The Latest News on Drugs and Natural Therapies

One of the people I admire most is a friend and neighbor who has lupus (systemic lupus erythematosus), a chronic autoimmune disease in which the immune system turns on itself. Although occasional flares of the disease are sometimes painful enough to send her to bed, usually she copes extraordinarily well, raising two children and maintaining a successful law practice. I know that others with this disease are not so lucky, and suffer serious and even life-threatening challenges to the kidneys, heart, blood vessels, brain, lungs or skin. If unchecked, lupus often gets worse so it is important to do all that can be done to slow, stop or even reverse the process.

Like all autoimmune diseases, lupus is multifaceted and tricky to treat, but like most autoimmune diseases it is also responsive to an integrated treatment protocol. To get both sides’ best advice, I spoke with rheumatologist Sheldon Paul Blau, MD, coauthor of Living with Lupus (Da Capo), and Mark Stengler, ND, author of Bottom Line Natural Healing newsletter and author of The Natural Physician’s Healing Therapies (Bottom Line Books).

A DOUBLE-EDGED SWORD: CONVENTIONAL DRUG TREATMENT

To prevent permanent damage to major organs, early diagnosis and treatment of lupus are essential. A few patients require little or no treatment, while others respond to nonsteroidals, corticosteroids and anti-malarial drugs. For those requiring more, Dr. Blau has success treating lupus patients with two drugs — mycophenolate mofetil (CellCept) and rituximab (Rituxan).

Mycophenolate is a potent drug that works by suppressing the immune system response, protecting the body from rogue antibodies that are causing inflammation, pain and damage. But immunosuppressive drugs are a double-edged sword. When you suppress the immune system for seemingly beneficial reasons, you also create a higher susceptibility to opportunistic infections such as pneumonia and shingles. Still, mycophenolate has fewer toxic side effects than cyclophosphamide (Cytoxan), a common current therapy, so it’s increasingly used.

Rituximab, one drug used to instigate B-cell depletion therapy, is another promising medication. This drug has been approved by the FDA for non-Hodgkin’s lymphoma and rheumatoid arthritis. Off-label use for lupus patients is based on a growing body of evidence that the abnormal hyperactivity of B lymphocytes — white blood cells that are derived from bone marrow and develop antibodies — plays a key role in lupus, says Dr. Blau. Yet he warns that once again the double-edged sword comes into play. B cells are responsible for fighting infection. When you reduce their numbers, the patient becomes more vulnerable to a broad range of infections.

BEYOND DRUGS: THE NATUROPATHIC APPROACH

Naturopathic treatment for lupus focuses on non-toxic therapies that address the triggers of autoimmunity and inflammation. In his La Jolla, California, practice, Dr. Stengler’s goal is to eliminate the need for pharmaceuticals for lupus except as needed for acute flares, which generally arise when the system is thrown out of balance. He carefully individualizes treatment for each patient, testing for root causes and treating imbalances that emerge. Dr. Stengler’s strategies include…

Treating possible root triggers of flares, such as…

  • Hormonal imbalances. When hormonal balances are upset, the immune system is affected too. In particular, Dr. Stengler considers imbalances with the stress hormones DHEA and cortisol and an estrogen-progesterone imbalance in women to be worrisome, and works to correct them with bioidentical hormones and/or supplements. These problems can be caused by menopause, chronic illness or stress and genetics.
  • Increased intestinal permeability and intestinal infections. A so-called “leaky gut” (in which bacteria, toxins and food permeate intestinal walls) can increase autoimmune reactivity and be a causative factor with lupus. To maintain a healthy, intact gut, it is essential to identify and rid the intestine of invasive bacteria or other organisms (eg, candida) that cause the immune system to become overactive.
  • Toxins. If your body is poisoned with environmental toxins such as lead (which has been detected in toys and other products from China), mercury (eg, from eating large, ocean-going fish such as swordfish) or cigarette smoke, Dr. Stengler will recommend a detoxification program such as oral and/or IV chelation.
  • Essential fatty acid imbalance or deficiency. To successfully control inflammation, your body requires sufficient fatty acids. If there’s a shortage, supplemental omega-3 fatty acids — EPA and DHA found in fish oil and ALA (alpha linolenic acid) — can help correct it.
  • Food allergies or sensitivities. It is important to identify and avoid any foods that contribute to an autoimmune reaction.

Consider supplements…

  • Fish oil. Studies demonstrate that omega-3 fatty acids in fish oil successfully combat inflammation.
  • Plant sterols and sterolins. These can balance and strengthen the immune system when used correctly. Often Dr. Stengler prescribes a daily plant nutrient supplement such as Moducare.
  • DHEA. This hormone has been shown in research to improve lupus symptoms in people with the disease.
  • MSM. Research indicates that MSM (methylsulfonylmethane), a source of organic sulfur, has anti-inflammatory effects that may be helpful for lupus patients.

Follow an anti-inflammatory diet…

  • Cut back on inflammatory foods. To fight inflammation, cut back on or, better yet, eliminate white flour and sugar products, high-fructose corn syrup, trans fats, additives, preservatives, pesticides and processed, fast and fried foods, as well as red meat, dairy, butter and margarine.
  • Emphasize whole, fresh foods. The government now recommends nine servings of fruits and veggies daily. Colorful produce is richer in a broad range of inflammation-fighting antioxidants. Healthy fats such as omega-3 fatty acids are also key in warding off inflammation. Good sources include walnuts, flaxseed oil and cold-water fish (wild salmon, sardines, mackerel, etc.), as well as the spices ginger and turmeric.

Other strategies…

  • Control stress. This is a must, since flares are most apt to occur after a period of intense emotional or physical stress, or an infection. Stress management strategies range from exercise to relaxation and meditation techniques to support groups and counseling.
  • Get regular exercise. This is difficult during flares, but exercise helps balance the immune system. Dr. Stengler is a big fan of water aerobics, which puts little stress on joints.
  • Acupuncture, acupressure and hydrotherapy. Dr. Stengler believes that acupuncture and acupressure may effectively reduce pain and inflammation and keep the body in balance. Hydrotherapy (hot baths, steam rooms, saunas, etc.) may also be helpful for some, though this needs to be carefully monitored by your physician who can individualize treatment.
  • Avoid the sun. Sun exposure can trigger a flare. Stay out of the sun and wear protective clothing.

While lupus can be baffling, debilitating and difficult to treat, it’s good news for my neighbor and other lupus sufferers that there are answers out there.