Feb. 28, 2010

ABCs of Nutrition

by Jenny Thorn Palter

 “What is the best lupus diet?” “Is alfalfa good or bad?” “Can omega-3s help my lupus symptoms?” “What does sunlight have to do with vitamin D?”

The scarcity of lupus-specific diet and nutrition information remains a great frustration. But research has given us insight into foods and lifestyle choices that can help diminish the harmful effects of lupus. In particular, there are foods that can affect the body’s inflammatory response—and inflammation, as we know, is the hallmark of autoimmune diseases like lupus. Our goal in this article is to offer science-based guidelines that will help you live better with lupus. A list of the sources for this article is in the “Resources” section at the end.

ALL ABOUT ALFALFA

Q. Is it true that alfalfa sprouts can cause lupus?

A. Not exactly. Alfalfa is a legume, part of the plant family that includes green beans, peanuts, soybeans, and snow peas. Alfalfa tablets have been associated with reports of a lupus-like syndrome or lupus flares, with symptoms that include antinuclear antibodies in the blood, muscle pains, fatigue, abnormal immune system function, and kidney abnormalities. These reactions are believed to be caused by the amino acid L-canavanine, which is in alfalfa seeds and sprouts (but not in the leaves).

Our recommendation:

Avoid alfalfa supplements if you have lupus or a family history of lupus.

ARE ANTIOXIDANTS OK?

Q. Can I help my lupus by adding antioxidants to my diet?

A. Maybe. Antioxidants, such as selenium and vitamin C, may protect against cell damage that can be caused by free radicals. Free radicals are molecules produced when your body breaks down food or by environmental exposures like tobacco smoke and radiation. Free radicals may be involved in heart disease, cancer, and other diseases. Although antioxidants have been shown to be effective in helping to prevent retinal diseases such as macular degeneration, their role in lupus disease progression and activity has not been well studied.

Our recommendation:

While antioxidant supplements are available, it may be the combination of nutrients in the foods high in antioxidants that have the greatest effect, so it is best to obtain antioxidants from a diet high in fruits, vegetables, and whole grains rather than through supplements. Examples include prunes, raisins, blueberries, blackberries, beets, and red bell peppers. Kale and spinach, while high in antioxidants, also are rich in vitamin K, known for its anticoagulant factors, so talk to your physician if you normally eat large quantities of either of these vegetables. (See also The Value of Vitamins.)

AND THEN THERE’S ASPARTAME…

Q. Is it true that aspartame can cause or trigger lupus?

A. Doubtful. We do not believe that aspartame leads to the development of lupus. Aspartame (NutraSweet®, Equal®), saccharin (Sweet’N Low®), acesulfame potassium (Sunett®), and sucralose (Splenda®) are all approved by the U.S. Food and Drug Administration (FDA) for use in a variety of foods and beverages. According to the National Cancer Institute, there is no scientific evidence that any of these products cause cancer (see “Resources” list), and many other studies confirm that artificial sweeteners are safe for the general population. (There is one known exception: Aspartame is not safe for people who have the rare hereditary disease phenylketonuria [PKU], and a PKU warning must be present on all products that contain aspartame.)

However, there is some evidence that long-term consumption of artificially sweetened beverages leads to increased overweight and obesity risk.

Our recommendation: 

It is OK for people with lupus to consume aspartame and other artificial sweeteners, but in terms of a well-balanced diet, all non-nutritive sugary foods and drinks should be consumed in moderation.

VITAL VITAMIN D

Q. I’ve read that the body needs sunlight to make vitamin D, but I’m supposed to avoid the sun so my lupus won’t flare. What should I do?

A. Let’s start with the connection between vitamin D, ultraviolet (UV) light, and your bones. Adequate amounts of calcium and vitamin D are required to maintain healthy bones. Calcium is an essential mineral that we get through our diet or in supplements, and vitamin D is needed to enhance the absorption of calcium from the small intestine. In turn, vitamin D can only be obtained from a combination of three factors: from exposure to UV light (specifically UVB from the sun), from foods that naturally have vitamin D or were fortified with vitamin D, and as a vitamin supplement.

Researchers are now finding vitamin D to be an important factor for immune system health in addition to bone health. Not only does vitamin D appear to modulate the immune system’s activity, but it may play a role in the development and severity of some autoimmune diseases, including lupus. Low levels of vitamin D have also been associated with increased risk of cardiovascular disease, a lowered ability to fight infection, and the development of osteoporosis later in life.

Multiple studies have shown alarmingly high numbers of people in the U.S. and other countries with low levels of vitamin D. People with lupus tend to have low levels of vitamin D due to a combination of lupus disease activity, corticosteroid use, and avoiding sunlight, because protection from UV light helps to prevent lupus flares. Geographic latitude, time of day, cloud cover, smog, darker skin, and sunscreen use all affect the amount of UV exposure—and vitamin D—you are getting. Older age and obesity are also risk factors for vitamin D deficiency.

Our recommendation:

If you have limited sun exposure because of lupus, talk to your physician about having your blood level of vitamin D checked; vitamin D can be supplemented with pills or through diet.

DANCE OF THE DIETS

Q. Is there a lupus diet?

A. No. Despite the numerous claims on the Internet and in various books, there is no specific diet for people with lupus—no list of exactly what you should eat, drink, and avoid to lessen the symptoms of lupus or, even better, to make it go away. Systemic lupus is not a disease of any particular part or organ system of the body. But the same answer applies to cutaneous lupus: When you are living with lupus, the most basic dietary guidelines apply.

Our recommendation:

Eat a nutritious, well-balanced, and varied diet that contains plenty of fresh fruits and vegetables, whole grains, and moderate amounts of freshly cooked meats and poultry. Try to eat baked or broiled fatty fish (see also Something’s Fishy) once or twice a week. Avoid or limit foods containing saturated fat, hydrogenated or partially hydrogenated fats, or trans fats. Drink plenty of water (if there is no fluid restriction) and limit sugary foods and drinks.

EDIBLE ECHINACEA?

Q. If echinacea boosts the immune system, is it helpful for lupus?

A. No. Echinacea is a plant that is said to have immune-stimulant properties. There is evidence that its use can cause flares of lupus nephritis and may cause low white blood cell counts (leukopenia) with long-term use. It’s also possible that echinacea may lead to liver inflammation and may affect the way certain drugs are broken down by the liver. If echinacea does stimulate the immune system, it could interfere with immunosuppressant drugs that you might be taking to manage lupus, such as prednisone, azathioprine, mycophenolate, and cyclosporine.

Our recommendation:

We do not support the use of echinacea if you have lupus.

SOMETHING’S FISHY

Q. Are there special benefits for lupus from eating fish?

A. Probably. In general, fish is a good food choice, as it is low in saturated (“bad”) fat, can be stored frozen, is often available in a variety of species, and can be prepared in many ways.

Of importance to people with lupus is that certain species of fish are high in beneficial omega-3 fatty acids (see also Awesome Omega-3s). Fish high in omega-3s include salmon (wild is safer than farm-raised, due to toxins in commercial fish “chow”), trout, mackerel, sardines, and non-canned tuna.

Mercury levels can be a concern, and women who are pregnant, nursing, or planning to get pregnant, as well as young children, should take special precautions. Salmon and sardines are good choices, as these typically have low levels of mercury. (See Environmental Protection Agency Web site in “Resources” list for more information.)

Our recommendation:

Eat baked or broiled fish several times a week; try to eat varieties high in omega-3s and low in mercury, and limit any farmed fish to once or twice a week at most. (Also, the U.S. Department of Agriculture has no established standards for “organic” fish, so don’t pay more just because you see “organic” on the package.)

TAKE IT TO HEART

Q. Is it true that women with lupus are at especially high risk for heart disease?

A. Yes. If you are a woman with lupus, you’re at a five- to 10-fold higher risk for heart disease than the general population. This is partly because you may have more risk factors, which can include:

  • Hypertension from kidney disease or corticosteroid use
  • Elevated cholesterol levels and type 2 diabetes from corticosteroid use
  • An inactive, sedentary lifestyle due to fatigue, joint problems, and/or muscle pain

But even after taking these risk factors into account, people with lupus are more likely to develop atherosclerosis.

Our recommendation:

Consider yourself at risk for cardiovascular disease if you have lupus. Help reduce your chances of heart attacks and other complications from coronary artery disease in several ways: Control all known risk factors; control lupus disease activity; and talk to your physician about lowering or stopping your corticosteroid use.

NONI JUICE NO-NO

Q. Can noni juice help my lupus?

A. We doubt it. Over the past decade, noni juice has been touted for its anti-cancer and immune-stimulating effects. However, there is no solid evidence that noni juice is beneficial for preventing or treating any specific medical condition. In fact, the potential effects of noni juice as an immune system stimulant could be harmful if you have lupus, because your immune system is already over-active. In addition, the nutritional content of noni juice can vary depending on the brand, and the potassium content can sometimes be quite high. This can be dangerous if you have kidney involvement as part of your lupus, because malfunctioning kidneys may be unable to regulate potassium levels. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack.

Our recommendation:

We do not support the use of noni juice if you have lupus.

AWESOME OMEGA-3S

Q. Are omega-3s good for me if I have lupus?

A. Probably. The reason lupus researchers are so interested in omega-3s is that these fatty acids lower inflammation by producing anti-inflammatory compounds.

Dietary sources of omega-3 fatty acids include fish oil, flaxseed and canola oils, and green, leafy vegetables. Fish oil contains both DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid); some nuts (English walnuts) and vegetable oils (canola, soybean, flaxseed/linseed, olive) contain ALA (alpha-linolenic acid).

Multiple studies have shown that recommended amounts of DHA and EPA in the form of dietary fish or fish oil supplements lower triglycerides; reduce the risk of heart attack, dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease; slow the buildup of atherosclerotic plaques (“hardening of the arteries”); and lower blood pressure slightly. However, high doses may have risks, such as an increased risk of bleeding.

Our recommendation:

Increase your intake of omega-3s by adding some of these foods to your diet: walnuts, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, cauliflower, and fatty fish, such as anchovies, bluefish, carp, catfish, halibut, herring, lake trout, mackerel, pompano, wild salmon, sardines, striped sea bass, fresh tuna (not canned), and whitefish.

WHERE THERE’S SMOKE…

Q. Is it true that smoking cigarettes make lupus worse?

A. Yes! Research has shown that smokers with lupus have more active disease and more discoid lupus involvement, including scarring. Smokers also have lower levels of complement regulatory proteins, which function as part of the immune system to fight off foreign invaders, such as bacteria and viruses. In addition, the chemicals in tobacco products limit the ability of hydroxychloroquine (Plaquenil®) to help with lupus symptoms.

Our recommendation:

Use every available means to try to stop smoking!

SOY JOY?

Q. Can soy isoflavones improve symptoms of lupus?

A. Probably not. The soy plant is a member of the pea family and has been a dietary staple in Asian countries for at least 5,000 years. Soy contains protein, isoflavones, and fiber. Isoflavones are believed to have estrogen-like effects in the body. Soy protein has been investigated for its health benefits in terms of cardiovascular disease risk factors, menopausal symptoms, weight loss, arthritis, brain function, and exercise performance enhancement. However, there is limited evidence to support the use of isoflavones to treat any health conditions.

Our recommendation:

Soy is not likely to help with lupus, but if you want to add a new protein source to your diet, soy products, such as tofu, offer all the essential amino acids.

THE VALUE OF VITAMINS

Q. Are there any vitamins that can worsen lupus?

A. Yes, it is likely that certain vitamins taken in excess can be harmful. Vitamin E has been implicated in heart disease and should be avoided. And because of possible involvement in lowering HDL (“good”) cholesterol levels, beta-carotene supplements—and vitamin A, which can be converted to an active form from beta-carotene—should be taken with care, especially by smokers.

Our recommendation:

Follow your physician’s guidelines and only supplement what you cannot obtain through the foods you eat.

Resources

U.S. Environmental Protection Agency: epa.gov/waterscience/fish/advice; 202-566-0400; .(JavaScript must be enabled to view this email address)

MedlinePlus®: nlm.nih.gov/medlineplus

National Cancer Institute: cancer.gov/cancertopics/factsheet/risk/aspartame; 800-422-6237; .(JavaScript must be enabled to view this email address)

National Institutes of Health National Center for Complementary
and Alternative Medicine: nccam.nih.gov; .(JavaScript must be enabled to view this email address);
888-644-6226

National Library of Medicine Dietary Supplements Labels Database: dietarysupplements.nlm.nih.gov/dietary; 202-334-2352;
.(JavaScript must be enabled to view this email address)

U.S. Food and Drug Administration: fda.gov; 888-463-6332


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