Sunday, May 16, 2010

Diet, Nutrition and Lupus









Diet and Nutrition


The information contained here was compiled from many websites.  Please see my links page for all of the ones I routinely use as a resource.


There is no special diet for lupus, despite the numerous claims on the Internet and in various books and other publications. But recommendations on how diet and nutrition affect lupus seem to be few and far between despite the fact that doctors postulated more than 15 years ago that diet might be one of the possible future therapies for people with this disease.  In general, you should try to eat a nutritious, well-balanced, and varied diet that contains plenty of fresh fruits and vegetables, whole grains, moderate amounts of meats, poultry, and oily fish, as fish oil has been found to help reduce inflammation.

More research is emerging. In the review article, Amy Christine Brown, RD, PhD, an assistant professor of nutrition at the University of Hawaii at Manoa in Honolulu, reports that certain foods and nutrients may improve lupus, while others may exacerbate the disease. 

"Patients with [lupus] may benefit from a balanced diet limited in calories and fat (especially saturated and omega-6 polyunsaturated fatty acids), containing rich sources of vitamin E, vitamin A (beta carotene), selenium and calcium," she writes.  Vitamin E, vitamin A, and selenium are antioxidants and may have anti-inflammatory properties in people with lupus.  Also potentially beneficial are fish oils (which contain omega-3 fatty acids), evening primrose oil, flaxseed, a plant herb called Tripterygium wilfordii, and supplements of a weak male hormone called dehydroepiandrosterone (DHEA), Brown says.  "Stay away from zinc, which is found in meat and shellfish, especially oysters," Brown tells WebMD. "It enhances immune response, and you don't want to help an immune system fight itself."

Omega-3 fatty acids found in oily fish appear to decrease the risk of coronary artery disease and may also protect against irregular heartbeats and help lower blood pressure. For these reasons, omega-3 fatty acids are important for women with lupus, who are at a 5-10-fold higher risk for heart disease than the general population.  One food for people with lupus to avoid is alfalfa. Alfalfa tablets have been associated with reports of a lupus-like syndrome or lupus flares. The lupus-like effects may include muscle pain, fatigue, abnormal blood test results, changes in how the immune system functions, and kidney problems. These reactions may be due to the amino acid L-canavanine (found in alfalfa seeds and sprouts, but not in leaves), which can activate the immune system and increase inflammation. I can tell you from firsthand experience that alfalfa sprouts trigger lupus flares.  My butterfly rash gets much worse and my fatigue levels go way up.  I love alfalfa and it’s one of the few foods I am not allergic to…here I go again, alluding to my allergies.  People with lupus should limit fat intake to less than 30% of total calories, and may want to avoid substances rich in omega-6 fatty acids including safflower oil, sunflower oil, poppy seed oil, and corn oil, because these fats may exacerbate the disease.  But the omega-3 fatty acids contained in the oils of several fish varieties, including mackerel, tuna, whitefish, and herring, may slow the disease and have an anti-inflammatory effect.

If you plan to add herbs, dietary supplements, or vitamins to your diet you should first discuss your decision with your lupus doctor. This is especially important as herbs or supplements may interact with medicines used to treat lupus. Herbs or supplements should never be used to replace medicines prescribed to control symptoms of lupus or medication side effects.  Many of us suffer from depression due to living with a chronic illness for so long and when my disease is affecting my brain.  My rheumatologist has put me on Paxil and Wellbuterin to treat the issues.  Some people may think they can add St. John’s Wort to the mix.  DON’T!  If you take this supplement, it can kill you with drug interactions. So, please check with your doctor and your pharmacist.  My pharmacist is amazing.  I have had the same pharmacy for nearly 10 years.  They catch the interactions my doctor’s may miss.  I take quite a few medications…like thirteen.  You may have to cut back or eliminate certain items from your diet because of the medications you are taking, or because of the damage that lupus has done to certain parts of your body.  Future studies may look at the use of bromelain, a complex of enzymes found in pineapples, to more clearly define any potential anti-inflammatory effect. Boxers use bromelain as an anti-inflammatory agent, and it could prove to be interesting to study if it has such an effect in people with inflammatory conditions.  Bromelain is used by many as a supplement to aid in digestion.  Its enzymes help breakdown food.  I find it has helped in the past when eating protein rich food.
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There has been one large study of dietary factors in relation to lupus disease activity. In this study of 216 lupus patients in Japan conducted by Yuko Minami, M.D., there was no association found between intake of total fat, type of fat, or omega-3 fatty acids and subsequent disease activity over a four-year period. However, higher intakes of antioxidants (for example, vitamins C and E) were associated with decreased disease activity. Thus, although currently available studies suggest that diets high in antioxidants -- and possibly omega-3 fatty acids -- may help lupus symptoms, this is still an unanswered question. The role of antioxidants in disease progression and activity is a relatively under-studied area of research. It is important to discuss any major change in your diet, especially changes that include use of dietary supplements, with your doctor. There may be potential interactions with prescribed medications or other aspects of your care that are important for your physician to evaluate.

There's no way to soften the bad news about drinking alcohol. While anyone is at risk from alcohol's negative side-effects, people who take prescription medications (and also some over-the-counter-ones) put themselves at an even greater risk of suffering health troubles.   The problems occur because alcohol can change the way the body uses, or metabolizes, certain medications. Alcohol is absorbed through the intestinal tract and shuttled to the liver, where chemical "knives" called enzymes break it into smaller molecules. Trouble is, alcohol causes the body to make more of these enzymes, especially when someone drinks regularly (even so-called "social" amounts of alcohol). Some of these enzymes are the same "knives" that break down medications so the body can use them. In producing more enzymes, the liver metabolizes medications faster. The bottom line: medications are sent into the bloodstream much faster and to a larger extent than when you don't drink. This can be dangerous, intensifying both the positive and negative side-effects of medications. 

It is a myth that you can avoid these alcohol medication side-effects by taking medications while you are not drinking: the liver is still in "over-drive," producing more of these enzymes for some time after you drink. Another myth: "You have to drink hard liquor to suffer dangerous consequences." Beer and wine are just as likely to cause problems.  Of the 50 most frequently prescribed drugs, more than half contain ingredients that react adversely with alcohol. Among the negative effects are seizures, headaches, nausea, vomiting, mental confusion and coma. Don't forget that medications that are available without a prescription can also react adversely with alcohol. People with lupus, for example, often take Tylenol to alleviate pain. Drinking any amount of alcohol can cause Tylenol to be toxic to the liver at much smaller doses. Alcohol mixed with aspirin can lead to bleeding in the stomach. If you are taking methotrexate or other immunosuppressive medications, drinking greatly increases the chance that you will suffer liver damage. 

Anyone with a chronic disease like lupus needs even better nutrition to also fight the chronic disease. Alcohol interferes with good nutrition in a couple of ways. Alcohol causes the body to waste some nutrients, basically by burning them up at a faster rate. In addition, the body's first priority is to metabolize or use alcohol, rather than the type of calories a person (especially teenagers) needs to grow. Anyone with lupus should avoid alcohol, particularly when taking medications, or restrict their alcohol intake as much as possible. 
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·        Corticosteroids can elevate blood pressure and the levels of cholesterol and lipids in the blood. Therefore, if you are taking steroids, you should limit the fat and salt in your diet, as both can contribute to these conditions.  Corticosteroids also can cause or worsen osteoporosis, a disease in which bones become fragile and more likely to break.  If you have osteoporosis you should eat foods rich in calcium every day to help with bone growth: examples are dark green, leafy vegetables (spinach, broccoli, collard greens), milk, cheese, and yogurt or calcium supplements that contain Vitamin D.
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At this time, there is no specific lupus diet. Most people with lupus do not require special diets. It is important to maintain a nutritionally sound and well balanced diet. A proper diet ensures that we consume all of the necessary vitamins, minerals, and supplements. However, if your doctor feels it would be helpful for you, it may be suggested that you try a reducing diet, salt free diet, or low protein diet or combination of the three. If you have kidney involvement, a salt free low protein diet may be helpful in minimizing water retention.  If you are experiencing fluid retention that causes swelling (edema), you should lower the amount of salt and sodium-containing foods you eat; in particular, processed foods should be avoided.  A healthy intake of vitamins and minerals is important for everybody. If you eat a good variety of nutritious foods to include fresh fruits and vegetables, fiber rich cereals and grains, and lean cuts of meat then you are probably getting all of the vitamins and minerals you need to be healthy. There's little scientific evidence to prove that taking in extra amount of micronutrients such as through supplementation, can help improve your lupus.

One thing I can tell you, if your insurance will cover it, find a good nutritionist or registered dietician.  They can be invaluable in helping you come up with a well balanced eating regimen.  As I have mentioned, I have a lot of allergies.  I will blog about the whole “I’m allergic to everything” more fully in a later post…I will address the issues I am facing with my so-called “diet”.  It’s easier to tell you the foods I am not allergic to than to tell you the ones I am not.

1.    Turkey
2.    Pork
3.    Apples
4.    Pears
5.    Vanilla
6.    Brussel Sprouts
7.    Celery
8.    Onion/Scallion/Leek
9.    Garlic
10. Iceburg Lettuce
11. Corn
12. Rice
13. Cabbage/Rutabaga
14. Potatoes/Yams
15. Grapes
16. Avocado
17. Pumpkin seeds (not the pumpkin…just the seed)
18. Sunflower seeds
19. Alfalfa Sprouts (and not really because of the triggering a lupus flare)

In 2004, I became allergic to all nuts (peanuts, walnuts, pecans, cashews, brazil, hazel, pistachio, pine, macadamia), eggs, wheat/gluten, shellfish, ocean fish).  Just this year, I lost pretty much all the rest of the food.  My immune system is being aggressive all the way around…not just with the lupus.  And I realize that what really should be the diagnosis for my disease is “hyperactive immune system” … because that would explain everything… my overlapping arthritis issues (Lupus, Rheumatoid Arthritis, Sj√∂gren’s Syndrome, Raynaud’s Phenomenon)…my Hashimoto’s Thyroiditis…my celiac sprue…my allergies & asthma…literally EVERYTHING.  But alas…they don’t see that all encompassing diagnosis as a benefit.  How do you treat something that is hyperactive if you can’t get at the entire system to “remove” or kill off part of it….kind of like how they treat for thyroid issues.  I know that there are studies underway looking at how Lupus and allergies maybe more closely linked than currently thought.

Anyway…I am happy not eating a lot…the meds I take make me nauseous anyway and eating just gives my stomach a reason to churn and rumble.  

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