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R Swamy Venuturupalli, MD, FACR

Joined: 09/02/2011

Expert Profile:

Dr. R. Swamy Venuturupalli is a board-certified rheumatologist practicing in Los Angeles. He is Clinical Chief of the Division of Rheumatology at Cedars Sinai Medical Center and Associate Clinical Professor of Medicine at UCLA as well as being Editor-in-Chief of Current Rheumatology Reports.

Dr. Venuturupalli grew up in Bombay, India, the son of two physicians. In 1995, he received his medical degree from the prestigious Topiwala National Medical College in Bombay. Dr. Venuturupalli completed his residency in Internal Medicine, with distinction, at the Upstate Medical University in Syracuse, NY. Following his residency, he was appointed Chief Resident in the department of medicine at Syracuse University, where he was in charge of managing and training 65 residents.

In 1999, Dr. Venuturupalli moved to Los Angeles for a combined fellowship in health services research with UCLA's School of Medicine, the RAND Corporation, and the Greater Los Angeles Veteran's Administration Medical Center. Along with his cohort, he conducted research on complementary and alternative medicine, publishing studies on Ayurvedic medicine, dietary supplements, and mind-body medicine. Dr. Venuturupalli then completed a rheumatology fellowship at the UCLA-Olive View medical program in 2002.

Dr. Venuturupalli's role as research investigator includes over a hundred clinical trials involving conditions such as lupus, rheumatoid arthritis, inflammatory muscle diseases, ankylosing spondylitis, etc. He participates in ongoing rheumatology research with Dr. Daniel Wallace, a leading physician in the field, at the Cedars Sinai Division of Rheumatology. Dr. Venuturupalli lectures frequently to the general public and to the staff and faculty at Cedars Sinai Hospital on various topics in rheumatology, including alternative and complementary medicine. He was also recently invited to give grand rounds at Cedars on topics such as antiphospholipid syndrome and myositis. Dr. Venuturupalli has authored numerous text-book chapters, is published in peer-reviewed journals, and is currently the Editor-in-Chief of the journal Current Rheumatology Reviews.

For the past eight years, Dr. Venuturupalli has held a private practice in association with a group of 4 rheumatologists. Dr. Venuturupalli is highly regarded by his colleagues and is a sought-after teacher in his field of expertise. He has served as the past president of the Southern California Rheumatology Society, a non-profit professional organization of rheumatologists focusing on professional education.

Areas of expertise: Inflammatory Muscle disease, Systemic Lupus Erythematosus, Anti- Phospholipid syndrome, Sjogren's syndrome, Osteoporosis, Vasculitis.

For more information visit Dr. Swamy's website and Facebook page.

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Stress

There is a big connection between stress and lupus. Although it...

Posted by R Swamy Venuturupalli, MD, FACR

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Nutrition, Omega-3 fatty acids and Gluten.

We keep putting stuff into our bodies that we shouldn't be and...

Posted by R Swamy Venuturupalli, MD, FACR

We keep putting stuff into our bodies that we shouldn't be and often we put too much. Caloric restriction or fasting actually helped Lupus in rats but I wouldn't recommend it for everyone. Once in a while it may be helpful though. However, prednisone makes you hungry so trying to get on the lowest dose of Prednisone is what you should aim for.

There are good fats and bad fats. Bad fats are the saturated fats such as animal fats, butter, lard etc. Good fats are unsaturated fats of which there are 2 types: Monounsaturated and Polyunsaturated. Monounsaturated fats are not bad in small amounts. They come from foods such as olive oil, avocados, almonds, peanuts and walnuts. Polyunsaturated fat comes from foods such as fish, seeds, flax seeds, soybean, walnuts and leafy greens. Within the polyunsaturated fats, there are Omega-3 fatty acids which are anti-inflammatory fatty acids.

A study published in 2008 showed that in humans, there was a big difference between the placebo group and the omega-3 fish oil group. There was a clear improvement in SLAM and BILAG -- which indicate how active your lupus is. So this was the first good published study that shows that omega 3's can make a difference in lupus. Omega 3's are the only 'good' fat to absorb into the body, and fatty fish are good although a lot of fish these days are tainted with mercury. A guide to which fish are safe can be found at: http://www.nrdc.org/health/effects/mercury/guide.asp

A lot of fish is farmed and farm fish don't have as much omega 3's as wild fish. This may have something to do with the fact that wild fish are more active, while farm fish don't move around as much. Another consideration is that wild fish is more expensive.

There are some good fish oil supplements made from wild fish because they extract the mercury out of the fish oil, however you need a lot of it to make a difference. One fish meal is probably equivalent to 9 or 10 capsules of fish oil.

One must be careful because some people have shellfish allergies and lupus patients especially seem to have more allergies than non-lupus patients because their immune systems are very activated and it's the immune system that causes allergies.

You should have about 4 grams of omega 3 fatty acids and there is also a prescription strength omega 3 called Lovaza (it's 4 grams) which is approved for the treatment of high triglycerides and low HDL.

Other foods that are rich in omega 3's are green leafy vegetables, soy, tofu. Don't consume soy and tofu in excess because they have estrogens in them and in women, breast cancer is a potential issue even though there is no conclusive evidence, it is still theoretically a risk. We are still trying to figure out the correlation between estrogen and lupus, so soy and tofu are ok in small amounts.

Some eggs are enhanced with omega 3's and whilst there's a huge cholesterol scare with eggs, they're not that bad. There are some good qualities in eggs and they are a decent source of protein.

Avoiding gluten rich foods can be beneficial. Gluten is found in wheat, rye barley, and it seems everyone loves bread, croissants, pasta etc, however this may not be good for you because these are insoluble fibers and proteins. They are very hard to digest and therefore are taking away precious energy resources. Since your immune system is already overactive in lupus it's already using up much or your energy and if you add hard to digest foods to that equation -- foods which not only take away energy resources but also aren't good for you -- you will increase fatigue. This is why I strongly recommend avoiding gluten rich foods.View Thread

Posted byR Swamy Venuturupalli, MD, FACR

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Reply: Vitamin D

You are not responding to the oral supplementation. Perhaps you are...

Posted by R Swamy Venuturupalli, MD, FACR

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Exercise

One of the most important strategies in managing Lupus is exercise....

Posted by R Swamy Venuturupalli, MD, FACR

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Reply: Antiphospholipid Antibody Syndrome

Anti-malarials can also be used to prevent clotting and avoiding...

Posted by R Swamy Venuturupalli, MD, FACR

3 Replies | ReplyReport This| Share this:Antiphospholipid Antibody Syndrome Anti-malarials can also be used to prevent clotting and avoiding...

Antiphospholipid Antibody Syndrome

All Lupus patients are at risk to get antiphospholipid antibody...

Posted by R Swamy Venuturupalli, MD, FACR

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Is it possible to get off steroids?

Steroids are produced in the adrenal gland and you need some amount...

Posted by R Swamy Venuturupalli, MD, FACR

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Is Hormone Replacement Therapy (HRT) safe for Lupu...

Yes, HRT is safe since they're not high doses of hormones. There...

Posted by R Swamy Venuturupalli, MD, FACR

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Vitamin D

Vitamin D is a big player in Lupus. Across the country there is a...

Posted by R Swamy Venuturupalli, MD, FACR

Vitamin D is a big player in Lupus. Across the country there is a prevalence of vitamin D deficiency of more than 50%. It seems that every autoimmune disease seems to have low vitamin D levels, especially in Lupus patients. The higher your vitamin D, the less inflammation and activation of the immune system. Vitamin D levels should be over 30, which is the normal level. Vitamin D is made in the skin and sun is very important in activating it, however we're very fearful of skin cancers in society and we avoid the sun like the plague which is why we may be beginning to notice an epidemic of vitamin D deficiency. Most dermatologists believe that 15 minutes of sun exposure 3 to 4 times a week is adequate for getting your vitamin D stores up without necessarily causing skin cancer, however these are soft recommendations. If you have a family history of skin cancers or melanomas you have to be careful of the sun. In these cases vitamin D supplementation is widely available in pill form. It doesn't interfere with other medicines because it's a naturally found substance within the body, so if there is any question about sun exposure, you should just take a supplement. Another consideration is that people with dark-colored skin do not absorb vitamin D as much. It is manufactured in the skin and absorbed in the gut where it goes through chemical reactions. Vitamin D1 gets converted to D2 when you get 2 hydroxyl groups. When you get 3 hydroxyl groups it becomes vitamin D3 which is the active version of it. So vitamin D3 is ready to use in oral form. We also know that vitamin D is good for the bones because it helps with calcium metabolism.

There is the possibility of vitamin D toxicity from taking it in excess, so you have to be careful. Levels over 90 can be associated with a toxicity syndrome, leading to symptoms such as headaches and cramping. Since you absorb most of your calcium from your gut and if you are absorbing too much there's some question as to whether they are associated with kidney stones and other issues.

In general it's best to keep your vitamin D levels between 30 and 50.View Thread

Posted byR Swamy Venuturupalli, MD, FACR

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Reply: Diagnosing Lupus

Lupus can be very difficult to diagnose and in some cases by the...

Posted by R Swamy Venuturupalli, MD, FACR

7 Replies | ReplyReport This| Share this:Diagnosing Lupus Lupus can be very difficult to diagnose and in some cases by the...

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