Systemic lupus erythematosus (SLE), often referred to as lupus, is a chronic autoimmune disease without a definitive cure. Affecting an estimated 1.5 million Americans, lupus prompts the immune system to attack healthy tissues and organs, leading to inflammation and a wide array of symptoms. While medication remains a cornerstone of lupus management, dietary and lifestyle modifications can play a crucial role in alleviating symptoms and improving overall well-being. This article explores the relationship between nutrition and lupus, offering guidance on dietary choices and lifestyle adjustments that may help individuals manage their condition more effectively.
Understanding Lupus
Lupus is characterized by periods of active disease, known as flares, interspersed with periods of remission. The condition can manifest differently in each individual, making diagnosis and management complex. There are four main types of lupus:
- Systemic Lupus Erythematosus (SLE): The most common form, accounting for approximately 70% of cases.
- Cutaneous Lupus: Primarily affects the skin but can progress to SLE.
- Drug-Induced Lupus: Triggered by certain medications and typically resolves after discontinuing the drug.
- Neonatal Lupus: Occurs in infants and usually disappears within six months.
Lupus is more prevalent among women, particularly those of Black, Hispanic/Latina, Asian American, Native American, Alaska Native, Native Hawaiian, and Pacific Islander descent. Genetic predisposition and environmental factors also contribute to the risk of developing lupus.
Common Lupus Symptoms
Lupus can mimic other diseases, making diagnosis challenging. Symptoms can vary and may come and go, further complicating the process. Common symptoms include:
- Pain or swelling in the joints
- Fatigue
- Brain fog and memory loss
- Hair loss
- Butterfly-shaped rash on the cheeks and nose
- Chest pain during deep breath
- Headaches
- Loss of balance
- Sensitivity to light
Chronic pain is a significant challenge for many individuals with lupus, affecting their quality of life.
Read also: Dietary Strategies for Lupus
The Role of Diet in Managing Lupus
While there is no specific "lupus diet," adopting a well-balanced, anti-inflammatory eating pattern can help manage symptoms, reduce inflammation, and improve overall health. A recent study indicated that lupus patients who increased their intake of plant-based foods while limiting processed foods, sugar, gluten, and animal products experienced improvements in fatigue, joint and muscle pain, and mood.
General Principles of a Lupus Diet Plan
Several general principles have been linked to better health in populations around the world. While it is not clear if following these dietary patterns will specifically affect SLE and its complications, these eating patterns have been associated with lower rates of heart disease, diabetes, and obesity. Since these chronic problems occur with greater frequently among people with SLE, eating a generally anti-inflammatory diet can help offset some of these complications of SLE. For example, individuals with SLE who are obese can have worse SLE symptoms, so maintaining a healthy weight or making changes to facilitate gradual weight loss (if needed) is a critical-and often neglected-part of managing lupus. Replacing high calorie processed meals and snacks with anti-inflammatory foods can help with feeling satisfied and maintaining a healthy weight. Similarly, heart disease and strokes are frequent in individuals with SLE, and can occur at a younger age than expected. As many anti-inflammatory plant-based foods have been known to prevent or even reverse heart disease, choosing foods that fight inflammation can help minimize this particular complication of SLE.
Anti-Inflammatory Diet
An anti-inflammatory plant-based diet that is high in fruits, vegetables, whole grains (such as wild rice, quinoa, or barley), beans, and nuts has been associated with better health. Many studies also suggest that little to no consumption of processed food (such as fast food or junk food) is associated with better health as well. While some disagree about the exact specifics of an anti-inflammatory diet, it is widely accepted that high amounts of fruits, vegetables, and plant-based protein sources form the backbone of a diet that fights inflammation. An example of an anti-inflammatory diet that has been linked to lower levels of inflammation and chronic disease is the Mediterranean diet. This is an eating pattern that is found in many areas that border the Mediterranean Sea, but the foods that are eaten and avoided in this diet can be tailored to nearly every culture. The Mediterranean diet focuses on high amounts of vegetables, fruit, olive oil, whole grains, and beans, and moderate amounts of fish, chicken, low-fat dairy, and nuts. The diet limits red meat, sugary drinks (including fruit juice), salt, processed foods, and processed meats.
Foods to Include in Your Lupus Diet
- Fruits and Vegetables: Aim to make half your plate fruits and veggies. These are rich in antioxidants and vitamins, helping to combat inflammation. Leafy greens like spinach and kale are particularly beneficial.
- Whole Grains: Choose whole-wheat bread and pasta, oatmeal, brown rice, couscous, oats, barley, bulgar, buckwheat, rye, and spelt over refined grains.
- Healthy Proteins: Incorporate lean meats, poultry, seafood, beans, nuts, and eggs into your diet. Fatty fish like salmon and sardines are excellent sources of omega-3 fatty acids.
- Healthy Fats: Opt for foods with healthy fats like olive oil, avocados, nuts, and fish.
- Vitamin D-Rich Foods: Include eggs, fortified cereal, mushrooms, salmon, and yogurt to maintain adequate vitamin D levels.
- Vitamin B6-Rich Foods: Consume chickpeas, bananas, pineapple, grapes, carrots, and avocados to ensure sufficient vitamin B6 intake.
- Vitamin C-Rich Foods: Add strawberries, citrus fruits, green peppers, broccoli, and cabbage to your diet for vitamin C.
- Probiotic Foods: Incorporate fermented foods like yogurt, kefir, and sauerkraut to promote gut health.
- Bone Broth: Consume bone broth for its beneficial nutrients like collagen, glutathione, and trace minerals. It can help reduce autoimmune and inflammatory symptoms.
The Mediterranean Diet
One study showed that following a Mediterranean diet helped support immune function, while reducing inflammation, disease activity and the risk of cardiovascular disease in those living with lupus. The Mediterranean diet is primarily plant-based, but it includes some fish, poultry, and dairy products. The diet bases meals on the following foods:
- A variety of vegetables, including green leafy vegetables such as kale, spinach, cabbage, and arugula
- Whole grains, such as brown rice, couscous, oats, barley, bulgar, buckwheat, rye, and spelt
- Healthy fats from extra virgin olive oil, avocados, and olives
- Oily fish, such as mackerel, sardines, tuna, and herring
- Nuts, beans, and legumes
- Fruits
Foods to Limit or Avoid
Eliminating or limiting certain foods, like those that are highly processed or high in saturated fat, trans fat and sodium can help regulate the immune response and lower the severity of lupus symptoms. Foods that people may wish to avoid or limit include:
Read also: The Benefits of Plant-Based Diets for Lupus
- Processed Foods: These are often high in additives, unhealthy fats, and sodium, contributing to inflammation. Limit canned soups, frozen meals, processed meats, and snacks like potato chips, crackers, and cookies.
- Sugary Foods: Sugar can trigger the release of inflammatory chemicals called cytokines and contribute to weight gain and high cholesterol. Limit candy, cakes, cookies, sodas, and sugar-sweetened drinks. Be mindful of hidden sugars in foods like pasta sauce, ketchup, yogurts, pre-packaged oatmeal, jams, and pasta sauces.
- High-Fat Foods: Saturated fats and trans fats can raise cholesterol levels and promote inflammation. Avoid fried foods, commercial baked goods, creamed soups and sauces, red meat, animal fat, processed meat products, and high-fat dairy.
- Salty Foods: Eating too much sodium (salt) can raise your risk for high blood pressure, which can cause heart attack and stroke. You could have high blood pressure and not know it - so it’s important to limit sodium to keep your blood pressure in a healthy range. Cook more meals at home. Check the Nutrition Facts label on packaged foods, and choose options with less sodium. Flavor your food with herbs and spices instead of salt.
- Alcohol: Limit alcohol consumption to moderation, as it can interact with some lupus medications.
- Alfalfa Sprouts: Alfalfa sprouts and seeds contain an amino acid called L-canavanine that may trigger inflammation, fatigue, and muscle aches in some individuals.
- Nightshade Vegetables: Some people find that nightshade vegetables (tomatoes, bell peppers, eggplants, and potatoes) worsen their symptoms due to chemical compounds called alkaloids. However, research on this is inconclusive.
- Gluten: Some people do find gluten to be inflammatory. If gluten triggers a flare, you may want to follow a gluten-free diet that cuts out ingredients like wheat, barley, rye, and spelt.
Addressing Specific Concerns and Symptoms
Depending on which medications a person is taking, a healthcare professional may recommend consuming foods that help manage their side effects. People should speak with a doctor about any side effects they experience.
Managing Nausea and Upset Stomach
People may manage these symptoms by eating:
- Bananas
- Rice
- Applesauce
- Toast
Countering Folic Acid Loss
Doctors may prescribe methotrexate for some individuals with lupus. Because this medication may cause folic acid loss, they may also prescribe folic acid supplements. Foods that contain folic acid include:
- Spinach
- Beef liver
- Avocado
- Rice
- Asparagus
Managing High Blood Pressure
Some people with lupus may take prednisone. Long term prednisone use may lead to high blood pressure. To help manage their blood pressure include the following foods in their diet:
- Whole grains
- Fruits
- Vegetables
- Nuts and legumes
- Skinless poultry and fish
- Low-fat dairy products
- Non-tropical vegetable oils
Supplements and Lupus
Some people with lupus need supplements to get enough of certain nutrients, like vitamin D. But supplements can interact with your lupus medicines, so it’s important to always talk with your doctor before you start taking any supplements.
Read also: Diet for Lupus Nephritis
- Vitamin D: Many individuals with lupus have low vitamin D levels. Supplementation may help control the underlying lupus.
- Omega-3 Fatty Acids: Found in fish oil supplements, may lead to a decrease in SLE disease activity, combat fatigue, and depressive symptoms.
- Folic Acid: If taking methotrexate, supplementation may be necessary to counter folic acid loss.
- Polyphenols: Found in many teas, spices, and herbs. Scientific studies have found that polyphenols are able to fight inflammation in many chronic diseases.
Lifestyle Factors
A large, long-term study found that a combination of five major lifestyle factors-having healthy eating patterns, maintaining a healthy body weight, exercising, consuming alcohol in moderation, and not smoking-were associated with a lower risk of developing lupus. While this study did not evaluate the impact of lifestyle factors on people who already had SLE, it stands to reason that these healthy principles may help lessen symptoms in SLE patients.
- Exercise: Regular physical activity can help maintain a healthy weight, reduce inflammation, and improve overall well-being.
- Weight Management: Maintaining a healthy weight or making changes to facilitate gradual weight loss (if needed) is a critical-and often neglected-part of managing lupus.
- Stress Management: Stress can trigger lupus flares. Practice relaxation techniques like yoga, meditation, or deep breathing exercises.
- Sleep: Make sleep a priority, aiming for seven to nine hours per night.
- Smoking Cessation: Smoking has been linked to an increased risk of developing lupus and can worsen symptoms.
Additional Tips
- Chew food slowly and thoroughly, swallowing one bite before putting the next in your mouth. This helps your brain have time to signal to the stomach that you are full.
- Practice the 4 hour rule. Do not wait longer than 4 hours between eating. This will prevent you from getting too hungry and overeating at your next meal.
- Use crunchy raw fruits and vegetables, such as a salad, before a meal to help start to fill you up on healthy foods before you even eat your meal.
- Pay attention to behavioral eating, such as eating due to boredom or because of changing moods. Overeating often results from reasons other than truly being hungry.
- Put a time limit on your snack. Give yourself 10 or 15 minutes to have your snack and then plan another activity.
- Read labels and take only one serving out of a box. Never eat out of big boxes or bags. Always put the food on a plate or in a single serving bag.
- Make a habit of having only one helping at meals. Use a smaller plate, but always try to have 4 to 5 food groups at your meals. This helps give you a variety of nutrients. Remember to follow serving sizes for each one.
- Your plate should be divided up as follows: ¼ of the plate starch, ¼ of the plate meat and ½ of the rest of the plate fruits and vegetables.
- When eating out, split meals or ask for a container to box up half of your large serving to save for the next day. This way you won't be tempted to eat it all in one sitting.
- Always eat breakfast. This gives you a good start for eating healthy and feeling good the rest of the day.
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