In this article, DietDoc gives some additional tips regarding dietary adjustments and use of supplements in managing systemic lupus erythematosus (SLE).
SLE patients should avoid eating excessive amounts of protein. Most South Africans are prone to eating far too much red meat, and not enough fish. SLE patients should make sure that they eat moderate quantities of the following types of fish as often as possible:
Cold-water fish - tuna, herring, mackerel, sardines, salmon
Fresh-water fish – trout
Seafood – shrimps
The most important reason for increasing fish intake is to ensure that SLE patients ingest sufficient omega-3 fatty acids. Omega-3 fatty acids help to boost immunity, combat arthritis and inflammation of the joints, and lower certain blood fats.
Soy protein is another source of protein that is useful in SLE diets, either as tofu or tempe, or textured vegetable protein. This kind of protein, which is derived from the soya bean, is low in fat compared to meat protein. Soya foods also contain bioflavonoids that boosts immunity.
Omega-3 fatty acids
Research has repeatedly shown that omega-3 fatty acids can improve immunity and reduce inflammatory diseases. Because SLE is classified as an autoimmune disease and characterised by arthralgia and acute polyarthritis, omega-3 fatty acids have an important role to play in alleviating these symptoms.
Eating fish regularly is an excellent way of boosting omega-3 intake, as mentioned above. The following are also good sources of omega-3 fatty acids, namely:
Fish oils (cod liver oil, tuna oil)
Plant oils (canola, soya and flaxseed oils)
Dark green, leafy vegetables (spinach, broccoli)
Omega-3-enriched foods such as eggs, milk and bread
Patients can also take salmon oil capsules as a supplement, which are available at chemists or health shops.
Increased intake of foods rich in dietary fibre help to lower the total fat content of the diet. Eat plenty of fresh fruit and vegetables, whole-wheat products, high-bran cereals, oats, brown rice, and legumes (dry beans, peas, lentils and soya).
Calcium and vitamin D
The requirement for both these nutrients may be increased by some of the medications that are used to treat SLE, for example anti-inflammatories and lipid-lowering medicines.
The best sources of calcium are dairy products. Use low-fat milk, yoghurt and cottage cheese to boost your calcium intake without increasing the amount of fat you eat. Patients can also use calcium supplements, e.g. Calcium Sandoz, Caltrate etc.
Vitamin D is manufactured in our bodies when we expose our skin to the sun, but patients with SLE are generally advised to avoid sun exposure. Vitamin D is found in milk and dairy products and some margarines, but it may be necessary for patients to take a supplement containing vitamin D. Supplementation should always be discussed with the prescribing doctor or dietician.
Vitamin A helps to boost immunity and keeps skin and mucous membranes healthy. It is found in egg yolk, liver, fatty fish, and cod liver oil. Dark green or dark yellow vegetables and fruit contain beta-carotene, which can be changed into vitamin A by the human body.
Good sources of beta-carotene include carrots, pumpkin, butternut, yellow sweet potatoes, spinach, broccoli, spanspek, mangoes, yellow peaches, pawpaw and apricots. Patients using low-fat milk and dairy products or lipid-lowering medications may require additional vitamin A. Because vitamin A is stored in the human body, excess intakes should be avoided, so don’t overdose on vitamin A supplements or cod liver oil.
Leafy vegetables and wholegrain cereals and bread contain some vitamin E. Probably the best sources of vitamin E in western diets are plant oils such as canola, soya and flaxseed oils. Vitamin E supplements may be required if patients are on lipid-reducing medication.
Folic acid is known to stimulate the immune system and patients taking anti-inflammatories and certain antimalarial medications to alleviate joint and skin symptoms, may develop a deficiency.
Fresh vegetables, especially broccoli, spinach, cabbage, and beans, peanuts and hazelnuts, wholegrain cereals and bread, brown rice, and liver are good sources of folic acid. Certain brands of bread and breakfast cereals are fortified with folic acid and can make a considerable contribution to daily intake.
Most multivitamin supplements contain folic acid or patients can buy separate folic acid tablets for their increased needs. The recommended dietary allowance for folic acid is 200 microgram a day, and the upper safe level is 400 micrograms a day.
Besides calcium, which was mentioned above, SLE patients also require additional magnesium, potassium, and selenium. SLE is one condition where excess zinc may play an aggravating role, so it may be advisable not to take supplements that contain very high levels of zinc.
As combined multivitamin and mineral supplements usually contain zinc, SLE patients should rather take a multivitamin preparation (to supply vitamins A, E and D, plus folic acid) and a separate selenium supplement (ask your doctor or chemist). Magnesium and potassium can usually be adequately obtained from the diet if you eat plenty of fruit and vegetables and unprocessed grains and cereals.
Foods that should be avoided
High-energy, high-fat foods – chips, cakes, pies, chocolate, fatty meat
Alfalfa tablets – these contain a compound called L-canavanine that may aggravate SLE
Excessive alcohol intake – limit your intake of alcoholic drinks to one or two on special occasions
In addition to these dietary tips, SLE patients should exercise regularly, but in moderation, and get plenty of rest, while avoiding excess sun exposure. – (Dr I.V. van Heerden, DietDoc)
Any questions? Ask DietDoc
SLE and diet