Vegetarian diet eases arthritis

Adapted from an article in the Lancet (12/10/91) by Dr Jens Kjeldsen-Kragh and colleagues of the Department of General Practice, University of Oslo, and from a report in the Independent by Celia Hall.

Fasting is known to be 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 this randomised, single-blind controlled trial.

'They began with a seven to ten day subtotal fast. After the fast the patients re-introduced a 'new' food item every second day'

27 patients were allocated to a four-week stay at a health farm. They began with a seven to ten day subtotal fast - taking only herbal teas, garlic, vegetable broth, decoction of potatoes and parsley, and juice extracts from carrots, beets and celery. After the fast the patients reintroduced a 'new' food item every second day. If they noticed an increase in pain, stiffness or joint swelling within two to 48 hours this item was omitted from the diet for at least seven days. If symptoms were exacerbated on reintroduction of this food item, it was excluded from the diet for the rest of the study period. During the first 3.5 months, the patients were asked not to eat food that contained gluten, meat, fish, eggs, dairy products, refined sugar or citrus fruits. Salt, strong spices, and preservatives were avoided - likewise alcoholic beverages, tea and coffee. After this period, the patients were allowed to reintroduce milk, other dairy products and gluten-containing foods in the way described above. The patients who did not use cod liver oil supplemented their diet with vitamin D during the first four months.

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 the number of tender joints, Ritchie's articular index, the number of swollen joints, pain scores, the 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 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.

Food allergy or intolerance is unlikely to explain the improvement in all the patients who changed their diet. Interest has been drawn to dietary fatty acids and their ability to modulate the inflammatory process (Kremer JM, Lawrence DA, Jubix W, et al. 'Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunological effects.' Arthritis Rheum 11990; 33: 810-20). A switch to vegetarian diet causes an extensive change in the profile of the fatty acids of the serum phospholipids. These changes may favour production of prostaglandins and leukotrienes with less inflammatory activity.

This dietary regimen seems to be a useful supplement to conventional medical treatment of rheumatoid arthritis.

- 'Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis' by Jens Kjeldsen-Kragh, Margaretha Haugen, Christian F. Borchgrevink, Even Laerum, Morten Eek, Petter Mowinkel, Knut Hovi, Oystein Forre.
- Dr J. Kjeldsen-Kragh is at present at the Institute of Immunology and Rheumatology, National Hospital, Olso, Norway (tel 47 2 867010; fax 47 2 207287).

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