Diet and Nutrition
There is no special diet for lupus, despite the numerous claims on the Internet and in various books and other publications. In general, you 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, as fish oil has been found to help reduce inflammation.
Omega-3 fatty acids found in oily fish appear to decrease the risk of coronary artery disease and may also protect against irregular heartbeats and help lower blood pressure. For these reasons, omega-3 fatty acids are important for women with lupus, who are at a 5-10-fold higher risk for heart disease than the general population.
One food for people with lupus to avoid is alfalfa. Alfalfa tablets have been associated with reports of a lupus-like syndrome or lupus flares. The lupus-like effects may include muscle pain, fatigue, abnormal blood test results, changes in how the immune system functions, and kidney problems. These reactions may be due to the amino acid L-canavanine (found in alfalfa seeds and sprouts, but not in leaves), which can activate the immune system and increase inflammation.
If you plan to add herbs, dietary supplements, or vitamins to your diet you should first discuss your decision with your lupus doctor. This is especially important as herbs or supplements may interact with medicines used to treat lupus. Herbs or supplements should never be used to replace medicines prescribed to control symptoms of lupus or medication side effects.
You may have to cut back or eliminate certain items from your diet because of the medications you are taking, or because of the damage that lupus has done to certain parts of your body.
- Moderate use of alcohol is usually not a problem for people with lupus, but alcohol can lower the effectiveness of some of the drugs used to treat lupus, can cause new health problems, and can make existing problems worse. For example, non-steroidal anti-inflammatory drugs -- such as aspirin, ibuprofen (Motrin®), naproxen (Naprosyn®), and celecoxib (Celebrex®) -- can cause ulcers and bleeding in the stomach and intestines at any time during treatment; the chance of developing an ulcer or internal bleeding increases with alcohol use. Also, anticoagulant medicines such as warfarin (Coumadin®) and the chemotherapy drug, methotrexate, may not be as effective if you are drinking alcohol.
- Corticosteroids can elevate blood pressure and the levels of cholesterol and lipids in the blood. Therefore, if you are taking steroids, you should limit the fat and salt in your diet, as both can contribute to these conditions.
- Corticosteroids also can cause or worsen osteoporosis, a disease in which bones become fragile and more likely to break.
- If you have osteoporosis you should eat foods rich in calcium every day to help with bone growth: examples are dark green, leafy vegetables (spinach, broccoli, collard greens), milk, cheese, and yogurt or calcium supplements that contain Vitamin D.
- If you are experiencing fluid retention that causes swelling (edema), you should lower the amount of salt and sodium-containing foods you eat; in particular, processed foods should be avoided.
Related Information
Q&A with Dr. Roubenoff - Nutrition and Lupus
15 Questions with Dr. Laura Coleman - Healthy Eating
Gaining Perspective: Small, consistent efforts can help you manage the weighty side effects of prednisone
Summer 2008 issue of Lupus Now magazine
So Long Salt
Summer 2007 issue of Lupus Now magazine
Frequently Asked Questions
Will eating nightshade vegetables increase my lupus flares or joint pain? It seems that every place I read about this has a different opinion about this.
The nightshade vegetables include white potatoes, tomatoes, peppers (sweet and hot), and eggplant. There are others, but they are not foods that are typically consumed in the U.S. While there is anecdotal evidence that some of these foods can be related to inflammation, there is no solid scientific evidence to support this concept. My advice would be for people to keep track of when they eat these foods, and to look for a pattern between consumption and a flare. They would want to observe a link between a particular food and a flare on multiple occasions -- not just a few times. If there does seem to be a connection, then by all means, a person could avoid one/all of the nightshade vegetables without creating any nutrient deficiencies. Peppers, for example, are high in vitamin C, but so are plenty of other foods (i.e. citrus), so limiting peppers in your diet isn't going to cause any problems. Bottom line -- there isn't any good scientific evidence linking nightshade vegetables to inflammation/flares, but if people believe there is an association for them, then it isn't going to hurt them to omit the offending food from their diet.
What can I do about the weight gain brought on by the prednisone?
Increased appetite is well recognized as a side effect of corticosteroid therapy. Often times, just being aware that this increase in appetite may occur with the steroid therapy, is the first step towards managing the potential weight gain. If you have to go on steroids or if you have to increase your dosage of steroids, you may want to consider planning out a healthy diet during the time you're taking steroids and making sure that you stick to it. During those times, however, when you're really hungry, here are some things you can do to combat the munchies:
- Drink a large glass of low sodium vegetable juice cocktail
- Eat a bowl of air popped or low fat microwave popcorn
- Eat a plate of raw vegetables dipped in fat-free sour cream
- If you can, go for a walk
- Drink a cup of decaffeinated flavored coffee with low fat milk
These are low fat substitutions, which can reduce your overall caloric intake and hopefully curb your weight gain. Taking steroids can also increase water weight gain. You can help to cut down the amount of fluid retention by reducing your sodium and/or salt intake. This can be accomplished by avoiding processed or convenience food whenever possible. If you are going to be eating convenience or processed foods, check the label and make sure that no item contains more than 200 mg of sodium per serving. Or if you are eating a whole frozen dinner, for example, try and stay between 500 and 700 mg of sodium. If you can avoid processed meats such as luncheon meats, sausages or bacon, you'll be reducing your sodium intake and that's good. If you have a choice among fresh, frozen or canned vegetables, stay away from the canned and choose fresh or frozen because they are lower in sodium.
Support groups and commercial weight loss programs can assist in weight control efforts.
I need some nutrition advice, as well as advice on vitamins, foods, etc.
At this time, there is no specific lupus diet. Most people with lupus do not require special diets. It is important to maintain a nutritionally sound and well balanced diet. A proper diet ensures that we consume all of the necessary vitamins, minerals, and supplements. However, if your doctor feels it would be helpful for you, it may be suggested that you try a reducing diet, salt free diet, or low protein diet or combination of the three. If you have kidney involvement, a salt free low protein diet may be helpful in minimizing water retention.
A healthy intake of vitamins and minerals is important for everybody. If you eat a good variety of nutritious foods to include fresh fruits and vegetables, fiber rich cereals and grains, and lean cuts of meat then you are probably getting all of the vitamins and minerals you need to be healthy. There's little scientific evidence to prove that taking in extra amount of micronutrients such as through supplementation, can help improve your lupus.
Is there anything I can add to my diet that could lower the inflammation that lupus causes?
There has been considerable interest in the influence of dietary factors on many different autoimmune diseases, including lupus. Much of this interest has focused on omega-3 fatty acids because of their potential effects on inflammation. Animal fats are a source of omega-6 fatty acids. Fish, flaxseed and canola oils, and green, leafy vegetables are sources of omega-3 fatty acids. The relative amount of omega-6 and omega-3 fatty acids in the diet affects the types of prostaglandins and other compounds the body produces that influence the inflammatory response. The omega-3 fatty acids in particular result in the production of more anti-inflammatory compounds.
There has been one large study of dietary factors in relation to lupus disease activity. In this study of 216 lupus patients in Japan conducted by Yuko Minami, M.D., there was no association found between intake of total fat, type of fat, or omega-3 fatty acids and subsequent disease activity over a four-year period. However, higher intakes of antioxidants (for example, vitamins C and E) were associated with decreased disease activity.
Thus, although currently available studies suggest that diets high in antioxidants -- and possibly omega-3 fatty acids -- may help lupus symptoms, this is still an unanswered question. The role of antioxidants in disease progression and activity is a relatively under-studied area of research. It is important to discuss any major change in your diet, especially changes that include use of dietary supplements, with your doctor. There may be potential interactions with prescribed medications or other aspects of your care that are important for your physician to evaluate.
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