Eat to avoid flares, limit drug side effects, stave off complications and simply feel better.
BALANCED DIET – YES. Alfalfa sprouts – no. If you have lupus, what you eat plays an important role in keeping symptoms under control and staying as healthy as possible.
Lupus is an autoimmune condition that causes constant fatigue, skin rashes, and joint pain and swelling. The most common form of lupus, called systemic lupus erythematosus, may involve inflammation in almost every body system. Major complications can include heart disease and kidney disease.
There's no single "lupus diet" to follow. The foods that may trigger lupus flares vary from one individual to the next. Patients who are on medications like steroids face additional dietary challenges from weight gain and other drug side effects.
Best practices and evidence on optimal nutrition for lupus are still emerging. However, experts agree that certain foods may be beneficial and others should be avoided.
A well-rounded diet that focuses on plant-based, unprocessed foods provides a wide range of nutrients that may reduce inflammation, tame lupus symptoms, reduce disease complications and help you maintain a healthy weight. These are specific diets and types of eating plans you might consider after talking with your doctor or dietitian:
Plant-based, nutrient-dense "superfoods" such as cruciferous vegetables like broccoli beans, legumes and fresh fruit are the basis of the Nutritarian diet, created by Dr. Joel Fuhrman to promote weight loss and help fight heart disease, diabetes and autoimmune conditions.
Animal fats and processed foods are frowned on. Unlike many other plant-based diets, even olive oil, as a processed food, is discouraged; instead, whole olives provide fiber, more micronutrients and fewer calories.
The Mediterranean diet is a top heart-healthy diet that emphasizes fruits, veggies, whole grains, beans, nuts and legumes. It's more permissive than the Nutritarian diet, and olive oil, as a Mediterranean cooking and salad dressing staple, is recommended. Fish and seafood are included, as are poultry, eggs, cheese and yogurt, in moderation.
Sweets and meat are only eaten infrequently, while red wine is optional. A 2013 study confirmed that people with systemic lupus have an up to 50-fold increased risk of a heart attack compared with the general population. "Patients with lupus can have premature heart disease," says Dr. Susan Manzi, director of the Allegheny Health Network Lupus Center of Excellence in Pittsburgh. "A good, heart-healthy diet is really important," says Manzi, who is also the board chair of the Lupus Foundation of America.
Based on the Mediterranean diet, the Anti-Inflammatory Diet was created by Dr. Andrew Weil, a leader in integrative medicine. His diet features extra recommendations such as green tea and dark chocolate, and heavily emphasizes fruits and vegetables.
Regular consumption of omega-3 fatty acids is recommended, while fast and fried foods are shunned. A research review in the February 2019 issue of Experimental and Therapeutic Medicine compiled findings from nearly 50 studies on diet, autoimmune disease and lupus. Omega-3 fatty acids elicit an anti-inflammatory effect by decreasing levels of inflammatory proteins in the body, according to the researchers from Romania.
The Glycemic-Index Diet ranks multiple carb-containing foods. "Good-carb" foods like bran cereal, and a variety of fruits and veggies, are lower on the glycemic index, which means they're digested more slowly and less likely to make your blood sugar spike. Many with lupus have weight concerns that can cause additional health problems, including up to half who are obese. These patients are more likely to suffer from fatigue, according to the in-depth review. In lupus patients who are obese, "losing weight by keep a low-glycemic-index or low-calorie diet proved to be efficient in lowering the level of fatigue, though disease activity was not influenced by diet," the researchers found.
The DASH (dietary approaches to stop hypertension) plan was created to reduce high blood pressure, which is a side effect of steroid medications. DASH is sometimes used to treat kidney disease, which can be a lupus complication. DASH is similar to other balanced diets that are rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, nuts, seeds and beans, with an added emphasis on low salt and sodium. DASH is also low in added sugars, red meat and fat.
Experience With Lupus
Mary Ross Fowler, who is now a registered dietitian in Winston-Salem, North Carolina, was a 21-year-old-college student when she was diagnosed with lupus. (Lupus often affects younger women.)
The diagnosis motivated Ross Fowler to learn everything she could about the connection between lupus and nutrition (and eventually decided her career). Although medication often can't be avoided, some people with lupus can significantly limit medications during periods of remission.
"When you're in that much pain, or you're so tired, or your hair is falling out, you're pretty desperate," Ross Fowler says. "I made radical changes to my diet in college. That's not easy to do. And my symptoms were gone within three weeks. That's what inspired me to go into the field of nutrition. Because it was so amazing – it was something I had never heard of. I thought I had a good diet until I read more about it."
A primarily nutritional approach to lupus works well for Ross Fowler, although she sometimes needs to take low-dose steroids for a short period. "For me, it's very important to stick with a strict, plant-based diet with no oil and low salt, and to reduce sugar," she emphasizes.
Definitions of anti-inflammatory diets are inconsistent, Ross Fowler says. "Some definitions will include a fatty fish," she notes. "But if you look at how our fish is farmed, there are lots of (toxic chemicals). Animal proteins in general can cause inflammation. The plant-based diet is, in itself, anti-inflammatory."
She's able to keep symptoms to a minimum. "At one point I had fevers and I was really tired," she says. "But now that I've been doing the diet for a while, it's just like: My hands might be stiff or my wrists might hurt. But I never get to that point where it's causing permanent damage to my joints."
It's never too late for anyone to incorporate a lupus-friendly dietary approach, she says: "Even if you've had lupus for 20 years, there's no harm in changing your diet. It will definitely help."
Each patient is different, so if you have lupus, talk with your health care team before making major changes to your diet.
Foods to Avoid
Specific foods that trigger lupus flares are highly individualized. However, there is some consensus on what to avoid or limit:
Alfalfa. The Lupus Foundation of America and Lupus Canada both advise against eating alfalfa, which may aggravate lupus symptoms. And individuals with lupus are advised against taking supplements that contain alfalfa as well. An amino acid in alfalfa sprouts, called L-canavanine, can stimulate the immune system and cause inflammation in people with lupus.
Refined grains. White rice, white flour and white bread lose essential fiber and nutrients in the milling process and eating refined grains may cause inflammation. Instead, patients with systemic lupus should introduce whole grains into their diet, the Romanian researchers advise. Whole grains provide more nutrition and reduce the possibility of causing inflammation.
Salt. Because it can raise blood pressure and worsen kidney problems, salt should be limited for many people with lupus.
Added sugars. White, brown or raw sugar and high-fructose corn syrup add empty calories to your diet, which contributes to weight gain and can crowd out more nutritious foods. Added sugars can be found in sugar-sweetened beverages, and in many breakfasts cereals and snack foods.
High-fat, high-cholesterol foods. Organ meats (liver, tongue), processed meats (hot dogs, cured bacon), baked goods, desserts, fried food and fast food are often high in unhealthy fats that aren't good for the heart. Limit these foods to reduce your blood cholesterol and "bad" LDL fat levels.
Individual food triggers. You know your body. If you notice your joints ache whenever you've recently eaten eggplant or peppers, for instance, it's OK to avoid them – as long as you're replacing them with similarly nutritious foods.
Weight loss and malnutrition can be a problem for people with lupus. "Some people may lose their appetite," says Laura Gibofsky, a registered dietitian at Hospital for Special Surgery in New York City. "When people are losing weight, it's compromising their immune function – which is already compromised."
When you're having a lupus flare or you're just feeling fatigued, eating properly can become more challenging. "Sometimes, people might not feel like preparing food for themselves, or even eating in general," Gibofsky says. "That can further exacerbate inflammation."
Nutrients You Need
Researchers are zeroing in on nutrients with specific benefits for people with autoimmune conditions like lupus. Although larger, long-term studies are needed for confirmation, these are some nutrients with possible lupus-fighting powers:
Omega-3 fatty acids. Krill oil (similar to fish oil), fish oil, olive oil, flaxseed oil and fish such as salmon, tuna, sardines and herring are primary omega-3 sources.
Protein. Consuming mModerate amounts of protein is important for overall health, including good kidney function. . Current nutritional guidelines call for about 50 grams of daily protein. However, people with kidney disease may be need to limit protein, according to their doctor's advice. Meat and eggs are major protein sources, but certain plant foods like lentils and tofu can also provide protein for people on a vegetarian or vegan diet.
Vitamins C. Vitamin C decreases the body's inflammatory response. Good sources include orange juice, tangerines, papaya and broccoli.
Vitamin B. Vitamin B complex can improve symptoms, according to the in-depth Romanian review article. Sources include red meat, liver, fortified cereals, chicken, salmon, sardines, avocado, nuts and eggs.
With lupus, keeping nutrients like iron or vitamin D in balance, while avoiding deficiencies or excesses, is complex. Sorting out food groups, diet plans and portion sizes is challenging for anyone. "That's where a registered dietitian can be very helpful, to make sure the patient is getting everything that they need," Gibofsky says.
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