On the 19th September Channel 4 aired the first episode in its second series of the Food Hospital, a show that tries to demonstrate how diet can have an effect on certain medical conditions. The programme featured Beth Murray, a young lady of 29 who had what appeared to be fairly severe rheumatoid arthritis. It is to be welcomed that Channel 4 are raising awareness of the fact that rheumatoid arthritis is not a disease of the elderly (a common misconception amongst the general public) and featured a young person with the disease.
NRAS is concerned however, that the programme left one with the impression that rheumatoid arthritis and inflammation can be controlled with diet alone and this is not the case. No mention was made by the presenter of recommendations in the evidence based NICE Clinical Guideline about early effective treatment with disease modifying anti-rheumatic drugs or the recommendations about diet detailed below.
The Guideline Development Group noted that many of the dietary interventions did seem to have benefit when taken with conventional therapies. However, no diet produced positive results for a broad diversity of outcome measures and there was insufficient evidence to support the recommendation of a single diet. There was no consistent evidence of benefit of any one particular diet.
Some of the diets might be unpopular with some patients, such as vegetarian diets, and some might be unpalatable with understandably poor compliance, such as elemental diets. It was felt that it would be helpful in a recommendation to give some direction to RA patients. There was discussion about the evidence to show that the principles of a Mediterranean diet might be beneficial in people with RA especially because of the impact of such a diet on cardiovascular risk factors. Because:
- People with RA are at even greater risk of cardiovascular disease than the rest of the population;
- Such a diet might be beneficial to the musculoskeletal symptoms of RA;
- This type of diet is more likely to be followed than some of the more unpalatable alternatives.
Recommendation
Inform people with RA who wish to experiment with their diet that there is no strong evidence that their arthritis will benefit. However, they could be encouraged to follow the principles of a Mediterranean diet (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on vegetable and plant oils).
It is important to note that some people do have food intolerances and when these have been identified to particular foods which are then subsequently removed from diet, they experience an improvement in their RA symptoms. However, this cannot be generalised across a whole RA population.
People with RA should eat a healthy diet but this should be part of a holistic approach to care which prioritises early appropriate drug treatment from a Consultant led multidisciplinary team and includes exercise, self management education and sign-posting to organisations such as NRAS who can provide tailored support.
Thank you for making these comments, as yet I have not seen the programme concerned, I recorded it, however I will watch it with a more open mind than I may have done considering the comments you have made on the subject.
Thanks for the advice, i too recorded it and look forward to seeing it.
I was heartened by your description of the patient in the programme and hope it goes a long way to inform people that RA can affect any age group. Thanks also for the links.
I really wish that programmers would include patient groups and leading charities in their preparation for documentaries, as I feel NRAS are more up to date and research based and would be able to give balanced advice to programmers. Axx
I agree with the comments above but having watched it with my husband and then read your blog - he observed that they did actually say to Beth that diet alone could not cure her arthritis - it is an incurable condition - but that they felt confident that through dietary changes her condition could be helped somewhat.
The emphasis was on weight loss too which does play a key role in relieving sufferers of all forms of arthritis (and most diseases) to an extent - especially those who cannot get much exercise because of the severity of their disease. I had not heard that weight and inflammatory markers are directly linked before though?
For me the most misleading aspect of this feature was the emphasis on the ESR as the main monitoring tool for disease activity - rather than actually enquiring about her RA symptoms. This was obviously just a programme maker's device and very simplistic. On the whole I still think that the programme did a great service by spotlighting RA despite these generalistic elements. Tilda
I've also taped the programme to watch later so thanks for the advice. Food has been about the only thing I've had control of during the past year. I've made radical changes to my diet and weight since diagnosis so this is of particular interest to me. Looking forward to watching what they have to say.
i watch the program and well yes they didnt point that out but for me it was the ra test whent from 28 to 18 somthing must be better if her inflamation came down surley thats some sort of marker is it not?
That Beth lost weight was good - less for her joints to deal with and may be this affected the inflammation - but as she was monitored over a period of 3 months the ESR could have gone down simply because it was being controlled more effectively by her medication.
As you will all have experienced, it is an incredibly erractic disease which makes it difficult to both treat and to seek out any foodstuffs that might be aggravating it. But I guess we all know we would be more healthy generally on a diet such as the Mediterranean one mentioned in Ailsa's blog.
So I suppose it's a question of fewer toxic treats. I'll just have a coffee, some chocolate and that prosecco tonight before I begin my new regime!
Seriously, I have been on a diet similar to the Mediterrean one for some time - just because it's what I prefer to eat - and it does seem to keep the weight off.
I found the program a little disappointing, I would have liked to have seen some more of how she coped with diet on a daily basis, examples of menu's and exactly how much better did she feel?
yes she lost weight and her crp was down, but I got the impression she was surprised at the drop in CRP, anyone else notice that?
I did notice she had a lovely pair of heels on when she came back though!! )
I wish I'd seen this article when it was written as I could have helped, being the subject. I don't think personally that food is a particularly big factor in my ESR decreasing back then, but the supplements definitely help. They made it look like I had a particularly rubbish diet before which wasn't correct, but I did the show to highlight that young people can be affected by RA. Having had it diagnosed since I was 14, I've always been treated like an adult. If that was now, I know things would be very different.
My daughter was diagnosed age 13 last year. She is on methotrexate and enbrel/etanercept. I’ve tried to encourage her to look at diet/supplements as she has low bone density. Can you share any recommendations ? Thanks
I have a lot of faith that your daughter will be fine, because the meds now compared to 20 years ago are fantastic! I'm now technically in remission - on methotrexate and tocilizumab but still need pain killers for damage previously done.
The main supplement they advised was a very high level fish oil - I take double cod liver oil. They also recommended spices like turmeric, and eating high levels of fish....but I don't like either. I also had low bone density but took calcium and vitamin D supplements - latest scan is great.
Hope that helps a little. I'm sure she'll be well looked after as they treat RA in teens much more seriously now.
Thank you, both. We do use a lot of turmeric in cooking but don’t eat much fish. I’ve had fish oil supplements in the cupboard for ages - might be time to get them out ! I’ll read your links later - thanks for your time in posting x
Very welcome, meboo. 😌🙏 If ever interested in understanding a bit more about Turmeric (+ Black Pepper), kindly consider: nutritionfacts.org/?fwp_sea...
Yes, if/ when you (& your daughter) have time, Katy’s experience might be of particular interest: m.youtube.com/watch?v=h2uVi...
Hi, the program was just replayed on tv, I missed it previously. Just wondering how your RA is these days snd if you stuck with the fishoil supplements and the added turmeric? Do you think these are still a goid plan? Hope you are doing well.
A great and sensible feature about something people do seem to think works whilst ignoring a placebo effect. I'm Celioc and believe that because this was found during the orginal RA investigations that cutting all bread etc did help me loose weight which in effect improved the RA. Because RA makes people at a higher risk of some other conditions its actully dangerous to believe in a diet cure becuase failure to monitor the condition happens unless perhaps some damage occurs.
Merely ‘thinking aloud’ 🤔💭 thoughts 🗣💬 tossed out to the universe 🌌 .
☺️ 🙏
Guessing in the 5 years since this was presented quite a few folks have emerged for whom dietary & lifestyle (d/l) changes have proven critical to their health improvement? 🤔 (And, of course, along with the guidance of their rheumatologist 👩⚕️👨⚕️ & judicious use of meds 💉 💊 .)
Perhaps, 5 years on, examination 🕵️♀️🔎 & reflection 🤔💭 might be re-visited towards those who have significantly improved via d/l paths? Maybe the question of how & why d/l works well for some might be an aspect worth exploring? After all, any means of improvement for any number of sufferers (few or many) may be well worth re-visiting? 🤔
Although there may never be a simple (simplistic) "one size fits all" 👕, there may be a more nuanced (complex) "one flexible size fits many" 🥋 ? 🤔
If d/l helps some of us (or many of us) improve our QoL (Quality of Life), maybe it’s worthwhile examining those processes more closely 🔎 ? Discussing those processes/ techniques? 🤔
After all, if some/ many are achieving results — 5 years down the line — isn’t that an indicator 🚨 🚩 that information, knowledge, experience is ‘evolving’ ♻️ ? Times are changing? Experience is changing? 🤔
Is new, realistic hope emerging as we see individuals walking about 🚶♀️ 🚶♂️ 🏃♀️ 🏃♂️ who have done well pursuing d/l? 🤔
Should d/l be revisited in the context/ experience of those individuals (in the 5 intervening years) who have had success with d/l? 🤔 And, individuals who have had concrete experience/ evidence — despite being considered merely "anecdotal" — yet ‘backed by’ (supported by) their rheumatological tests 💉 📈📉 / documented medical histories 📑 📊 📁 ? 🤔
Perhaps considered merely "anecdotal" experience in a larger medical 👨⚕️/ scientific 👩🔬 context requiring rigorous ‘proof, proof, proof’ 👩⚖️. Yet, for those individuals for whom QoL has significantly improved via d/l, their improved life is all the proof they need? 🤔 (For those individuals, their serious d/l proved worthwhile? 🤔 )
Those individuals serve as ‘living examples’ of what d/l can do for some (many?) of us? 🤔
Maybe for individuals interested in seriously pursuing such d/l avenues more in-depth — careful, thoughtful examination could be re-visited, re-explored? 🤔
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