A good friend has come down with a complex of symptoms that may turn out to be rheumatoid arthritis (RA). RA differs from the much more common "wear and tear" osteo arthritis. RA is known as an inflammatory arthritis. It is one of several diseases that involve a generalized inflammatory condition. RA can affect many organs but typically inflames the lining of joints. Inflammation of the joint linings may lead to articular damage and joint deformities. It can be a very disabling disease.
As I attempted to better educate myself on RA, I quickly realized that I was moving once again on to the very unsteady ground of nutritional research and the strange situation of the nutritional research seeming to be invisible to the medical experts.
I followed the pattern I usually follow when I want to learn more about a disease. I went first to the best search engine I know for the latest in medical thinking. This is a site called UpToDate.
I have a paid subscription, which is quite common among physicians and hospitals. The site has 3800 authors, editors and peer reviewers who are the leading experts in many fields. On a very regular basis, they review the literature in their specialty. In a team approach, with embedded links to graphs and associated topics, they prepare very informative and up-to-date chapters available online. The result is the most modern medical knowledge available at our fingertips.
There is a large amount of material about RA in UpToDate. Most of it deals with diagnosis and treatment. The treatments apparently have improved dramatically in the past 20 years and include very powerful drugs and unfortunately the potential for very powerful side effects.
I was particularly interested in their opinion on diets for inflammatory arthritis. Their diet recommendations are summarized in a chapter titled: Complementary Therapies for Rheumatoid Arthritis. The very small section states:
“Foods and diets — There is no evidence that food allergies or sensitivities cause or worsen RA in most people. However, some people notice that their symptoms improve when they fast or eliminate certain foods from their diet, leading the person to believe that an allergy or sensitivity is contributing to arthritis. However, elimination diets are difficult to maintain long-term and can lead to malnutrition. Thus, it is important to involve an experienced healthcare provider in decisions regarding diet. In some cases, a consultation with a dietitian will be recommended.”
Next I went to a site called Pubmed.
This is a government site which catalogues all of the published medical studies done around the world. I was immediately struck by the fact that there were dozens of studies showing that fasting and certain low fat and/or gluten free and/or milk free vegetarian diets had a dramatic effect on decreasing arthritis symptoms for significant numbers of patients.
It seemed that once again I had entered a medical twilight zone. The experts were saying that there was “no evidence showing that food allergies or sensitivities cause or worsen RA” and yet there were numerous studies showing clinical improvement with elimination diets.
I then went to Dr. McDougal’s website as he is an activist in the low fat-vegetarian diet world. He has an entire section on inflammatory arthritis. His site had a listing with concise reviews of many of the studies found in the world’s medical literature. For interested readers, the link to his article and review is:
I also pasted below the list of studies referenced by him to allow a quick review of the medical literature although I strongly suggest visiting his web site.
One area which he didn’t review was the role of gluten and inflammatory arthritis. Celiac disease is caused by sensitivity to gluten. Gluten is found in rye, wheat and barley containing foods. Population screenings for gluten sensitivity is showing that 1 in 100 to 1 in 200 people in the general population have Celiac disease. This means that a diet which includes bread could be making 1-3 million Americans ill. It has also been shown that the vast majority of those with celiac disease do not know that they have it and that one of the symptoms can be an inflammatory arthritis.
A study done in Stockholm, Sweden in 2001 showed that in a population of 66 patients with RA randomly assigned to vegan gluten free vs. healthy non-gluten free diets. 42% of those on the gluten free diet improved as opposed to 4% of those on the normal healthy diet.
The bottom line again seems disturbing. How can we have all these studies suggesting that diet can make a difference and our experts are basically pushing aggressive use of medication with very little mention of trying dietary manipulation? At the least one would think that these studies would create significant interest in having more studies done.
I am sure that once again a major problem is that the drug companies fund the majority of our medical studies. A vegan gluten and/or milk free diet does not create wealth and there is no real incentive in the part of the pharmaceutical companies to run studies proving that these diets may help.
If I had an inflammatory arthritis, particularly in the early stages, I would try a milk free, gluten free vegan diet. If it helped, I would very slowly add foods back in to try and determine just which food was a problem. If this diet did not help, I would probably try a basic elimination diet. I would suggest trying this type of diet with the help of a nutritionist.
(As always, please discuss any major change in diet with your physician.)
Studies summarized below are from Dr McDougal's web site and most of them can also be found in Pubmed.
Link is posted above.
Dietary factors for the development of inflammatory polyarthritis by Dorothy Pattison in the December 2004 issue of Arthritis & Rheumatism found people with a high consumption of meat and meat products have more than twice the risk of inflammatory arthritis than do people who consume less. High intake of dairy products also meant almost twice the risk, and high total protein intake was associated with three times the risk of inflammatory arthritis. Not surprisingly, less fruit intake also means more arthritis. This was a study of 23,630 people from Norfolk, England.
In 1979, Skoldstam fasted 16 patients with rheumatoid arthritis for 7-10 days with a fruit-and vegetable juice fast, followed by a lacto vegetarian diet for 9 weeks. One-third of the patients improved during the fast, but all deteriorated when the milk products were reintroduced (a lacto vegetarian diet) (Scan J Rheumatol 8:249, 1979).
In 1980, Hicklin reported clinical improvement in 24 of 72 rheumatoid patients on an exclusion diet. Food sensitivities were reported to: grains in 14, milk in 4, nuts in 8, beef in 4, cheese in 7, eggs in 5, and one each to chicken, fish, potato, and liver (Clin Allergy 10:463, 1980).
In 1980, Stroud reported on 44 patients with rheumatoid arthritis treated with the elimination of food and chemical avoidance. They were then challenged with foods. Wheat, corn, and beef were the greatest offenders (Clin Res 28:791A, 1980).
In 1981, Parke described a 38-year-old mother with 11-years of progressive erosive seronegative rheumatoid arthritis who recovered from her disease, attaining full mobility, by stopping all dairy products. She was then hospitalized and challenged with 3 pounds of cheese and seven pints of milk over 3 days. Within 24 hours there was a pronounced deterioration of the patient's arthritis (BMJ 282:2027, 1981).
In 1981, Lucas found a fat-free diet produced complete remission in 6 patients with rheumatoid arthritis. Remission was lost within 24-72 hours of eating a high-fat meal, such as one containing chicken, cheese, safflower oil, beef, or coconut oil. The authors concluded, "...dietary fats in amounts normally eaten in the American diet cause the inflammatory joint changes seen in rheumatoid arthritis." (Clin Res 29:754, 1981).
In 1982 Sundqvist studied the influence of fasting with 3 liters of fruit and vegetable juice daily and lactovegetarian diet on intestinal permeability in 5 patients with rheumatoid arthritis. Intestinal permeability decreased after fasting, but increased again during a subsequent lactovegetarian diet regime (dairy products and vegetables). Concomitantly it appeared that disease activity first decreased and then increased again. The authors conclude, "The results indicate that, unlike a lactovegetarian diet, fasting may ameliorate the disease activity and reduce both the intestinal and the non-intestinal permeability in rheumatoid arthritis." (Scand J Rheumatol 11:33, 1982.)
In 1983, Lithell studied twenty patients with arthritis and various skin diseases on a metabolic ward during a 2-week period of modified fast on vegetarian broth and drinks, followed by a 3-week period of a vegan diet (no animal products). During fasting, joint pains were less intense in many subjects. In some types of skin diseases (pustulosis palmaris et plantaris and atopic eczema) an improvement could be demonstrated during the fast. During the vegan diet, both signs and symptoms returned in most patients, with the exception of some patients with psoriasis who experienced an improvement. The vegan diet was very high-fat (42% fat). (Acta Derm Venereol 63:397, 1983).
In 1984 Kroker described 43 patients from three hospital centers who underwent a 1-week water fast, and overall the group improved significantly during the fast. In 31 patients evaluated, 25 had "fair" to "excellent" responses and 6 had "poor" responses. Those with more advanced arthritis had the poor responses. (Clin Ecol 2:137, 1984).
In 1985, Ratner removed all dairy products from the diet of patients with seronegative rheumatoid arthritis, 7 out of 15 went into remission when switched to milk-free diets (Isr J Med Sci 21:532, 1985)
In 1986, Panush described a challenge of milk in a 52-year-old white woman with 11 years of active disease with exacerbations allegedly associated with meat, milk, and beans. After fasting (3 days) or taking Vivonex (2 days) there was no morning stiffness or swollen joints. Challenges with cow's milk (blinded in a capsule) brought all of her pain, swelling and stiffness back (Arthritis Rheum 29:220, 1986).
In 1986, Darlington published a 6-week, placebo-controlled, single-blinded study on 48 patients. Forty-one patients identified foods producing symptoms. Cereal foods, such as corn and wheat gave symptoms in more than 50% of patients (Lancet 1:236, 1986).
In 1986, Hanglow performed a study of the comparison of the arthritis-inducing properties of cow's milk, egg protein and soy milk in experimental animals. The 12-week cow's milk feeding regimen produced the highest incidence of significant joint lesions. Egg protein was less arthritis-inducing than cow's milk, and soy milk caused no reaction. (Int Arch Allergy Appl Immunol 80:192, 1986).
In 1987, Wojtulewski reported on 41 patients with rheumatoid arthritis treated with a 4-week elimination diet. Twenty-three improved. (Food allergy and intolerance. London: Bailliere Tindall 723, 1987).
In 1988, Beri put 14 patients with rheumatoid arthritis on a diet free from pulses, cereals, milk, and non-vegetarian protein foods. Ten (71%) showed significant clinical improvement. Only three patients (11%) adhered to the diet for a period of 10 months (Ann Rheum Dis 47:69, 1988.)
In 1988, Hafstrom fasted 14 patients with water only for one week. During fasting the duration of morning stiffness, and number and size of swollen joints decreased in all 14 patients. No adverse effects of fasting were seen except transient weakness and lightheadedness. The authors consider fasting as one possible way to induce rapid improvement in rheumatoid arthritis (Arthritis Rheum 31:585, 1988).
In 1991, Kjeldsen-Kragh put 27 patients on a modified fast with vegetable broths, followed by a vegan diet, and then a lacto-ovovegetarian diet. Significant improvement occurred in objective and subjective parameters of their disease (Lancet 2:899, 1991) A two-year follow-up examination found all diet responders but only half of the diet nonresponders still following the diet, further indicating that a group of patients with rheumatoid arthritis benefit from dietary manipulations and that the improvement can be sustained through a two-year period (Clin Rheumatol 13:475, 1994.) Patients dropping out with arthritic flares in the diet group left the study mainly when the lactovegetarian diet (dairy products) were introduced (Lancet 338:1209, 1991).
In 1991 Darlington reported on 100 patients who had undergone dietary manipulation therapy in the past decade, one-third were still well and controlled on diet alone without any medication up to 7 ½ years after starting the diet treatment. They found most patients reacted to cereals and dairy products (Lancet 338:1209, 1991).
In 1991, Skoldstam fasted 15 patients for 7 to 10 days. Almost all of the patients showed remarkable improvement. Many patients felt the return of pain and stiffness on the day after returning to their "normal" eating and all benefit was lost after a week (Rheum Dis Clin North Am 17:363, 1991).
In 1992, Sheignalet reported on 46 adults with rheumatoid arthritis who eliminated dairy products and cereals. Thirty-six patients (78%) responded favorably with 17 clearly improved, and 19 in complete remission for one to five years. Eight of those 19 stopped all medications with no relapse. Favorable benefits appeared before the end of the third month in 32 of the patients (Lancet 339:68, 1992).
In 1992, van de Laar showed benefits of a hypoallergenic, artificial diet in six rheumatoid patients. Placebo controlled rechallenges showed intolerance for specific foodstuffs in four patients. In two patients, biopsy of the joints showed specific (IgE) antibodies to certain foods (Ann Rheum Dis 51:303, 1992).
In 1992, Shigemasa reported a 16-year-old girl with lupus who changed to a pure vegetarian diet (no animal foods) and stopped her steroids without her doctor's permission. After starting the diet her antibody titers (a reflection of disease activity) fell to normal and her kidney disease improved (Lancet 339:1177, 1992.
In 1995, Kavanaghi showed an elemental diet (which is an hypoallergenic protein-free artificial diet consisting of essential amino acids, glucose, trace elements and vitamins) when given to 24 patients with rheumatoid arthritis improved their strength and arthritic symptoms. Reintroduction of food brought the old symptoms back (Br J Rheumatol 34:270, 1995).
In 1998, Nenonen tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and control groups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to an omnivorous diet aggravated symptoms. The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis (Br J Rheumatol 37:274, 1998).
Posts
No comments:
Post a Comment