From the Archives: Summer 2009 issue of Lupus Now
Ask the Experts
Q. Do anti-inflammatory diets work for lupus, 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.
A. Unfortunately, there is no anti-inflammatory diet, per se. We do know that the omega-3 fatty acids (fish oils) do have anti-inflammatory properties, while the omega-6 fatty acids have pro-inflammatory properties. Different types of dietary fats also 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 of fruits, vegetables, and low-fat proteins such as chicken and fish (bluefish, salmon, and mackerel are higher in omega-3 fatty acids).
Rooibos tea is a South African herbal tea which 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. 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. -- Laura Coleman. R.D., Ph.D.
Q. I am 24 years old and go to the gym three-four times a week. Does lupus affect a man's CPK level? Will lifting weights cause my lupus to get worse?
A. Creatine phosphokinase (CPK) is an enzyme found mainly in the heart, brain, and skeletal muscle. A person’s CPK level can be affected by lupus, and may be increased by a heart attack, brain injury or stroke, myocarditis (inflammation of the heart muscle), dermatomyositis (muscle weakness with skin rash), polymyositis (muscle weakness especially in the muscles closest to the torso, such as shoulders and hips), or pulmonary infarction (lung tissue death). In fact, a little myositis, or general muscle inflammation, is common in the acute stages of lupus or during a lupus flare.
When you lift weights, you also raise your CPK levels. The idea is that if you have muscle inflammation, you might release more muscle antigen (which the body sees as foreign) and make your symptoms worse. This is a theory, but I do not subscribe to it. I believe that the aerobic effects of exercise far outweigh the downside of releasing small amounts of antigen. -- Robert Lahita, M.D., Ph.D.
Q. What diseases are more common, and what complications are faced, as people with lupus become older?
A. Lupus and its treatments accelerate many facets of "normal" aging, such as osteoporosis, heart disease, hardening of the arteries, cataracts, etc. It's not so much that the person with lupus ages differently from a person without lupus, it's that it happens faster. The best you can do is keep as active as possible, try to keep your diet low in saturated fats, your weight in the normal range, don't smoke, and work with your doctor to keep your lupus under control. -- Ronenn Roubenoff, M.D., M.H.S.
Q. I was diagnosed with lupus eight months ago. My medications are Plaquenil, methotrexate, and prednisone. Now my hair is really thinning, and I'm worried whenever I comb or wash it.
A. If you had hair loss before being on these medications, then thinning of the hair (called alopecia) is most likely due to your lupus, and the treatment would be to get better control of your lupus. If the hair loss is a new problem since you’ve been on the medicines, then it is probably due to the methotrexate or prednisone. If this latter scenario is true, then I would recommend continuing to try to come down on your prednisone (as guided by your rheumatologist), and to take a strong vitamin called folinic acid (leucovorin) 10 mg once a week taken the day after your methotrexate. It works by protecting healthy cells from the effects of methotrexate or similar medications while still allowing methotrexate to enter the body to kill targeted cells. The folinic acid vitamin can only be given by prescription, so you would have to discuss this with your rheumatologist. If you are already taking folic acid daily I’d recommend this instead, as it is stronger and so works better at preventing methotrexate side effects. -- Don Thomas, M.D.
Q. I was diagnosed with lupus at age five. I am 21 now. Are the children you treat very young, suicidal, and also coping with high levels of depression, and how have you helped them?
A. We do have children with lupus who were diagnosed as young as you. We know that it is difficult and often frustrating to grow up with a chronic condition like lupus and that the medications or the disease itself can affect your mental state.
We take a team approach to these issues of growing up, and teens and young adults need to be included in the team as they get older since they are the ones dealing and living with the disease. Other important individuals on the team are our nurses, social workers, psychologists, and psychiatrists, your regular doctor, and other supportive people in your life, and we try to integrate all of them. Keeping open communication and having people on your support team (including friends and family) who understand your experiences can help. We always encourage people to seek out help and empower themselves with information.
In treating some of the psychiatric issues you describe, we carefully evaluate if it is related to the lupus or not. Often we need to give medicines (antidepressants) to help with mood, along with traditional medicines to treat lupus, such as prednisone, Plaquenil®, and immunosuppressives such as Imuran®, methotrexate, CellCept®, or cytoxan. -- Peter Chira, M.D.
Laura Coleman, R. D., Ph.D. 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 and the Materials Review Panel of the LFA Education Committee. She is the editor of a new textbook entitled Nutrition and Rheumatic Disease, published by Humana Press.
Robert Lahita M.D., Ph. D. is a professor of medicine at Mount Sinai Medical School and chairman of medicine at Jersey City Medical Center in Jersey City, NJ. He is also a senior attending physician at Jersey City Medical Center and at Saint Vincent’s Medical Center.
Ronenn Roubenoff, M.D., M.H.S. is a senior director of immunology and medical research at Biogen Idec, Inc. in Cambridge, MA. Dr. Roubenoff has done pioneering work on the interactions of nutrition, exercise, and hormonal and immune regulators of metabolism in aging and chronic disease. He is co-author of a New York Times bestselling book on exercise and nutrition treatment of arthritis.
Don Thomas, M.D. has been a rheumatologist with Arthritis and Pain Associates of Prince George’s County, MD. He is an assistant professor of medicine at the Uniformed Services University of the Health Sciences, and a member of the Medical and Scientific Advisory Board of the LFA, Greater Washington Chapter (DC, Northern VA, and MD).
Peter Chira, M.D. is pediatric rheumatologist and professor at Stanford University School of Medicine. Dr. Chira's research focuses on improving the transition and educational process for adolescents with rheumatic diseases, including lupus, as they move from pediatric care to adult care, and evaluating the role of information technology in this transition.
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