Autoimmune diseases — Dr. Ewa Dąbrowska’s fruit-and-vegetable diet instead of medication?

Aim of the study: Various nutritional therapies have been proposed in rheumatoid arthritis, particularly diets rich in ω-3 fatty acids, which may lead to eicosanoid reduction. Our aim was to investigate the effect of potentially anti-inflammatory diets (Mediterranean, vegetarian, vegan, ketogenic) on pain.

Results: We used mean differences or standardized mean differences and the inverse variance method of pooling using a random-effects model. The search retrieved 564 unique publications, of which we included 12 in the systematic review and 7 in the meta-analysis. All studies had a high risk of bias and the evidence was very low. The main conclusion is that anti-inflammatory diets resulted in significantly lower pain than ordinary diets (-9.22 mm; 95% CI -14.15 to -4.29; p = 0.0002; 7 RCTs, 326 participants).

Aim of the study: To determine the effect of a multidisciplinary lifestyle program in patients with RA with low-moderate disease activity.

Results: Of the 83 people randomized, 77 completed the study. Participants were 92% female with mean (s.d.) age of 55 (12) years, BMI of 26 (4) kg/m2 and mean DAS28 of 3.8 (0.7). After 16 weeks the PFJ group had a mean 0.9-point greater improvement of DAS28 vs the control group (95% CI 0.4, 1.3; P < 0.0001). The PFJ intervention led to greater decreases in body weight (difference -3.9 kg), fat mass (-2.8 kg), waist circumference (-3 cm), HbA1c (-1.3 mmol/mol) and low-density lipoprotein (-0.32 mmol/l), whereas patient-reported outcome measures, blood pressure, glucose and other lipids did not change. The 16-week PFJ multidisciplinary lifestyle program substantially decreased disease activity and improved metabolic status in people with RA with low-moderate disease activity.

Aim of the study: Rheumatoid arthritis (RA) is an autoimmune disease that leads to chronic inflammation and joint damage. Various plant-based diets are thought to have effects on RA symptoms and disease activity. Relevant literature on the effect of different types of plant-based diets on RA was reviewed.

Results: Most of the studies suggested the Mediterranean diet may positively affect the severity of RA. However, the included studies show heterogeneity. Therefore, more randomized controlled studies are needed in this area to increase understanding of the effect of diet on RA and facilitate the implementation of strategies to prevent RA.

Aim of the study: The Mediterranean diet (MedD) exerts anti-inflammatory and anti-oxidant effects that are beneficial in autoimmune thyroid diseases (ATD). Recently, a gluten-free diet (GFD) has been proposed for non-celiac patients with Hashimoto's thyroiditis (HT), but its usefulness is under debate. The present pilot study evaluates the effects of these two dietary regimes, with a focus on redox homeostasis, in HT.

Results: In the MedD group, significantly lower values of AGEs and higher values of GPX, TRX and TEAA with anti-oxidant action were detected (p < 0.05) at 12 weeks compared to baseline, and compared to the GFD and FD groups, in which the oxidative stress parameters did not change significantly (p > 0.05). No significant differences in serum levels of TSH, FT4, Ab-Tg, Ab-TPO compared to baseline were found in any group. This pilot study confirms the protective effect of the MedD against oxidative stress, while a GFD does not significantly influence markers of oxidative stress and/or thyroid autoimmunity/function parameters.

Aim of the study: Autoimmune diseases (ADs) are chronic inflammatory disorders with increasing global prevalence and substantial health and economic burden. The Mediterranean diet (MD), known for its anti-inflammatory and immunomodulatory properties, may offer complementary benefits in the management of these conditions.

Results: Fifteen studies (5 randomized controlled trials, 6 cross-sectional, 3 pre-post trials, and 1 cohort) involving patients with rheumatoid arthritis, Crohn's disease, ulcerative rectocolitis, multiple sclerosis, and celiac disease were included. Higher MD adherence was associated with improved quality of life in patients with multiple sclerosis and celiac disease (moderate certainty), and to a lesser extent in rheumatoid arthritis (low certainty). Reductions in C-reactive protein were observed in some studies, but findings were inconsistent and of low certainty. One cohort study reported reduced mortality in patients with Crohn's disease and inflammatory bowel disease. Limited evidence suggested favorable effects on gut microbiota and body composition. Adherence to the MD may provide benefits in quality of life and inflammation-related outcomes among patients with ADs. However, the overall certainty of evidence remains limited.

Aim of the study: Although the Mediterranean diet (MD) has beneficial effects on heart health, cognitive function, cancer, and other chronic diseases, little is known about its effect on rheumatoid arthritis (RA). This study aimed to examine the association between adherence to MD and the risk of developing rheumatoid arthritis RA.

Results: During a median follow-up of 9.42 years, 773 participants developed RA. Compared with the bottom quartile of the MEDI-LITE score, the risk of RA was lower in the highest quartile (adjusted hazard ratio (HR) = 0.713, 95% CI = 0.580 to 0.876). Six studies were included in the meta-analysis. The pooled odds ratio (OR) for the highest versus lowest adherence to MD and the risk of RA was 0.838 (95% CI = 0.758 to 0.926). Higher adherence to MD was associated with a lower risk of RA. Our finding provides updated evidence on the importance of diet in RA development and novel directions for RA prevention.