In this presentation, Ms. Everett covers the relationship of diet and nutritional considerations and lupus, osteoporosis, medication side effects, and vitamins and supplements. This is the first of a two-part presentation. In Part II, Ms. Everett will focus more specifically on nutrition and the importance of heart health and kidney health for people with lupus. Before beginning the presentation, Ms. Everett highlighted that nutrition has become an important area of research in regard to lupus.
Ms. Everett began by explaining that there is no food that can cause lupus. Lupus is an autoimmune disease, an illness that can affect many body systems. The foods that you eat, however, and the medications you take may have an effect on some of your symptoms. It is also important to understand that there is a link between lupus and osteoporosis and cardiovascular disease. Healthy nutrition can impact on those with these co-occurring diseases. Nutrition (e.g., in the case of osteoporosis, calcium intake) in turn may impact the symptoms and outcomes of these co-occurring illnesses. Here are some key issues and benefits that relate to proper nutrition and people living with lupus;
Ms. Everett then discussed some important general nutrition guidelines of which individuals with lupus should be aware. Some key guidelines include diets low in fat, cholesterol, and sodium; low in refined sugars like soda and concentrated juices; and high in fiber. It is important to be aware of high protein diets which can often stress the kidneys. Most importantly, Ms. Everett stresses the importance of keeping a well-balanced diet.
Next, Ms. Everett reviewed some of the key foods that are important for your diet. She emphasized that balance is essential – that is, to not eat too much of one thing and not enough of another. Different foods have different nutritional components. Included in the important foods that Ms. Everett highlighted were a variety of fruits and vegetables; foods low in calories and saturated fats; and foods high in antioxidants, fiber, calcium, vitamin D, and Omega 3 fatty acids.
Fruits and Vegetables
When bought fresh, there are no added cholesterol and saturated fats added to fruits and vegetables, and they are low in fat and sodium. Fruits and vegetables contain antioxidants and fiber and are a great source of Vitamin C and Vitamin A.
Fats and oils
Not all fats are unhealthy. Polyunsaturated fats and monounsaturated fats are the healthier fats compared to saturated fats. Some of these fats are high in anti-inflammatory properties and have a rich source of Vitamin E. Foods that contain unsaturated fats include; nuts, seeds, avocados, olive oil, soybean oil, and canola oil. It is important to understand that these fats are still high in calories - therefore, portions should be monitored. These fats, however, are preferred over saturated fats.
Saturated fats, on the other hand, can increase inflammation. Some examples of saturated fats are high fat dairy foods (whole milk, half and half, cheeses, butter, and ice cream), fried foods, commercial baked goods, creamed vegetables/soups/sauce, sausages, Italian meats, red meat, animal fat, and processed meat products.
Choose Low Calorie Foods
Avoid drenching your food in dressing, oil, butter, and sugar, which can increase your calorie intake. High calorie foods can cause weight gain and inflammation so it is important to make healthy choices when choosing what foods to eat.
It remains unproven whether diets high in antioxidants can help with inflammation associated with lupus. Fruits and vegetables are sources of antioxidants such as Vitamin A, Vitamin C, Vitamin E, Selenium, Carotenes, and Bioflavonoids. Later on in the presentation Ms. Everett highlights some key foods that contain these nutrients.
High Calcium and Vitamin D Intake
Foods high in calcium and vitamin D promote healthy bones. Some medications for lupus deplete your body of calcium, so including calcium in your diet is essential.
Grains are a good source of fiber and energy, foliate, B6, B2, selenium, and zinc, and are naturally low in fat. Some whole grain foods include brown and wild rice, whole wheat bread, whole wheat pasta, rye, oats, quinoa, corn, and barley.
Dairy products hold the richest source of calcium and provide a good amount of protein, vitamin D, selenium, B vitamins, and zinc. Foods high in calcium are shown to help build strong teeth and bones, which are very important for lupus patients because of their high risk of osteoporosis.
When choosing dairy products, remember to go either low-fat or fat-free. Some examples include 1% and skim milk, low fat and low sodium yogurt, and low fat cheese. Foods to avoid are 2% and whole milk, which contain a large amount of fat and cholesterol. If you do not or cannot consume milk, choose lactose-free milk, soy milk, and almond milk that are fortified with calcium and Vitamin D. Aim for three or more servings a day.
Meat, Fish, and Poultry
Contain zinc and B vitamins and are a good source of Omega-3 fatty acids and protein to maintain muscle.
Some healthy tips that Ms. Everett spoke about when buying and preparing your meats, fish, and poultry:
Omega 3 Fatty Acids
Research indicates that omega 3 fatty acids from fish or fish oils may help manage high triglycerides and heart disease (see references at end of this summary). There have not been any studies, however, that show a reduced disease activity with lupus. Foods rich in omega 3 fatty acids include salmon, sardines, mackerel, bluefish, herring, mullet, tuna, halibut, lake trout, rainbow trout, ground flaxseed, walnuts, pecans, canola oil, walnut oil, and flaxseed oil, and are part of a heart-healthy meal plan.
Beans, Nuts, and Seeds
Good source of vitamin E, selenium, protein, and fiber. Some foods that you can snack on throughout the day include:
When purchasing, look for beans that are unsalted and low in sodium. When buying canned beans, make sure to rinse and drain excess liquid to remove extra sodium.
Ms. Everett next highlighted some of the important foods for people with lupus to avoid. These foods include:
Next, Ms. Everett spoke in greater detail on the role that osteoporosis plays for people with lupus and, again, some ways to practice a healthy diet.
It is important to understand that osteoporosis has no symptoms. There is no pain in the bones where individuals with osteoporosis would hypothetically feel sore, so it is important to speak with your doctor to have a regular bone mass density test performed. Again, there is a high risk of osteoporosis for people with lupus because of often decreased physical activity, vitamin D deficiency, medication side effects, and the additional risk of kidney disease. Listed below are nutritional tips to follow:
Some studies indicate that flax may protect against lupus nephritis (kidney disease associated with lupus). These studies are small and poorly controlled, therefore more research needs to be done to determine whether taking flaxseed supplements is helpful.
Is a bone building nutrient that helps to prevent or slow down osteoporosis. Aim to get 1000 - 1500 mg calcium and 400-800 IU vitamin D per day. Often hidden in foods like wild salmon (with bones), enriched/fortified soy milk, mushrooms (shitake), broccoli, kale, sardines (with bones), fortified milk, and fortified breakfast cereals.
Some studies indicate that DHEA may have a role in reducing flares and disease activity; also a role in decreasing the need for steroids. These studies, however, are small and poorly controlled, therefore further studies are needed to determine the safety and effectiveness of DHEA.
It is important to not just rely on supplements to help improve your symptoms, as both diet and supplements together are important. Supplements are unregulated, so the quality and content may vary widely. You may need to take up to several doses per day of supplements to get the same effect that is in the food. Always try and consume the food before looking into supplements. Again, speak with your doctor.
When choosing supplements and vitamins, be sure to read the product labels carefully to make sure the ingredient lists make sense to you. Often some may have blood thinning effects. More studies need to be done to confirm the safety and effectiveness of supplements, so again, always consult with your doctor.
Supplements to be avoided:
Ms. Everett closed her presentation by going over some key take home points:
Learn more about the HSS SLE Workshop, a free support and education group held monthly for people with lupus and their families and friends.
Summary Written by Christie Carlstrom, SLE Workshop Coordinator and Social Work Intern at HSS.