Can a gluten-free vegan diet help people with rheumatoid arthritis?

Can a gluten-free vegan diet help people with rheumatoid arthritis?
From the BMJ Group
Thursday 20 March 2008

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You may have read reports of a study that showed a vegan diet can be helpful for people with rheumatoid arthritis. But is it true? There are lots of problems with the way the study was carried out, and the results are far from clear.
What do we know already?

Rheumatoid arthritis is a painful condition that causes stiffness and swelling in your joints. It happens because of a problem with your immune system. Your immune system fights infections in your body, but if you have rheumatoid arthritis, it also attacks healthy tissue in your joints. People with rheumatoid arthritis have a higher risk of heart attacks and strokes.

There are lots of treatments for rheumatoid arthritis. Many people take ibuprofen or a similar drug to help with pain and swelling. Other drugs can be used to slow down the damage to your joints.

There has been a lot of interest in whether eating particular types of food can help with the symptoms of arthritis. One small study suggests a Mediterranean diet, which includes lots of fruit, vegetables and fish and little meat, might help reduce the joint pain people get from rheumatoid arthritis. Researchers have also studied fish oil and vegetarian diets.

Researchers have now done a study looking at whether a vegan, gluten-free diet could help people with rheumatoid arthritis. A vegan diet involves no animal products of any kind. Gluten is found in wheat and some other cereals. Avoiding gluten means cutting out most types of bread, pasta, pizza, pastry and cakes. In the study, one group followed this strict diet, while another group followed a healthy, balanced diet that wasn't vegan.

All the people in the study carried on taking their usual medicines for rheumatoid arthritis.
What does the new study say?

People in the study who ate the vegan, gluten-free diet lost some weight. But as they were normal weight to begin with, we don't know if that's a good thing. They also saw very small drops in their cholesterol levels, compared to the start of the study.

They had a slightly higher amount of a natural antibody that helps fight the damage caused by rheumatoid arthritis. But we don't know what, if any, effect this had on the disease.

The researchers didn't look at whether the people on the diet had less pain or joint damage from rheumatoid arthritis. So we don't know if it had any effect on the main problems from the disease.

It's also obvious from the study that a vegan, gluten-free diet is very hard to stick to. Out of 38 people who tried the diet, eight gave up within three months. Another eight dropped out before the end of the study, which lasted a year. And this was despite having a week of training about how to prepare vegan food, and continuing support from doctors, nurses and dietitians. No-one dropped out of the study from the group who were asked to eat a balanced, non-vegan diet.
Where does the study come from?

The study was done by researchers from the Rheumatology Unit at Karolinska University Hospital in Stockholm, Sweden. It appeared in the journal Arthritis Research and Therapy, published by a company called BioMed Central.
How reliable are the findings?

This study has a number of problems that make it hard to rely on the findings. It was a small study, and only looked at 66 people to start with. Of these, 16 people who were supposed to eat a vegan diet dropped out before the end of the study.

The researchers only looked at the results of the people who didn't drop out. This means that they ignored results for all the people who found the diet hard to stick to, or perhaps had to stop the diet for health reasons.

The researchers compared the weights and cholesterol levels of the two groups against their figures at the start of the study, not against the other group. This makes it hard to draw conclusions about whether one diet worked better than the other.
What does this mean for me?

Rheumatoid arthritis is a painful condition, and it's only natural to consider anything that might help. But this study is a long way from proving that a gluten-free or vegan diet can help with rheumatoid arthritis. The most the researchers could say was that there's a "potential" benefit.
What should I do now?

There's no need to make drastic changes to your diet as a result of this study. It doesn't show that a vegan diet helps people with rheumatoid arthritis.

And strict diets, like a vegan diet, can make it hard to get all the nutrients your body needs. It's a good idea to talk to a doctor or dietitian before making big changes to what you eat, especially if you plan to completely cut out particular foods.

The Food Standards Agency (FSA), which advises on food safety in the UK, says vegans need to take special care that they get enough:

* Protein (found in beans, lentils and soya products)
* Iron (from green vegetables)
* Selenium (from nuts, especially brazils)
* Vitamin B12 (from yeast extract, bread or fortified breakfast cereals).

It's important to remember that the people in the study were taking medicines for arthritis as well as eating a vegan diet. The research doesn't suggest that a diet can be used instead of drugs. Not getting the right medicines for rheumatoid arthritis can mean you're in pain, and also mean more damage to your joints.

If you have rheumatoid arthritis and your treatment isn't helping, make an appointment to see your doctor. Changing the drug or drugs you're taking may help to reduce your symptoms.
From:

Elkan A, Sjoberg B, Kolsrud B, et al. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study. Arthritis Research and Therapy. 2008; 10: R34.