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Nutrition 3701

25 October 2010

Lecture 17-RHEUMATOID ARTHRITIS AND NUTRITION

 

 

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

                        iron

                        zinc

                        copper

                        selenium

                        vitamin C

                        vitamin B6

                        vitamin E

                        histidine

                       

 

    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

 

          Anorexia

                        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

 

               malabsorption

                                   

                        -this gives rise to a decrease in nutrient uptake

 


 

Specific nutrients in relation to rheumatoid arthritis

                        Iron

 

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

 

                        zinc

 

                                    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

 

 

                        copper

 

                                    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

 

 

 

 

 

 

 

 

 

            selenium

 

                                    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

 

                          histidine

 

                                    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

 

 


ELIMINATION DIET CONTINUED

 

                        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

                                                ginseng

                                                lactobacillus

 

Novel supplements are all unproven

                       

            Functional foods

            Fish

            Sulphur containing foods

            Peppers

 

 

               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

 

 

                                                 PEPPERS

                                                                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

Glucosamine

 

 

 

                                   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