When you have lupus, eating becomes a difficult thing! Nutrition experts teach you how to eat properly and stay healthy

(1) When organ involvement and dysfunction occur

Systemic lupus erythematosus is a disease that affects multiple organs. As different organs are affected, the diet needs to be adjusted according to the progression of the disease, organ involvement and functional impairment.

For example, the kidney is a common target organ. When significant nephrotic syndrome (proteinuria, hypoproteinemia, hyperlipidemia, edema) occurs, the diet needs to place more emphasis on low-fat and low-salt (<6 g/d) intake. Vegetable oil intake needs to be strictly controlled to no more than 25 mL/d, and high-fat foods such as deeply processed foods, animal oils, and baked goods need to be limited.

At this time, adequate and high-quality protein intake is also one of the important dietary requirements. Milk, eggs, soybeans, meat, poultry, and seafood that are rich in high-quality protein with high biological value should be quantitatively increased according to the patient's metabolic needs.

On the other hand, when the disease progresses to chronic renal insufficiency, protein intake needs to be further quantified. Doctors need to further plan the patient's protein intake based on the evaluation of kidney function and the patient's metabolic needs, and quantitatively regulate the intake of high-protein foods.

In addition, as kidney function declines, electrolyte disorders such as high potassium, low calcium, and high phosphorus may occur, which also require parallel adjustments in dietary intake.

(2) When metabolic side effects occur during drug treatment

Many therapeutic drugs for systemic lupus erythematosus have complex metabolic side effects, and patients often need to pay attention to healthy dietary intake requirements to minimize drug side effects.

For example, cortisol can aggravate water and sodium retention, hypertension, and congestive heart failure; promote the occurrence of dyslipidemia and accelerate atherosclerosis; cause increased blood sugar and central obesity; and induce osteoporosis and femoral head necrosis.

Therefore, patients receiving cortisol therapy should strictly limit their intake of salt and processed foods, reduce animal fats and offal rich in saturated fat, avoid excessive intake of refined sugar and added sugar foods that put too much load on blood sugar, encourage calcium-rich dairy products (>500 mL/d), soy products, and seafood, and ensure the intake of protein-rich animal foods and a variety of fresh vegetables.

In addition, if cortisol therapy is combined with significant gastrointestinal reactions such as peptic ulcers and bleeding, the patient needs to adjust to a low-residue liquid/semi-liquid diet based on gastrointestinal function, and may even need to choose enteral nutrition solution or suspend oral intake for a certain period of time and provide intravenous parenteral nutrition support.

(3) When the disease progresses and wasting symptoms appear

Systemic lupus erythematosus is a chronic inflammatory disease that is often accompanied by significant symptoms of wasting, such as weight loss, loss of appetite, and fatigue. Many patients and their families are very concerned about how to make timely adjustments to dietary intake to improve nutritional support.

For patients who already have decreased intake and loss of nutritional status, it is recommended to consult a nutritionist for symptomatic support, relieve digestive system symptoms, and adjust the diet to encourage patients to consume more energy and protein-rich foods, increase gastrointestinal tolerance, and improve nutritional status.

【Solution】

During the consultation process, the nutritionist will calculate the patient's daily energy and nutrient requirements based on the patient's medical history and dietary status, make meal schedule recommendations, and develop a recipe.

If necessary, patients should be given oral nutritional supplements to strengthen their support under the advice of their physician. Dietary reinforcement and nutritional support is a continuous follow-up process. If the patient's oral diet is insufficient, and the dietary intake has not improved after more than one week of nutritional consultation and dietary adjustment and oral nutritional supplementation, or the intake is less than 60% of the recommended amount for 1 to 2 weeks, further strengthening is required after a doctor's evaluation, and artificial nutritional support including enteral nutrition and/or parenteral nutrition is given.

The selection of this series of nutritional support methods should follow the principle of step-by-step treatment: from nutritional counseling and education (oral nutritional supplements can be added), to progressively selecting enteral nutrition tube feeding, partial parenteral nutrition + enteral nutrition, and total parenteral nutrition.

▌The topic of this article is from the article "Union Medical Journal" 2022, 13(2) [Union Medical Journal] Inspiration from "China Systemic Lupus Erythematosus Development Report 2020"

Li Rongrong

Chen Wei

Editor: Liu Yang and Zhao Na

Proofread by Li Na, Li Yule, and Dong Zhe

Producer: Wu Wenming

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