The Encyclopedia of Natural Medicine, 3rd Ed.

Systemic Lupus Erythematosus

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Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect any part of the body. In autoimmune diseases the immune system attacks the body’s cells and tissue, resulting in inflammation and tissue damage. In SLE, the tissues most often damaged are the heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system.

SLE can vary in severity and clinical course. There are often times of remission interrupted by periods of illness (called flares). SLE occurs nine times more often in women than in men. It most often affects women in their childbearing years (ages 15 to 35) and is also more common in women of non-European descent.

Causes

There is abundant evidence that SLE is an autoimmune reaction in which antibodies formed by the immune system attack components of joint tissues. Yet what triggers this autoimmune reaction remains largely unknown. Speculation and investigation have centered on genetic factors, abnormal bowel permeability, lifestyle, nutritional factors, food allergies, and microorganisms.

As with other autoimmune diseases, there is definitely a genetic predisposition for SLE. However, research indicates that this predisposition requires an environmental trigger. Since 90% of patients with SLE are female, there appears to be a hormonal aspect or some protective factor on the X chromosome. Defective manufacture of male sex hormones (androgens) has been proposed as a potential predisposing factor for SLE.1

Researchers have also sought to find a connection between certain infectious agents (viruses and bacteria), but no organism can be consistently linked to the disease.

Drug-induced lupus erythematosus (DILE) is an autoimmune disorder similar to SLE and caused by chronic use of certain drugs. There is a long list of medications known to cause DILE, but the three associated with the highest number of cases are hydralazine, procainamide, and isoniazid. Generally, the symptoms recede after the drugs are discontinued.

Therapeutic Considerations

The general approach to SLE from a naturopathic perspective is nearly identical to the approach to rheumatoid arthritis (RA); see that chapter. Just as in RA, the major focus in dietary therapy for SLE is to eliminate food allergies, increase the intake of antioxidant-rich food and nutrients, follow a vegetarian diet, and alter the intake of dietary fats and oils. Vegetarian diets are often beneficial in the treatment of inflammatory conditions such as SLE, presumably as a result of decreasing the availability of arachidonic acid (found in animal products) for conversion to inflammatory compounds. Another important way in which a vegetarian diet may be helpful is that is has a higher alkalinity than a meat-based diet. And, just as in RA, fish oils have shown considerable benefit in improving symptoms and disease activity scores in SLE.24

DHEA

As stated above under “Causes,” a defect in male sex hormone production is common in SLE. Supplemental DHEA has shown therapeutic benefits in patients with SLE in several studies. Clinical research began with a small preliminary study in which DHEA use was associated with improved SLE disease activity index scores and decreased prednisone use.5 Each patient received 200 mg per day of DHEA for three to six months. Eight of the 10 patients reported improvements in overall well-being, fatigue, energy, and/or other symptoms. For the group as a whole, there was a significant improvement in the physician’s overall assessment of disease activity. After three months, the average prednisone requirement had decreased from 14.5 to 9.4 mg per day.

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WARNING: For SLE treatment, given the high dosages of DHEA required to show benefit, we strongly recommend against self-medication. Because of substantial risk of side effects, working with a physician to monitor the proper dosage and benefit of DHEA is necessary.

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This study has been followed up with several higher-quality studies. In a double-blind study, 28 female patients with mild to moderate SLE were given DHEA (200 mg per day) or a placebo for three months.6In the patients receiving DHEA, the average dosage of corticosteroids dropped by 30% while the dosage rose by 40% in the placebo group. There were three lupus flare-ups in the DHEA group, compared with eight in the placebo group. A larger double-blind trial involving 191 patients with SLE confirmed that DHEA supplementation could be associated with a modest stabilization of disease and reduction in steroid dose.7 Other studies have also showed that DHEA improved quality-of-life scores in SLE patients.8,9 In all of these studies, mild acne was a common side effect of DHEA at these dosages.

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QUICK REVIEW

• Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect any part of the body.

• Like other autoimmune diseases, there is definitely a genetic predisposition for SLE. However, research indicates that this predisposition requires an environmental trigger.

• The general approach to SLE from a naturopathic perspective is nearly identical to the approach to rheumatoid arthritis.

• Vegetarian diets are often beneficial in the treatment of inflammatory conditions such as SLE, presumably as a result of decreasing the availability of arachidonic acid for conversion to inflammatory compounds.

• Fish oils have shown considerable benefit in improving symptoms and disease activity scores in SLE.

• A defect in male sex hormone production is common in SLE. Supplemental DHEA (under physician supervision) has shown therapeutic benefits in patients with SLE in several studies.

Botanical Medicines

Please consult the chapter “Rheumatoid Arthritis” for more information. Dosages are given below for our recommendations.

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TREATMENT SUMMARY

SLE is often an aggressive disease that needs aggressive treatment. In mild to moderate cases, the measures below are extremely effective. Foremost is the use of diet to reduce the causes and ameliorate the symptoms. Symptom relief can also be attained through the use of nutritional supplements, botanical medicines, and physical medicine techniques. In severe cases, drug therapy may be necessary, at least in the acute phase. However, do not abandon natural measures, because they will actually enhance the effectiveness of the drugs, allowing for lower dosages when drugs are necessary, while providing a foundation for healing by addressing the underlying causative factors and utilizing modalities that are both safe and beneficial in long-term use. Please see the chapter “Rheumatoid Arthritis” for a more complete discussion of our recommended treatments.

Diet

The first step is a therapeutic fast or elimination diet, followed by careful reintroduction of individual foods to detect those that trigger symptoms. Although any food can cause a reaction, the most common are wheat, corn, dairy products, beef, foods in the nightshade family (tomatoes, potatoes, eggplant, peppers), pork, citrus, oats, rye, egg, coffee, peanuts, cane sugar, lamb, and soy.

After all allergens have been isolated and eliminated, a vegetarian or Mediterranean-style diet rich in organic whole foods, vegetables, cold-water fish (mackerel, herring, sardines, and salmon), olive oil, and berries and low in sugar, meat, refined carbohydrates, and animal fats is indicated. The recommendations in the chapter “A Health-Promoting Diet” are appropriate in the long-term support of SLE.

Nutritional Supplements

• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”

• Key individual nutrients:

  images Vitamin C: 500 to 1,000 mg per day

  images Selenium: 200 to 400 mcg per day

  images Vitamin E (mixed tocopherols): 200 to 400 IU per day

  images Vitamin D3: 2,000 to 4,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)

• Fish oils: 3,000 mg EPA + DHA per day for seven days; 1,000 mg per day thereafter

• One of the following:

  images Grape seed extract (>95% procyanidolic oligomers): 150 to 300 mg per day

  images Pine bark extract (>90% procyanidolic oligomers): 150 to 300 mg per day

• Probiotic (Lactobacillus species and Bifidobacterium species): a minimum of 5 billion to 10 billion colony-forming units

• One of the following:

  images Pancreatin (10X USP): 350 to 750 mg between meals three times per day

  images Bromelain: 250 to 750 mg (1,800 to 2,000 MCU) between meals three times per day

Botanical Medicines

• One of the following:

  images Meriva: 500 to 1,000 mg twice daily

  images BCM95 Complex: 750 to 1,500 mg twice daily

  images Theracurmin: 300 mg one to three times daily

• Ginger:

  images 8 to 10 g dried ginger

  images Ginger extracts standardized to contain 20% gingerol and shogaol: 100 to 200 mg three times per day

Physical Medicine

• Heat (moist packs, hot baths, etc.): 20 to 30 minutes, one to three times per day

• Cold packs for acute flare-ups or following heat

Other Considerations

• Improving digestion with hydrochloric acid supplementation may be useful. Positive results from other tests may indicate that treatment for intestinal permeability, dysbiosis, and environmental toxicity is advisable.

• DHEA may be taken under the supervision of a physician.