If it seems like everyone is talking about autoimmune disease, you’re not wrong: autoimmunity becoming a huge issue1,2,3. In Canada, the incidence of autoimmunity is growing at a whopping 7% per year1. While autoimmunity is talked about like a single disease, it is in fact a group of very different diseases and there is a lot of misinformation about how to tackle them. So let’s start by looking at lupus, and how anti-inflammatory nutrition can support healing. If there is another autoimmune condition you are interested in learning more about, please DM me on Instagram.
What is lupus?
The term lupus most commonly refers to a condition known as systemic lupus erythematosus, or SLE, which is marked by chronic inflammation that affects the kidneys, joints, skin, cardiovascular system and nervous system.
Lupus is an autoimmune condition, meaning that the immune system has become dysregulated and overactive, creating damage to a person’s own cells. As with most autoimmunity, it develops through an interplay between genetic predisposition and environment2. Stress, Western-style diet, inactivity, gut dysbiosis and infections such as Epstein-Barr virus and herpes have also been connected to autoimmune conditions such as lupus2-4. It is thought that viral infections might contribute to molecular mimicry that transfers autoimmunity to human cells; what this means is that fragments of viral or bacterial cells can look very similar to fragments of our cells – so the immune system gets confused and attacking our cells too. In one paper, it was claimed that the viral load in immune cells in someone with lupus is estimated to be10-40 times higher than someone without the disease3.
Women are overwhelmingly more at risk of developing lupus than men – 9 times more likely to be exact. It is thought that the immune-strengthening properties of estrogen play a role here, as well as the adaptability of our immune systems to accommodate pregnancy. Lupus is most commonly diagnosed between the ages of 15 and 45, meaning that isn’t just something that happens when you are older and less healthy. It’s also worth noting that lupus has been associated with medical silicones, an important reminder for women considering breast implants, or their removal3.
If you want to learn more about the disease, and its diagnosis, I encourage you to visit the Johns Hopkins Lupus site to learn more.
What is the best diet for lupus sufferers?
Our current, Western-style, hyper-processed eating pattern is associated with obesity and chronic inflammation, two risk factors that may predispose to autoimmune diseases such as lupus, but that aren’t the whole story2. We are also starting to look differently at how salt affects our immune system; our high salt diet has been hypothesized to play a role in immune T-cell regulation that might increase risk of autoimmunity like lupus2,5.
Now for the hard truth: there is no evidence-based gold-standard diet for lupus. It’s probably surprising to you…but in fact there are very few evidence-based gold standard diets in clinical nutrition. From an integrative nutrition perspective, I focus on the following factors when treating someone with autoimmunity:
- using the functional properties of food to support immune health and combat inflammation, such as omega 3 fatty acids for inflammation
- to ensure adequate nutrition for potential deficiencies or address risk factors from treatment, such as heart disease risk
- help prevent steroid-induced weight gain, high cholesterol or blood sugar issues in those taking the medications
Anti-inflammatory nutrition for lupus
When designing an anti-inflammatory diet, I am looking to include mostly whole plant foods which are high in vitamins, minerals and phytochemicals that help fight inflammation and support the immune system. I monitor the types of fat to ensure that more inflammatory fats such as saturated fat and omega 6 fatty acids are minimized. I also focus on fibre that helps feed gut bacteria and support the gut-immune axis.
However, in lupus, there are some classically anti-inflammatory foods which might not be beneficial as they may overstimulate the immune system.
What should you avoid in your diet for lupus?
While an incredibly immunosupportive food, and a top anti-inflammatory pick for others, the Johns Hopkins Lupus centre recommends you avoid it with lupus. It is thought that allicin, ajoene, and thiosulfinates in garlic may actually exacerbate an overstimulated immune system.
Likewise, Johns Hopkins Lupus centre recommends that you avoid alfalfa sprouts as they contain a substance called L-canavanine that may also overstimulate the immune system5.
Most of our sodium intake comes from hyper-processed and restaurant foods; by cooking with whole foods, your sodium intake will decrease. What’s more, hyper-processed foods tend to spike blood sugars and are inherently overeatable, which could contribute to weight gain and blood sugar issues.
Nightshades and Lupus
It has been suggested that food components such as lectins in nightshade vegetables, along with saponins in foods like quinoa and gluten in grains is responsible for the leaky gut that triggers autoimmunity4. However, it’s important to note that these foods have been a part of our diet for thousands of years…and our autoimmune epidemic is less than 100 years old. In addition, there are cultures that eat many nightshades where lupus is rare; epidemiological research has also found an association between high lycopene intakes and reduced mortality in SLE6. That being said, some people with lupus believe that nightshades – potatoes, tomatoes, eggplant, and others – make their symptoms worse. I would rule out all other potential causes before ditching nightshades but I also believe that if a food makes you feel bad, stop eating it.
Everyday Nutrition Tips for Lupus
The foundation of any healthy anti-inflammatory diet for lupus is plenty of fruits and vegetables. Try to make half of every plate fruits and vegetables at meal time. In addition to fibre, vitamins and minerals, the phytochemicals in fruits and vegetables really can’t be replicated in other foods or supplements. You’ve got to eat the whole food. Eat a variety of colours, because they all have their own benefits. For example, red foods like tomatoes contain lycopene, which has been associated with reduced mortality in lupus – but it was a small study…so don’t go drinking gobs of tomato juice as the evidence isn’t conclusive6.
Vitamin C may be important for disease outcomes, so consume plenty of vitamin C rich foods such as bell peppers, green vegetables, kiwis, berries, citrus and tropical fruits5.
Research suggests that selenium, zinc and copper might be low in those with lupus5,7. Eating more nuts and seeds can help boost your intake. ¼ cup of raw pumpkin seeds contains 1/3 of a woman’s daily zinc needs. Cashews are high in copper. And just one Brazil nut daily will give you a tasty way to ‘supplement’ selenium – please don’t overdo the Brazil nuts as too much selenium is actually dangerous.
I recommend getting as much turmeric into your diet as possible – aim for 1 teaspoon or more. Research on turmeric, and its active component, curcumin, shows it may improve inflammation and pain in lupus and support kidney health5,8,9.
Some research suggests that phytoestrogens from foods like soy or flax may also be beneficial5. If you’re wary of what you read on the internet about tofu, don’t fear.
I recommend making more of your protein choices plant-based, as this may help to reduce intake of saturated fat and protect the kidneys5. There are plenty of protein-rich plants to choose from, so start experimenting with them in your favourite recipes.
Do your best to avoid refined flours and sugars with lupus; this will help you keep your blood sugars in balance, support a healthy gut flora and decrease inflammation.
Lupus and Gut Health
It is well established that alterations in the gut flora, or microbiota, can impact immune function2,4. Because of the prevalence of autoimmunity in affluent countries, it is thought that the hygiene hypothesis may play a role2,4. This theory states that because we live in overly clean and sanitary environments, our bodies may lack the necessary exposure to less harmful microbes that positively influence the development of the nervous system. Instead, when faced with potential infections, the immune system overreacts and the becomes dysregulated, encouraging autoimmunity2,4. Research has clearly demonstrated vast differences in the gut microbiota of children living in affluent versus less affluent nations4.
Gut barrier dysfunction, or leaky gut, has been suggested as a core concern in autoimmunity because of the potential for endotoxins from gut microbes to enter the circulation and trigger immune responses4,10. What’s more, intestinal dysbiosis, which is an abnormal balance of bacteria in the gut, has been suggested in lupus11. Our high fat diets, coupled with high sugar intake, can increase gut barrier dysfunction and cause overgrowth of more harmful bacterial species that might leak into the circulation4. In animal studies, lupus has been associated with decreased gut barrier function; in one pilot level human trial, researchers found the livers of people with lupus to contain Enterococcus gallinarum, a bacteria associated with the development of lupus in the animal model10.
Eating a whole food, plant-based diet will help you get the 25g of fibre women need daily (it’s 38g for men) – and that fibre will feed gut bacteria to support gut health in addition to improving inflammation and supporting heart health5. Taking probiotic may also be supportive.
Should you go on a gluten free diet for lupus?
Lupus and celiac disease can co-exist; if you have not been tested for celiac disease, I strongly recommend it. Without celiac disease, avoiding gluten is highly controversial. The current evidence doesn’t support going gluten free; however, with the potential for gut barrier dysfunction and connection between celiac disease, hypothyroid and lupus, I wouldn’t rule it out for a client. This becomes a decision between you and your care team. Of course, if not eating gluten makes you feel better – then you don’t need a study to tell you that.
Should you go on a vegan diet for lupus?
If you are passionate about moving towards a totally plant-based diet, I’m all for it. There are many reasons why a whole food, plant-based diet may be supportive of improving your symptoms – from fibre for a healthy gut to an abundance of anti-inflammatory phytochemicals and a reduction in animal protein and fat. If you are interested in going plant-based, always see a dietitian to help you create a balanced dietary strategy so you feel energized and are getting all of the nutrients you need.
Nutritional supplements for lupus
It could be really easy to over-supplement in auto-immunity. Well-meaning practitioners might give you an assortment of options to support gut health, immune health, bone health or fight acne…leading to a cupboard full of pills that might not actually be helping that much. So let’s take a look at what you really need to watch for – and where the better choice is a supplement, real food, or both.
Zinc is a mineral that is typically associated with protein in foods; it may help combat acne and support gut barrier integrity and immune function. Zinc has been noted to be low on those with SLE7; however, some suggest that zinc intake should be monitored closely5. For this reason, talk to your health team about zinc. I recommend increasing your intake of zinc-rich plant foods, like nuts and seeds, which tend to have lower levels than animal sources to achieve adequate but not excessive intake unless recommended otherwise.
Autoimmunity is associated with vitamin D deficiency3; while many of us think of vitamin D for bone health, it is also an immunomodulator that most of us who live in temperate climates are insufficient, or deficient in. If it is available to you, I recommend getting your vitamin D levels tested so your doctor can prescribe high dose vitamin D if necessary. In the absence of testing, 2000-4000IU of vitamin D daily is a safe choice. More is not better; while you want to fight deficiency, vitamin D supplementation has not been shown to improve disease outcomes yet in the research5. Talk to your doctor about vitamin D if you have any condition that puts you at risk of high calcium in the blood.
Omega 3 Fatty Acids
Omega 3 fatty acids have decades of research to suggest that they are an important part of an anti-inflammatory diet. Research also suggests benefit in lupus, sometimes at very high doses that may not be feasible or safe without a doctor’s supervision12. For this reason, I recommend daily intake of omega 3-rich seeds: 2-3 tablespoons of hemp seed, or ground flax or ground chia daily. If you consume fish, eat small, low mercury omega 3 rich fish such as herring, mackerel, salmon and sardines twice a week. Omega 3 fatty acids will also support heart health, which is important in lupus.
On top of this I recommend that you take an omega 3 supplement that is high in both EPA and DHA. Use a high potency formula, like NutraVege Omega3 Plant 2x and aim for at least 1g of EPA to support heart health and calm inflammation. If you are at risk of bleeding, or are on blood thinning medications, talk to your doctor before beginning omega 3 supplementation. Food sources are always safe.
Also, note that The Johns Hopkins Lupus centre recommends avoiding both melatonin and echinacea, which may overstimulate the immune system.
Inflammation can place bones at risk; what’s more, steroids for lupus can make your bones even more vulnerable…so getting adequate calcium and vitamin D is critical. If you can, I recommend getting your calcium daily from food. If you are dairy free, you can still get your calcium. If you choose to supplement, I recommend no more than 500mg of calcium daily.
Turmeric and its active, curcumin, has been researched for reducing inflammation and pain in lupus as well as kidney protection; doses range from 100-200mg to upwards of 2g5,8,9. Start with food first and then talk to your team about supplemental turmeric.
Because of how important gut health is to autoimmunity, I would consider a probiotic. Take care when choosing a probiotic, as many of them are all marketing with little clinical benefit.
Can you heal lupus with diet?
There is no cure for lupus; however, I am always very positive about what life can look – and feel – like with chronic autoimmunity. In my practice, I see the power of intelligent nutrition to help minimize pain and symptoms so that you can have more good days, good weeks and good years. Lifestyle change takes sustained effort; so stay strong and never give up, Feeding yourself well is always a good idea…but finding the exact balance of nutrition that helps you feel your best may take time. I highly recommend sitting down with an integrative dietitian 1 on 1 to get personalized nutrition advice.
1.Lerner, Aaron, Patricia Jeremias, and Torsten Matthias. “The world incidence and prevalence of autoimmune diseases is increasing.” Int J Celiac Dis3.4 (2015): 151-5.
2.Manzel, Arndt, et al. “Role of “Western diet” in inflammatory autoimmune diseases.” Current allergy and asthma reports14.1 (2014): 404.
3.Campbell, Andrew W. “Autoimmunity and the gut.” Autoimmune diseases 2014 (2014).
4.Rook, Graham AW. “Hygiene hypothesis and autoimmune diseases.” Clinical reviews in allergy & immunology 42.1 (2012): 5-15.
Constantin, Maria-Magdalena et al. “Significance and impact of dietary factors on systemic lupus erythematosus pathogenesis.” Experimental and therapeutic medicine vol. 17,2 (2019): 1085-1090. doi:10.3892/etm.2018.6986
Han, Guang-Ming, and Xiao-Feng Han. “Lycopene reduces mortality in people with systemic lupus erythematosus: A pilot study based on the third national health and nutrition examination survey.” Journal of Dermatological Treatment27.5 (2016): 430-435.
Sahebari, M., et al. “Association between serum trace element concentrations and the disease activity of systemic lupus erythematosus.” Lupus23.8 (2014): 793-801.
Handono, Kusworini et al. “Treatment of low doses curcumin could modulate Th17/Treg balance specifically on CD4+ T cell cultures of systemic lupus erythematosus patients.” Central-European journal of immunologyvol. 40,4 (2015): 461-9. doi:10.5114/ceji.2015.56970
Gupta, Subash C., Sridevi Patchva, and Bharat B. Aggarwal. “Therapeutic roles of curcumin: lessons learned from clinical trials.”The AAPS journal15.1 (2013): 195-218.
Rosenbaum, James T., and Gregg J. Silverman. “The microbiome and systemic lupus erythematosus.” New England Journal of Medicine378.23 (2018): 2236-2237.
Hevia, Arancha et al. “Intestinal dysbiosis associated with systemic lupus erythematosus.”mBiovol. 5,5 e01548-14. 30 Sep. 2014, doi:10.1128/mBio.01548-14
Arriens, Cristina, et al. “Placebo-controlled randomized clinical trial of fish oil’s impact on fatigue, quality of life, and disease activity in systemic lupus erythematosus.” Nutrition journal14.1 (2015): 82.