Tuesday, February 18, 2014

Systemic lupus erythematosus and Vitamin D

Systemic lupus erythematosus, or lupus, is a chronic disease that affects many systems in the body. Lupus is an autoimmune disease, which means that your immune system has a hard time telling the difference between your own healthy cells and foreign things like germs, bacteria, or viruses. This causes your body to attack your healthy tissue, which can cause inflammation and pain.

People with lupus often have periods of flares, which is when you have worse symptoms, and periods of remission, when the symptoms are better or not there at all. When lupus symptoms are flaring up, the disease is called “active”. There are many different symptoms of lupus that affect different body systems. The most common symptoms are rashes, fatigue, fever, sensitivity to the sun, and joint pain.

It is not fully understood how lupus develops. Researchers think that lupus comes from a combination of genetics, hormones, and the environment.

Many studies have shown that there is a link between vitamin D and lupus. People who have lupus are more likely to have low levels of vitamin D. Studies have shown that people with higher levels of vitamin D have fewer lupus symptoms. People with lupus who have low levels of vitamin D are more likely to have risk factors that increase their chances of getting heart disease than people with high levels of vitamin D.

Some studies have shown that giving vitamin D supplements to people with lupus can help their symptoms improve and decrease chances of a flare up. However, more experiments are needed to understand just how helpful vitamin D is in lupus, if at all.

Research hasn’t been able to show yet that low vitamin D levels cause lupus. Doctors don’t know yet whether taking a vitamin D supplement can help to prevent or manage lupus.

If you have lupus and want to take vitamin D, it is unlikely to make your lupus worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to treat your lupus.

If you have lupus, you shouldn’t take vitamin D in place of your treatment medications. Talk to your physician for more advice about taking supplements.

What is lupus?

Systemic lupus erythematosus, or lupus, is a chronic disease that affects many systems in the body, like the skin, heart, and muscles. Lupus develops when your immune system stops working like it should.  Lupus is an autoimmune disease, which means that your immune system has a hard time telling the difference between your own healthy cells and foreign things like germs, bacteria, or viruses. This causes your body to attack your healthy tissue, which can cause inflammation and pain.

It is common for people with lupus to have periods of flares, which is when you have worse symptoms, and periods of remission, when the symptoms are better or not there at all. When lupus symptoms are flaring up, the disease is called “active”.

Lupus can be hard to diagnose, because many of the symptoms are similar to other autoimmune diseases1.

What are the symptoms of lupus?

Since lupus can affect so many different body systems, there are a lot of symptoms that can vary from person to person. The most common symptoms are1,2

  • Fatigue
  • Fever
  • Joint and muscle pain
  • Chest pain
  • Swelling in feet, legs, or hands
  • Rashes
  • Sensitivity to the sun
  • Hair loss
  • Sores in the mouth or nose

Some people with lupus might have symptoms that involve specific body parts, like:

  • Digestive system: Nausea, vomiting, stomach pain
  • Heart: Abnormal heartbeat. People with lupus have increased chances of getting heart disease, because it can cause inflammation around the heart or a buildup of plaque in the blood vessels.
  • Lungs: Difficulty breathing
  • Nervous system: Headaches, numbness or tingling, problems with eyesight, seizures
  • Bones: People with lupus have increased chances of bone fractures or getting osteoporosis3.

How common is lupus?

About 5 million people around the world have some type of lupus. Lupus mostly affects women of reproductive age, but men and children can also develop lupus. There are some risk factors that increase your chances of getting lupus, such as4:

  • Gender. 9 out of 10 people who have lupus are females.
  • Race. African-Americans are three times more likely to develop lupus than Caucasians. Other races that have a higher risk are Hispanics, Native Americans, Asian-Americans, and Pacific Islanders.
  • Age. Lupus usually develops between the ages of 15 and 45.
  • Family history of lupus.
  • Smoking. Some research has shown that smoking may increase your chances of getting lupus.

What causes lupus?

It is not fully understood what causes lupus or how it develops. Researchers think that lupus is caused by a combination of genetics, hormones, and the environment. Since most of the people with lupus are female, it is possible that estrogen might play a role in lupus.

Most researchers think that lupus occurs when something in the environment interacts with someone who has genes that make them more likely to develop lupus. Researchers call this interaction an environmental trigger.

In lupus, environmental triggers can also cause the lupus to flare up. The immune system will start making proteins called auto-antibodies, which is what will attack your healthy cells in your body and cause inflammation and pain1.

The most common environmental triggers that can cause lupus flares are1:

  • UVB light
  • Infections or viral illnesses
  • Exhaustion or emotional stress
  • Stress to the body, such as surgery, pregnancy, or trauma
  • Some medications

What is the link between lupus and vitamin D?

Many studies have shown that there is a link between vitamin D and lupus. People who have lupus are more likely to have low levels of vitamin D, and people with a more severe disease are more likely to have low vitamin D levels.  This may be because people with lupus are sensitive to the sun, so they often avoid being outdoors or wear high SPF sunscreen.

However, researchers think that not getting enough vitamin D may also be an environmental trigger that increases the chances of getting a flare up and increases your chances of developing lupus in the first place5.

Vitamin D receptors are found on the surface of a cell where they receive chemical signals. By attaching themselves to a receptor, these chemical signals direct a cell to do something, for example, to act in a certain way, or to divide or die.

There are vitamin D receptors found on cells in the immune system, and vitamin D can bind to these receptors. This can cause the auto-antibodies to decrease and stop attacking the healthy cells in your body. Therefore, it is thought that vitamin D can help prevent lupus flares by reducing inflammation in the body6,7,8.

While it is thought that having enough vitamin D can help to prevent flares in people who have lupus, more experiments need to be done to determine definitively if taking vitamin D supplements can help prevent or treat lupus. Research hasn’t been able to show yet that low vitamin D levels cause lupus.

What does the research say in general about vitamin D and lupus?

Preventing lupus

Most studies that have been done about preventing lupus haven’t been able to find a clear link between vitamin D and lupus. A study that followed a large group of women for many years found that there was no link between the amount of vitamin D they ate from foods and supplements or were exposed to in adolescence and their chances of getting lupus later in life. However, the researchers didn’t look at vitamin D levels in the body and only relied on what the women could remember about how much vitamin D they consumed or sunlight they were exposed to9.

More studies are needed to determine if there is a link between vitamin D levels during childhood and adolescence and the chances of developing lupus later in life.

Managing and treating lupus

People with lupus are very likely to have low levels of vitamin D. This may be because people with lupus are sensitive to the sun, so they often avoid being outdoors or wear high SPF sunscreen.

People with active lupus often take medications that can interfere with vitamin D in your body, which may make them more likely to become vitamin D deficient10.

Studies have shown that people with higher levels of vitamin D have fewer symptoms from lupus. People living in places where there is more sunlight have a lower risk of developing autoimmune diseases11. African-Americans with lupus have been found to have lower levels of vitamin D than Caucasian people with lupus12.

Researchers have found that in winter months with low sunlight, people with lupus are more likely to have active symptoms, as well as more likely to have low levels of vitamin D. People with lupus are also more likely to have more flares during low sunlight months compared to high sunlight months13.

In a review of many studies, the majority of studies showed that people with lower levels of vitamin D were more likely to have more severe active lupus symptoms. Higher levels of active lupus are related to increased risk of damage to other organs, like the heart or kidneys14.

To date, most of the research that has been done is observational, meaning that researchers can’t say for sure whether or not low levels of vitamin D cause lupus, or if it is having lupus that causes low levels of vitamin D.

What does recent research say about vitamin D and lupus?

An experiment done in Egypt in 2012 looked at vitamin D levels and symptoms in people with lupus before and after supplementing with vitamin D. There were 2 groups in this study. The first group got 2,000 IU of vitamin D per day for 12 months, and the second group got a dummy pill. The researchers found that15:

·        The people in the vitamin D group had an improvement in lupus symptoms and had less flares, compared to the people getting the dummy pill.

·        Vitamin D levels were lowest in the people who had the most active lupus.

People in the vitamin D group had lower levels of inflammation in their body than people getting the dummy pills.

This study shows that having low levels of vitamin D may result in higher levels of lupus activity, symptoms, and flares. The researchers suggested that vitamin D may help to normalize the immune system in people with lupus. They concluded with a recommendation that people with lupus could benefit from supplementing with vitamin D, but also that more trials are needed to confirm these results.

·        An experiment published in 2014 looked at people with cutaneous lupus erythematosus, which is a form of lupus that only affects the skin. The researchers first looked at vitamin D levels in people with lupus compared to people who didn’t have lupus. Then, they gave vitamin D supplements to the people with lupus who had low vitamin D levels. The researchers gave them 1,400 IU vitamin D with 1,250 mg calcium per day for 40 days, then 400 IU with 1,250 mg calcium twice a day for 1 year after that. They found that16:

·        Vitamin D levels were lower in the people with lupus, compared to the people without lupus.

·        The people who got the vitamin D supplements had significant improvements in their lupus disease activity, as well as lower numbers of lesions on their skin.

The researchers concluded that having lupus increases the chances of having low vitamin D levels, and that taking a vitamin D supplement may help to improve lupus symptoms and disease activity. This study only looked at Caucasians, so we don’t know if vitamin D supplements would have the same effect in people of different ethnicities.

An experiment done in 2012 in France looked at people with lupus who had low levels of vitamin D. The researchers gave them 100,000 IU vitamin D per week for 4 weeks, followed by 100,000 IU vitamin D per month for 6 months. Afterwards, they looked at their vitamin D levels and at different cells in the body that can cause the immune system to act differently. They found that8:

  • After taking a vitamin D supplement, the people with lupus had lower levels of cells that cause the immune system to make more antibodies, which is what causes the body to attack its own healthy cells.
  • The people who took the vitamin D supplement also had higher levels of cells that can help to regulate the production of antibodies. In people with lupus, these cells can help to prevent the body from attacking its own healthy tissue.

The researchers stated that taking a vitamin D supplement may help the immune system in people with lupus.

A study published in 2014 followed a large group of people with lupus from 7 different countries in North America, Europe, and Asia. The researchers looked at their vitamin D levels, lupus disease activity levels, and heart disease risk factors. They followed them over 6 years and found that17:

  • The people with the highest vitamin D levels had the lowest levels of lupus disease activity.
  • The people with the lowest levels of vitamin D had higher blood pressure, amounts of fat in the blood, and levels of a protein related to heart disease risk.
  • The people with the highest levels of vitamin D were less likely to have an illness related to the heart, such as a heart attack or stroke.

This study was observational, which means that the researchers can’t say for sure that having low vitamin D levels caused the people to get heart disease.

Key points from the research

  • People who have lupus are more likely to have low levels of vitamin D.
  • People with lupus who have higher levels of vitamin D tend to have less lupus disease activity, symptoms, and flares.
  • There are higher rates of lupus flares in winter months than in summer months.
  • People with lupus who have low levels of vitamin D are more likely to have risk factors that increase their chances of getting heart disease than people with high levels of vitamin D.
  • Supplementing with vitamin D results in fewer lupus symptoms and less inflammation in the body.
  • Overall, more experiments are needed to give a clearer answer about how helpful vitamin D supplements are to help treat or manage lupus.

What does this mean for me?

Low vitamin D levels in people with lupus are linked to worse symptoms and outcomes like heart disease.

Research has shown that there is a link between vitamin D and lupus. People with lupus are more likely to have low levels of vitamin D. Low vitamin D levels in people with lupus are linked to worse symptoms and outcomes like heart disease.

Some studies have shown that giving vitamin D supplements to people with lupus can help their symptoms improve and reduce the number of flare ups. More research is needed to see just how effective vitamin D might be for lupus, if at all. Research hasn’t been able to show yet that low vitamin D levels cause lupus. Doctors don’t know yet whether taking a vitamin D supplement can help to prevent lupus.

If you have lupus and want to take vitamin D, it is unlikely to make your lupus worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to treat your lupus.

If you have lupus, you shouldn’t take vitamin D in place of your treatment medications. Talk to your physician for more advice about taking supplements.

If I have lupus, can I get sun exposure?

Sunlight can often make lupus skin symptoms worse, so people with lupus are advised to wear sunscreen or avoid the sun during the middle of the day. Avoiding the sun and wearing sunscreen also means that you can’t get the vitamin D you need from the sun and need to get vitamin D from other sources. If you have lupus and are sensitive to the sun, the best way to get vitamin D is from supplements.

References

  1. Lupus Foundation of America. What is Lupus? 2014. Web. Accessed 1 February 2014. <http://www.lupus.org/answers/entry/what-is-lupus>
  2. National Institute of Health. Systemic lupus erythematosus. 2014. Web. Accessed 1 February 2014. < http://www.nlm.nih.gov/medlineplus/ency/article/000435.htm>
  3. Alele JD & Kamen DL. The importance of inflammation and vitamin D status in SLE-associated osteoporosis. Autoimmunity Reviews 2010;9:137-9.
  4. WebMD. Lupus Health Center. 2011. Web. Accessed 1 February 2014. <http://www.webmd.com/lupus/guide/lupus-systemic-lupus-erythematosus-cause>
  5. Antico A, Tampoia M, Tozzoli R & Bizzaro N. Can supplementation with vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature. Autoimmunity Reviews 2012;12:127-136.
  6. Aranow C. Vitamin D and the immune system. J Investig Med 2011;59(6):881-886.
  7. Breslin LC, Magee PJ, Wallace JMW, & McSorley EM. An evaluation of vitamin D status in individuals with systemic lupus erythematosus. Proceedings of the Nutrition Society 2011;70:399-407.
  8. Terrier B, Derian N, Schoindre Y, et al. Restoration of regulatory and effector T cell balance and B cell homeostatis in systemic lupus erythematosus patients through vitamin D supplementation. Arthritis Research & Therapy 2012;14(R221):1-10.
  9. Hiraki LT, Munger KL, Costenbader KH, et al. Dietary intake of vitamin D during adolescence and risk of adult onset systemic lupus erythematosus and rheumatoid arthritis. Arthritis Care & Research 2012;62(12):1829-1836.
  10. Mok CC, Birmingham DJ, Leung HW, et al. Vitamin D levels in Chinese patients with systemic lupus erythematosus: relationship with disease activity, vascular risk factors and atherosclerosis. Rheumatology 2012;51:644-652.
  11. Pelajo CF, Lopez-Benitez JM & Miller LC. Vitamin D and autoimmune rheumatological disorders. Autoimmunity Reviews 2010;9:507-510.
  12. Kamen DL, Cooper GS, Bouali H, et al. Vitamin D deficiency in systemic lupus erythematosus. Autoimmunity Reviews 2006;5:114-7.
  13. Birmingham DJ, Hebert LA, Song H, et al. Evidence that abnormally large seasonal declines in vitamin D status may trigger SLE flare in non-African Americans. Lupus 2012;21(8)1-18.
  14. Sakthiswary R & Raymond AA. The clinical significance of vitamin D in systemic lupus erythematosus: A systematic review. PLOS One 2013;8(1):1-6.
  15. Abou-Raya A, Abou-Raya S & Helmii M. The effect of vitamin D supplementation on inflammatory and hemostatic markers and disease activity in patients with systemic lupus erythematosus: A randomized placebo-controlled trial. Journal of Rheumatology 2013;40:265-272.
  16. Cutillas-Marco E, Marquina-Vila A, Grant WB, et al. Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity. Lupus 2014;0:1-9.
  17. Lertratanakul A, Wu P, Dyer A, et al. 25-hydroxyvitamin D and cardiovascular disease in patients with systemic lupus erythematosus: data from a large international inception cohort. Arthritis Care & Research 2014. ‘Accepted Article’, doi: 10.002/acr.22291.

 

Posted by Kari J. Kindem, CFHom, CEASE Practitioner, Classical Homeopath at 5:14 PM