Nutrition and Lupus

Jenna K. Larsen, M.S. 
Columbia University, Institute of Human Nutrition, New York, NY

and

Jodi L. Norton 
Columbia College, New York, NY

With or without lupus, nutrition is important for living a long life.  However, patients with lupus have an even greater stake in maintaining a good diet. A healthy diet is crucial for you to function at your best, prevents against numerous diseases, and helps maintain high energy levels.  In lupus patients, certain foods not only help to  decrease the inflammatory cascade but they also become important when coping with the many side effects that lupus patients experience. Knowing which foods are important is essential for living your best life possible!*

The following books by Dr. Andrew Weil, the renowned Harvard trained holistic health and integrative medicine physician, are also great resources for those with lupus and other autoimmune conditions. Click on the images below to learn more.


 

Controlling flare ups with anti-inflammatory foods 

What is Inflammation?

Inflammation is a healing response that occurs as a result of injury or infection. It involves the production of substances that increase blood flow to an area. For instance, a bite or cut that gets red and warm to the touch is “inflamed”.  Lupus patients are in a state of chronic Inflammation which is associated with joint pain, muscle pain, and skin rashes. 

The food choices you make can significantly affect the process of inflammation. Is there a specific anti-inflammatory diet for lupus? No. There is no diet that can replace the need for medications. However, choosing anti-inflammatory foods can help to decrease inflammation and pain while avoiding pro-inflammatory foods can prevent aggravation. Read below to find out which foods to incorporate into your diet and which to avoid.

Anti-Inflammatory Foods:

Foods that decrease inflammation can have a beneficial impact on lupus patients. Most diets high in essential fatty acids, vitamin E, beta-carotene and selenium are recommended for individuals with lupus, because these nutrients help to limit inflammation. Herbs and spices, like green tea, ginger, turmeric, and rosemary, are also anti-inflammatory.

Omega-3 Fatty Acids

Omega-3 fats are required for many biological processes. Multiple studies have shown that their anti-inflammatory properties are significantly beneficial in managing lupus. Oily fish such as salmon, mackerel, herring, sardines and tuna are great sources of omega-3 fats-aim for at least two servings per week.  Walnuts, flaxseeds, soy products, and green, leafy vegetables are also great sources of omega-3 fats.  If you don’t eat these foods very often, supplementation is recommended (2-4 g/day EPA+DHA capsules), but consult your doctor before starting any supplement regimen.

  • Garlic 

Garlic possesses a whole host of great health benefits. It not only boasts anti-Inflammatory properties, but it also has anti-thrombotic, and vasodilating properties to help improve cholesterol levels, lower blood pressure, and decrease clot formation. In addition, garlic contains antioxidants to help prevent against cancer. 

To active the beneficial compounds in garlic, let it sit for at least 60 seconds after being chopped/crushed prior to subjecting to heat or acidic foods like lemon juice. Incorporate garlic into meals where it can be the last ingredient added in order to avoid overcooking it. Adding it to salads and rice dishes is a great way to add flavor without the extra calories. Try combining it with ginger and add to grilled chicken and seafood.

Note: Some lupus patients report garlic as a trigger for flare ups. It is recommended that garlic supplementation be avoided. If you think that fresh garlic is related to flares, talk to your doctor or try eliminating it from your diet

  • Turmeric

For over 4000 years, turmeric has been used in dishes in order to alleviate a wide variety of ailments including inflammation, digestive problems, infections, and even cancers. Turmeric is best known for its use in curry dishes but also gives mustard its yellow color. The yellowish pigment in curry is called curcumin. Numerous studies have found that curcumin’s anti-inflammatory effects are comparable to the drugs hydrocortisone and phenylbutazone. 

Ideas for adding turmeric to your meals:  Aim for at least 1 tsp per day.

-      Add to bean dishes, stews, and soups
-      Add to egg salad
-      Mix into brown rice with raisins and peanuts
-      Add to sautéed apples, green beans and onions

  • Ginger

Ginger has been used in China for thousands of years as a medicinal remedy. Studies have also shown that it is effective for joint pain and inflammation. In a study of 261 people with osteoarthritis of the knee, those who received ginger extract twice per day required fewer pain medications compared to placebo. Lupus patients may take 2-4 grams per day of fresh ginger juice, extract, or tea to relieve joint paint. Rubbing topical ginger oil into a painful joint is also effective.

  • Antioxidants

Antioxidants are generally thought to protect against cancer. However, a body of research suggests that some antioxidants can actually block inflammation by lowering the activation of inflammatory signals. Although antioxidant supplements are available, it is best to get them through healthy foods. Fruits and vegetables are the best sources of antioxidants, so aim for at least five servings per day.
 

Pro-Inflammatory Foods 

While there are many food components that prevent inflammation, there are just as many that can promote it.  Lupus patients need to be especially aware of which foods to avoid to prevent inflammation and immune system activation which can trigger flare ups. 

  • Saturated and Trans- Fats

Both saturated and trans-fats have been shown to have pro-inflammatory effects, which is a major contributor to joint pain. Additionally, red meat may trigger the immune system and exacerbate symptoms.  Red meats not only include beef, but also lamb and pork. Other foods that are high in saturated fats include bacon, butter, sour cream, coconut, and whole-milk dairy products. Foods that are high in trans-fats include margarine and shortening, packaged foods such as cake mixes, Bisquick, and soups, as well as fast foods items including fries, chicken, and other fried foods. If partially-hydrogenated oils are written on the ingredients list, the product contains trans-fats even if the nutritional label states otherwise!

  • Nightshade family of fruits and vegetables

Although scientific evidence is weak, some lupus patients report experiencing flare ups as a result of consuming vegetables in the night shade family. The alkaloid, solanine, which is contained in these vegetables, may lead to inflammation. The main night shade vegetables that are consumed in the United States include tomatoes, white potatoes, eggplant, tobacco sauce, paprika, and sweet and hot peppers. If you think that these foods may be causing flare ups, write down when they are eaten and when a flare up takes place. If you notice a pattern between consumption and a flare up, avoid these foods. 

  • Alfalfa sprouts and Garbanzo Beans

There is limited evidence that alfalfa sprouts and garbanzo beans may trigger flare ups in lupus patients.  Garbanzo beans are also referred to as chickpeas and are the main ingredient in hummus. Alfalfa sprouts and garbanzo beans contain the compound L-canavanine, which may increase inflammation and stimulate the immune system. Moderate consumption will likely not cause problems, but avoid eating large qualities or supplementing with alfalfa tablets. However, be aware that the evidence against these foods is very weak and mostly anecdotal. If you notice a pattern between consumption and a flare up, avoid these foods or talk to your physician.

 

Nutritional Remedies for Lupus Symptoms

The symptoms of lupus have far reaching effects that often interfere with the patient’s life. Whether symptoms are due to medications or the flare ups from lupus itself, there are many nutritional components that should be incorporated into ones diet that will help to reduce their severity. 

Fatigue

If you have lupus, you have most likely experienced the most common symptom- fatigue. Fatigue can be influenced by a variety of factors, including pain, depression, quality and quantity of sleep, exercise, illness severity, and stress. Maintaining a well-balanced diet that incorporates plenty of fruits, vegetables, and whole grains can help keep energy levels up. Also avoid consuming large quantities of food at one time, instead opting for 5 small meals per day. This will keep blood sugar levels stable so that energy levels are optimal all day long. Additionally, incorporate moderate amounts of lean meat, such as chicken and turkey and plenty of fatty fish such as salmon.  Avoid excess intake of caffeine and high-sugar foods which offer an energy boost in the short term but are followed by a feeling of lethargy.

Weight Gain

Often lupus patients are treated with powerful steroids, which lead to increased appetite and subsequent weight gain. Whether you have already gained weight or are concerned about gaining weight affects the number of calories that you require. In order to lose weight or avoid weight gain, focusing on the number of calories eaten per day is essential. The following website will help you determine the number of calories that you need per day in order to maintain your current weight.  http://www.shapefit.com/dailycalorie-calc.html

If you would like to lose weight, you must decrease your caloric intake. A pound of weight loss is equal to a deficit of 3500 calories. Therefore, in order to lose one pound per week, you must decrease your intake by 500 calories per day. This can be achieved both through exercise and through diet change. For instance, if you work out for 30 minutes per day, you only need to reduce your number of calories by 250 calories per day for a pound of weight loss per week.

In order to reduce caloric intake, it often helps to write down which foods you eat, the portion size, and the number of calories. Portion size is key as smaller portions will lead to small changes. Focus on foods with higher nutrient density and lower energy density. For instance, vegetables like broccoli and spinach are high in nutrients but low in calories (energy) whereas a candy bar has a low amount of nutrients but more energy.  Nutrient dense foods will allow you to feel full without tacking on the calories. Also choose lean protein sources, foods with unsaturated fat, and unprocessed carbohydrates like whole grains. It is important to eat breakfast regularly, get plenty of exercise, and make these changes lifestyle habits rather than short term solutions.

Mouth Sores

Mouth sores can be a common symptom of lupus activity. Furthermore, when lupus patients are place placed on NSAIDS or methotrexate, oral ulcers or mouth sores can develop on the palate, lips, and cheeks. Because these can be painful, avoid acidic, spicy, rough, and salty foods. Instead, choose bland and soft foods that are easy to swallow. In order to get veggies into your diet, cook them until they are soft and tender to avoid mouth sore aggravation. You can also mix food with gravies, broths or sauces to make swallowing easier. If you have a sweet tooth, choose frozen fruit bars or other frozen treats which will often feel good on mouth sores.

 In patients taking methotrexate, supplementing with at least 1mg folic acid per day can reduce the incidence of mouth sores. However, be sure to talk to your doctor before starting supplementation. 

Nausea

 

  • Ginger

Patients with severe lupus may be treated with chemotherapy drugs to suppress the immune system.  Unfortunately, chemotherapy does not come without side effects, one of which is nausea.  Ginger has been shown to reduce the severity and duration of nausea.  In China, it has been used in medicine for over 2000 years to treat stomach upset, diarrhea, arthritis, and nausea. Additionally, it has been used to reduce inflammation.  The herb is found in extracts, tinctures, capsules, and oils. Fresh ginger root can also be purchased and prepared as tea (recipe) or used as a spice when cooking. Try adding ginger and garlic to grilled chicken and seafood. 

For nausea, lupus patients should take 1.5-3.0mL/day liquid ginger extract per day or 2 to 4 grams of fresh ginger root per day.  To prevent vomiting, take ½ tsp of powdered ginger every four hours as needed (do not exceed four doses per day).  You may also chew a 1/4oz piece of fresh ginger when needed.

Nutrition

Besides ginger, combining sweet and salty foods can also help with nausea. Aim to eat small frequent meals that are lower in fat and fiber for best results.

Nephrotic Syndrome

Lupus is a disease that affects many organs of the body. The kidney is no exception. Often when the kidney is affected, nephrotic syndrome can result. Nephrotic syndrome is a condition in which damage occurs to the glomeruli of the kidney, which filter blood in the kidney in order to form urine,  Nephrotic syndrome is common in patients with severe lupus and is a condition in which nutritional choices become very important. Protein should be reduced to just 6 to 8 oz/day, sodium should be limited to 2-3 g/day, and potassium should be reduced to 2000mg/day. Foods that are high in potassium include bananas, oranges, dairy, cheese, legumes, and chocolate.  Additionally, phosphorus in the diet should also be reduced. However, due to the ubiquitous amount of phosphorus in many foods, phosphate binders should be taken.  Foods that are especially high in phosphorus include red meats, chicken, fish, dairy products, legumes, processed foods, chocolate, dried fruits, and dark colored sodas, so be sure to minimize the consumption of these.  It is important to consult your doctor about appropriate food choices for controlling nephrotic syndrome.

Bone Loss

Women with lupus are at an increased risk of osteoporosis due to the disease itself as well as from medications.  Steroid medications including prednisone and glucocorticoids can trigger bone loss. Additionally, it is often difficult for patients with severe lupus to exercise which leads to inactivity. Weight bearing exercise is extremely important for preventing osteoporosis, putting lupus patients at an increased risk. 

  • Calcium:

In order to minimize bone loss, consuming foods that are high in calcium is very important. Milk, cheese, and yogurt are high in calcium, but should be eaten with caution in patients with nephrotic syndrome.  Dark green, leafy vegetables such as spinach, broccoli, and collard greens are also great sources of calcium.

In addition, calcium supplementation is recommended for lupus patients.  500mg capsules should be taken twice per day (at breakfast and dinner) for optimal absorption. It is recommended that lupus patients take calcium citrate rather than calcium carbonate because calcium carbonate can interfere with Cipro, Floxin, and Moroxin drugs.  If patients choose to take calcium carbonate, space doses 2 hrs apart from taking lupus medications

  • Vitamin D

Vitamin D is required for optimal calcium absorption.  Since sunlight exposure is the main source of vitamin D, lupus patients are at an increased risk of deficiency due to UV light sensitivity. Therefore, 1000 IU/day of vitamin D tablets is highly recommended.

Anemia: 

Blood disorders are a common occurrence among lupus patients, the most common of which is anemia (50% of lupus patients). Anemia occurs when there is a deficiency in the protein hemoglobin, which is responsible for carrying oxygen from the lungs to the body tissues. It is important for those with anemia to consume enough iron in their diet.  Lean meats such as poultry and fish are great sources of iron but those patients with nephrotic syndrome should only eat 6-8oz/day. Green, leafy vegetables in the cabbage family such as broccoli, kales, turnip greens, and collards are also high in iron as well as legumes and whole wheat products. Dairy products, high fiber foods, tea, and coffee can reduce iron absorption by up to 50% so consume these foods between meals. Vitamin C increases iron absorption, so it is recommended that lupus patients eat a breakfast containing iron fortified foods with orange juice rather than coffee.

Cardiovascular Disease  

Cardiovascular disease (CVD) is the leading cause of death in those with lupus. The recommendations above are all consistent with a heart healthy diet. Use the chart below to determine the recommended intake per day of each nutrient in order to reduce your risk of developing CVD.

Nutrient

Recommended Intake per day

Saturated Fat

< 7% of total calories

Polyunsaturated fat

Up to 10% of total calories

Monounsaturated fat

Up to 20% of total calories

Trans-fat

Avoid whenever possible

Fiber

20-30 grams

Fruits and Vegetables

≥ 5 servings

Plant sterols and stanols (found in fortified salad dressing and margarine)

2-3mg/d decreased cholesterol by 9-20%

Sodium

2000-3000 milligrams


* Before changing your diet or taking nutritional supplements, be sure to consult your doctor.

* Please see References.

* Supplementation should only be incorporated if your dietary intake is insufficient or if certain foods are contraindicated due to lupus.  Also, be sure to exercise caution when choosing nutritional supplements, as some may have ill effects.  Please increase your awareness by reading the following article on the use of dietary supplements for chronic illness.