Ask the Experts -- Spring 2006
Q: Is there such a thing as a lupus diet?
A. No, there is no one specific diet that is commonly prescribed for people with lupus. Because SLE can involve a variety of organ systems in the body, dietary management is highly individualized. Some patients, for example, may have kidney damage or high blood pressure, requiring them to limit their sodium and/or protein intake, while other patients may only have skin involvement and not require these same restrictions. For this reason, it is essential that patients talk to their doctor to find out whether they need to follow any special diet. In general, a well-balanced, varied diet is a good starting point for patients with lupus, as an adjunct to their medical therapy.
Numerous dietary modifications have been studied, including, but not limited to: caloric restriction; fish oil; vitamin E, vitamin C, and vitamin A supplementation; and zinc reduction. None of these modifications have been particularly successful, however, so the most reasonable approach is to eat a diet high in fresh fruits, vegetables and whole grains, with moderate amounts of lean meats and poultry and an emphasis on fish, particularly marine fish high in omega-3 fatty acids. -- Laura A. Coleman, Ph.D., R.D.
Q. When monitoring SLE activity, what lab values are used to predict a lupus flare is about to occur?
A. There is a lot of work being done now to find better biomarkers or laboratory tests that can help to predict flares, responses to treatments, and overall disease activity in people with lupus. Currently two tests can be helpful for some subsets of patients: complement levels and antibodies to double-stranded DNA (anti-dsDNA). Complement is a name for a series of inflammatory proteins. When the activity of these proteins increases, some drop in the overall level of the proteins can occur. When this happens alongside increases of antibodies such as anti-dsDNA, there may be an increased risk for flares, especially (but not necessarily limited to) flares in the kidneys.
Other laboratory tests are not great at predicting flares in advance but can be used for early diagnosis and treatment. In general the following tests should be followed routinely in all lupus patients, and some of these (depending on the history of the patient) would be tested more often: CBC (counts of the white blood cells and platelets); metabolic profile (chemistry tests that reflect liver and kidney function and/or other potential problems in vital organs); urinalysis (an early check for abnormalities in the kidneys); and complement levels.
Some of the characteristic autoantibodies are often looked for at the beginning of a person's lupus diagnosis (ANA, anti-dsDNA, extractable nuclear proteins SSA-Ro, SSB-La, nRNP and Sm, as well as anticardiolipin antibodies), and some of these tests might be repeated if an individual becomes pregnant (SSA-Ro, SSB-La and anticardiolipin) and/or develops evidence for a blood clotting problem (anticardiolipin, anti-beta2 glycoprotein 1, lupus anticoagulant). It is hoped that in the near future we will have increased ability to predict and prevent problems from developing. -- Joan T. Merrill, M.D.
Q. I have heard and read that complimentary treatments (e.g., yoga, tai chi, meditation, message therapy, etc.) may be beneficial to lupus patients, in combination with standard treatments. Do you have an opinion on complimentary treatments?
A. It would be very difficult to generalize about all complementary medicine in a paragraph. In general we would recommend avoiding anything in pill form for which there is no ingredient list and/or containing more than the USDA recommended levels of fat soluble vitamins (A, D, E or K). People with lupus should also avoid alfalfa products. With those cautions in mind, the kinds of therapies mentioned above: yoga, tai chi, meditation, and massage therapy are generally helpful, healthful treatments which can improve overall health and well-being. However, these should be considered adjunctive approaches and it is not recommended that these be used instead of appropriate evaluation and treatment of lupus by a rheumatologist. -- Joan T. Merrill, M.D.
Q. I have systemic lupus and am considering having the spider veins in my legs treated with injections of polidocanol or aethoxysclerol. Can you tell me anything about these drugs, or the procedure, in relation to lupus?
A. In a search of PubMed, a major reference base, I can find no evidence that having spider veins treated with injections of polidocanol or aethoxysclerol either induces or exacerbates lupus. Thus, it is likely that the risk for causing problems with lupus is low. As with any medical intervention, though, there are no guarantees of complete safety. Of concern is the potential side effect of thrombosis (clotting). Superficial thrombosis is unlikely to be medically significant, but may in some cases be a cosmetic problem. Deep thrombosis, while a much less common side effect, could be a serious threat to one's health. Lupus patients who are known to be at high risk for forming thromboses may wish to discuss this potential side effect carefully with their physicians and weigh the risks versus the benefits. Of course, anyone considering the procedure will also wish to discuss the other risks of the procedure with a physician experienced in the procedure. -- Lela Lee, M.D.
Joan T. Merrill, M.D. is Head of the Clinical Pharmacology Research Program at the Oklahoma Medical Research Foundation in Oklahoma City and also the LFA Medical Director.
Laura Coleman, Ph.D., R.D. is with the Epidemiology Research Center at the Marshfield Clinic Research Foundation in Marshfield, WI.
Lela Lee, M.D. is Chief of Dermatology at the Denver Health Medical Center in Denver, CO.