Lupus: Systemic Lupus Erythematosus (SLE)
Nutrition and Lupus Disease Activity
Vitamin D is an essential nutrient, and the precursor to the active form is produced in the skin after absorbing ultra-violet light. Other sources of vitamin D include fatty fish like salmon and mackerel; fortified foods like margarine, milk, and breakfast cereals; and vitamin D supplements.66
Studies have shown that vitamin D may be important in reducing the risk of lupus.67 It has been shown that higher blood levels of vitamin d are associated with less severe lupus disease activity.68
Two observational studies found that women with systemic lupus erythematosus have significantly lower levels of 25-hydroxy vitamin D.2,69 Another study found that, while 22% of healthy control women had a deficiency in vitamin D, 69% of women with lupus exhibited a deficiency in this vitamin.5
Reduced levels of vitamin D in people with lupus may be due to one or both of two possible scenarios:
- The deficiency is related to the disease itself; or
- The deficiency is caused/exacerbated by avoiding sun exposure due to increased photosensitivity of individuals with lupus.
As previously discussed, lupus and some of its treatments can cause bone loss and lead to osteoporosis. Healthy levels of vitamin D are necessary to help the body absorb calcium and keep bones as strong as possible and this is especially important in individuals with lupus.
Life Extension suggests that 25-hydroxyvitamin D levels be kept between 50 and 80 ng/mL for optimal health. This usually necessitates supplementation with 5,000–8,000 IU vitamin D daily for most individuals. However, supplemental doses should always be determined based upon blood test results.
The oil from fatty fish, such as mackerel, tuna, salmon, and halibut, is especially rich in omega-3 fatty acids.70 Fish oil is rich in two types of omega-3 fatty acids: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
Omega-3 fatty acids, also sometimes referred to as polyunsaturated fatty acids (PUFAs), promote health in a number of ways. EPA and DHA are of particular interest in autoimmune diseases, including lupus.
Similar to vitamins, the body needs EPA and DHA, but can only produce them in very limited quantities. Therefore, these fatty acids must be included in the diet in adequate amounts.71
Recent evidence has revealed a critical role for EPA and DHA in establishing balanced immunity in autoimmune disease. Experimental studies found that EPA was able to induce immune cells into a regulatory phenotype, thus countering the action of aggressive effector immune cells.72
Two clinical studies found that taking fish oil reduced lupus severity.73,74 Another study found that taking fish oil reduced the level of serum lipids in people with lupus,75 which may be useful as they are at a greater risk of developing heart disease.
The ratio between inflammatory omega-6 fatty acids and anti-inflammatory omega-3 fatty acids in the blood is of critical importance in autoimmune diseases. If the ratio is too high, disease activity may increase.76 Life Extension recommends that everyone strive to maintain an omega-6 to omega-3 ratio of 4:1 or lower. Readers can learn more about the importance of the omega-6 to omega-3 ratio and how to test it in the Life Extension Magazine article entitled "Optimize Your Omega-3 Status."
There are several forms of vitamin E, four tocopherols and four tocotrienols, each of which has different levels of activity in the human body. Vitamin E has been shown to reduce several different markers of inflammation in the body, including inflammatory cytokines.77 Since inflammation is responsible for the widespread tissue damage in lupus, antioxidant vitamins may aid in prevention or delay of the disease.
Vitamin E helps stabilize membranes of lysosomes, or immune cells that contain destructive enzymes used to fight intruders. When membranes are unstable, these enzymes cause damage to surrounding healthy tissue. Vitamin E can help prevent the onset of autoimmune attacks by stabilizing membranes of lysosomes.78 The symptoms of mice with lupus that were treated with vitamin E greatly improved. The mice lived longer, immune cell activity was normalized, anti-DNA antibodies were reduced, and kidney function improved.79
One study indicates that vitamin E can reduce the level of autoantibodies in lupus patients,80 but further studies are needed to confirm these effects. A case report of two patients indicates that a topical formula containing vitamin E improves the health of skin in people with discoid lupus erythematosus.45
The active form of vitamin A, called retinol, is important for healthy skin, bones, and soft tissues,81 and supports healthy immune function.82 Since people with lupus have an abnormally functioning immune system and a higher risk of osteoporosis, healthy vitamin A levels are especially important for this population. Interestingly, one study showed that people with lupus consumed less vitamin A in their diets than age-matched healthy controls, which may contribute to a vitamin A deficiency.83
Consumption of beta-carotene, a vitamin A precursor, is an ideal way to ensure that vitamin A levels are sufficient while simultaneously avoiding vitamin A toxicity. The body will convert beta-carotene into active vitamin A as necessary and excrete any excess.
Plants and Herbs
Curcumin. Curcumin, a bioactive derivative of the spice turmeric, has been tested over the last several years for its antioxidant, anti-cancer, and anti-inflammatory clinical properties. Curcumin decreases the ability of lupus autoantibodies to bind their specific antigens an average of 52%.84 The damaging inflammation of lupus-mediated injury is facilitated by the binding of autoantibodies to protein and nucleic acid antigens. Therefore, successful blocking of antigen/autoantibody binding suppresses inflammation before it even begins.
Experimental studies have revealed a considerable role for curcumin in modulating inflammatory cross-talk between cells of the immune system by suppressing cytokines such as IL-1beta, IL-6, IL-12 and tumor necrosis factor-alpha (TNF-α).85 Moreover, a recent animal model of an autoimmune disease identified nuclear factor-kappa beta (NF-kβ) suppression as a key mechanism behind curcumin’s anti-inflammatory action.
A clinical trial tested the effects of curcumin in 24 patients with the lupus-associated kidney disease lupus nephritis. One group of patients took 500 mg of turmeric daily over a 3-month period, which is equivalent to a daily curcumin dose of 22.1 mg. Compared with the placebo group, the turmeric group exhibited significant improvement in proteinuria.86
Although some clinical studies have been conducted showing some signs and symptoms are reduced in some autoimmune diseases such as multiple sclerosis and rheumatoid arthritis, clinical studies have not yet been conducted to determine if curcumin has a similar effect with lupus.85 However, these results are promising and suggest potential beneficial effects of curcumin in people with lupus.
Ginkgo. Ginkgo biloba, or more simply "ginkgo," is an herb that has been used for thousands of years in traditional Chinese medicine. This nutrient is often prepared by making an extract from the dried leaves. These extracts contain high concentrations of molecules called flavonoids and terpenoids, which are antioxidants and improve blood flow, respectively.87
A clinical study revealed that taking 120 mg of Ginkgo biloba extract three times per day for 10 weeks significantly reduced the number of Raynaud’s phenomenon attacks, a set of symptoms that often affect people with lupus.88
Pine bark extract. There is evidence that extract from the bark of the pine tree (Pinus pinaster) helps improve lupus inflammation, although more information is likely needed to make definite conclusions about this ingredient.
One study found that administration of pine bark extract reduced oxidative stress and improved lupus signs and symptoms in six patients that received the supplement in addition to prescription medications compared to a placebo group.89 Specifically, the patients who took pine bark extract exhibited a reduction in SLEDAI score, meaning that disease as a whole was decreased.
White peony extract. White peony (Paeonia lactiflora) root is a traditional Chinese medicinal herb that contains bioactive compounds called glucosides. A water and alcohol extract of the peony root, known as total glucosides of peony, has more than 15 identified compounds. The most active and abundant of these is paeoniflorin, which represents more than 90% of the total glucosides of peony.90,91 A number of studies have shown paeoniflorin and total glucosides of peony have immunomodulatory, anti-inflammatory, and pain-relieving properties, and provide supportive evidence for peony’s historical use in the treatment of autoimmune conditions, including lupus.90-92
One study that examined case histories of lupus patients treated with total glucosides of peony found that consistent treatment for five years or more was associated with lower medication dosages and lower disease activity compared with patients who had not used peony extract.93 In a mouse model of lupus, levels of lupus antibodies decreased significantly and disease-associated kidney damage was reduced after 15 and 30 days of treatment with total glucosides of peony.94
Laboratory and animal investigations indicate in conditions of immune over-activation, total glucosides of peony strengthen immune regulation and quiet immune over-activity.91 Total glucosides of peony was found in a laboratory study to induce the differentiation of immune cells affected by lupus into regulatory cells capable of quieting immune over-activity.95 Paeoniflorin alone has also demonstrated immune-regulatory effects in immune cells.96,97
Other Natural Therapies
Dehydroepiandrosterone. Dehydroepiandrosterone (DHEA) is a hormone naturally produced by the adrenal gland and is converted into sex hormones. In addition to being produced in the body, DHEA can be derived from the Mexican yam.81
Low levels of DHEA-s, a plentiful metabolite of DHEA in humans, have been observed in patients with lupus and other inflammatory diseases.98 DHEA and its various metabolites exert considerable influence over immune system activity by regulating production of multiple cytokines including IL-2, IL-1, IL-6 and TNF-α.98
In a clinical trial, when individuals with lupus took 200 mg of DHEA daily for 24 weeks, the number of patients who experienced lupus flares was significantly reduced.99 In another study, the same investigators showed that taking 200 mg of DHEA daily for 24 weeks reduced blood levels of the cytokine IL-10, which enhances antibody production.100 This reduction in IL-10 may have contributed to the reduced incidence of lupus flares seen in the first study.
Another double-blind, randomized, controlled trial involving 41 women found that six months treatment with 20–30 mg DHEA daily improved mental and emotional well-being in lupus patients.101 Also, at a dose of 200 mg daily, DHEA improved bone mineral density in postmenopausal women with lupus.102
Life Extension suggests that DHEA-s blood levels be kept between 350–490 µg/dL for men and 275–400 µg/dL for women in order to achieve optimal immunomodulatory action.
Plants to Avoid
The seeds of the alfalfa plant have the potential to cause transient lupus-like symptoms, including autoimmune-related anemia, in certain people and primates.103,104 Alfalfa seeds are rich in the amino acid L-canavanine, which was shown to be the responsible triggering agent in humans, and in certain types of mice.103,105 Due to these potential effects, people with lupus should avoid alfalfa seeds.
Echinacea is an herb that has long been used to promote a strong immune system to prevent and/or infections like the flu and colds.106 Considering that lupus is a disease characterized by an overactive immune system, people with lupus would likely benefit from staying away from echinacea, which has been shown to be an immune system stimulant. While studies have not yet been conducted to determine the effect of echinacea specifically on lupus, case studies have shown that taking this herb can exacerbate the severity of other autoimmune diseases.107 Additionally, a number of studies have shown that echinacea can induce human immune cells to secrete proinflammatory cytokines that are known to play a role in lupus disease.108 People with lupus should avoid echinacea.
Tripterygium wilfordii (Thunder God Vine)
Some reports exist in the scientific literature suggesting that using Thunder God Vine, a Chinese herbal, may ameliorate symptoms associated with autoimmune diseases.109 Due to these reports, Thunder God Vine is sometimes suggested by alternative health resources to those with lupus. However, Life Extension has reviewed the available scientific literature and concluded that, in most cases, the risk outweighs the potential benefit with this plant.
Several reports of severe toxicity and even death associated with the use of Thunder God Vine are available, and it appears that the dose required for clinical effectiveness is very close to that required to cause toxicity.110,111 Another report linked Thunder God Vine use with low bone mineral density in women.112
Life Extension does not suggest that use of Tripterygium wilfordii outside of a clinical setting. If a healthcare practitioner decides to use this therapy with patients, only a standardized extract of the skinned root should be used, as other parts of the plant are highly toxic.113
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