Lupus alternative treatment with natural supplements - Treating systemic lupus erythematosus with herbs and vitamins
January 2 2016 by Ray Sahelian, M.D.

Lupus is a chronic disorder that for unknown reasons causes the body's immune system to attack its own tissues. Systemic lupus erythematosus predominantly affects women and is more common in blacks. Although survival rates have improved, over one half of patients have permanent damage in one or more organ systems. While lupus can affect women and men of any age, it's much more likely to affect blacks, Hispanics, Asians or Native. It occurs 10 to 15 times more frequently among adult females than adult males, and most often affects people aged 15 to 44. The most common symptoms of the disease include achy joints, fever, arthritis, extreme fatigue, skin rashes, and anemia. Sometimes symptoms disappear for a prolonged period, a term doctors call "remission." Women with lupus who become pregnant face a much higher risk of serious complications and even death. Heart disease risk is much higher in those with lupus.

Natural alternatives that may be helpful
Little is known regarding the influence of herbs, supplements, and diet in lupus. Here I mention some of the research that has been done thus far and I hope to continue updating this page as more information becomes available. If you have lupus please discuss with your doctor before making any drastic chances or additions to your treatment plan.

Fish oils and omega-3 fatty acids -- fish oil supplements improve symptoms of systemic lupus erythematosus. Also consider eating more fish such as salmon, halibut and sardines (packed in mustard or tomato sauce).
Vitamin D could be of benefit, particularly in those who do not have much sun exposure.
     Arthritis Res Ther. 2014. Vitamin D levels in Indian systemic lupus erythematosus patients: association with disease activity index and interferon alpha. Low levels of vitamin D3 have been associated with several autoimmune disorders including multiple sclerosis, rheumatoid arthritis, type 1 diabetes and systemic lupus erythematosus (SLE). The major source of vitamin D3 is sunlight but exposure of SLE patients to UV rays has been shown to exacerbate disease pathology. Studies in various populations have shown an association between low vitamin D levels and higher SLE disease activity. Plasma 25-OH vitamin D3 significantly correlated in an inverse manner with systemic lupus erythematosus disease activity index Results suggest an important role of vitamin D in regulating disease activity in SLE patients and the need to supplement vitamin D in their treatment.
Green tea with EGCG - drink a glass a day in the morning.
Cordyceps mushroom extract, see codyceps study mentioned below.
Lipoic acid is an antioxidant, limit usage to 50 mg two or three times a week.
Turmeric root, which contains curcumin, may have some potential benefit for lupus nephritis.

DHEA -- this hormone may help but has side effects. At this point I don't recommend the long term use of DHEA due to adverse reactions, including hair loss.

Curr Rheumatology Rep. 2013. Updated review of complementary and alternative medicine treatments for systemic lupus erythematosus. It is estimated that over 50% of patients with SLE have utilized complementary and alternative medicine (CAM) treatments to reduce symptoms and manage their health. This review describes recent studies of vitamins and supplements, acupuncture, and mind-body interventions in SLE patients. The recent trials of CAM treatments for SLE indicate that supplements such as vitamin D, omega 3 fatty acids, N-acetyl cysteine and turmeric show some promise for reducing SLE disease activity.

Supplements that may not be helpful for lupus patients
There is very little research regarding supplements or herbs that may have a detrimental effect on lupus symptoms. However, echinacea and spirulina should be used with caution until more research is available.

Would it be possible to list supplements on your lupus web page that are contraindicated for those with lupus? I noticed that spirulina is elsewhere on your website, but not on the lupus page itself. I have also heard that alfalfa, golden seal, and echinacea should not be taken if you have lupus. Listing these and any others would be a great help to those with lupus.
   I am reluctant to point out any herbs or supplements that may make lupus symptoms worse. There is a potential for spirulina and echinacea to influence this condition, but until full human trials are conducted I do not want to prematurely warn against using goldenseal, alfalfa, or other herbs.

Lupus diet, foods
Substances that may aggravate lupus include excess calories, excess protein, high fat (especially saturated and omega-6 polyunsaturated fatty acids), and iron. Some people with lupus placed on a food allergy elimination diet report improvement in their lupus symptoms; however, this may be related to a decrease of other substances in the diet. Eat more fish and vegetables while reducing sugar and sweets.

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Omega 3 fatty acids and systemic lupus erythematosus - Lupus and Fish Oils
Stephen Wright, MD, Specialist Registrar in Rheumatology, Department of Therapeutics and Musculoskeletal Education and Research Unit, Queen's University Hospital, Belfast, United Kingdom has evaluated the role of dietary supplementation with low-dose omega-3 fish oils in lupus. Results show omega-3 fatty acids improves lupus symptoms and show evidence of a protective cardiovascular effect. .

Stephen Wright, MD, Specialist Registrar in Rheumatology, Department of Therapeutics and Musculoskeletal Education and Research Unit, Queen's University Hospital, Belfast, United Kingdom has found supplementation with low-dose omega-3 fish oils improves lupus symptoms and shows evidence of a protective cardiovascular effect. Sixty patients participated in the trial. They received 3 grams of omega-3 fish oils daily, for 24 weeks. The investigators measured disease activity using the revised Systemic Lupus Activity Measure (SLAM-R) and the British Isles Lupus Assessment Group (BILAG) index of disease activity for SLE. In the fish oil group, there were statistically significant improvements at 24 weeks in lupus disease activity with changes in SLAM-R and BILAG. Stephen Wright, MD concludes, "Low-dose dietary supplementation with omega-3 fish oils in SLE not only has a therapeutic effect on disease activity but also improves endothelial function and reduces oxidative stress and may, therefore, confer cardiovascular benefits." A Randomised Placebo-Controlled Interventional Trial of Omega-3-Polyunsaturated Fatty Acids on Disease Activity and Endothelial Function in Systemic Lupus Erythematosus, presented at the 71st annual meeting of the American College of Rheumatology on November 9, 2007.

The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosus.
J Rheumatol. 2004. Northern Ireland Center for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Ulster, Northern Ireland, UK.
To determine the effect of dietary supplementation with omega-3 fish oils with or without copper on disease activity in systemic lupus erythematosus. Fish oil supplementation has a beneficial effect on murine models of SLE, while exogenous copper can decrease the formation of lupus erythematosus cells in rats with a hydralazine-induced collagen disease. A double blind, double placebo controlled factorial trial was performed on 52 patients with lupus. Patients were randomly assigned to 4 treatment groups. Physiological doses of omega-3 fish oils and copper readily obtainable by dietary means were used. One group received 3 g MaxEPA and 3 mg copper, another 3 g MaxEPA and placebo copper, another 3 mg copper and placebo fish oil, and the fourth group received both placebo capsules. Serial measurements of disease activity using the revised Systemic Lupus Activity Measure (SLAM-R) and peripheral blood samples for routine hematological, biochemical, and immunological indices were taken at baseline, 6, 12, and 24 weeks. There was a significant decline in SLAM-R score from 6.12 to 4.69 in those subjects taking fish oil compared to placebo. No significant effect on SLAM-R was observed in subjects taking copper. Laboratory variables were unaffected by either intervention. In the management of lupus, dietary supplementation with fish oil may be beneficial in modifying symptomatic disease activity.

Vitamin D should be considered
Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D?
Ann Rheum Dis. 2010 . Amital H, Szekanecz Z, Szücs G, Nagy E, Csépány T, Kiss E, Rovensky J, Tuchynova A, Kozakova D, Doria A, Corocher N, Agmon-Levin N, Barak V, Orbach H. Department of Medicine 'B' and Centre for Autoimmune Diseases, Sheba Medical Centre, (Affiliated to Tel-Aviv University) Tel-Hashomer, Israel.
In a cohort of patients with SLE originating from Israel and Europe vitamin D serum concentrations were found to be inversely related to disease activity.

Cordyceps mushroom
Study on effect of Cordyceps sinensis and artemisinin in preventing recurrence of lupus nephritis]
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002.
To observe the effect of cordyceps sinensis and artemisinin in preventing recurrence of lupus nephritis. Sixty-one LN patients, who had no activities by corticosterone and cyclophosphamide (CTX) impacting therapy were randomly divided into two groups. The 31 cases in the treated group were given Cordyceps powder 2-4 g/d before meal and artemisinin 0.6 g/d after meal in three portions orally taken for 3 years. The 30 patients in the control group were treated with tripterygiitotorum and/or Baoshenkang tablet. The consecutive observation lasted for 5 years to monitor the clinical manifestations of lupus and laboratory indexes including blood creatinine, creatinine clearance rate (CCr) and antinuclear antibodies (ANA). Cordyceps and artemisinin could prevent the recurrence of lupus nephritis and protect kidney function.

Turmeric has curcumin
Oral Supplementation of Turmeric Decreases Proteinuria, Hematuria, and Systolic Blood Pressure in Patients Suffering from Relapsing or Refractory Lupus Nephritis: A Randomized and Placebo-controlled Study.
J Ren Nutrition. 2011.
In this study we investigated effects of oral curcumin supplementation on patients suffering from relapsing or refractory lupus nephritis. The present study was conducted in Lupus clinic of Hafez Hospital, Out-Patient Department of Shiraz University of Medical Sciences. With each meal, each patient in the trial group received 1 capsule for 3 months, which contained 500 mg turmeric, of which 22 mg was the active ingredient curcumin (3 capsules daily). The control group received 3 capsules (1 with each meal) for the same period, which contained starch and were identical in color and size to capsules given to patients in the trial group. A significant decrease in proteinuria was found. Also, systolic blood pressure and hematuria were found to decrease significantly. Short-term turmeric supplementation can decrease proteinuria, hematuria, and systolic blood pressure in patients suffering from relapsing or refractory lupus nephritis and can be used as an adjuvant safe therapy for such patients.

DHEA hormone supplementation
Effects of dehydroepiandrosterone supplement on health-related quality of life in glucocorticoid treated female patients with systemic lupus erythematosus.
Autoimmunity. 2005.
The objective of this study was to evaluate the efficacy of low dose dehydroepiandrosterone on health-related quality of life in glucocorticoid treated female patients with systemic lupus erythematosus. Forty one women ( >or= 5 mg prednisolone/day) were included in a double-blind, randomized, placebo-controlled study for 6 months where DHEA was given at 30 mg/20 mg ( <or= 45/ >or= 46 years) daily, or placebo, followed by 6 months open DHEA treatment to all patients. Quality of life was assessed at baseline, 6 and 12 months, using four validated questionnaires and the patients' partners completed a questionnaire assessing mood and behaviour at 6 months. DHEA treatment increased serum levels of sulphated DHEA from subnormal to normal. The DHEA group improved in SF-36 "role emotional" and HSCL-56 total score. During open DHEA treatment, the former placebo group improved in SF-36 "mental health" with a tendency for improvement in HSCL-56 total score. Both groups improved in McCoy's Sex Scale during active treatment. DHEA replacement decreased high-density lipoprotein (HDL) cholesterol and increased insulin-like growth factor I (IGF-I) and haematocrit. There were no effects on bone density or disease activity and no serious adverse events. Side effects were mild. We conclude that low dose DHEA treatment improves quality of life with regard to mental well-being and sexuality and can be offered to women with systemic lupus erythematosus where mental distress and/or impaired sexuality constitutes a problem.

I read that you were concerned that people are overdosing themselves on DHEA. You recommend 1 to 5 mg. However I have lupus and I heard 200 milligrams of DHEA can possibly help. I also have hair loss which I am trying to improve. What do you suggest?
   I can't make a specific recommendation since that is the role of your health care provider, but DHEA is known to increase hair loss. I don't think this hormone is safe to use for prolonged periods in high dosages.

Pycnogenol and lupus
Pycnogenol efficacy in the treatment of systemic lupus erythematosus patients.
Phytother Res. 2001.
A pilot study was performed to evaluate the efficacy of Pycnogenol treatment in systemic lupus erythematosus (lupus) patients. Eleven lupus patients were treated with first line medication according to disease activity and in addition, six of them received Pycnogenol and five a placebo. The lupus disease activity index (SLEDAI), serum anti-dsDNA antibodies, fibrinogen, C-reactive protein levels, erythrocyte sedimentation rate, production of reactive oxygen species (ROS) by neutrophils, spontaneous apoptosis and p56(lck) specific activity in peripheral blood lymphocytes were evaluated. Pycnogenol treatment determined a significant reduction of ROS production, apoptosis, p56(lck) specific activity and erythrocyte sedimentation rate. In addition, the decrease of SLEDAI was significant in the Pycnogenol treated group compared with the placebo group. The results obtained suggest that Pycnogenol could be useful for second line therapy to reduce the inflammatory feature of lupus.

Birth control pills may trigger lupus
Certain women may be prone to develop lupus when they start taking combined oral contraceptives. Dr. Samy Suissa found out that the increased risk of developing lupus in connection with starting on the pill appears to be greatest in the first 3 months of use, and with first- and second-generation contraceptives containing higher doses of estrogen. This suggests "an acute effect in susceptible women and possibly a dose-response effect of estrogen on SLE onset," she and her colleagues report in the April 15, 2009 issue of Arthritis and Rheumatism scientific magazine.

Lupus Symptom
Each person with lupus has different symptoms that can range from mild to severe. Lupus symptoms are not consistent, but may come and go over time depending on a number of factors including stress, sleep patterns, diet, et.. However, some of the most common symptoms of lupus include painful or swollen joints, fatigue, and unexplained fever A characteristic lupus skin sign is a red skin rash. This is the so-called butterfly or malar rash. This lupus skin sign may appear across the nose and cheeks. Lupus rashes may also occur on the face and ears, upper arms, shoulders, chest, and hands. Because many people with lupus are sensitive to sunlight (called photosensitivity), skin rashes often first develop or worsen after sun exposure. Another lupus symptom may be cold hands similar to Raynaud's phenomenon. However, the most common lupus symptom is fatigue.

Arthritis and skin manifestations are most common lupus signs, but kidney, hematologic and neurologic manifestations contribute largely to illness and mortality. Lupus often gets worse during pregnancy and with oral contraceptives.

Before a patient can be classified with systemic lupus erythematosus, at least four of the following 11 disorders must be present: Malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, antinuclear antibodies.

At some point, over 90 percent of patients have polyarthralgias or polyarthritis because of the disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment in these patients, especially those who have mild polyarthralgias or polyarthritis. NSAIDs may adversely affect renal function, a special concern because 50 percent of patients with systemic lupus erythematosus develop associated nephritis.

The most common initial lupus symptom is fatigue. Other lupus symptoms include fever, and muscle and joint pain. This is called a "flulike syndrome." Fatigue is the most common and bothersome complaint. It is also often the only symptom that remains after treatment of acute flares. A flare in lupus is an acute increase in symptoms. Fever during lupus flares is usually low-grade, rarely exceeding 102°F. A temperature greater than this should stimulate a search for an infection as the source of the fever. However, any fever in lupus should be considered an infection until proven otherwise. Muscle pain (myalgia) and joint pain (arthralgia) without or with joint swelling (arthritis) are very common with the new onset of lupus and with subsequent flares.

Lupus nephritis, one of the most serious manifestations of systemic lupus erythematosus, usually arises within 5 years of diagnosis.

Discoid lupus -- (Cutaneous Lupus Erythematosus
Discoid lupus is a  chronic and recurrent disorder primarily affecting the skin and characterized by sharply circumscribed macules and plaques displaying erythema, follicular plugging, scales, telangiectasia, and atrophy. The cause of discoid lupus erythematosus (DLE) is unknown. The disorder is more common in females, most often in those in their 30s, but the age range is far wider than that of SLE.

Lupus rash
The skin is involved in more than 90% of people with lupus. Skin symptoms are more common in whites than in African Americans. While the classic lupus rash is a redness on the cheeks (malar blush) often brought on by sun exposure, many different types of rashes can be seen in SLE. Discoid lupus with the red skin patches on the skin and scaliness is a special characteristic rash that can lead to scarring. It usually occurs on the face and scalp and can lead to loss of scalp hair (alopecia). Hair loss can occur with flares of SLE even without skin rashes in the scalp. In this situation, the hair regrows after the flare is treated. Hair loss can also occur with immunosuppressive medications.

Medical Lupus treatment
Plaquenil - hydroxychloroquine sulfate 200 mg tabs. Side effects include irreversible retinopathy, blurred vision, hair bleaching, alopecia (loss of hair), pruritus, rash, nausea. The risk of irreversible hydroxychloroquine toxic retinopathy is much greater than previously appreciated.
   Immune-suppressing drugs used in the treatment of lupus patients may increase the risk of blood cancer, but not lung, cancer. Annals of the Rheumatic Diseases, January 2008.

Lupus risk factors - research
Risk factors for developing systemic lupus erythematosus: a case-control study in southern Sweden.
Rheumatology (Oxford). 2002.
Department of Rheumatology, University Hospital of Lund, Sweden.
To explore the risk factors that have been suggested to be associated with the development of
systemic lupus erythematosus. A case-control study was performed and a questionnaire was developed to obtain the data. Consecutive female incident cases diagnosed between 1981 and 1999 in a defined geographical area in southern Sweden were included. Controls, matched for calendar year of birth, were selected randomly from the same area. In total, 85 cases and 205 controls agreed to participate. The questionnaire included questions about formal education, body weight and height, medical history, family history of autoimmune diseases, exposure to ultraviolet radiation, animals, hair-colouring dyes, alfalfa (lucerne) sprouts, smoking and alcohol habits, history of physical traumata, blood transfusion, silicone breast implants, exogenous oestrogens, other medication, and significant negative life events. Using a multivariate model, a history of hypertension, drug allergy, a type I/II sun-reactive skin type and a family history of SLE were all significantly associated with an increased risk of developing SLE, whereas consumption of alcohol was inversely associated with the risk of SLE. A suggested association with increased systemic lupus erythematosus risk was seen for smoking and blood transfusions. Neither exposure to exogenous oestrogen nor exposure to hair-colouring dyes was associated with SLE. Risk factors of both exogenous and endogenous origin were identified in this population-based series of systemic lupus erythematosus patients.

Lupus and exercise
A pilot study on the effects of exercise in patients with systemic lupus erythematosus.
Arthritis Care Res. 2000.
A pilot study was designed to assess the efficacy and safety of different exercise therapies on patient-reported fatigue and functional status. Ten patients with systemic lupus erythematosus (lupus) were randomly placed in either an aerobic exercise group or a range of motion/muscle strengthening (ROM/MS) exercise group. Outcome measures assessed at baseline and the end of the study were fatigue, functional status, disease activity, cardiovascular fitness, isometric strength, bone mineral density (BMD) of the lumbar spine and femoral neck, and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation, respectively. Both aerobic and ROM/MS types of exercise were safe and did not worsen lupus disease activity. Patients in both exercise groups showed some improvement in fatigue, functional status, cardiovascular fitness, and muscle strength. Both groups showed increased bone turnover, but BMD was unchanged. Eighty percent of the patients met the compliance standard for the study. This pilot study shows the feasibility of exercise for lupus patients. The potential value of this approach shows promise in the routine management of these patients.
Lupus symptom.

Questions and answers by Ray Sahelian, M.D.
Q. Can you tell me if mangosteen or the spice curcumin are helpful in lupus?
   A. I have not seen such studies.

Q. Is the use of krill oil contraindicated in those with lupus?
   A. I have not seen any studies that would make me think that krill oil would have harmful effects in those with lupus. Perhaps it may even help?

My 21 yr. old daughter has systemic lupus erythematosus. Her exhaustion is extreme. If she takes Plaquenil or Chloroquine, she then has 'Lupus Psychosis'. Do you know anything about Kalawalla, from Organic Hope (
    We have not heard of kalawalla. We looked on the internet and found Kalawalla to be listed as Polypodium Leucontomos on one website. There's a company selling kalawalla 300 mg 50.1 Standardised extract. We searched Medline and found no listing for kalawalla. Another search on Medline revealed no listing for Polypodium Leucontomos, but there were listings for Polypodium Leucotomos. Kalawalla and Rapuani are apparently brand names for Polypodium Leucotomos.

I have been diagnosed with lupus for several years. My condition was getting worse. My cousin introduced me to Dr. Sahelian and I had the fortune of having lunch with him one day. He asked me about my diet. I was drinking several glasses of milk a day. He said I should reduce the milk and add salmon and cold water fish to my diet. Within several weeks my lupus symptoms were reduced and my fatigue was much better. I think in my case diet had something to do with the severity of my lupus condition.

I just wanted to say thank you for your webpage on lupus that is supported by research papers. I truly appreciate research-based discussions.

I have SLE for almost 20 years. My latest blood test for the DNA or anti nuclear came back at 58. My question is How can I get this number to be normal. My doctor said that less than 5 is the normal range, when I asked him what can I do, he said I would die. Is this true? What can you tell me about getting better? I have fibromyalgia and taking tramadole and flexiril and trazadone and plaquinil lyrica lortab I take other medication for high blood pressure also Inspra and Diovan. And for pre-diabetes I take metformin.
   I can't provide specific advice but you may benefit from reading about the different medical conditions on this web site and natural ways to treat them and review the options with your doctors.

My wife has diagnosed lupus before a year and still today we are struggling a lot with disease. Is there any way to treat a patient with the drugs without any side effects. Now she is on steroid and immunosuppressive medicines but still struggling with the many flares. If you have any clinic in Ahmedabad, India please send me the contact detail so that I can take an appointment.

My resent blood test showed ANA 1:1000. That result, along with my chronic fatigue symptoms, butterfly face rash and sun induced skin flareups, and kidney inflamation is starting to point me to a Systemic Lupus diagnosise direction - further test will no doubt tell me more. Have you any thoughts or experience on using CMOT (cerasomal-cis-9-cetylmyristoleate) as an autoimmune modulator ? I have read about this relating to Dr Len Sands of the San Diego Immunological Center, information of which seems to relate to Arthritis, but wondered if it has been found successful for Lupus?
   A Medline search in 2010 did not reveal any such studies.