A Functional Medicine Systemic Lupus Erythematosus (SLE) Protocol: Testing, Diagnosing, and Treatment

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder marked by the immune system attacking the body's own tissues, resulting in inflammation and damage to various organs. SLE affects nearly 1.5 million Americans and mainly occurs among women. Surprisingly, many individuals with SLE remain undiagnosed or are misdiagnosed due to the disease's variable presentation. Although there is no definitive cure for SLE, early detection and a comprehensive treatment plan can mitigate symptoms, improve quality of life, and reduce the risk of complications. This article will explore a functional medicine approach to preventing and managing Systemic Lupus Erythematosus.

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What is Systemic Lupus Erythematosus?

SLE is the most prevalent form of lupus, characterized by an autoimmune response that causes the immune system to mistakenly target its own tissues. This leads to extensive inflammation and damage across various organs, including the joints, skin, brain, lungs, kidneys, and blood vessels (4).

Systemic Lupus Erythematosus (SLE) Symptoms

Lupus symptoms vary widely and can range from mild to severe. They may affect a single area or multiple parts of the body and can change over time. Common symptoms include.

• Arthritis with painful, swollen joints and morning stiffness
• Fever and fatigue
• Facial rash (malar or "butterfly" rash)
• Round, scaly rashes on the body
• Sun sensitivity with rash development
• Hair loss, sores in the nose and mouth, and color changes in fingers and toes (Raynaud's phenomenon)
• Swollen glands, leg or eye swelling, and pain when breathing deeply or lying down

Lupus can cause inflammation and organ damage, including:

• Kidney damage, potentially leading to kidney failure (lupus nephritis)
• Seizures, memory problems, and changes in the brain and central nervous system
• Heart issues: heart valve damage, pericarditis, myocarditis, and vasculitis
• Blood clots, low blood cell counts, and inflammation of lung tissue (pleurisy)

Lupus may also increase the risk of developing other conditions, such as cardiovascular disease, due to heart and blood vessel tissue inflammation, leading to atherosclerosis, coronary artery disease, and heart attacks (5,6).

What Causes Systemic Lupus Erythematosus (SLE)

The precise origin of lupus is still a mystery, and ongoing investigations are trying to identify the factors that may cause or contribute to the condition. Lupus is a complicated autoimmune disorder where the immune system mistakenly targets the individual's tissues and organs. There are several factors thought to be involved in activating the disease (7,8):

Genetic factors

Studies suggest that specific genes may have a role in lupus development. These genes encode proteins that can potentially affect the immune system. Researchers are exploring how imbalances in these proteins might be associated with the emergence of lupus (8).

Environmental factors:

Elements in the environment, such as viral infections, ultraviolet light exposure, certain medications (oral contraceptives and other hormone therapies), and tobacco use, could potentially activate lupus in predisposed people (8).

Immunological and inflammatory factors

It is hypothesized that if the body is unable to effectively eliminate damaged or dead cells, this could deceive the immune system into continuously attacking itself, resulting in an autoimmune response and the manifestation of lupus. Moreover, researchers are examining the involvement of various cell types and the impact of their alterations on the development of lupus (8).

Triggers for Flares

Lupus flare triggers can differ among patients, with stress being one potential factor. A study of 54 systemic lupus erythematosus patients revealed that 61.1% identified stress as a flare trigger, with variations across different ethnic groups. Additionally, infections can provoke flares by causing immune system inflammation similar to that observed in SLE. For example, germs, including viruses, bacteria, and tiny organisms called protozoa, can trigger the body's immune system to act abnormally. This can happen through processes like molecular mimicry, where the germs have similar features to our own cells, causing confusion; epitope spreading, where the immune response expands to target healthy cells; and bystander activation, where the immune system accidentally attacks healthy cells while trying to fight off the germs. These processes can lead to a malfunctioning immune system. Other physical changes, such as surgery, injury, pregnancy, or childbirth, may also act as triggers, initiating lupus or causing a lupus flare (10) (11).

Functional Medicine Labs to Test to Diagnose Systemic Lupus Erythematosus (SLE)

Antinuclear Antibody Evaluation (ANA)

The ANA test can be used to detect a range of autoimmune conditions, including systemic lupus erythematosus. This antinuclear antibody (ANA) test can indicate whether your immune system is more likely to produce lupus-related autoantibodies. The majority of individuals (97%) with lupus have a positive ANA result (14).

Lupus Antibody Panel (SLE)

If a patient tests positive for the ANA test, it is recommended that they be tested for more specific antibodies related to SLE. This Autoimmune Analyzer is used to help monitor as well as diagnose those with SLE and includes the antibodies Anti-dsDNA and anti-Sm, which are highly specific for SLE (14).

Environmental Toxins

The RTL Tox Complete by RealTime Laboratories is a urine test that may benefit patients with SLE who have environmental triggers as a contributing factor to their SLE symptoms. This comprehensive test screens for the presence of  different toxic chemicals, including pesticides, which are known to potentially exacerbate SLE symptoms or contribute to disease onset (8).

Stress Test

The Adrenocortex Stress Profile by Genova Diagnostics is a comprehensive assessment beneficial for patients with SLE by evaluating adrenal function and stress hormone levels, which can influence disease progression and exacerbate symptoms. This test measures key hormones, such as cortisol and DHEA, that play crucial roles in stress response, immune function, and energy regulation, all of which are important factors in the management of SLE.

Inflammation and Immune Function

The GI-MAP test from Diagnostic Solutions is a cutting-edge stool analysis that can help identify potential causes of inflammation and immune dysfunction in patients with SLE. Utilizing qPCR technology, this test detects the DNA of various microbes in stool, including bacteria, parasites, fungi, and viruses, which may contribute to SLE symptoms and disease activity. In addition to identifying microbial imbalances, the GI-MAP test measures markers of inflammation, digestion, and immune function, all of which are crucial factors in understanding and managing SLE. Imbalances in the gut microbiome can contribute to chronic inflammation and immune dysregulation, which may exacerbate SLE symptoms and even play a role in the development of the disease.

Additional Labs to Check

While the functional medicine labs mentioned above will help you get to the root cause of symptoms, a few additional tests may also be beneficial to run simultaneously.

Additional Immune Function Tests

Testing, such as for Epstein-Barr Virus (EBV) and cytomegalovirus (CMV), may be indicated based on physician discretion and risk factors/history, as these are known contributors to SLE.

Kidney Function Test

Since SLE can affect the kidneys, a test measuring a substance called creatinine can help spot kidney problems early on. For practitioners desiring a more comprehensive test, the Renal Function Panel gives more insight into possible kidney abnormalities related to SLE (18).

Organ Biopsies and Imaging

In some cases, your doctor might need to take a small sample of an affected organ (like skin or kidney) or do imaging tests (like X-rays or ultrasound) to get a clearer picture of what's going on inside your body. This helps them confirm an SLE diagnosis and determine the extent of organ involvement (18).

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Functional Medicine Treatment Protocol for Systemic Lupus Erythematosus (SLE)

A functional medicine treatment protocol for SLE addresses the complex interplay of genetic, environmental, immunological, and inflammatory factors. Personalized interventions such as dietary and lifestyle modifications, targeted supplements, and stress management techniques may help manage symptoms and progression of SLE.

Lifestyle Changes

One of the main lifestyle interventions for managing SLE is physical activity, which offers multiple benefits. Exercise strengthens vital body components, such as the heart, lungs, bones, and joints, that may be affected by lupus. It also helps regulate chemicals involved in inflammation, thereby reducing inflammation itself. Engaging in low-impact movements can alleviate muscle stiffness, enhance the range of motion, and lower the risk of heart disease. Moreover, physical activity can improve mental well-being, making it easier to cope with stressors, positively influencing mood and self-esteem, and decreasing fatigue.

In addition to exercise, other lifestyle interventions can help reduce the risk of SLE or manage its symptoms. To avoid potential triggers and minimize environmental factors that could activate lupus in predisposed people, consider practicing good hygiene and maintaining a strong immune system. The goal is to lower the risk of viral infections. To do that, people should wash their hands regularly, get vaccinated, and consume a balanced diet. Protect yourself from ultraviolet (UV) light exposure by wearing sunscreen with a high SPF, donning protective clothing, and avoiding sun exposure during peak hours. Be cautious with medications, especially those that trigger lupus symptoms (such as oral contraceptives), and consult your healthcare provider before starting any new medication. Refrain from tobacco use, as it can exacerbate lupus symptoms and increase the risk of other health complications.

Stress Management

Managing stress is crucial for individuals with SLE, as it can trigger or worsen symptoms. Start by recognizing stress signs and sources, and keep a diary to track triggers and develop coping strategies. Plan for potentially stressful situations and prioritize relaxation through breaks, setting boundaries, and engaging in calming activities. Adopt healthy routines, such as sufficient sleep, exercise, and a balanced diet to mitigate stress and better manage lupus symptoms. Studies have shown that 1 hour of yoga for 6 months decreased inflammatory markers and helped maintain oxidative and antioxidant levels, thus improving immune function in participants with SLE.

Therapeutic Diet and Nutrition Considerations for Systemic Lupus Erythematosus (SLE)

There isn't a single diet that can prevent or treat SLE. Therefore, those with SLE should concentrate on adhering to the core principles of a nutritious diet. This includes eating balanced meals, incorporating diverse fruits and vegetables, enjoying a couple of servings of fatty fish every week, and reducing the intake of excessively processed foods. One particular diet worth considering is the Mediterranean diet, which is characterized by high consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil, a moderate intake of fish and dairy, and limited consumption of red meat and sweets. One study, conducted on 280 participants found that greater adherence to a Mediterranean diet led to fewer cardiovascular risk factors and lower disease activity for participants with SLE. In addition, research indicates that nuts and legumes could be beneficial for people with SLE as they are known to be a prominent source of anti-inflammatory polyunsaturated fats. Overall, the Mediterranean diet balances and reduces inflammation in the body. Since SLE is an inflammatory disorder, this diet may help patients reduce their symptom burden.

It is crucial for individuals with SLE who also have other health conditions (e.g., heart disease, diabetes) or organ damage related to SLE to consult their healthcare provider about any dietary restrictions they should follow. For example, those experiencing kidney damage due to SLE may need to closely monitor their salt and protein intake (27).

Supplements Protocol for Systemic Lupus Erythematosus (SLE)

Many supplements have shown efficacy in treating symptoms of SLE. A few of the most popular include:

Fish Oil

Fish oil, which is rich in omega-3 fatty acids, has been found to potentially help people with SLE. In one study, 27 participants with active SLE were given 20 grams of a marine oil called MaxEPA (eicosapentaenoic acid) daily or a placebo (olive oil). The results showed that 14 people who took MaxEPA experienced improvements, while 13 people who took the placebo saw no change or got worse. Another study lasting 24 weeks, involving 60 SLE patients, found that taking 3 grams of omega-3 fatty acids daily led to significant improvements in disease activity, blood vessel function, and reduced oxidative stress (damage to cells caused by free radicals). A third study using 3 grams of MaxEPA as omega-3 fish oil also showed a significant decrease in SLE disease activity among those taking fish oil compared to a placebo.

Dose: 3 grams daily

Duration: 24 weeks

Curcumin

Curcumin is a natural compound found in turmeric, which has been known for its anti-inflammatory and antioxidant properties. It has been found to help people with SLE, particularly those with lupus nephritis. In a randomized, placebo-controlled study of 24 patients with relapsing or refractory lupus nephritis, participants were given 500 mg of turmeric containing 22.1 mg of curcumin with each meal for 3 months, or a placebo. The results showed a significant decrease in proteinuria (excess protein in the urine), hematuria (blood in the urine), and systolic blood pressure in the curcumin group compared to the placebo group. No adverse effects related to turmeric supplementation were observed during the study.

Dose: 500 mg turmeric (containing 22.1 mg of curcumin) three times a day with meals

Duration: 3 months

Vitamin D

Vitamin D is essential for maintaining healthy bones and teeth, as well as supporting the immune system. It is produced in the skin upon exposure to sunlight, but can also be obtained from certain foods or supplements. Vitamin D deficiency is common in SLE patients, possibly due to sun avoidance. In one study, 31 SLE patients with vitamin D deficiency or insufficiency were treated with vitamin D3 supplements, resulting in improved disease activity and reduced fatigue after 12 months. Another study involving 98 SLE patients found that vitamin D deficiency was significantly associated with increased disease activity both at the time of diagnosis and at the two-year mark. These findings suggest that vitamin D supplementation may help improve outcomes for SLE patients.

Dose: Vitamin D3 8000 IU daily was given for 8 weeks if vitamin D deficient, 8000 IU daily for 4 weeks if “insufficient.” This was followed by 2000 IU daily for maintenance.

Duration: Ongoing based on lab testing results

Ashwagandha

Ashwagandha (Withania somnifera) is a well-known adaptogenic herb that helps combat stress and anxiety and promotes overall well-being. It has been used in traditional Ayurvedic medicine for centuries and is considered safe and effective for managing stress levels.

In a double-blind, randomized, placebo-controlled study, 64 adults with a history of chronic stress were given either 300 mg of high-concentration full-spectrum Ashwagandha root extract or a placebo twice a day for 60 days. The treatment group experienced a significant reduction in stress-assessment scores and a substantial decrease in serum cortisol levels compared to the placebo group.

Managing stress is crucial for patients with SLE as it can exacerbate symptoms and disease activity. Ashwagandha may provide a natural and safe way to improve stress resilience and overall quality of life for SLE patients.

Dose: 300 mg of high-concentration full-spectrum Ashwagandha root extract, taken twice a day.

Duration: 60 days

Vitamin C

Vitamin C is a vital nutrient that helps support a healthy immune system. It acts as a powerful antioxidant and plays a role in various processes in the body. Vitamin C is important for both the body's natural defense system and the immune system that adapts to specific infections.

Research shows that vitamin C helps protect the body's barriers against germs, supports the skin's ability to fight off harmful substances, and boosts the function of immune cells like neutrophils. It also aids in the removal of used-up immune cells from infection sites, reducing tissue damage. In addition, vitamin C helps immune cells called B- and T-cells grow and function properly.

Not having enough vitamin C can weaken the immune system and make people more prone to infections. On the other hand, infections can lower vitamin C levels in the body because of increased inflammation and the body's higher need for this nutrient. Taking vitamin C supplements can help prevent and treat infections that affect the respiratory system and the rest of the body. For people with SLE, it's essential to keep the immune system strong to manage the disease.

Dose: 100-200 mg/day

Duration: Ongoing

When to Retest Labs

It is crucial for practitioners to regularly retest labs to monitor the progress of treatment and ensure its effectiveness. The frequency of retesting can vary based on individual needs, the specific tests being conducted, and the severity of the condition. Generally, retesting is performed every 3 to 6 months or as needed, based on the patient's response to the treatment and any changes in symptoms.

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Summary

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder affecting nearly 1.5 million Americans, primarily women, and often remains undiagnosed or misdiagnosed due to its variable presentation. The disease causes the immune system to attack the body's tissues, leading to inflammation and organ damage. While there is no definitive cure, early detection and a comprehensive functional medicine approach focusing on genetic, environmental, immunological, and inflammatory factors can help manage SLE. Adopting lifestyle changes such as regular exercise, stress management, and following a balanced, nutritious diet like the Mediterranean diet can improve quality of life. Targeted supplements such as fish oil, curcumin, and vitamin D may also help alleviate symptoms. Regular retesting of labs every 3 to 6 months or as needed ensures the effectiveness of the treatment plan and enables healthcare providers to monitor patients' progress.