This article focuses specifically on the heart and renal (kidney) disease as these relate to nutritional considerations for people with lupus. See Nutrition and Lupus: How to Maintain a Healthy Diet for a more general overview of nutrition and its overall importance for people with lupus.
Heart disease is the leading cause of death in the United States. Heart disease is a slow and silent process. Often patients will not feel any symptoms, so it is important to be aware of the risk factors that are at play. Factors such as high blood pressure, high cholesterol, tobacco use, diabetes, physical inactivity, and poor nutrition can put people with lupus at an even greater risk for heart disease, or for worsening symptoms. It is important to understand that there are a lot of small steps you can take to help reduce your risk.
Lupus and heart disease
Some important issues to consider with lupus are:
- Corticosteroids (prednisone) can lead to hardening of the arteries, known as atherosclerosis.
- Atherosclerosis is a common cause of heart disease in people with lupus.
- Kidney disease in association with lupus can affect the heart.
- Women with lupus have a higher risk of heart disease than the general population.
- Women with lupus are more likely to present risk factors such as high blood pressure (hypertension), high triglycerides, high cholesterol, and high homocysteine levels.
How to lower the risk of heart disease
All of these risk factors are important to be aware of. There is still much you can do to limit or lessen your risk from future disease. Although we are unable to change risk factors like our genetics, gender, and age, there is still much we can do to lessen our risk. Some techniques of controlling risk factors of heart disease are:
- Increasing physical activity
- Going to physical therapy
- Practicing healthy eating habits
- Joining a smoking cessation program if you are a smoker
- Controlling your weight
It addition, it is very important that you keep in close contact with your doctor in order to control and monitor lupus and the medicines you take.
Goals to a healthy heart
For your blood tests levels:
- Keep your low-density (LDL) “bad” cholesterol below 100mg/dL
- Maintain your total cholesterol below 200 mg/dL
- Keep your high-density (HDL) “good” cholesterol above 40 mg/dL
- Maintain triglycerides below 150 mg/dL
- Fasting glucose “blood sugar” below 100 mg/dL
- Prednisone can raise your blood sugar, so make sure you maintain a healthy blood sugar level
- Control your blood pressure by keeping it below 120/80 mm Hg
General food guidelines:
- Limit saturated fat to less than 7% of calories per day (13 grams for a 2000 calorie diet). Saturated fats come from both animal and plant sources. Examples of animal sources are butter, lard, and shortening, as well as fat in meats, poultry, and whole milk dairy products. Plant source examples include palm oil, palm kernel oil, and coconut oil. Choosing monounsaturated fats and polyunsaturated fats can benefit heart health when replacing saturated and trans fats. Examples of monounsaturated fats are olive oil, canola oil, peanut oil, sunflower oil, and sesame oil, as well as avocados, peanut butter, and many nuts and seeds. They are a good source of vitamin E. Polyunsaturated fats contain essential fats including omega-3s and omega-6s. Sources of polyunsaturated fats include:
- soybean oil
- corn oil
- safflower oil
- vegetable oil
- sunflower seeds.
- Limit trans fat to less than 1% of calories.
- Avoid foods that contain partially hydrogenated oils.
- Limit cholesterol to less than 200 mg/day.
- Choose fruits, vegetables, poultry, legumes, grains, and low-fat dairy, and be sure to watch your portion sizes.
- Limit sodium to 2000 mg/day.
- Sodium is found naturally in foods in small amounts. Note that one teaspoon of salt contains approximately 2300 mg. Salt is often added to processed foods such as frozen meals; canned soups and sauces; pudding mixes; breads, cereals and muffins; soy sauce; cheeses; canned vegetables and canned fish; smoked meats, and cold cuts. When buying food, compare sodium content on food labels. Do your best to eat natural and fresh foods. Use spices and herbs to enhance flavor, rather than salt. Excess sodium intake can cause high blood pressure, kidney disease, heart attack, stroke, swelling/edema, and osteoporosis.
- American Heart Association
- General Population: less than 2,300 mg of sodium per day.
- African Americans, those in their middle-age, older adults, and people with diabetes, kidney disease, and high blood pressure: less than 1,500 mg per day.
- Institute of Medicine of the National Academy of Sciences
- Adults 19-50: 1,500 mg
- Adults 50-70: 1,300 mg
- Adults 71+: 1,200 mg
Reading food labels is very important when watching your sodium intake, so look for:
- Sodium free or no sodium - less than 5 milligrams of sodium and no sodium chloride in ingredients
- Very low sodium - 35 milligrams or less of sodium
- Low sodium -140 milligrams or less of sodium
- Reduced or less sodium - At least 25 percent less sodium than the regular product
- Consume alcohol in moderation
- Avoid exposure to tobacco products
- Maintain normal blood sugar levels
- Maintain a healthy weight
- Exercise 30 minutes a day
- For men, maintain waist circumference below 40 inches
- For women, maintain waist circumference below 35 inches
Heart Healthy Foods and Nutrients
- Omega 3 Fatty Acids
A number of studies have shown that omega-3 fatty acids, particularly EPA and DHA, can contribute to heart health. Omega-3’s consist of alpha linolenic acid (ALA), docosahexaenoic acid (DPA), and eicosapentaenoic acid (EPA). Food sources of omega-3’s include the following:
- Alpha linolenic acid (ALA)
- vegetable oils, nuts, seeds, and soy foods
- Docosahexaenoic acid (DPA) and eicosapentaenoic acid (EPA)
- Fatty fish such as mackerel, salmon, herring, trout, sardines, or tuna
There are many ways to boost your omega-3 intake, including:
- Cook or marinade food with canola and olive oil
- Add ground flaxseeds/chia seeds to cereals, soups, and baked foods
- Add almonds/walnuts to salads or snack mixes
- Eat two four-ounce servings of fatty fish each week
- Fish oil supplements: If you have heart disease, the American Heart Association recommends one gram of omega-3 fatty acids from DHA and EPS per day. Talk to your doctor before taking fish oil supplements to determine if they are right for you.
- Soy Protein
Soy protein is a low-fat protein alternative for meat and cheese. Some studies indicate that soy protein may also help reduce cholesterol. Further research is needed.
- Add tofu to vegetable stir-fry
- Have a soy patty instead of hamburger
- Snack on edamame or soy nuts
- Use soymilk in cereal and oatmeal
Fiber has been shown to help with weight control and blood sugar levels. Aim to eat at least 25 grams of soluble and insoluble fiber daily.
- Soluble fiber
- Helpful in lowering LDL cholesterol
- Eat at least 10 grams daily
- Sources: oatmeal, barley, beans, fruits, vegetables
Ways to boost your fiber intake:
- During breakfast, eat whole fruit instead of juice and choose high fiber cereal and oats
- During lunch, add one cup of beans to salads and soup and have sandwiches on 100% whole wheat bread
- During dinner, serve whole grains such as brown rice, quinoa, bulgur, buckwheat and corn
Here is an example of the difference between a low fiber and a high fiber breakfast:
- Low fiber breakfast:
- one cup sweetened cereal, croissant, and eight oz. coffee
- 2.3 grams of fiber
- 27 grams of fat & 105 mg cholesterol
- High fiber breakfast
- one cup old-fashioned oats, one slice whole-grain toast and eight oz. orange juice
- 12.5 grams of fiber
- five grams of fat
Smart Choices for a Heart Healthy Diet
- Rich in monounsaturated fats, vitamin E, magnesium
- May lower cholesterol and triglycerides
- Five ounces/week is recommended
- Fruits and vegetables
- Provide fiber, antioxidants, folate, potassium, vitamin A and vitamin C
- Dark chocolate (70% cocoa or higher)
- Rich in cocoa phenols & flavonoids
- Watch your portions
- Green Tea
- Rich in flavonoids. More research is needed to understand its impact.
Mediterranean Diet vs. Western Diet
- The Mediterranean Diet consists of: fruits, vegetables, whole grains, legumes, fish, and olive oil. This diet is high in fiber and antioxidants and low in red meat and high-fat dairy.
- Western-type Diets consist of red meat, dairy, butter, fats, processed foods, sugar and salt.
DASH Diet (Dietary Approach to Stop Hypertension)
- High in calcium, potassium, and magnesium
- Low in sodium, saturated fat, and cholesterol
- High in fiber
- DASH Foods
- 4-5 servings of potassium rich fruits and vegetables
- Potatoes, sweet potatoes, spinach, zucchini, tomatoes, kiwi, bananas, apricots, oranges
- 2-3 servings calcium-rich foods
- Fat-free and low-fat milk products
- 4-5 servings/week of nuts, seeds and legumes
- Provide fiber, magnesium, and protein
Focus on Lifestyle Changes
These are some key techniques that can help you make these changes in your lifestyle:
- Make one diet or exercise change at a time
- Try a food diary
- Enlist family and friends for support
- Talk to your doctor, nurse, and nutritionist
- It’s ok to have a treat (once in a while)
In order to help you to begin to maintain your own healthy diet at home, try and incorporate these into your diet:
- Add fruits to marinated meats instead of high sodium sauces
- Purchase low fat or fat free dairy products
- Use soy products as alternative to dairy
- Use plain yogurt for sour cream recipe
- Substitute whole eggs with egg whites or egg substitutes
- Use oil in place of butter or margarine
- Use heart healthy oils such as olive, canola, flax oil, walnut oil, avocado oil and peanut oil
- Use herbs and spices to flavor foods instead of salt
- Use sugar substitute such as Splenda or Truvia
- Try whole grains (i.e., whole wheat pastas, brown rice)
- Cut the recommended fat or oil by half in a recipe
- Omit fat/oil and use a non-stick oil spray
- Cut the recommended sodium by half or less
Healthy Cooking Methods
- Steamed (vegetables, chicken, fish)
Tips: instead of two slices of pepperoni pizza and an eight oz. Coca-Cola, which equals 14 grams of fat, 780 calories, 753 mg of sodium, and 75 mg of cholesterol, choose a roasted turkey sandwich on wheat bread with two teaspoons of light mayo, lettuce & tomato, along with an unsweetened iced tea and one apple, equaling three grams of fat, 580 calories, 440 mg of sodium, and 28 mg of cholesterol.
Kidney Disease and Lupus
Lupus nephritis is a form of kidney disease that affects people with lupus. Lupus nephritis is inflammation of the kidneys in which tiny filters in the kidneys are damaged, resulting in a loss of kidney function. Retention of fluids is a common symptom of this disease. It causes weight gain and swelling and puffiness in the legs, ankles, and/or fingers. Lupus nephritis may be treated with corticosteroids or immunosuppressive agents.
Health Risk Factors for People with Lupus
To lessen your risk for diabetes, be sure to limit sugary foods and watch your portions of carbohydrates, i.e., fruits, starchy vegetables (like potatoes, corn, green peas), milk/yogurt, breads/grains, desserts, and breads/grains. It is important to keep your heart healthy and to stay active.
To lessen your risk for osteoporosis, be sure to stay active, maintain a healthy weight, stop smoking if you currently are, and get adequate calcium and vitamin D.
The dietary recommendations are very similar to those suggested for heart disease. Ms. Everett highlighted that patients should follow a heart healthy diet by keeping salt intake low and, depending on your blood work, cutting back on protein foods and avoid high potassium foods. This is very important to check with your doctor.
Your doctor may advise you to limit the amount of protein in your diet. Since you would need to eat a smaller amount of protein, choose heart-healthy protein foods like fish, chicken breast, lean red meats, egg whites, low fat soy products, and low fat dairy products as your main protein sources. Limit servings of milk, yogurt, cheese, dried beans and peas, nuts and seeds, peanut butter, and some soy products, which are high in both protein and phosphorus. Phosphorus is a mineral that builds up in the blood as kidney failure progresses.
High Potassium Foods
If your doctor tells you to limit high potassium foods, these foods include avocados, bananas, cantaloupe, dried fruits, honeydew, kiwi, mangos, artichoke, dried beans & peas, pumpkin, potatoes, French fries, Spinach (cooked), oranges & orange juice, papaya, prune juice, milk, yogurt, ice cream, chocolate, molasses, salt substitute, seeds and nuts, sweet potatoes, tomatoes, tomato sauce, vegetable juice, and winter squash.
Try to eat lower potassium foods such as apples, berries, grapes, lemons, peaches, canned pears, pineapple, plums, watermelon, vegetables carrots, cabbage, cauliflower, cucumber, eggplant, green beans, lettuce, onion, summer squash, sweet peppers, dairy substitutes (nondairy creamers, rice milk [unenriched], sorbet or popsicles, nondairy whipped topping, popcorn (unsalted), pretzels (unsalted) and red licorice. Remember to watch your portions of these foods. The bigger the portion, the more potassium that is consumed.
- Limit unhealthy fats and sodium
- Eat foods high in fiber
- Choose antioxidant-rich foods
- Eat two servings of fatty fish per week
- Maintain a healthy weight
- Exercise regularly
Learn more about the HSS SLE Workshop, a free support and education group held monthly for people with lupus and their families and friends.
See separate summary for Nutrition and Lupus: How to Maintain a Healthy Diet.
Summary Written by Christie Carlstrom, SLE Workshop Coordinator and Social Work Intern at HSS.