eating principles:
short fasts (5-7 days) are recommended with 2 week intervals between them (see Fasting in Materia Medica)
elimination/rotation diet, rotation diet, rotation diet expanded
decrease red meat and dairy products (Corman, 1985)
treat hypochlorhydria (Allison, 1945)
therapeutic foods:
sesame seeds, kale, artichokes, green beans, millet, celery, barley, okra, almonds, collards, turnip greens, raw goat's milk, goat whey and black mission figs, gelatin (make a gelatin mold with cherry concentrate no sugar), burdock root, cherries, pineapple, quince, watercress, blackberries, black currants, mustard greens, limes, lettuce, olive oil (Jensen)
foods rich in beta carotene and Vitamin A (Marz)
foods rich in the omega-3 fatty acids: salmon, mackerel, herring, sardines (Marz)
fresh juices:
celery and parsley (Jensen, p. 49) or tea (decoct 7-8 minutes) (Shefi)
cucumber, endive and goat's whey (Jensen)
celery and apple (Shefi)
grapefruit (Walker)
celery (Walker)
carrot and celery (Walker)
goat milk or whey and black mission figs (Jensen, p. 43)
avoid:
food intolerances
cow's milk and other dairy products, spinach, asparagus, rhubarb, vegetables from the nightshade family: tomatoes, green peppers, potatoes, pimentoes, eggplant, coffee, caffeine, sugar, refined foods, fried foods
high protein diet due to kidney damage associated with SLE
» drug interaction:
prednisone/prednisolone: causes increased gluconeogenesis and consequently leads to protein wasting; some authors recommend a high protein diet to compensate (Trovato, et al., 1991; 44: 1651-1658); however, this may be questionable considering the kidney damage associated with SLE
therapeutic foods:
» Cold-type arthritis:
garlic, green onions, pepper, black beans, sesame seeds, chicken, lamb, mustard greens, ginger, spicy foods, grapes, grape vine tea, parsnip (Ni, p. 103)
avoid:
cold foods, raw foods
therapeutic foods:
» Wind-type arthritis:
scallions, grapes, grapevine tea, black beans, most grains, green leafy vegetables (Ni, p. 103)
avoid:
meats, shellfish, sugar, alcohol, smoking, and stimulants
therapeutic foods:
» Damp-type arthritis:
barley, mung beans, mustard greens, red beans, millet, sweet rice wine with meals, cornsilk tea, diuretic foods, and herbs (Ni, p. 104)
avoid:
Cold foods, raw foods, dairy products
therapeutic foods:
» Heat-type arthritis:
fresh fruits and vegetables, dandelion, cabbage, mung beans, winter melon, soybean sprouts (Ni, pp. 104-105)
avoid:
spicy foods, alcohol, smoking, stress, green onions, red meat
supplements
Beta carotene (for discoid lupus) 50 mg three times daily (Newbold, 1976)
Vitamin A (Gershwin, 1984)
Vitamin B12 1000 mcg 2x weekly (Block, 1953)
Vitamin E and Selenium 1200-1600 IU per day and 50 mcg per day (ibid.)
Calcium pantothenate 6-10 g per day initially, then 2-4 g per day (Goldman, 1950)
Omega-3 fatty acids (Kelley, 1985)
Omega-6 fatty acids (Zurier, 1977)
DHEA: Several lines of investigation lead to the consideration of DHEA as a candidate for hormonal therapy in systemic lupus erythematosus, including DHEA deficiency in patients with SLE, the effects of sex steroids on SLE, the immunomodulatory effects of DHEA, and the results of DHEA in animal models of SLE. DHEA has been shown to increase the production of interleukin-2, a component of the immune system which is consistently decreased in individuals with SLE.
In one study of ten female patients, with mild to moderate SLE and various disease manifestations, using 200 mg/day of DHEA orally, all indices for overall SLE activity including the SLEDAI (SLE Disease Activity Index) score and physicians overall assessment were improved, and corticosteroid requirements were decreased. Another series of uncontrolled observations in 50 patients suggested that DHEA has overall benefits for lupus activity, alleviating specific lupus symptoms as well the systemic manifestations of lupus, with incremental benefits over 3 to 12 months of treatment. DHEA appeared to decrease the number of lupus flares and to have a steroid sparing effect. A more recent study of 23 women with mild to moderate SLE found statistically significant improvements were found in all lupus outcomes over 6 months, with an optimum serum DHEAS of 1000 microg/dl, but that the clinical response to DHEA was not clearly dose dependent and that serum levels of DHEA and DHEAS correlated only weakly with lupus outcomes.
(Van Vollenhoven, RF, et al. Arthritis Rheum 1994;37:1305-1310; Van Vollenhoven, RF and McGuire, JL. Ann Med Interne (Paris) 1996;147(4):290-296; Derksen RH. Semin Arthritis Rheum 1998 Jun;27(6):335-347; Barry NN, McGuire JL, van Vollenhoven RF. J Rheumatol 1998 Dec;25(12):2352-2356.)
» drug interaction:
prednisone/prednisolone: causes Sodium retention
prednisone/prednisolone: causes reduced activation of Vitamin D (Travato, 1991; 44:1651-1658; Tuttle, 1982; 126: 1161-1162); 1,25(OH)2D3 can be measured to determine if supplementation necessary, with low levels can use calcitriol
prednisone/prednisolone: causes increased urinary excretion of Zinc, Vitamin K and Vitamin C (Buist, 1984; 4 (3):114)
footnotes
Barry NN, McGuire JL, van Vollenhoven RF. Dehydroepiandrosterone in systemic lupus erythematosus: relationship between dosage, serum levels, and clinical response. J Rheumatol 1998 Dec;25(12):2352-2356.
Abstract: OBJECTIVE: To examine in women with systemic lupus eythematosus (SLE) who
participated in a clinical trial the relationship between daily dose of dehydroepiandrosterone (DHEA), serum levels of DHEA and DHEA sulfate (DHEAS), clinical effectiveness, and side effects. METHODS: Twenty-three women with mild to moderate SLE were treated with DHEA for a 6 month period. The starting dose was 50 mg/day, and monthly stepwise increases were allowed. Subjects were assessed monthly by the Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure (SLAM), Health Assessment Questionnaire, and other outcomes. Serum testosterone, DHEA, and DHEAS levels were obtained and side effects noted monthly. RESULTS: Statistically significant improvements were found in all lupus outcomes over 6 months. Serum DHEA and DHEAS levels correlated with the dose of DHEA. Serum DHEA and DHEAS correlated negatively with SLAM score. A second order regression analysis of serum DHEAS level versus SLAM score suggested that the optimal serum level of DHEAS was 1000 microg/dl. The most common side
effect was acne. CONCLUSION: The clinical response to DHEA was not clearly dose dependent. Serum levels of DHEA and DHEAS correlated only weakly with lupus outcomes, but suggested an optimum serum DHEAS of 1000 microg/dl.
Monitoring these serum levels appears to have limited clinical utility.
Derksen RH. Dehydroepiandrosterone (DHEA) and systemic lupus erythematosus. Semin Arthritis Rheum 1998 Jun;27(6):335-347. (Review)
Abstract: OBJECTIVE: This study was performed to evaluate in vivo and in vitro data on the effects of the adrenal steroid dehydroepiandrosterone (DHEA) with emphasis on its potential use in the treatment of systemic lupus erythematosus (SLE). METHODS: The literature dealing with DHEA was reviewed. RESULTS: Initially, research on DHEA focused on effects of DHEA in relation to obesity. Over the past decade, research stimulated by associations between the physiological decline in DHEA and aging, cardiovascular disease, changes in metabolism, brain function, and immune senescence have generated insight into the many effects that DHEA or its metabolites may have. In SLE a role for sex hormones in both the etiopathogenesis and disease activity is recognized. In SLE, as in aging, low DHEA levels are frequently found, especially with corticosteroid treatment. CONCLUSIONS: Research data in the elderly, on both hormonal and immunologic effects, suggest that DHEA may become an adjunctive treatment for SLE patients.
Van Vollenhoven RF ; McGuire JL. Studies of dehydroepiandrosterone (DHEA) as a therapeutic agent in systemic lupus erythematosus. Ann Med Interne (Paris) 1996;147(4):290-296.
Abstract: Several lines of investigation led to the consideration of dehydroepiandrosterone (DHEA) as a candidate for hormonal therapy in systemic lupus erythematosus, including DHEA deficiency in patients with SLE, the effects of sex steroids on SLE, the immunomodulatory effects of DHEA, and the results of DHEA in animal models of SLE. Uncontrolled observations in 50 patients suggested that DHEA has overall benefits for lupus activity, alleviating specific lupus symptoms as well the systemic manifestations of lupus, with incremental benefits over 3 to 12 months of treatment. DHEA, which was very well tolerated and safe, appeared to decrease the number of lupus flares and to have a steroid sparing effect. These results were confirmed in a small placebo-controlled trial, although the results were of borderline statistical significance. Currently, a number of additional trials with DHEA are underway, and it is anticipated that DHEA will find its place as a useful agent in the treatment of SLE. (Abstract courtesy of Thorne Research, Inc.)
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