"Healthy Eating & Weight Management & Lupus" Chat Transcript for Dr. Laura Coleman

November 13, 2008

Moderator
Thank you for joining us today for the Lupus Live Webchat. Our topic today is Healthy Eating & Weight Management & Lupus.

Dr. Laura Coleman is a registered dietitian who received her Ph.D. in Nutritional Sciences from Tufts University School of Nutrition. Her early work focused on metabolic changes in people with rheumatoid arthritis, and she later began work on metabolic changes in people with lupus. She is a member of the Lupus Now Advisory Board for the Lupus Foundation of America (LFA), as well as a member of the Materials Review Panel of the LFA Education Committee. She has published numerous articles on diet and rheumatic disease and is the editor of a new textbook entitled Nutrition and Rheumatic Disease, published by Humana Press.

Dr. Coleman's areas of interest include nutrition and childhood obesity.

Without further delay, let's begin.

Moderator
I heard that certain foods could cause Lupus to flare up, is that true? I have had SLE for 16 years now and foods don't bother me. -- Catlettsburg, KY

Dr. Coleman
Unless a particular food seems to trigger a lupus flare, there is no reason to avoid any 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. The only caveat is that if a person has lupus-related kidney problems, for example, certain foods may need to be avoided, but that is still not because of them causing flares.

Moderator
I am an 18 year old that was diagnosed with SLE 3 years ago. I have also just started attending college. What would be some easy suggestions for staying in shape and avoiding the "freshman 15" while not getting overwhelmed? Also, what are some nutritious snacks that would be easy to keep in my dorm room? -- Carlisle, PA

Dr. Coleman
Those are great questions. As for suggestions for staying in shape, (and without knowing any of the specifics about your lupus), you should be able to take advantage of a variety of resources that your college athletic center has. If there is a pool that you can use, swimming is a great way for people with rheumatologic disorders to stay in shape because there’s no stress on joints in the water. Walking on a treadmill or an elliptical trainer are also possible. Your best guide to what types of exercise you can tolerate is your own body -- if a particular form of exercise bothers you, then don’t do it. We conducted a study a number of years ago in people with RA and found that not only did they tolerate a strength training regimen, but they benefited from it even more than healthy people. Most importantly though, check with your doctor before beginning any new exercise regimen.

Now, as for snacks to keep in your dorm room, a small refrigerator would be a great investment if you have the space for that. You could keep fruits/fruit juices and vegetables, low-fat cheese and yogurts, and low-fat or skim milk handy. Dried fruits are also an option -- if you mix them with some nuts, you’ll get a good source of protein as well as carbohydrates. Whole grain cereals are also easy to keep on hand.

Jen
I have gained 44 pounds since starting prednisone three years ago -- what's the best way to lose that weight? Working out can be difficult some days because of joint inflammation and fatigue. How safe is Alli - the new diet drug?

Dr. Coleman
Weight gain is problematic for many people taking steroids for lupus and unfortunately, no specific diet exists for the treatment of lupus or to prevent weight gain on prednisone. Check with your physician before starting any new diet or exercise program. 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. If feasible, exercise is also an important part of health and weight maintenance but as you point out, it is sometimes difficult due to joint pain. See my response, above, for suggestions.

Some general suggestions that might help you:

Eat a varied diet with plenty of fruits and vegetables, whole grains, and low-fat meat and dairy products;
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;
Develop a schedule for eating and stick to it. Since steroids can increase your appetite, having a schedule can help prevent overeating;
Shop from a list whenever you go to the grocery store. This can prevent buying foods that may contribute to weight gain.

As for your question about Alli, the diet drug, this drug works by blocking the digestion/absorption of some of the dietary fat that you consume. While it is approved by the Food and Drug Administration, it is advisable for you to consult with your physician before beginning a weight loss regimen of any type, and certainly one involving medication.

Moderator
Hi I wanted to know if I am on a vegan diet (no milk) is it ok and will the diet help? I have had a radical hysterectomy done last year and I have Lupus for the past 2 yrs, am on steroids 10mg, Plaquenil 400mg thanks. -- Scarsdale, NY

Dr. Coleman
Unfortunately, it's hard to say for sure whether or not a vegan diet will help with lupus. What we do know is that there is little convincing data from human research studies to support any specific diet modification (including a vegan diet) or nutritional supplementation. As for whether a vegan diet is OK, the answer is maybe. While it’s possible to obtain all essential nutrients following a vegan diet, it is more challenging since so many foods are excluded. My recommendation is that you check with your physician about your circumstances, and that you get some guidance from a registered dietitian, at least while beginning a vegan diet.

Moderator
I've heard lupus patients should not eat certain foods such as night shade vegetables or things with animal protein. How does eating these foods worsen lupus and what are comparable veggies and protein sources we can eat? -- Bronxville, NY

Dr. Coleman
Night shade vegetables include potatoes, tomatoes, eggplant and peppers. As for whether or not these foods can worsen lupus, there is no scientific evidence to suggest people should avoid eating them. In some cases -- if a person has kidney damage and needs to limit potassium intake -- it might be suggested. It is very much an individual decision as to whether you want to avoid consuming these vegetables. As for animal protein, the extent to which it may "worsen" lupus depends on your specific situation. For someone with kidney damage, eating too much protein could be problematic. Talk with your doctor about whether you need to limit your intake of protein. If not, then there is no reason for you to avoid either animal proteins or the night shade vegetables.

lope
Is there anything I can do to get rid of water retention caused by prednisone, like the usual herbal teas lots of people drink when on a weight loss diet? I have lupus nephritis but it's well under control, kidney parameters are in range.

Dr. Coleman
In general, if water retention is a problem, limiting sodium intake can help. I don't know whether this is something that you might already be doing due to your lupus nephritis, but perhaps you could discuss it with your physician. As for the herbal teas, I would caution you about the consumption of certain products. There are health claims associated with a number of herbal teas but these are generally unsupported by the scientific literature. One example is rooibos tea; this South African herbal tea has been used in that country to treat a variety of ailments including allergies and asthma. Rooibos contains polyphenol, an antioxidant compound, which provides the purported health benefits. However, no studies have been conducted in humans to examine whether the effects seen in a laboratory setting also occur in real life.

monty
What is your opinion on taking an Omega 3 if you are currently taking a blood thinner?

Dr. Coleman
Omega 3 fatty acids are a type of essential fatty acid, meaning that they're essential for human health and can't be made by the body. They are found in fatty types of fish (bluefish for example) as well as some plant foods (walnuts, flax). The omega 3 fatty acids have anti-inflammatory, anti-thrombotic properties, meaning that they help to prevent inflammation and clotting in the body. For this reason, it is possible that omega 3 fatty acid consumption - depending on the source/quantity - could interfere with our use of a blood thinner. Since I do not know the details of the medications that you are taking, I would urge you to discuss this issue with your physician.

TM
I know in general exercise is good for you. Have there been any studies that suggest that healthy weight/weight loss reduces lupus flares?

Dr. Coleman
Unfortunately, there isn’t any scientific evidence that body weight is involved in symptom development or in the severity of lupus symptoms or flares. That being said, it's a good idea for overall good health to maintain a desirable body weight. In theory, an ideal body weight means less stress on joints, which may help reduce pain.

Moderator
Is Acai Berry good for lupus? -- Dartmouth, MA

Dr. Coleman
Acai berry is claimed to have health benefits due to potent antioxidant properties (high in polyphenols). However, recent research compared the polyphenol content of a variety of fruit juices, and found that acai berry juice was not as high in polyphenol content as concord grape juice or red wine. Furthermore, there have been no studies of acai berry consumption in people with lupus. There is no evidence to suggest that it is good for lupus, but if you like acai berry juice, moderate consumption, along with a diet high in other fruits and vegetables should be fine.

Moderator
I've read that eating alfalfa sprouts can trigger lupus flare. I started eating Ezekiel/Essene bread awhile back (made from sprouted grains such as barley, wheat, spelt, etc.) No alfalfa, but could other sprouts be causing problems, especially if eaten every day as in the bread? -- Springfield, OH

Dr. Coleman
You are correct that ingestion of large amounts of alfalfa (8 to 15 tablets per day) may contribute to worsening symptoms of lupus. There is no evidence that other sprouted grains such as those that you mention are problematic. If you have been eating the bread and have not noticed any problems with your lupus, then I wouldn’t worry about it. If, however, your lupus has been worse and you think that it might be related to the consumption of the bread, then I would recommend talking with your physician and showing him the ingredient list.

Moderator
With prednisone, patients have to be so careful watching salts, sugars and fats. There are a lot of great recipes that help maintain a healthy balance, but there are very few options for kidney patients who are also restricted in protein and potassium. How can we as caretakers plan meals that are so restrictive? My child is a 16 year old male, what is the recommended protein/carb/potassium/salt intake for him as a lupus nephritis patient? -- Savannah, GA

Dr. Coleman
It is very challenging to prepare foods when someone has multiple dietary restrictions, and is a growing boy besides! Without knowing the details of your son’s situation, I really can’t provide specific advice on the amount of protein etc. that he should be consuming. I would urge you to meet with a registered dietitian (your son’s doctor should be able to provide you with a referral, or you can check the website for the American Dietetic Association - www.eatright.org - for dietetics professionals in your area). An RD can help you plan meals based on your son’s individual nutrient needs and food preferences.

Moderator
Do anti-inflammatory diets work for lupus patients, in terms of relieving pain or inflammation in joints, etc.? How about Rooibos tea? I've read many places that this tea also reduces inflammation. -- Albuquerque, NM

Dr. Coleman
Unfortunately, there is no anti-inflammatory diet, per se. The omega-3 fatty acids (fish oils) do have anti-inflammatory properties, and the omega-6 fatty acids have pro-inflammatory properties. Different types of dietary fats have been studied in terms of their role in inflammation, but there have been only limited human studies and results have been mixed. The most prudent advice is to consume a healthy, balanced diet rich in fruits, vegetables, and low-fat proteins such as chicken and fish (bluefish, salmon or mackerel are higher in omega 3 fatty acids). As for the tea, see my response, above. Bottom line – if you like the tea, it’s fine to drink it in moderation, but claims about its ability to reduce inflammation are generally unfounded.

Moderator
I have read that L. acidophilus is not good for patients with lupus. Can you confirm this? -- New York City, NY

Dr. Coleman
Lactobacillus acidophilus is a “probiotic” product, meaning that it is a live micro-organism that when consumed in adequate amounts, can confer health benefits. Different types of probiotics have different effects, but in general, regulation of immune function has been listed as a potential effect. Anyone with a condition affecting the immune system, such as lupus, should check with their physician before taking a product that could modulate immunity.

Moderator
Dr. Coleman, I am a 35 year old woman with SLE Lupus, and would like to know what vitamins and nutritional supplements I should be taking to reduce flair ups and inflammation. The doctors I have been seeing refuse to talk about this issue with me, and only want to give me medications such as prednisone. I know supplements such as the B vitamins, and Noni juice help, but what are others? -- Blaine, MN

Dr. Coleman
I understand your interest in using supplements to help control your lupus, but unfortunately, at this time, there is little convincing evidence from human studies to support the use of any specific modified diet or nutrient supplementation. Using the Noni juice that you mention as an example, reported manufacturer health claims include improvement in joint pain, but very little scientific data is available to support this claim. In fact, several cases of liver damage have been reported in people taking Noni juice supplements. No studies have been done in patients with lupus. I would urge caution in the use of this product.

Moderator
My question is related to natural and organic foods. Is it better to eat organic foods or natural foods, and what is the difference? -- Upper Marlboro, MD

Dr. Coleman
That's a great question. As for the difference between organic and natural foods, the USDA has established an organic certification program to regulate how organic foods are grown, handled and processed. The word "organic" refers to the way farmers grow and process agricultural products, such as fruits, vegetables, grains, dairy products and meat. Organic farming practices are designed to encourage soil and water conservation and reduce pollution. If a food has a USDA organic label, that means that it’s produced according to USDA organic standards, and that at least 95% of the food’s ingredients are organically produced. Natural food, on the other hand, generally refers to food items that are not altered chemically or synthesized in any form. These are derived from plants and animals. Thus a natural food item is not necessarily organic and vice versa. As for whether or not it’s better to eat either natural or organic foods, that’s very much an individual choice, based on weighing a variety of factors (health, cost, environmental concerns, etc.).

Moderator
Dr. Coleman, I have B12 insufficiency and need protein. Recently, a low glomerular filtration rate showed I had moderate loss of kidney function, which means I am now losing protein in urine. In light of my B12 insufficiency and protein loss, how much protein should my daily diet include if ingesting additional protein puts additional stress on my kidneys? With regard to kidney function, is one protein food better than another protein source? Are there diet restrictions that could benefit my kidneys? -- Camden, AL

Dr. Coleman
Those are excellent questions. First and foremost, I urge you to consult with your doctor and a dietitian in order to determine exactly how much protein you require and help you plan meals accordingly. Research has found that high protein intakes are associated with accelerated kidney damage, and that lower protein intake helps with a slower decline in kidney function. As for one protein food being better than another protein source, the answer is that it depends on your overall condition -- are there other dietary restrictions that you need to follow, for example? In general, consuming foods that are 'complete proteins' (meaning that they provide all of the essential amino acids) will give you the most benefit.

Moderator
I read a newspaper column by Pharmacist who stated that vitamins can worsen autoimmune disease. The Pharmacist recommended a formula called Padma Basic. What is your opinion of vitamins and autoimmune diseases? -- Margate, FL

Dr. Coleman
According to the manufacturer’s information, Padma Basic is derived from an all natural traditional Tibetan herbal formula that has been used for centuries, and that is claimed to “support the immune system.” It is very important to understand that when a product is sold as a dietary supplement, the claims made by the company are NOT approved by the Food and Drug Administration. You can look up the composition of Padma Basic on the company’s website -- I would urge you to do this, and then bring the ingredient list to your physician before consuming.

Moderator
Our final question for today … I have been told to not eat foods high in iron and potassium, and to take vitamins without iron because iron may bring on a flare. Is that true? What other foods should patients with SLE avoid? -- Moscow, ID

Dr. Coleman
Studies conducted in animals have found that excessively high iron intakes may contribute to kidney damage. There is no solid evidence from human studies though. Iron is an important nutrient for the production of red blood cells and people with lupus may have a problem with anemia, so I would not suggest restricting your iron intake unless there is a specific reason to do so. Please consult with your physician who has knowledge of the specifics of your situation.

I'd like to thank everyone for submitting such great questions! I'm sorry that we couldn't get to every one of them, but hopefully we hit on the major concerns that people have. Best of luck to everyone!

Moderator
Thank you to Dr. Laura Coleman for joining us today.

Please join us Wednesday, December 10 at 3 p.m. ET for our guest Dr. Al Herzog. Dr. Herzog will discuss Depression & Lupus.

Thanks for your participation. Have a nice day.

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