by Melvyn R. Werbach, M.D.

A chronic disorder occurring predominantly among women, lupus may be confined to the skin (discoid lupus) or it may be a generalized connective tissue disorder with widespread findings (systemic lupus erythematosus; SLE). While conventional drug treatment has the risk of serious side effects, the nutritional approach can often produce considerable improvement without significant danger to the patient.

The amino acids phenylalanine and tyrosine appear to aggravate the disease, apparently due to a specific intermediary block in their metabolism. Findings from both animal¹ and human² studies have confirmed the efficacy of removing these amino acids from the diet.

Also, studies using an animal model of SLE have found that diets high in fat may promote the onset and progression of the disease by weakening immune responses,³ suggesting that a low fat diet could be beneficial.¹

A vegan diet may be ideal, both because beef and dairy products are rich in phenylalanine and tyrosine, and because the diet is usually low in fat. When a woman with SLE and typical skin lesions started a diet recommended by a “well-known food faddist” consisting entirely of fruit and vegetables, the authors were surprised to discover that, within one week, 95% of her facial lesions had disappeared. At the end of 2 weeks, her face was entirely clear. They then tried the diet on a few of their SLE patients. Most showed considerable resolution of skin lesions within 2 weeks.⁴

In SLE, both linoleic acid (omega-6 series) and alpha-linolenic acid (omega-3 series) metabolites are significantly reduced in the plasma phospholipid fraction, suggesting that essential fatty acid metabolism is altered.⁵

Supplementation of the omega-3 fatty acids EPA and DHA has been beneficial in both animal and human studies. In a double-blind crossover study, 17 patients with active SLE randomly received MaxEPA (a proprietary fish oil preparation) 20 g daily or 20 g olive oil daily added to a standardized low-fat diet for 34 weeks. Fourteen patients achieved useful or ideal status while they were receiving MaxEPA, while 13 patients were rated as worse or unchanged while receiving olive oil placebo. The difference between the two treatments was statistically significant.⁶

SLE patients sometimes suffer from myalgia (muscle pain) which may be due to a magnesium deficiency. If so, magnesium supplementation should cure the symptom.⁷ In discoid lupus, supplementation with beta-carotene may reduce sun sensitivity, even in treatment-resistant patients.⁸

Other nutritional supplements that appeared beneficial in early open trials include vitamin B3.⁹ vitamin B12,¹⁰ pantothenic acid,¹¹ vitamin E,¹⁰ and selenium.¹² Because of abnormal tryptophan metabolism and the possibility of promoting auto-antibody production,¹³ SLE patients should avoid supplementation with tryptophan or its metabolic precursor, 5-hydroxytryptophan, until they are shown to be safe for this population.

Finally, SLE patients have an increased risk of food sensitivity,¹⁴ and elimination of the offending foods may be followed by remission.¹⁵ For example, when a baby boy with symptoms and laboratory findings suggestive of lupus was found to have antibodies to milk, his symptoms resolved upon milk elimination, and returned on 2 occasions when he drank milk.¹⁶

Doctor Werbach cautions that the nutritional treatment of illness should be supervised by physicians or practitioners whose training prepares them to recognize serious illness and to integrate nutritional interventions safely into the treatment plan.

1. Corman LC. The role of diet in animal models of systemic lupus erythematosus: Possible implications for human lupus. Semin Arthritis Rheum 15(1):61-9, 1985

2. Nishimura N et al. Intermediary metabolism of phenylalanine and tyrosine in diffuse collagen diseases. Arch Dermatol 80:466-77, 1959

3. Morrow J et al. Dietary fat and immune function. J Immunol 135(6):3857, 1985

4. Anderson NP, Ayres S Jr. Light sensitive dermatoses. JAMA 103(17):1279-85, 1934

5. Suryaprabha P et al. Reactive oxygen species, lipid peroxides and essential fatty acids in patients with rheumatoid arthritis and systemic lupus erythematosus. Prostaglandins Leukot Essent Fatty Acids 43(4):251-5, 1991

6. Walton AJ et al. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis 50(7):463-6, 1991

7. Romano TJ. Magnesium deficiency in systemic lupus erythematosus. J Nutr Environ Med 7:107-11, 1997

8. Haeger-Aronsen B et al. Oral carotenoids for photohypersensitivity in patients with erythrohepatic protoporphyria, polymorphous light eruptions and lupus erythematodes discoides. Int J Dermatol 18(1):73-82, 1979

9. Hoffer A. Lupus erythematosus. Townsend Letter for Doctors & Patients October, 1997:74-5

10. Block MT. Vitamin E in the treatment of diseases of the skin. Clin Med January 1953, pp. 31-4

11. Goldman L. Preliminary and short report: Intensive panthenol therapy for lupus erythematosus. J Invest Dermatol 15:291, 1950

12. Juhlin L et al. Blood glutathione-peroxidase levels in skin diseases: Effect of selenium and vitamin E treatment. Acta Derm Venereal (Stockh) 62(3):211-4, 1982

13. McCormick JP et al. Characterization of a cell-lethal product from the photooxidation of tryptophan: Hydrogen peroxide. Science 191:468-9, 1976

14. Diumenjo MS et al. [Allergic manifestations of systemic lupus erythematosus.] Allergol Immunopathol (Madr) 13(4):323-6. 1985

15. Cooke HM, Reading CM. Dietary intervention in systemic lupus erythematosus: 4 cases of clinical remission and reversal of abnormal pathology. Int Clin Nutr Rev 5(4):166-76, 1985

16. Anderson JA et al. Hyperreactivity to cow-s milk in an infant with LE and tart cell phenomenon. J Pediatr 84:59-67, 1974

Reprinted with permission from the International Journal of Alternative and Complementary Medicine, Green Library, 9 Rickett St., Fulham, London SW6 1RU, United Kingdom.