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.
From evidence to recommendations
(Taken from NICE Clinical Guideline 79 - nice.org.uk/nicemedia/pdf/C...
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.
For more information about diet, please visit the NRAS website - nras.org.uk/about_rheumatoi....
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