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Diet and lupus

We receive numerous questions about what sort of diet a lupus patient should follow and whether there are any foods they should avoid. This article by Dr. David D'Cruz will hopefully answer some of these questions:-

Many patients with lupus are concerned that a strict diet may be necessary to help their condition. Infact our general advice is to have a broad general and nutritious diet with perhaps a slightly increased intake of oily fish such as mackerel, sardines and salmon and perhaps a little less red meat. The only food that should be avoided is alfalfa sprouts as this may cause lupus to flare. It would be sensible to keep within the recommended calorie intake, which is roughly 1,900 calories per day for women and 2,500 calories per day for men. These figures are based on adults with a sedentary lifestyle wishing to maintain their current weight.

The risks of obesity are well known and include a higher risk of heart attacks, cancer and strokes. Lupus patients have a higher risk of cardiovascular problems such as strokes and heart attacks. It is therefore even more important for lupus patients to try and maintain a healthy weight.

Patients on corticosteroids such as prednisolone often gain weight which may be very difficult to shift even on reducing the prednisolone. Steroids are known to upset cholesterol levels and blood sugar levels increasing the risk of diabetes. Furthermore blood pressure may rise both with the steroids and associated weight gain. We have recently conducted a pilot study to test the effects of a standard calorie controlled diet, that is usually recommended from the dieticians department, compared to the low glycaemic index diet that is now very fashionable.

The principle of the low glycaemic index (GI) diet is that certain foods increase the blood sugar very rapidly as these sugar containing foods are easily digested. Thus low GI foods would include proteins such as fish and meat as well as vegetables and certain fruits such as strawberries. High GI foods would include any foods containing refined sugars such as biscuits, many breakfast cereals and sweets. Paradoxically dark chocolate which contains very little sugar may be taken in moderation. By keeping to low GI foods, weight loss can be achieved.

Our results showed that both diets were well tolerated by lupus patients on long term steroid tablets and both groups of patients lost significant amounts of weight ranging from 2 - 4 kg. Very few side effects were reported by the patients. One striking advantage of both diets was that severe tiredness improved significantly with the weight loss. One concern of the higher protein intake with the lower GI diet would be that cholesterol and blood pressure levels might be upset. However this was not the case and cholesterol levels remained the same as did blood pressure.

The low GI diet represents a significant advance over the Atkins diet since the GI diet does not prohibit foods such as carbohydrates as with the Atkins diet. For patients on steroids who are finding it difficult to shift the weight gain it would seem reasonable to consider a low GI diet. We are in the process of applying for a grant to broaden our diet study for a longer period of time as this pilot study was only 6 weeks long.

In summary there are considerable benefits to losing weight in lupus - not least being the considerable improvements in tiredness that are such a major problem in patients with lupus. Keeping to a healthy weight will also minimise the risk to cardiovascular health that is increasingly important in lupus patients.

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