Vegan Diet and Rheumatoid Arthritis
Nutrition Alerts
Vegan Diet and Rheumatoid Arthritis
Source: Nenonen MT, et al. Br J Rheumatol 1998;37: 274-281.
We tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid arthritis (RA) patients randomized into diet and (omnivorous) control groups. The intervention group experienced subjective relief of RA symptoms during intervention. Return to an omnivorous diet aggravated symptoms. Half of the diet patients experienced adverse effects (nausea or diarrhea) during the three-month diet and withdrew from the experiment prematurely.
Indicators of RA activity did not differ statistically between groups. The positive subjective effect experienced by patients was not discernible in objective measures of disease activity (Health Assessment Questionnaire, duration of morning stiffness, pain at rest, and pain on movement). However, a composite index showed a higher number of patients with between three and five improved disease activity measures in the intervention group. Stepwise regression analysis showed a decrease in disease activity with three factors: intake of lactobacilli-rich and chlorophyll-rich drinks; an increase in fiber intake (mean 42 g daily); and no need for gold, methotrexate, or steroid medication (r2 = -0.48, P = 0.02). Subjects also lost 9% of their body weight on average, and increased their daily protein intake from 58 g to 80 g daily.
Nenonen and colleagues from the Helsinki National Research and Development Center for Welfare and Health, tested a "living food" or uncooked vegan diet. Seeds, grains, and fermented products, together with their processing, characterize a "living food" diet, as does the absence of animal products, added salt or raffinated (conventionally sweetened) substances.
Both diet and control groups were prohibited from having caffeine, chocolate, and alcohol, and no one was taken off medication. Patients with the best adherence had the least objective disease activity, but adherence was a problem. Only five or six of the 19 (mean age 49; 18 women) who completed the diet intervention drank their 0.5-1 liter of fermented wheat and wheatgrass drink daily. Eight dropped out because of nausea; three dropped out because of diarrhea. The fermented wheat bacteria supplied the lactobacilli; the wheatgrass drink was not analyzed.
Specific foods are often linked with RA symptoms. Though Nenonen et al note that RA patients’ intestinal flora appear to differ from that of healthy subjects, it is unclear from this analysis why fermented and uncooked products may be useful in RA.
Creative chefs might help Nenonen et al and their subjects. Good cooks can make almost anything taste good, even without cream, butter and salt, though those are like stethoscopes, reflex hammers, and tongue depressors to doctors. But there’s no cooking here. Just fermenting.
It’s impossible to tell whether the fiber, the relatively high protein level, the lactobacilli, the weight loss, the wheatgrass, or something else was completely responsible for the modest subjective effect.
For RA patients who are truly committed to changing their symptoms and can stick to an extreme diet, a living food diet may be worth a short, time-limited trial. These results warrant better quality future research and more work in the kitchen. (This Nutrition Alert was written by John La Puma, MD, FACP, Adjunct Professor of Nutrition, Kendall College; Director, C.H.E.F. Clinic C.H.E.F. Skills Research, Alexian Brothers Medical Center, Elk Grove Village, IL.)
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