Diet by rheumatic diseases 4.55/5 (53)

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Definition

In chronic conditions such as Systemic connective tissue diseases:, Vasculitis diseases and other rheumatic diseases, an adequate and correctly composed diet can be important for health over time.

Symptoms and sequelae can be affected. Magazines, newspapers, the internet and books also discuss whether the diseases and prognosis improve through adapted diet and food, diet and lifestyle and often come up with new reports and advice. It is not easy to get a quick overview of this topic. The purpose of this page is to refer to professional advice that is based on either good scientific works or advice from medical specialists in the area.

Three conclusions: 1. Diet for rheumatic diseases should be varied and contain fatty fish, preferably "Mediterranean Diet«. 2. Sugar in food and drink is unfavourable. Avoid being overweight. 3. Certain people may lack nutrients in their diet or that they are not absorbed through the stomach and intestines.

Many rheumatic diseases are characterized by chronic inflammation in the joints, gastrointestinal tract, muscles, lungs, kidneys and other connective tissue. The inflammation consumes energy. Together with reduced appetite due to pain and the use of drugs, the disease can lead to weight loss and severe malnutrition over time. At the same time, a lack of vitamins and trace elements can occur (reference: Receive F, 2020). Nutritional status can be assessed through the medical history, clinical examination, measurement of height and weight (for BMI) and laboratory tests. In addition, you can use measurement tools for nutritional status such as "MUST". Malnutrition is a condition that can be normalised, provided that the underlying disease is treated optimally and re-nutrition is done gently.

Weight can be classified according to body mass index (BMI, weight in kg divided by height in meters squared). Underweight BMI < 18,5 kg/m2, Normal weight BMI 18,5 kg/m2 – 24,9 kg/m2

Cholesterol and saturated fat

In chronic rheumatic inflammations that have been present for several years in rheumatic diseases such as arthritis (rheumatoid arteritis), Systemic lupus (SLE) og Takayasu arteritis sees an increased incidence of atherosclerosis (atherosclerosis) that occur earlier in life than expected. Apart from good treatment of the disease, the right diet is important to reduce damage. Cholesterol-lowering drugs are also used in particularly vulnerable people.

The cholesterol level, especially the bad cholesterol LDL-cholesterol / lipoprotein in the blood is an independent risk factor for atherosclerosis. High LDL cholesterol is caused by hereditary predisposition, but also by consumption of saturated fat, trans fats og cholesterol through the diet. Reduction of high cholesterol can therefore be affected by a change in diet. Medicines can reduce the production of cholesterol in the liver such as different types of statins or they reduce absorption from the gut (ezetimibe/Ezetrol).

Diet that reduces cholesterol are oats, barley and whole grains such as brown rice and wholemeal bread, nuts and seeds such as walnuts, almonds, flaxseed, pumpkin seeds, rapeseed oil, olive oil and other vegetable oils, vegetables, especially cabbage, and root vegetables, legumes such as beans, peas, chickpeas and lentils, fatty fish such as mackerel, herring and organic salmon, supplements of marine fatty acids such as cod liver oil or algae oils, avocados, soy products (not soy oil) and margarines with added plant sterols from Vita Hjertegod Fasting and strict vegetarian food (Reference Food and Health).

Splendor. Research on healthy people suggests that fasting has an effect on the immune system, so that inflammatory substances and cells (IL -2, IL-4, CD4+ lymphocytes) can be favorably affected. Studies on rheumatic diseases show that fasting for 7-10 days can improve symptoms and the rheumatic inflammation in Rheumatoid arthritis (RA) (reference: Shield strain L, 1979). However, this effect disappears as soon as normal meals are reintroduced. Experiments with fasting and then consumption of a strict vegetarian diet have shown that some people get less active disease over a longer period of time, but there are very few who in practice manage to stick to such a strict diet. However, for many with rheumatic diseases, regular consumption of a sufficiently nutritious diet is important (see below), which is not compatible with fasting. Fasting is therefore not recommended for severe rheumatic diseases such as Systemic connective tissue diseases:, vasculitis diseases or similar where the disease consumes a lot of energy or absorption of nutrients from the gut may be reduced.

Food

Some people report that some foods almost immediately have an unpleasant effect on the rheumatic disease, regardless of diagnosis. Such an effect can hardly be explained from the influence of disease mechanisms and the immune system. It is more likely that the food contains substances that either act directly on the inflammation or release similar substances from the body.

Pork, tomatoes, spinach and citrus fruit

Some foods release substances that transiently affect blood vessels, giving swelling and increased heat. Such substances are so-called "vasoactive amines" that include histamine og serotonin. The content of histamines is high in pork, meat sauce, tomatoes and spinach. These are foods that people with rheumatic disease (and others) can respond to. Other vasoactive amines (octopamine and phenylephrine) are found in citrus fruits such as orange, clementine and lemon (Reference: Haugen M, 1999).

Coffee and alcohol

Intake of coffee and alcohol can release the "stress hormones" adrenaline and / or norepinephrine in the body (reference: Prineas RJ, 1980). Alcohol can also increase histamine levels. Some red wines contain especially high concentrations of histamine that trigger allergy-like symptoms. (AuntHistamines are medicines for allergy).

However, coffee contains antioxidants (see below) that can be beneficial when part of the diet. By methotrexate treatment which is widely used against rheumatoid arthritis, nausea is a common side effect. Coffee can alleviate these side effects (reference: Malaviya AN, 2017). In one study, the dose of caffeine was moderate. 1-1,4 teaspoons of freeze-dried instant coffee were given in the morning and at midday on the methotrexate day and a corresponding dose the next morning (30-45mg caffeine in each dose). Others believe that larger quantities of coffee are needed to achieve an effect. Coffee can theoretically also reduce the effect of Methotrexate, but a study on arthritis (rheumatoid arthritis) did not confirm this in practice (Reference: Benito-Garcia E, 2006). By Sjögren's syndrome and other conditions with dry mouth, coffee may be uncomfortable on the mucous membranes of the mouth and throat. Alcohol can contribute to increased dryness.

Omega-3, fish and plant oils

Polyunsaturated fats from fish and plants may in theory reduce rheumatic inflammation (via lower IL-1, IL-2, IL-6, TNF-α and IFN-ү). In practice, supplementation of omega-3 in the diet has still not had a measurable effect. Olive oil for example Mediterranean diet also contains other substances that can reduce inflammation (via lymphocyte proliferation, "natural killer cells" activity, proinflammatory cytokines) (reference; Paolino S, 2019). Possibly the relationship between a low content of saturated fatty acids and a lot of polyunsaturated fat is favorable, but this remains to be shown in practice (Peterson S, 2018).

additives

Agents such as emulsifiers, thickeners and stabilizers are added to foods to preserve the consistency. Animal studies suggest that additives can affect the intestinal bacterial composition (microbiota, please see below), which can be unfavourable. Carboxymethyl cellulose (E466) and mono- and diglycerides of fatty acids (E471) can cause inflammation in animals, and polysorbate (E433) can cause obesity in such animal experiments. Whether this also applies to humans remains to be seen. Not all additives are believed to be unfavorable. Lecithin (E322), on the contrary, can be beneficial for the intestine (reference: Zinöcker MK, 2019). More about microbiotics here (Bindevevessykdommer.no)

Antioxidants and vitamins

Free oxygen radicals occur normally in the body, but possibly have an unfavorable role in the rheumatic inflammation and in the normal aging process. Antioxidants such as Vitamin A, E, C, zinc and selenium can in theory reduce such free oxygen radicals. However, people with rheumatic diseases can have low levels of antioxidants, as can be measured in research studies. The reason does not appear to be low intake, but probably the antioxidants are consumed in the inflammatory process. It may therefore seem logical to increase intake through dietary supplements such as multivitamins and mineral supplements, as we see a lot of advertising for. However, studies have not shown a clear connection between dietary supplements and lower disease activity, quite the opposite. It has actually been debated whether increased mortality occurs among those who take supplements with beta-carotene, vitamin A and vitamin E or vitamin C (reference: Bjelakovic G et al JAMA 2007). However, recent studies indicate that a vitamin-rich diet (foods containing a lot of vitamins) is not harmful to health (reference: Paganini-Hill, A 2015). Thus, antioxidants that are consumed via foods such as fruit, fruit juice, potatoes, berries and vegetables (kale tops the list) will be healthy and possibly beneficial against the development of disease. In particular, rose hips, blueberries, crickets, lingonberries, walnuts and sunflower seeds are rich in antioxidants. Coffee also contains antioxidants.

Other supplements

The definition is on dietary supplements are foods that are intended to supplement a regular diet. The products must be concentrated sources of vitamins and minerals or other substances with a nutritional or physiological effect. they must be sold in pre-packaged and dosed form and consumed in small, measured quantities (Reference: Regulations on diet). Many athletes use dietary supplements to improve performance. Many people feel the supplements make them quicker and stronger. One problem is that some of the supplements that are sold are "contaminated" with substances that are covered by the doping rules. A Norwegian study showed that as many as 21 of 93 (23%) examined products contained doping substances, drugs or illegal amounts of caffeine (reference: Heal C, 2019). One must assume that such agents may have adverse side effects.

Sugar

There are found evidence that sugary drinks, including fruit drinks and juices, can exacerbate joint inflammation. One reason may be that the sugar via the intestine causes the formation of substances that are absorbed into the blood and increases inflammation (Reference: DeChristopher, 2016).

Microbiota

The intestine is the headquarters of a bacterial population that together makes up 0,3-3% of the weight of an adult human (NIH, 2012; Sender R, 2016). Since the 1990s, people have become increasingly aware that bacteria can have both beneficial and adverse effects on the immune system. Animal studies indicate that a low-fat diet provides a better distribution of the various intestinal bacteria than fatty food, and that the distribution of the various intestinal bacteria can be important for the development of rheumatic disease.

DHEA & LDN

DHEA ("De-hydro-epi-androsterone") is a hormone produced by the adrenal glands. Low levels have been detected in rheumatic connective tissue disease. Supplements with DHEA has been tested in SLE, Sjøgrens syndrome and fibromyalgia (reference: Finckh A, 2005) in several studies, but without concluding that DHEA has a therapeutic effect over time. LDN (Low dose Naltrexone) More info on separate pages.

Osteoporosis (Low bone density)

In case of chronic rheumatic inflammation such as connective tissue disease (SLE, Sjögren's syndrome, Systemic sclerosis, Myositis, MCTD), Vasculitis (temporal arteritis, Takayasu, GPA/Wegener and others), Rheumatoid arthritis (RA) og Ankylosing spondylitis there is an increased risk of developing bone loss. The reason is that the rheumatic inflammation affects the skeleton, reduces physical activity and affects nutrition. Some medications (cortisone, Prednisone) are also strongly contributing.

Prevention of osteoporosis. Osteoporosis is important to counteract, especially if Prednisolone or other cortisone drugs are used. Measuring bone fragility is done via "bone density" or "bone mass measurement" and is easy to do with a DEXA scanner at X-ray institutes or hospital outpatient clinics. To counteract the development of brittle bones, one should consume plenty of calcium via milk products or dietary supplements. Vitamin D found in oily fish, fishoil, margarine and in sunlight. Calcium and vitamin D supplementsFor example, Calcigran Forte chewable tablets are appropriate for regular treatment with cortisone (Prednisolone). Smoking and lots of alcohol are also unfavorable. Regular physical activity (walking, exercise) strengthens the skeleton (reference: Drake MT, 2015)

High blood pressure and diet

High blood pressure does not occur rarely in systemic connective tissue disease and vasculitis. The reason may be kidney failure, drug side effect, obesity, or coincidence. Untreated, high blood pressure will cause the heart to pump against higher resistance. One consequence is heart failure (kadial insufficiency) in the long term. Medication (antihypertensives) are effective, but proper diet and normal body weight are also important. One recommends avoiding fat, salt and high calorie diets. Fast food often contains a lot of salt and calories. Rather use lean meat (chicken fillet), spices, lots of fruits and vegetables and fiber-rich foods. Exercise and weight reduction reduces blood pressure, while alcohol increases it.

Pregnancy and diet

For pregnant women with rheumatic connective tissue diseases or vasculitis, it is important that the disease is under good control both when the pregnancy begins and during the course. Good health is also important. Dietary supplements cannot replace a regular and healthy diet, but supplementation of folic acid (0,4mg / day) is recommended for all pregnant women (reference: Norwegian Directorate of Health, 2015). All medications must be evaluated in order to determine if they can be continued during a pregnancy. Particularly important is methotrexate and CellCept/mycophenolate is terminated well before the pregnancy. Those who have used folic acid as a supplement to methotrexate or salazopyrin before pregnancy, continue with the same folic acid dose throughout pregnancy. Measurements of vitamin and iron status should be done via a doctor. If there are signs of deficiencies, supplements are off Vitamin D and iron. The pregnant should reduce the intake of coffee, black tea, cola and other caffeine drinks to maximum 1-2 cups daily. More here Directorate of health nn Norway, nutrition,

Vegetarian and vegan food

A proper plant-based diet and a low intake of red meat and processed meat products can reduce the risk of cardiovascular disease, diabetes 2 obesity and cancer. A vegetarian diet does not contain meat or fish. Vegetarians who still include fish are often called pescetarians. Vegetarian diets usually contain dairy products and eggs. Vegan diets, on the other hand, only contain plate-based foods. Vegetarian and vegan diets are often rich in beneficial unsaturated fatty acids, but lack some nutrients. It is therefore important to have good guidance and follow-up by a doctor or other health personnel. Iron deficiency anemia is no more common than with other diets, but a lack of vitamin B12 and vitamin D should be ruled out. Iodine deficiency can occur, but cannot be measured in regular blood tests. Over time, many people will need supplements of vitamins and minerals (reference: Fadnes LT, 2022); (Norwegian Directorate of Health, 2022). In severe systemic rheumatic disease, it is important to avoid too low a body weight with loss of muscle mass and an increased incidence of osteoporosis / osteoporosis. Often, animal proteins that deviate from vegetarian and vegan diets or customized protein supplements will then be necessary.

Medication and diet

Drugs may affect nutrition (interactions). Examples are that cholesterol lowering tablets (statins), drugs for obesity (Xenical) and antacids such as Link and Novaluzid may cause low levels of fat-soluble vitamins (A, D, E and K vitamins). Diuretic medicine (such as Burinex, Esidrex, Centyl) also differentiates potassium and magnesium, which should be measured in blood samples and optionally supplemented. More about drug interactions here.

Religious and cultural considerations for diet

Link here (Norwegian Directorate of Health)

Diet, oral and dental health here (supervisor)

Diet for immunosuppressive drugs

By using methotrexate or Salazopyrin (sulfasalazine) folic acid absorption from the intestine is normally counteracted. Supplementation with folic acid tablets is therefore recommended. Vegetables and fruit naturally contain folic acid, but supplementary folic acid tablets (1 mg daily) are also recommended for methotrexate. Methotrexate and other anti-sickness drugs can cause nausea as a side effect. Small and frequent meals can help. Drink plenty of water and avoid a lot of fatty, spicy food and a lot of sugar. Combination of several immunosuppressive drugs (for example Prednisolone, Methotrexate, MabThera, Remicade/Remsima/Inflectra) increases the risk of infection. Users should therefore avoid foods that may contain bacteria. This can be raw meat, raw fish (sushi), raw eggs, unpasteurized cheese, milk or unwashed vegetables.

Vasculitis diseases and diet

It has not been shown that diet or dietary supplements influence the course of the vasculitis disease. However, rheumatic inflammation over time leads to an increased risk of atherosclerosis with increased risk of heart attack and stroke in the long run. This is shown for Takayasu arteritis og Wegeners granulomatosis / GPA. Preventive diet and lifestyle should be striven for. The food should include fresh fruit, vegetables, grains, lean meat products (chicken) and fish. Low blood values ​​of vitamins or high cholesterol values ​​should be corrected by diet, supplements and/or cholesterol-lowering drugs. Those who use prednisolone or other cortisone preparations are exposed to Osteoporosis and should use calcium and vitamin D supplements (Calcigran Forte chewable tablets or similar). Unfortunate lifestyle factors such as smoking and high alcohol consumption are unfavorable. Being overweight should be avoided by regular activity and a proper diet.

Atherosclerosis

Rheumatic inflammation at, among other things, arthritis (RA) contributes to an increased risk of Atherosclerosis (atherosclerosis) (reference: Dessein PH, 2015). During the course, a heart attack and stroke may occur. In arthritis, optimal drug treatment is important, but risk factors must also be reduced such as high cholesterol (via diet and medication), smoking, poorly regulated diabetes (diabetes) and obesity. High intake of polyunsaturated fatty acids via "Mediterranean diet" reduces the risk of atherosclerosis. Treatment with biological drugs probably has a beneficial effect on atherosclerosis in arthritis (reference: Provan SA, 2015).

More about general diet advice from the Norwegian Directorate of Health can be found here

Diet in the various rheumatic diseases is described during the diagnoses:

Literature on rheumatic diseases

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