Introduction
Our diet is of great interest to all of us. We believe that our health is linked to what we eat, and most of us make an effort to eat healthy food. Patients with systemic lupus erythematosus (SLE) sometimes wonder if their disease could be treated with special foods. We explore the relationship between food, eating and SLE in this article to help answer some common questions. We stress knowledge that is based on scientific evidence, and place less emphasis on advertisements and poorly-supported claims. A good book for us is The Essential Arthritis Cookbook, 1^st edition, published by the Arthritis Center and the Department of Nutrition Sciences, Univerisity of Alabama at Birmingham, Appletree Press, Inc. Mankato, Minnesota.

Can we treat SLE with special foods or diets?
Unfortunately, there are few well-conducted studies regarding the treatment of SLE with foods. From animal studies, we know that restricting the amount of calorie (the amount of energy in food) eaten tends to prolong life and reduce heart disease in mice. There are special mice that develop a condition similar to SLE. When they are fed a diet rich in polyunsaturated fat, they developed less kidney damage and lower antibody levels. Polyunsaturated fat is found in vegetable oils, like margarine and corn oil, while saturated fat is found in food made from animals, like lard, ghee and butter. We also know that too much or too little iron in the body can worsen kidney damage and shorten life in rats. One study in humans found that polyunsaturated fat diet improves the blood chemical tests in twelve lupus patients, but they remained the same from other points of view.

In summary, there is no evidence that special foods or diets can be used to treat SLE. However, the lessons learnt from animals are generally useful: we should have enough iron and polyunsaturated fat and we should not overeat. It is not clear if these help treat SLE, but they are good practices anyway.

Are there any foods that may worsen my SLE?
It is not proven that any food can worsen SLE or cause a disease flare, therefore, there is no need to avoid any particular food. Traditionally, Chinese people avoid prawns and crabs they are sick because they believe that they contain "toxins". Actually, Western medicine has not looked at this question, but logically, they should be OK for lupus patients.

Lupus patients, however, have to avoid poorly-cooked or raw food because it contains bacteria that can cause problems. For example, chicken often harbour Campylobacter, so thorough cooking is necessary. Bacteria from food may cause vomiting and diarrhoea (foor poisoning) but on rare occasions, a generalised infection that can be dangerous may result.

In recent years, people are turning to health foods and food supplements in the belief that their wellbeing may be enhanced. A food supplement is defined as any product (except tobacco) that contains at least one of the following: (1) a vitamin, (2) a mineral, (3) an herb or botanical, (4) an amino acid, (5) a dietary substance "for use to supplement the diet by increasing total dietary intake," or (6) any concentrate, metabolite, constituent, extract, or combination of any of the aforementioned ingredients. Since such supplements are not sold as drugs, there is no stringent control and sometimes unsubstantiated claims are made by the producers.

Most of the time, they should be safe but how can we be sure? There is a check-list devised by the American Arthritis Foundation on how to spot an unproven remedy. It is obtained from the website http://www.arthritis.org/resource/fs/unproven.asp.

Diets for special situations
Sometimes, your doctor may feel that a special diet is in order. For proper education, he will refer you to see a Dietitian, who is a trained professional who is able to analyse your diet and give precise instructions to optimise your food intake.

Some tips on cooking and food
We should know what we are capable of doing physically and plan our activities according to it. There is no point in frustrating ourselves with goals that are too hard to meet. An energy-saving plan is also needed in the kitchen. One way to save energy is to shop wisely, minimising the number of trips to the market without resulting in a shopping basket that is too heavy to carry. We should have enough rest between household chores and cooking. Learning to pamper our joints is useful especially if we have arthritis. Using the right kitchen tools is important. Blunt knives waste energy and cooking pots that are not well balanced on the stove may topple and pose a danger.

The concept of convenience foods is useful. Our homes should be well-stocked with foods that are easily prepared for those days that we don’t feel well. These include canned food, canned soups, instant noodles and porridge, eggs and biscuits.

What should we do when we don’t feel like eating? We should remember that food is important for our bodies even though it does not appeal to us. We should try to eat something. Making food more fragrant may stimulate our appetite. When our mouths are painful or dry, frequent sips of water can help (it’s fashionable to carry small bottles of water around anyway). Non-sugared and sourish sweets may help to stimulate saliva flow. We should avoid too much sugar because of weight gain and dental caries.

Sometimes we feel like vomiting and have a poor appetite. Since we need to eat for energy, we must devise means to overcome this. Eating small amounts of simple foods can help. We should avoid milk, very sweet foods or large meals.

Constipation is another common problem. When it is due to excessively hard stools, we should plan to eat less fibre (as found in vegetables, fruits and cereals) and drink more water and juices. Stool softeners like lactulose can help (this has to be given by your doctor). Inactivity can also lead to constipation, so we should remain active and spend less time in bed or on the couch.

Often, diarrhoea is simply due to too little fibre in our diet and can be remedied by eating more of it. If it persists, we should consult a doctor to ensure that it is not due to infection or other diseases of the intestines like irritable bowel syndrome or inflammatory bowel disease.

Heartburn may be treated by taking smaller meals and avoiding food just before bed. Smoking and obesity predispose to heartburn too. In addition, do not wear your belt too tightly! Medical treatment is needed if simple measures are not sufficient.

Medication and diet
There are a few things about food and diet we have to watch out for in relation to certain medications. Steroids, including prednisolone, methylprednisolone, dexamethasone, hydrocortisone, when ingested or injected (not usually not when applied on to the skin) can cause one to have a great appetite. It is not surprising that many people who are on steroids put on weight.

Cyclophosphamide is often used to treat SLE especially when the disease is harder to control. When it is administered as a monthly injection, it can cause nausea and vomiting about four to six hours after the infusion. When this occurs, let your doctor know and he can prescribe another medicine to prevent this.

Pain-killers like Ponstan or Honstan (mefenamic acid), Indocid (indomethacin), Oruvail (ketoprofen), Voltaren (diclofenac sodium), Synflex (naprosyn), Clinoril (sulindac) and others are best taken after meals to reduce gastric irritation. Panadol (paracetamol) is quite kind to the stomach and need not be taken after food.

New to the market are drugs that can strengthen the bones in people with osteoporosis. These medicines (like etidronate or alendronate [Fosamax])are poorly absorbed when mixed with food. They are best taken half to one hour before foods. Since they can harm the initial portion of our intestines (the gullet or oesophagus), it is advisable to remain upright for an hour after taking them to ensure their rapid passage into the stomach.

Summary
SLE is not caused by foods, and it cannot be cured by eating a special selection of foods. The majority of lupus patients can enjoy a healthy normal diet. Sometimes, special dietary restrictions are required, for which the service of a Dietitian is invaluable. We also recommend a few simple measures to ensure that eating and cooking remain pleasurable. A few highlights about food and medicines are mentioned.