After Jewell Singletary was diagnosed with lupus, she developed rheumatoid arthritis as well—a common pairing, since both are autoimmune conditions—and had to use a cane to navigate her college campus. When she graduated, the now 38-year-old New Jersey resident decided to be more focused on supporting her health, in an effort to maintain her mobility as she began her career.
She started in the kitchen.
First to be tossed were sugary drinks, fried foods, and highly processed options, she says. Once she eliminated them, it didn’t take long before she could discard one more important item: her cane.
“My mobility improved dramatically just from these dietary changes,” she says. “I haven’t needed to use a cane since, and that progress made me realize how much switching my eating could do.” A few years later, she tried cutting dairy products and felt another health boost, followed by cutting red meat and pork products. Recently she’s tried reducing her consumption of gluten, and she reports she’s already feeling some positive effects, like more overall energy.
“Dietary habits can absolutely help you manage lupus in a much better way, and some research suggests it may even help reduce your risk of developing lupus if it runs in your family,” says Dr. Diane Kamen, a professor of medicine in the division of rheumatology and immunology at the Medical University of South Carolina and a member of the medical-scientific advisory council for Lupus Foundation of America. “At this point, lupus is not curable, but it is manageable, and a big part of how to do that is through lifestyle habits like exercise, sleep, stress management, and diet.”
Read More: The 7 Best Foods for Fighting Inflammation
What the research says
There isn’t a “lupus diet” that’s recommended for those who have the condition, but as Singletary found, food can have a major impact on symptoms like fatigue, as well as inflammation-related effects like painful, stiff joints. For some, dietary changes may affect other issues like frequent headaches, anxiety, and skin irritation, and researchers are digging into the connection.
According to a 2021 study in the journal Lupus Science & Medicine, a type of dietary fiber known as resistant starch may have an impact on lupus by boosting the effectiveness of the gut microbiome, which is the community of bacteria and other organisms in the gastrointestinal tract. This fiber feeds the good bacteria in the gut, which in turn support the immune system and reduce lupus-related symptoms as well as risk of a condition called antiphospholipid syndrome—an effect of lupus that may cause blood clots. Resistant starch is found in foods like oats, barley, beans, peas, plantains, and lentils.
In a 2020 study that involved more than 173,000 women, high consumption of nuts and legumes reduced potential lupus risk by 41%. In research published this year that looked at symptom severity, increased vegetable consumption was linked to improvements in joint and muscle pain, and also benefited mood, fatigue, and weight management. That study found that the effects were particularly robust when the shift toward plant foods was accompanied by decreased consumption of processed food, sugar, gluten, and dairy.
Other research on the impact of diet for systemic lupus erythematosus, published in 2018, notes that food choices not only show promise for managing lupus symptoms, but also play a role in lowering the risk of associated conditions for lupus, such as cardiovascular disease, diabetes, metabolic syndrome, and high cholesterol.
Despite results like these, more research is needed to investigate the connections between specific foods and lupus, says Kamen. But in the meantime, for those who have the condition, making even small changes may add up to better health in the long run.
Top tips if you have lupus
In general, nutrition guidance for those with lupus is similar to advice that applies to everyone, Kamen says. That means more fruits and vegetables as well as whole grains, since those contain important nutrients, as well as fiber, that can help bring down inflammation and mitigate symptoms, she says. In terms of specific tips for those with lupus, here are some to consider:
Make changes when you’re on corticosteroids
Use of these medications for controlling lupus symptoms is common, and it’s helpful to eat in a way that counteracts some of their known side effects, says Dana Ellis Hunnes, a registered dietitian and author of Recipe for Survival: What You Can Do to Live a Healthier and More Environmentally Friendly Life.
For example, corticosteroids can cause fluid retention, and adding a salty diet to the mix can exacerbate that issue. Also, a high-protein diet is often recommended since a medication like prednisone can speed up protein breakdown, which can result in even more protein loss if a digestive issue like Crohn’s is involved.
Corticosteroids decrease calcium as well, so Hunnes says that most people on these medications will need to focus on boosting that mineral in their diet, and possibly take a supplement as well. Calcium is found in foods like yogurt, milk, salmon, and broccoli. Other potential effects of the drugs include higher cholesterol and increased blood sugar, so Hunnes adds that it’s important to limit sugar and fat.
Watch for food intolerance and sensitivity
Food allergies are often easy to spot since they can cause a dramatic reaction, but food sensitivities may be harder to detect, according to Dr. Bindiya Gandhi, a Georgia-based functional-medicine physician. These foods may cause indigestion, tiredness, headaches, and bloating, and the biggest problem for those with lupus is that an intolerance reaction can boost inflammation, which Gandhi says may become chronic if those foods are regularly consumed.
“Pay attention to how you feel right after you eat, but also hours later,” she says. “An initial inflammation response might be mild, but as your body works to digest that food, it could become more noticeable.”
For instance, maybe eating eggs makes you congested, or gluten contributes to midday brain fog. If you feel this way after eating certain foods but still consume them often, your inflammation response doesn’t have time to power down, Gandhi says. That can lead to higher risk of lupus flares in the near future.
Eat for better kidney health
Keep in mind that diets may have to change based on the health of certain organ systems, adds Hunnes. With lupus, the kidneys can be the most affected. If that happens, specific dietary recommendations need to be followed.
Hunnes says limiting animal proteins tends to be the most advisable strategy, as well as restricting minerals like potassium, phosphorus, and sodium, since they can’t be effectively filtered by the kidneys if those organs are damaged. Speaking with a dietitian about a renal diet is helpful, as well as adding nutrient-dense foods such as berries, garlic, olive oil, bell peppers, and cabbage.
Focus on your gut
Although keeping your digestion on track is a crucial part of staying healthy for everyone, the recent research on the microbiome suggests it can be a major boon for lupus patients.
“One big benefit is that a well-functioning gut can keep inflammation in check throughout the body, which is crucial for disease management,” says Erin Kenney, a Boston-based registered dietitian and author of Rewire Your Gut. Although there are probiotic supplements that support robust beneficial bacteria in your microbiome, getting what you need from food first can give you more nutrients, she says.
Key tactics include focusing on a high-fiber diet, especially fruits and vegetables, as well as including more fermented foods like yogurt, pickled vegetables, kefir, kombucha, and sauerkraut. Highly processed foods, including meats such as hot dogs and bacon, have been linked to poor gut health, Kenney says, so it’s best to limit those options in your diet.
Although the suggestions from doctors, researchers, and dietitians make important starting points, many people with lupus, like Singletary, have found that it really does come down to a personal level when monitoring how food affects them. Tracking food intake and seeing trends in symptom exacerbation has become an everyday activity for many who have lupus.
For example, Margo Pinckney, 45, of Philadelphia, initially cut out processed foods after being diagnosed with lupus. But after several years of navigating through her symptoms and becoming more aware of how diet influenced how she felt, Pinckney kept refining her meals and snacks based on which foods caused flares in her symptoms, especially fatigue. That led to steering clear of the dairy aisle.
“Cheese used to be my best friend—I would put it on everything,” she says. “However, when I began to limit and then eliminate dairy, I felt better. I feel like I deal with less inflammation by paying attention to what I eat.”
For Ingrid Perez-Martin, a 41-year-old lupus patient in Georgia, spicy foods are the most problematic. The longer she’s had lupus, the more challenging these have become, she says.
“Foods I used to be able to eat all the time now wake me up in the middle of the night, because I have to throw up,” she adds. “There’s no food that’s worth adding more sickness or another hospitalization to my life. It’s that dramatic. I can clearly see the signs when I eat the wrong thing, so I try to be more purposeful and eat what my health requires.”
Perez-Martin became so knowledgeable about healthy eating and overall wellness for her condition that she became a nutrition educator and fitness instructor. “Paying attention to how I treat my body is something I should have been doing regardless of lupus,” she says. “But now that I have the condition, I take my health more seriously than ever.”
With Sheraya Weeks, a 42-year-old lupus patient in Maryland, dairy is also a problem, but she’s particularly sensitive to fast food, which makes her feel sluggish, she says. Since extreme fatigue is such a frustrating symptom for lupus patients, maintaining consistent energy is key. Weeks says that when she skips the drive-through and focuses on healthy foods instead, she simply feels better.
Examples like these point toward how much diet comes down to individual reactions, Kamen says. Being able to “read” the effects of certain foods can go a long way toward personalized nutrition that can offer considerable benefits for handling lupus, including better sleep, lower inflammation, more energy, lighter mood, and better gut health.
“Simply put, you can’t get into any kind of balance, whether you have lupus or not, without addressing what you’re putting into your body,” says Kamen. “Managing your health often starts on your plate.”
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Contributor: Elizabeth Millard