# Nutrition in systemic lupus erythematosus
General nutritional status and disease course
In SLE, nutritional status appears to influence how active the disease is. Studies show that people with SLE more often experience malnutrition or poor body composition, particularly regarding muscle mass.
ResearchediPositive results in clinical studies, not yet standard treatment
This is associated with chronic inflammation, certain medications, and sometimes limited food intake due to gastrointestinal complaints.
Recent research suggests that caloric restriction in experimental models of SLE can reduce disease activity and lower blood pressure.
ExperimentaliOngoing in study setting, outcome still unknown
This indicates that the amount of food intake may be relevant, but this has not yet been directly established in patients and should certainly not be attempted without guidance.
The relationship also works the other way: lower disease activity is associated with better nutritional intake and more muscle mass. This makes it difficult to determine exactly what is cause and effect.
Vitamin D
Vitamin D plays a role in immune regulation, and many people with SLE have low vitamin D levels.
ResearchediPositive results in clinical studies, not yet standard treatment
Studies show that low vitamin D levels are associated with higher disease activity and more anti-dsDNA antibodies (the specific immune antibodies that characterize SLE).
Whether supplementing vitamin D truly improves the disease is not yet fully clear.
ResearchediPositive results in clinical studies, not yet standard treatment
Your own vitamin D level can be measured through blood tests, and your doctor or dietitian can assess whether supplementation is worthwhile. Natural sources include fatty fish, eggs, and fermented dairy products; sun exposure also helps, though you should be careful with UV radiation in SLE.
Body composition and muscle mass
People with SLE more often lose muscle mass than healthy people of the same age.
ResearchediPositive results in clinical studies, not yet standard treatment
This is due to the disease itself, inflammation, and sometimes medications such as corticosteroids. Well-maintained muscle mass is associated with better health outcomes.
This requires adequate protein and regular physical activity, but the exact amount of protein needed varies from person to person. Discuss this with your dietitian or healthcare provider.
Fat and cardiovascular disease
People with SLE more often have heart problems and high cholesterol levels than the general population, partly due to chronic inflammation.
ResearchediPositive results in clinical studies, not yet standard treatment
Good body composition (with adequate muscle mass) is associated with a more favorable fat profile and less cardiac risk.
ResearchediPositive results in clinical studies, not yet standard treatment
This emphasizes the importance of physical activity and adequate protein, not strict fat restriction. Specific recommendations regarding type and amount of fat belong in a conversation with your dietitian.
Urate and kidneys
Urate (a breakdown product of purines) in high amounts in the blood can strain the kidneys.
ResearchediPositive results in clinical studies, not yet standard treatment
This is relevant because SLE itself can already cause kidney problems.
Foods rich in purines include organ meat, certain fish species, and large amounts of alcohol. If you have kidney problems, your doctor or dietitian can advise you to consume these cautiously.
ResearchediPositive results in clinical studies, not yet standard treatment
However, this is not a general rule for all SLE patients; only relevant if urate or kidney function is a problem.
Salt and blood pressure
Many people with SLE use corticosteroids, which can raise blood pressure and cause fluid retention.
ResearchediPositive results in clinical studies, not yet standard treatment
Salt restriction may help, especially if you have blood pressure problems. However, this is not a universal remedy, but something to discuss with your doctor.
Gastrointestinal complaints and food intake
SLE can cause inflammation in the stomach and intestines, which makes eating difficult. Some medications (such as certain immunosuppressants) can cause nausea.
ResearchediPositive results in clinical studies, not yet standard treatment
In that case, frequent, small meals may help. Certain foods may be better tolerated than others; this is very individual. Discuss food choices with your doctor or dietitian if you have gastrointestinal problems.
Probiotics and gut bacteria
Research is ongoing into the role of gut bacteria (microbiome) in autoimmune diseases, including SLE.
ExperimentaliOngoing in study setting, outcome still unknown
This is still in an early stage; there are no proven recommendations for specific probiotics or prebiotics in SLE.
Nutritional supplements and medication interactions
If you use certain medications for SLE (for example certain immunosuppressants or antimalarial drugs), some supplements and food items may interact with them.
ResearchediPositive results in clinical studies, not yet standard treatment
Examples include:
- Large amounts of vitamin K (in vegetables) can affect certain immunosuppressants.
- Antioxidants and certain herbs can counteract immunosuppressive effects.
This does not necessarily mean you must avoid these foods, but your doctor should know about them. Always ask permission before starting to use supplements.
Alfalfa and nutritional supplements as a risk factor
Alfalfa and certain supplements have in some cases been associated with worsening of SLE symptoms.
ResearchediPositive results in clinical studies, not yet standard treatment
This is rare, but it is wise to discuss this with your doctor before trying new supplements.
Summary for practice
- A balanced diet with sufficient protein, vitamins and minerals is important for body composition and disease management.
- Vitamin D status is relevant; have this checked.
- Salt, urate and fluid intake may be relevant depending on your specific medications and side effects.
- Stomach complaints require individual adjustments.
- Always speak with your dietitian or doctor before making major dietary changes or using supplements.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._