine months; the other, 8 tablets a day for more than two years. Since alfalfa could be a problem for people with lupus, Dr. Blau recommends that his patients avoid it.
Stay away from cured meats and hot dogs. Both contain compounds that in large amounts can aggravate symptoms in people with lupus, says Joseph McCune, M.D., associate professor of rheumatology at the University of Michigan Hospitals in Ann Arbor.
Take it easy on mushrooms and beans. They add flavor to any dish, but both contain hydrazines and amines, compounds that in large amounts can aggravate lupus symptoms, says Dr. Blau.
Load up on garlic. Numerous studies show that garlic has a remarkable ability to reduce blood cholesterol levels and help prevent clotting in the arteries.
If you have lupus, you may have heard about the potential beneficial effects of fish oil for this condition. Doctors sometimes suggest fatty fish for several autoimmune diseases, including lupus, rheumatoid arthritis, Raynaud's disease, psoriasis and scleroderma. (Autoimmune diseases are the result of the immune system turning on the body.) These conditions involve inflammation, or pain and swelling, of the joints, skin and vital organs. But since they don't involve infection, drugs such as antibiotics usually don't help.
"Fish oil apparently reduces inflammation by substituting for other fats when your body makes inflammation-generating biochemicals," explains William Clark, M.D., professor of medicine at the University of Western Ontario in London, Ontario, and a leading researcher of lupus and fish oil.
Your body normally makes two groups of potentially inflammatory biochemicals, prostaglandins and leukotrienes, using whatever fats are available. If you eat meats and eggs, your body uses a component of the fats found in these foods, arachidonic acid, to make very potent forms of these biochemicals. (To a much lesser extent, your body can also use corn oil, safflower oil and sunflower oil to make these biochemicals.) If fish oil is abundant, however, your body uses it to produce forms of prostaglandins and leukotrienes that are less likely to cause inflammation.
Does fish oil really help control the symptoms of lupus? "Studies of mice with lupus that were fed large amounts of fish oil instead of other dietary fats show that these diets do help reduce inflammation and improve kidney function and immunity," says Richard Sperling, M.D., assistant professor of medicine at Harvard Medical School and a rheumatologist at Brigham and Women's Hospital in Boston. "In the few studies done so far with humans, however, results have been disappointing, with no clear benefits."
That doesn't mean that fish oil is a bust, however. It's possible that the people in these studies got too little fish oil and too much of other fats, says Dr. Sperling. It's also possible that they started the diet too late in the course of their disease or were followed for too little time to see benefits, he speculates.
If you have lupus and you decide that you want to try fish oil, your best bet may be to substitute fatty fish (broiled or poached--not fried!) for meats and eggs, experts say. Amounts as small as 6 grams a day may help reduce inflammation, but up to 15 to 18 grams a day may be necessary for cardiovascular protection, Dr. Clark says. One fish oil capsule contains only 300 milligrams (0.3 gram) of fish oil, so you'd still have to take about 60 capsules a day (ugh!) to reach the 18-gram level.
One seven-ounce serving of mackerel, Pacific salmon or fresh albacore tuna offers 5 grams of omega-3's, about as much as you would get in 16 capsules. (Omega-3 fatty acids are the beneficial part of the oil found in fish.) The same amount of Atlantic herring has 4.24 grams of omega-3's; canned anchovies, 4.1 grams; canned pink salmon, 3.38 grams; and bluefin tuna, about 3 grams.
Some doctors worry that combining fish oil with anti-inflammatory medicines such as aspirin may prolong the amount of time it takes for blood to clot. But in one study of people with rheumatoid arthritis who had been taking anti-inflammatory drugs such as aspirin, there was no increase in bleeding time, Dr. Sperling says.
Antioxidants May Offer Protection
There’s no doubt that inflammation produces free radicals. And lupus creates inflammation, sometimes all over the body. Doctors who recommend vitamins C and E, the mineral selenium and beta-carotene (the yellow pigment found in carrots, cantaloupe and other orange and yellow fruits and vegetables) to people with lupus are hoping that over time, these nutrients will help reduce the inflammation by mopping up some of the free radicals.
“Studies of animals with lupus do show that these nutrients can help stop the damage from inflammation,” Dr. Blau says. “I give these nutrients to all of my patients, from day one.”
He recommends a daily intake of 1,000 milligrams of vitamin C, 1,000 international units of vitamin E, 25,000 international units of beta-carotene and a supplement that includes 50 micrograms of selenium and 15 milligrams of zinc, which is used by the body to produce a free radical–dousing enzyme. Dr. Blau urges all people with lupus to discuss any vitamin or mineral treatment with their doctors.
In two studies, people with discoid lupus, a form of lupus typically characterized by red, inflamed skin in a butterfly pattern on the nose and cheeks, who took more than 300 international units of vitamin E daily (most took 900 to 1,600 international units daily) saw clearing of their inflamed skin. And a British doctor reported that large doses of beta-carotene (50 milligrams, or 83,000 international units, three times daily) completely cleared up sun-induced skin rashes in three of his patients with discoid lupus.
Vitamins C and E and beta-carotene are considered safe, even in fairly large amounts. Both selenium and zinc have much smaller ranges of safety. It’s best not to take more than 100 micrograms of selenium or 15 milligrams of zinc a day without medical supervision, experts say.
Drugs, not supplements, are standard treatment for lupus. But some experts believe that these nutrients may help ease symptoms.
Nutrient Daily Amount
Beta-carotene 25,000 international units
Calcium 1,000 milligrams
Selenium 50 micrograms
Vitamin C 1,000 milligrams
Vitamin D 400 international units
Vitamin E 1,000 international units
Zinc 15 milligrams
MEDICAL ALERT: Anyone with lupus should be taking vitamin and mineral supplementation only after discussing it with a physician.
Vitamin D can be toxic in large amounts, so supplements should be taken only under medical supervision.
It's a good idea to consult your doctor before taking vitamin E in doses exceeding 600 international units daily. If you are taking anticoagulant drugs, you should not take vitamin E supplements.
Bone Up with Calcium and Vitamin D
“If these drugs are being given to women in their twenties and thirties, a time when they should be maintaining optimum bone mass, chances are that they will begin to develop osteoporosis fairly early in life, by their forties or fifties,” says Joseph McCune, M.D., associate professor of rheumatology at the University of Michigan Hospitals in Ann Arbor. Osteoporosis, which literally means porous bones, can lead to painful, crippling fractures.
That’s why doctors who treat lupus recommend that anyone taking corticosteroid drugs for the condition get at least 1,000 milligrams of calcium a day through foods and supplements, if necessary. They also keep an eye on vitamin D, aiming for the Daily Value of 400 international units, to help calcium absorption. Some doctors recommend supplements; others reserve vitamin D supplements for those who are already showing signs of osteoporosis on special x-rays that measure bone density. Vitamin D can be toxic in large doses, so supplements should be taken only when approved by your doctor.
A glass of 1 percent low-fat milk, a top source of calcium, offers 300 milligrams, so you’ll need to drink slightly more than three glasses a day to reach 1,000 milligrams. That same amount of milk provides almost 400 international units of vitamin D. Egg yolks and fatty fish such as salmon are also excellent sources of vitamin D.
I am age 64, I was diagnosed with SLE and Sjogren's Syndrome at age 63. I am very fortunate to be diagnosed this late in life, however, I've still had these diseases about 7 years already. My doctor recently took me off 80% of the vitamin supplements I was taking, including a multi-vitamin and vitamin C. I know a lot about nutrition, but not the latest in regards to nutritional supplements and lupus. I will follow my doctor's orders, because I will have extensive blood work done in another 3-4 months and I'm interested to see the results. I hope to see more articles on this. thank you.
Food Factors
Should Fish Be Your Dish?
Prescriptions for Healing
Have you or a family member had an experience with this? Help others by sharing your story now.
