Systemic Lupus Erythematosus: Nutritional Considerations

SLE is one of a number of autoimmune diseases that may be influenced by essential fatty acids, which are precursors of proinflammatory eicosanoids and cytokines. These hormone–like chemicals are a hallmark of disease activity in SLE, and some (thromboxane A2, tumor necrosis factor alpha (TNF α) increase the risk for other inflammatory conditions, including cardiovascular disease, in SLE patients. Although clinical trials have not established a role for diet therapy in preventing or treating SLE, some rationale exists for the use of a low–fat, low–cholesterol diet and a proportionately greater intake of omega–3 fatty acids. The primary nutritional issues are as follows:

Omega–3 fatty acids. Omega–3 fatty acids reduce production of the proinflammatory cytokines (TNF α, interleukin–1) that are implicated in SLE¹ by 40% to 60%.² In patients with lupus nephritis, taking 30 to 45 grams per day of flax seed (a rich source of alpha–linoleic acid) reduced serum creatinine and proteinuria.^3,4 Similarly, supplementation with fish oils has been reported to improve disease activity⁵ and to reduce triglycerides in pediatric SLE patients.⁶ While these studies suggest that flax oil or other sources of omega–3 fatty acids may be helpful, they included a limited number of participants; their findings require assessment in further studies.

Antioxidants. Poorer antioxidant status is a risk factor for the development of SLE.⁷ Theoxidative stress that may accompany low antioxidant intake is a frequent finding in, as well as a possible contributor to, SLE and its complications.^8,9 Preliminary evidence suggests that antioxidant supplementation using proanthocyanidins may reduce disease activity¹⁰ and, with vitamin C and vitamin E, decrease some measures of oxidative stress.¹¹ However, these findings require confirmation in larger controlled trials.

Low–fat, low–cholesterol diet. Patients with SLE frequently have dyslipidemia characterized by elevated triglyceride levels and low high–density lipoprotein (HDL)¹² and are at increased risk for cardiovascular events.¹³ A diet low in saturated fat and cholesterol produced significant reduction in LDL cholesterol in patients with SLE.¹⁴ (See Hyperlipidemia.)

Two additional nutritional considerations merit discussion:

Patients with SLE are at risk for glucocorticoid–induced osteoporosis and fractures.¹⁵ Limited evidence shows that, at least in pediatric SLE patients, spinal bone density significantly improves with calcium and vitamin D supplementation.¹⁶ Adult patients on chronic glucocorticoid therapy should supplement with calcium and vitamin D.

Some evidence suggests that patients benefit from dehydroepiandrosterone (DHEA). At doses of 200 mg/d, DHEA has been found to lower elevated levels of interleukin–6, improve assessments of disease activity, and reduce flares in lupus patients. Some studies have also found steroid–sparing effects and reductions in bone loss with only mild side effects (hirsutism, acne).^17,18 However, the potential adverse effects of DHEA on uterine health are not fully elucidated.

Orders

See Basic Diet Orders.

Vitamin D and calcium supplementation, as appropriate. 

What to Tell the Family

SLE is a serious autoimmune disorder that can be partly treated by lifestyle and nutritional changes. Smoking cessation, avoidance of sun exposure, and regular physical activity are important measures. Supplementation with omega–3 fatty acids may decrease the activity of the disease and, especially in conjunction with a low–fat, low–cholesterol diet, protect the heart. Patients using chronic steroid therapy are at risk for osteoporosis. These patients should have their bone density checked on a regular basis and should supplement their diets with calcium and vitamin D.