Lupus Erythematousus – The Food Factor
Forty years ago, if you were diagnosed as having lupus, otherwise known as systemic lupus erythematosus (SLE), the prognosis would not have been good. Odds were that you would have a 50/50 chance of dying within five years. Today doctors are most likely to tell you that, thanks to modern medicine, to greater awareness among physicians about the disease, to improvements in detection and treatment, your chances of living out your normal life span with SLE can be as high as 90 per cent – and so they are. But what doctors seldom examine is the epidemic of this illness caused by drugs.
Lupus is a baffling disorder with a multitude of symptoms and a different pathogenesis in each individual. Diagnosing this disorder, which affects nine times more women than men, can be difficult.
Although the general consensus is that it affects around 1 in 1000 people in Europe and America, recent research shows that it is underdiagnosed and that rates may be double what we have previously assumed (Lancet, 1996; 347: 367-9).
Lupus is an autoimmune disease which causes inflammation of the connective tissue, in particular of the membranes around the joints (with symptoms similar to those of rheumatoid arthritis) and around such organs as the lungs, kidneys and heart. Its most well known characteristic, however, is a red rash on the cheeks. In some cases this rash may spread to the entire upper body.
The less common form of lupus, discoid lupus erythematosus (DLE) presents as a red, scaly rash on the face the “wolf mask” from which lupus derives its name. DLE can remain static or it can turn into SLE the most common and severe form of lupus. When this happens the body begins to form antibodies against itself, causing inflammation, tissue damage and pain. Lupus can affect virtually any organ or system within the body and it can be life threatening.
The criteria for diagnosing lupus has not been revised since 1982 (Arthritis Rheum, 1982; 25: 1271-7), which may account for so many cases going undetected. When a physician is attempting to diagnose lupus, one of the first things he will check will be the patient’s levels of anti nuclear antibodies (ANA). Some 95 per cent of lupus sufferers will have raised ANA (Rheum Dis Clin North Am, 1990; 16:617-39). ANA is common in other rheumatic diseases and in autoimmune liver and thyroid diseases. It is also present in around 2 per cent of the population without producing symptoms (Adv Immunol, 1989; 44: 93-151). There will also be a higher level of foreign DNA (Arthritis Rheum, 1990; 33: 634-43). In fact, SLE patients produce a large number of antibodies and, depending on which are present, physicians can predict with some certainty how the disease will develop (Clin Exp Immunol, 1985; 62: 337-45; J Clin Immunol, 1991; 11: 297-316).
What confounds doctors is what causes the immune system to go haywire in the first place. As with so many autoimmune disorders, doctors’ bewilderment leads them to assume that SLE can’t be cured and so they concern themselves more with what can be done to suppress and control symptoms. Because SLE patients can have a wide variety of symptoms, often it is treated in a rather haphazard way with courses, cocktails even, of drugs in the hopes that one of them will do the trick.
What this means is that, although more people are surviving SLE, they are at best living with a vastly decreased quality of life, and at worst, trading the risk of death from lupus for the risk of death from the drugs used to control it. For instance, one of the most common treatments is steroids, such as prednisone or prednisolone, to suppress the action of the immune system. These are given either as creams or in pill form. The side effects of steroids are wide ranging and too serious to use on a just in case basis. At one end of the spectrum they include weight gain, puffiness in your face and easy bruising. At the other extreme patients will suffer osteoporosis (Ann Int Med, Nov 15, 1993; Clin Pharm, 1993; 25(2): 126-35), muscle wastage (Euro Respir J, 1992; 5(8): 997-1003; Pol Tygo Lekar, 1989; 44(27): 6324), cataracts (Dermatol Clin, 1992; 10: 505-12; Surv Opthamol, 1986; 31: 2602) diabetes, hypertension and increased susceptibility to infection.
Studies have shown that steroids can cause permanent damage after just a single dose, and may actually cause further damage to a individual’s already fragile immune system (see WDDTY, 1996; 7(2): 1-3, 11-12).
There are dangers in other drugs used to treat SLE. Cyclosporin, an immunosupressant usually used to stop rejection of transplanted organs, can cause kidney dysfunction, high blood pressure and stomach problems; anti malaria drugs such as chloroquine and hydroxychloroquine have been found, mostly by trial and error, to exert some beneficial effects on the arthritic symptoms associated with SLE. But their most common side effect is visual impairment, which can occur in doses above 6 mg per day (Arthritis Rheum, 1979; 22: 832).
Other side effects include tinnitus, insomnia, hyperactivity and anemia. Another immunosuppressant, methotrexate, can cause stomach complaints and nausea as well as damage to the liver and lungs (Ann Rheum Dis, 1990; 49: 25-7). Death can occur in high doses, especially if the patient is taking daily, instead of weekly doses (Drugs and Therapeutics Bulletin, 1993; 31: 18). The side effects of these drugs are so severe that they should only be used in extreme cases where the patient’s life is under threat.
By concentrating on suppressing and managing symptoms, it seems that medicine is missing some important clues about where SLE may come from. Medicine believes that SLE can be organic, originating within the individual’s body, triggered by toxins or genetic predisposition. But it can also be iatrogenic, caused by many different medicines given to treat other, unrelated disorders (Science, 1994; 266: 810-13). There are, in fact, more than 80 different drugs which can cause lupus.
For instance an attack of SLE can be brought about by the use of procainamide (used to treat heart arythmias), propylthiouracil (an antithyroid), trimethadione (an antituberculosis drug), hydralazine (a vasodilator) or even the tetanus vaccine.
The over consumption of antibiotics, particularly those containing sulphonamide (Septra, Septrin, cotrimoxazole) to treat viruses such as those associated with colds or flu (for which they are almost always totally ineffective) has been shown to damage the immune system and is very commonly associated with bringing on an attack of lupus.
Women who have SLE have been shown to have very low levels of testosterone, apparently because their bodies break down the hormone more rapidly than others (Arthritis Rheum, 1994; 26: 1517-21). Patients of both sexes may also have elevated levels of prolactin (J Rheumatol, 1993; 20: 1095-100). Because of this, women with SLE are increasingly given hormone therapy, though there is little evidence that it is effective (Arth Rheum, 1985; 28: 1243-50; Ann Rheum Dis, 1991; 50: 897-8). What has been demonstrated, though, is that putting women on high doses of estrogen (such as those contained in some birth control pills) can both produce SLE like symptoms and aggravate existing SLE (Scan J Rheumatol, 1991; 20: 427-33).
The lupus induced by medicines has a slightly different character to other forms of lupus (Rheum Dis Clin North Am, 1994; 20: 6186), which are 10 times more common. Once medication is stopped, SLE symptoms can disappear within four to six weeks. But harmful antibodies can remain in the system for as long as a year (N Eng J Med, 1994; 330: 1871-9).
Where does lupus come from?
Research has turned up an intriguing possible link with the menstrual cycle. In the 1980s a maverick UCLA scientist named Patrick Schlievert was trying to convince the Centers for Disease Control (CDC) in America that a new strain of Staphylococcus aureus was producing a lethal toxin which was leading to Toxic Shock Syndrome (TSS). It took years for the CDC to officially recognize the Toxic Shock Syndrome Toxin-1 (TSST-1) and admit that tampons weren’t the cause of TSS, but simply the growth medium for a particularly deadly bug which, once a woman was infected, acted like a time bomb inside her. A first exposure to the virus produced flu like symptoms and sensitized the immune system. Although the woman would recover from the illness, the Staph virus would remain in her vagina, where its population would surge, feeding on the nutrient rich menstrual blood and endometrial tissue, resulting in TSS.
A byproduct of his research, however, was the discovery that, of the women who survived TSS, a substantial proportion developed autoimmune disorders: 11 of the 123 women in one survey developed lupus and a further 40 per cent had early symptoms of arthritis a striking finding considering that most TSS sufferers were under the age of 35 (J Infec Dis, 1981; 143: 509-16; Ann Int Med, 1982; 96: 982-6; see also The Coming Plague, Laurie Garrett, Penguin, 1994). But not all women infected with the Staph a virus develop TSS. The question is, is there a population of women walking around with more subtle self destruction taking place inside of them which is linked to the virus?
There are other theories as well. In America, Dr. William Crook has suggested that chronic intestinal yeast infections can promote a wide range of illnesses, from fatigue, depression, and bloating to more serious diseases such as lupus. The theory is that the yeast germ, known as Candida albicans, produces toxins which are absorbed from the gastrointestinal tract into the body. These toxins are thought to provoke either autoimmune reactions or other adverse effects. (Nutrition and Healing, 1995; 2(12): 1, l0-11). Treatment with an anti-candida diet (see box p5) has been shown to reduce levels of anti nuclear antibodies (ANA), the cells which attack the body.
The link between food allergy and lupus is another fruitful avenue for exploration, according to the copious anecdotal evidence to date. In one report a child with lupus was found to have antibodies to milk. Symptoms vanished when he eliminated milk from his diet, and returned when he drank milk on a further two occasions (J Pedia, 1974; 84:59-647). In a study from Australia, four patients with lupus had marked symptom relief after following a programme that included nutritional supplements and avoiding allergenic foods. In addition to a reduction in symptoms, their ANA levels became normal (Int Clin Nutr Rev, 1985; 5(4): 166-76).
Sidebar: SLE – Immune System Meltdown
Systemic lupus erythematosus is another one of those puzzling Twentieth century diseases without an obvious cause. Like arthritis, SLE, which effects at least one in a thousand patients (a figure that doctors believe is highly conservative), is an autoimmune
disease, where the body begins producing antibodies against itself, causing steady tissue damage anywhere in the body immune system meltdown in slow motion.Unlike arthritis, SLE attacks and destroys the body’s connective tissues, the skin and eventually the vital organs. The aches and pains accompanying it can feel like arthritis of the entire body.
While orthodox medicine only knows how to throw powerful suppressive drugs at the problem (which slow down this destruction considerably, but often at great cost), a handful of unorthodox nutritional pioneers are achieving great success with lupus by treating it as an allergic reaction.
Perhaps the most interesting work is being done by an Australian, Dr Chris Reading. Dr Reading has postulated that most of our illnesses stem from certain inherited weaknesses. To make his diagnosis in individual cases, he asks his patients to fill out their family trees that is, the illnesses suffered by all blood relatives. In studying the family trees of more than 2000 patients, Dr Reading has discovered a number of family patterns which correspond with certain illnesses or factors, making family members vulnerable to certain illnesses. In the case of SLE, Dr Reading usually finds other evidence of autoimmune diseases such as arthritis, pernicious anemia, vitiligo, thryoid, depressive illness, leukemia and/or cancer. “When cancer, arthritis and depression keep bobbing up in a family,” he says, “you think of SLE.”
This is what he terms an “autoimmune pattern” which is mostly caused, he finds, by food allergy.
In the experience of Dr Reading and also our panel member Dr Jonathan Wright, the biggest culprits are grains, milk, eggs, beef and yeast. As with grains, each of these other substances contain subfractions like gluten which actually cause the disturbance. After years of consuming allergenic substances which interfere with digestion, patients often have serious problems with nutritional deficiencies, which eventually suppress the immune system.
Perhaps most exciting, Dr Wright and Dr Reading are discovering patterns invariably linking certain foods with certain diseases; grain allergies, for instance, seem to be linked such illnesses as learning difficulties in children, depression, diabetes, thyroid and SLE.
Although their information and results thus far are anecdotal, the success that doctors like Wright and Reading are achieving on a large number of patients argues for taking their work seriously and investigating it further.
It’s time for medicine to lay the germ theory to rest. The reasons we get ill are complicated and individual, a combination of factors, and not simply a bug that we “catch.” Increasingly, it appears that the biggest enemy out there is not a microbe but some of the food we choose to put on our table.
Sidebar: What else causes lupus?
Lupus can be triggered by a wide variety of medicines including:
- Hydralazine
- Steroids: procainamide and prednisone
- Anticonvulsants: phenytoin, hydantoin, primidone
- Isoniazid
- Chlorpromazine
- Antibiotics: penicillin, Septrin, Septra
- Practolol
- Antithyroid: propylthiouracil, methylthiouracil
- Methyldopa
- Certain other factors can cause lupus flare ups. These include:
- Exposure to sunlight (including sunbeds)
- Birth control pills containing estrogen
- Colds and flu
- Pregnancy
In cases of active lupus, a patient may be treated with some or all of the following drugs:
- Non steroidal anti inflammatory drugs for symptomatic relief
- Antimalarial for rashes, arthritis and malaise
- Steroids for severe flare ups and in low doses for maintenance
- Immunosuppressive drugs in conjunction with steroids for “maintenance”
In addition, a patient may receive anti hypertensives, antibiotics, anticonvulsants, and antithrombosis drugs.
Sidebar: Treating lupus naturally
Alternative treatments for SLE may involve a multi pronged approach. Some or all of the following may be helpful in bringing your lupus under control or helping it to clear up altogether.
Dietary measures:
Since lupus is associated with food allergies, it may be wise, as a first course of action, to rule out any of these. Your nutritionist may wish to put you on a strict exclusion diet or test your blood directly, or both (for some DIY allergy investigation tips see WDDTY, 1995; 6(9): 9).
There have been very few studies on lupus and diet (Lancet, 1992; 339: 1177; Ann Rheum Dis, 1991; 50: 463-6). It seems the most helpful advice is to try and maintain a low calorie, low fat diet since that has been shown to help some SLE sufferers (Lancet, Jan 26, 1985), as may supplementation with selenium (Acta Derm Venereal (Stockh), 1982; 62(3): 211-4).
An anti candida programme will include all of the above as well as cutting out refined sugars, and possibly the use of well tolerated conventional anti yeast medication such as nystatin, and/or possibly the use of herbs (such as berberis).
There has been research to show that SLE patients have lower than normal stomach acid levels. Supplements of hydrochloric acid and vitamin B complex can bring about improvement (J Immuno, 1984; 133(1): 222-6). Since essential fatty acids have an anti inflammatory effect, supplementing your diet with omega-3 derived from fish oils can help reduce the inflammation which often characterizes the disease. Omega-6 fatty acids, found in evening primrose oil, borage oil or blackcurrent seed oil, have also been used with some success (Nutrition and Healing, 1995; 2(12): 12).
Vitamin B6 is known to block the toxic effects of certain drugs and chemicals that cause lupus, so if you are on medication, or being weaned off it, supplements can help to ease symptoms. Large doses of vitamin B6 can in themselves be toxic and should be administered under the guidance of a competent practitioner (see Alan Gaby, B6: The Natural Healer, Keats).
You may also have a “leaky” gut which is allowing excess food molecules to find their way into your blood system. This should be investigated and remedied.
Alfalfa seeds and sprouts (but not the mature tops), and juice can both produce lupus like symptoms and aggravate existing lupus (Science, 1982; 216: 415-7; N Eng J Med, 1983; 308: 1361), so these should be eliminated from your diet.
Avoid fluoride:
You may need to invest in a reverse osmosis water purifier (available from Good Healthkeeping on 01507-327655; they can also check your fluoride levels) if you live in a heavily fluoridated area. You will need to reduce or cut out altogether your intake of tea and soft drinks. Drink herbal tea made with non fluoridated water instead. Switch to a non fluoride toothpaste even Boots produce them these days!) Wash all fruit and vegetables, since pesticides contain fluoride.
Herbal remedies:
South African pennywort has a good track record in treating SLE. It is important that you use the African subspecies of SA pennywort, since other varieties do not have the same chemical constituents.
The root of Tripterygium wilfordi may be beneficial in both DLE and SLE though care should be exercised in children and adults of reproductive age since its use may lead to impaired sperm production and cessation of menstrual periods.
Both side effects may eventually disappear when the treatment is discontinued. The glycoside extract of the root is less likely to produce harmful reproductive side effects (J Trad Chin Med, 1983; 3(2): 131-2; Chin Med, 1981; 94: 827-34).
Homeopathy:
Cistus canadensis can help SLE skin eruptions, although the usual remedy of choice is Thuja.
Another study has shown that nux vomica (both alone and in combination with other remedies) has as high as an 80 per cent success rate (J of Liga Medic Homoeo Inter, 1987; 2(1): 27-31).
Relax:
High levels of stress can affect the course of autoimmune diseases (Ann Intern Med, 1992; 117: 854-66), so it may be prudent to take up meditation, yoga or any other pastime which allows you to switch off for a while.
Sidebar: WDDTY verdict – Time for a new diagnosis criteria?
SLE is difficult to diagnose and even more difficult to treat. Many of the treatments currently administered to sufferers of SLE are nothing more than a shot in the dark. Since SLE can manifest in a multitude of ways, producing many and varied symptoms, attempts to suppress them can often lead to prescribing a dangerous cocktail of drugs, which in themselves may end up aggravating the lupus.
Because it has been nearly 15 years since criteria for diagnosing lupus have been revised, it is quite likely that many individuals suffering from lupus go undetected. This not only means that there is a great deal of unnecessary suffering, but that medical science may be missing out on valuable data which could improve our understanding of this disease.
Much of medicine’s time and money to date has been spent trying to find the single best method of clinical management, instead of looking at the disease from an epidemiological point of view. All evidence suggests that toxins, whether in the form of allergies, yeast, Staph a. bacteria or medicine, are causing a not so subtle self destruct in possibly one out of every 500 people. The most urgent thing is to research these diseases within the context of the bigger picture of our lives and to find out what toxins in our environment and/or in our systems are making our bodies push the self destruct button.
- This article first appeared in the December 1996 (Vol. 7 Issue 9) edition of What Doctors Don’t Tell You.
