Along with nutritional deficiencies, steroid medications can cause significant weight gain and increased cholesterol, blood glucose, and triglycerides, further underscoring the need for patients with SLE who are taking these agents to follow a healthy diet to counter the effects.6 There are also specific things that individuals with SLE should avoid, including alfalfa sprouts and garlic, which can stimulate an already overactive immune system.7 

Alcohol intake should be avoided or minimized, as it can lead to liver and stomach damage, particularly when combined with corticosteroids, acetaminophen, and warfarin. People who are taking methotrexate should never drink alcohol.


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Consultation and Referral

Rheumatologists may not discuss the topic of nutrition with their patients, which is “mainly due to the complex nature of the disease, and doctors often do not have time to discuss diet when there are so many other topics to cover,” Gibofsky explained. “Many rheumatologists will admit that diet is not their area of expertise and will instead refer their patient[s] to meet with a registered dietitian (RD) who can better help with these questions.”

In a study published in 2015, patients with SLE were referred for nutrition counseling with a registered dietician (RD), and 41 of 71 referrals participated in the sessions.8 At the end of the 6-month period, the patients who received nutrition counseling were more likely to have lost weight; decreased their intake of foods high in fat, sodium, and calories; and increased their consumption of fruits, vegetables, fiber, and fish.

With the vast amount of misinformation available online, Gibofsky often sees patients who went on restrictive diets that are purported to reduce lupus symptoms, which they may have read about on the internet or heard about from a neighbor. “Upon further discussion, I find that they do not actually feel better on the diet and, in fact, they have multiple nutritional deficiencies that could actually be the reason behind their worsening symptoms,” she said.

Given the numerous ways nutrition can have an impact on patients with SLE, it is critical that they understand the optimal way to eat based on each individual case. Although many insurance companies do not pay for visits with an RD, it would be ideal for patients with SLE to consult one.

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References

  1. Statistics on lupus. Washington, DC: Lupus Foundation of America. http://www.lupus.org/about/statistics-on-lupus. Accessed February 27, 2017.
  2. Manzel A, Muller DN, Hafler DA, et al. Role of “Western diet” in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014;14(1):404. doi:10.1007/s11882-013-0404-6
  3. Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthritis Rheum. 2013;43(1):77-95. doi:10.1016/j.semarthrit.2012.12.002
  4. Klack K, Bonfa E, Neto EFB. Diet and nutritional aspects in systemic lupus erythematosus. Rev Bras Reumatol. 2012;52(3):395-408. doi:10.1590/S0482-50042012000300009
  5. What people with lupus need to know about osteoporosis. Bethesda, MD: National Institutes of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases. www.niams.nih.gov/health_info/bone/Osteoporosis/Conditions_Behaviors/osteoporosis_lupus.asp Accessed February 27, 2017.
  6. The Johns Hopkins Lupus Center. Diet. www.hopkinslupus.org/lupus-info/lifestyle-additional-information/lupus-diet. Accessed February 27, 2017.
  7. The Johns Hopkins Lupus Center. Things to Avoid. www.hopkinslupus.org/lupus-info/lifestyle-additional-information/avoid. Accessed February 27, 2017.
  8. Everett ST, Wolf R, Contento I, et al. Short-term patient-centered nutrition counseling impacts weight and nutrient intake in patients with systemic lupus erythematosus. Lupus. 2015;24(12):1321-1326. doi:10.1177/0961203315582284

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