SYSTEMIC LUPUS ERYTHEMATOSUS

By: 

ION Archives

Issue: 
Autumn
Year of publication: 
2001

Systemic Lupus Erythematosus, an inflammatory autoimmune condition, can range in severity from mild to life-threatening. Alexander Luce Dip.ION looks at the possible causes associated with the disease and provides a nutritional approach to its management

Systemic lupus erythematosus (SLE) is an autoimmune illness that causes a characteristic rash accompanied by inflammation of connective tissue, particularly joints, throughout the body. In autoimmune diseases, the immune system attacks the body instead of protecting it. Kidney, lung and vascular damage are potential problems resulting from SLE. Sometimes the nervous system is affected, in which case psychosis, amnesia, deep depression and epileptic seizures may develop.

Initial symptoms often resemble those of arthritis, with swelling and pain in the fingers and other joints. A red rash may appear across the cheeks, and red, scaling lesions on the body may be present. Eighty to 90% of SLE cases are women of childbearing age, with Asian women being more at risk of developing the condition.

CAUSES

The cause of SLE is unknown although many experts believe that it could be linked to a virus, which has still yet to be identified. Several drugs, such as procainamide, hydralazine, methyldopa, and chlorpromazine, can create SLE-like symptoms, although these normally disappear once the drugs are discontinued. Environmental pollution and industrial emissions may also trigger SLE-like symptoms in some people.(1)

Discoid lupus erythematosus (DLE) is a milder form of lupus that, rather than being systemic, affects the skin. Like SLE, it’s not known what causes DLE, although sun exposure can trigger the first outbreak. DLE is most common among women in their thirties.

RISK FACTORS

Risk factors include a family history of SLE, other collagen diseases or asthma,(2) exposure to toxic chemicals,(3) and low blood levels of antioxidant nutrients (which help protect the immune system), such as vitamins A and E.(4) Free radical activity is thought to promote SLE in vulnerable people.(5)

CONVENTIONAL TREATMENT

Medical intervention depends on the severity of the disease. Anti-inflammatory drugs are usually the first choice of medication. Anti-malarial drugs are often prescribed to help relieve skin problems and sun sensitivity associated with SLE. In severe cases corticosteroids and immune suppressive agents may be given. The side effects of these drugs can be particularly detrimental, ranging from facial hair growth and puffiness, to complications such as diabetes and osteoporosis. Radiation therapy and anti-cancer drugs have also been used in some SLE patients.

DIETARY CONSIDERATIONS

A semi-vegetarian diet that includes vegetables, fruit, whole grains, legumes and seeds, with the addition of oily fish is recommended. Foods high in omega-3 fatty acids such as fish and flaxseed may decrease lupus-induced inflammation. In one trial, nine people with kidney damage due to SLE were given increasing amounts of flaxseed for a total of twelve weeks.(6) After examining the results, researchers concluded that 30 grams a day was the optimal intake for improving kidney function, decreasing inflammation, and reducing atherosclerotic development. Flaxseeds also contain antioxidants, potentially helpful to those with SLE.(7) To date, all studies on fish oil have used supplements and not fish. Nonetheless, it is advised that SLE patients eat several servings of fatty fish, such as mackerel, herring, trout and salmon, each week.

According to animal and preliminary human studies, consuming fewer calories, less fat, and foods low in phenylalanine and tyrosine (prevalent in high protein foods, such as meat and dairy) might be helpful.(8) Women in Japan who frequently ate fatty meats, such as beef and pork, were reported to be at higher risk for SLE compared with women eating little of these foods.(9) Therefore red meat, which promotes inflammation, should be avoided.

Due to the link between low antioxidant activity and SLE, drinking freshly pressed vegetable juices (rich in antioxidants) on a regular basis is an efficient way of boosting levels of these nutrients. In addition to adequate water intake (5-8 glasses a day), vegetable juices are beneficial for the liver, kidneys, skin and the health of joints.

Patients with SLE should be investigated for the possibility of food allergies. Spanish researchers discovered that individuals with SLE tend to have more allergies, including food allergies, than healthy people, or even people with other autoimmune diseases.(10) Casein, the main protein in cow’s milk, contains immune altering properties.(11) This might explain why some people with SLE have been reported to be intolerant of milk products. Beef may also be a possible trigger.(12)

Alfalfa seeds and sprouts contain the amino acid L-canavanine, which provokes a lupus-like condition in monkeys (13) and possibly humans.(14) For this reason, it is often recommended that people with SLE should avoid these foods.

NUTRITIONAL THERAPY

Vitamin A

Vitamin A is an antioxidant required for the healing of skin tissues, and is a powerful immune enhancer. A study with mice has shown that vitamin A deficiency may speed up the disease process of SLE.(15) Supplementation needs vary from one individual to another, although due to toxicity, doses should not exceed 25,000iu a day. Beta-carotene, a precursor of vitamin A, can be safely used at higher levels.

Pantothenic acid (B5)

Known as the “anti-stress” vitamin, pantothenic acid is required in the production of adrenal hormones and the formation of antibodies. It also plays an important role in the conversion of fats, proteins and carbohydrates into energy. In one study involving 67 patients with DLE who were treated with 10 to 15gms of calcium pantothenate daily, all patients experienced a significant improvement to their condition within 4 to 6 months.(16) As a caution, individuals should consult a nutritional therapist before using doses at this level as side effects may be experienced.

Vitamin B12

Vitamin B12 intramuscular injections, 1000mg twice weekly, for six weeks, has been shown to ease skin lesions in patients with SLE.

Vitamin C

This vitamin is vital for proper immune function. It is also required for tissue growth and repair. Recommended doses are between one and eight grams throughout the day.

Vitamin E

Vitamin E in doses of 200 to 1600iu a day may be beneficial for SLE patients.(17) Vitamin E may be applied locally to the skin.

Omega-3 essential fatty acids (EFAs)

The omega-3 EFAs in fish oil - eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – help to decrease inflammation. In a double blind study, those given 20 grams of fish oil daily combined with a low-fat diet led to improvement in fourteen of seventeen people with SLE in three months.(18) Those wishing to take high doses of fish oil should consult a nutritional therapist.

L-Lysine

Lysine works by helping to prevent mouth sores which may be present in SLE patients. The amino acid also contains antiviral properties. The recommended dose is 500-1000mg a day.

Glucosamine sulphate

This compound, which is classified as an amino sugar, is important for the maintenance of the skin, bones and connective tissue and may be beneficial in the control of SLE symptoms. A suitable dosage is 500mg two to three times a day.

DHEA

Low levels of DHEA, which is a hormone synthesised in the body from cholesterol in the body, have been linked to SLE patients. The supplement has been used with some success in people with SLE. In one double blind trial those given 200mg of DHEA a day were significantly better after three months, and were able to decrease prednisone (a corticosteroid which suppresses immune function and inflammation), more than those taking placebo.(19) Due to possible side effects, DHEA is not sold in the UK at present, although in the USA it can be purchased freely.

Others

Other nutritional supplements that may be helpful in the treatment of SLE include zinc (15 to 80mg), which is important for the proper functioning of the immune system and promotes the healing process. Proteolytic enzymes, which should be taken with meals, have an anti-inflammatory effect. Garlic in supplement form is a potent immune enhancer.

HERBAL RECOMMENDATIONS

There is some encouraging evidence to suggest that the Chinese herb Tripterygium wilfordi may benefit those with SLE or DLE. It seems to work by suppressing immunity and acting as an anti-inflammatory agent. When 26 people with DLE took 30 to 60 grams of Tripterygium a day for two weeks, most experienced some degree of improvement.(20) Skin rashes in eight people completely cleared up, while in ten over 50% of the rash improved. Tripterygium (30–45 grams per day) was also given to 103 people with SLE. After one month, 54% experienced relief from symptoms such as joint pain and malaise. Because of potential side effects, people with SLE should consult a Chinese herbalist before using this herb.

Note

Those suffering from Systemic Lupus Erythematosus should not stop taking existing medication without discussing it with their GP. As specific drugs can interact with specific nutritional supplements and herbs, a nutritional therapist who is treating a client with this condition should liaise with their client’s GP before suggesting a supplement regime.

REFERENCES

 

Kardestuncer T, Frumkin H. Systemic lupus erythematosus in relation to environmental pollution: an investigation in an African-American community in North Georgia. Arch Environ Health 1997;52:85–90.
Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333–37.
Kardestuncer T, Frumkin H. Systemic lupus erythematosus in relation to environmental pollution: an investigation in an African-American community in North Georgia. Arch Environ Health 1997;52:85–90.
Comstock GW, Burke AE, Hoffman SC, et al. Serum concentrations of alpha-tocopherol, beta-carotene, and retinol preceding the diagnosis of rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis 1997;56:323–35.
Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333–37.
Clark WF, Parbtani A, Huff MW, et al. Flaxseed: a potential treatment for lupus nephritis. Kidney Int 1995;48:475–80.
Prasad K. Hydroxyl radical-scavenging property of secoisolariciresinol diglucoside (SDG) isolated from flaxseed. Mol Cell Biochem 1997;168:117–23.
Corman LC. The role of diet in animal models of systemic lupus erythematosus: possible implications for human lupus. Semin Arthritis Rheum 1985;15:61–69 [review].
Minami Y, Sasaki Ti, Komatsu S, et al. Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of dietary and reproductive factors. Tohoku J Exp Med 1993;169:245–52.
Diumenjo MS, Lisanti M, Valles R, Rivero I. Allergic manifestations of systemic lupus erythematosus. Allergol Immunopathol (Madr) 1985;13:323–26 [in Spanish].
Carr R, Forsyth S, Sadi D. Abnormal responses to ingested substances in murine systemic lupus erythematosus: apparent effect of a casein-free diet on the development of systemic lupus erythematosus in NZB/W mice. J Rheumatol 1987;14 (suppl 13):158-65.
Carr RI, Tilley D, Forsyth S, et al. Failure of oral tolerance in (NZB X NZW)F1 mice is antigen specific and appears to parallel antibody patterns in human systemic lupus erythematosus (SLE). Clin Immunol Immunopathol 1987;42:298–310.
Bardana EJ Jr, Malinow MR, Houghton DC, et al. Diet-induced systemic lupus erythematosus (SLE) in primates. Am J Kidney Dis 1982;1:345–52.
Roberts JL, Hayashi JA. Exacerbation of SLE associated with alfalfa ingestion. N Engl J Med 1983;308(22):1361 [letter].
Gershwin ME et al. Nutritional factors and autoimmunity IV. Dietary vitamin A deprivation induces a selective increase in IgM autoantibodies and hypergammaglobulinaemia in New Zealand black mice. J. Immunology 1984;133(1):222-26.
Ayres s, Mihan R. Lupus erythematosus and vitamin E: an effective and non-toxic therapy. Cutis 1979;23:49-54.
Welsh AL. Lupus erythematosus: treatment by combined use of massive amounts of pantothenic acid and vitamin E. Arch. Derm. Syph. 1954;70:181-98.
Walton AJE, Snaith ML, Locniskar M, et al. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis 1991;50:463–66.
Van Vollenhoven RF, Engleman EG, McGuire JL. Dehydroepiandrosterone in systemic lupus erythematosus. Results of a double-blind, placebo-controlled, randomized clinical trial. Arthritis Rheum 1995;38:1826–31.
Werbach MR, Murray MT. Botanical Influences on Illness. Tarzana, CA: Third Line Press, 1994, 234–35 [review].

BIBLIOGRAPHY

Werbach, MR. Nutritional Influences on Illness. Keats Publishing Inc, 1987.
Weiner, MA. Maximum Immunity. Gateway Books, 1986.

Alexander Luce is a Dip.ION nutritionist practising in the Battersea area.

 

Keywords: 
HEALTH CONDITIONS
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