Changes of Intestinal Microflora in Patients with Rheumatoid Arthritis during Fasting or a Mediterranean Diet

Abstract

Background: Therapeutic dietary interventions are effective treatments for rheumatoid arthritis (RA). The mechanisms to affect inflammation and clinical outcome in rheumatoid arthritis are only partly understood. Alterations in intestinal microflora are believed to be associated with disease activity in RA. Aim: To evaluate changes in short-chain fatty acid (SCFA) profiles and clinical outcome in RA during medical fasting or mediterranean diet. Methods: Fifty consecutive in-patients from an Integrative Medicine Department were included in a prospective observational, non-randomised, clinical trial. Patients underwent a 7-day fasting (MF) therapy or a Mediterranean diet (MD) as part of a multimodal therapeutic treatment approach. Results: The mean Disease Activity Score (DAS-28) significantly decreased in both groups (p < 0.001) from 5.7 ± 0.9 to 4.1 ± 1.3 in the MF and from 5.4 ± 1.4 to 4.5 ± 1.3 in the MG group, with no significant difference between the groups (p = 0.115). VAS showed a consecutive decrease of pain in both study groups which was significantly higher in the fasting group on day 7 (p = 0.049). No significant differences between the study groups were found in the profile of total-fatty acids (p = 0.069), butyrate (p = 0.611) and propionate (p = 0.419). Measurement of acetate, however, showed significant differences (p = 0.044) with an increase from 17,4 ± 9.8 µmol/g to 21,4 ± 16.4 µmol/g in MF compared to a decrease from 15,2 ± 10.4 µmol/g to 13,8 ± 9.3 µmol/g in MD. There was no significant correlation between dietary induced changes of SCFA and changes of disease activity. Conclusion: Alterations in SCFA were found in terms of significant changes to increased acetate levels in the fasting group. A correlation between changes of SCFA from intestinal microflora and disease activity in RA could not be revealed. Further studies are needed in the field of dietary inducible changes of the intestinal microflora in patients with RA.

The Effect of Dietary Interventions on Chronic Inflammatory Diseases in Relation to the Microbiome: A Systematic Review

“…In the 2005 study by Michalsen et al, there was a non-significant reduction in DAS28 (−0.2 DAS28 points, p = 0.425) and trend towards an increase in Lactobacillus and Bifidobacterium in seven patients [ 64 ]. Later, in a larger population ( n = 28), Abendroth et al (2010) showed a decrease in DAS28 score ( p < 0.001), CRP, and SCFA (22.9 ± 13.8 to 20.4 ± 9.8 μmol/g) [ 65 ].…”

“…The Mediterranean diet, a primarily plant-based dietary pattern with an emphasis on healthy fats and small portions of animal-based products, is known as a healthy dietary pattern associated with reduced risk of chronic diseases, such as CVD, and all-cause mortality [ 92 , 93 ]. In this review, Mediterranean diets were only effective at reducing clinical outcomes in patients with T2DM and had a limited or inconsistent clinical effect on patients with RA and IBD [ 56 , 64 , 65 , 70 , 71 , 72 ]. Additionally, when compared head-to-head, Candela et al showed that a vegan macrobiotic diet resulted in greater daily fiber intake (+15 g/day) and was more effective at reducing FBG and CRP than a Mediterranean diet [ 69 ].…”

“…In the 2005 study by Michalsen et al, there was a non-significant reduction in DAS28 (−0.2 DAS28 points, p = 0.425) and trend towards an increase in Lactobacillus and Bifidobacterium in seven patients [64]. Later, in a larger population (n = 28), Abendroth et al (2010) showed a decrease in DAS28 score (p < 0.001), CRP, and SCFA (22.9 ± 13.8 to 20.4 ± 9.8 µmol/g) [65]. Furthermore, in a population with T2DM patients, Liu et al performed a six-month intervention with a low-fat Mediterranean diet that significantly reduced FBG and HbA1c [71].…”

Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases

“…Though there have been studies demonstrating the benefit of initial short spans of fasting combined with various diets, such as vegetarian, data strictly on fasting remains limited in RA patients [ 39 , 40 ]. Two small German studies of patients with RA (some patients with fibromyalgia were also included) undergoing about a week of modified fasting periods (protocol including 8 days with a 300-kcal daily limit) reported a small reduction in RA disease activity scores [ 57 , 58 ]. There is also an ongoing clinical trial in Europe examining the effectiveness of therapeutic fasting (time-restricted eating hours) on patients with RA [ 59 ].…”

Evidence-Based Complementary and Alternative Medicine in Inpatient Care

“…The aim of inpatient nutritional therapy as an integral component of naturopathic complex therapy is the indication-related use of foods and dietary measures for maintaining health and for therapy. Nutritional therapy is especially valuable in the complementary treatment of currently increasing widespread diseases such as diabetes mellitus, 18,19 rheumatic diseases, 20 –22 cardiovascular diseases, 23 –25 and chronic intestinal diseases. 26…”