2. • Although it has been appreciated for
some time that diseases processes can
interfere with adequate nutrition, we are
only now beginning to understand how
altered nutritional status contributes to the
pathogenesis of disease.
3. • There is enormous public interest in the
relationship between diet and arthritis.
Speculative lay publications on this subject
abound, and health food stores offer a
plethora of nutritional supplements
represented as therapies for arthritis.
4. The relation between nutrition and
rheumatic diseases will be discussed
under the following headings:
1. Metabolic response to inflammation.
2. Role of nutrition in the pathogenesis of
rheumatic diseases.
3. Free radicals & antioxidants vitamins.
5. 1. Folic acid.
2. Trace elements.
3. Fatty acids.
4. Allergic arthritis.
5. Other complementary and alternative
medicine remedies.
6. Metabolic response to
inflammation
The catabolic effect of inflammatory disease is
multifactorial and may lead to weight loss
through a variety of mechanisms:
1. Fever is associated with increased energy
expenditure.
2. Catecholamine-mediated increases in lipolysis,
glycogenolysis, hyperglycaemia and
hypoinsulinaemia to increase energy substrate
in acute phase response to injury.
7. 3. After few days, hyperinsulinaemia and increased
protein catabolism. The increased amino acids
may then serve as precursors for hepatic
production of acute phase response and
gluconeogenesis.
4. Increased production of eicosanoids and
cytokines associated with the inflammatory
state lead to an enhanced catabolic effect and
increased protein breakdown.
8. Patients with hypoalbuminemic malnutrition
have significantly higher mortality rate as
a result of infections and other metabolic
stresses.
9. Role of nutrition in the pathogenesis of
rheumatic diseases
• Patients with active RA and JRA require
increased dietary energy and protein and
frequently exhibit deficiencies in
micronutrients including selenium, zinc,
magnesium, vitamin C, and vitamin A.
they have high intake of fat particularly
saturated fatty acids (FA), which could
have significant effects on immune
function.
10. • These nutritional alterations are at times
associated with frank malnutrition.
• Patients with OA were found to be 15 Ibs
overweight on average and had a high
prevalence of deficient vitamin intake.
11. • An increased risk of gout was found with
higher meat or seafood consumption but
not with higher consumption of non meat
animal or vegetable protein or purine rich
vegetables.
• Furthermore, a strong inverse relationship
was found between the consumption of
dairy products especially low fat dairy
products and the incidence of gout.
12. • The ingestion of milk proteins (casein and
lactalbumin) has been shown to reduce
serum uric acid levels in healthy subjects
because of the uricosuric effect of these
proteins (Choi et al, 2004).
• High protein diet was associated with
increased uric acid excretion and may
reduce the blood uric acid level
13. Free radicals and antioxidant
vitamins
Free radicals are chemicals with unpaired
electrons. They are formed continuously in
tissues by endogenous and some exogenous
mechanisms.
Hazards:
1. They are capable of causing damage to many
macromolecules including cell membranes,
lipoproteins, proteins and DNA.
14. 2. They are implicated in the development of many
common human diseases associated with aging
including OA.
Benefits:
Free radicals are also essential to normal immune
competence:
1. Intracellular free radicals production is part of
host response necessary for the killing of
invading microorganisms.
15. 2. Free radical reactions are associated with the
release of arachidonic acid and conversion of it
to eicosanoids. These substances are essential in
the function of a normal immune system.
So it is critical to balance between potentially
destructive reactions and naturally occurring free
radicals generation that is essential for normal
immune competence.
16. Antioxidants defense systems:
Intracellular defense is provided primarily by
antioxidant enzymes including superoxide
dismutase, catalase and peroxidases.
In joints, hyaluronic acid may also have an
antioxidant function.
A number of small molecule antioxidants may
have an important role in the extracellular space
where antioxidant enzymes are sparse. These
include vitamin E, β carotene (a vitamin A
precursor), other carotenoids, vitamin C.
17. The concentrations of these antioxidants in
blood are primarily determined by dietary intake.
Beta carotene:
The caroteniods are red yellow pigment
found in all photosynthesizing plants.
Cleavage of beta carotene results in 2
molecules of vitamin A.
18. In contrast to vitamin A, beta carotene is a
potent anti oxidant and can also function
as an immunostimulant.
It enhances activation markers of human
peripheral blood cells.
It increases both cytotoxic T lymphocyte
functions and macrophage secretion of
TNF.
19. Vitamin E:
It is the major lipid soluble antioxidant
found in the cell.
It protects the unsaturated double bonds
of FA in the phospholipids bilayer from
oxidation.
It is critical to maintaining the normal
function of the immune system. T cells are
more sensitive to vitamin E deficiency.
20. Vitamin C:
Is important in decreasing free radical
reactions in both intracellular and extra
cellular fluids.
It is required for the hydroxylation of
proline and lysine in the production of
collagen.
It is involved in several enzymatic reactions
in the formation of neuropeptides
21. Previous studies suggested that synovial vitamin
C deficiency could contribute to rheumatoid
synovitis (Sahud and Cohen, 1971).
It protects neutrophil metabolic activity and
function from reactive oxidants.
It is the first line plasma antioxidant in the
defense against phagocyte reactive oxidants.
It enhances immune responses indirectly by
maintaining optimal levels of vitamin E.
22. Vitamin D:
Its deficiency may contribute to
osteopenia in RA.
May have some beneficial effect in
the treatment of psoriatic arthritis.
1, 25 dihydroxyvitamin D3 has
inhibitory effects on psoriatic
fibroblast function and proliferation.
23. It has significant effects on T lymphocyte
proliferation and cytokine production.
1, 24 dihydroxyvitamin D3 can potentiate
the inhibitory effects of cyclosporine on
helper T cells from patients with RA.
24. Folic acid
• Treatment with methotrexate may be
associated with decrease in plasma levels
of folic acid which are associated with
hyperhomocysteinemia which has been
found to be associated with an increased
risk for arthrosclerosis.
25. • This is because MTX interferes with the
conversion of dihydrofolic acid to
tetrahydrofolic acid. As the latter is a
critical cofactor for the conversion of
homocysteine to methionine, it is easy to
understand why the addition of
supplemental folic acid will lower levels of
circulating homocysteine.
26. Trace elements
Copper zinc and iron are integral components of
metalloproteinases found within intestinal
mucosa.
Increased circulating levels of IL1, IL6 and TNFα
may affect the bioavailability of these trace
elements by inducing the increased production
of metalloproteinasaes within the liver and
intestine.
27. Zinc:
• It is essential for a large and diverse
collection of enzymes involved in multiple
areas of normal metabolic functioning.
It less reactive and less toxic than copper.
Dietary sources include meat, fish and
dairy products.
28. Body storages are limited.
Absorption of zinc is decreased by
ingestion of iron or copper.
The immune effects of zinc are clarified
by the association of autoimmune disease
after treatment with D penicillamine with
its known ability to chelate zinc as well as
magnesium and pyridoxine.
29. Zinc can act as lymphocyte mitogen in
vitro.
It has been demonstrated to enhance
natural killer (NK) cell activity in vitro.
30. Besides these factors, the rationale for using zinc
in inflammatory diseases also includes:
1. A tendency for decreased zinc concentration at
critical tissue stores in inflammatory disease.
2. The tendency of certain drugs such as D
penicillamine and cortisone to suppress zinc
concentration.
31. 3. The fact that RA patients were found to
have depressed oral intake of zinc in diet
and also decreased serum
measurements of it.
4. The anti-inflammatory effect of zinc
complexes in chronic models of
inflammation (Kremer, 2005).
32. Selenium:
1. Has 3 major functions:
• Reduction of organic and inorganic
peroxides.
• Metabolism of hydroperoxides which
are intermediate steps in the
metabolism of PGs and leukotrienes.
• Modulation of respiratory burst.
33. 2. It is likely that both the anti-
inflammatory and immune modulating
effects of selenium are mediated by
means of the effects of its ligand enzyme
(glutathione peroxidase) on the production
of eicosanoidss and reduction of
hydroperoxides.
34. 3. A reduction of serum selenium has been
found in patients with systemic sclerosis.
4. Kashin- Beck disease is an
osteoarthropathy of children and
adolescents which occurs in areas of china
in which deficiencies of both selenium and
iodine are endemic.
35. Copper:
1. Copper is an essential nutrient for biological
systems including the immune system.
2. It is a cofactor in the enzymes: superoxide
dismutase and cuproenzyme ceruloplasmin;
both have antioxidant properties.
36. 3. 2 copper –dependent enzymes present
within lymphocytes are important in
immune function:
*Cytochrome C oxidase: acts in intracellular
energy metabolism.
*Sulfhydryl oxidase: a cofactor in Ig M
formation and B cell differentiation.
37. Iron:
Iron deficient population at risk of
infectious diseases.
The iron containing enzyme catalase
catalzes the decomposition of H2O2
to O2 and water, protecting the
cellular environment from free
radical- induced damage.
38. • Serum level of iron decrease in
inflammation and infection
The immune effects of iron may be at
least partially mediated through alteration
in PG synthesis. They may have to do with
a general role in cellular growth and
protein synthesis.
39. Fatty acids
• Certain long chain FAs are deemed
essential in our diet because their
deficiency can result in severe growth
retardation and death.
40. • Because of mammalian inability to
interconvert omega 3 and omega 6 FAs,
the composition of phospholipids in
cellular membranes is determined by
nutritional intake.
41. • FAs found in membrane bilayer are
substrate for the production of PGs and
leukotriene species essential for many
biological activities including modulation of
inflammatory and immune responses.
42. • Omega 3 FAs represent the largest species
of FAs in the cerebral cortex and retina
and can be derived only from diet. The
most abundant omega 3 FAs are
eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA).
43. • Omega 6 FAs are derived mainly from
terrestrial sources and are ubiquitous in
plant seeds.
44. • EPA and DHA compete with omega 6
arachidonic acid (AA) for positions in the
phospholipids membrane of human cells.
• This is the basis of the
immunosuppressive effects of EPA & DHA,
since EPA has a higher affinity for the
enzymes cyclooxygenase 5 lipooxygenase.
45. • Eicosanoids derived from omega 6 AA
increase the immunological response and
enhance IL1 and TNFα production, while
that of EPA lead to a reduction.
• Furthermore, EPA and DHA reduce the
presentation of ICAM-1 and E-selectin;
essential for the recruitment of
inflammatory cells.
46. • Therapeutic effects of omega 3 FA on RA
can not be achieved by merely increasing
the number of fish meals. A high quality
omega 3 concentrate in a dose of 3 gm or
more should be used daily (Kremer, 2000).
47. • At the same time, the red meat (high in
AA and saturates) and vegetable omega 6
oils should be restricted. Olive and rape
seed oil should be used instead. No clinical
response will occur immediately, but will
start after 2-3 months and may even
increase with chronic use.
48. • The role of omega 3 FA in cardiovascular
disease is well established. Effects of
omega 3 FA that may improve the status
of individuals with impaired circulation
include the following:
1. Improved rheologic status secondary to
increased erythrocyte deformability.
2. Decreased plasma viscosity.
49. 3. A more favorable response to ischemia.
4. A reduced vasospastic response to
catecholeamines and angiotensin.
5. Increased levels of tissue plasminogen activator.
6. Increased endothelial –dependent relaxation of
arteries in response to bradykinin, serotonin,
adenine diphosphate and thrombin.
50. Allergic arthritis
• The idea that rheumatologic disease might be
etiologically linked to ingestion of food is not a
new one.
Patients with Behcet's syndrome had striking
exacerbation of disease 48hs of ingestion of
English walnuts.
A hypersensitivity to certain foods has been
speculated to be the cause of at least some
cases of palindromic rheumatism.
51. L- Canavanine, a non protein amino acid found
in alfalfa, has been linked to exacerbation of
SLE.
• For a response to food to be linked to a hyper
sensitivity reaction resulting in articular
symptoms, it is necessary to implicate an altered
intestinal permeability that would allow passage
of intact food antigens into the circulation.
52. • A food antigen can be linked to arthritis if
a flare of clinical symptoms occurs within
48 hs of a blinded challenge with putative
offending antigen. An elimination diet, in
which a patient totally discontinues
ingestion of the food in question, with
total clearing of articular symptoms, would
also provide implicative evidence.
53. Complementary & alternative
medicine
Micronutrients such as sugar, fiber,
vegetarian foods, amino acids have shown
to affect inflammatory diseases.
Coenzyme Q10 is an antioxidant and a
facilitator of mitochondrial energy
metabolism.
54. Phytoestrogens:
Are dietary non nutrient factors.
Estrogen like compounds.
By competing with natural estrogens for
receptor sites, they may lower the
bioavailability of circulating estrogens.
May protect against breast cancer, and
perhaps SLE.
55. Flavonoids:
• Are a large group of phenolic compounds.
• Occur naturally in most fruits and
vegetables, as well as beer, wine, tea and
coffee.
• Inhibit eicosanoid mediated inflammation.
• Some of them are potent free radical
scavengers, and inhibit lymphocyte
proliferation.
56. • Those derived from green tea stimulate
lymphocyte proliferation and NK activity in
mice.
• They may be associated also with
antitumor and antiplatelet activities.
57. Genistein: is an isoflavone that induces
apoptosis, inhibits platelet assresation,
DNA topoisomerase II, leukotriene
production, and angiogenesis, whereas it
reduces the bioavailability of sex
hormones.
58. Glucosamine & chondrotin:
• Are cartilage extracellular matrix
components.
• Widely promulgated as a remedy for OA
on the basis that they might provide a
substrate for matrix synthesis and repair.
• The mechanism by which they might do
this remain something conundrum.
59. • Sulfate: some experiments on cultured
cells suggested that increase in serum
sulfate enhance glycosaminoglycan
synthesis. There is a possibility that
sulfate supplementation might have a
beneficial role in cartilage health.
60. • Avocado/ soybean unsaponifiables: had
guardedly positive results suggesting
benefit in OA.
• A ginger derived product has also been
tested in a trial that had moderately
positive results suggesting benefit in OA.
61. Diet, Nutrition, and
Osteoarthritis
• Despite abundant lay claims diet, nutrition
and OA, scientific study on these
relationships is in its early stages.
• The strongest risk factor for OA,
particularly of the knee, is overweight and
obesity.
62. • Potential roles of specific nutrients in OA
prevention and treatment are under study,
but to date, results are somewhat less
clear. The ratio of dietary omega-6 to
omega-3 fatty acids has been proposed to
be related to OA because they are
precursors of proinflammatory and anti-
inflammatory eicosanoids and cytokines,
respectively.
63. • However, human data are lacking to
substantiate this relationship Low serum
levels of some vitamins as C, D have been
associated with OA in epidemiological
research but much more work must be
conducted to understand the roles of
these and other vitamins in OA prevention
and treatment.
64. • Biological plausibility exists for the
protective properties of antioxidants
against OA, so continued research to
assist in making specific dietary
recommendations with respect to these is
needed for OA patients.
65. • As the study of diet, nutrients, and OA
evolves, it is prudent for practitioners to
stay abreast of the research so that they
can address patients' questions and
recommend diets with adequate omega-3
fatty acids, vitamins, minerals, and
antioxidants while avoiding megadoses
(Melanson, 2007).
66. • Periodic supervised fasting is also very effective
for osteoarthritis. For more than 50 years,
fasting clinics throughout Europe have
successfully employed periodic juice fasting for
managing arthritis. Fasting enhances the
eliminative and cleansing capacity of the lungs,
skin, liver, and kidneys. It also rests and restores
the digestive system and helps to relax the
nervous system and mind
(www.holisticonline.com)
67. Diet, Nutrition, and rheumatoid
arthritis
The most common allergic foods are
wheat, corn, and dairy. An elimination diet
may identify whether these foods
constitute a problem: avoid allergenic
foods completely for two weeks, then
reintroduce the foods one at a time, every
three days, and note if RA symptoms get
worse.
68. Citrus, chocolate, alcohol, red meat,
spices, and carbonated drinks may also
aggravate RA. A vegetarian diet high in
antioxidants and flavonoids (green tea,
blueberry, elderberry) and low in saturated
fats
69. A small percentage of people respond
dramatically to a diet free of nightshades.
These include peppers, eggplant,
tomatoes, and white potatoes. A month-
long trial is recommended.
70. One clinical study demonstrated that
selenium combined with vitamin E reduces
RA symptoms. Dose is 50 to 75 mcg per
day of selenium and 400 to 800 IU of
vitamin E.
71. • Zinc (45 mg per day) and manganese (45 mg
per day)
• Omega-3 fatty acids keep white blood cells from
producing substances that cause swelling. Dose
is 1,000 to 1,500 IU per day.
• Bromelain: anti-inflammatory when taken
between meals. Dose is 2,000 to 2,500 mg twice
a day.
72. • Quercetin: stabilizes mast cells, found in
increased numbers in the synovial
membranes of affected joints. Dose is 250
to 500 mg three times per day, on an
empty stomach (www. arthritis-
symptom.com).
73. Lupus Diet:
- The amino acids phenylalanine and
tyrosine appear to aggravate the
disease, apparently due to a specific
intermediary block in their
metabolism. Findings from both
animal and human studies have
confirmed the efficacy of removing
these amino acids from the diet.
74. - Also, studies using an animal model of SLE
have found that diets high in fat may
promote the onset and progression of the
disease by weakening immune responses,
suggesting that a low fat diet could be
beneficial.
75. - A vegan diet may be ideal, both because
beef and dairy products are rich in
phenylalanine and tyrosine, and because
the diet is usually low in fat.
76. - When a woman with SLE and typical skin lesions
started a diet recommended by a “well-known
food faddist” consisting entirely of fruit and
vegetables, it was surprising to discover that,
within one week, 95% of her facial lesions had
disappeared. At the end of 2 weeks, her face
was entirely clear (www. arthritis-
symptom.com).
-
77. - Then the diet was tried on a few of their
SLE patients. Most showed considerable
resolution of skin lesions within 2 weeks.
- Most showed considerable resolution of
skin lesions within 2 weeks (www.
arthritis-symptom.com)..
78. • Nutritional Factors in a Lupus Diet:
- In SLE, both linoleic acid (omega-6
series) and alpha-linolenic acid
(omega-3 series) metabolites are
significantly reduced in the plasma
phospholipid fraction, suggesting
that essential fatty acid metabolism
is altered.
79. - SLE patients sometimes suffer from
myalgia (muscle pain) which may be due
to a magnesium deficiency. If so,
magnesium supplementation should cure
the symptom. In discoid lupus,
supplementation with beta-carotene may
reduce sun sensitivity, even in treatment-
resistant patients.
80. - Other nutritional supplements that appeared
beneficial in early open trials include vitamin B3.
vitamin B12, pantothenic acid, vitamin E, and
selenium. Because of abnormal tryptophan
metabolism and the possibility of promoting
auto-antibody production, SLE patients should
avoid supplementation with tryptophan or its
metabolic precursor, 5-hydroxytryptophan, until
they are shown to be safe for this population.
81. Lupus Diet - Food Sensitivities:
Finally, SLE patients have an increased risk
of food sensitivity, and elimination of the
offending foods may be followed by
remission. For example, when a baby boy
with symptoms and laboratory findings
suggestive of lupus was found to have
antibodies to milk, his symptoms resolved
upon milk elimination, and returned on 2
occasions when he drank milk.
82. Diet, Nutrition, and AS
• Vegan diet & Ankylosing Spondylitis
A vegan diet excludes all meat, poultry,
fish, eggs and dairy food and includes lots
of fresh fruits, vegetables, wholegrains,
pulses, seeds and nuts.
83. • There has been an interesting study with
arthritis sufferers involving a one week
fast followed by three weeks of a vegan
dietary regime. At the end of the period, it
was found that 60% of the participants
felt better with "less pain and increased
functional ability.“
84. • A later study into the dietary habits of
patients suffering with Ankylosing
Spondylitis found that all patients ate
meat or dairy products on a regular basis
while most of them only occasionally ate
fresh fruits and vegetables
(www.internethealthlibrary.com).
85. Fat free diet & Ankylosing Spondylitis
Meat and dairy products contain
arachidonic acid, a fatty acid which
contributes to the inflammation
experienced in rheumatism and arthritis
because it is converted into inflammatory
prostaglandin and leukotrienes.
86. • In one study, arthritis sufferers reported a
complete absence of symptoms after
going on a fat free diet for 7 weeks.
Interestingly, when fats were re-
introduced into their diets, their symptoms
returned (www.internethealthlibrary.com).
87. • Deadly nightshade plants & Ankylosing
Spondylitis
There is a theory that the sodium alkaloids
found in plants from the deadly nightshade
family (eg. potatoes, aubergines, tomatoes, and
red and green peppers) may cause/contribute to
arthritis and Ankylosing Spondylitis in some
people.
88. • This theory was given credence by a study
in which a group of 3,000 rheumatoid
arthritis sufferers cut out foods from the
deadly nightshade family and
subsequently, they had reduced aches,
pains and disfigurement
(www.internethealthlibrary.com).
89. Food Combining & Ankylosing Spondylitis
• Many foods are not easily digested when eaten
together.
• The Hay system of food combining
recommends, for example, that high protein
foods (eg. meats, dairy, eggs, fish, nuts, soya)
should not be eaten at the same meal as high
carbohydrate foods (eg. rice, potatoes, bread)
because proteins require an acid medium in the
stomach to be broken down whereas
carbohydrates require an alkaline medium.
90. • This means that the bulk of the diet
should be fruits, salad and vegetables
which are neither starch nor protein and
eat wholefoods rather than refined
foods(www.internethealthlibrary.com).
91. Vitamin C & Ankylosing Spondylitis
Vitamin C is known to boost the immune
system and one report found that pain
was significantly reduced in elderly people
suffering from arthritis when vitamin C
was added to their diet
(www.internethealthlibrary.com).
92. Evening Primrose Oil & Ankylosing
Spondylitis
A report in the Lancet reveals that EPO is
effective for a substantial number of
patients suffering from arthritic pain
(McCormick et al, 1977,
www.internethealthlibrary.com)
93. Gluten Free diet & Ankylosing Spondylitis
• Many people who suffer with arthritis have an
enzyme deficiency in their small intestines which
prevents them from absorbing gluten - a sticky
protein found in wheat and rye flour.
• Interestingly, those areas where gluten cereals
are included in the staple diet are also those
areas with the highest incidence of arthritis.
94. • Conversely, countries where rice or corn
(low gluten foods) is the staple grain have
a much lower rate of arthritic and
rheumatic diseases
(www.internethealthlibrary.com).
95. Vitamin D & Ankylosing Spondylitis
• An article in the British Medical Journal reported
that "vitamin D deficiency seems to play an
important role in causing both fractures and the
osteopenia (bone frailty) of long-standing
rheumatoid arthritis."
• The authors pointed out that advanced arthritis
sufferers rarely leave the house and
consequently do not receive adequate sunlight
for their bodies to synthesise vitamin D.
96. • Obtaining an hour a day of direct daylight
or dietary supplementation of vitamin D is
a factor often overlooked in chronic
arthritis sufferers
(www.internethealthlibrary.com).
97. • Vitamin E & Ankylosing Spondylitis
Vitamin E is now recognised to be an important
nutrient in arthritic disorders helping reduce
inflammation in the tissues. One research paper
found that may be beneficial for patients
suffering from Ankylosing Spondylitis by
reducing the inflammatory process.
(www.internethealthlibrary.com)
98. • The use of a low starch diet in the
treatment of patients suffering from
ankylosing spondylitis.
The majority of ankylosing spondylitis (AS)
patients not only possess HLA-B27, but during
active phases of the disease have elevated levels
of total serum IgA, suggesting that a microbe
from the bowel flora is acting across the gut
mucosa.
99. • Biochemical studies have revealed that
Klebsiella bacteria, not only possess 2
molecules carrying sequences resembling
HLA-B27 but increased quantities of such
microbes are found in fecal samples
obtained from AS patients and such
patients have Crohn's like lesions in the
ileo-caecal regions of the gut.
100. • Furthermore AS patients from 10 different
countries have been found to have elevated
levels of specific antibodies against Klebsiella
bacteria.
• It has been suggested that these Klebsiella
microbes, found in the bowel flora, might be the
trigger factors in this disease and therefore
reduction in the size of the bowel flora could be
of benefit in the treatment of AS patients.
101. • Microbes from the bowel flora depend on
dietary starch for their growth and
therefore a reduction in starch intake
might be beneficial in AS patients. A "low
starch diet" involving a reduced intake of
"bread, potatoes, cakes and pasta" has
been devised and tested in healthy control
subjects and AS patients.
102. • The "low starch diet" leads to a reduction
of total serum IgA in both healthy controls
as well as patients, and furthermore to a
decrease in inflammation and symptoms in
the AS patients. The role of a "low starch
diet" in the management of AS requires
further evaluation.
103. Diet and weight management
and rheumatic diseases
• Although studies are underway to examine
the effects of diet on rheumatic disease,
researchers do not fully understand the
role of diet in rheumatic disease. However,
the Arthritis Foundation recommends the
following dietary guidelines for people
with arthritis and other rheumatic
diseases:
104. * Variety:
Eating a variety of foods from the five different
food groups supplies your body with the
nutrients it needs. The strain of cooking certain
foods combined with fatigue, pain, and certain
medications may make it more difficult for a
person with rheumatic disease to eat healthy.
However, new appliances, resting in-between
food preparations and occasional use of
convenience foods can help you eat a more
varied diet.
105. * Weight:
By maintaining your ideal weight, you can
reduce the strain on your weight-bearing
joints, such as the knees and hips. When
trying to lose weight, a person should eat
less and exercise more.
106. * Starch and fiber:
A diet high in starch and fiber increases
your energy level and makes bowel
movements more regular. In addition,
many foods high in starch and/or fiber are
often low in fat, helping keep weight at a
healthy level.
107. * Fat, cholesterol, and sugar:
Avoiding too much fat, cholesterol, and
sugar in your diet also may help maintain
your ideal weight. In addition, older adults
with rheumatic disease may have high
blood pressure and heart disease, which
can largely be prevented with a proper
diet.
108. * Sodium (salt):
A low-salt diet may benefit many older adults
with rheumatic disease who have high blood
pressure. Sodium can cause water retention
which can aggravate high blood pressure. Some
convenience foods, such as frozen meals and
fast food, are high in sodium. In addition,
certain medications cause the body to retain too
much sodium.
109. * Alcohol
Alcohol consumption can affect a
medication's effectiveness. In addition,
alcohol can cause weight gain and weaken
bones. Care should be taken when
drinking alcohol. Always consult your
physician concerning how alcohol affects
your medications and your health.
110. • The following is a list of certain food
associations and specific rheumatic
diseases:
- Purines: Purines are the components in
certain foods that convert to uric acid in
the body. High levels of uric acid have
been linked to the onset of gout.
111. - Low-calcium and high-alcohol diets:
Diets low in calcium but high in alcohol intake
may increase a person's chance of developing
osteoporosis, a bone deteriorating disease.
- Food contamination:
Certain bacteria on foods, such as Salmonella,
may lead to infectious arthritis.
