Cecilia Lourdudoss, Ph.D. student at the Unit for Research Therapy, Inflammatory Diseases (ClinTRID), Karolinska Institutet in Stockholm, Sweden, spoke with the Lupus Foundation of America recently about her latest research findings on the association of diet and steroid use in people with lupus, published in Lupus Science & Medicine.
In this study, vitamin D was not found to be associated with decreased lupus activity (fewer flares) as previous studies have indicated. However, other nutrients were found to potentially protect against increases in disease activity. More research is needed to confirm these findings. Nevertheless, it is important for people with lupus to eat a nutritious, well-balanced, and varied diet that contains plenty of fresh fruits and vegetables, whole grains and fatty fish, as well as moderate amounts of red meat.
What was the purpose of your study?
The purpose of this study was to see if the type of diet in patients with lupus and steroid treatment are related.
Why was steroid use an indicator of disease activity in your study? Steroids are used during active lupus or lupus flares. They are either initiated or increased in dose when patients’ lupus becomes active. Therefore, we considered steroids as a good substitute for lupus activity.
What were the key findings in your study?
This study found that:
- Contrary to other findings, increased vitamin D intake did not associate with decreased lupus activity; however, the study did not look at vitamin D intake from sunlight, where the majority of people get their vitamin D.
- Beta-carotene (found in dark green, orange and yellow vegetables and fruits), an omega-6 fatty acid (found in vegetableoils, nuts, seeds and animal products) and vitamin B6 (found in fortified cereals, beans, poultry, fish, and some vegetables and fruits) were ‘negatively’ associated, meaning they may protect against increases in steroid dose; and
- Higher steroid dose levels indicated increased appetite.
What do your findings mean regarding alcohol intake for people with lupus? Should people with lupus consider consuming alcohol moderately?
We would always be very cautious about recommending alcohol consumption given the risks associated with inappropriate or excessive alcohol intake. Our findings show that alcohol intake was associated with no steroid use. However, this does not clearly indicate that increased alcohol intake gives a protective effect to avoid steroid use. To give out recommendations regarding alcohol intake, our results need to be confirmed in a larger group of lupus patients, and in comparison with several other studies with similar results.
Why do you think these findings differ from other studies examining vitamin D consumption in lupus?
Our study looked at vitamin D obtained from the diet. Most other studies in this area have looked at vitamin D in serum or obtained from supplements. It is important to remember that vitamin D obtained from the diet does not always reflect the total vitamin D intake as the majority is obtained from sunlight.
In your study, steroids were found to be associated with increased energy (calories from food) intake. What do you recommend to people with lupus to prevent or decrease the amount of weight gain caused by steroids?
It is common to gain weight during steroid treatment. Lupus patients taking steroids during longer periods may have an advantage of maintaining their original weight. Increased body mass index (or BMI – a measure of body fat based on weight and height) is associated with cardiovascular disease, worse lipid profile (the pattern of cholesterol in the blood) and poorer quality of life in people with lupus. A good way to decrease the total caloric intake is to consume more of low energy, dense foods such as vegetables and fruits and to decrease/avoid certain energy, dense foods such as soda, chips, candies, chocolate and processed meat. In addition, physical activity, as much as your lupus symptoms allow, can be beneficial.
What are the next steps in this study? Are more studies planned? We have recently submitted another manuscript about the link between diet and atherosclerosis (hardening of the arteries) in people with lupus. In addition, we are currently working on three other projects focusing on dietary aspects in patients with rheumatoid arthritis (an autoimmune disease that causes pain, stiffness, inflammation, swelling, and sometimes destruction of joints).
So, should someone with lupus be following a specific diet or nutrition plan? For most people, the answer is “no.”
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Date prepared: March 2016
Summary based on research article published on: 19 January 2016.
From: Lourdudoss C, et al. The association between diet and glucocorticoid treatment in patients with SLE. Lupus Sci Med 2016;3:e000135 doi:10.1136/lupus-2015-000135
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