This is the second presentation this year from Clinical Nutritionist Sotiria Everett and Part 2 of our Nutrition and Lupus series. In this presentation, Ms. Everett focuses more specifically on the heart and renal (kidney) disease as these relate to nutritional considerations for people with lupus. (See Part 1 for a more general overview of nutrition and its importance for people with lupus.)
Ms. Everett began her presentation by discussing some important general facts about heart disease. Heart disease is still the leading cause of death in the United States. Heart disease is a slow and silent process. Often patients will not feel any symptoms, so it is important to be aware of the risk factors that are at play. Factors such as high blood pressure, high cholesterol, tobacco use, diabetes, physical inactivity, and poor nutrition can put people with lupus at an even greater risk for heart disease, or for worsening symptoms. It is important to understand that there are a lot of “little” things you can do to help reduce your risk.
Ms. Everett next highlighted some of the important issues that relate to lupus and heart disease:
All of these risk factors are important to be aware of. There is still much you can do to limit or lessen your risk from future disease. Ms. Everett highlighted that although we are unable to change risk factors like our genetics, gender, and age, there is still much we can do to lessen our risk. Some techniques that Ms. Everett discussed included controlling risk factors of heart disease by increasing physical activity, going to physical therapy, practicing healthy eating habits, seeking out a nutritionist, joining a smoking cessation program if you are a smoker, controlling your weight, and so on. It is very important that you keep in close contact with your doctor in order to control and monitor lupus and the medicines you take.
Ms. Everett describes these all as therapeutic lifestyle changes, and not a diet or something you will do once in a while.
To maintain a healthy weight, it is important to know approximately how many calories you need to eat each day. Ms. Everett discussed that men require about 2200-2400 per day, whereas women require about 1800-2000 calories per day. Try and exercise for at least 30 minutes daily to help maintain your weight. It is important to reduce abdominal obesity where waist circumference for men should be below 40 inches and, for women, below 35 inches. It is also important to maintain your body mass index (BMI) below 25.
Next, Ms. Everett discussed in greater detail some of the important foods and nutrients that are important to lessen the risk of heart disease: Omega-3 fatty acids, soy protein, and fiber.
A number of studies have shown that omega-3 fatty acids, particularly EPA and DHA, can contribute to heart health. Omega-3’s consist of alpha linolenic acid (ALA), docosahexaenoic acid (DPA), and eicosapentaenoic acid (EPA). Food sources of omega-3’s include the following:
There are many ways to boost your omega-3 intake, including:
Fish oil supplements:
If you have heart disease, the American Heart Association recommends one gram of omega-3 fatty acids from DHA and EPS per day. Talk to your doctor before taking fish oil supplements to determine if they are right for you.
Soy protein is a low-fat protein alternative for meat and cheese. Some studies indicate that soy protein may also help reduce cholesterol. Further research is needed.
Fiber has been shown to help with weight control and blood sugar levels. Aim to eat at least 25 grams of soluble and insoluble fiber daily.
Ways to boost your fiber intake:
Here is an example of the difference between a low fiber and a high fiber breakfast:
Ms. Everett next discusses some key techniques that can help one in making positive lifestyle changes.
In order to help you to begin to maintain your own healthy diet at home, Ms. Everett next provided some useful recipe substitutes to try and incorporate into your diet:
Tips: instead of two slices of pepperoni pizza and an eight oz. Coca-Cola, which equals 14 grams of fat, 780 calories, 753 mg of sodium, and 75 mg of cholesterol, choose a roasted turkey sandwich on wheat bread with two teaspoons of light mayo, lettuce & tomato, along with a low calorie iced tea and one apple, equaling three grams of fat, 580 calories, 440 mg of sodium, and 28 mg of cholesterol.
Next, Ms. Everett reviewed some important facts about kidney disease and some essential dietary recommendations for people with lupus. Lupus nephritis is a form of kidney disease that affects people with lupus. Lupus nephritis is inflammation of the kidneys in which tiny filters in the kidneys are damaged, resulting in a loss of kidney function. Retention of fluids causes weight gain and swelling and puffiness in the legs, ankles, and/or fingers. Lupus nephritis may be treated with corticosteroids or immunosuppressive agents.
The dietary recommendations are very similar to those suggested for heart disease. Ms. Everett highlighted that patients should follow a heart healthy diet by keeping salt intake low and, depending on your blood work, cutting back on protein foods and avoid high potassium foods. This is very important to check with your doctor.
Your doctor may advise you to limit the amount of protein in your diet. Since you would need to eat a smaller amount of protein, choose heart-healthy protein foods like fish, chicken breast, lean red meats, egg whites, low fat soy products, and low fat dairy products as your main protein sources. Limit servings of milk, yogurt, cheese, dried beans and peas, nuts and seeds, peanut butter, and some soy products, which are high in both protein and phosphorus. Phosphorus is a mineral that builds up in the blood as kidney failure progresses.
If your doctor tells you to limit high potassium foods, these foods include avocados, bananas, cantaloupe, dried fruits, honeydew, kiwi, mangos, artichoke, dried beans & peas, pumpkin, potatoes, French fries, Spinach (cooked), oranges & orange juice, papaya, prune juice, milk, yogurt, ice cream, chocolate, molasses, salt substitute, seeds and nuts, sweet potatoes, tomatoes, tomato sauce, vegetable juice, and winter squash.
Try to eat lower potassium foods such as apples, berries, grapes, lemons, peaches, canned pears, pineapple, plums, watermelon, vegetables carrots, cabbage, cauliflower, cucumber, eggplant, green beans, lettuce, onion, summer squash, sweet peppers, dairy substitutes (nondairy creamers, rice milk [unenriched]), sorbet or popsicles, nondairy whipped topping, popcorn (unsalted), pretzels (unsalted) and red licorice. Remember to watch your portions of these foods. The bigger the portion, the more potassium that is consumed.
Some other risk factors that can affect people with lupus are diabetes and osteoporosis.
To lessen your risk for diabetes, be sure to limit sugary foods and watch your portions of carbohydrates, i.e., fruits, starches, milk/yogurt, desserts, and breads/grains. It is important to keep your heart healthy and to stay active.
To lessen your risk for osteoporosis, be sure to stay active, maintain a healthy weight, stop smoking if you currently are, and get enough calcium and vitamin D.
Ms. Everett summarized her presentation by sharing some key points that people with lupus should follow in order to maintain and also lessen their risk for developing future disease.
Ms. Everett concluded by speaking briefly about the nutrition services at Hospital for Special Surgery. She highlighted that meeting with a nutritionist can be effective if you are interested in a one-on-one consultation about your diet. For more information on a nutrition consultation at HSS, please call 212-774-7638 or 212-606-1293.
The Division of Rheumatology at HSS has also launched a cardiovascular disease (CVD) prevention counseling program for HSS patients with systemic lupus erythematosus (SLE) and/or positive antiphospholipid antibodies (aPL). This free-of-charge program, which is partially supported by the New York Community Trust and partially by HSS, will provide a basic assessment and education of the CVD risk factors in patients who participate in counseling.
Learn more about the HSS SLE Workshop, a free support and education group held monthly for people with lupus and their families and friends.
See separate summary for Part 1: Nutrition and Lupus Part 1: Ways to Maintain a Healthy Diet.
Summary Written by Christie Carlstrom, SLE Workshop Coordinator and Social Work Intern at HSS.