Is Diet Important in Rheumatoid Arthritis?

Abstract

There is evidence from several well documented case reports that occasional patients with rheumatoid arthritis (RA) may develop aggravation of their arthritis as a result of allergy to some ingredient in the diet. A variety of foodstuffs have been implicated including milk and milk products, corn and cereals. Total fasting results in improvement in rheumatoid arthritis, but appears to be mediated by diminution in production of chemical mediators of inflammation, rather than by elimination of a dietary allergen. There is conflicting evidence from studies using various intestinal probes that patients with rheumatoid arthritis may have a 'leaky' intestinal mucosa allowing food allergens to be more easily absorbed. Clinical therapeutic trials of exclusion diets have employed the standard strategy of the double-blind randomized method. However, this presupposes that patients entered into such a study are capable of improvement with dietary manipulation. Since this is often not the case, a more appropriate method would be to employ the 'intensive research design' also known as 'single case experiment' and 'N of 1' study. 'Masked food intolerance' is an attractive hypothesis, but extremely difficult to prove. It is doubtful whether fish oils and/or evening primrose oil will be of significant long term benefit for patients with RA. However, they do provide for the possibility that a fatty acid-like substance may be found which may be incorporated into cell membranes, thereby preventing production of mediators of inflammation, such as prostaglandin E2 and leukotriene B4.

Promotion of IgA Immune Response in Patients with Crohn&rsquo;s Disease by Oral Bacteriotherapy with <i>Lactobacillus GG</i>

“…Im provement of the nutritional state of the pa tient is also crucial. In rheumatological disor ders, the role of nutritional treatment is not established [33], In our study oral bacteriotherapy with Lac tobacillus GG appeared to act as an immunotherapeutic agent promoting the antigen-spe cific IgA immune response, specifically in Crohn's disease and irrespective of its activity possibly indicating an intrinsic defect in the Ann NulrMclab 1996;40:137-145immunological barrier of the gut. We suggest that the oral bacteriotherapy balanced that barrier.…”

Modulation of immune function by dietary lectins in rheumatoid arthritis

“…The control of RA by dietary manipulation has been infrequently tested and has not always yielded convincing results (Shatin, 1964;Ziff, 1983;Darlington et al 1986;Buchanan et al 1991), probably because the gastrointestinal tract may not play a pathogenic role in all cases of RA and because most previous clinical trials have only controlled for single, rather than multiple dietary elements which may simultaneously influence disease expression and progression. Van de Laar & van der Korst (1992) demonstrated symptomatic improvement in a subset of patients with RA who were seropositive for RF when they were placed on elemental diets (protein-free diets consisting of essential amino acids, glucose, trace elements and vitamins).…”

Controversial aspects of adverse reactions to food

“…Other investigators were unable to reduce clinical complaints through avoidance diet in rheumatoid arthritis (72, 73). However, Panush et al analyzing anecdotal cases, suggested that immune reactions provoked by foods may lead to tissue injury and abnormal immune reactions in the joints, and thus conditions known as “rheumatic diseases” may develop ( 74).…”