Rheumatoid arthritis is an autoimmune condition characterised by chronic inflammation in joints that causes heat, pain, redness, swelling and loss of function. The exact cause of rheumatoid arthritis is unknown although dietary, immune, genetic, hormonal and microbiological factors have been implicated. Anecdotally, dietary factors do appear to play an important role in the development of the disease. In particular improvements are often seen in those people who switch to a vegetarian diet. But there is little interest in dietary solutions to rheumatoid arthritis amongst the mainstream medical community because they have neither the required level of nutritional knowledge, nor the financial incentive to follow such a line of reasoning. However, a paper published in the American Journal of Nutrition in 1999 demonstrates clearly that a vegetarian dietary regime can be effective in the treatment of rheumatoid arthritis.
The Norwegian researchers randomly assigned rheumatoid arthritis sufferers to either an experimental group or a treatment group. Patients in the experimental group were sent to a health farm for 4 weeks where they fasted for seven days, and were then placed on a vegetarian diet. When the patients returned home, for the next 12 months they followed their assigned vegetarian diet plan. In contrast, the control group was sent to a convalescent home for 4 weeks where they consumed a normal omnivorous diet, which they followed for the remainder of the study period. The researchers made every attempt to make the 4 weeks stay as similar as possible in the two groups. Throughout the study period the researchers made assessments of the subjects in both groups in order to record how they were responding to the two diets.
The treatment given to the experimental group was based on a diet that has been used to treat rheumatoid arthritis for many years in Norway, but it was adapted to make it suitable for a clinical study. There is published evidence that fasting is beneficial to the treatment of arthritis, and so the researchers decided to introduce this component to allow the subjects the chance to see initial rapid improvements which might encourage them to stick to the diet for the length of the study. Following this fasting period, the subjects followed a vegan diet for 3.5 months, and were not allowed to eat meat, dairy, fish, eggs, refined sugar, citrus fruits, salt, strong spices, preservatives, tea, coffee or alcohol (Table 1). These foods were excluded because research and anecdotal evidence suggests they aggravate rheumatoid arthritis.
Table 1. Food choices allowed on the initial vegan diet and the subsequent vegetarian diet for the experimental group
Following the first 3.5 months, the treatment group were allowed to consume a greater range of foods (Table 1), but these foods were only to be reintroduced one at a time. The purpose was to eliminate foods that may cause food allergies and intolerances, are then slowly re-introduced them to the diet. Elimination diets such as these are often used by nutritionists to identify problem foods. In this study new foods were introduced every second day, and the subjects were instructed to monitor their rheumatic symptoms when any new foods was reintroduced. If symptoms deteriorated, the food was eliminated again before being reintroduced seven days later. If symptoms re-appeared, the food item was eliminated for the entire length of the study.
The majority of the symptoms in the treatment group were significantly lower than the control group for the duration of the trial. These included clinical variables such as pain, duration of morning stiffness, grip strength, tender joints, swollen joints, weight, movement; and laboratory variables such as erythrocyte sedimentation rate, C-reactive protein, platelet count and white blood cell count. In addition, the subjects in both groups were put into categories of responders and non responders, depending on their rate of progress on the control and treatment diets. In the control group only 2 subjects were considered to have responded well to the diet, but in the treatment group 12 of the 27 showed a large improvement in symptoms. In a follow up after the trial, all of the treatment diet responders were still following their vegetarian diet out of choice.
A number of reasons were put forward by the authors to explain the positive results. Those who responded best to the vegetarian diet had the least faith in medical treatments, suggesting a psychological aspect, although the placebo effects cannot explain all of the findings. Other effects considered by the authors were reductions in pro-inflammatory prostaglandins and elimination of food intolerances. Immunosuppression due to calorie restriction was ruled out because weight loss was no different between responders and non responders. Of more significance however, was the finding that the IgG antibody response to Proteus mirabilis (a gut bacterium) fell during the study period, significantly so in the responders. Antibody activity against P. mirabilis has been previously been shown to be elevated in sufferers, suggesting that a leaky gut (possibly due to food allergy) may play a role in the development of rheumatoid arthritis.
The most intriguing aspect of treatment rheumatoid arthritis may therefore be related to the gut. Alterations in faecal flora were recorded by the researches, suggesting that there may be a link between the bacterial content of the gut and rheumatoid arthritis. Although care must be taken to attribute cause and effect, the most attractive explanation is that the vegetarian diet somehow modulated the bacterial content of the digestive system and this in some way altered the aetiology of the disease. The bacterial content of the gut is after all know to contain roughly 500 species of microbes, some of which can modulate host immune status. In addition, the elimination diet may allow a previously leaky gut to heal, which in turn would prevent bacterial antigens passing into the blood stream where they could stimulates an antibody reaction.
Whatever the mechanisms, it would appear that vegetarian diets can be beneficial in the treatment of rheumatoid arthritis. The elimination of food known to cause inflammation, intolerances or negatively affect gut bacteria is a good strategy in search for an effective treatment. The vegetarian elimination diet in this study has been used to successfully treat rheumatoid arthritis in Norway for many years. In addition, vitamin D deficiency is increasingly being linked to autoimmune diseases and so supplementation with a high level of D3 is recommended (here here). A good multivitamin should provide adequate levels of most the major minerals and vitamins for optimal health, as described previously (here). Because omega 3 fats are known to suppress pro-inflammatory prostaglandin production, fish oil would also seem a sensible addition to any dietary regime.
RdB
