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Fasting and vegetarian diet in rheumatoid arthritis

 

Clinical bottom line

Few trials likely to be bias free (randomised, blind), and valid (longer duration) exist. The results are mixed, but a cautious interpretation may be that there is no evidence of lack of effect, while what evidence we have suggests some benefit.


Clinical observation has been that diet may improve the symptoms of rheumatoid arthritis. The biology underlying any dietary influences is not exact. Some food additives are taken by patients with RA. It has also become traditional in some centres for patients to fast, followed by a vegan or vegetarian diet with add-back of foods not associated with symptom worsening. This may be accompanied by holistic approaches involving physiotherapy, exercise, and psychotherapy. A systematic review has examined the evidence-base for fasting and vegetarian diet.

Reference

H Müller et al. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 2001 30: 1-10.

Review

Only MEDLINE was searched (up to 1997), and reference lists checked. Criteria for inclusion were trials with follow-up information for at least three months, and full journal publication.

Results

The review detected 31 reports. Only one was randomised. A further randomised report with just under three months duration was also included. The other reports were observational studies, or controlled studies. Most were very small, with few having more than 30 patients in total, or 30 patients per group. The main findings in each study are reported, including clinical and biochemical or immunological findings.

Pooling of clinical finding data was done for two randomised and two non-randomised studies separately and together, showing an overall effect size of about 0.8. This is quite a large effect.

Comment

No-one would want any approach to treatment not to work in a difficult and protracted disease like rheumatoid arthritis. This review does a good job in drawing the published work together, and commenting on it sensibly, so we can see the whole picture. That picture may not be pretty, but has a few good points. There is preliminary evidence (no more than that) that fasting and a vegetarian diet may improve biochemistry and symptoms.

This is definitely the first step to saying that more and better research is needed.