Mediterranean diet intervention in rheumatoid arthritis
- Department of Immunology and Transfusion Medicine, Ullevaal University Hospital, Oslo, Norway
- Correspondence to:
Dr J Kjeldsen-Kragh, Department of Immunology and Transfusion Medicine, Ullevaal University Hospital, Kirkeveien 166, N-0407 Oslo, Norway;
jens.kjeldsen-kragh{at}ioks.uio.no
Is the controlled clinical trial the only tool for testing the efficacy of dietary treatment?
The belief that diet may influence the severity of rheumatoid arthritis (RA) is part of the folklore of the disease, and dietary treatment has been one of many unconventional remedies that have been widely used at health farms in northern Europe. Over the years, several stories about arthritic patients who improved dramatically after changing diet have appeared, not only in the lay press but also in scientific journals. Although the possible benefits of specific diets for patients with RA have been tested in a number of trials, many of the studies that showed positive results of dietary treatment have not been published as full papers in peer reviewed journals, probably because these studies lacked controls or were poorly designed and/or inadequately described.
A scientific investigation of the efficacy of dietary treatment of RA was pioneered by Swedish doctors. More than two decades ago Sköldstam et al conducted the first controlled randomised trial, in which they tested the effect of fasting and lactovegetarian diet in patients with RA.1 They reported that fasting resulted in a striking reduction in disease activity but, unfortunately, the patients deteriorated again when they started eating. Since then only a few randomised controlled trials on dietary treatment of patients with RA have been carried out.2–8 These trials are not directly comparable because of differences in the diets, and accordingly the results varied from no effect2 to good clinical response to the experimental diet.4
WHY DOES DIET HELP SOME PATIENTS WITH RA?
There has been much speculation about why some patients with RA improve by changing diet. Allergy or other adverse antibody mediated reactions towards certain foods have been suggested,3,9–13 but seem to have a role in only a few patients with RA. …
