What Causes Lupus? One Reason May Lie in Your Gut

Imbalances in your intestinal microbiome may be a trigger of autoimmune disease. Eating a variety of plants could help. Here’s what you should know.

Researchers studying lupus, an autoimmune disease that strikes mostly women of childbearing age, are zeroing in on the gut.

You might think of germs as the enemy, but it’s more complicated. Your body is home to potentially thousands of different species of bacteria of different kinds, called the human microbiome. In your gut, they help break down food and protect you from infection.

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Think of yourself as an ecosystem, full of life. The bacterial ecosystem in humans and other mammals is one of the most complex ecosystems on the planet.

Your microbiome isn’t exactly like your neighbor’s or sister’s. Hormones make a difference. For example, although men can get lupus too, sex hormones may change the gut in ways that explain why lupus is more common in women.

How you live affects your microbiome. There may be many subtle effects of environment that aren’t yet recognized. It is known that diet and medications, especially antibiotics, change your ecosystem. In general, healthier people eat more plants and have a more diverse collection of bacteria.  

Many details of how the microbiome affects immunity remain mysterious. It’s an especially fast-growing focus for research on autoimmune problems, when your immune system creates symptoms, attacking parts of your body, although no identifiable infection is present.

It makes sense to suspect gut microbes in conditions involving the digestive system, such as inflammatory bowel disease. But your gut plays a role in conditions that don’t have an obvious connection to digestion, including type 1 diabetes, rheumatoid arthritis, and lupus.

During the past decade, researchers have established that the gut microbiomes of lupus patients are less diverse and altered in distinctive ways. Their goal is to find a tell-tale pattern that would lead to tests that predict who is most at risk for lupus and better prevention and treatment methods.

Too much of certain species may, for example, trigger your body to produce interferons, a group of proteins named for their ability to interfere with viruses. That would help explain why people with lupus develop fevers and feel exhausted, as they might with a virus like the flu.

Symptoms of lupus usually start anywhere from someone’s teen years to their 30s. Besides fatigue and unexplained fevers, early signs of lupus include:

• Thinning, ragged body hair caused by inflammation of your skin and scalp
• Painful swollen joints
• Gastrointestinal problems (abdominal pain, nausea, vomiting, diarrhea, and constipation) due to lupus slowing your digestive process

A butterfly rash across your cheeks and nose is a clear sign, but only about half of lupus patients develop it.  

Women of color are two to three times more likely to develop lupus than caucasians, although it’s not clear how the gut may be involved.

Some people with lupus develop antiphospholipid syndrome: Their immune system mistakenly attacks proteins in their blood and causes clots. Manipulating gut bacteria may prevent the dangerous disorder.

New lupus treatments may involve diet, perhaps including probiotics (cocktails of beneficial microbes) or prebiotics (which feed desirable microbes).

In the future, doctors may opt to transfer a healthy microbiome to patients through the feces of healthy donors because they reflect the state of the gut. The process, called a fecal transplant, is used safely and successfully on a hard-to-beat intestinal infection, C. difficile.

While research is underway, you can take steps to fight or prevent conditions possibly tied to your gut bacteria.

Infants are born germ-free but quickly collect bacteria. Children born by C-section seem to miss out on needed bacteria in the mother’s vagina, so one simple step may be to apply vaginal fluid to the baby’s skin.

To get more bacterial diversity, everyone might benefit from eating as many as 30 different types of plant foods in a week, including:

• Whole grains
• Nuts and seeds
• Vegetables
• Fruits
• Legumes
• Herbs and spices

Variety is important. If you’re eating yogurt, add fruit salad and a seed and nut mixture. That’s a good breakfast. You can switch to oatmeal with berries one morning and rye bread toast the next.

Fiber feeds the bacteria you want to favor and helps keep your microbiome diverse. Load up on greens and other vegetables. Garlic, onions, and asparagus all contain a key fiber called inulin.

If you already have a digestive problem, you may need to choose your vegetables carefully or eat them cooked. Whole grains may be helpful for some people.

If you have lupus, you might benefit from keeping a food and symptom diary that could steer you towards the most helpful diet.

It’s a safe bet that no one should gorge on white foods — sugar, flour, and potatoes — which have become a big part of the American diet. If lettuce, tomatoes, and the occasional apple or orange are your only fruits and vegetables, it’s time to feed your gut better.  

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