From the National Magazine

Lupus & Diet

Louise Noble
State Registered Dietician in Hampshire.

Louise is a very experienced dietician who has an interest in lupus having followed the progress of her friend who has had lupus over the years.

Louise has undertaken a search on diet and lupus, and apart from a useful review paper she found only two papers, on diet and lupus in mice! However, a considerable amount of research has been done on related conditions.

Fats
The body responds differently to different types of fats. There is some evidence that certain types of fats have an effect on immune responses, which may be relevant to autoimmune diseases such as lupus.

Saturated fats - her advice is to cut down on saturated fats (generally animal foods) eg visible fat should be cut off meat. Low fat diary products should be chosen and we should try to cut down on processed foods such as cakes, biscuits, pies, pastry etc. that are high in fat. Takeaway meals such as fish and chips, pizza, Chinese and Indian food are often high in fat so have these as occasional treats.

Polyunsaturated fats are divided into two groups. Sunflower oil, corn oil and polyunsaturated spreads made from these oils are better than saturated fats but should not be taken in excess, especially in inflammatory disease. Polyunsaturated fats can become saturated when heated to excess, so an excess of crisps and fried foods should be avoided even if cooked in these oils.

Some polyunsaturated fats are very good for inflammatory disease such as oily fish (usually with brown or pink flesh such as trout, mackerel, tuna (fresh better than tinned) and fish oil (pure fish oil is better than fish liver oil from white fish such as cod). Research shows that they are beneficial in inflammatory diseases such as rheumatoid arthritis and psoriasis as they dampen down the immune response. They can be taken in capsules. Fish oil capsules with evening primrose oil (epa +gla) are very good including supermarket own brands. Its generally best to avoid those fortified with vitamins A and D as few people need more of these vitamins.

Sunlight is the bodys main source of vitamin D. However, you only need to expose your hands and face to the sun for about 20 minutes a day between April and September to get enough so supplements should not be necessary unless otherwise advised by your consultant.

Cholesterol
If a high cholesterol level is found in lupus it is probably a result of the disease rather than a high cholesterol intake in food. Eggs have received a bad press, but they can be eaten in moderation as the amount of cholesterol in them is negligible compared to the amount made naturally in the liver. The general dietary advice for someone with a high cholesterol level is to cut your fat intake, concentrating on reducing saturated fats and replacing them with moderate amounts of polyunsaturated and monounsaturated fats.

In moderation, monounsaturated fats such as olive oil (and spreads) and nut oil play a role in reducing the incidence of heart disease and are a better choice than butter or other margarines or oils.

Protein
Although huge portions of protein are not thought to be good, there is no real evidence that a vegetarian diet is necessary. Protein foods include meat, fish, eggs, cheese, nuts and pulse vegetables (beans, peas and lentils). Vary the type of protein at your meals to ensure that you get the full range of other nutrients (vitamins and minerals). Choose lean meat and remember that it is an important source of minerals such as iron and zinc and some vitamins including vitamin B12. If you cut out red meat, make sure you include other sources of these nutrients including fortified breakfast cereals, green leafy vegetables and pulses. About 3oz protein for a main meal and 1oz for a light meal is a good guide.

Starch
Approximately 1/3 of the diet should be starch e.g. bread, pasta, rice, potatoes or breakfast cereals. As with the protein foods, variety is the spice of life. It is especially important to stoke up on starch e.g. toast or cereals for breakfast at the start of the day.

There is no evidence that there is an increase in intolerance to wheat despite media messages and the increasing number of people on a wheat free diet. A very few people have Coeliac disease and have to avoid all gluten, but this can be definitively diagnosed by an intestinal biopsy.

Fruit and Vegetables
Approximately one-third of the diet should be fruit and vegetables. Try to include at least 5 portions a day, not counting potatoes. Frozen vegetables are just as nutritious as fresh, whose nutritional value deteriorates on storage. A few people with arthritis react badly to acid foods such as pickles and citrus fruit, but most dont, so unless you react badly dont cut them out.

Allergy and food intolerance
Research (double blind randomised controlled trials) shows that true food intolerance is quite rare but mind over matter can cause some people to believe that they have food intolerance. True food allergy is rare and normally dramatic eg peanut allergy causing anaphylactic shock and collapse.

Tests often show a slight immune response to proteins, but this may be a normal response of the body to foreign material and nothing to be concerned about. None of the tests currently available is sufficiently specific or sensitive to have gained the confidence of trained dieticians.

Occasionally the natural bacteria in the digestive system can be temporarily disturbed, for instance after taking antibiotics, and people have a short-term intolerance to foods such as milk, but this is only temporary and attempts should be made to reintroduce the foods.

Some foods e.g. live yoghurts encourage the growth of the healthy bacteria in the gut. Avoid excess sugars and yeast until the digestive system returns to normal.

If you feel that you have a food allergy or intolerance, be careful that you dont put yourself at risk of a lack of specific vitamins or minerals by cutting that food out. For example cutting out all dairy products can result in a lack of calcium and increased risk of osteoporosis.

If you are concerned, ask you doctor to refer you to a State Registered Dietician (SRD) for advice. Also start keeping a food and symptom diary so you can clearly document the effects of including or avoiding certain foods. The dietician will almost certainly ask you to do this.

Irritable Bowel Syndrome (IBS)
This is common in lupus. It is often linked with stress, inadequate fluids and poor eating habits e.g. missing meals, not eating slowly enough or dashing about after a meal. Attention to these works for many people. Chewing gum, fizzy drinks and caffeine containing drinks can cause some IBS symptoms.

Other tips are to eat regular meals and to spread fibre foods throughout the day rather than having a huge helping of bran in the morning. Too much fibre will cause constipation if you dont drink enough, so if this is a problem, make an effort to drink more water and see what happens over the next couple of weeks. Be aware that symptoms do not resolve overnight.

IBS can be linked with food intolerance, although we dont know if this is cause or effect and again it can be a perceived reaction rather than a real one. However, exclusion diets can cause more problems than the IBS. Always ask yourself is the diet worth it? And ask to see a dietician to be sure you dont put yourself at nutritional risk.

Fluid intake
As with anyone, aim to drink about 2 litres of fluid per day. Water is the best thing to drink but caffeine is not too much of a problem for most people, so 4-5 cups of tea or coffee a day would be okay. Tea contains modest amounts of antioxidants, which have been found to be beneficial. Beware of tooth decay with too much fruit juice.

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