Diet by rheumatic diseases 4.52/5 (50)

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Symptoms of Systemic connective tissue diseases:, Vasculitis diseases and other rheumatic diseases can be affected by diet and nutrition. The magazines, newspapers, internet and books also discuss whether the diseases and prognosis are improved through adapted diet and food, diet and lifestyle and often come 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 professional advice based on either good scientific work or advice from medical specialists in the field.

Cholesterol and saturated fat

Rheumatic diseases such as arthritis (rheumatoid arthritis), Systemic lupus (SLE) og Takayasu arteritis unfortunately has an increased incidence of atherosclerosis (atherosclerosis) over time. Apart from good treatment of the disease, proper diet is important in order to reduce damage.

  • Cholesterol level (especially LDL-cholesterol / lipoprotein) in the blood is an independent risk factor for atherosclerosis
  • High LDL cholesterol is caused by
  • Reduction of high cholesterol is done by
    • Changed diet
    • Drugs that either reduce the production of cholesterol in the liver (different types of statins) or reduce the uptake from the intestine (Ezetrol)
  • Diet that reduces cholesterol (Reference Food and Health)
    • Oats, barley and whole grains like brown rice, coarse bread, etc.
    • Nuts and kernels like walnuts, almonds, flax seeds, pumpkin seeds
    • Rape seed oil, olive oil and other plant oils
    • Vegetables, especially cabbage, and root vegetables
    • Pulses like beans, peas, chickpeas and lenses
    • Fatty fish such as mackerel, herring and ecological salmon
    • Supplements of marine fatty acids such as tran or algae oils
    • Avokado
    • Soya products (not soya oil)
    • Margarines added plant esterols from «Vita Hjertegod»

Fasting and strict vegetarian food

Research on healthy subjects suggests that fasting has an effect on the immune system so that inflammatory substances and cells (IL-2, IL-4, CD4 + lymphocytes) are favorably affected. Studies with patients show that fasting over 7-10 days improves both symptoms and rheumatic inflammation in Rheumatoid arthritis (RA) which have many common features with systemic connective tissue diseases and vasculitis (reference: Shield strain L, 1979). However, this effect disappears as soon as regular meals are reintroduced. Experiments with patients who fast and then adopt a strict vegetarian diet have shown that some people receive less active disease over a long period of time, but very few actually manage to stick to such a strict diet. For many people with rheumatic disease, regular intake of nutritious diets is important (see below), which is not compatible with fasting. Thus, fasting is not generally recommended for severe rheumatic disease, including systemic connective tissue diseases and vasculitis diseases.


Some foods are reported almost immediately to cause unpleasant effects on the rheumatic disease. More than one in three patients with rheumatic diseases believe the symptoms increase with the intake of special nutrients. It seems to be the same between the individual diagnoses. Such effect is not explained by the influence of the immune system. The foods are more likely to contain substances that either act directly on the inflammation or release free 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) which may be beneficial when they are part of the diet. In case of methotrexate treatment and nausea as a side effect, coffee may relieve discomfort (reference: Malaviya AN, 2017). Some believe unusually large amounts of coffee are needed to achieve effect. In the said study, the dose of caffeine was moderate. 1-1,4 teaspoons of freeze-dried instant coffee were given in the morning and at noon methotrexate day and a corresponding dose the next morning (30-45mg caffeine in each dose).

Coffee can theoretically 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). It is possible that the ratio between a low content of saturated fatty acids and a lot of polyunsaturated fat is favorable, but this remains to be shown in practice.


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, it has become increasingly clear 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 foods, and that the distribution of the various intestinal bacteria may be important for the development of rheumatic disease.


Foods are added to consistency agents (emulsifiers, thickeners and stabilizers) to preserve consistency. Animal studies suggest that certain additives affect the bacterial composition of the gut (Microbiota, please see above) and may contribute to intestinal inflammation and obesity. Whether this also applies to humans remains to be seen. Carboxymethyl cellulose (E466) and mono- and diglycerides of fatty acids (E471) can cause inflammation of the stomach, and polysorbate (E433) can cause obesity in animal experiments. Not all additives are believed to be unfavorable. Lecithin (E322) may be beneficial for the gut (reference: Zinöcker MK, 2019)

Antioxidants and vitamins

So-called "free oxygen radicals" can damage the body via the immune system. Antioxidants such as Vitamins A, E, C, zinc and selenium can in theory reduce free oxygen radicals. However, people with rheumatic diseases sometimes have low levels of antioxidants (measured in research studies). The cause does not appear to be low intake, but it is likely that the antioxidants are consumed in the inflammatory process. It may therefore seem logical to increase your intake through dietary supplements (for example multivitamins and mineral supplements), as is often advertised. However, studies have not shown a clear link between dietary supplements and lower disease activity, on the contrary. In fact, it has been discussed 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). Antioxidants ingested via foods such as fruit, fruit juice, potatoes, berries and vegetables (kale tops) are believed to be healthy and possibly beneficial to disease development. Leek, blueberry, cricket, cranberries, 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.


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).


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 here (in Danish)

Osteoporosis (Low bone density)

In case of chronic rheumatic inflammation such as connective tissue disease (SLE, Sjögren's syndrome, Systemic sclerosis, Myositis, MCTD), Vasculitis (Giant cell arteritis (Temporal arteritis), Takayasu, Wegener / GPA 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. Measurement of osteoporosis is done via "bone density" or "bone mass measurement" and is easy and do at x-ray institutions or hospital polyclinics. To counteract the development of osteoporosis one should consume abundant calcium via dairy products or 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 , which must be terminate at least three months in advance of pregnancy. Those who have used Folic acid as a supplement to methotrexate or Salazopyrin before scheduled pregnancy, should continue with the same Folic acid dose during pregnancy. Measurements of vitamin and iron status should be done by physician. If there are any signs of deficiencies, then add 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

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 (in Danish).

Religious and cultural considerations for diet

Link here (Norwegian Directorate of Health)

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

Diet, oral and dental health here (supervisor)


Some use antipyretic drug treatment with methotrexate or salazopyrin (sulfasalazine) which counteracts normal folic acid uptake from the intestine. Supplements with folic acid tablets are therefore recommended. Vegetables and fruits contain natural folic acid.

Combination of several immunosuppressive drugs (such as Prednisolone, Methotrexate, MabThera, Remicade / Remsima / Inflectra) increases the risk of infection. Avoid foods that may contain bacteria. This can be raw meat, raw fish (sushi), raw eggs, non-pasteurized cheese, milk or unwashed vegetables.

Vasculitis diseases and diet

It is not shown that diet or supplements affect the course of the disease. However, rheumatic inflammation over time causes increased risk atherosclerosis with increased risk of heart attack and stroke in the long run. This is shown for Takayasu arteritis og Wegeners granulomatosis / GPA. Preventative diet and lifestyle should be sought. The food should include fresh fruits, vegetables, grain, lean meat products (chicken) and fish. Low blood levels of vitamins or high cholesterol levels should be corrected by dietary 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). Unfortunate lifestyle factors such as smoking and high alcohol consumption are unfavorable. Overweight should be avoided by regular activity and proper diet.

Disease modifying treatment with methotrexate reduces folic acid uptake which should be supplemented in the form of folic acid 1mg / day tablets. In addition, vegetables and fruits contain natural folic acid. Methotrexate and other disease-reducing drugs can cause nausea as a side effect. Small and frequent meals can help. Drink a lot and avoid a lot of greasy, spicy food and lots of sugar.


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).

Risk of infection

Combination of several immunosuppressive drugs (such as Prednisolone, Methotrexate, MabThera, Remicade / Remsima / Inflectra) increases the risk of infection. Avoid foods that may contain bacteria. This can be raw meat, raw fish (sushi), raw eggs, non-pasteurized cheese, milk or unwashed vegetables.

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