Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory, multisystem, relapsing-remitting autoimmune disease. Its progression differs in individuals and may even be unpredictable within the same patient over time, making it a challenge to manage.
SLE prevalence worldwide exceeds 50–100 per 100,000 depending on ethnicity, with the highest in African, Hispanic, Chinese and Asian descendants. SLE is significantly predominant in females.
Clinical Features:
SLE can affect virtually every organ and system in the body. In mild forms, the joints and skin maybe affected. In moderate forms, vessels, central nervous system, adrenals, bones and muscles, but it is severe when kidneys and heart tissue damage occurs. Lupus nephritis develops in around 50% of patients and can progress to end-stage kidney disease in 10%.
SLE can be difficult to diagnose and often takes time as symptoms such as fatigue, rashes, fever, joint & muscle pain and headaches may look similar to other diseases. An internationally accepted classification criteria has now been established for SLE and the presence of anti-nuclear antibody (ANA) is obligatory.
Conventional Treatments
Treatment of SLE usually depends on the organ and systems involved and severity of disease. Hydroxychloroquine, corticosteroids, nonsteroidal anti-inflammatory drugs and immunosuppressants are often used, but have many side effects.
Causes:
The precise cause is not confirmed, but a complex interaction between genetics, hormones and environmental triggers over time is suggested to cause the breakdown of immune tolerance and autoantibody production in SLE patients.
There have been a number of studies linking a disturbed equilibrium (dysbiosis) in the microbiome of the gut and oral cavity in SLE. In particular, one study of SLE patients identified lower microbial diversity and higher proportions of bacteria; Prevotella, Fretibacterium and Selenomonas. Streptococcus, Campylobacter and Veillonella bacteria have also been positively correlated with the microbiomes of SLE patients.
Other findings:
Significantly low levels of serum vitamin D are observed in SLE patients. Sun exposure can often make SLE skin symptoms irritated.
More than 80 risk genes for the disease have been studied.
Oestrogens may increase disease risk and trigger flares. Hormone replacement therapy, early menarche, menstrual irregularities and early or surgical menopause have all been implicated.
Many viruses have been linked to SLE including Epstein–Barr virus, Cytomegalovirus, Parvovirus B19 and Rotavirus.
Environmental Factors - ultraviolet radiation, smoking, silica, sedentary lifestyle, stress and medications show well-established linkages to SLE. At least 118 medications have been associated with induced SLE e.g. procainamide, hydralazine.
What is the Immune system doing in Lupus?
It is complex and will be different in every individual, but some common themes:
Dysregulation of the inflammatory response
Production of multiple autoantibodies (eg ANA, dsDNA and anti-Sm)
Impaired clearance of nucleic acids and cell debris
Impaired T regulatory cells, and other T-helper cells (TH17/TH1)
Enhanced type I Interferon (IFN) response
Abnormality in B cell tolerance
Immunocomplex formation and deposition causing progressive organ damage
What does the science say about nutrition & lifestyle interventions?
Studies in SLE are scarce for natural interventions to date when compared to other Autoimmune conditions and have been conducted mainly on experimental models of the disease. However, some interesting findings:
Diet - In a recent study, SLE patients who changed their eating patterns to incorporate more plant-based foods while limiting processed foods and animal products reported improvements in their symptoms. The greatest decreases in symptom severity were provided by low/no dairy (27.1% decrease), low/no processed foods (26.6% decrease) and vegan (26% decrease) eating patterns. Weight loss, fatigue, joint/muscle pain and mood were the most cited symptoms that improved.
Vitamin D - supplementation in SLE patients equal to or greater than 2000 IU/day was associated with decreased inflammatory cytokines and inflammatory blood markers.
Microbiome - Studies demonstrate significant changes in the bacterial microbiome of lupus patients. There is evidence supporting the existence of a leaky gut in lupus patients and in lupus-prone mice. This leaky gut may allow live bacteria or bacterial components to enter the circulation and cause inflammation. Invasive bacterial infections are more common and often more severe in lupus patients. Nutritional interventions to support leaky gut and microbiome should be considered.
Selenium - A study showed approximately, 50% of adolescents with juvenile SLE had below reference Selenium levels. Selenium levels should be assessed in SLE patients.
Curcumin - The natural polyphenolic compound, curcumin, found in turmeric modulates defective immune cells and pro-inflammatory cytokines in SLE.
Fish Oil - Several clinical studies report dietary supplementation of EPA or fish oil may reduce disease activity of SLE or prolong the remission period.
Sleep - A meta-analysis indicates sleep quality of SLE patients is worse than that of the general population; thus, more attention should be paid to the sleep status.
Exercise - Results of a study showed that a lifestyle change of consistent exercise could restrict disease pathology in Central Nervous System lupus.
Personalised Nutrition & Lifestyle interventions in SLE : A Case Report
Due to the complexity of Lupus, a personalised nutrition and lifestyle approach comes into its own, rather than following general diets or protocols. Below is a published case study example:
'A 63-year-old male, with a four year history of SLE, safely and successfully integrated personalised nutrition and lifestyle modifications to improve the symptomatic outcome of his SLE. He safely used a variety of nutritional interventions and supplementation, including dietary improvements, omega-3 fish oils, N-acetyl cysteine, prebiotics, intermittent fasting and stress reduction.
His symptoms decreased significantly or disappeared over four years of nutritional interventions. This case demonstrates the safety and potential usefulness of personalised nutrition, stress reduction techniques and targeted supplementation in helping decrease symptoms of SLE. Energy levels and overall performance improved, skin rashes and acid reflux resolved, joint pain and stiffness decreased, and brain fog gradually lessened over the four years'. (Ref: http://dx.doi.org/10.2139/ssrn.3743841)
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