15 Questions - Healthy Eating

(June 2011) Diet and nutrition guidelines for people with lupus are not different than for anyone else. In general, people with lupus 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. Our expert for "Healthy Eating" is Dr. Laura Coleman. 

1. Are there certain foods that aggravate lupus symptoms and should be avoided if possible?  Harbor City, CA

One food that should be avoided is alfalfa.  Alfalfa supplements have been associated with lupus flares, perhaps because of the amino acid L-canavanine which can increase inflammation.  Other foods that are sometimes mentioned as ones to avoid include ‘night shade’ vegetables (potatoes, tomatoes, eggplants and peppers), but there is only anecdotal evidence that they may increase inflammation.  Scientific evidence has not suggested that these vegetables aggravate disease symptoms.  In general, unless a particular food seems to trigger a lupus flare, there is no reason to avoid most foods.  Foods that seem to trigger a flare vary greatly from person to person, so a food that causes problems for one person may have no effect on you.  There is no ‘lupus diet’ of foods that either should or should not be consumed, unless someone has kidney damage and has been advised to limit their protein intake.

2. Are there foods that are better to eat when I'm nauseous?  I don't eat gluten, because it makes my SLE symptoms worse, but I'll try just about anything else.  I need to take my pills with food and I know the nausea is worse if I don't have anything in my stomach.  Binghamton, NY

As long as your doctor hasn’t advised you to limit your protein intake, you could focus on high-protein foods to help with medication-related nausea.  Cheese, peanut butter, eggs, or yogurt (plain) are all gluten-free.  Any fresh produce is also a good choice, and sometimes tart foods (citrus, for example) can help with nausea.  Another option is to try some of the gluten free products now available, such as gluten free crackers or breads.  Foods without strong odors are often better tolerated, so try dry gluten-free bread rather than toast.   

3. I am told natural sugars in the diet aggravate an already volatile inflammatory process taking place in the body of lupus patients. If this is true, will you help us understand why this happens?  Charlotte, NC

There have been anecdotal reports that “natural” sugar - high fructose corn syrup (HFCS) - triggers an inflammatory response in the body, and because of this, may exacerbate lupus symptoms.  HFCS is chemically similar to table sugar (sucrose) and there is no solid scientific evidence that sugar aggravates inflammation.  The main problem with HFCS is that it is added to many foods that are part of the typical American diet (salad dressing, tomato sauce, cookies, soda, etc.), and for this reason, contributes to obesity.  Obesity may be related to inflammation.  It would be prudent for anyone, not just patients with lupus, to reduce the amount of sugar in their diet, whether or not it is “natural”.   

4. What is your experience with benefits of intolerance testing? Does gluten, dairy avoidance help prevent flares? Are most autoimmune illnesses related to food intolerance?  Dubai, United Arab Emirates

There is no clear scientific evidence that food intolerances are related to lupus or other autoimmune disorders.  Intolerances are episodic, recurrent, variable, non-immune reactions to foods.  Diagnosis of food intolerances is difficult, and typically involves total elimination of a suspect food from the diet while monitoring symptoms.  Avoiding gluten or dairy products will not necessarily prevent flares; food “triggers” vary greatly from person to person.  If you suspect that you may have a food intolerance, talk with your physician about further evaluation.     

5. I have SLE lupus and been trying to lose weight for years i lose the weight then i get put back on steroids and up my weight goes sometimes by 40 pounds.  Then I get depressed because I’ve worked so hard to get the weight off and poof its back on within weeks. Do you have any suggestions for us with this hopeless problem?   Clearwater, FL

Weight gain is problematic for many people taking steroids for lupus.  In general, a healthy, balanced diet, with fruits and vegetables as the mainstay, is recommended.  Low-fat proteins, such as fish or chicken, are also good choices.  Some general suggestions that might help you: 1) eat a varied diet with plenty of fruits and vegetables, whole grains, and low-fat meat and dairy products; 2) Try keeping a food diary, writing down everything that you eat.  Studies have shown that this can be very helpful for people trying to lose weight by making them more aware of their eating; 3) Develop a schedule for eating and stick to it.  Since steroids can increase your appetite, having a schedule can help prevent overeating; 4) Shop from a list whenever you go to the grocery store.  This can prevent buying foods that may contribute to weight gain.  If feasible, exercise is also an important part of health and weight maintenance.  Check with your physician before starting any new diet or exercise program. 

6. How effective are these Anti-Inflammatory Diets? Hummelstown, PA

There are many different “anti-inflammatory” diets, and though each may have some unique features, they all emphasize increased consumption of omega-3 fatty acids (versus the more commonly consumed omega-6 fatty acids).  Omega-3 fatty acids are found in fatty fish or fish oil supplements.  In addition, plenty of fruits and vegetables, whole grains, and lean protein sources (fish and chicken), and less saturated fat, red meat, refined carbohydrates, and processed foods are recommended.  There is no solid scientific proof that an “anti-inflammatory” diet per se is effective, but including foods such as those mentioned above often leads to a healthier intake overall.  Furthermore, this type of diet is likely to reduce calorie intake and help prevent obesity, which can itself reduce inflammation.  Be sure to check with your health care provider before starting any new diet plan.

7. After almost each blood test that I have done in the hospital, the doctors’ find that my calcium levels are dangerously low. I take multivitamins and calcium and vitamin D supplements daily, so I am concerned that I may be doing something wrong. I also drink milk and eat yogurt. Can you give me any advice on what I can do to improve my calcium levels?  Charlotte, NC

Serum calcium is tightly regulated by hormones that maintain levels within a normal range.  If blood levels get too low, then hormones act to pull calcium out of bones to restore calcium balance.  If blood levels get too high, then other hormones act to increase the amount of calcium put into storage or excreted by the kidneys.  In addition to the calcium and vitamin D in a person’s diet, the amount that your intestines absorb, your hormone levels, and the levels of other compounds in your blood that may affect calcium balance (protein or phosphate levels, for example) also play a role in calcium balance.  It sounds as if you are getting an adequate amount of calcium and vitamin D in your diet, but without knowing more about your specific medical situation (if your kidneys are involved in your lupus, for example, that could be playing a role since the kidneys are involved in determining the amount of calcium excreted), it’s impossible to know why your levels are low.  Please talk with your health care provider and ask what might be causing your low calcium level.     

8. What types of vitamins and supplements do you recommend for people with lupus?  Norfolk, VA

There are no clear recommendations for vitamin or mineral supplements for people with lupus.  That being said, a multi-vitamin and mineral supplement that contains 100% of the recommended dietary allowances may be most advisable.  Depending on the specifics of your situation, you may benefit from additional calcium or vitamin D to maintain bone mass, or from iron if anemia is a problem.  I recommend that you talk with your health care provider before beginning to take any dietary supplements.  Some supplements can interact with prescription medications, so always let your provider know before making any changes.

9. Shortly after being told I had lupus, I started having digestive troubles, like bloating and nausea. When I stopped eating foods with gluten the problems disappeared entirely. Is this related to the lupus?  Denville, NJ

Some patients with lupus may have gluten sensitivity in addition to, or even instead of, lupus.  If you haven’t already been tested for celiac disease (gluten sensitive enteropathy), then you may want to ask your physician.  Regardless, if you find that avoiding gluten helps alleviate your symptoms, then it makes sense to continue doing so.  Most large grocery store chains now carry a wide variety of gluten-free breads, crackers, pastas, cereals, etc.  

10. I'm vegetarian and I know protein is an important part of our diet. What other forms of protein are there besides tofu that I can integrate into my diet?  Laingsburg, MI

Depending on what type of vegetarian diet a person follows, there are a variety of ways to incorporate adequate amounts of protein into the diet.  The most stringent vegetarian diet is a vegan diet, in which no animal products whatsoever are consumed.  A vegan diet presents the greatest challenge, but if someone is a lacto-ovo (consumes milk and eggs) or even just a lacto-vegetarian, then the choices become much greater. If you are a lacto-ovo vegetarian, then I would encourage you to include low-fat dairy products and eggs as a regular part of your diet.  If you follow a vegan diet, then you will have to rely primarily on grains and legumes as protein sources.  Beans (soybeans or lentils, for example), nuts, brown rice, seitan, veggie burgers, and soy milk are all good choices.  Be sure to include a variety of foods in your daily diet so that you are getting all of the essential amino acids (which may be lacking in some non-animal proteins).   

11. I have just been diagnosed with nephritis--presumably caused by lupus--stage 2 or 3.  Does following a kidney preserving diet work as well for people who have lupus nephritis as it might for people who have kidney disease not caused by a progressive inflammatory disease?  Huntington Beach, CA

Yes.  For people with lupus nephritis, dietary restrictions may be needed, depending on the levels of kidney function and the amount of protein in the urine.  Salt (or sodium) intake should be reduced to help control the amount of urinary protein, and protein restriction can help slow the progression of lupus nephritis. 

12. I have heard conflicting information regarding the safety of caffeine, specifically coffee and its effects on the body of people with Lupus, specifically those with Antiphospholipid Antibody Syndrome. Can you shed some light on this?  Nashville, TN

People with Antiphospholipid Antibody Syndrome (APS) may have to take medications that increase the risk of bleeding.  Depending on the specific type of medication, dietary restrictions may be needed, but in general, there is not any solid evidence that caffeine (coffee) is unsafe for people with lupus or APS.  Talk with your health care provider about whether any foods or beverages should be avoided if you are taking medication.  Also, while coffee may not be harmful, it can have a diuretic effect and can be hard on your stomach, particularly if you are taking medications that may also be irritating.  For all of these reasons, it is wise to consume coffee or other caffeine-containing beverages in moderation. 

13. Do some people with Lupus have adverse reactions to artificial sweeteners (Splenda)?  Is there any research being done on this topic?  Oceanside, NY

There is limited research on the role of artificial sweeteners in contributing to lupus, and the research that has been done has had conflicting results. Whether or not you choose to use artificial sweeteners is a personal choice, and depends on what other health conditions, if any, you may have that warrant your avoiding regular sugar.  Talk with your health care provider if you are concerned about the need to use artificial sweeteners. 

14. Doctors in other countries recommend that people with Lupus should not eat spinach or other greens. What do you recommend?  Frederick, MD

In general, there is no need to avoid spinach or other green vegetables.  Spinach is high in iron and other beneficial nutrients. One issue to be aware of is that spinach does contain high amounts of oxalate which can reduce calcium absorption, so it may be helpful to not consume spinach and calcium-containing foods or supplements together. 

15. I am allergic to fish/iodine so Omega vitamins and related are no good for me, is there any alternative to this?  Also, is it OK to add soy to my diet? I love soy milk but read that is not recommended to lupus patients (is that so?).  My hemoglobin is always low, what foods should I eat most?  Carolina, Puerto Rico

In order to increase the amount of omega 3 fatty acids in your diet, there are alternatives to fish.  Walnuts/walnut oil or flax seeds/flax seed oil are some of the best sources.  In fact, these foods are as good as fish!

Soy products are high in isoflavones, a type of phytoestrogen, and have estrogenic activity in the human body. There is relatively little research on the effects of a soy diet on lupus.  One animal study from Japan that was conducted within the past several years found that mice put on a diet high in soy had a worsening of the clinical course of lupus, but another more recent study (also in mice) found that not only did soy isoflavones not lead to worsening of lupus, the disease may actually have been improved. What this means is that the "jury is still out" on the effects of a diet high in soy.  Keep in mind that the studies mentioned here were conducted in animals; not humans.  So while there is the potential for large quantities of soy to contribute to a worsening of your disease, smaller amounts are probably OK.  Talk with your health care provider about your specific situation though.

Lastly, it is common for people with autoimmune diseases such as lupus to be anemic (low hemoglobin).  In general, foods high in iron should be included as a regular part of your diet.  Specific recommendations may vary depending on your particular disease, but the best sources of iron are red meat (other meats are good too), legumes, iron-enriched breads and cereals, and green leafy vegetables.  Iron absorption is increased if you consume it along with a vitamin C source – try an enriched cereal with orange juice in the morning!