Arthritis Benefits of Diet Revision
Several diet revision studies have shown benefit for patients with rheumatoid
arthritis. These studies support the more common and persistent claims in the community
that diet revision has benefits. Carinini and Brostoff reviewed the concepts of and
evidence for food-induced arthritis.
They stated: "Despite an increasing interest in food allergy and the conviction of innumerable
patients with joint disease that certain foods exacerbate their symptoms, relatively
little scientific attention has been paid to this relationship. Abnormalities of the
gastrointestinal tract are commonly found in rheumatic disease...Support for an intestinal
origin of antigens comes from studies of patients whose joint symptoms have improved on
the avoidance of certain foods antigens, and become worse on consuming them. These have
included patients with both intermittent symptoms, palindromic rheumatism and more chronic
disease."
In one study of diet revision, 33 of 45 patients with rheumatoid arthritis improved
significantly on a hypoallergenic diet. The authors concluded: "Increasing numbers of
scientific studies suggest that dietary manipulation may help at least some rheumatoid
patients and perhaps the greatest need now is for more careful and well-designed research
so that preconceptions may be put aside and role of diet, as a specific or even a
non-specific adjunctive therapy, may be determined."
In a review article, Darlington and Ramsey suggest that there are now enough good
studies that show that diet therapy in some cases may improve symptoms and possibly halt
the progression of arthritis. They review both supplementation and food elimination
approaches. They suggested that diet therapy should begin with elimination of all foods
which might be causing symptoms, followed by single food re-introductions to discover
which foods reproduce symptoms. They list corn, wheat, cow's milk, pork, oranges, oats,
rye, eggs, beef, coffee, malt, cheese, grapefruit, lemon, tomato, peanuts, and soya as the
foods most likely to cause arthritis.
Appelboom et al reported benefit from the exclusion of dairy products in patients with
ankylosing spondylitis and related spondyloarthropathies; 18 of 25 patients complied with
6 weeks of dairy exclusion - 13 had major improvement and 8 of these discontinued NSAID
use; another 4 had moderate improvement.
Food Proteins Cause Arthritis
Sr. Wm. Osler had first suggested that dietary proteins were important in the
pathogenesis of Henoch-Schonlein purpura and arthritis. The term "palindromic
arthritis" was used to describe transient synovitis in food-sensitive patients. The
occurrence of transient episodes of inflammatory arthritis with the complete absence of
signs and symptoms between attacks is typical of one pattern of food allergy, but the
connection to more chronic and progressive disease has been more difficult to recognize.
The frequent occurrence of arthritis in patients with digestive tract disease is a
major clue. About 20% of patients with regional enteritis and 10% with ulcerative colitis
develop inflammatory arthritis. Intestinal bypass for obesity leads to polyarthritis in 20
% of patients and is associated with other features of "autoimmune" disease.
Another clue is that people with celiac disease who continue to eat gluten-containing
foods such as bread, pasta, cakes and cookies develop rheumatoid arthritis. Another
clue is an animal model of rheumatoid arthritis in rabbits who develop typical joint
lesions when they are fed cow's milk.
A wheat gluten mechanism has been studied in rheumatoid arthritis patients.
Careful observation revealed that wheat ingestion is followed within hours by increased joint
swelling and pain. Little and his colleagues studied the mechanism, as it developed
sequentially following gluten ingestion. Parke et al concurred with this explanation of
the gut-arthritis link in their report of three patients with celiac disease and
rheumatoid arthritis. The mechanism they postulated involves several stages:
The
digestive tract must be permeable to antigenic proteins or peptide fragments, derived from digested
food. The food antigens appear in the blood stream and are bound by a specific antibody
(probably of IgA or IgG, not IgE class), forming an antigen-antibody complex, a
circulating immune complex (CIC).
The antigen-antibody complexes activate the rest of the immune response, beginning
with the release of mediators - serotonin is released from the blood platelets. Serotonin
release causes "symptoms" as it circulates in the blood stream and enhances the
deposition of CICs in joint tissues.
Once in the joint, the immune complexes activate complement, which in turn damages cells
and activates inflammation. Inflammation causes pain, swelling, stiffness,
and loss of mobility.
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