The Expert Series: Diet and lupus

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Host  0:00  
Welcome to The Expert Series, brought to you by the Lupus Foundation of America. Our speaker today is Dr. Laura Coleman, translational medicine expert for Novartis Institutes for Biomedical Research. Dr. Coleman has a PhD in nutrition, is a registered dietitian and has expertise in nutrition science related research. Today she will be speaking about diet and lupus. I would now like to turn it over to Dr. Coleman and thank her for joining us.

Dr. Coleman  0:28  
Thank you. Today I will be talking about diet and lupus, separating fact from fiction. Unlike the case for many other chronic diseases, there is no lupus diet, the way there is a diet for hypertension, diabetes, heart disease, or many other chronic diseases for example, overall, people with lupus should eat a nutritious, well balanced and varied diet that contains plenty of fresh fruits and vegetables, whole grains, dairy, and moderate amounts of meats, poultry, and fish. 

Unfortunately, a lot of misinformation exists in the popular press, which adds to the confusion and often leads to more questions than answers for people with lupus. In this segment, we will address common beliefs and try to separate fact from fiction. 

First, certain foods cause lupus flares. And that is fiction. Unless a particular foods seems to trigger a lupus flare for you, 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. Some foods that have been said to make lupus worse include nightshade vegetables, and animal protein. Nightshade 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. 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 example, if a person has kidney damage and needs to limit potassium intake, eating less meat might be a way to do that. Talk with your doctor about whether you need to limit your intake of protein or these kinds of vegetables. If not, then there is no reason for you to avoid either animal proteins or the nightshade vegetables. 

Second, fish oil cures joint inflammation. This is also fiction. Fish oil is a shorthand way of referring to the omega three fatty acids. These are a type of essential fatty acids, meaning that they're essential for human health and cannot be made by the body. They are found in fatty types of fish, wild-caught salmon, or bluefish for example, as well as some plant foods, walnuts or flax. The omega three fatty acids have anti-inflammatory, anti-thrombotic properties, meaning that they help to prevent inflammation and abnormal blood clotting in the body. Omega three 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 three fatty acids could be important for women with lupus who are at a five to 10 fold higher risk for heart disease than the general population. It is possible that omega three fatty acid consumption depending on the source and quantity could reduce inflammation and ease joint pain. However, it's not clear whether the doses of omega three fatty acids required to suppress autoimmunity and inflammation could also limit the body's ability to fight off bacteria, viruses or other harmful germs. If you're hoping to reduce joint inflammation, the best approach is to consume foods rich in omega three fatty acids such as the fatty fish, nuts and flax seed as part of a balanced diet. If you do take a fish oil supplement, make sure that it states that it is purified to remove mercury and other heavy metals, as these supplements are not regulated by the Food and Drug Administration. 

Third, people with lupus should follow an anti-inflammatory diet. This is also fiction. Different types of dietary fats have been studied in terms of their role in inflammation. But there has been only limited human studies about diet and lupus and results have been mixed. The best advice is to consume a healthy, balanced diet rich in fruits, vegetables, and low fat proteins such as chicken and fish, bluefish, wild-caught salmon, trout, sardines or mackerel, for example, are all higher in the omega three fatty acids. That being said, a traditional Mediterranean diet might be helpful for chronic diseases that are related to oxidative stress, inflammation or the immune system such as lupus. This diet emphasizes fruits, vegetables, nuts, grains and fish, along with extra virgin olive oil as the primary source of mono unsaturated fats. Not only does extra virgin olive oil have a high concentration of mono unsaturated fats, but it also contains polyphenol compounds. These are commonly found in plant-based foods and are the main dietary source of antioxidants, which may also be good for your health. Examples of polyphenols include flavonoids found in plants such as parsley, thyme, chamomile, and green tea, and resveratrol found in grapes. 

Next, people with lupus should not exercise. This is fiction. Exercise is an important part of health and weight maintenance. With all of the different options for exercise, your own body is your best guide as to what types of exercise you may be able to do. If a particular form of exercise bothers you, then don't do it. But people with lupus should be as physically active as possible. We conducted a study a number of years ago among people with rheumatoid arthritis, and found that not only did they tolerate a strength training regimen, but they benefited from it even more than healthy people. Swimming is also a great way for people with rheumatologic disorders to stay in shape because there is no stress on joints in the water. walking on a treadmill or an elliptical trainer is also possible. Most importantly, though, check with your doctor before beginning any new exercise regimen. 

Next, weight gain often seems to be a challenge for someone with lupus. And this is a fact. Weight Gain often happens to people with lupus, especially those who are taking glucocorticoids, also called corticosteroids. Unfortunately, no specific diet exists for the treatment of lupus or to prevent weight gain while on steroid therapy. Glucocorticoids act as powerful ant- inflammatory and immunosuppressive agents, but the drugs also increase the chances for developing obesity and related conditions, including type two diabetes mellitus, hypertension, and cardiovascular disease. It is wise to attempt to maintain body weight within a healthy range, since more weight can mean more stress on joints and more pain. 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 good choices. And nutritionists can help us develop a plan to resist urges to eat potato chips and desserts, substituting healthier low fat and lower calorie options. 

Some general suggestions for weight control include: 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, and stay active. Physical activity is an important part of health and weight maintenance. Always check with your physician before starting any new exercise program. 

Next, acai berry is good for people with lupus. And this is fiction. Acai berry is said to have health benefits due to its powerful 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, so there's no evidence to suggest that it's good for lupus. If you do like acai berry juice, it's fine to include it in the diet high in other fruits and vegetables as well.

Next, dietary supplements help reduce lupus flares. This is fiction. Unfortunately, at this time, there is little convincing evidence from human studies to support the use of any specific modified diet or nutrient supplementation. 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. For example, manufacturers of Noni Juice supplements have reported improved joint pain with the use of this supplement, 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, and no studies have been done in patients with lupus. 

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. 

Next, iron causes lupus flares and should be avoided in the diet. Fiction. Iron is an important nutrient for the production of red blood cells. Studies conducted in animals have found that excessively high iron intakes may contribute to kidney damage. However, there is no solid evidence that this is the same for people. People with lupus may have a problem with anemia, which is caused by low iron levels. So iron intake should not be restricted unless there is a specific reason to do so. 

And lastly, people with lupus are at high risk for vitamin D deficiency. This is a fact. Not having enough vitamin D is quite common in the general population and even more common in people with lupus. This is partly because people with lupus are told to avoid the sun in order to prevent flares and sunlight helps the body to make vitamin D. Studies and people with lupus have shown that a vitamin D supplement has positive effects on bone disease, bone density, immunity, cardiovascular health and possibly lupus activity and fatigue. But the exact doses, effectiveness and safety of vitamin D supplements for people with lupus are not yet completely understood. The recommendation for the general public is 800 to 1000 international units per day, but no more than 2000 IUs daily. People with lupus should talk to their lupus doctor about whether a vitamin D supplement might be needed. 

I enjoyed talking with you today and hope that this information has been helpful. Thank you very much.

Host  13:40  
Thank you Dr. Coleman for joining us today and sharing your insights on such important information about diet and lupus. For those listening in, we invite you to check out next month's presentation on lupus and brain fog. If you'd like to learn more about living well with lupus, you can find additional resources on the National Resource Center for Lupus or you can call one of our health educators at 1-800-558-0121. Or if you would like to connect with others who are impacted by lupus, check out our online community LupusConnect where you can talk with others find emotional support, and discuss practical insights for coping with the daily challenges of lupus. Thank you and have a wonderful day.