Lupus is an autoimmune condition impacting 1.5 million Americans, 90% of whom are women of childbearing age. While there are different forms of lupus, the most common kind is systemic lupus erythematosus (SLE), or systemic lupus, accounting for 70% of cases. (Source)
There's no set diet for those living with lupus, but eating well and incorporating anti-inflammatory foods can help manage both the symptoms and the long term effects. Let's take a look at what the science says. (Source)
The Symptoms of Lupus
Lupus causes inflammation in tissues that are otherwise healthy, resulting in pain and swelling. While there are no two cases of lupus that are alike, the most common symptoms are:
- stiffness, swelling and pain in the joints
- a rash on the face (bridge of the nose and cheeks), as well as on other parts of the body
- skin lesions that get worse when exposed to sun
- changes in color to fingers and toes when under stress or exposed to cold temperatures
- shortness of breath
- chest pain
- dry eyes
- memory loss
When lupus symptoms get worse and you're feeling sick, that's what's known as a flare. Flares can be mild or severe, and also unpredictable, although there may be indications that one is pending, such as:
- feeling more tired than usual
- stomach ache
Lupus flares can come out of nowhere, and some things that trigger some with lupus may not affect others. There are a number of known triggers for lupus flares, as well as ways to manage them.
- Excessive exposure to the sun can rev up lupus symptoms. While healthy immune systems clear cells damaged by UV rays, the immune systems of those with lupus don't, so those cells stick around and trigger an attack, and therefore, a flare.
- If you smoke and you have lupus, it's recommended that you quit, since smoking has been associated with inflammation and lupus flares.
- Both emotional and physical stress can provoke lupus flares, and depression and anxiety are prevalent in those with lupus (25% have depression, 37% have anxiety).
- The antibiotics bactrim and septra (sulfamethoxazole and trimethoprim) should be avoided by those with lupus, since they cause both sun sensitivity and lower blood counts, which can lead to flares.
Some foods and supplements can antagonize lupus symptoms. Let's take a look at the role of diet in lupus.
Is There a Diet That's Best for Those With Lupus?
In a way, this is a trick question. As we said at the start of the piece, there's no established diet that's best for everyone with lupus. That being said, there are some guidelines, including certain foods and supplements to be avoided, and others that science has deemed a good idea for those living with lupus. Any changes made to your diet should be discussed with your health care provider.
Overall, maintaining good nutritional habits is a positive step toward managing lupus symptoms and enjoying the best quality of life possible. Eating a well-balanced diet, including vegetables, fruits, whole grains, proteins, and healthy plant oils, as well as staying active and hydrated, can:
- reduce inflammation and its symptoms
- prevent nutrient deficiencies. In particular, vitamin D deficiency is common in those with lupus, and a lack of vitamin D can lead to osteoporosis.
- combat side-effects of medications. Lupus medications can cause weight gain, gastrointestinal issues, an increased risk of heart problems, and more, so staying on top of nutrition is essential.
Foods and Supplements with Benefits
Lupus is a systemic condition, meaning it impacts organs and organ systems throughout the body, including the joints, kidneys, brain, heart and lungs. Therefore, it's important to consume foods that address a variety of nutritional needs and have the capacity to reduce inflammation. Here's what the science community recommends.
- Vitamin A, good for healthy skin and bones, has been shown to decrease inflammation in those with lupus. It can be found in kale, spinach, broccoli, carrots, sweet potatoes, pumpkin, tomatoes, red bell pepper, cantaloupe, and mango.
- Vitamin C can regulate immune functions and prevent further tissue damage. It is found in broccoli, chard, all greens, okra, kale, spinach, sauerkraut, cabbage, soy beans, and rutabaga, among others.
- Vitamins B6 and dietary fiber may prevent the occurrence of symptoms in those with lupus. Tuna, salmon, chickpeas, and dark leafy greens are sources of B6, and dietary fiber is in lentils, pears, blackberries, raspberries, artichoke hearts, chia seeds, avocados, and chickpeas.
- Calcium is an important nutrient for lupus patients. As mentioned above, people with lupus (women in particular) are at risk of bone loss and osteoporosis due to inflammation, kidney disease, lack of estrogen, a sedentary lifestyle caused by severe lupus symptoms, and the impact of drugs that may be taken to treat lupus, such as corticosteroids or glucocorticoids. Calcium is found in green leafy vegetables, salmon, sardines, and tuna.
- An omega-3 fatty acid known as DHA was found in a small study to protect mice from autoimmunity triggered by inhalation of crystalline silica dust, an environmental trigger of lupus. DHA appeared to stop the mice’s bodies from enacting an autoimmune response, indicating it might be able to do so for other triggers and possibly minimize the severity of lupus flares. DHA is in fatty fish, such as salmon, tuna, herring, and sardines.
- Polyphenols work in the body as antioxidants, combating environmental damage from UV and pollution. They also might help protect against cardiovascular diseases, diabetes, and some neurodegenerative conditions. In those with lupus, polyphenols may moderate the intestinal bacteria and help prevent increased gut permeability (also known as leaky gut). They are found in black and green teas, blueberries, black currants, apples, and tomatoes.
Foods and Supplements to Avoid
Some foods can aggravate lupus flares and have known links to risks associated with lupus, such as heart disease and kidney problems. What should you steer clear of?
- Garlic contains allicin, ajoene, and thiosulfinates, antibacterial compounds that enhance the work of the immune system. If you have lupus, though, your immune system doesn't need to be activated anymore, so it's important not to consume a large amount or use it consistently.
- While we've established that there's no specific diet you should follow if you have lupus, it's recommended that you avoid foods that contribute to or cause inflammation, and that includes refined sugars (brown sugar, evaporated cane juice, high-fructose corn syrup, liquid fructose, raw sugar). Those with lupus often have insulin resistance and are at higher risk of developing diabetes. Additionally, one study indicated that those with lupus who consume higher amounts of sugars added to foods had more active symptoms, as opposed to those who didn't.
- Consuming large amounts of foods high in cholesterol and fat may be connected to an increased risk of developing cardiovascular disease, although recent research suggests this may not be true for everyone. Because of both disease activity and immunosuppressant drugs, people who have lupus are more likely to have cardiovascular disease than the rest of the population, so remain vigilant about diet, exercise, and maintaining healthy levels of weight, good cholesterol, and blood pressure.
- Commonly used to boost the immune system, echinacea can actually contribute to lupus flares, and should be avoided.
- Alfalfa sprouts contain L-canavanine, an amino acid that also stimulates the immune system, creating inflammation for people with lupus.
Diet and Lupus Medication
Given the complicated nature of lupus and its impact on multiple organs, treatment involves a variety of medications, including:
- Antimalarials reduce autoantibodies, or proteins in the blood that attack healthy tissue. They're also used by lupus patients to reduce pain and inflammation, as well as to prevent flares and lower the doses of other lupus medicines.
- Immunosuppressants control an overactive immune system, and doses vary depending on the severity of one's lupus.
- Targeted medications specifically address certain cell receptors and/or the enzymes inside cells to block functions that promote the sending of inflammatory signals.
- Steroids decrease the amount of overactive blood cells that cause inflammation, thereby reducing inflammation and pain.
- Blood thinners prevent blood clots, especially if you have antiphospholipid syndrome, a condition that causes blood clots.
Side Effects and Diet
Lupus medications do have side effects, some of which can increase the risk of developing certain conditions. Nutrition can have an impact on how your body reacts to these side effects and even help mitigate them. Here are some of the side effects you might have from various lupus medications, and what they mean for your diet.
- Corticosteroids can also increase your cholesterol, triglyceride, and blood sugar levels, so while you're taking them, you should follow a low-sodium, low-fat, and low-carbohydrate diet. Steroids can also deplete certain nutrients, such as potassium and vitamins C and D, so your health care provider may recommend taking supplements.
- Blood thinners can interact with certain foods, and can even be rendered less effective by them. For example, vitamin K (found in dark greens, asparagus, seaweed, and green and chamomile teas) can make the blood thinner warfarin less effective, so if you're using warfarin, the amount of vitamin K you're ingesting needs to stay consistent. It's also recommended to avoid alcohol, cranberry juice, and grape juice while taking warfarin.
- Medications such as antimalarials and non-steroidal anti-inflammatory drugs (NSAIDs) can cause stomach irritation and even bleeding ulcers, so your health care provider may prescribe something to protect your stomach and/or advise that they be taken with food.
The Bottom Line on Lupus and Diet
Lupus treatment and symptom management is bioindividual, as such knowing your medication options and side effects as as well as an awareness of what triggers flares will allow you to gather the information needed to determine which approach may be best for you. Although there's no specific diet for lupus, proper nutrition is a big part of not only mitigating symptoms, but helping to reduce the odds of developing conditions such as diabetes, kidney disease, and cardiovascular issues that those with lupus are more likely to develop. If you’re being treated for lupus, be sure to consult with your health care provider about any changes to your diet or medications. If you are interested in additional lifestyle changes to manage your lupus and reduce your symptoms, WellTheory’s Care Team can support you with a personalized Care Plan.