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Nutrition 3701

25 October 2010




ARTHRITIS- The influence of diet and nutraceuticals




Rheumatoid arthritis

   1) nutritional imbalance

              protein energy malnutrition

                     a)  cytokine mediated metabolism

                 b) anorexia

                 c) gastrointestinal involvement

                                    i) malabsorption


2) specific nutrients in relation to RA





                        vitamin C

                        vitamin B6

                        vitamin E




    3) dietary therapy

                                elimination therapy



    4) Functional foods


    5) Nutraceuticals

            supplementation therapy

                                    w6 and w3




Nutritional imbalance

      Protein energy malnutrition


Widespread in RA patients- poor prognosis and rehospitalisation and increased mortality rate


       Cytokine mediated metabolism

Lean body mass (LBM) decreases due to PEM- most of metabolic activity in LBM – this gives rise to deficient immune competence and elevated IL-1 and TNF-a  via unknown mechanism associated with hypermetabolism –that is to say elevated energy metabolism


elevated IL-1 and TNF-a  via unknown mechanism associated with hypermetabolism –that is to say elevated energy metabolism



                        More prevalent during active disease

Elevated IL-1 and TNF-a  produce anorexia in animals


Inverse relation in humans between dietary intake and blood levels of these 2 inflammatory cytokines




Gastrointestinal tract involvement




                        -this gives rise to a decrease in nutrient uptake



Specific nutrients in relation to rheumatoid arthritis



Anemia- most common cause is a cytokine mediated failure of the bone marrow to increase red blood cell production in response to erythropoetin and impaired release of iron from reserves



lots of iron in synovial tissue- possible

mediator of inflammation-oxidation

-iron chelators stops iron mediated oxidation in animal models




                                    decreased levels in rheumatoid arthritis patients


                                    Zinc supplementation comes with risks


                                         -risks of zinc supplementation


-impairment of lymphocyte/neutrophil functions


-increased LDL-c/HDL-c ratio





                                    Theory- Cu/Zn in superoxide dismutase


                                     However copper levels in synovial

fluid and plasma and correlate positively with disease activity


pharmacologic treatment  improves disease and brings copper levels down












                                    anti-inflammatory and immunomodulatory


                                    down in rheumatoid arthritis  patients’ plasmas


                                    however- most Se supplementation

trials no real improvement in disease even when normal plasma levels restored


Se supplementation increases Se in PMN leukocytes of healthy individuals but not those of RA patients-PMN leukocytes critical to reducing RA symptoms


                        Vitamin C


Essential to collagen synthesis -RA leads to collagen breakdown faster than collagen synthesis


                                                Vitamin C supplementation leads to no clinical improvement in RA


                        Vitamin B6


                                                down in RA patients’ plasma


                                                suppression correlated with degree of

inflammation and levels of pro-inflammatory cytokines


            however supplementation- no clinical improvement



                        Vitamin E


some studies lower serum levels of vitamin E compared to healthy controls


other studies suggest lower levels in synovial fluid compared to paired serum samples in RA patients


antioxidant- synovium- vitamin E supplementation shows no clinical improvement




                                    low serum levels in RA


                                    correlates with disease activity (clinical and laboratory measures)


supplementation does not work





Dietary therapy

                        Elimination therapy


                             Dong diet

Eliminating additives preservatives red meat, herbs, dairy products, spices, carbonated drinks and ethanol


                                    Eat seafood, vegetables and rice


No difference in RA clinical outcome between dong and placebo diets for RA patients


                                    Other dietary elimination studies have come up with same thing


Role of diet is controversial because existing studies do not give clear cut results





                        Food intolerances


                                    Potential food antigens absorbed through the GI tract

Dairy, cereals, maize, wheat gluten, tartrazine and certain dyes (azo dyes) have been speculated upon as potential food antigens causing or promoting rheumatoid arthritis


-debatable as to whether elimination of such antigens would have any impact whatsoever on cause or promotion of  RA





Dietary therapy

                       Supplementation therapy-functional foods


                                    Novel supplements

                                                New Zealand green lipped mussel extract

Devil’s claw

            (Harpagophytum root extract)

                                                Sea kelp




Novel supplements are all unproven


            Functional foods


            Sulphur containing foods




               FISH- only fish oils supported for clinical use


                                                 SULPHUR CONTAINING FOODS


Asparagus, eggs, onion, garlic- sulphur necessary for building bone cartilage and connective tissue-no evidence to support clinical use




                                                                Capsaicin- anti-pain-reduces neural sensitivity


                                                                No clinical evidence to support the use of peppers

               Supplementation therapy-Nutraceuticals

                                w6 and w3 foods to reduce inflammation

                                                reminder of pathways


Evening primrose oil

                                    Borage oil

            Blackcurrant oil

Fungal oil

Chrondroitin sulphate





                                   EVENING PRIMROSE OIL-SEE CLASS HANDOUT

                                    BORAGE OIL-SEE CLASS HANDOUT

                                    BLACKCURRANT OIL-SEE CLASS HANDOUT   


                                    FUNGAL OIL-Nothing done to date but there is potential for improvement


                                    CHONDROITIN SULPHATE -no evidence to support clinical use


                                    GLUCOSAMINE- no evidence to support clinical use