Chat Transcript for Dr. Laura Coleman, April 11, 2007
Moderator
Good afternoon. The Lupus Foundation of America is pleased to welcome Laura Coleman, Ph.D., R.D.
Dr. Coleman is a registered dietitian who received her Ph.D. in Nutritional Sciences from the Friedman School of Nutrition Science and Policy, Tufts University. Her early work focused on metabolic changes in patients with rheumatoid arthritis, and she later began work on lupus. She is a member of the advisory board for the Lupus Foundation of America (Lupus Now publication) and a member of their patient education materials committee. She has published multiple articles on diet and rheumatic disease and is currently editing a textbook entitled Nutrition and Rheumatic Disease, to be published later this year by Humana Press.
We welcome Dr. Laura Coleman, and thank her for joining us this afternoon.
Moderator
Without further delay, let's begin. The first question comes to us from Michigan. Are artificial sweeteners (like aspartame) and sprouts (alfalfa and bean sprouts) unsafe for lupus patients? Will they cause flares?
Dr. Coleman
Artificial sweeteners and sprouts are 2 entirely different topics. There is no research on the role of artificial sweeteners in contributing to lupus flares; as for their safety, it is an individual choice as to whether a person wants to use one of these products. Safety concerns would be no different for a patient with lupus than they would be for any other individual. As for sprouts, there is some evidence that a substance in sprouts (L-canavanine) may contribute to lupus flares. It is generally recommended that patients should avoid consuming large quantities of sprouts as a precaution, and certainly if there appears to be a relationship between sprout ingestion and flares, then they should be avoided. In general, occasional consumption should not cause problems for most people. Consumption of alfalfa tablets should be avoided.
Moderator
We have another question from Michigan. I heard from a fellow patient at U of M with lupus nephritis that her doctor recommended a diet primarily of egg albumin powder. He told her this was the best diet for kidney transplant patients. Is this true?
Dr. Coleman
The optimal diet for kidney transplant patients must be individually based, depending on a person's kidney function. In general, after a kidney transplant, protein may be limited immediately post-transplant, with increasing amounts of protein added as tolerated. Eventually, many transplant patients need no special diet, but this depends entirely on each individual set of circumstances. Egg albumin powder is high in essential amino acids, meaning those that cannot be made by our bodies.
Dawnish
I am interested to know if whey or soy protein is okay to use if you have lupus nephritis or just lupus in general?
Dr. Coleman
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, but an animal study recently conducted in Japan has found that in mice, a diet high in soy led to a worsening of the clinical course of lupus. What this means is that while the "jury is still out" on a diet high in soy, there is the potential for large quantities to contribute to a worsening of your disease.
Moderator
We have a question from Florida. Is there a diet that can prevent lupus flares of the kidneys?
Dr. Coleman
While there isn't a diet per se that can prevent lupus flares of the kidneys (lupus nephritis), high protein intakes have been associated with more rapid kidney damage in both animal and human studies, and protein restriction has long been recommended for patients with kidney disease. The specific amount of protein restriction should be determined on an individual basis, depending on your particular condition, and in consultation with your physician.
jwillow2
I've heard that patients with lupus should avoid tomatoes and eggplant. Is this true?
Dr. Coleman
Foods high in histamine, such as tomatoes, have been blamed for exacerbations of some autoimmune diseases. However, a large placebo controlled study of these foods failed to show a consistent effect. In general, I would not recommend limiting your diet unnecessarily; moderate consumption is probably OK. If, on the other hand, you notice that your symptoms become worse (on multiple occasions) after ingesting tomatoes, then by all means, limit your intake. Every person responds differently to a particular food.
Moderator
The next question comes from Washington DC. One of the common problems faced by lupus patients is anemia. What dietary adjustments can be made to reduce the occurrence of anemia? Are there particular foods that can be eaten to prevent anemia from occurring?
Dr. Coleman
Eating a lot of green, leafy vegetables is a good start. Foods such as spinach and broccoli are reasonably good sources of iron. However, these foods contain a type of iron called "non-heme" iron, as opposed to "heme" iron, which is found in meat, fish and poultry (liver is a particularly good source). Heme iron is much better absorbed than non-heme iron, meaning that your body uses it more efficiently. The absorption rate for non-heme iron depends on other components of your diet, which can either increase or decrease the rate of absorption. Dairy products (because of the calcium), foods that are high in fiber, and items such as tea and coffee (which contain tannins) can reduce the amount of non-heme iron that your body absorbs by as much as 50%. On the other hand, vitamin C can help to increase the rate of non-heme iron absorption. This is why it's a good idea to have a breakfast of iron-fortified cereal with orange juice but no coffee! In general, try to include a variety of foods in your diet to increase your total dietary iron, include a source of vitamin C at every meal, include meat, fish or poultry in several daily meals, and avoid excessive amounts of coffee or tea (and if you do drink these beverages, consume them between meals rather than with meals).
Moderator
Indiana wants to know about the following. Is it true that people with lupus should be on a vegetarian or vegan diet?
Dr. Coleman
No! There are no definitive dietary recommendations for patients with lupus. The most prudent approach is to include a well-balanced diet, with a variety of foods including fresh fruits and vegetables, whole grains, and moderate amounts of lean meat, poultry, and an emphasis on fish, especially marine fish high in omega-3 fatty acids. While it is possible to achieve adequate intakes of essential nutrients by following a vegetarian or vegan diet, it is more difficult to do so and requires effort and knowledge. Some nutrients, such as iron, calcium, vitamin B12, for example, are either found exclusively in animal products, or are found in a form that is more bioavailable, meaning that your body can use it more efficiently. If you are interested in following a vegetarian or vegan diet for personal reasons, I would urge you to consult with your physician who may be able to recommend a dietitian who can help you plan a diet that will adequately meet all of your nutrient needs. From a strictly physical standpoint, there is no particular need for a person with lupus to follow a vegetarian diet however. For more guidance on nutrient needs, see www.mypyramid.gov.
Moderator
Michigan has a question. I have had lupus for about 4 years. I'm getting bigger and bigger from the prednisone. My doctor keeps telling me to lose weight. How do I do this?
Dr. Coleman
This is the million dollar question -- how to achieve successful weight loss. It is hard for anyone, but particularly for people with lupus because of some of the medications that you may be taking (prednisone, for example, which can affect both your appetite and your metabolism). Having a support system in place to help you with weight loss is important. Can your doctor refer you to a dietitian who could advise you? You could also go to the American Dietetic Association website (www.eatright.org) and see the section "Find a Dietitian" to locate a nutrition professional in your area.
Moderator
A question from New York. I am currently taking a supplement to build up my immune system and also taking an antimalarial drug called Plaquenil. What I want to know is "Is this combination wrong?" One seems to be building up my immune system while the drug is suppressing my immune system.
Dr. Coleman
I would definitely recommend that you talk with your physician about any over the counter supplements you are consuming. Many of these supplements can interact with prescription medications and can cause harmful side effects. Also, dietary supplements are not regulated for safety or efficacy the way drugs are in the U.S., so it's hard to know what you are actually getting. Not knowing what particular supplement you are taking, I cannot comment on your individual situation but would urge you to talk about this with your doctor. So to answer your question "is this combination wrong," I would say that it could be.
Moderator
Illinois asks ... I have been diagnosed with SLE/lupus nephritis; I also have high cholesterol and high blood pressure. My doctor has not put me on any specific diet. Should I be? Are there any specific foods that trigger a lupus flare, (severe joint pain and fatigue)?
Dr. Coleman
As for whether there are any specific foods that trigger a lupus flare, the answer is unfortunately rather vague. Some foods may trigger a flare for some people but not others, and some people may not have problems with any foods at all. That being said, patients can pay attention to their diet, and if a specific food is suspected of triggering a flare, they should require that a pattern of ingestion followed by worsening occurs at least 3 times before eliminating a food from the diet. Even if it appears that a food is causing some trouble, it could be that another factor, such as the source of the food, use of chemicals or other preservatives, or even the interaction of several foods, is the problem. Importantly, patients should not unnecessarily limit their diets such that they are not able to obtain all essential nutrients. Regarding the issues of high cholesterol and high blood pressure, patients with these conditions are often put on low-fat, low-cholesterol, low-sodium diets, but specific dietary recommendations will depend on each individual's unique circumstances. You should ask your physician if you have any questions about your particular need for a special diet, but you are wise to consider this possibility.
Gigi
In a previous answer, you seemed to put bean sprouts and alfalfa sprouts in the same category. I have always avoided alfalfa sprouts, but have eaten bean sprouts with no ill effects. However, a tea I was drinking which, unbeknownst to me, contained alfalfa, made me very ill for a year and a half. When I made the discovery of the alfalfa content, I stopped drinking it, and my terribly symptoms went away immediately. Isn't there a difference between alfalfa and other sprouts?
Dr. Coleman
I'm glad that you asked for this clarification. I was only referring to alfalfa sprouts in my previous answer.
Moderator
The next question comes from Florida. I was just diagnosed 2 months ago with systemic lupus, stage 4 kidney disease. How do I know which foods trigger my flare ups? I've been reading a lot of books and they all say different things. I'm also on chemotherapy so does that affect my diet as well?
Dr. Coleman
As for the question about which food trigger flares, please see my response to the question from "Illinois" above. Re: chemotherapy. Yes, chemotherapy certainly can affect a person's nutritional status and dietary requirements. There are many different chemotherapeutic agents, and different drugs have different side effects (change in appetite, change in taste, altered vitamin requirements, and others). Please talk with your physician about your particular situation.
Moderator
Ireland is joining us today. I find the symptom of fatigue very hard to cope with, especially as I am studying for finals. What type of food groups are the best for increasing energy levels?
Dr. Coleman
Unfortunately, there is no simple solution to the problem of fatigue, and it is a problem that many patients find difficult to cope with. That being said, maintaining a well-balanced diet, along with an adequate amount of physical activity and rest, can improve energy levels. Your diet should be high in fresh fruits, vegetables and whole grains, with moderate amounts of lean meats, poultry and an emphasis on fish, particularly marine fish high in omega-3 fatty acids. Avoid excessive intake of caffeine-containing foods (coffee, cola, etc.) and foods high in processed sugars, which may give you a short term energy boost, but can be followed by a feeling of lethargy.
lorim
There has been some positive research re: Omega-3s with regard to joint health. Is this true? If so, how do you know which supplements to look for? Not all are created equal.
Dr. Coleman
You are correct that omega-3 fatty acids have anti-inflammatory effects. These oils are found in oily fish such as salmon, mackerel, and herring, for example. Omega-3s work by reducing the production of pro-inflammatory compounds, thereby suppressing immune mediators of lupus. Although the majority of animal studies have shown that omega-3 fatty acids alleviate the severity of autoimmune disease, only modest effects have been observed in humans. Given the mixed results, more clinical trials of fatty acid supplementation for lupus patients are needed. The best advice that I can provide at this time is to include fish rich in omega-3 fatty acids in your diet on a regular basis.
Moderator
Colorado wants to know ... I am lactose intolerant and I have SLE. I am also very deficient in calcium and vitamin D. I drink soy milk for instead of cow's milk. I have heard and read that soy is not very good for people with lupus. Do you know anything about this?
Dr. Coleman
Regarding your question about soy, please see my response to "Dawnish" above. You are wise to be concerned about your calcium and vitamin D status but perhaps there are some alternative ways to increase your intake of these nutrients. For example, lactaid milk (which has most of the lactose already broken down) can be tolerated by some people, as can other dairy products that have lower amounts of lactose, such as yogurt and cheese. You could also try consuming a lactaid tablet -– available over the counter -– prior to ingesting dairy products. Many juices are also now fortified with calcium and vitamin D, in amounts equal to what is found in milk. Lastly, calcium and/or vitamin D supplements are also available in many forms, and are sometimes necessary to achieve an adequate intake of these nutrients.
Moderator
This question comes from Texas. I have Lupus SLE and it has affected my entire digestive system including my colon. I am completely clueless on what I should and shouldn't eat. I love red meat. Is it true that it is not good for people with lupus? Could you give me an idea of what I should be eating? Plus, I have diarrhea on a daily basis (mostly in the mornings). What can I do diet wise to prevent this?
Dr. Coleman
While I can't comment on your specific situation, I can comment that in general, there is no need for patients with lupus to avoid any one food. That being said, depending on whether your kidneys are involved, and what medications you are taking, your nutrient needs may be altered. I would encourage you to talk with your physician and he/she can help advise you on any specific dietary requirements. As for the diarrhea, this could be due to a number of different factors, including some drugs, so again, I would encourage you to discuss this problem with your doctor. In general, a diet that contains adequate amounts of fiber (from whole grains, fresh fruits and vegetables) can help to regulate digestive function.
Karen
I recently read that there is a correlation between lupus and food allergies. Do lupus patients tend to have more food allergies than those not affected by lupus?
Dr. Coleman
Some people with lupus placed on food allergy elimination diets have reported improvement in their symptoms, but this doesn't allow us to identify what the "offending" food actually is. A food allergy is diagnosed by a combination of test results and medical history. Symptoms can include difficulty breathing, hives, abdominal cramping, diarrhea, and others. Not all people will experience all symptoms. An excellent source of information is www.foodallergy.org. There is a pamphlet that you can download called “Do You Have A Food Allergy?” I would urge you to print this out and discuss it with your physician if you are concerned about food allergies.
Moderator
Georgia is asking ... Does caffeine enhance or increase lupus symptoms or flares?
Dr. Coleman
No, not necessarily. Everyone reacts to caffeine intake differently, and some people are more sensitive to the effects of caffeine than others. Coffee, for example, could irritate your stomach, as can some medications used to treat lupus, so it is possible that you could benefit from reducing coffee consumption for that reason. Quantity also needs to be considered -– consumption of 1 cup of caffeine-containing beverage per day vs. drinking 10+ cups per day. Coffee consumption has not been shown scientifically to be harmful to lupus patients however.
Moderator
This comes from Virginia. I have heard that if you have lupus you should avoid all alcohol, especially wine. Is there any truth to that?
Dr. Coleman
Studies that have examined the association between alcohol consumption and risk of lupus have not found any association between the two. Alcohol has not been found to place a person at increased risk of disease, nor has it been seen as protective. For someone already diagnosed with lupus, whether or not they should avoid alcohol consumption would depend on their particular circumstances (i.e. medications, other medical conditions, etc.) Talk with your physician, but in general, many people are able to enjoy an occasional glass of alcohol -– wine included -- without any adverse effects.
Moderator
And another question from Texas. What recommendations do you have for someone with non-insulin dependent diabetes and lupus?
Dr. Coleman
Knowing what to eat when you have multiple medical conditions seems complicated, but actually, the same basic guidelines often apply to multiple conditions. While I can't comment specifically on what type of diet you should follow, which would depend on whether you have any other medical conditions, what medications you are taking, how much physical activity you participate in, etc., I can offer some general guidelines. By following a diet consistent with current recommendations for all individuals, including an intake high in fresh fruits and vegetables, whole grains, lean meats, poultry and fish, you should increase your intake of many beneficial nutrients (omega-3 fatty acids, zinc, vitamin E, vitamin A, beta carotene, vitamin B6, vitamin B12, folate) and limit your intake of less beneficial nutrients (sugar, sodium and fat). A rule of thumb is to 1) eat color! (i.e. spinach is preferable to iceberg lettuce) and 2) try to eat the way your great grandmother would have eaten! (i.e. avoid processed, convenience and fast foods). Also, for more information see www.mypyramid.gov.
Moderator
Maryland wants to know ... Can garlic cause flares and if so, why?
Dr. Coleman
Garlic is generally used to decrease blood pressure and cholesterol levels, although the efficacy is controversial. First, I would want to know whether you were referring to fresh garlic or to garlic supplements. Garlic as a dietary supplement is not regulated the way drugs are in the U.S., and sometimes the purity of what is in a supplement and the accuracy of labeling is suspect. If you are asking about garlic supplements, I would recommend that you try eliminating them for a period of time and see whether your flares decrease -– it is possible that a contaminant in the supplement, +/- the garlic itself, could be exacerbating your symptoms. If you are asking about fresh garlic, such as what you would use in food preparation, different people react to particular foods in different ways, but occasional use is cooking is not likely to cause significant problems for most people. I cannot comment on your specific situation, but if you believe garlic -– fresh or as a supplement -– is related to your flares, talk with your physician or try eliminating it from your diet (see above).
Moderator
Our last question today comes from Arizona. What do you know about the acai berry and its help lowing inflammation?
Dr. Coleman
Acai berries grow on a type of palm tree found in areas around the Amazon River in Brazil. They are small, round, purple berries known for their anti-oxidant properties. Extracts or juices made from the berries are sometimes sold in health food stores, and while there have been many claims made about the health benefits of the acai berry, these have not been tested scientifically. Furthermore, this berry is not typically available in the U.S. Other fruits and vegetables can also provide high amounts of antioxidant nutrients (vitamin C, beta carotene, etc.) and are more readily available, such as blueberries, strawberries, dried apricots, sweet potatoes.
Moderator
That is all the time we have for today's chat. Thank you to Dr. Laura Coleman for joining us today.
Please join us in early May for a chat on disability and work-related issues for people with lupus. Check back on our Website for the date and time.
This concludes today's chat. Thank you for participating. Help spread the word about our lupus chats. See you next time.
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