Diet and food selection
Does diet have a role in the etiology of rheumatoid arthritis?
Although dietary factors have been extensively studied in many chronic diseases,
the role of diet in the epidemiology of rheumatoid arthritis (RA) has received
little attention. Fish oil supplementation has consistently been shown to have a
beneficial effect on the symptoms of established RA. There is evidence that RA
is less severe in the southern Mediterranean countries, such as Italy and
Greece, where oil-rich fish, fruit, vegetables and olive oil are consumed in
greater amounts than in many other countries. Lower intakes of fruit and vegetables and dietary vitamin C are associated
with an increased risk of developing inflammatory polyarthritis. These findings provide further evidence for a role of
diet in the development of inflammatory arthritis.
Proceedings Nutr Soc. 2004 Feb.
Supplements that may be useful in autoimmune conditions
Research in this area has just started and my goal is to update you with
information on dietary supplements that could be helpful in reducing the
severity of an autoimmune disease. Please keep in
mind that we know very little at this point and you should consult with your
doctor before making any changes in your treatment plans.
Vitamin D
Most people think of vitamin
D in terms of bone strength. Vitamin D inhibits proinflammatory processes by suppressing the
enhanced activity of immune cells that take part in the autoimmune reaction.
Supplementation may be therapeutically beneficial particularly for
Th1 mediated autoimmune disorders. Some reports imply that vitamin D may even be
helpful in multiple sclerosis and diabetes type 1.
Omega-3 fatty acids
Fish oils, or eating a diet that includes fish at least
three times a week, may reduce symptoms. Another option is fish eggs, also called
roe. Fish oils have anti-inflammatory fatty acids called EPA and DHA that could
reduce the inflammation response.
Effects of eicosapentaenoic acid supplementation on
immunoglobulin A nephropathy.
Eicosapentaenoic acid (EPA), which is purified from fish oil, attenuates
inflammatory responses by decreasing eicosanoid and cytokine production. EPA
reportedly improves renal survival in patients with immunoglobulin (Ig)A
nephropathy. Ther Apher Dial. 2010. Yoko Clinic,
Kitakyushu, Fukuoka, Japan.
Effects of dietary omega3 and omega6 lipids and vitamin E on
proliferative response, lymphoid cell subsets, production of cytokines by spleen
cells, and splenic protein levels for cytokines and oncogenes in MRL/MpJ-lpr/lpr
mice.
Omega3 Fatty acid rich fish oil (FO) and vitamin E may delay the progress of
certain autoimmune diseases. The observations from this study
suggest that both FO and vitamin E modulate the levels of specific cytokines,
decrease the levels of proinflammatory cytokines, inflammatory lipid mediators,
and c-myc, and increase TGF-beta1 levels in spleens of MRL/lpr mice and thus may
delay the progress of autoimmune diseases. J Nutr Biochem. 1999.
Green tea and EGCG
Green tea protects rats against autoimmune arthritis by modulating
disease-related immune events.
Green tea, a product of the dried leaves of Camellia sinensis, is the most
widely consumed beverage in the world. The polyphenolic compounds from green tea
possess antiinflammatory properties. We investigated whether green tea extract
can afford protection against autoimmune arthritis and also examined the
immunological basis of this effect using the rat adjuvant arthritis (model of
human rheumatoid arthritis. Green tea induced changes in arthritis-related
immune responses. We suggest further systematic exploration of dietary
supplementation with green tea extract as an adjunct nutritional strategy for
the management of rheumatoid arthritis.
J Nutr. 2008 Nov; Department of Microbiology and Immunology, University of
Maryland School of Medicine, Baltimore, MD 21201, USA.
Flavonoids
The flavones luteolin and apigenin inhibit in vitro antigen-specific
proliferation and interferon-gamma production by murine and human autoimmune T
cells.
Plant-derived flavonoids are inhibitors of various intracellular processes,
notably phosphorylation pathways, and potential inhibitors of cellular
autoimmunity. In this study, the inhibiting effects of various flavonoids on
antigen-specific proliferation and interferon-gamma (IFN-gamma) production by
human and murine autoreactive T cells were evaluated in vitro. T-cell responses
were evaluated for the human autoantigen alpha B-crystallin, a candidate
autoantigen in multiple sclerosis, and for the murine encephalitogen proteolipid
protein peptide PLP (139-151). The flavones
apigenin and
luteolin were found to be
strong inhibitors of both murine and human T-cell responses while fisitin,
quercetin, morin and hesperitin, members of the subclasses of flavonoles and
flavanones, were ineffective. Antigen-specific IFN-gamma production was reduced
more effectively by flavones than T-cell proliferation, suggesting that the
intracellular pathway for IFN-gamma production in T cells is particularly
sensitive to flavone inhibition. These results indicate that flavones but not
flavanoles or flavanones are effective inhibitors of the potentially pathogenic
function of autoreactive T cells. The effects of flavones were the same for
human and murine autoreactive T cells, stressing the usefulness of animal models
of autoimmunity for further studies on the effects of flavonones on autoimmune
diseases. Biochem Pharmacol. 2004 August.
Quercetin ameliorates experimental autoimmune myocarditis
in rats.
Experimental autoimmune myocarditis (EAM) in rats is an animal model of human
giant cell myocarditis and post-myocarditis dilated cardiomyopathy. The
pathogenesis of EAM has not been elucidated, but there is accumulating evidence
that cytokines secreted from monocytes/macrophages and T cells play a crucial
role in the induction and progression of disease. Flavonoids are a large group
of polyphenolic compounds abundantly present in the human diet, which scavenge
oxygen radicals and have anti-inflammatory activities. The present study
suggests that quercetin
ameliorates EAM, at least in part, by interfering production of proinflammatory
(TNF-α and IL-17) and/or anti-inflammatory (IL-10) cytokines. J Pharm Pharm
Sci. 2010. Department of Microbiology and Immunology, Faculty of Pharmacy, Vojvode Stepe Belgrade, Serbia.
Rose hip herbal remedy in patients with
rheumatoid arthritis - a randomised controlled trial.
In a double-blind placebo-controlled trial, patients with rheumatoid arthritis
(RA) according to ARA/ACR criteria were randomised to treatment with capsulated
rose-hip powder 5g daily or matching placebo for 6 months. The results indicate
that patients with RA may benefit from additional treatment with rose hip
powder. Phytomedicine. 2010 Feb;17(2):87-93. Epub 2009. Institute for Social Medicine, Epidemiology and Health Economics,
Charité University Medical Centre, Berlin, Germany.
Andrographis
Efficacy of an
Andrographis paniculata composition for the relief of rheumatoid arthritis
symptoms: a prospective randomized placebo-controlled trial.Clin Andrographis
paniculata possesses anti-inflammatory effects, attributed to the main
constituent andrographolide proposed as alternative in the treatment of
autoimmune disease. Rheumatol. 2009 Aug9 .Burgos RA, Hancke JL, Bertoglio JC,
Aguirre V, Arriagada S, Calvo M, Cáceres DD.Institute of Pharmacology and
Morphophysiology, Universidad Austral de Chile, P.O. Box 567, Valdivia, Chile.
Alpha-lipoic acid is effective in
prevention and treatment of experimental autoimmune encephalomyelitis.
Alpha-lipoic acid (alpha-LA) is a neuroprotective metabolic antioxidant that has
been shown to cross the blood brain barrier. We tested whether alpha-LA is
capable to prevent MOG35-55-induced experimental autoimmune encephalomyelitis (EAE),
an established model of multiple sclerosis (MS). Daily oral administration of
alpha-LA, starting at the time of immunization, significantly prevented EAE
progression as compared to control mice. This was associated with a reduction of
CNS infiltrating T cells and macrophages as well as decreased demyelination. We
then tested alpha-LA in a therapeutic protocol aimed at suppressing EAE after
its onset. Intraperitoneal, but not oral, administration of alpha-LA
significantly prevented disease progression when compared to vehicle-treated
controls. Our data indicate that alpha-LA can effectively interfere with the
autoimmune reaction associated with EAE through mechanisms other than its
antioxidant activity and supports further studies on the use of alpha-LA as a
potential therapy for MS. J Neuroimmunol. 2004 March.
What are some types
of autoimmune disease?
There are several recognized conditions that are considered
autoimmune disease. Here they are in alphabetical order:
Alopecia Areata
leads to hair loss
Autoimmune encephalomyelitis -
alpha lipoic acid may
be helpful, see study below.
Autoimmune hemolytic anemia (AIHA) and immune mediated hemolytic anemia (IMHA).
Autoimmune hepatitis is a condition in which the body’s
immune system attacks liver cells. This immune response causes inflammation of
the liver. A genetic factor may make some people more susceptible to autoimmune
diseases. About 70 percent of those with autoimmune hepatitis are female.
I was on line searching and your name came up I loved your articles and I would
like to ask your opinion. My wife was diagnosed with autoimmune hepatitis a few
years ago and now her liver enzymes elevated again. Do you have any
recommendation as far as her diet? Anything that you recommend as far as herbal
medication.
I have not studied the natural, herbal or dietary treatment
of this condition.
Autoimmune myositis is usually divided between polymyositis and masticatory
muscle myositis.
Would natural products benefit someone with
the condition of polymyositis? My daughter is in her late 30's, and was
diagnosed less than two years ago. She has tried prednisone, methotrexate, IVIG
(couldn't tolerate), cellcept, Immune Matrix products and testing, chinese
medical remedies, and at almost six feet tall, she is losing muscle mass and
weight. She is down to less than 118 pounds, and is so debilitated she cannot
work any longer. She is off of gluten, dairy and eats mostly organic and raw
foods. She suffered with asthma and lichen planus as a child, and had mono as a
teenager. Her Polymyositis started as Dermatomyositis, two months after she
married. Any links, tips, resources, or potential remedies you might suggest
would be greatly appreciated.
Oral creatine supplements combined with home exercises improve
functional performance without significant adverse effects in patients with
polymyositis or dermatomyositis. They appear safe, effective, and inexpensive.
Arthritis Rheum. 2007 May 15. Creatine supplements in patients with idiopathic
inflammatory myopathies who are clinically weak after conventional pharmacologic
treatment: Six-month, double-blind, randomized, placebo-controlled trial.
Dermatomyositis is an uncommon disease marked by muscle weakness and a distinctive skin rash.
Diabetes type I
Among children who are genetically predisposed to
develop type 1 diabetes, dietary consumption of omega-3 fatty acids
appears to reduce the risk of becoming diabetic. Type 1 diabetes has a
strong hereditary component, and it occurs when the immune system
mistakenly attacks the islet cells in the pancreas that produce insulin.
This islet "autoimmunity" is decreased by high dietary levels of omega-3's
in children with a family history of type 1 diabetes or who have a genetic
pattern linked to the condition.
Hashimoto's thyroiditis - Autoimmune thyroiditis (hypothyroidism) - Autoimmune
thyroid disease
I have found your site to be an extremely helpful reference for
the most current studies on supplements. Thank you. I have an unusual
autoimmune disorder (Hashimoto’s Encephalopathy) which I have helped to
stabilize great deal through use of supplements and diets (under the
supervision of a M.D. Naturopath). Although this is prescription
medication not a supplement, I’m wondering about what data you may have
collected on low dose naltrexone. There seems to be a lot of anecdotal
information about its beneficial impact on a broad range of autoimmune
disorders.
I have not studied this medication well enough.
Hypoadrenocorticism (Addison’s disease)
Immune-mediated thrombocytopenia (ITP)
Inflammatory Bowel Disease (IBD)
Myasthenia Gravis --The
muscle building supplement
creatine may help increase muscle strength.
Optic Neuritis is an inflammation of the optic nerve. The condition
usually develops from an autoimmune disorder. Major symptoms are sudden loss of
vision (partial or complete), or sudden blurred or "foggy" vision, and pain on
movement of the affected eye. In most cases, visual functions return to near
normal within eight to ten weeks, but they may also advance to a complete and
permanent state of visual loss. Up to 50% of patients with MS will develop an
episode of optic neuritis, and 20-30% of the time optic neuritis is the
presenting sign of MS. There is a higher incidence of optic neuritis during the
spring months. Balashov KE, Pal G, Rosenberg ML. Optic neuritis incidence is
increased in spring months in patients with asymptomatic demyelinating lesions.
Multiple Sclerosis. Feb2010;16(2):252-4.
Comments: Is it because of low vitamin D levels having gone
through winter and decreased sun exposure?
Pemphigus
Primary biliary cirrhosis information
Relapsing polychondritis is an inflammatory and destructive disorder
involving primarily cartilage of the ear and nose but also potentially affecting
the eyes, the trachea, bronchi tree, heart valves, kidneys, joints, skin, and
blood vessels. Diagnosis is by a combination of clinical, laboratory, imaging,
and sometimes biopsy findings. Medical treatment usually involves prednisone and
drugs that suppress the immune system.
SLE, systemic lupus erythematosus
information and natural ways to treat it.
Rheumatoid
arthritis is an autoimmune disease in which joints,
usually including those of the hands and feet, are symmetrically inflamed, resulting in
swelling, pain, and often the eventual destruction of the joint's interior.
Rheumatoid arthritis is the most common inflammatory joint disease and
a major cause of disability, morbidity, and mortality. It occurs
worldwide, affecting approximately one per cent of adults. Rheumatoid
arthritis may be accompanied by fatigue, weight loss, anxiety, and
depression. some natural options are worth a try. Smoking cigarettes can
worsen the symptoms of rheumatoid arthritis.
The risk of
lymphoma is higher
in people with inflammatory polyarthritis relative to that seen in the
general population. Inflammatory polyarthritis is a form of rheumatoid
arthritis involving two or more joints. The incidence is higher in
patients with rheumatoid arthritis and those who take disease modifying
anti-rheumatic drugs. The highest risk is seen in patients treated with
methotrexate.
Scleroderma is an autoimmune skin condition
Sjogren's syndrome is an autoimmune disease
Autoimmune disease symptom
These vary widely depending on the
disease as well as from patient to patient. It is difficult to say that
any particular set of symptoms is indicative of an autoimmune condition.
Inflammation is a common autoimmune disease symptom. Dizziness, fatigue,
malaise and a low-grade fever are among autoimmune disease symptoms
associated with collagen vascular–type of autoimmune diseases. The
symptoms mentioned earlier can be caused by a variety of other medical
conditions unrelated to autoimmunity.
People with immune-related disorders such as rheumatoid arthritis
and lupus may be at increased risk for developing potentially deadly
blood clots during hospital stays.
TNF blocker prescription drugs
TNF blocker prescription drugs to treat rheumatoid arthritis, Crohn's
disease and other conditions may cause serious and deadly fungal
infections. The so-called TNF blocker medications include Johnson &
Johnson's Remicade, Abbott Laboratories Inc's Humira, UCB's Cimzia, and
Amgen Inc and Wyeth's Enbrel. Humira, Cimzia, Enbrel and Remicade work by
suppressing the immune system. This can expose some patients to serious,
even fatal, fungal infections.
In August 2009 FDA added stronger warnings to a group of best-selling drugs used to treat arthritis and other inflammatory diseases, proposing they can increase the risk of cancer in children and adolescents. Food and Drug Administration scientists believe the medications increase the risk of cancer after they are used beyond 2 or 3 years. The federal agency reviewed several dozen reports of cancer in children taking the medications, some of which were fatal. Half of the cases were lymphomas. These pills are known as tumor necrosis factor blockers and work by neutralizing a protein that, when overproduced, causes inflammation and damage to bones, cartilage and other tissue. The meds are prescribed to children with rheumatoid arthritis, inflammatory bowel disorder and Crohn's disease. The FDA will bolster the "black box" warning on the five drugs sold in the U.S., including Abbott Laboratories' Humira, Johnson & Johnson's Remicade and Simponi, and Enbrel which is co-marketed by Amgen Inc. and Wyeth. Enbrel was the biggest moneymaker of the group. The action also affects Belgian drugmaker UCB's Cimizia, which launched in May 2009.
Caution
Activation of autoimmunity following use of immunostimulatory herbal
supplements.
Arch Dermatol. 2004.
Section of Dermatology, University of Chicago, IL, USA.
Evidence for the scientific basis of purported therapeutic
effects and adverse effects of herbal supplements continues to grow. Many
herbal supplements are touted for their immunostimulatory properties, and
both in vitro and in vivo experiments have supported this claim. Although
this explains their beneficial effects in preventing or curtailing
disease, to our knowledge, no immunostimulatory herbal supplements have
been reported to exacerbate disorders of immune system overactivity.
We describe 3 patients whose autoimmune disease onset and/or
flares correlated with ingestion of herbal supplements with proven immunostimulatory effects. Echinacea and the
alga Spirulina platensis are implicated in 2
patients' flares of pemphigus vulgaris, and a supplement containing the
algae Spirulina platensis and Aphanizomenon flos-aquae was ingested by a
third patient days before both onset and a severe flare of dermatomyositis.
The third patient showed heterozygosity for a tumor necrosis factor alpha
(TNF-alpha) promoter polymorphism, leading to increased production
of TNF-alpha, which may have predisposed her to developing dermatomyositis.
Immunostimulatory herbal supplements may exacerbate
preexisting autoimmune disease or precipitate autoimmune disease in
persons genetically predisposed to such disorders. Increased production of
TNF-alpha may play a role, although more research is needed to clarify the
mechanisms of such phenomena.
Autoimmune natural treatment questions
Q. I am also a physician in practice residing in Connecticut who is grateful to
you for all your insight and contribution to the field of Complementary /
Alternative Medicine. I have read some of your writings on hormonal therapy and
autoimmmune disease and i find them very informative and interesting. I also
routinely use supplements in my practice and take pride in practicing
Integrative medicine which i hope one day will be ubiquitous. My question to you
relates to what you consider are adequate hormone holidays for patients with
autoimmune disease who are placed initially on Pregnenolone 25mg and DHEA 25mg
or higher. In practice I may start with higher doses initially and then taper
down to maintenance dosing of about 5 mg depending on response for the long
term. Also on a more personal note i have family members who would like to see a
physician experienced in the these areas of hormonal therapy ( As family members
i would rather they see someone other than myself) within the greater New York
area is there someone here you recommend. I don't have to tell you that it is
hard to find physicians knowledgeable in this area. Dr. Sahelian once again
thank you. I respect you as a mentor and look forward to your thoughts on these
questions.
A. I truly appreciate the positive feedback and hope
you continue helping your patients heal. It is very difficult to know which
patients will respond to hormonal therapy. I personally prefer the cautious
approach and would not use a dosage greater than 10 mg. I have seen too many
people with serious side effects on high doses, including cardiac rhythm
disturbances. You may be fine treating quite a large number of people with
higher dosages with no apparent side effects, but eventually you will come
across a patient who will have a serious untoward response. I prefer trying less
risky options first, such as diet with high amount of fish and lower amounts of
omega 6 oils, fish oil supplements, flavonoids, and perhaps certain herbs.
Hormones are a last resort. And even if DHEA and pregnenolone work initially,
continuing their use is not practical due to eventual side effects. There's
still much we need to learn about the use of nutrients and herbs for autoimmune
conditions and hopefully more info will be published in the future regarding the
natural approach to these conditions.
Q. Is it okay to take
saw palmetto or
lipoic acid for someone
with an autoimmune condition?
A. It's really difficult to predict how herbs and
supplements interact with an autoimmune condition or the medicines a person is
taking to treat the autoimmune condition. I would suspect small amounts would be
fine, but I can't be sure.
Q. I have found your site through researching my illness.
I have autoimmune urticaria and rheumatoid arthritis. After struggling for 8
years with harsh steroids and immune suppressants i think i finally found a
decent treatment. I have begun taking superoxide dismutase and cordyceps. I have
followed the bottles directions for dosage. I have seen a dramatic improvement
with both of my conditions. However I still am getting symptoms. I would like to
increase the dosage of both the cordyceps and superoxide dismutase to see if i
can completely control my illness. I am totally amazed at how well these
supplements work for my autoimmune disease. I would recomend them for anyone
looking to go the natural route for autoimmune disorders.
A. Please keep us updated.
Q. Are EGCG,
the green tea extract, and
resveratrol helpful in autoimmune disease?
A. Perhaps, but we need lots more studies.
Q. Is
polymyalgia rheumatica
an autoimmune disease?
A. It is not classified as an autoimmune disease.
I use your website regularly. I noticed that spirulina has
a warning for those with autoimmune disease. How about chlorella?
I have not seen such studies, so I don't know if chlorella
pills would have a similar effect.
I have some interesting autoimmune issues: autoimmune
thyroiditis, Raynaud's and erythromalalgia. For about 20 years I had consistent,
elevated liver enzymes (althought for the last 4 years or so they have been
normal). I added the NAC after reading one of Sherri Roger's books on
detoxification and found that I noticed a clearer head, less pain and overall
improved energy. (However, I have been taking many other nutritional supplements
and have made some dramatic changes in my diet over the years.) But now I am
wondering if pairing the NAC with food becomes irrelevant if the dose is
reasonably high enough to allow for a therapeutic effect.
It is difficult to predict in any one individual whether
taking N acetyl cysteine would be more beneficial if taken with or without food.
A good way to find out is, for a period of one to three weeks, to take the pills
with food and another 1 to 3 weeks without food to see if there is any
difference in reduction of symptoms or signs. That is the best way to find out
in your particular case which option is better.
I've been using anti-opiates to treat autoimmune diseases for years now, with a good percentage of patients responding very positively. In fact some are near miracles. Of course you won't hear a lot about this treatment because most antiopiates have lost patent protection.
I am a college professor and MD who has been doing
research online for a holistic protocol for an autoimmune condition called cutaneous histiocytosis (also the possibility of systemic histiocytosis) that
has afflicted my precious furkid Basset Hound for two years now (we did not get
the actual diagnosis until now). This is where the body is making too many
histiocytes and I am being told that his immune system needs to be supressed (So I was curious if you knew of any holistic products that help modulate the
immune system when it is in overdrive such as with histiocytosis (knows as
Langerhans histiocytosis in humans). I am sure there must be some herbs or other
holistic supplements that help modulate the immune system as well as some herbs
that have a strong inflammatory response as well? Since this disease also had a
strong inflammatory component associated with it as well.
The whole issue of the effects of different herbs on the
immune system is complicated since there are times when some herbs are initially
immunostimulants and then after a few days or weeks or months they become
immunosuppressive and vice versa. I have not studied this topic enough to have a
good suggestion. Since long term studies with herbal products are not common, it
is difficult to know, plus the whole thing becomes more complicated since
different herbal extraction processes, dosages, length of use, interactions with
other supplements, medications, substances in the diet, alcohol, coffee, sleep
patterns, etc, all make it quite complex, along with each person's unique immune
system function.
Does the herb maca stimulate the immune system and if so--can
it be used if you have an autoimmune disorder?
I have not seen research with maca involving those with such
conditions.