Kimberly M. Sanders, ND
@_drkimsanders

As a naturopathic autoimmune specialist, one of the most complex autoimmune disorders that I manage is Systemic Lupus Erythematosus (SLE). In addition to joint pain and inflammation, lupus patients may also encounter poor quality of life, fatigue, and loss of bone density. Historically, one of the supplements used to improve quality of life and bone density in lupus patients is dehydroepiandrosterone, also known as DHEA. DHEA is a steroid hormone produced by the body’s adrenal glands that has anti-inflammatory effects. This naturally occurring steroid hormone is often found to be low in autoimmune patients.1 When this hormone is evaluated on lab testing and found to be low, supplementation may be indicated. However, the research surrounding the use of this hormone supplement is conflicting and may help guide our use of this supplement.

Effects of DHEA supplements on lupus symptoms

In 2002, a study was performed in 120 women with Lupus. Half of the women received 200mg per day of DHEA supplementation, and the other half received a placebo for four months. The study found a decrease in lupus flares in the women who supplemented DHEA and found that the supplement was well-tolerated.2 Another study was performed on women with lupus using a synthetic DHEA drug called prasterone. The women with lupus were given 200mg per day of DHEA in addition to conventional lupus treatments or were given a placebo in addition to conventional lupus treatments for one year. The results showed that using the synthetic DHEA improved lupus symptoms. However, this study found that many women had acne and excess facial hair growth as a side effect.3 Another study looked at the use of a lower DHEA supplement dose on quality of life in women with lupus. In this study, the dose of DHEA was 20-30mg per day as compared to 200mg in previous studies. Half of the women in the study were given a placebo for six months. The results of the study showed that the DHEA supplements improved mental well-being and sexual health in women with lupus. However, the supplement group also had a decrease in their good HDL cholesterol levels. This is a concerning finding given that heart disease is a common problem for lupus.4 In 2007, a group of researchers looked at seven studies on DHEA to draw final conclusions about the possible benefit of DHEA supplements for quality of life in lupus patients. The review group concluded that DHEA supplements have a “clinically significant impact on health related quality of life in the short term” for lupus patients.5 However, a more recent study done in 2010 did not find any positive effect of DHEA supplements on fatigue or well-being in women with inactive lupus.6

Effects of DHEA supplements on bone density

Patients with lupus are often prescribed steroids, like prednisone, to help control inflammation and reduce the autoimmune response. Osteoporosis, or a loss of bone density, is one of the major side effects of long-term prednisone use that may be helped by DHEA supplementation. One study looked at the use of DHEA supplements for improving bone mineral density in women with lupus. The study found that postmenopausal women who were not already on medications for their bone density had a good response to DHEA and showed improved bone density on testing after 12 months of supplementation.7 Another study evaluated the effect of prasterone, the synthetic prescription DHEA, on bone density in women being treated with prednisone for lupus. The study found that 200mg of prasterone use prevented the loss of bone density and improved bone density in the lower spine and the hip.8 One study evaluated if 200mg of prasterone was more effective than 100mg of prasterone on bone density. This study found that 200mg is more effective and offers “mild protection” against bone loss in women with lupus who are also taking steroids.9

Conclusions

DHEA supplementation may have beneficial effects for women with lupus who are experiencing poor quality of life, fatigue, and loss of bone density from steroid use. However, the studies are not conclusive about the benefit. Additionally, DHEA supplements are not without side effects. Some of the side effects and complications include acne, facial hair growth, and a decline in good cholesterol levels. Additionally, DHEA supplements may interfere with a patients normal hormone levels. Patients with a personal history or family history of cancer should avoid DHEA supplements. Patients should discuss this research and the potential risks and benefits of DHEA supplementation with their physicians before starting supplements on their own due to the potential side effects. Lastly, the studies indicate that DHEA is most effective for bone density protection in women who have already entered menopause. Women who are not yet in menopause may not benefit from DHEA supplementation.


Kimberly SandersKimberly M. Sanders, ND, is a licensed naturopathic physician in Connecticut. She graduated from the University of Bridgeport and completed her CNME-accredited residency training there, as well. She was named 3-time MVP of the ZRT Cup Competition as a medical student. Dr Sanders currently owns ArthroWell Naturopathic, a specialty practice in rheumatology. She has undergone extensive pediatric and rheumatology training, and has lectured on the topic of autoimmunity and autism at the annual CNPA and NHAND conferences. Her passion in practice is finding the underlying cause of immune dysfunction and restoring balance to the immune system with functional medicine.


References:

  1. Tóth E, Horváth C. [The role of adrenal and gonadal hormones in the pathogenesis of autoimmune polyarthritis]. Orv Hetil. 2002;143(20):1121-8.
  2. Chang DM, Lan JL, Lin HY, Luo SF. Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2002;46(11):2924-7.
  3. Petri MA, Mease PJ, Merrill JT, et al. Effects of prasterone on disease activity and symptoms in women with active systemic lupus erythematosus. Arthritis Rheum. 2004;50(9):2858-68.
  4. patients (Nordmark G, Bengtsson C, Larsson A, Karlsson FA, Sturfelt G, Rönnblom L. Effects of dehydroepiandrosterone supplement on health-related quality of life in glucocorticoid treated female patients with systemic lupus erythematosus. Autoimmunity. 2005;38(7):531-40.)
  5. Crosbie D, Black C, Mcintyre L, Royle PL, Thomas S. Dehydroepiandrosterone for systemic lupus erythematosus. Cochrane Database Syst Rev. 2007;(4):CD005114.
  6. Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma JW, Derksen RH. Effects of dehydroepiandrosterone on fatigue and well-being in women with quiescent systemic lupus erythematosus: a randomised controlled trial. Ann Rheum Dis. 2010;69(6):1144-7.
  7. Hartkamp A, Geenen R, Godaert GL, Bijl M, Bijlsma JW, Derksen RH. The effect of dehydroepiandrosterone on lumbar spine bone mineral density in patients with quiescent systemic lupus erythematosus. Arthritis Rheum. 2004;50(11):3591-5.
  8. Mease PJ, Ginzler EM, Gluck OS, et al. Effects of prasterone on bone mineral density in women with systemic lupus erythematosus receiving chronic glucocorticoid therapy. J Rheumatol. 2005;32(4):616-21.
  9. Sánchez-guerrero J, Fragoso-loyo HE, Neuwelt CM, et al. Effects of prasterone on bone mineral density in women with active systemic lupus erythematosus receiving chronic glucocorticoid therapy. J Rheumatol. 2008;35(8):1567-75.
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