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A Review of Dietary Micronutrients in Autoimmune Systemic Lupus

Updated: Sep 28, 2022

Introduction to the Origins of SLE

Systemic Lupus Erythematosus (SLE) is an autoimmune condition which may effect multiple organ systems. In terms of etiology, autoimmune diseases, including SLE, are very complex and multifactorial. Environmental and epigenetic factors are likely to be in a complex dance with genomic factors. Known environmental factors that may contribute to the onset of autoimmunity in general include, but are not limited to, emotional stress; microbial infections; gluten and other food sensitivities; nutrient deficiencies; and, of course, environmental toxins. [1-5] This last category includes an endless list of industrial-age chemicals in use today, with glyphosate (Roundup) and vaccine additives arguably receiving the most public scrutiny in our current times. Interestingly enough, these are likely to be the same environmental risk factors that contribute to cancer, heart disease, diabetes, PCOS, autism, mood disorders, IBS, chronic respiratory diseases, osteoporosis, chronic kidney diseases, and the vast majority of the remaining chronic conditions on the market today, in which have increased exponentially since the advent of the industrial revolution.


If not properly addressed, over time these environmental factors most likely lead to an unattended state of chronic inflammation and oxidative stress with some combination of gut-related changes, such as dysbiosis and leaky gut, [6-9] in conjunction with additional hormonal, metabolic, and immune system imbalances, ultimately leading to the spectrum of chronic disease, of which SLE is just a needle in a haystack. Which specific chronic condition and at which phase of life that an individual is afflicted with said condition is where the concept of biochemical individuality comes into play, with genetic and environmental factors leading the pathophysiological process.


It is often very difficult for a practitioner to pinpoint the exact cause of SLE for a specific client since there are so many contributing factors. However, sometimes the client themselves may identify a specific triggering event to which they did not have the condition before this time. It is very helpful when a practitioner receives one of these clues which can then be used when considering the treatment approach. The main treatment strategy for SLE by the conventional medicine practitioner will usually be limited to control of symptoms with pharmaceutical drugs such as corticosteroids and monoclonal antibodies.


On the other hand, whether alongside or independent of your conventional care, the functional medicine practitioner will do a deep investigation to try and address all possible root causes of the disease. In the functional clinic, the client will undergo an educational process. Over time, transformation and implementation of lifestyle factors and behaviors, such as dietary changes and gut-healing protocols, often lessens the severity of SLE symptoms for many clients. Complete reversal of SLE (and many other autoimmune conditions) is sometimes possible, but is by no means an easy process. Achieving remission of an autoimmune process requires great guidance on the part of the functional practitioner, as well as treatment protocol compliance and, arguably more important, a healing mindset on the part of the client.

The ultimate defining factor in autoimmune disease is that the immune system has become defective and loses the ability to distinguish self from non-self. In other words, the cells of the clients immune system become ramped up and begin to attack its own body. Exactly which organ system or systems get attacked is rather unique in each client. Given that good gut health is intimately linked to a properly functioning immune system, it is very probable that all SLE clients have one or more gut-related conditions. The most common of these gut-related conditions is gut dysbiosis and intestinal permeability, also known as leaky gut. Dysbiosis refers to an altered gut microbiome in which there is a loss of microbial diversity, with increased levels of pathogenic microbes and decreased levels of keystone species (i.e. the most beneficial and health-conferring microbes). Leaky gut is a state in which integrity of the intestinal lining becomes compromised, allowing toxins, undigested food particles, and microbes to abnormally flow from the gastrointestinal tract into the circulatory system. [10-11]


Sufficient micronutrient intake is always critical to consider in maintaining quality health and wellness.

Let's take a look at some recent research regarding how functional nutrition and the food-as-medicine approach may play a role in management of SLE.


Water-Soluble Vitamins

Vitamin C is an important nutrient for SLE clients due to its antioxidant and anti-inflammatory effects, as well as its ability to lower the anti-double-stranded DNA autoantibody and IgG levels. Vitamin C helps to lower the risk for potential cardiovascular complications. In one four-year study, vitamin C intake at low-moderate dosage (~110 milligrams per day) was associated with lower risk of active disease in SLE. In another study, 500 milligrams per day for 12 weeks resulted in decreased lipid peroxidation in individuals with SLE, indicating improvements in oxidative stress.


Quality food sources of vitamin C include kiwi, citrus fruit (oranges, tangerines, grapefruit, lemons, limes), papaya, strawberries, sweet red peppers, broccoli, and Brussels sprouts. If unable to eat sufficient amounts of these foods, individuals with SLE may want to consider supplementing with at least 500 milligrams of vitamin C per day. According to the orthomolecular folks, when the body is under stress, for example, the way it is under stress with an autoimmune process occurring, higher levels of vitamin C of up to 10,000 grams per day, or to bowel tolerance, may be warranted.


The vitamin B complex has been shown to lower triglyceride and low-density lipoprotein (LPL) cholesterol levels and may also improve clinical symptoms in SLE. Some studies have suggested that individuals with SLE were deficient in some of the B vitamins and one study showed that even low-moderate intake of B6 (1.7 milligrams per day of pyridoxine) was associated with decreased SLE disease activity. Quality sources of B-complex vitamins include red meat, liver, eggs, sardines, chicken, salmon, nuts, bananas, avocados and some fortified cereals and grains. [12-14]

Fat-Soluble Vitamins

Retinoic acid, one of the active metabolites of vitamin A, not only has cancer-fighting properties, but may also help to inhibit inflammation and reduce autoantibody levels, which are both important clinical parameters in SLE. Animal sources that are rich in vitamin A include beef liver, cod liver oil, eggs, butter, and milk while plant-based sources include carrots, pumpkin, sweet potato, cantaloupe, mango, butternut squash, broccoli, and some fortified cereals and grains. In general, the upper intake level for animal-sourced and supplemental forms of vitamin A is said to be about 10,000 IU (3000 ug RAE) per day to avoid potential toxic effects which may occur as a result of high doses over the long term. High dose vitamin A supplementation is especially contraindicated for pregnant women due to potential fetal toxicity.


Vitamin D is particularly important in people with autoimmune conditions, including SLE, since this vitamin plays roles in maintaining immune system homeostasis. Vitamin D deficiency may be a risk factor for SLE and autoimmunity in general. People with SLE had a higher rate of vitamin D blood levels below 30 nanograms per milliliter of blood compared with healthy individuals. While exposure to sunlight is a great source of vitamin D, some SLE clients may have to limit sun exposure if the symptom of photosensitivity becomes bothersome. For those individuals whom cannot achieve daily sun exposure (those with severe photosensitivity, living in northern climates, etc.) supplementation of vitamin D at a minimum of 2000 international units (IU) per day may be warranted.


Vitamin E works synergistically with both omega-3's and vitamin C and could be supplemented up to 800 IU per day. Quality sources of vitamin E include olive oil, sunflower seeds, peanuts, tree nuts (almonds, pecans, hazelnuts, etc.), avocado, spinach, and asparagus. Additional vegetables oils may have high vitamin E content, but choosing a high quality organic vegetable oil is critically important because most vegetable oils on the market today are of extremely poor quality and may be more harmful than beneficial. I look forward to performing a deep dive on fats and oils in the near future. [12-14]


Minerals

Selenium is an element that has both antioxidant and anti-inflammatory effects. One of the greatest sources of dietary selenium comes from Brazil nuts. Additional food sources include tuna, salmon, halibut, oysters, clams, shrimp, crab, pork, beef, chicken, eggs, ricotta cheese, and other mixed nuts.


Dietary calcium should be considered in maintaining bone density since this is a common comorbidity in clients with SLE and autoimmunity. Calcium may be acquired from yogurt, milk, cheese, sardines, bok choy, figs, white beans, and tofu that is prepared with calcium. Supplementation of calcium should not be in isolation, but should be in the form of full-spectrum supplements which also contain appropriate levels of other bone-building nutrients including vitamins D, K2, delta and gamma tocotrienols (these are specific forms of vitamin E), the elements magnesium, boron, and vanadium, as well as genistein and collagen peptides.


Iron supplementation is likely only needed in certain clients such as those that have been tested for low iron levels or in individuals that do not receive enough iron from the diet (e.g. vegans). SLE clients with renal impairment should pay closest attention to iron intake levels since too much iron may cause additional stress to the renal system. Foods with excess sodium should be avoided because sodium may also exacerbate renal dysfunction. Processed foods and canned foods tend to be higher in sodium so individuals that follow a whole-foods-based and anti-inflammatory diet such as the Paleo- or Mediterranean-style diets should not have too much of problem there.

While zinc is clearly a very critical element involved in many metabolic processes and needed for immune system functioning, too much zinc may be contraindicated in SLE. One study showed that decreasing zinc levels actually resulted in improved SLE symptoms and reduced levels of anti-double-stranded DNA autoantibodies, an important clinical marker for SLE clients. Dietary zinc should not be excluded, but supplementing with zinc may be contraindicated for this reason, perhaps with the rare exception of fighting off the occasional upper respiratory cold or flu. [12-14]


Polyphenols

Although under-studied in the literature, it is known that polyphenols are an incredibly important class of plant-based compounds that are most highly concentrated in fruits, vegetables, tea, coffee, dark chocolate, red wine, and certain nuts. Polyphenols have many immune-supportive roles including their beneficial impact on the gut microbiome.


Flavonoids are the largest class of polyphenols (there are 5000~6000 flavonoids classified to date) and are well-described as having antioxidant, antimicrobial, anti-inflammatory, anti-aging, and anti-cancer properties. Foods that are high in flavonoids include, but are not limited to, berries, oranges, apples, watermelon, kiwi, lettuce, asparagus, broccoli, celery, spinach, green beans, white beans, tomatoes, lentils, walnuts, tea, and red wine.


Michael Joseph of Nutrition Advance performed a very comprehensive review of the 100 foods highest in polyphenols, which conveniently helps to summarize many of the findings of the Phenol-Explorer database. Isoflavones, one subclass of flavonoids, have estrogen-like properties, anti-inflammatory and antioxidant effects, they decrease proteinuria levels, and they may reduce autoantibody levels. Isoflavones are found in soy beans, black beans, olive oil and certain cereal products.


Curcumin is one specific polyphenol that comes from the Curcuma longa plant, also known as the turmeric spice. Curcumin is a powerful anti-inflammatory by modulating pro-inflammatory cytokines, adhesion molecules, and C-reactive protein, which may help in reducing pain. Curcumin also has antioxidant, antibacterial, hypoglycemic, and wound healing effects. Low therapeutic dosages start at about 100~200 milligrams per day, but curcumin safety has been established up to about 12 grams per day. One major contraindication for high-dose curcumin would be for individuals taking blood thinning medications (Warfarin, Coumadin, etc.) since curcumin is a natural blood thinner and the synergistic effect with medications results in an increased risk of hemorrhage. [12-16]


Green tea is another superfood that is loaded with polyphenols including epigallocatechin gallate (EGCG) which is the most well studied green tea compound to date. According to a 2017 study, supplementation using 1000 milligrams of a green tea extract for 12 weeks reduced disease activity and improved quality of life when compared to individuals in the placebo group. [17]

Additional Recommendations to Consider in SLE

Royal jelly is produced by young nurse bees, is rich in vitamins and amino acids, may maintain healthy cholesterol levels, has anti-inflammatory and immunoregulatory effects, and may be worth trying out for individuals with autoimmunity. [12-13] This type of superfood deserves a deep dive within its own separate article.


Addressing leaky gut, dysbiosis, inflammation, and oxidative stress with gut-healing nutrients, probiotics, natural anti-inflammatory and antioxidant compounds is essential in the functional treatment of SLE and other autoimmune conditions. Again, these are topics that require much more extensive coverage in future articles. Other lifestyle recommendations to consider for the management of SLE include:

  1. quit smoking, if applicable

  2. discover and avoid all potential sources of toxin exposure

  3. begin an exercise routine and stay hydrated to assist the body's natural detoxification systems

  4. become a master of stress management

  5. if you are not getting quality sleep, learn about how to improve upon sleep hygiene

  6. and, of course, consult with your local functional medicine practitioner for more specific and personalized health counseling

References:

  1. https://pubmed.ncbi.nlm.nih.gov/30118900/

  2. https://www.frontiersin.org/articles/10.3389/fimmu.2019.02608/full

  3. https://pubmed.ncbi.nlm.nih.gov/30213697/

  4. https://pubmed.ncbi.nlm.nih.gov/31401314/

  5. https://pubmed.ncbi.nlm.nih.gov/34377090/

  6. https://pubmed.ncbi.nlm.nih.gov/31806905/

  7. https://pubmed.ncbi.nlm.nih.gov/32056521/

  8. https://pubmed.ncbi.nlm.nih.gov/26903965/

  9. https://pubmed.ncbi.nlm.nih.gov/22109896/

  10. https://pubmed.ncbi.nlm.nih.gov/35346981/

  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250981/

  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327661/

  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387408/

  14. https://lpi.oregonstate.edu/ (Used for food sources)

  15. https://www.nutritionadvance.com/nutrition/top-food-sources-polyphenols/

  16. http://phenol-explorer.eu/

  17. https://onlinelibrary.wiley.com/doi/epdf/10.1002/ptr.5827

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Disclaimer: The information within this blog is for educational purposes only and is not meant to be interpreted as medical advice, or to diagnose, treat, or cure any disease. The articles within this blog are simply a sharing of knowledge and information based on research and / or experience. If you feel the need to see a doctor for your condition, then you should definitely follow your instincts and do just that. Please do not alter your dose of any prescribed medications without the direct supervision of your healthcare practitioner. The information contained herein is not intended to replace a one-on-one relationship with a qualified healthcare practitioner. These statements have not been evaluated by the FDA.

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