Systemic Lupus Erythematosus (Holistic)

About This Condition

A butterfly-shaped rash on the face may be the first visible sign of lupus. While causes of this autoimmune disease are not clear, treatments do exist. According to research or other evidence, the following self-care steps may be helpful.
  • Get more omega-3s

    Reduce lupus-related inflammation by frequently eating foods rich in omega-3s, such as flaxseed and fatty fish; take up to 20 grams a day of fish oil under a doctor’s supervision

  • Discover DHEA

    Under a physician’s supervision, take up to 200 mg a day of the hormone dehydroepiandrosterone to improve symptoms

  • Uncover food sensitivities

    Work with a knowledgeable health professional to find out if certain foods aggravate your condition

About

About This Condition

Systemic lupus erythematosus (SLE) is an autoimmune illness that causes a characteristic butterfly-shaped rash on the face accompanied by inflammation of connective tissue, particularly joints, throughout the body. In autoimmune diseases, the immune system attacks the body instead of protecting it. Kidney, lung, and vascular damage are potential problems resulting from SLE.

The cause of SLE is unknown, though 90% of cases occur in women of childbearing age. Several drugs, such as procainamide, hydralazine, methyldopa, and chlorpromazine, may create SLE-like symptoms. Environmental pollution and industrial emissions were associated with an increased risk of SLE in one study.1 In one reported case, zinc supplementation appears to have aggravated drug-induced SLE.2 Ultraviolet radiation from sun exposure is a commonly recognized trigger of the skin manifestations of lupus.3 Some environmental chemicals such as hydrazine4 and food dyes such as tartrazine5 may be environmental triggers of SLE in susceptible people.

Risk factors include a family history of SLE, other collagen diseases or asthma,6 menstrual irregularity,7 beginning menstruation at age 15 or later,8 exposure to toxic chemicals,9 and low blood levels of antioxidant nutrients, such as vitamin A and vitamin E, or beta-carotene.10 Free radicals are thought to promote SLE.11

Discoid lupus erythematosus (DLE) is a milder form of lupus that affects the skin. Like SLE, it’s not known what causes DLE, though sun exposure may trigger the first outbreak. DLE is most common among women in their thirties.

Symptoms

Symptoms include decreased energy, weakness, fever, nausea, diarrhea, muscle and joint pain, chest pain, bruising, loss of appetite, weight loss, and a red, butterfly-shaped rash across the nose and cheeks. In addition, people with SLE may have symptoms of mouth sores, joint swelling, hair loss, changes in personality, seizures, and a coin-shaped, red skin rash elsewhere on the body that is aggravated by sunlight. Kidney, lung, and blood-vessel damage are potentially life-threatening manifestations of SLE.

Healthy Lifestyle Tips

In preliminary research, smoking has been linked to significantly increased risk of developing SLE, while drinking alcohol has been associated with a decrease in risk.12 The importance of these associations remains unclear, though an increased risk for many other diseases has been definitively linked to excessive consumption of alcohol.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Feast on fish and flaxseed
Foods high in omega-3 fatty acids, such as fish and flaxseed, may decrease lupus-induced inflammation.

Foods high in omega-3 fatty acids, such as fish and flaxseed, may decrease lupus-induced inflammation. In one preliminary trial, nine people with kidney damage due to SLE were fed increasing amounts of flaxseed for a total of 12 weeks. After examining the results, researchers concluded that 30 grams per day was the optimal intake for improving kidney function, decreasing inflammation, and reducing atherosclerotic development. Flaxseeds also contain antioxidants, potentially helpful to those with SLE.

To date, all studies on fish oil have used supplements and not fish (see below). Nonetheless, many doctors recommend that SLE patients eat several servings of fatty fish each week.
Try a low-fat diet
Some animal studies have suggested that eating fewer calories and less fat may help improve lupus.

An isolated case of someone with SLE improving significantly after the introduction of a vegetarian diet has been reported. In Japan, women who frequently ate fatty meats, such as beef and pork, were reported to be at higher risk for SLE compared with women eating little of these foods. Consuming fewer calories, less fat, and foods low in phenylalanine and tyrosine (prevalent in high protein foods, such as meat and dairy) might be helpful, according to animal and preliminary human studies.
Avoid alfalfa
Alfalfa seeds and sprouts contain the amino acid L-canavanine, which provokes a lupus-like condition in monkeys and possibly humans.

Alfalfa seeds and sprouts contain the amino acid L-canavanine, which provokes a lupus-like condition in monkeys and possibly humans. For this reason, some doctors recommend that people with SLE should avoid these foods. Cooking alfalfa seeds has been reported to erase this effect.
Uncover food allergies
Work with a knowledgeable healthcare provider to see if food allergies are contributing to your condition.

Spanish researchers discovered that people with SLE tend to have more allergies, including food allergies, than do healthy people or even people with other autoimmune diseases. While one study reported that drinking milk was associated with a decrease in SLE risk, other investigations point to both beef and dairy as foods that might trigger allergic reactions in some people with SLE. Casein, the main protein in cow’s milk, has immune-stimulating properties. This might explain why some people with SLE have been reported to be intolerant of milk products. Although there are several published case reports of patients with SLE showing clinical improvement after avoiding allergenic foods, additional research is needed to determine the importance of allergies as a cause of SLE. People with SLE who wish to explore whether allergies are contributing to their condition should consult a doctor.

Supplements

What Are Star Ratings?
Supplement Why
3 Stars
Fish Oil
Up to 20 grams fish oil per day after consultation with a doctor
Supplementing with fish oil may improve symptoms and decrease disease activity.

The omega-3 fatty acids in fish oil—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—decrease inflammation. Supplementation with EPA and DHA has prevented autoimmune lupus in animal research. In a double-blind trial, 20 grams of fish oil daily combined with a low-fat diet led to improvement in 14 of 17 people with SLE in 12 weeks. Other studies also found that supplementing with 10 to 15 grams of fish oil per day, or with the amount of EPA and DHA provided by 10 grams per day of fish oil, is beneficial for people with SLE. People wishing to take such a large amount of fish oil should first consult with a doctor.

2 Stars
DHEA
Take under medical supervision: 50 to 200 mg daily
Treatment with DHEA may improve symptoms and decrease disease activity.

Low blood levels of the hormone DHEA and the related compound DHEA-sulfate have been associated with more severe symptoms in people with SLE. Preliminary trials have suggested that 50 to 200 mg per day DHEA improved symptoms in people with SLE. One double-blind trial of women with mild to moderate SLE found that 200 mg of DHEA per day improved symptoms and allowed a greater decrease in prednisone use, but a similar trial in women with severe SLE found only insignificant benefits.

Experts have concerns about the use of DHEA, particularly because there are no long-term safety data. Side effects at high intakes (50 to 200 mg per day) in one 12-month trial included acne (in over 50% of people), increased facial hair (18%), and increased perspiration (8%). Less common problems reported with DHEA supplementation were breast tenderness, weight gain, mood alteration, headache, oily skin, and menstrual irregularity.

High amounts of DHEA have caused cancer in animals. Although anticancer effects of DHEA have also been reported, they involve trials using animals that do not process DHEA the way humans do, so these positive effects may have no relevance for people. Links have begun to appear between higher DHEA levels and risks of prostate cancer in humans. At least one person with prostate cancer has been reported to have had a worsening of his cancer despite feeling better while taking very high amounts (up to 700 mg per day) of DHEA. While younger women with breast cancer may have low levels of DHEA, postmenopausal women with breast cancer appear to have high levels of DHEA, which has researchers concerned. These cancer concerns make sense because DHEA is a precursor to testosterone (linked to prostate cancer) and estrogen (linked to breast cancer). Until more is known, it would be prudent for people with breast or prostate cancer or a family history of these conditions to avoid supplementing with DHEA. Preliminary evidence has also linked higher DHEA levels to ovarian cancer in women.

Some doctors recommend that people taking DHEA have liver enzymes measured routinely. Anecdotes of DHEA supplementation (of at least 25 mg per day) leading to heart arrhythmias have appeared. At only 25 mg per day, DHEA has lowered HDL cholesterol while increasing insulin-like growth factor (IGF). Decreasing HDL could increase the risk of heart disease. Increasing IGF might increase the risk of breast cancer.
2 Stars
Pine Bark Extract (Pycnogenol)
60 to 120 mg per day
In a small, controlled study, Pycnogenol seemed to help decrease systemic lupus erythematosus activity, measured with a combination of signs, symptoms, and blood measurements.

In a small, controlled study, people with SLE were given medication and either a placebo or Pycnogenol in the amount of 120 mg per day for 30 days followed by 60 mg per day for another 30 days. SLE disease activity, measured with a combination of signs, symptoms, and blood measurements, declined further in the group taking Pycnogenol.

2 Stars
Tripterygium wilfordii
Take under medical supervision: an herbal extract equivalent to 30 to 45 grams daily
This Chinese herb may relieve symptoms such as malaise and joint pain.

Preliminary evidence indicates that some Chinese herbs may help those with SLE. In one preliminary trial, a formula composed of 17 Chinese herbs was given to people with SLE. Of the people who were also taking cortisone, 92% improved, but 85% of those taking the herbs alone also benefited. People with SLE-induced kidney damage given a combination of conventional drugs plus a Chinese herbal formula for six months did significantly better than those given the drugs alone. Various Chinese herbs have prolonged survival in animals with SLE.

One of these Chinese herbs, Tripterygium wilfordii, is thought to benefit those with SLE or DLE by both suppressing immune function and acting as an anti-inflammatory agent. When people with DLE took 30 to 45 grams of tripterygium per day for two weeks in a preliminary trial, most experienced some degree of improvement, including reduction or disappearance of skin rashes. Skin rashes in eight people completely cleared up, while in ten people over 50% of the rash improved.

A preliminary trial gave the same dose of tripterygium to people with SLE. After one month, 54% experienced relief from symptoms such as joint pain and malaise.

Use of the crude tripterygium herb is not recommended, and people interested in using it should work with their doctor to obtain the specially prepared and standardized extracts used in clinical studies. Because of potential side effects, people with SLE or DLE should consult with a doctor experienced in herbal medicine before using this herb. In the first two studies summarized, less than 8% of women with DLE and approximately one-third of women with SLE experienced amenorrhea (cessation of menstruation) after taking tripterygium. Other side effects ranged from stomach upset or pain, to nausea, loss of appetite, dizziness, and increased facial coloring. Both studies found that these effects subsided with time once people stopped using the herb. However, some reports have found more serious side effects and even death with use of tripterygium.Pregnant women should not use the herb.

Finally, a report suggests that long-term use (over five years) of tripterygium significantly reduced bone density in women taking it to treat lupus. While this loss of bone density was less severe than that found with long-term use of prednisone, lupus patients should have their bone density checked at yearly intervals by their doctor when using the herb.
2 Stars
Vitamin D
Refer to label instructions
In a double-blind trial, people who took vitamin D daily experienced a decrease in disease activity and flare-ups.
People with SLE frequently have low blood levels of vitamin D (measured as 25-hydroxyvitamin D). In a double-blind trial, supplementing with 2,000 IU per day of vitamin D for 12 months significantly decreased disease activity by an average of 37%, compared with a placebo. In addition, the proportion of patients who experienced a disease flare during the study was significantly lower in the vitamin D group than in the placebo group (10% vs. 24%). Vitamin D in the amount of 50,000 IU once a week for 24 weeks also decreased disease activity in another study. A few patients taking vitamin D in the first study developed elevated levels of calcium in the blood or urine. Therefore, SLE patients interested in taking vitamin D supplements should be monitored by a doctor.
1 Star
Astragalus
Refer to label instructions
Though a safe amount has not been established, one preliminary trial found that this herb could decrease overactive immune function in people with this disease.

One Chinese preliminary trial also found that astragalus could decrease overactive immune function in people with systemic lupus erythematosus. However, much more research is needed to know whether astragalus is safe in lupus or any other autoimmune disease.
1 Star
N-Acetyl Cysteine
600 mg three times per day
In a case report, a woman with kidney disease due to SLE (lupus nephritis) may have had an improvement in her kidney function due to treatment with N-acetylcysteine (NAC).
In a case report, a woman with kidney disease due to SLE (lupus nephritis) had an improvement in her kidney function and was able to taper off of her steroid medicine after starting treatment with N-acetylcysteine (NAC) in the amount of 600 mg 3 times per day. She continued NAC, and after a total of 13 months her disease was considered inactive.

References

1. Kardestuncer T, Frumkin H. Systemic lupus erythematosus in relation to environmental pollution: an investigation in an African-American community in North Georgia. Arch Environ Health 1997;52:85-90.

2. Fjellner B. Drug-induced lupus erythematosus aggravated by oral therapy. Acta Derm Venereol 1979;59:368-70.

3. Millard TP, Hawk JL, McGregor JM. Photosensitivity in lupus. Lupus 2000;9:3-10 [review].

4. Reidenberg MM, Durant PJ, Harris RA, et al. Lupus erythematosus-like disease due to hydrazine. Am J Med 1983;75:365-70.

5. Pereyo N. Hydrazine derivatives and induction of systemic lupus erythematosus. J Am Acad Dermatol 1986;14:514-5 [letter].

6. Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333-7.

7. Minami Y, Sasaki Ti, Komatsu S, et al. Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of dietary and reproductive factors. Tohoku J Exp Med 1993;169:245-52.

8. Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333-7.

9. Kardestuncer T, Frumkin H. Systemic lupus erythematosus in relation to environmental pollution: an investigation in an African-American community in North Georgia. Arch Environ Health 1997;52:85-90.

10. Comstock GW, Burke AE, Hoffman SC, et al. Serum concentrations of alpha-tocopherol, beta-carotene, and retinol preceding the diagnosis of rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis 1997;56:323-35.

11. Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333-7.

12. Hardy CJ, Palmer BP, Muir KR, et al. Smoking history, alcohol consumption, and systemic lupus erythematosus: a case-control study. Ann Rheum Dis 1998;57:451-5.

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