Articles

Introduction

What should I know about Systemic Lupus Erythematosus?

The scene is a village somewhere in 10th century Europe. A woman arrives at the local physician/bloodletter’s shop looking like a wolf has eaten way her flesh. The physician names this condition "Lupus," which is Latin for "wolf." Nearly a millennium later, a Frenchman named Cazenave coins the term lupus erthemateux to describe patients suffering from an angry-looking rash that erodes the skin on their cheeks and noses. These are the earliest historical descriptions of the chronic disease now known as "systemic lupus erythematosus."

It is not surprising that systemic lupus erythematosus, also called simply "SLE" or just "lupus" was first recognized as a skin disease. The hallmark feature of SLE is a bright red, butterfly-pattern facial skin rash. But SLE is anything but a superficial disease; it can devastate the joints and internal organs. In the late 19th century, following more detailed descriptions of it clinical manifestations, SLE became recognized as a multi-system disease. (1) , (2)

SLE is a disease of the connective tissue, the tissue that forms the body’s structural framework. Tendons and ligaments are made of connective tissue that attaches muscles to bones and bones to other bones. Cartilage is the connective tissue that cushions bones and functions as the body’s shock absorber. Connective tissue binds various tissues and organs together, keeping them in their proper locations, and it forms the network upon which cells cluster together to form organs. All internal organs are held in place with tough sheets of connective tissue called "fascia." Other connective tissues store unused food materials.

Every part of the body is penetrated and encompassed by connective tissue. Blood itself is classified as a connective tissue. Compared to other tissue types, connective tissue contains relatively few cells. Composed mainly of extracellular material; connective tissue forms our "intracellular cement." It is literally the glue that holds us together. Since connective tissue is everywhere, it is easy to why SLE can be so devastating. Skin contains lot of connective tissue, which explains why the characteristic facial skin rash is the most visible sign of SLE.

Why does SLE target connective tissue? Lupus is an "autoimmune" disease. People suffering from autoimmune diseases produce "autoantibodies," abnormal antibodies that attack their own tissue as if it were a foreign invader. The immune system is designed to distinguish "self" from "non-self." When a foreign substance or organism penetrates the body’s outer defenses, the immune system recognizes the infiltrator as "non self" and calls up an army of antibodies to destroy it. Scientists are not sure what causes this often-devastating breakdown of normal immune function. A popular theory is that autoimmune diseases such as SLE, develop in genetically susceptible individuals after exposure to a "triggering" agent which may be a virus or possibly something in the environment. (3)

Statistic

Lupus Trust of New Zealand, 2006.

• At least five million people worldwide have lupus.
• More than 100,000 new cases of lupus develop every year.
• Nine of ten new cases of the disease develop among women ages 15 to 44 throughout the world.

• In Malaysia, it is estimated that more than 10,000 people have been diagnosed with SLE over the past 30 years.
  

• In New Zealand lupus is 3 - 4 times more common amongst New Zealand Maori and Pacific Island peoples.

National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS), 1999.

75% of Lupus cases are women. African American women rank first with lupus cases. American Indian women rank second with lupus cases. Hispanic women rank third with lupus cases. Caucasian women rank fourth with lupus cases.

Signs and Symptoms

Lupus affects somewhere between 1.4 and 2 million Americans, and its exact cause remains a mystery. SLE predominately affects women (75 percent) and most commonly individuals ranging in age from 15-45 years. While it can be life threatening, lupus is manageable for the most part. The list of symptoms include:

• Butterfly pattern of redness on skin of the cheeks and nose  
• Fatigue  
• Changes in mental function and behavior
• Atherosclerosis  (Hardening of the arteries)
• Nephritis (Kidney inflammation and possible decrease in function)
• Anemia or an imbalance in one or more components of the blood
• Abnormal antibodies
• Headaches and visual disturbance

Treatment Options

Conventional

The symptoms of lupus, like in other autoimmune diseases, tend to flare up and recede. Lupus therapy has two goals. The first objective is to reduce the symptoms during the flares. Secondly, treatment is aimed at extending the periods of remission as long as possible. (4) People with lupus need social and psychological support. Being informed and educated about the illness gives a sense of control and empowerment. A healthy, nourishing diet is vitally important. Smoking should be avoided. Exercise must be properly balanced with rest. Limited exposure to sunlight is recommended, along with the use of sunscreens, since UV light can aggravate the lupus skin rash.

Medications for lupus include the following:

NSAIDs (Non-steroidal anti-inflammatory drugs) Antimalarials Corticosteroids such as prednisosne Cytotoxic drugs such as cyclophosphamide and azathioprine.

Nutritional Suplementation

DHEA (Dehydroepiandrosterone) is a natural steroid hormone produced by the adrenal glands. DHEA serves as a "precursor," or starting material, for other steroid hormones such as estrogen and testosterone. After secretion from the adrenals, DHEA enters the bloodstream and circulates throughout the body. Once inside the cells, DHEA is converted to other hormones as determined by a person’s age, sex, and bodily needs. For women after menopause whose ovaries have stopped making estrogen, DHEA serves as a back-up source.

DHEA can be purchased as a dietary supplement. The DHEA in supplements is manufactured from diosgenin, a natural substance found in wild yams that has a similar chemical structure to DHEA. Wild yam extracts are sometimes sold as "natural sources" of DHEA. The body, however, cannot convert disogenin into DHEA, so these products are not a substitute for DHEA.

Based on research that began in the early 1990's, DHEA has gained recognition as a promising treatment for SLE. DHEA seems to relieve lupus symptoms and reduce the need for anti-inflammatory corticosteroid drugs. DHEA does have side effects such as mild acne, possibly due to increased testosterone levels. There are concerns that taking DHEA for long periods might lower the beneficial HDL cholesterol. (5)

In one animal study, DHEA significantly delayed the activity of a key inflammatory chemical produced in the body called "interleukin-6" (IL-6) and prolonged the survival of mice with lupus-like disease. (6) In another mouse study, DHEA increased boosted production of interleukin-2 (IL-2), which, in contrast to interleukin-6, reduces lupus inflammation. DHEA dramatically reversed the clinical signs of SLE in the mice. (7)

DHEA has been tested in humans with SLE. In a double-blind study 28 women with mild to moderate SLE took 200mg of DHEA or a placebo daily for three months. Women on DHEA had fewer symptoms and decreased their use of prednisone, a commonly used anti-inflammatory steroid medication. Overall disease activity diminished, while the women taking the placebo had increases in symptoms and need for the drug. Lupus flare-ups occurred more often in the placebo group. Mild acne was a frequent side effect of DHEA. (8)

A group of female lupus patients was found to have below normal blood levels of vitamin B12. None, however, had pernicious anemia, which is commonly caused by severe B12 deficiency. (9)

Fish oils and flaxseed oil are rich in beneficial fats called "omega-3 fatty acids." People with SLE have been found lacking in two important omega-3 fatty acids called "EPA" and "DHA." (10)

In an animal experiment, a diet supplemented with fish oil, slowed development of SLE in lupus-prone mice remarkably. At 10 months of age, 94 percent of the mice consuming the fish oil supplemented diet were still alive. In contrast 100 percent of the mice fed only saturated fats had died, while 65 percent of the mice fed corn oil expired. (11) In another study, lupus prone mice supplemented with fish oil had reduced levels of inflammatory compounds in their tissues, delayed onset of kidney disease and prolonged the survival time. (12)

Other animal experiments have found that omega-3 fatty acids reduce inflammation improve immune function. (13)

Some researchers found that vitamin E, given at the right doses, is a safe and effective treatment for lupus. (14) The studies supporting this are quite small, however, so the evidence is considered preliminary from a scientific perspective. In one study, four patients with lupus took 900-1,600 IU of vitamin E a day and experienced either complete or almost complete disappearance of symptoms. On the other hand, two patients receiving only 300 IU of vitamin E daily showed no benefit. (15) In another small trial, 12 patients with lupus took 100-150mg of vitamin E given three times daily after meals plus an additional 150mg by intramuscular injection two to three times a week. Eight patients had excellent results, one had good results, and three patients had poor results. (16)

There are many chemical constituents (termed phytochemicals) found in plant medicines that have beneficial pharmacological effects in humans. Some bioactive phytochemicals include tannins, resins, polysaccharides, saponins, glycosides, and volatile oils among others. Recent literature has reported that two of these phytochemicals, sterols and sterolins (plant "fats"), occur naturally in fruits, vegetables, seeds, and nuts and have clinically beneficial effects in human subjects in many conditions.

Sterol is found in all plant-based foods, and sterolin is a glucoside moiety joined to the sterol chemical structure. Both sterols and sterolins were identified as early as 1922. In the natural state, these plant "fats" are bound to the fibers of the plant, making the sterols and sterolins difficult to be absorbed during the normal transit of digested food through our gut. Seeds are the richest source of the sterols and sterolins, but are usually removed during processing by the food industry.

Plant sterols and sterolins have been reported to be effective adjunctive agents in the management and treatment of disease states such as high cholesterol levels, benign prostatic hyperplasia, pulmonary tuberculosis, and stress-induced immune suppression and HIV among others. (17) , (18) , (19) , (20) , (21) Some of the most promising uses of these plant "fats" is in the management of autoimmune disorders such as lupus, multiple sclerosis, rheumatoid arthritis, and myasthenia gravis. Of note is that the sterols should be combined with sterolin in order to be an effective agent for the immune system. (22)

Sterols and sterolins have been reported to modulate the function of T-cells, significantly enhancing the proliferation of the CD-4 TH-1 cells and increasing the production of the interleukin 2 (IL2) and gamma-interferon (FN-g and IFN-y). (23) These results indicate that sterols and sterolins are adaptogenic in that they modulate the immune and stress response.

Care should be taken if an individual is taking immunosuppressive agents. Based on pharmacology, if an individual is taking hypocholesterolemic agents concurrently with plant sterols and sterolins, a dosage adjustment in the pharmaceutical medication may be necessary.

Herbal Suplementation

In test-tube studies and human trials, Grapefruit seed extract shows broad-spectrum antimicrobial activity. Studies indicate that grapefruit seed extract kills bacteria by disintegrating their membrane coat. (24)

Grapefruit seed extract inhibits the growth of H. pylori and C. jejuni, two bacteria that cause gastrointestinal ulcers. (25) By thwarting harmful micro-organisms in the gut, including Candida yeast, grapefruit seed extract helps maintain bowel integrity. (26) In one human study, an improvement in constipation, gas, abdominal distress, and night rest were noticed after four weeks of therapy with grape seed extract.

The Chinese have valued astragalus for centuries as an herb that strengthens vitality and fortifies the body’s defenses against illness. Astragalus is classified by modern herbalists as an "adaptogen," an agent that helps the body adapt to stress. Studies show astragalus improves the body’s stress response by supporting the adrenal glands. (27) , (28)

Experiments have reported that astragalus promotes regeneration of cells in the bronchials after viral infection. Astragalus demonstrates a range of immune-strengthening properties. Studies show active ingredients in the herb called polysaccharides improve function of "killer cells" and T-cells, two key components of the immune system. There is also reason to believe astragalus may improve resistance to colds and shorten the duration of a cold as well. (29) Due to a belief that it inhibits bone marrow depression, astragalus has been studied in patients with AIDS and cancer. (30) , (31) Astragalus is claimed to protect against cell damage in the liver, (32) , (33) improve oxygenation of the heart and blood vessels, and boost stamina and endurance. (34) , (35)

Oregano has been used as a cooking spice and medicinal herb for centuries. Oregano oil is an old traditional remedy for respiratory disorders such as coughs, bronchial congestion, stomachache, arthritis, and urinary troubles. (36)

Oregano oil is now used as an antifungal and antibacterial agent in various conditions. (37) In one study, oil of oregano was given to 14 adult patients whose stools tested positive for intestinal parasites. After six weeks of supplementation with 600mg emulsified oil of oregano daily, there was complete disappearance of the parasites Entamoeba hartmanni (four cases), Endolimax nana (one case), and Blastocystis hominis in eight cases. Three more individuals had reductions of Blastocystis hominis. Gastrointestinal symptoms improved in 7 of the 11 patients who had tested positive for Blastocystis hominis. (38) Oregano oil contains thymol and carvacrol, two ingredients with reported antibacterial action. (39)

Oregano contains vitamin E and another natural antioxidant, the flavonoid "rosmarinic acid." (40) (Rosemary and basil are two other sources of rosmarinic acid.)

Rosmarinic acid is an inflammation reducer, comparable in strength to aspirin, ibuprofen, and naproxen. (41) Rosmarinic acid inhibits the body’s production of inflammation-causing substances called "leukotrienes" and "compliment proteins" while at the same time increasing production of "prostaglandin E2," which reduces inflammation. These properties make oregano and other supplements containing rosmarinic acid potential agents in inflammation, cancer, and immune disorders. (42) , (43)

Oregano does contain naringin and naringenin, the chemical constituents contained in grapefruit juice that alter the metabolism of some drugs. (44)

Olive trees are widely cultivated throughout the Mediterranean countries for its universally popular fruit. But olive trees have more to offer than just the olive and its delicious, healthful oil. The olive leaf has been used as a traditional medicine in health conditions including malaria, infections, cardiovascular diseases, and for improving general well being. (45) Olive leaf contains a key active ingredient called "oleuropein," that may have anti-viral properties, making it a potentially helpful herb in lupus. Oleuropein is also an anti-oxidant, which may give it a role in helping to prevent cardiovascular disease. (46)

Olive leaf extract has been reported to be an effective antimicrobial agent against a wide variety of disease causing bacteria, including Salmonella, Staph aureus, Klebsiella and E. coli. These organisms are some of the major causes in respiratory and intestinal infections. (47) Studies suggest that oleuropein is responsible for olive leaf's antimicrobial properties. (48) , (49) Lab studies have found that oleuropein stimulates activity of immune cells called "macrophages" which serve as the body's garbage collectors to remove toxins and destroy forgeign organisms. (50)

Nearly forty years ago, researchers began testing a synthetic derivative of oleuropein called calcium elenolate as an anti-viral drug. (51) , (52) Even though it showed strong anti-viral properties in the test tube, this was never followed up, as calcium elenolate was found to be inactivated by proteins in the blood. Clinicians are now reporting that natural olive leaf extracts are helpful as support in problems such as Crohn's disease.

Diet & Lifestyle

Postmenopausal Estrogen Therapy Over sixty-nine thousand women were evaluated from the Nurses Health Study, ages 30 to 55. With never-users of postmenopausal hormones as a reference group, it was found that never-users had a relative risk for lupus erythematosus of 2.1, 1.2 for current users, and 1.8 for past users. A proportional increase in the risk for systemic lupus erythematosus was observed with the duration of use of postmenopausal hormones. Postmenopausal hormone therapy is associated with an increased risk for developing systemic lupus erythematosus. (53)

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