Fish Oil & Systemic Lupus Erythematosus
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Systemic lupus erythematosus (SLE), is an autoimmune illness that causes a characteristic rash accompanied by inflammation of connective tissue, particularly joints, throughout the body. In autoimmune diseases, the immune system attacks the body instead of protecting it. Kidney, lung, and vascular damage are potential problems resulting from SLE.

The cause of SLE is unknown, though 90% of cases occur in women of childbearing age. Several drugs, such as procainamide, hydralazine, methyldopa, and chlorpromazine, can create SLE-like symptoms. Similarly, environmental pollution and industrial emissions may also trigger SLE-like symptoms in some people.1 In one reported case, zinc supplementation appears to have aggravated drug-induced SLE.2

Risk factors include a family history of SLE, other collagen diseases or asthma,3 menstrual irregularity,4 beginning menstruation at age 15 or later,5 exposure to toxic chemicals,6 and low blood levels of antioxidant nutrients, such as vitamin A and vitamin E, or beta-carotene.7 Free radicals are thought to promote SLE.8

Discoid lupus erythematosus (DLE) is a milder form of lupus that affects the skin. Like SLE, it’s not known what causes DLE, though sun exposure can trigger the first outbreak. DLE is most common among women in their thirties.

Dietary changes that may be helpful: An isolated case of someone with SLE improving significantly after the introduction of a vegetarian diet has been reported.9 In Japan, women who frequently ate fatty meats, such as beef and pork, were reported to be at higher risk for SLE compared with women eating little of these foods.10 Consuming fewer calories, less fat, and foods low in phenylalanine and tyrosine (prevalent in high protein foods, such as meat and dairy) might be helpful, according to animal and preliminary human studies.11

Foods high in omega-3 fatty acids, such as fish and flaxseed, may decrease lupus-induced inflammation. In one trial, nine people with kidney damage due to SLE were fed increasing amounts of flaxseed for a total of 12 weeks.12 After examining the results, researchers concluded that 30 grams per day was the optimal intake for improving kidney function, decreasing inflammation, and reducing atherosclerotic development. Flaxseeds also contain antioxidants, potentially helpful to those with SLE.13

To date, all studies on Fish oil have used supplements and not fish (see below). Nonetheless, many doctors recommend their SLE patients eat several servings of fatty fish each week.

Spanish researchers discovered that individuals with SLE tend to have more allergies, including food allergies, than do healthy people or even people with other autoimmune diseases.14 While one study reported that drinking milk was associated with a decrease in SLE risk,15 other investigations point to both beef16 and dairy17 as foods that might trigger allergic reactions in some people with SLE. Casein, the main protein in cow’s milk, has immune-stimulating properties.18 This might explain why some people with SLE have been reported to be intolerant of milk products. Researchers and doctors still do not know whether avoidance of allergens will significantly help people with SLE. People wishing to explore the effects of discovering and avoiding foods they might be sensitive to should consult a doctor.

Alfalfa seeds and sprouts contain the amino acid L-canavanine, which provokes a lupus-like condition in monkeys19 and possibly humans.20 For this reason, some doctors recommend that people with SLE should avoid these foods. Cooking alfalfa seeds has been reported to erase this effect.21

Lifestyle changes that may be helpful: In preliminary research, smoking has been linked to significantly increased risk of developing SLE, while drinking alcohol has been associated with a decrease in risk.22 The importance of these associations remains unclear, though an increased risk for many other diseases has been definitively linked to excessive consumption of alcohol.

Nutritional supplements and other natural therapies that may be helpful: The omega-3 fatty acids in Fish oil—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—decrease inflammation. Supplementation with EPA and DHA has prevented autoimmune lupus in animal research.23 In a double-blind study, 20 grams of Fish oil daily combined with a low-fat diet led to improvement in 14 of 17 people with SLE in 12 weeks.24 Smaller amounts of Fish oil have led to only temporary improvement in other double-blind research.25 People wishing to take such a large amount of Fish oil should first consult with a doctor.

Antioxidant levels have been reported to be low in people with SLE, though this finding was not statistically significant in one trial.26 When animals are fed antioxidant-deficient diets they develop a condition similar to SLE; supplementation with antioxidants, such as vitamin C, vitamin E, beta-carotene, and selenium, has helped animals with existing SLE.27 It remains unclear whether antioxidant supplementation would have a positive effect on people with SLE.

Some preliminary evidence suggests that vitamin E might help people with DLE. Two doctors reported good to excellent results by giving 800–2,000 IU of vitamin E per day to eight people with DLE.28 29 According to these researchers, lower amounts of vitamin E did not work as well. In another small trial, vitamin E, also given in high amounts, had no effect.30 Unlike with DLE, there appears to be no reports on the effects of vitamin E in people with SLE.

In one report, 250,000 IU beta-carotene per day cleared up all facial rashes in as little as one week for three people with DLE.31 However, another study involving 26 people (19 with DLE and seven with SLE) found that using an even higher intake (400,000 IU per day) for an average of five and a half months was ineffective.32 Research has not yet supported the use of beta-carotene for people with SLE.

Preliminary data suggest that pantothenic acid may help those with DLE. In one study, taking 10–15 grams of pantothenic acid per day with 1,500–3,000 IU of vitamin E for as long as 19 months, helped 67 people with DLE.33 Pantothenic acid by itself for shorter periods of time in lower amounts has been reported to fail.34 The amounts of pantothenic acid and vitamin E used in the first study are very high and should not be taken without the supervision of a physician.

In a double-blind trial, 27 women with mild to moderate SLE were given 200 mg of DHEA per day or placebo.35 Three months later, those assigned to DHEA were significantly better and were able to decrease prednisone use more than those taking placebo. Other studies have also supported the use of DHEA in people with SLE.36 37 Low blood levels of DHEA and DHEA-sulfate have been associated with more severe symptoms in people with SLE.38 Two hundred milligrams per day is an extremely high and potentially toxic amount of DHEA. No one should take such amounts without medical supervision.

Experts have concerns about the use of DHEA, particularly because long-term safety data do not exist. Side effects at high intakes (50–200 mg per day) appear to be acne (in over 50% of people), increased facial hair (18%), and increased perspiration (8%). Less common problems caused by DHEA have been reported to be breast tenderness, weight gain, mood alteration, headache, oily skin, and menstrual irregularity.39 Because this trial was not controlled, it is possible that some of the less common "side effects" were unrelated to DHEA and might have occurred even with placebo.

High amounts of DHEA have caused cancer in animals.40 41 Although anticancer effects of DHEA have also been reported,42 they involve trials using animals that do not process DHEA the way humans do, so these positive effects may have no relevance for people. Links have begun to appear between higher DHEA levels and risks of prostate cancer in humans.43 At least one person with prostate cancer has been reported to have had a worsening of his cancer despite feeling better while taking very high amounts (up to 700 mg per day) of DHEA.44 While younger women with breast cancer may have low levels of DHEA, postmenopausal women with breast cancer appear to have high levels of DHEA, which has researchers concerned.45 These cancer concerns make sense because DHEA is a precursor to testosterone (linked to prostate cancer) and estrogen (linked to breast cancer). Until more is known, it would be prudent for individuals with breast or prostate cancer or a family history of these conditions to avoid supplementing with DHEA. Preliminary evidence has also linked higher DHEA levels to ovarian cancer in women.46

Some doctors recommend that people taking DHEA have liver enzymes measured routinely. Anecdotes of DHEA supplementation (of at least 25 mg per day) leading to heart arrhythmias have appeared.47 At only 25 mg per day, DHEA has lowered HDL cholesterol while increasing insulin-like growth factor (IGF).48 Decreasing HDL could increase the risk of heart disease. Increasing IGF might increase the risk of breast cancer.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Preliminary evidence indicates that some Chinese herbs may help those with SLE. In one trial, a formula composed of 17 Chinese herbs was given to 306 people with SLE.49 Of the 230 individuals who were also taking cortisone, 92% improved, but 85% of those taking the herbs alone also benefited. Forty-one people with SLE-induced kidney damage given a combination of conventional drugs plus a Chinese herbal formula for six months did significantly better than 35 individuals given the drugs alone.50 Various Chinese herbs have prolonged survival in animals with SLE.51

One of these Chinese herbs, Tripterygium wilfordi, is thought to benefit those with SLE or DLE by both suppressing immunity and acting as an anti-inflammatory agent. When 26 people with DLE took 30–60 grams of Tripterygium per day for two weeks, most experienced some degree of improvement.52 Skin rashes in eight people completely cleared up, while in ten over 50% of the rash improved. Tripterygium (30–45 grams per day) was also given to 103 people with SLE. After one month, 54% experienced relief from symptoms such as joint pain and malaise. Because of potential side effects, people with SLE should consult with a doctor experienced in Chinese herbal medicine before using this herb.

Two separate trials have reported that people taking Tripterygium may experience side effects.53 In less than 8% of women with DLE, amenorrhea (cessation of menstruation) occurred; approximately one-third of women with SLE experienced amenorrhea. Other side effects ranged from stomach upset or pain, to nausea, loss of appetite, dizziness, and increased facial coloring. Both studies found that these effects subsided with time once individuals stopped using the herb.

Alfalfa tablets have been reported to worsen SLE,54 though this association has been disputed.55 Some doctors suggest that until more is known, people with SLE should avoid alfalfa seeds and supplements.

One Chinese study also found that astragalus could decrease overactive immunity in people with systemic lupus erythematosus.56 However, much more research is needed to know if astragalus is safe in lupus or any other autoimmune disease.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Checklist for Systemic Lupus Erythematosus

Ranking

Nutritional Supplements

Herbs

Primary

 

Tripterygium wilfordi

Secondary

DHEA

Fish oil (EPA/DHA)

 

Other

Pantothenic acid

Vitamin E

Astragalus

Information about the effects of a particular supplement or herb on a particular condition has been qualified in terms of the methodology or source of supporting data (for example: clinical, double blind, meta-analysis, or traditional use). For the convenience of the reader, the information in the table listing the supplements for particular conditions is also categorized. The criteria for the categorizations are: "Primary" indicates there are reliable and relatively consistent scientific data showing a health benefit. "Secondary" indicates there are conflicting, insufficient, or only preliminary studies suggesting a health benefit or that the health benefit is minimal. "Other" indicates that an herb is primarily supported by traditional use or that the herb or supplement has little scientific support and/or minimal proven health benefit.
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References:

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2. Fjellner B. Drug-induced lupus erythematosus aggravated by oral therapy. Acta Derm Venereol 1979;59:368–70.

3. Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333–7.

4. Minami Y, Sasaki Ti, Komatsu S, et al. Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of dietary and reproductive factors. Tohoku J Exp Med 1993;169:245–52.

5. Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333–7.

6. Kardestuncer T, Frumkin H. Systemic lupus erythematosus in relation to environmental pollution: an investigation in an African-American community in North Georgia. Arch Environ Health 1997;52:85–90.

7. Comstock GW, Burke AE, Hoffman SC, et al. Serum concentrations of alpha-tocopherol, beta-carotene, and retinol preceding the diagnosis of rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis 1997;56:323–35.

8. Nagata C, Fuyita, Iwata H, et al. Systemic lupus erythematosus: a case-control epidemiologic study in Japan. Int J Dermatol 1995;34:333–7.

9. Shigemasa C, Tanaka T, Mashiba H. Effect of vegetarian diet on systemic lupus erythematosus. Lancet 1992;339:1177 [letter].

10. Minami Y, Sasaki Ti, Komatsu S, et al. Female systemic lupus erythematosus in Miyagi Prefecture, Japan: a case-control study of dietary and reproductive factors. Tohoku J Exp Med 1993;169:245–52.

11. Corman LC. The role of diet in animal models of systemic lupus erythematosus: possible implications for human lupus. Semin Arthritis Rheum 1985;15:61–9 [review].

12. Clark WF, Parbtani A, Huff MW, et al. Flaxseed: a potential treatment for lupus nephritis. Kidney Int 1995;48:475–80.

13. Prasad K. Hydroxyl radical-scavenging property of secoisolariciresinol diglucoside (SDG) isolated from flax-seed. Mol Cell Biochem 1997;168:117–23.

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19. Bardana EJ Jr, Malinow MR, Houghton DC, et al. Diet-induced systemic lupus erythematosus (SLE) in primates. Am J Kidney Dis 1982;1:345–52.

20. Roberts JL, Hayashi JA. Exacerbation of SLE associated with alfalfa ingestion. N Engl J Med 1983;308(22):1361 [letter].

21. Malinow MR, McLaughlin P, Bardana EJ Jr, Craig S. Elimination of toxicity from diets containing alfalfa seeds. Food Chem Toxicol 1984;22:583–7.

22. Hardy CJ, Palmer BP, Muir KR, et al. Smoking history, alcohol consumption, and systemic lupus erythematosus: a case-control study. Ann Rheum Dis 1998;57:451–5.

23. Kelley VE, Ferretti A, Izui S, Strom TB. A fish oil diet rich in eicosapentaenoic acid reduces cyclooxygenase metabolites, and suppresses lupus in MRL-1pr mice. J Immunol 1985;134:2914–9.

24. Walton AJE, Snaith ML, Locniskar M, et al. Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus. Ann Rheum Dis 1991;50:463–6.

25. Westberg G, Tarkowski A. Effect of MaxEPA in patients with SLE. Scand J Rheumatology 1990;19:137–43.

26. Comstock GW, Burke AE, Hoffman SC, et al. Serum concentrations of alpha-tocopherol, beta-carotene, and retinol preceding the diagnosis of rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis 1997;56:323–35.

27. Weimann BJ, Weiser H. Effects of antioxidant vitamins C, E, and beta-carotene on immune functions in MRL/lpr mice and rats. Ann N Y Acad Sci 1992;669:390–2.

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29. Ayres S Jr, Mihan R. Lupus erythematosus and vitamin E: an effective and nontoxic therapy. Cutis 1979;23:49–54.

30. Yell JA, Burge S, Wojnarowska F. Vitamin E and discoid lupus erythematosus. Lupus 1992;1:303–5.

31. Newbold PC. Beta-carotene in the treatment of discoid lupus erythematosus. Br J Dermatol 1976;95:100–1.

32. Dubois EL, Patterson C. Ineffectiveness of beta-carotene in lupus erythematosus JAMA 1976;236:138–9 [letter].

33. Welsh AL. Lupus erythematosus: Treatment by combined use of massive amounts of pantothenic acid and vitamin E. Arch Dermatol Syphilol 1954;70:181–98.

34. Cochrane T, Leslie G. The treatment of lupus erythematosus with calcium pantothenate and panthenol. J Invest Dermatol 1952;18:365–7.

35. Van Vollenhoven RF, Engleman EG, McGuire JL. Dehydroepiandrosterone in systemic lupus erythematosus. Results of a double-blind, placebo-controlled, randomized clinical trial. Arthritis Rheum 1995;38:1826–31.

36. Van Vollenhoven RF, Morabito LM, Engleman EG, McGuire JL. Treatment of systemic lupus erythematosus with dehyroepiandrosterone: 50 patients treated up to 12 months. J Rheumatol 1998;25:285–9.

37. Van Vollenhoven RF, Engleman EG, McGuire JL. An open study of dehydroepiandrosterone in systemic lupus erythematosus. Arthritis Rheum 1994;37:1305–10.

38. Barry NN, McGuire JL, van Vollenhoven RF. Dehydroepiandrosterone in systemic lupus erythematosus: relationship between dosage, serum levels, and clinical response. J Rheumatol 1998;25:2352–6.

39. van Hollenhoven RF, Morabito LM, Engleman EG, McGuire JL. Treatment of systemic lupus erythematosus with dehydroepiandrosterone: 50 patients treated up to 12 months. J Rheumatol 1998;25:285–9.

40. Orner GA et al. Dehydroepiandrosterone is a complete hepatocarcinogen and potent tumor promoter in the absence of peroxisome proliferation in rainbow trout. Carcinogenesis 1995;16:2893–8.

41. Metzger C, Mayer D, et al. Sequential appearance and ultrastructure of amphophilic cell foci, adenomas, and carcinomas in the liver of male and female rats treated with dehydroepiandrosterone. Taxicol Pathol 1995;23:591–605.

42. Schwartz AG. Inhibition of spontaneous breast cancer formation in female C3H (A vy/a) mice by long-term treatment with dehydroepiandrosterone. Cancer Res 1979;39:1129–32.

43. McNeil C. Potential drug DHEA hits snags on way to clinic. J Natl Cancer Inst 1997;89:681–3.

44. Jones JA, Nguyen A, Strab M, et al. Use of DHEA in a patient with advanced prostate cancer: a case report and review. Urology 1997;50:784–8.

45. Zumoff B, Levin J, Rosenfeld RS, et al. Abnormal 24-hr mean plasma concentrations of dehydroisoandrosterone and dehydroisoandrosterone sulfate in women with primary operable breast cancer. Cancer Res 1981;41:3360–3.

46. Skolnick AA. Scientific verdict still out on DHEA. JAMA 1996;276:1365–7 [review].

47. Sahelian R. New supplements and unknown, long-term consequences. Am J Natural Med 1997;4:8 [editorial].

48. Casson PR, Santoro N, Elkind-Hirsch K, et al. Postmenopausal dehydroepiandrosterone administration increases free insulin-like growth factor-I and decreases high-density lipoprotein: a six-month trial. Fertil Steril 1998;70:107–10.

49. Wang ZY. Clinical and laboratory studies of the effect of an antilupus pill on systemic lupus erythematosus. Chung His I Chieh Ho Tsa Chih 1989;9: 452,465–8 [in Chinese].

50. Ruan J, Ye RG. Lupus nephritis treated with impact therapy of cyclophosphamide and traditional Chinese medicine. Chung Kuo Chung His I Chieh Ho Tsa Chih 1994;14:260,276–8 [in Chinese].

51. Chen JR, Yen JH, Lin CC, et al. The effects of Chinese herbs on improving survival and inhibiting anti-ds DNA antibody production in lupus mice. Am J Chin Med 1993;21:257–62.

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53. Werbach MR, Murray MT. Botanical Influences on Illness. Tarzana, CA: Third Line Press, 1994, 234–5 [review].

54. Roberts JL, Hayashi JA. Exacerbation of SLE associated with alfalfa ingestion. N Engl J Med 1995;308(22):1361 [letter].

55. Whittam J, Jensen C, Hudson T. Alfalfa, vitamin E, and autoimmune disorders. Am J Clin Nut 1995;62:1025–6.

56. Klepser T, Nisly N. Astragalus as an adjunctive therapy in immunocompromised patients. Alt Med Alert 1999;Nov:125-8 [review].

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