The Mediterranean Diet, Nutritional Value, and Lupus

Diet and proper eating habits are extremely important for people with lupus. But, where do you start and what health plans are worth trying? The Mediterranean diet may be able to help you prioritize the right foods for you.

The Mediterranean diet is one of the many diets that have risen and fallen in popularity during the past few decades. Fad diets have a bad reputation because they are usually developed without the input of a nutritionist. Many also use unproven supplements. However, the Mediterranean diet is unique in that it is both nutritionally valid and has research behind it.

So, what is the Mediterranean diet?

The Mediterranean diet is based off of what people traditionally eat in the Mediterranean region, which includes:

• Italy
• Greece
• Monaco
• France
• Morocco
• Spain

In the 1960’s, these countries had unusual death rates, including a lower risk of death from heart attack and stroke. Many people believed that the cause was the diet in the region. These countries are known for their varied cuisine. But, in the areas near the Mediterranean Sea, they generally eat large amounts of the foods that are plentiful in that region.

According to the diet’s guidelines, the Mediterranean diet involves ample amounts of:

• Whole vegetables and fruits
• Whole grains
• Beans and other legumes (including peanuts and lentils.)
• Nuts and seeds
• Fish and seafood
• Olive oil

It advises that people eat very little:

• White or red meat
• Dairy products like cheese and yogurt
• Eggs

And drink red wine in moderation.

The Mediterranean diet also avoids:

• sugar or sweetened foods
• refined or processed grains or oils
• processed foods high in sodium and preservatives

Aside from these guidelines, the diet has a lot of freedom. It is relatively affordable and can be easily modified to accommodate medical diets and personal preferences.

The World Health Organization sees the Mediterranean diet and similar diets such as the New Nordic diet as healthy and environmentally sustainable.  Studies on the Mediterranean diet link it to weight loss, lower risk of heart attack, stroke, type-2 diabetes, and longer lifespan.

Most researchers believe that this is because foods related to heart disease, especially red meat, are limited. At the same time, foods related to overall health, including unprocessed plant-based foods and unsaturated fats such as Omega-3 fatty acids, are emphasized in the diet.

Olive oil, as well as nuts and seeds, contain monounsaturated fat and plant-associated compounds that lower cholesterol levels, including LDL cholesterol.  The many plant-based foods are full of antioxidants, but these are not generally considered to be as key to the health benefits of the Mediterranean diet as the unsaturated fat content.

NOTE: Before making any significant diet changes, consult with your lupus treatment team and potentially a nutritionist/dietician

Diet, Nutrition, and Lupus

Lupus is a disease characterized by inflammation and over-active immune system activity. Diet can affect both inflammation and overall health, making it an important tool for controlling flares and reducing the symptoms of lupus.

Diet and nutrition have a complex relationship with the immune system. Gut issues are also common for people with lupus, and dietary changes help alleviate these in particular.

The body uses many different nutrients to regulate its immune response. This relationship only gets more complex when the microbiome, the colonies of bacteria and other microorganisms are taken into account. These microorganisms help to tune the immune system, produce other nutrients essential to good health, and even prevent infection.

Because lupus effects people in different ways, there is no one diet that is recommended for people with lupus.

Generally, people with lupus are advised to avoid certain foods that can contribute to increased inflammation including:

• Alfalfa sprouts and mung bean sprouts
• Garlic
• Saturated Fats
• Trans-Fats
• Sugar
• Salt
• Processed Foods

Because people with lupus are sensitive to UV light, they are also often to increase their intake of vitamin D through their diet. Vitamin D can be found in oily fish, a major part of the Mediterranean diet. Vitamin D is also found in red meat, egg yolk, and some fortified foods.

People with lupus can benefit from special diets, even from special meal delivery services. You can read more about meal delivery, here. In particular, people with lupus are often pointed towards Calorie-restricted diets and the Autoimmune Protocol Diet (AIP) depending on the particular problems that they face. Of the two, the calorie-restricted diet does raise some concern. According to the National Institutes of Health, “Scientists also don’t know whether these eating patterns are safe or even doable in the long run. …There’s not enough evidence to recommend any such eating regimen to the public.”

Benefits of Mediterranean Diet for Lupus

In a review of four studies, sticking to the diet appeared to improve mobility and reduce pain.

According to an article published in the Journal of Rheumatology in January 2021, the basic guidelines of the Mediterranean diet potentially have real benefits for people with lupus. They looked at 280 patients, a fairly small number, and tracked their diet via a 14-point questionnaire. They also tracked measurements of SLE activity, including SLEDAI-2k. And cardiovascular health such as obesity, diabetes mellitus, hypertension, and blood lipid level. Sticking to the Mediterranean diet was associated with less SLE symptoms and better cardiovascular health.

Although this is a small study, such a result would fall into line with what we know about diet and lupus.

In general, a good diet for lupus will include a lot of antioxidants, fiber, calcium, vitamin D, and omega-3 fatty acids. This means that lean meats (including fish,) whole colorful fruits and vegetables, legumes (beans, peanuts, lentils, and other similar plants,) whole (not processed) grains, and nuts are on the diet. The Mediterranean diet mostly sticks to these guidelines. The main difference between them is that dairy products, such as yogurt, a source of vitamin D, calcium, and other nutrients, are not on the Mediterranean diet.

The Mediterranean diet also may be helpful in rheumatoid arthritis (RA,) an autoimmune condition that is similar to SLE and can occur alongside it.

The reason for the recorded benefits of the Mediterranean diet are not clear, but may be due to the following:

• Decreased levels of lipids, the substance that has the potential to clog arteries.
• Increased levels of antioxidants, which protect cells in the body from damage, reducing the effect of autoimmune attacks. When cells are protected from damage, this also gives the body fewer things to react to.
• Foods that promote healthy hormone levels, which are involved with the immune system.
• Modifying the gut microbiome (with food) into a community that promotes health.

Researchers believe that the benefits brought in by the Mediterranean diet are due to better nutrition and better overall health. The diet includes many foods that reduce inflammation but these foods are also beneficial in other key ways.

The Mediterranean diet has many foods that are linked to heart health. Cardiovascular disease (CVD) is a potentially surprising symptom of lupus, or, more accurately, people with lupus have a higher risk of developing CVD. Each year in the United States, about 1 in 3 deaths is caused by CVD. It can affect almost every level of the body and its functions.

The diet is also compatible with a diabetes-moderating diet. Diabetes mellitus, or diabetes, also frequently co-occurs with lupus. The Mediterranean diet is low-sugar and high in whole foods, which is known to be beneficial for diabetes. You can read more about the effects of sugar on lupus.

Although many medications for heart disease and diabetes can be taken alongside medications for lupus, diet and exercise is a very effective way to deal with all of the diseases at once.

The Mediterranean Diet: Things to Keep in Mind

The Mediterranean diet is very close to an ideal option and is relatively easy to stick to. However, it is not perfect and you should keep several things in mind if you are considering switching to this diet to treat your lupus.

First, the diet contains a high percentage of fats. It is monounsaturated fat, the so-called “healthy” fat, mostly in the form of olive oil which comes with many other healthy chemicals called polyphenols. However, this high-fat content may not be ideal for some people. If your doctor has recommended a calorie-restricted or low-fat diet. Then the Mediterranean diet is not going to fit those guidelines.

Second, although alcohol is imbibed “in moderation” in the Mediterranean diet, it doesn’t have many benefits for people with lupus. Alcohol can interact with the gut microbiome and cause inflammation, can contribute to the lupus symptom known as “brain fog,” interact with medications and with medication processing, and increase the risk of gout.

Gout, notably, is a painful condition caused by damaged kidneys (as in lupus nephritis, lupus of the kidneys) being unable to process a diet rich in a substance called purines. The purines that cause gout are found in meat, seafood, and alcohol, and are associated with a fatty diet. A vegetable-based diet does not contribute as much to gout. And the Mediterranean diet is not usually linked to flare ups of the syndrome, but it is something to keep in mind.

There should not be many problems associated with switching to a Mediterranean diet, but always check with your treatment team before switching diets.