Lupus: uncovering and addressing the root causes of autoimmune dysfunction

Symptoms of lupus (systemic lupus erythematosus)

In lupus, the immune system attacks at a cellular level, affecting any tissue or organ in the body. Each person’s experience of lupus is different, as different parts of the body may be affected. Episodes generally subside after the initial attack, however, some people undergo brief flares during longer periods of remission.

Symptoms can include:

• Joint pain and swelling (found in 50% of people with lupus)
• Muscle pain
• Swollen glands
• Unexplained fever
• Kidney inflammation called lupus nephritis
• Chest pain, with deep inhalation
• Loss of appetite / weight loss
• Skin rashes – made worse with exposure to the sun (found in 20% of people with lupus), often on the face known as a ‘butterfly rash’
• Fatigue, lethargy and weakness (found in 10% of people, but may be severe and debilitating)
• Hair loss
• Mouth or nose ulcers
• Raynaud’s disease – pale / purple fingers and / or toes, when exposed to cold
• Swelling around eyes and in the legs
• Photosensitivity (especially to sunlight)
• Oedema (water retention) to hands, feet and face
• Anaemia and low iron status
• Headaches, and inflammation of the nervous system and brain

Lupus occurs predominantly in women, however, 1 in 10 diagnosed with lupus are men, and while they can experience all of the above symptoms, they are more likely to develop:

• Kidney disease and inflammation
• Cardiovascular problems
• Unexplained fever
• Weight loss
• Serositis – an inflammation of the membrane around the lungs, felt on taking a deep breath
• Swelling of feet and hands
• Antiphospholipid antibodies, increasing risk of blood clots and stroke
• Low white blood cell count, and low iron

Diagnosis of lupus can be difficult, as symptoms mimic a range of conditions and there is no definitive test. Some immune system markers are common to people with lupus, such as Type 1 interferon, complement proteins C3 and C4 dysregulation, in addition to the presence of antinuclear antibodies (ANA) common to autoimmune conditions and anti-Smith antibodies found in 70% of people with lupus. However, the presence or absence of these markers does not definitively diagnose or exclude lupus but may support diagnosis.

Causes of lupus

Like other autoimmune conditions, the definitive cause/s of systemic lupus erythematosus have not been established. However, current research is demonstrating that a complex interaction between genetic susceptibility and environmental triggers are heavily implicated in all autoimmune conditions. Known as epigenetics, this process explains how, in susceptible individuals, triggers such as those listed below can provoke the mistaken attack on ‘self’ cells that define autoimmune diseases.

The most common risk factors in lupus include:

• Genetic predisposition / family history
• Vitamin D deficiency – as a selective immune system regulator, Vitamin D inhibits autoimmune disease
• Genetic MTHFR polymorphisms which can impair methylation (a process that is essential to healthy detoxification) but in particular simultaneous gene expression of DNMT1, DNMT3A, DNMT3B, MBD2 and MBD2
• Viruses and infectious agents,(particularly the Epstein-Barr virus, also known as glandular fever or mononucleosis), measles, herpes and in recent evidence SARS-CoV-2
• Being female
• Sunlight exposure
• Gluten and dairy consumption
• Having Coeliac disease or another autoimmune condition
• About 10% of all lupus cases are drug-induced. Specific medications such as penicillin and other antibiotics, and sun sensitising drugs; sulfa drugs (Bactrim®, Septra®, Gantrisin®, Orinase®, Azulfidine®), and tetracycline drugs (Minocin®) are linked to the development of lupus
• Smoking/vaping
• Chronic stress/trauma including adverse childhood experiences (ACEs)
• Exposure to heavy metals such as mercury (e.g. in dental fillings and fish), toxins, and chemicals such as organic solvents
• Mycotoxins from mould exposure
• Being of Hispanic, Pacific Islander, Asian, Native American or African descent means a greater likelihood of developing lupus at a younger age, and with higher mortality and more serious complications
• A 5-fold greater representation of gut species Ruminococcus gnavus found in people with lupus nephritis
• Digestive disorders such as intestinal hyperpermeability (aka leaky gut), poor gastric secretions, SIBO, IBS, IBD, and fungal infections such as Candida albicans
• Gut microbiome dysbiosis, in particular, the lack of Bacteroides uniformis (which inhibits the growth of Ruminococcus gnavus). Certain dysbiotic bacteria have been associated with autoimmune activation, such as Citrobacter, Klebsiella, and Proteus species

Lupus treatment – the conventional approach

There is no medical cure for lupus to date. Systemic lupus erythematosus conventional treatment by an SLE specialist includes medications to control symptoms and help manage the condition. Medications are often given in addition to exercise recommendations and lifestyle changes, such as stopping smoking, avoiding sun exposure and stress management. A new classification criteria based on the signs and symptoms can aid in directing treatment strategies.

Your SLE specialist may prescribe medications such as:

• Pain relief: paracetamol
• Inflammation reduction: corticosteroids (not recommended long term), and  non-steroidal anti-inflammatory drugs (NSAIDs) for reducing inflammation (for short term use only, but not for use with kidney disease)
• Skin and joint symptoms: hydroxychloroquine medications, to reduce immune system activity
• Control of immune function: disease-modifying  anti-rheumatic drugs (DMARDs) which somewhat suppress the immune overactivity
• Suppression of immune function: in moderate to severe cases immunosuppressant drugs such as azathioprine, mycophenolate, mofetil, cyclosporine, leflunomide, cyclophosphamide and methotrexate

All medications have side effects, with some of these drugs requiring close monitoring by specialists due to the significance of side effects. Some immune-suppressing drugs can also impair the body’s ability to fight off infections.

Conventional treatments do not address the underlying causes or factors contributing to lupus, and along with some very uncomfortable side effects, is why people with lupus often seek natural ways to improve their health after a lupus diagnosis. Alternative treatment options can include the functional medicine approach that supports each person with lupus holistically and naturally.

Natural treatment for people with lupus – the functional medicine approach

From a functional medicine standpoint, natural treatment for people with lupus starts with an in-depth history taking, which will look at medical history, genetic predispositions, environmental exposures, diet, medications and more to determine what the root cause triggers may be, and what other contributing factors may be exacerbating symptoms and disease progression.

Your functional medicine practitioner will design a detailed, personalised treatment strategy with targeted herbal, lifestyle, and supplemental medicine and dietary changes to address specific symptoms, support organ function, reduce inflammation and modulate the immune system to reduce attacks on the body. They will also factor in maintaining robust immune function for fighting off the usual colds, flu and other viral and bacterial infections.

Depending on the patient and their health picture, these strategies may include:

Testing for:

• Food intolerances, allergies and sensitivities
• Gut dysbiosis, intestinal hyperpermeability and parasites
• Heavy metals, mould and mycotoxin exposure
• Methylation dysfunction
• Blood tests depending on your symptoms

Dietary changes:

• Include/increase consumption of – anti-inflammatory foods, lecithin, Omega 3 fatty acids via wild-caught oily fish (sardine, mackerel, anchovies, salmon and herring), plant flavonoids found in colourful fruits and vegetables, berries, healthy fats such as coconut, avocado and extra virgin olive oil, nuts and seeds, only grass fed animal foods, garlic, onion, mushrooms, and eggs
• Avoid all processed foods and soft drinks, sugar, alcohol, coffee, black tea, dairy and wheat, gluten, smoked and cured meats, as inflammatory foods/triggers
• Increase fibre intake to improve and support gut microbiome diversity and makeup
• Eliminate identified food sensitivities, allergies or intolerances

Supplementary nutrients:

• Glycine an amino acid to support antioxidation, liver detoxification, sleep and anxiety
• Digestive enzymes – to ensure digestion and absorption of vital nutrients
• Selenium, magnesium, and Vitamin D3 – to reduce autoimmunity
• Vitamins B6, B12 and folinic acid – for healthy methylation
• R-lipoic acid, N-acetyl cysteine, Vitamin C, tocotrienols – antioxidants, energy production
• CoQ10, resveratrol – antioxidants for heart and nerve health, and energy
• Precision probiotics for improving gut microbiota diversity and makeup

Herbal medicines:

• California poppy, Jamaican dogwood, and white willow for pain management
• Boswellia, turmeric, bupleurum, ginger and cat’s claw as anti-inflammatories
• Ginkgo biloba, gotu kola, and bacopa for healthy cognitive and nerve function
• Reishi mushroom and echinacea for immune modulation
• St Mary’s thistle (Silybum marianum), globe artichoke to support detoxification

Lifestyle medicine:

• Gentle exercise to maintain mobility, such as walking, Tai chi, yoga and forest bathing, and massage
• Techniques for building stress resilience via vagal nerve stimulation, singing, gargling, massage, and meditation/mindfulness practices

Topical treatments:

• Creams or lotions, individually compounded with botanicals, nutrients, minerals, and therapeutic oils to reduce inflammation and irritation of the skin

In addition, your practitioner will be mindful of optimising immune resilience, for reducing the reactivation of Epstein-Barr virus, and for reducing the risk of SARS-CoV-2 infection and long COVID symptoms.

If you’re looking for holistic, personalised and supportive care that gets results, we’d love to help. One of our functional medicine practitioners at Melbourne Functional Medicine will guide you towards better health. Working alongside your practitioner and your health coach, you’ll have all the support, health breakthroughs and direction you need to meet your health goals and get back to living life.

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