Food, Diet, Nutrition & Rheumatic Diseases—Are They Really Related?

Interest & Influence

Although the role of diet in the management of rheumatic disease appears to be modest at best, significant interest in this topic remains, likely reflecting the inadequacies of our current understanding and management of rheumatic disease.³

Recent developments have provided some novel insights into the possible etiopathogenesis of rheumatic disease. Monoclonal anti-citrullinated protein antibodies (ACPA) have been shown to cross-react with numerous plant and microbial proteins; this would be consistent with the possibility that environmental factors, such as microbes or food antigens, may trigger the generation of ACPAs, which then leads to rheumatoid arthritis by cross-reacting with various citrullinated human autoantigens though molecular mimicry.¹⁸

Eating a generally healthier diet may reduce the risk of developing rheumatoid arthritis.¹⁹ Erythrocyte levels of the n-6 polyunsaturated fatty acid, linoleic acid, may be inversely associated with risk of rheumatoid arthritis, and omega-3 fatty acids may potentially lower the risk of transition from ACPA positivity to inflammatory arthritis.^20,21 Immunoregulatory mRNAs in bovine milk may influence the onset of arthritis (see Table 2, p. 37, and Table 3).²²

Table 3: Selected Studies

One particularly interesting way in which diet may affect rheumatic disease could be through an effect on the microbiome. Microbiomics is an emerging field, and our understanding of it is increasing dramatically. The hope is, that with increased understanding, it may be possible to one day develop treatments that target the microbiome to manage or even prevent rheumatic disease.²³

New data also suggest a possible role for fasting in the management and prevention of chronic medical conditions, including rheumatic disease. In one study, subjects who participated in five consecutive days of fasting per month experienced beneficial effects on body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, cholesterol and C-reactive protein.²⁴ It will be interesting to see if a beneficial regimen for a fasting or nutritional elimination diet can be developed for and tolerated by patients with rheumatic disease.

Importance

The relationship between nutrition and rheumatic disease is of continued interest and has possible implications for the etiopathogenesis of rheumatic disease. However, it is unlikely that diet has more than a marginal role in the current treatment of rheumatic disease, even with recent reports and developments. Although there may be a benefit when used in conjunction with DMARDs, diet will not replace or substitute for DMARDs.^3,5,6,10,25

We expect that any role for diet, food or nutrition in the treatment of rheumatic disease will become further diminished as our science improves and therapies become better and safer (see Table 4).^3,5,6,10,25 Nonetheless, as Camus said, “There is no sun without shadow, and it is essential to know the night.” We respect the enthusiasm and persistence of those colleagues who continue to study nutrition in the treatment and understanding of rheumatic disease.³

Table 4: Conclusions

“Science requires an almost complete openness to all ideas. On the other hand, it requires the most rigorous and uncompromising skepticism.” —Carl Sagan