• Types
• Symptoms
• Diagnosis
• Causes
• Triggers
• Treatment and Management
• Success Stories

How Lupus Works

Lupus is an autoimmune disease in which the immune system attacks the DNA and nuclei of its own cells when cells break apart. The pathophysiology is complex and involves both the innate and adaptive immune systems, but lupus predominantly has to do with overactive B cells (which belong to the adaptive immune system). Interferons, the part of the immune system that fights viruses, may also be overactive in lupus patients.

This educational video from Osmosis by Elsievir does a great job of showing how SLE works.

Types of Lupus

Lupus can come in many different forms. Lupus in general is called systemic lupus erythematosus (SLE) and can affect many different organs in the body. Other forms include lupus nephritis (lupus of the kidneys); neuropsychiatric lupus (lupus involving the brain); drug-induced lupus (lupus induced from medications); and cutaneous lupus (lupus affecting the skin only). 

Symptoms

The manifestation of lupus varies from patient to patient. While some patients can have only one or two symptoms of lupus, others will exhibit many more. Symptoms can present in multiple organs and can range from mild to life-threatening. Some common ones include: 

• Rashes on the face or body
• Fatigue
• Arthritis
• Brain fog
• Hair loss
• Photosensitivity
• Oral ulcers or nasal ulcers
• Chest pain
• Shortness of breath

Lupus can also affect the functioning of the kidneys, nerves, and brain, as well as different blood cell types, potentially causing anemia, low platelets, and low white blood cell count. 

Diagnosis

Lupus is typically diagnosed by rheumatologists based on a number of different clinical symptoms and laboratory values. The American College of Rheumatology published updated classification criteria for SLE in 2019 to help clinicians to determine if a patient has lupus. 

What Causes Lupus?

Available research suggests that a combination of genetic, environmental, and hormonal factors cause lupus. 

Genes

Research has indicated that there is a genetic component to lupus. Multiple genes have been implicated in SLE development, with a 2010 study published in Nature Reviews finding more than 30 genetic associations with the disease. A study published in 2018 in the Seminars of Arthritis and Rheumatism found that twins of lupus patients were more likely to develop lupus or other autoimmune diseases. 

Environmental Factors

Environmental factors, particularly obesity, can also influence lupus risk. In a prospective cohort study among 238,130 women in the Nurses Health Studies, obese participants were 85 percent more likely to have SLE than participants with normal BMIs. One possible explanation for this association is that obesity can contribute to gut dysbiosis. Additionally, an excess of adipocytes (fat cells) can push the immune system toward inflammatory pathways. 

Hormones

Women are much more likely than men to suffer from lupus, representing roughly 90 percent of all lupus cases, and women between the ages of 15 and 44 are the most likely to develop the disease. This may be because estrogen stimulates the production of antibodies, making autoimmune responses more likely.  

Can Certain Foods Make Lupus Symptoms Worse? 

Certain dietary elements are generally inflammatory and thus prone to making lupus worse. These include excess salt, highly processed foods, processed and red meats, and refined sugar—all of which are common in the standard American diet. High-fat diets can potentially worsen lupus, as well. 

In addition to causing inflammation directly, highly processed foods can promote weight gain and obesity. Obesity, in turn, can contribute to chronic inflammation that heightens the risk of developing autoimmune diseases, including lupus. 

Interestingly, a study published in 2015 found that lupus patients had higher levels of AGEs (advanced glycation end-products), inflammatory compounds found in the highest concentrations in animal products and fried foods. 

Triggers

Any factors that put stress on the body can exacerbate lupus and cause symptoms to flare up. Common triggers for SLE flare-ups include:

• Stress
• Lack of sleep
• UV radiation
• Smoking cigarettes
• Viruses
• Bacterial infection 
• Hormonal fluctuations (particularly estrogen)

How to Treat and Manage Lupus

While there is no cure for lupus, there are ways to manage it. Medications can be an essential part of managing SLE, but lifestyle changes can help reduce and relieve symptoms of autoimmune disease, as well.

Foods to Alleviate Lupus 

Gut dysbiosis—an imbalance in the gut microbiome—has been closely associated with multiple autoimmune diseases, including lupus, rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease. It is unclear at this time whether gut dysbiosis in lupus occurs as a result of the disease itself or occurs prior to the actual disease onset. In either case, fostering a healthier gut microbiome can be a boon for autoimmune health, since up to 70 percent of the immune system is located in the gut. Fruits and vegetables, which are rich in fiber and phytonutrients, are excellent for promoting a healthy gut microbiome.

Chia seeds and flax seeds are high in fiber as well as omega-3 fatty acids, which can potentially decrease lupus disease activity. Polyphenols in fruits and vegetables exert anti-inflammatory activity, as well. Turmeric and ginger have powerful phytonutrients that can help decrease inflammation. 

Fiber also seems protective against lupus disease activity. After systematically reviewing 184 studies on diet and SLE, the authors of a 2020 report published in Frontiers in Immunology recommended that lupus patients consume a low-calorie, low-protein diet that contains plenty of fiber, polyunsaturated fatty acids, vitamins, minerals, and polyphenols.

In a study published in Lupus in January 2022, researchers surveyed SLE patients about their experiences using dietary changes to manage their symptoms. The greatest reduction in symptoms was reported among those who reduced their intake of dairy and processed foods and those who reported trying a vegan diet.  

Other Tools

In addition to the dietary changes mentioned above, SLE is largely managed by medications. Hydroxychloroquine is often the first-line medication. Azathioprine, mycophenolate mofetil, belimumab, and other immunomodulators are also used for management. 

Lifestyle modifications that can help with all autoimmune-related issues include improving sleep quality, exercising regularly, and decreasing stress levels.

Patients should consult with their rheumatologists to determine an optimal treatment plan. 

Success Stories

Read these inspiring stories from patients who reduced their lupus symptoms after adopting a whole-food, plant-based diet.

• I Overcame Lupus with a Plant-Based Diet
• From Crippling Lupus to Living Pain-Free on a Plant-Based Diet
• After a Stroke, This Doctor Reversed Her Lupus With a Plant-Based Diet

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

The post What Is Lupus? A Rheumatologist Breaks Down Causes, Symptoms, and Lifestyle Strategies That Can Help appeared first on Forks Over Knives.

Eventually, my gout pain transformed to another form of arthritis, affecting multiple joints in my body. A medical student at the time, I was frustrated that I couldn’t explain my own symptoms. I went to several rheumatologists, and none of them could explain my symptoms either. My inflammatory markers were high, but my blood work showed no other signs of autoimmune disease. I noticed that it seemed like food sometimes affected my pain, but I couldn’t determine the pattern. 

Reaching a Turning Point

While in medical school, I ate a lot of unhealthy frozen meals and fast food just to get by so that I could study and keep up with my work. My diet did improve throughout my 20s, as I began incorporating more fresh vegetables and fruits, but I still ate a lot of animal products. 

In 2015, my wife, Melissa Mondala, MD, and I both began our residencies at Loma Linda University. The only Blue Zone in the U.S., Loma Linda, California, is home to a large population of vegetarians and vegans, and Melissa was amazed to discover how many residents were active and healthy well into their 80s and 90s. It got her interested in lifestyle medicine, and in 2017, she decided to try a whole-food, plant-based (WFPB) diet to treat some of her own health conditions. 

When Melissa first had me try some plant-based dishes, I didn’t enjoy them. Yet as the months went by, I became more interested in the idea of WFPB. I read How Not to Die by Michael Greger, MD, and watched the Forks Over Knives documentary film. In May 2018, I decided to give WFPB a shot. 

Encouraged by Fast Results

The transition was definitely challenging for me. I had no trouble cutting out meat and fast food, but avoiding the endless aisles of processed food at the grocery store—that was hard. It was tough resisting chips and other junk foods. 

But I noticed that, with each passing week on a WFPB diet, my pain and stiffness were lessening. Within three months, my pain and inflammation significantly improved, and I stopped having flare-ups. This really surprised me. I didn’t even have to take painkillers. It was the greatest feeling in the world. I had blood work done and found that one of my inflammatory markers, C-reactive protein, was negative, after being positive for 10 years! 

Nothing beats being pain-free, and I was determined to stick with this new lifestyle. 

Changing Lives

Today, I continue to thrive on a whole-food, plant-based diet. This way of eating has definitely changed my life. It has influenced my friends and family, too, as they strive to eat more plants. 

It’s also changed the way I practice medicine as a rheumatologist. Lifestyle medicine, with an emphasis on WFPB eating, is now the foundation of my practice. It’s so satisfying to help my patients feel better. I use my social media to be a light in this space by talking about autoimmune diseases and plant-based nutrition. Nothing beats being pain-free.

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

The post As a Rheumatologist, I’ve Helped My Patients and Myself with a Plant-Based Diet appeared first on Forks Over Knives.