Lupus - SLE, SCLE, ALS

What is it?

Lupus is an autoimmune, systemic condition. Autoimmune because it occurs when our immune system attacks the cells and tissues of our body. Systemic, because in many instances it affects multiple organ systems throughout the body. By contrast an autoimmune condition like type I diabetes involves only one organ, our pancreas. 

The organs attacked by lupus include the heart, blood vessels and lungs, the liver and kidneys as well as the skin, joints and nervous system. This attack is made with elements of our immune system called antibodies. These are generally anti-nuclear antibodies that attack proteins in the cell nucleus. The antibodies also form immune complexes (clumps of antibodies with cells or microbes) that circulate in the blood and stick in the tissues causing malfunction. These antibodies are also present in other diseases, so it requires the presence of more than one of them to confirm that a patient has lupus.

Who is affected?

Lupus is an autoimmune condition that affects about 1 in 1,000 people. Its distribution is not uniform however. Women are up to 9 times more likely to get it than men, and normally develop it during their child bearing years, demonstrating a role for female sex hormones. Racially people of Afro-Carribean origin are 4 times more likely to have it than people of North European origin. However, the racial picture is a more complex than at first appears, as people living in Africa nowadays are no more likely to have it than Europeans. Smokers may have a slightly increased risk of the disease, although this is by no means certain(3).

Causes

As with most autoimmune disorders the causes are both genetic and environmental.

Genetics

Around one in 3 of all identical twins with lupus have a twin who also has lupus. With non-identical twins it is 1 in 20. This indicates that our genes play a significant role. Experts in the field currently think that more than 30 genes are involved(4). To find out more about these genes associated with lupus see here.

Environment

Women get lupus 9 times more frequently than men. The female sex hormone oestrogen increases antibody levels, although at the same time it suppresses the production of white blood cells, called lymphocytes. The increase in antibody numbers is potentially a factor in making lupus more likely to take hold, although there is not yet any concrete evidence linking new onset of lupus and oestrogen levels(5). 

A number of diseases have been linked with lupus. The Epstein Barr virus which causes glandular fever, the Herpes Zoster virus that causes shingles and the Cytomegalovirus, are all associated with an increased risk.

There are a number of chemical poisons that have also been linked with lupus. These include: mercury, cigarette smoke and silica, which have all been associated with an increased risk.

While diet is not considered to be relevant to risk of contracting lupus it is possible that epigenetic effects such as lack of protective methylation of DNA could be a factor. Lupus patients do display lack of protective methylation of their DNA. Methylation levels are improved by adequate amounts of vitamins B12 and folate.

Diagnosing SLE

Being a systemic autoimmune disease, SLE can affect multiple systems within the body. As such it is very difficult to diagnose without blood tests for a range of typical antibodies. The key antibodies to test are anti-nuclear and anti dsDNA. Along with certain symptoms this can lead to a positive diagnosis for lupus, however, these antibodies can sometimes be found in people with other conditions.

This is not a disease to self-diagnose as there are many symptoms. If you don't know of another family member with lupus, it is highly likely that a cluster of the symptoms mentioned below will most likely relate to another malaise.

Symptoms

The symptoms of lupus are many and varied, due to the systemic nature of the disease. Some of the more typical symptoms include a malar rash (butterfly shaped rash) either side of the nose, glomerulonephritis (leaky kidneys leading to blood in the urine), and cognitive and behavioural changes.

Other symptoms include cold hands and feet, fatigue, aching in the small joints and muscles, mouth ulcers and inflammation of the outer sheath of the heart and lungs.

Typically these symptoms flare up, and then die down again. Before and during these flare ups there may be more autoantibodies detected in the blood.

Diet and lifestyle for lupus

The best diet for lupus does depend on which sub-types of the disease you have. You should approach it by:

  1. Basing your diet around foods that are recognized as being generally healthy and that help dampen down your body's inflammatory autoimmune responses.
  2. Tailoring your diet to cope with the specific symptoms and drugs that feature in your sub-type of lupus.

The Auto-immune diet

Anti-inflammatory and antioxidant foods should be of general benefit. For an anti-inflammatory effect omega 3 oils are some of the most powerful. These are found in oily fish such as salmon, trout, mackerel, kippers and sardines. Powerful anti-oxidants can be found in green tea, prunes, turmeric and cocoa powder.

In general people with autoimmune disease often have leaky gut (guts that allow larger particles through the gut wall than is normal), and altered populations of bacteria (dysbiosis) in the intestines. In the case of lupus there is some evidence that changing the population of bacteria in the gut could help(6). The best approach to normalise dysbiosis, is to avoid gluten and alcohol while consuming certain types of fibre from starchy vegetables, such as celeriac, parsnip, swede, beetroot and potatoes. Adding unflavoured yoghurt to this mix, gives an instantaneous boost to numbers of friendly bacteria, and should help.

Things to avoid

Avoid alfafa seeds and sprouts as these contain an amino acid called l-canavanine, which has been associated with relapses in a few cases(7). 

Other foods that you may hear mentioned as worth avoiding include garlic, echinacea and nightshade vegetables such as tomatoes, peppers and aubergine (eggplant). 

Lupus nephritis

This complication is common, affecting as many as 74% of lupus patients, and involves damage to the kidneys. To control the symptoms that may occur such as swelling of the extremities and high blood pressure certain dietary changes can help.

Protein and salt restriction

As protein leaks out through the urine it may be advisable to consume more protein.

Lupus anti-coagulant (anti-phospoholipid syndrome) 

This condition often occurs as a secondary syndrome in those with lupus erythematosus, and also other auto-immune conditions such as rheumatoid arthritis and systemic sclerosis. Because blood clotting is a common symptom regular movement throughout the day can help reduce risk.

It is likely that you will be taking an anti-clotting medication such as warfarin, heparin or even aspirin, if you have APS. As such it is important to balance the amount of foods you consume that increase clotting as well as those that reduce it.

Vitamin K - phylloquinone and menaquinone

Vitamin K helps blood to clot. If your blood is thinned too much by the medications you are taking you may need more vitamin K. It seems unlikely that vitamin K will cause you problems with excessive clotting however unless you have liver problems, as to some extent its effects are regulated inside our body.

Phylloquinone is found in green leafy vegetables, with kale, cabbage, spinach, chard and salad onions all containing reasonable amounts. Dairy produce contains menaquinone, the other main form of vitamin K. Eating green leafy vegetables and dairy produce in moderation should not be a problem for people with APS.

Alcohol, fish oil and vitamin E

Too much alcohol can dangerously thin the blood and so it is wise to limit intake of alcoholic drinks. Fish oils are generally good for auto-immune disorders like lupus but care must be taken if you are also taking blood thinning medications that the cumulative effects of medications and fish oil does not thin the blood too much. Vitamin E is also a blood thinner and it is important to avoid supplements of vitamin E. If you take a multivitamin pill check amounts of vitamin E are not greater than the RDA (recommended daily allowance) level of 15mg or 23 IU.

Sub acute lupus

This is a manifestation of lupus that mainly affects the skin. It involves sensitivity to the sun and normally it becomes neccessary to avoid the sun. The sun is responsible for keeping our vitamin D levels up and levels of vitamin D have been associated with increased activity lupus(8). As a result it is a good idea to ensure that plenty of vitamin D is consumed through the diet. Long term medication for sub acute lupus may include corticosteroids. These can increase the risk of osteoporosis. More calcium in the diet and weight bearing exercise may help counter this effect of the medication, by increasing bone density.

Vitamin D

Vitamin D can be got from oily fish, cod liver oil, eggs and supplements. Check that you are getting the D3 cholecalciferol form. The D2 ergocalciferol form (in mushrooms, some plants and a few supplements) is not valuable and can be discounted for purposes of correcting the vitamin D deficiency you may develop with sub acute lupus.

Calcium

Dietary calcium is available from plain yoghurt, cheese and sardines. Vitamin D also help you absorb more calcium from your diet. It is also wise to do weight bearing exercises such as running, weight training or even walking. All of these exercises help increase bone density and reducing the risk of fractures which can occur with osteoporosis. 

DrDobbin says:

Lupus is an exceptionally complex disease. However, nowadays many patients can live a relatively normal life both in terms of quality and duration. A cure may be some way down the line, although it is possible that only a few factors are ultimately responsible for what is a disease with many different symptoms and eventual outcomes. 

A Scientific American article on Lupus from 2005 gives an update on where the research was at 10 years ago(9). 

References

3) http://www.ncbi.nlm.nih.gov/pubmed/15022327/ Smoking and lupus

4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847514/ Genetic risk factors for lupus

5) http://researchpub.org/journal/iti/number/vol1-no2/vol1-no2-3.pdf The female sex factor in SLE.

6) http://www.sciencedaily.com/releases/2014/10/141020212750.htm probiotic and prebiotic approach.

7) http://www.ncbi.nlm.nih.gov/pubmed/16890899 alfafa products may not be safe.

8) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213833/ Vitamin D and sub acute lupus activity.

9) http://www.nature.com/scientificamerican/journal/v292/n3/full/scientificamerican0305-70.html