The pancreas is very important, since it produces the enzymes that the body uses to breakdown proteins, sugars, fats, and starches into a form that the body’s cells can use for energy. It also produces hormones that regulate digestion, blood sugar levels, and whether we feel hungry or full. This makes it vital to maintaining a healthy weight and to a functional metabolism in general. The pancreas also holds channels that connect the liver to the rest of the digestive system. Bile from the liver drains through the pancreas into the first part of the small intestine, called the duodenum, where it begins to digest the broken-down food. 

The hormones that the pancreas produces include:

• Insulin – Insulin signals the body to store sugar in the cells instead of letting it freely flow in the bloodstream. 
• Glucagon – Glucagon signals the body to release stored sugars into the bloodstream to supply energy 
• Gastrin and Amylin – Gastrin and Amylin signals the stomach to produce gastric acid or continue digestion.

When lupus causes inflammation to the pancreas, these hormones might not be produced in adequate amounts.

What is the Digestive System?

Systemic lupus erythematosus (SLE) can have an effect on most organs in the body, including the organs of the digestive system. You can read more about the effects of lupus on the microbes that live in the digestive system here. This also includes the pancreas.

The digestive system is a series of organs that are responsible for taking in and processing food, extracting nutrients, absorbing water, and breaking down complicated molecules, including toxins. The digestive system also regulates the flow of nutrients, vitamins, minerals, and sugars in the bloodstream, keeping the levels balanced and the cells of the body healthy. The dietary intake of each individual person has a large effect on the digestive system. You can read more about important nutrients like Omega-3 fatty acids and lupus here. 

The digestive system works like a disassembly line, breaking down food into molecules that the body can use. 

First, food and water is taken in through the mouth, crushed into smaller pieces by teeth, moved around by the tongue, partially digested by saliva, before being swallowed to the esophagus. 

From there, it is broken down in the stomach by gastric acid and enzymes, before entering the small intestine where it is digested and nutrients are absorbed into the body through the membrane. 

In the large intestine, whatever material remains is collected, drained of any residual water, and finally excreted from the body as feces. 

The liver, pancreas, gallbladder, and other organs support this system with regulatory hormones, additional enzymes, and areas that process certain molecules. The kidneys are not considered part of the digestive system, but they do support it by filtering out waste products from the bloodstream.

Pancreatitis and Lupus

Pancreas-related problems are a rare symptom of autoimmune diseases such as lupus. Specifically, Lupus causes inflammation and swelling as it attacks the cells of the pancreas, a condition known as pancreatitis. Pancreatitis interferes with how the organ produces enzymes and hormones, and blocking the ducts that carry bile from the liver to the intestines. 

The symptoms of pancreatitis includes abdominal pain (including pain that feels like it’s at your back,) nausea, vomiting, and fever. 

Other causes of pancreatitis, including gallstones, alcohol use, genetic disorders, infections, or injuries to the abdomen, are much more common. It is estimated that only about 2-4% of cases of pancreatitis are caused by autoimmune disease, according to the National Library of Medicine. However, lupus medications such as immunosuppressants and the stress on the body from lupus can make the pancreas more vulnerable to infection and damage. You can read more about lupus medications here. 

Diabetes and Lupus

Diabetes is one of the major issues that can come about when the pancreas is damaged. Diabetes is a condition where the body doesn’t receive enough of a signal from the hormone insulin to properly modulate blood sugar levels in the body. When a carbohydrate or sugar-rich meal is digested, this lack of insulin causes a surge of sugar in the blood that can lead to problems in the kidney, heart, brain, and other organs. Diabetes can occur when the body stops reacting to insulin, but also if the pancreas is damaged and doesn’t produce enough insulin. 

For many reasons, including damage to the pancreas, people with SLE have a very high risk of developing diabetes. You can read more about diabetes and lupus here. Having both diabetes and SLE causes them to ‘feed into’ each other, one condition making the other worse and so on. It is important to treat both diabetes and SLE individually to get both under control.

Treating Pancreatic Issues and Lupus

People with lupus who have diabetes have to take regular insulin injections to maintain proper blood sugar. 

Treatment with lupus medications, such as corticosteroids or azathioprine, reduces inflammation and, as a consequence, reduces damage to the pancreas as well as other organs. 

However, some of the medications for lupus can have poor interactions with diabetes, with corticosteroids causing weight gain and prednisone leading to worse insulin resistance – and, as a consequence, worse diabetes! It is important to make sure that your medicine regimen is safe for both conditions.

A Lupus Warrior’s Takeaway

If you start feeling symptoms of pancreatitis, it is worth getting checked out as soon as possible. This is because not only can the issues have serious consequences, but the symptoms of pancreatitis can also be symptoms of more urgent and serious conditions. Leaving possible pancreatitis for too long can, potentially lead to complications like scarring as the damage gets worse.

In other words, get checked out if you can, and make sure that your treatment team is aware of any diabetes or potential pancreas issues.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects every organ system in the body. Regular exercise can help with many of the symptoms of lupus, especially where it affects the cardiovascular system (including the heart and brain) and mental health, as well as being good for the overall health of the body. You can read more about the cardiovascular risks of lupus here. 

However, for many people with lupus, it can be difficult to get enough exercise. Lupus symptoms like joint pain and fatigue play a part, but some people with lupus don’t feel that they have any time or energy to spare for exercise. You can read more about fatigue and lupus here. 

Between work, childcare, and other obligations, adding in a workout routine can seem daunting. Fortunately, there are options for people with lupus that are easier and more accessible than going to a gym. Short, simple home exercises and stretches can be done in between or a part of other activities, and once they are used to exercising regularly, many people with lupus report that they have less pain, more energy, and better mood as a result. 

For some people with lupus, the ancient meditative exercise practice of Yoga might be ideal.

What is Yoga?

Yoga is an ancient meditation technique that has been practiced for thousands of years. It’s a major part of Hindu philosophy, and it is a way to “unite” the body and mind by controlling the movement of the body and focusing the senses. Modern Yoga focuses on only one part of the philosophy of yoga, the holding of certain postures or poses, known as Asanas. While only a part of the whole philosophy of yoga, regularly practicing these postures carries many benefits including building core strength, strengthening other muscle groups, improving posture, stretching muscles and tendons, strengthening the cardiovascular system through stamina and breathing exercises, reducing anxiety, and improving focus. 

However, it should be noted that yoga as a whole is much more than just asanas. It’s an ancient tradition of meditation, spiritual practice, and enlightenment, and while finding information on practicing the postures and exercises is easy to find these days, the other parts of traditional yoga can be difficult to come by. 

In the Western world, Yoga (typically Hatha-style Yoga) is often taught in classes with an instructor, sometimes indoors or outdoors, with exercise mats and nonrestrictive clothing. It involves gentle exercise movements, breathing exercises, and the holding of poses which is gentle on the joints while still providing exercise benefits. The classes can be paid (and vary in price) or might be freely available through school or community center programs. These classes are typically in person, but since 2020, they can sometimes be hybrid or remote. There are also videos that can be purchased that go through a series of poses called a routine, and other videos can be found online, which allows people to practice yoga in their home on their own, on their own time and schedule. It’s generally considered to be best to have a teacher in a class or private setting, however, since they can make sure that you are doing the poses correctly. Like with exercise, incorrect form can put extra stress on the body, leading to pain and even serious health conditions. A teacher or trainer can also help adapt routines to your physical capabilities. 

Yoga as an exercise can be done on its own or with music, scents, and other additions. It can even be done alongside prayer, which does connect it back to its spiritual roots. These are mostly personal preferences – any addition or accommodation that helps you to regularly practice yoga will help you make the most of the benefits.

Meditation, Stress, and Lupus

Yoga is considered a type of meditation, and meditation is well-known to have benefits for people with lupus. The mindfulness technique of meditation has been proven to reduce depression, anxiety, and stress by giving the brain – and body – space to heal from the burdens of everyday life with a chronic disease. 

Stress relief cannot be understated – mental stress affects the body, too. When stressed, the body naturally ramps up the immune system, causing inflammation. While this is beneficial in a situation such as an injury or sickness, this stress response can trigger the symptoms of autoimmune disorders like lupus. The symptoms of lupus cause further stress, and the damage from lupus increases over time. Relieving stress helps to break the cycle and has been shown to reduce the symptoms of lupus. Massage and art therapy can help relieve stress for people with lupus, but meditation has the advantage of being easily done on one’s own at home. You can read more about massage and lupus here. 

Meditation is generally done while sitting, and uses breathing, mantras, and focus techniques to create a calm, even state of mind. While some people use tools like essential oils or incense or music, many forms of meditation need nothing more than a few minutes of a person’s time. Meditation relieves stress, clears the mind, and also allows the body to rest, which helps with energy and alertness. It can also help with insomnia when done before bed. Both meditation practice and better sleep are associated with lower levels of anxiety. You can read more about lupus and anxiety here. 

There is some evidence that people’s perception of pain is also reduced by meditation – the source of the chronic pain might still be there, but they aren’t as affected by it. 

While it does take some time out of the day, meditation can be done as part of a morning or evening routine, on commutes, or during breaks. The main disadvantage is that it is a sedentary practice – you are sitting and not getting much exercise – but it still has many benefits.

Mindfulness is the best known and studied meditation, but there are many different types. The internet is full of videos and meditation aids, so people with lupus can easily find a type of meditation that is right for them. And, for some people, yoga, which combines physical activity and stretches with meditation techniques, may be exactly what they are looking for.

What does Yoga Do for People with Lupus?

Yoga provides many of the benefits of exercise to people with lupus:

• Stretches muscles and tendons
• Increases blood flow and strengthens the heart and lungs 
• Helps regulate the sleep-wake cycle (also known as the circadian rhythm,) metabolism, and the immune system
• and produces endorphins, which are natural mood-boosters and painkillers. You can read more about how physical activity affects mood here. 

Yoga also calms the mind and creates a routine, which also is beneficial for people with lupus. When yoga is a part of a class, either in person or online, it also helps alleviate the social isolation that many people with lupus endure, improving mental health. 

However, the benefits of yoga go beyond stress relief and stretching. In a 2018 review in the Journal of Behavioral Medicine, researchers noted that, in small randomized controlled trials, it appeared to reduce pro-inflammatory immune system cells that are often found in people with lupus such as interleukins (IL-6 and IL-1 beta) and tumor necrosis factor (TNF-Alpha). An updated review in 2021 supported this reduction in inflammation, but noted that the trials were small and not standardized. The yoga programs in the studies varied in length and frequency (8-12 week programs, weekly or daily, 30-90 minutes of class time,) and would have benefited from more standardization. However, despite this, yoga was consistently seen to have benefits for people with autoimmune diseases when done regularly. As alternative medicine becomes more accepted in the medical community, more solid research studies will be available.

When done correctly, there are few downsides to yoga. Most of the problems come about when people do the poses improperly or do poses that their body is not ready for. Going out to classes can expose people with lupus to infection, pollutants, and sunlight. Sunlight sensitive and immunosuppressed people should be careful with this, as with any outing. Yoga facilities that use essential oils as a part of their practice might be irritating for some people with lupus, and regular class attendance can be difficult with the unpredictability of lupus flares. Fortunately, some classes are now hybrid and there are many online resources that can help with performing yoga regularly at home. It’s a matter of personal preference and what is available, and each individual person with lupus will have different preferences.

Does the Style of Yoga Matter?

There are many different styles of yoga, just as there are many different styles of meditation. The teachers and practitioners of each one will claim that their style is the best – however, according to a 2016 review, different yoga styles did not make a large difference. All styles studied provided roughly the same benefits. The key is that the teacher must be qualified and competent. Like any exercise, yoga can be done improperly, and potentially cause harm. 

The takeaway here is: Don’t worry about the style of yoga. Instead make sure that you find a good teacher that is available to you, either live or virtual. The style or method of teaching is important, but that can be left to personal preference – positive experiences maximize the benefits that you can get from yoga and encourage regular practice. The Lupus Foundation of America recommends restorative yoga, Iyengar yoga, and hatha yoga for people with lupus and advises against hot yoga, Bikram yoga, vinyasa yoga, or ashtanga yoga due to the physical demands. Again, though, it is about personal preference.  

A Lupus Warrior’s Takeaway

You are probably sick of people telling you to “eat healthier,” “get more exercise,” or “stop stressing.” You already know that. You’ve probably tried a lot of things – finding the right combination of diet, routines, and techniques for you is, unfortunately, a long journey for many people with chronic illnesses. You can read more about the challenges of lupus here. 

Yoga is a great, easily accessible technique that provides many benefits, and it might be exactly what you need! Or it might not – there are many other techniques out there to try. You know your body best and you will find what works best for you. Keep trying. It will be worth the search.

Mediation & Mediator Variables

When designing research studies, it is necessary to consider what will be measured. And, part of that process is defining the independent and dependent variables.

Independent variables are the variables that are changed intentionally by the researchers (different medication dosages, etc.) or are standard variables like age or time. The measurement of these variables does not change as a result of some other variable.

Dependent variables, on the other hand, are variables that are being studied and measured. A hypothesis is a guess at the change in the dependent variable based on the presentation of some independent variable.

Mediation models are another type of study which include mediator variables. Mediator variables are used to clarify the understanding between an independent variable and a dependent variable. In this way, mediator variables attempt to describe chains of action that may be influenced.

Sleep Strategies

Looking for ways to get to sleep faster and stay asleep? These may help:

1. Avoid blue light (cellphone screens, television, computers, etc.) 30 minutes before bed
2. Wake up at the same time everyday (weekends, too!)
3. Ban pets from your bedroom if they wake you up in the middle of the night
4. Keep your room slightly cooler than normal
5. Exercise daily — but try not to work out too close to bedtime
6. Limit naps. Try to schedule naps and aim for consistency of schedule
7. Watch your caffeine intake
8. Do not use alcohol to help you fall asleep. It decreases sleep quality and can lead to dependence issues

What are SMART goals?

SMART is an acronym that can help you remember the important aspects of a good goal. All goals should be:

• S – specific
• M – measurable
• A – attainable
• R – relevant
• T – time-framed

When you follow the SMART goal setting technique it allows you to set realistic expectations, track your progress and it will help you to more easily obtain your goals. When using the SMART technique, you will think in the long term. For example, if this is your New Year’s resolution, think about what you want to accomplish the entire year and break this goal into smaller chunks of time.

A good way to start is by making two lists.

1. List #1
   • Make a list of everything you want to accomplish to help you get and stay healthy over the course of the year like walking or running a 5K or meditating for 30 minutes each day
2. List #2
   • Create a short list of specific health priorities for each month. Start with your first month and add 2 priorities. Then, only add 1 priority for each month thereafter

Digging into SMART goals

Once you have created your lists of top priorities and long-term goals, it’s time to put your plan into action. Here are the five criteria of the SMART technique for setting your health goals and allowing you to have the best chance of success.

• Specific
  • The more specific you make your goals, the better. Being specific will help you focus as well as help you see the goal being achieved.
  • Instead of saying “I’m going to start walking,”  be more detailed with your goals. For example: “I will walk around the neighborhood for 20-minutes on Monday, Wednesday and Friday morning before leaving for work.”
  • Be sure to include how long you will do this routine before increasing the behavior.
• Measurable
  • When have you achieved your goal? You won’t know unless your goal is measurable.
  • Instead of saying “I will eat better,” add an element that can be measured. For example: “I will eat 5 servings of vegetables each day.”
  • Only make goals that have solid measurable criteria.
• Achievable
  • It’s exciting to start a health program and it’s easy to get caught up in the amazing possibilities for a future YOU. But, it is extremely important that you make sure the goals you are setting are actually attainable.
  • For example, a goal of walking in a 5k charity walk in 3 months is much more achievable than making a goal to run a marathon.
  • Gradually increase your goals as you succeed and you can build up to new goals that previously weren’t achievable.
• Realistic
  • Reaching your goal feels amazing…not reaching your goals can be discouraging. Before you commit your goals to a list on fridge, make sure they are doable.
  • Make sure your abilities and commitments will not interfere with realistically being able to achieve goals. It’s great to be ambitious, but impractical goals are easily abandoned.
• Timely
  • “Someday” will not get you out of bed early for your morning walk. Putting a date to your goals will give them accountability.
  • For example, “I will walk a 5K in 3 months and will walk for 15 minutes every Monday, Wednesday, and Friday leading up to the event.”

You can do it!

Regularly re-evaluating your goals is just as important as setting them. You can use the same SMART goals framework for re-evaluation. If it’s too easy (or too hard) you can adjust either the specifics, the measurement, or the timeframe to make it more appropriate for you.

Do not try to stick with goals that make you miserable. This will only make it more difficult to achieve them, which may eventually lead to not even attempting to achieve your ultimate goals. Choose activities that you enjoy doing and eat healthy foods that you enjoy eating.

And always remember: You’ve got this!

Do certain symptoms seem to come on before you go into a full-on lupus flare? Share your experiences and learn from other Lupus Warriors. Click below!

Predicting a flare – sticking to the treatment plan

Your lupus treatment team has worked to put together a treatment plan that keeps lupus symptoms at bay. A major part of this is taking medications as prescribed.

Anti-malarial drugs, such as Plaquenil, are particularly important when it comes to managing lupus flares. Some days, it can seem like the side effects and complicated dosing instructions for medications are more trouble than they are worth. But, according the John’s Hopkins Lupus Center, anti-malarial medications “may help reduce flares by as much as 50%.”

In addition to sticking to your treatment plan, it is important to track your symptoms. A 2013 study conducted by Dr. Michelle A. Petri of Johns Hopkins found that kidney involvement (renal problems) was linked to a doubling of the 1-year risk of having a lupus flare.

There is also empirical evidence suggesting that the following strategies can help minimize flares:

• Avoiding ultraviolet (UV) light
• Managing stress and anxiety
• Eating a healthy diet
• Exercising
• Getting enough physical and emotional rest

Advanced predictors of a lupus flare

New research is exploring “biomarkers” as a potential indicator for lupus flares. A biomarker is something that can be measured or identified in a person (or other organism) that indicates the presence of a disease or infection.

Some examples of biomarkers that have been explored for a connection to lupus flares includes:

• Anti-double-stranded DNA antibodies (anti-dsDNA)
• Complement or complement split products (examples include: C3, C4, & CH50)
• Anti-C1q antibodies
• Anti-nuclear antibodies (examples include: Anti-Sm ab, ANA)
• Cytokines or chemokines (examples include: BAFF/BLyS, IL-2R)

A review published in October 2017 looked into 69 studies previously conducted on flare biomarkers. Despite many studies having positive results across a number of biomarkers, the researchers concluded that, “none of the newly studied biomarkers stood out,” and that “none of these biological markers is completely reliable in diagnosing exacerbations.”

The researchers acknowledge many of the challenges in comparing these studies, including the lack of data standardization. There was hope in the review that some of the antibodies researched could be useful following additional study.

Unfortunately, at this time, there is no gold standard for predicting or identifying a symptom flare. But, biologic research of this type is quite promising.