Diät und Rheuma

Näheres unter Ernährung bei Rheuma. Hier Literatur zu den Themen Diät und Rheuma sowie Fasten und Rheuma:

Br J Rheumatol 1991 Apr;30(2):125‑34 Is diet important in rheumatoid arthritis?

Buchanan HM, Preston SJ, Brooks PM, Buchanan WW

Department of Dietetics, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

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.

Publication Types: Review Review, tutorial

Comments:

Comment in: Br J Rheumatol 1991 Aug;30(4):315‑6

PMID: 2012942, UI: 91191287

Baillieres Clin Rheumatol 1995 Nov;9(4):771‑85

Diet and arthritis.

Cleland LG, Hill CL, James MJ

Royal Adelaide Hospital , Australia .

Choice of diet is one way in which an individual can influence his/her own health, and it is to be expected that patients will seek their physician's expert opinion regarding dietary matters. Respect for the legitimacy of these enquiries and balanced informed discussion, which includes general advice for a prudent diet, as well as disease‑specific recommendations when indicated, can be the key to a productive relationship between patients and physician. The issue of dietary advice has an impact on the management of most forms of arthritis including osteoarthritis (obesity/energy balance), gout (dietary purines, energy balance, alcohol, fluid intake) and rheumatoid arthritis (n‑3 fatty acids). Food hypersensitivity appears to be a rare cause of polyarthritis, and elimination diets and fasting have little or no place in routine practice. Strategies under investigation include oral tolerization, the utility of which remains to be established.

Publication Types:

Review

Review, tutorial

PMID: 8591653, UI: 96161429

Hawaii Med J 1999 May;58(5):126‑31

The dietary treatment of inflammatory arthritis: case reports and review of the literature.

Danao‑Camara TC, Shintani TT

Straub Clinic and Hospital, Inc., Honolulu, HI 96813, USA.

Two patients with seropositive inflammatory arthropathies who experienced clinical improvement on the Waianae diet are presented. The scientific literature validates the usefulness of fasting in the control of joint inflammation. Elimination diets are variably successful. Fasting followed by a vegetarian diet can produce a sustained positive response measured clinically and by laboratory variables of inflammation; the efficacy of such an approach appears to hinge on the alteration of fecal flora. Swaying the balance of dietary fats in favor of the omega 3 and omega 6 fatty acids has an antiinflammatory effect, but does not appear to correct the basic immunologic processes involved in the development of the arthropathies. Practical guidelines for the application of this information are offered.

Publication Types:

Review

Review of reported cases

PMID: 10377605, UI: 99305368

Rheum Dis Clin North Am 1991 May;17(2):273‑85

Dietary therapy for arthritis.

Darlington LG

Charing Cross and Westminster Medical School, United Kingdom.

Patients believe that dietary manipulation may help their arthritic symptoms, and because they have‑‑until recently‑‑not felt that their doctors were interested in diet, they have been vulnerable to commercial exploitation. In the past decade, scientific studies have shown that dietary manipulation may help at least a sub‑group of rheumatoid patients. Mechanisms of improvement are understood incompletely, but many theories have been proposed. Further, careful studies are needed so that doctors may understand the subject and advise patients appropriately.

Publication Types:

Review

Review, tutorial

PMID: 1862238, UI: 91319947

Br J Rheumatol 1993 Jun;32(6):507‑14

Review of dietary therapy for rheumatoid arthritis.

Darlington LG, Ramsey NW

Rheumatology Unit, Epsom General Hospital, Surrey.

There are now sufficient good scientific studies, from the UK and abroad, to suggest that, at least in some patients with RA, dietary therapy may influence at least the symptoms and possibly the progression of the disease. Since dietary treatment is safe and may reduce or avoid the need for drugs, it is appealing to patients, who are increasingly anxious about potential drug toxicity. It must, however, be medically supervised to avoid misinterpretation of results, to avoid patients taking diets to extremes, with resultant malnutrition, particularly in children, and to prevent patients from persisting with ineffective diets when they should be receiving drug treatment. Medical interest in dietary treatment also ensures that patients discuss their diets with orthodox practitioners rather than being driven by our scepticism into the hands of unqualified people who may exploit patients' interest in the subject.

Publication Types:

Review

Review, tutorial

Comments:

Comment in: Br J Rheumatol 1993 Nov;32(11):1030

PMID: 8508288, UI: 93284376

Schweiz Rundsch Med Prax 1993 Mar 23;82(12):359‑63

[Nutrition and chronic polyarthritis].

[Article in German]

Diethelm U

Medizinisches Zentrum, Bad Ragaz.

Patients suffering from chronic and incurable diseases often try to influence their symptoms by dietary modification. The effect of complete fasting on pain in rheumatoid arthritis is remarkable, but not fully understood. Polyunsaturated fatty‑acids, specially omega‑3‑fatty‑acids from fish oil, are significant as precursors of mediators for inflammation. In rare instances food allergy may cause or aggravate arthritis. The actual knowledge is presented in a concentrated form and some practical advice is given.

Publication Types:

Review

Review, tutorial

PMID: 8465134, UI: 93219730

1: Clin Exp Rheumatol 2000 May‑Jun;18(3):357‑62

Serum levels of interleukin‑6 and dehydroepiandrosterone sulphate in response to either fasting or a ketogenic diet in rheumatoid arthritis patients.

Fraser DA, Thoen J, Djoseland O, Forre O, Kjeldsen‑Kragh J

Centre for Rheumatic Diseases, National Hospital, Oslo, Norway.

david.fraser@klinmed.uio.no

[Medline record in process]

OBJECTIVE: To investigate the effects of either a 7‑day fast or a 7‑day ketogenic diet upon serum interleukin‑6 (IL‑6) and dehydroepiandrosterone sulphate (DHEAS) in RA patients. METHODS: We measured serum concentrations of DHEAS and IL‑6 in 23 RA patients with active disease, 10 of whom followed a 7‑day sub‑total fast and 13 of whom consumed a ketogenic diet (isoenergetic, carbohydrate < 40 g/day) for 7 days. Clinical and laboratory variables were measured at baseline, on day 7 and after re‑feeding on day 21. Correlation analyses were used to assess the associations between serum IL‑6, DHEAS and disease activity variables at each timepoint.

RESULTS: Fasting, but not the ketogenic diet, decreased serum IL‑6 concentrations by 37% (p < 0.03) and improved disease activity at day 7. Both fasting and the ketogenic diet increased serum DHEAS levels by 34% as compared with baseline (both p < 0.006). Levels of IL‑6, but not DHEAS, correlated with several disease activity variables.

CONCLUSION: Both fasting and a ketogenic diet significantly increased serum DHEAS concentrations in RA patients. Only fasting significantly decreased serum IL‑6 levels and improved disease activity. As the increases in serum DHEAS were similar in response to both fasting and a ketogenic diet, it is unlikely that the fall in serum IL‑6 or clinical improvements after fasting were directly related to increases in serum DHEAS. The fasting‑induced fall in serum IL‑6 may underlie the fall in CRP and ESR observed in RA patients in response to a 7‑day fast.

PMID: 10895373, UI: 20353928

Rheumatology (Oxford) 1999 Oct;38(10):948‑52

Changes in plasma free fatty acid concentrations in rheumatoid arthritis patients during fasting and their effects upon T‑lymphocyte proliferation.

Fraser DA, Thoen J, Rustan AC, Forre O, Kjeldsen‑Kragh J

Centre for Rheumatic Diseases, Akersbakken 27, Rikshospitalet, 0172 Oslo, Norway.

OBJECTIVE: To measure whether changes in the concentrations of circulating free fatty acids (FFAs) after a 7 day fast in rheumatoid arthritis (RA) patients would inhibit in vitro T‑lymphocyte proliferation.

METHODS: The concentration and composition of plasma FFAs were measured in nine RA patients at the conclusion of a 7 day fast. A FFA mixture was made up based on these findings (20% linoleic, 43% oleic, 10% stearic, 27% palmitic acid). Mitogen‑induced lymphocyte proliferative responses were measured after co‑culture of peripheral blood mononuclear cells (PBMC) from healthy individuals in the presence of increasing concentrations of this FFA mixture (from 0 to 2000 microM) and in the presence of FFA mixtures where the relative proportions of fatty acids varied.

RESULTS: Both the concentration of the FFA mixture and the ratio between the unsaturated and saturated fatty acids significantly influenced in vitro lymphocyte proliferation (P<0.0001). Unexpectedly, the highest concentrations of the FFA mixture increased lymphocyte proliferation. At equimolar concentrations (600 microM), manipulating the amounts of oleic and linoleic fatty acids relative to stearic and palmitic fatty acids had a potent inhibitory effect upon lymphocyte proliferation.

CONCLUSION: Fasting‑associated increases in total plasma FFA concentrations do not inhibit, but rather enhance, in vitro lymphocyte proliferation. An inhibitory effect could only be achieved by manipulating the balance between the unsaturated and saturated fatty acids.

PMID: 10534544, UI: 20006396

Clin Rheumatol 1999;18(5):394‑401

Decreased CD4+ lymphocyte activation and increased interleukin‑4 production in peripheral blood of rheumatoid arthritis patients after acute starvation.

Fraser DA, Thoen J, Reseland JE, Forre O, Kjeldsen‑Kragh J

Centre for Rheumatic Diseases, National Hospital, Oslo, Norway. david.fraser@klinmed.uio.no

We investigated the effects of acute starvation on mitogen‑induced T‑cell activation and Th1/Th2 cytokine responses in rheumatoid arthritis (RA) patients. Ten RA patients with active disease underwent a 7‑day fast followed by a 2‑week refeeding period. Immunological, hormonal, laboratory and clinical evaluations were carried out on days 0, 7 and 21. Using flow cytometry, mitogen‑stimulated T‑cell activation was assessed in fresh heparinised blood via analysis of CD69 expression. Production of Th1 (interferon‑gamma) and Th2 (interleukin‑4, IL‑4) cytokines was also assessed by ELISA. The 7‑day fast significantly decreased the erythrocyte sedimentation rate, C‑reactive protein level, joint count, morning stiffness, body weight, CD4+ and CD8+ counts and CD69+ expression on mitogen stimulated CD4+ lymphocytes. A significant increase in mitogen‑induced IL‑4 production after fasting was found. The fast markedly reduced serum leptin and insulin‑like growth factor‑1 concentrations. No significant differences occurred in serum cortisol or prolactin before and after fasting. Decreases in CD4+ lymphocyte activation during fasting correlated with decreases in body weight. Our results suggest that the clinical and laboratory improvements in fasting RA patients may be attributed to decreased CD4+ T‑cell activation and an increase in the number and/or function of IL‑4‑producing Th2 cells. Factors associated with loss of body weight during acute starvation appear to have an inhibitory effect on CD4+ lymphocyte activation.

PMID: 10524554, UI: 99452185

Arthritis Rheum 1988 May;31(5):585‑92

Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis.

Hafstrom I, Ringertz B, Gyllenhammar H, Palmblad J, Harms‑Ringdahl M

Department of Medicine III, Karolinska Institute at Sodersjukhuset, Stockholm, Sweden.

Fourteen patients with rheumatoid arthritis (RA) were studied before, during, and after a 1‑week total fast. Disease activity decreased, as did the neutrophil release of lysozyme induced by the ionophore A23187. The ability of zymosan‑activated RA patient serum to aggregate control neutrophils was reduced, together with serum concentrations of C3. The relative contents of arachidonic acid and eicosapentaenoic acid were increased in serum, platelets, and neutrophils, whereas levels of linoleic acid and linolenic acid were unchanged. Fasting also reduced the release of leukotriene B4 from neutrophils. We thus conclude that a reduced ability to generate cytotaxins, reduced release of enzyme, and reduced leukotriene formation from RA neutrophils, together with an altered fatty acid composition of membrane phospholipids, may be mechanisms for the decrease of inflammatory symptoms that results from fasting.

PMID: 2837251, UI: 88240604

Clin Rheumatol 1991 Dec;10(4):401‑7

Diet and disease symptoms in rheumatic diseases‑‑results of a questionnaire based survey.

Haugen M, Kjeldsen‑Kragh J, Nordvag BY, Forre O

Department of General Practice, University of Oslo, Norway.

Experiences with food intake, diet manipulations and fast were registered in rheumatic patients. The study was a questionnaire‑based survey in which 742 patients participated. It comprised 290 patients with rheumatoid arthritis, 51 patients with juvenile rheumatoid arthritis, 87 patients with ankylosing spondylitis, 51 patients with psoriatic arthropathy, 65 patients with primary fibromyalgia and 34 patients with osteoarthritis. One third of the patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthropathy reported aggravation of disease symptoms after intake of certain foods while 43% of the patients with juvenile rheumatoid arthritis and 42% of the patients with primary fibromyalgia stated the same. Twenty‑six percent of the patients with juvenile rheumatoid arthritis and 23% of the patients with rheumatoid arthritis, ankylosing spondylitis and primary fibromyalgia had previously tried certain diets in the attempt to alleviate disease symptoms, whereas 13% of the patients with psoriatic arthropathy and 10% with osteoarthritis had tried diet therapy. Less pain and stiffness were reported by 46% of the patients and 36% reported reduced joint swelling. Similar beneficial effects of diet were also reported in other rheumatic disease groups. Fifteen percent of the patients with rheumatoid arthritis and ankylosing spondylitis had been through a fasting period. Less pain and stiffness were reported by 2/3 of the patients in both groups and half of the patients in both groups reported a reduced number of swollen joints.

PMID: 1802495, UI: 92200801

Rheumatology (Oxford) 1999 Nov;38(11):1039‑44

Diet therapy for the patient with rheumatoid arthritis?

Haugen M, Fraser D, Forre O

Publication Types: Editorial

PMID: 10556253, UI: 20028149

1: Rheum Dis Clin North Am 1999 Nov;25(4):937‑68, ix

Diets, dietary supplements, and nutritional therapies in rheumatic diseases.

Henderson CJ, Panush RS

Department of Nutrition, Georgia State University, Atlanta, USA.

hendersoncj@juno.com

Rheumatoid arthritis and many other systemic rheumatic diseases remain illnesses of unknown cause for which current therapy is often inadequate. This leads patients to seek questionable remedies, prominent among which are dietary manipulations. Is there a role for dietary modifications in the routine therapy for patients with rheumatic diseases? This article discusses the relationships between diets, fasting, elemental nutrition, vitamins, minerals, and foods for rheumatic diseases. Known scientific‑based evidence for the use, safety, and efficacy of diets and dietary‑related practices subscribed by patients with rheumatic diseases are presented. Studies that link diet with arthritis offer the possibility of identifying new therapeutic approaches for selected patients and of developing new insights to disease pathogenesis. Dietary therapy for arthritis, however, is still being investigated.

Publication Types:

Review

Review, academic

PMID: 10573768, UI: 20041063

Am J Clin Nutr 1999 Sep;70(3 Suppl):594S‑600S

Rheumatoid arthritis treated with vegetarian diets.

Kjeldsen‑Kragh J

Department of Immunology and Transfusion Medicine, Ullevaal University Hospital, Oslo, Norway. jens.kjeldsen‑kragh@ioks.uio.no

The notion that dietary factors may influence rheumatoid arthritis (RA) has been a part of the folklore of the disease, but scientific support for this has been sparse. In a controlled, single‑blind trial we tested the effect of fasting for 7‑10 d, then consuming an individually adjusted, gluten‑free, vegan diet for 3.5 mo, and then consuming an individually adjusted lactovegetarian diet for 9 mo on patients with RA. For all clinical variables and most laboratory variables measured, the 27 patients in the fasting and vegetarian diet groups improved significantly compared with the 26 patients in the control group who followed their usual omnivorous diet throughout the study period. One year after the patients completed the trial, they were reexamined. Compared with baseline, the improvements measured were significantly greater in the vegetarians who previously benefited from the diet (diet responders) than in diet nonresponders and omnivores. The beneficial effect could not be explained by patients' psychologic characteristics, antibody activity against food antigens, or changes in concentrations of prostaglandin and leukotriene precursors. However, the fecal flora differed significantly between samples collected at time points at which there was substantial clinical improvement and time points at which there were no or only minor improvements. In summary, the results show that some patients with RA can benefit from a fasting period followed by a vegetarian diet. Thus, dietary treatment may be a valuable adjunct to the ordinary therapeutic armamentarium for RA.

Publication Types:

Clinical trial

Randomized controlled trial

Comments:

Comment in: Am J Clin Nutr 2000 May;71(5):1211‑3

PMID: 10479237, UI: 99408702

Scand J Rheumatol 1995;24(2):85‑93

Changes in laboratory variables in rheumatoid arthritis patients during a trial of fasting and one‑year vegetarian diet.

Kjeldsen‑Kragh J, Mellbye OJ, Haugen M, Mollnes TE, Hammer HB, Sioud M, Forre O

Institute of Immunology and Rheumatology, National Hospital, Oslo, Norway.

We have previously reported that significant improvement may be obtained in rheumatoid arthritis patients by fasting followed by a vegetarian diet for one year. The present study was carried out to examine to what extent biochemical and immunological variables changed during the clinical trial of fasting and vegetarian diet. For the patients who were randomised to the vegetarian diet there was a significant decrease in platelet count, leukocyte count, calprotectin, total IgG, IgM rheumatoid factor (RF), C3‑activation products, and the complement components C3 and C4 after one month of treatment. None of the measured parameters changed significantly during this period in the group of omnivores. The course of 14 of 15 measured variables favored the vegetarians compared with the omnivores, but the difference was only significant for leukocyte count, IgM RF, and the complement components C3 and C4. Most of the laboratory variables declined considerably in the vegetarians who improved according to clinical variables, indicating a substantial reduction in inflammatory activity. The leukocyte count, however, decreased in the vegetarians irrespective of the clinical results. Thus, the decline in leukocyte count may be attributed to vegetarian diet per se and not to the reduction in disease activity. The results of the present study are in accordance with the findings from the clinical trial, namely that dietary treatment can reduce the disease activity in some patients with rheumatoid arthritis.

Publication Types:

Clinical trial

Randomized controlled trial

PMID: 7747149, UI: 95265961

Clin Rheumatol 1994 Sep;13(3):475‑82

Published erratum appears in Clin Rheumatol 1994 Dec;13(4):649

Vegetarian diet for patients with rheumatoid arthritis‑‑status: two years after introduction of the diet.

Kjeldsen‑Kragh J, Haugen M, Borchgrevink CF, Forre O

Department of General Practice, University of Oslo, Norway.

We have previously reported that a significant improvement can be obtained in rheumatoid arthritis patients by fasting followed by an individually adjusted vegetarian diet for one year. The patients who changed their diet could be divided into diet responders and diet nonresponders. After the clinical trial the patients were free to change diet or medication and after approximately one year they were asked to attend a new clinical examination. We compared the change from baseline (i.e. at the time of study entry) to the time of the follow‑up examination for diet responders, diet nonresponders and controls who ate an omnivorous diet. The following variables favoured diet responders: pain score, duration of morning stiffness, Stanford Health Assessment Questionnaire index, number of tender joints, Ritchie's articular index, number of swollen joints, ESR and platelet count [corrected]. The difference between the three groups were significant for all the clinical variables, except for grip strength. There was no significant difference between the groups with regard to laboratory or anthropometric variables. At the time of the follow‑up examination all diet responders but only half of the diet nonresponders still followed a diet. Our findings indicate that a group of patients with rheumatoid arthritis benefit from dietary manipulations and that the improvement can be sustained through a two‑year period.

Publication Types:

Clinical trial

Controlled clinical trial

PMID: 7835013, UI: 95136638

Lancet 1991 Oct 12;338(8772):899‑902

Controlled trial of fasting and one‑year vegetarian diet in rheumatoid arthritis.

Kjeldsen‑Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, Hovi K, Forre O

Department of General Practice, University of Oslo, Norway.

Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food. The effect of fasting followed by one year of a vegetarian diet was assessed in a randomised, single‑blind controlled trial. 27 patients were allocated to a four‑week stay at a health farm. After an initial 7‑10 day subtotal fast, they were put on an individually adjusted gluten‑free vegan diet for 3.5 months. The food was then gradually changed to a lactovegetarian diet for the remainder of the study. A control group of 26 patients stayed for four weeks at a convalescent home, but ate an ordinary diet throughout the whole study period. After four weeks at the health farm the diet group showed a significant improvement in number of tender joints, Ritchie's articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, C‑reactive protein, white blood cell count, and a health assessment questionnaire score. In the control group, only pain score improved score. In the control group, only pain score improved significantly. The benefits in the diet group were still present after one year, and evaluation of the whole course showed significant advantages for the diet group in all measured indices. This dietary regimen seems to be a useful supplement to conventional medical treatment of rheumatoid arthritis.

Publication Types:

Clinical trial

Randomized controlled trial

Comments:

Comment in: Lancet 1991 Nov 9;338(8776):1209‑10

Comment in: Lancet 1992 Jan 4;339(8784):68

Comment in: Lancet 1992 Jan 4;339(8784):68‑9

Comment in: Lancet 1992 Jan 4;339(8784):69

Comment in: Lancet 1992 May 9;339(8802):1177

PMID: 1681264, UI: 92016867

1: Br J Rheumatol 1994 Jun;33(6):569‑75

Vegetarian diet for patients with rheumatoid arthritis: can the clinical effects be explained by the psychological characteristics of the patients?

Kjeldsen‑Kragh J, Haugen M, Forre O, Laache H, Malt UF

Department of General Practice, University of Oslo, Norway.

In a controlled, single blind clinical trial we have demonstrated recently a beneficial effect of fasting and vegetarian diet in RA. In the present study we compared 53 patients who participated in this clinical trial with 71 other RA patients with regard to some psychological parameters. The patients who participated in the clinical trial differed significantly from other RA patients. Firstly, they had a higher internal score and a lower chance score on the Multi‑dimensional Health Locus of Control Scale (MHLCS). Secondly, their belief in the effect of ordinary medical treatment, evaluated by a 10‑cm visual analogue scale, was lower, and their belief in the effect of 'alternative', unconventional forms of treatment was higher. Of the patients who were randomized to a vegetarian diet, there was no significant difference between diet responders and diet non‑responders with regard to the MHLCS scores. But, diet responders had a significantly lower belief in the effect of ordinary medical treatment compared with diet non‑responders. The psychological distress imposed on the patients by changing from an omnivorous diet to a vegetarian diet was monitored during the clinical trial by means of the General Health Questionnaire. Throughout the clinical trial, this variable favoured the vegetarians compared with the omnivorous and the diet responders vs the diet non‑responders. We conclude, firstly, that patients with certain psychological characteristics were selected to the clinical trial; secondly, that the MHLCS scores could not explain the clinical improvement, but it may have been influenced by the patients' beliefs in ordinary and 'alternative' forms of treatment; and thirdly, that dietary treatment decreased psychological distress.

Publication Types:

Clinical trial

Randomized controlled trial

PMID: 8205407, UI: 94265016

Z Arztl Fortbild (Jena) 1993 Mar 12;87(3):223‑8

[The importance of fasting and vegetarian diet in rheumatic diseases].

[Article in German]

Lutzner H

Fachklinik fur ernahrungsabhangige Krankheiten, Uberlingen.

Publication Types:

Review

Review, tutorial

PMID: 8470408, UI: 93227665

Scand J Rheumatol 1999;28(4):201‑9

Diet and rheumatoid arthritis‑‑a review.

Mangge H, Hermann J, Schauenstein K

Department of Medical and Chemical Laboratory Diagnosis, School of Medicine, University of Graz, Austria.

Publication Types:

Review

Review, academic

PMID: 10503555, UI: 99430880

Clin Rheumatol 1998;17(4):269‑70

Rheumatoid arthritis, fasting, diet and bacteria: myths and enthusiasm.

Nenonen MT

Publication Types:

Editorial

Review

Review, tutorial

PMID: 9776106, UI: 98447001

Rinsho Byori 1999 Jun;47(6):561‑5

[Effects of a 5‑day fast on clinical laboratory data from patients with

rheumatoid arthritis].

[Article in Japanese]

Okubo S, Hashimoto Y, Futamura A, Watanabe N, Mashige H, Fujita A, Koda M, Nakahara K

Central Laboratory, University of Tokyo Hospital.

There have been few studies on the effects of a fast on clinical laboratory data in Japanese. We studied twelve women with rheumatoid arthritis who were not taking any medicine and stayed in the Koda hospital for a diet which lasted 55 days. They basically took a 1200 kcal vegan diet and undertook a 3‑5‑day fast three times. The clinical laboratory data obtained before and after the second fast (day 27‑day 31) were compared. Average body weight decreased by 1.5 kg. There were no changes in CRP. Rapid turnover proteins such as alpha 1 and beta 2‑microglobulin decreased, whereas albumin, IgG, IgA and IgM increased. HDL‑C increased without a change in LDL‑C or triglycerides. Free T3 decreased and free T4 increased, while TSH did not change. The increases in albumin, Ig, HDL‑C and free T4 were not consistent with the results of previous studies. This difference may have been due to the low calorie vegan diet before the fast.

PMID: 10434574, UI: 99363418

Rheum Dis Clin North Am 1991 May;17(2):351‑62

Antirheumatic effects of fasting.

Palmblad J, Hafstrom I, Ringertz B

Department of Medicine 3, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden.

Total fasting induces within a few days a substantial reduction of joint pain,

swelling, morning stiffness, and other arthritic symptoms in patients with rheumatoid arthritis. This remission subsides slowly after discontinuation of fasting. Its mechanisms are complex and involves diminished activation of neutrophils and lymphocytes and decreased generation of leukotrienes and of concentrations of serum complement factors, as well as of other proinflammatory systems. Moreover, ketosis and other metabolic and endocrine changes may be of significance for symptom expression and recognition.

Publication Types:

Review

Review, tutorial

PMID: 1862244, UI: 91319953

Lancet 1992 Jan 4;339(8784):69

Diet, fasting, and rheumatoid arthritis.

Panayi GS

Publication Types:

Comment

Letter

Comments:

Comment on: Lancet 1991 Oct 12;338(8772):899‑902

PMID: 1346002, UI: 92106916

Rheum Dis Clin North Am 1991 May;17(2):259‑72

Does food cause or cure arthritis?

Panush RS

University of Medicine and Dentistry of New Jersey, New Jersey Medical School.

Rheumatoid arthritis and most other forms of inflammatory joint

disease‑‑systemic rheumatic diseases‑‑remain illnesses of unknown cause for which current therapy often is inadequate. The possibility that food antigens induce or perpetuate symptoms in at least some patients is novel, rational, and exciting. Studies that relate diet with arthritis might offer the potential of identifying new therapeutic approaches for selected patients and of developing new insights into disease pathogenesis.

Publication Types:

Review

Review, tutorial

PMID: 1862237, UI: 91319946

Arthritis Rheum 1983 Apr;26(4):462‑71

Diet therapy for rheumatoid arthritis.

Panush RS, Carter RL, Katz P, Kowsari B, Longley S, Finnie S

Although diet therapy for arthritis has received considerable publicity, there is little objective information about its efficacy. We undertook a 10‑week, controlled, double‑blind, randomized trial of patients with active rheumatoid arthritis (RA). Twenty‑six patients completed the study; 11 were on an experimental diet (a specific popular diet free of additives, preservatives, fruit, red meat, herbs, and dairy products) and 15 were on a "placebo" diet. Of 183 variables analyzed, there were no clinically important differences among rheumatologic, laboratory, immunologic, radiologic, or nutritional findings between patients on experimental and placebo diets. Six RA patients on the placebo and 5 on the experimental diet improved by objective criteria. Improvement averaged 29% for patients on placebo and 32% for patients on experimental diets. Two patients on the experimental diet improved notably, elected to remain on the experimental diet following the study period, have continued to improve, and noted exacerbations of disease upon consuming nonexperimental diet foods. Our study failed to provide evidence of objective overall clinical benefit of this diet as followed by a group of patients with longstanding, progressive, active RA. However, our data are not inconsistent with the possibility that individualized dietary manipulations might be beneficial for selected patients with rheumatic disease.

Publication Types:

Clinical trial

Randomized controlled trial

PMID: 6838671, UI: 83178477

Scand J Rheumatol 1979;8(4):249‑55

Effect of fasting and lactovegetarian diet on rheumatoid arthritis.

Skoldstam L, Larsson L, Lindstrom FD

16 patients with classical rheumatoid arthritis (RA) selected at random underwent fasting for 7‑‑10 days, followed by a 9‑week period on a lactovegetarian diet. 10 RA patients acted as controls, taking normal diet. Pain, stiffness, medication, and clinical and biochemical findings were recorded before fasting, on the first day after the conclusion of the fasting period, and at the end of the lactovegetarian period. After fasting, 5 of 15 patients showed objective signs of improvement, compared with only one of the controls. The fasting patients showed reduced pain, stiffness, consumption of analgetics, several clinical variables, and serum concentration of orosomucoid. At the conclusion of the lactovegetarian diet period only one Diet patient showed objective improvement. No differences were found between the Diet patients and the controls concerning symptoms, drug consumption, or clinical and biochemical variables. We conclude that fasting may produce subjective and objective improvements in RA, though of short duration, but the findings of this investigation do not indicate that lactovegetarian diet has any beneficial effects.

Publication Types:

Clinical trial

Controlled clinical trial

PMID: 534318, UI: 80103204

Rheum Dis Clin North Am 1991 May;17(2):363‑71

Fasting, intestinal permeability, and rheumatoid arthritis.

Skoldstam L, Magnusson KE

Department of Rheumatology, University of Lund, Sweden.

Otherwise healthy and well‑nourished patients with rheumatoid arthritis show significant clinical improvement from practising prolonged fasting for 7 to 10 days. The improvement is reversible and lost when eating is taken up again. Although of little therapeutic value, the anti‑inflammatory effect of short‑term fasting is of significant interest and better understanding of the mechanisms is desirable.

Publication Types:

Review

Review, tutorial

PMID: 1862245, UI: 91319954

Scand J Rheumatol 1982;11(1):33‑8

Influence of fasting on intestinal permeability and disease activity in patients with rheumatoid arthritis.

Sundqvist T, Lindstrom F, Magnusson KE, Skoldstam L, Stjernstrom I, Tagesson C

We have investigated the influence of fasting and lactovegetarian diet on intestinal and non‑intestinal permeability in 5 patients with rheumatoid arthritis. We used low‑molecular weight polyethyleneglycols (PEG 400) as probe molecules and a deterministic mathematical model to assess the permeability characteristics. Both intestinal and non‑intestinal permeability decreased after fasting, but increased again during a subsequent lactovegetarian diet regime. Concomitantly it appeared that disease activity, as shown by a clinical six‑joint score, first decreased and then increased again. The results indicate that, unlike lactovegetarian diet, fasting may ameliorate the disease activity and reduce both the intestinal and the non‑intestinal permeability in rheumatoid arthritis.

Publication Types:

Clinical trial

Randomized controlled trial

PMID: 7063809, UI: 82152629

Scand J Rheumatol 1982;11(1):33‑8

Influence of fasting on intestinal permeability and disease activity in patients with rheumatoid arthritis.

Sundqvist T, Lindstrom F, Magnusson KE, Skoldstam L, Stjernstrom I, Tagesson C

We have investigated the influence of fasting and lactovegetarian diet on intestinal and non‑intestinal permeability in 5 patients with rheumatoid arthritis. We used low‑molecular weight polyethyleneglycols (PEG 400) as probe molecules and a deterministic mathematical model to assess the permeability characteristics. Both intestinal and non‑intestinal permeability decreased after fasting, but increased again during a subsequent lactovegetarian diet regime. Concomitantly it appeared that disease activity, as shown by a clinical six‑joint score, first decreased and then increased again. The results indicate that, unlike lactovegetarian diet, fasting may ameliorate the disease activity and reduce both the intestinal and the non‑intestinal permeability in rheumatoid arthritis.

Publication Types:

Clinical trial

Randomized controlled trial

PMID: 7063809, UI: 82152629

Ann Rheum Dis 1983 Feb;42(1):45‑51

Neutrophil functions and clinical performance after total fasting in patients with rheumatoid arthritis.

Uden AM, Trang L, Venizelos N, Palmblad J

The effects of fasting for 7 days were investigated in 13 patients with rheumatoid arthritis (RA) in comparison with a control regimen in a cross‑over trial. The effects of fasting on clinical performance and blood neutrophil functions were studied. During fasting, with a mean weight loss of 5.1 kg, clinical inflammation in the joints and the erythrocyte sedimentation rate (ESR) decreased. During the control period the joints either remained unchanged or deteriorated, and no change was observed in the body weight or the ESR. The locomotion of neutrophils under agarose, induced by a reference serum, decreased during the fasting period (p less than 0.001), but no change in their locomotion was induced by an Escherichia coli bacterial factor. During the control period, however, the locomotion induced by either stimulant was significantly decreased. Generation of migration‑stimulating factors from the patients' plasma declined 3 days after the end of fasting (p less than 0.001). The adherence of the neutrophils to nylon fibres was unchanged during both periods. The bactericidal capacity improved during fasting, both in comparison with the initial value (p less than 0.005) and with the values from the control period (p less than 0.001). An association was found between improvement in inflammatory activity of the joints and enhancement of neutrophil bactericidal capacity. Fasting appears to improve the clinical status of patients with RA. This could partly be due to the observed changes in the functions of the neutrophils, since the latter contribute to the inflammatory joint reactions.

Publication Types:

Clinical trial

Controlled clinical trial

PMID: 6338840, UI: 83151857