Systemic Lupus Erythematosus

The omega-3 fatty acids in fish oil—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—decrease inflammation. Supplementation with EPA and DHA has prevented autoimmune lupus in animal research.⁹ In a double-blind trial, 20 grams of fish oil daily combined with a low-fat diet led to improvement in 14 of 17 people with SLE in 12 weeks.¹⁰ Other studies also found that supplementing with 10 to 15 grams of fish oil per day,¹¹ or with the amount of EPA and DHA provided by 10 grams per day of fish oil,¹² is beneficial for people with SLE. People wishing to take such a large amount of fish oil should first consult with a doctor.

Low blood levels of the hormone DHEA and the related compound DHEA-sulfate have been associated with more severe symptoms in people with SLE.¹³ Preliminary trials have suggested that 50 to 200 mg per day DHEA improved symptoms in people with SLE.^14,15 One double-blind trial of women with mild to moderate SLE found that 200 mg of DHEA per day improved symptoms and allowed a greater decrease in prednisone use,¹⁵ but a similar trial in women with severe SLE found only insignificant benefits.¹⁷

Experts have concerns about the use of DHEA, particularly because there are no long-term safety data. Side effects at high intakes (50 to 200 mg per day) in one 12-month trial included acne (in over 50% of people), increased facial hair (18%), and increased perspiration (8%). Less common problems reported with DHEA supplementation were breast tenderness, weight gain, mood alteration, headache, oily skin, and menstrual irregularity.¹⁴

High amounts of DHEA have caused cancer in animals.^19,20 Although anticancer effects of DHEA have also been reported,²¹ they involve trials using animals that do not process DHEA the way humans do, so these positive effects may have no relevance for people. Links have begun to appear between higher DHEA levels and risks of prostate cancer in humans.²² At least one person with prostate cancer has been reported to have had a worsening of his cancer despite feeling better while taking very high amounts (up to 700 mg per day) of DHEA.²³ While younger women with breast cancer may have low levels of DHEA, postmenopausal women with breast cancer appear to have high levels of DHEA, which has researchers concerned.²⁴ These cancer concerns make sense because DHEA is a precursor to testosterone (linked to prostate cancer) and estrogen (linked to breast cancer). Until more is known, it would be prudent for people with breast or prostate cancer or a family history of these conditions to avoid supplementing with DHEA. Preliminary evidence has also linked higher DHEA levels to ovarian cancer in women.²⁵

Some doctors recommend that people taking DHEA have liver enzymes measured routinely. Anecdotes of DHEA supplementation (of at least 25 mg per day) leading to heart arrhythmias have appeared.²⁶ At only 25 mg per day, DHEA has lowered HDL cholesterol while increasing insulin-like growth factor (IGF).²⁷ Decreasing HDL could increase the risk of heart disease. Increasing IGF might increase the risk of breast cancer.

In a small, controlled study, people with SLE were given medication and either a placebo or Pycnogenol in the amount of 120 mg per day for 30 days followed by 60 mg per day for another 30 days. SLE disease activity, measured with a combination of signs, symptoms, and blood measurements, declined further in the group taking Pycnogenol.²⁶

Preliminary evidence indicates that some Chinese herbs may help those with SLE. In one preliminary trial, a formula composed of 17 Chinese herbs was given to people with SLE.²⁷ Of the people who were also taking cortisone, 92% improved, but 85% of those taking the herbs alone also benefited. People with SLE-induced kidney damage given a combination of conventional drugs plus a Chinese herbal formula for six months did significantly better than those given the drugs alone.²⁸ Various Chinese herbs have prolonged survival in animals with SLE.²⁹

One of these Chinese herbs, Tripterygium wilfordii, is thought to benefit those with SLE or DLE by both suppressing immune function and acting as an anti-inflammatory agent. When people with DLE took 30 to 45 grams of tripterygium per day for two weeks in a preliminary trial, most experienced some degree of improvement, including reduction or disappearance of skin rashes.³⁰ Skin rashes in eight people completely cleared up, while in ten people over 50% of the rash improved.

A preliminary trial gave the same dose of tripterygium to people with SLE. ³¹ After one month, 54% experienced relief from symptoms such as joint pain and malaise.

Use of the crude tripterygium herb is not recommended, and people interested in using it should work with their doctor to obtain the specially prepared and standardized extracts used in clinical studies. Because of potential side effects, people with SLE or DLE should consult with a doctor experienced in herbal medicine before using this herb. In the first two studies summarized, less than 8% of women with DLE and approximately one-third of women with SLE experienced amenorrhea (cessation of menstruation) after taking tripterygium. Other side effects ranged from stomach upset or pain, to nausea, loss of appetite, dizziness, and increased facial coloring. Both studies found that these effects subsided with time once people stopped using the herb. However, some reports have found more serious side effects and even death with use of tripterygium.³²Pregnant women should not use the herb.

Finally, a report suggests that long-term use (over five years) of tripterygium significantly reduced bone density in women taking it to treat lupus.³³ While this loss of bone density was less severe than that found with long-term use of prednisone, lupus patients should have their bone density checked at yearly intervals by their doctor when using the herb.

One Chinese preliminary trial also found that astragalus could decrease overactive immune function in people with systemic lupus erythematosus.³⁶ However, much more research is needed to know whether astragalus is safe in lupus or any other autoimmune disease.