Arthritis und Rheuma 2018; 38(05): 356-362
DOI: 10.1055/s-0038-1675729
Kinderrheumatologie
Georg Thieme Verlag KG Stuttgart · New York

Rheuma und Ernährung

Was kann empfohlen werden?Rheumatic disease and nutritionCurrent recommendations
A. Michalsen
1   Charité – Universitätsmedizin Berlin, Stiftungsprofessur für klinische Naturheilkunde; Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie
2   Immanuel Krankenhaus Berlin, Abteilung und Zentrum für Naturheilkunde, Klinik für Innere Medizin
› Author Affiliations
Further Information

Korrespondenzadresse

Univ.-Prof. Dr. med. Andreas Michalsen
Abteilung für Naturheilkunde
Klinik für Innere Medizin
Immanuel Krankenhaus Berlin
Am kleinen Wannsee 5D, 14109 Berlin

Publication History

Publication Date:
30 October 2018 (online)

 

Zusammenfassung

Viele Patienten mit rheumatischen Erkrankungen fragen nach den Möglichkeiten, ihre Erkrankung über die Ernährung zu beeinflussen. In Erhebungen und epidemiologischen Studien werden immer wieder Ernährungsfaktoren beschrieben, die mit dem Auftreten rheumatischer Erkrankungen bzw. von Schüben verbunden sind, allerdings kann kein einheitliches Ernährungsmuster beschrieben werden. Wie allgemein im nichtpharmakologischen Therapiebereich stehen nur in begrenztem Umfang Daten aus randomisierten Studien zur Evidenzbewertung zur Verfügung. Für die rheumatoide Arthritis (RA) belegen zwei randomisierte Studien die Wirksamkeit der mediterranen Ernährung. Für die vegetarischen Kostformen weisen v. a. experimentelle Daten auf grundsätzlich deutliche antientzündliche Effekte und klinische Studien auf günstige klinische Wirkungen bei kardiovaskulären Erkrankungen hin. Die Wirksamkeit glutenfreier Diäten bei RA ist fraglich und glutenfreie Diäten sollten nur bei Zöliakie oder starken Hinweisen auf eine Nicht-Zöliakie Glutensensitivität (NCGS) empfohlen werden. Mehrere Studien und eine systematische Übersicht belegen die Wirksamkeit eines sieben- bis zehntätigen Fastens auf die Symptome und Funktion bei RA. Folgt auf das Fasten eine vegane und vegetarische Ernährung, sind nachhaltige Effekte von bis zu einem Jahr dokumentiert. Der mögliche Nutzen verschiedener spezifischer Nahrungsmittel und Nahrungsergänzungen wie grüner Tee, Granatapfel, Ingwer, Leinöl, Gelbwurz ist klinisch derzeit nicht ausreichend belegt, aber v. a. für Gelbwurz (Curcuma) vielversprechend. Neuere klinisch-experimentelle Daten belegen den Einfluss des Darm-Mikrobioms auf die Entstehung der Erkrankung. Allerdings sind bislang spezifische probiotische Therapieansätze nicht ausreichend durch Daten aus klinischen Studien gestützt.


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Summary

There is an increasing interest for nutritional therapies in patients with rheumatic diseases. Patients and some smaller surveys are frequently reporting causal associations of the beginning of disease or symptomatic flareups. However, there is no homogenous profile of such nutritional factors. As generally with non-pharmacological treatments evidence from randomized controlled trials is scarce. Two randomized studies have proven the effectiveness of the traditional Mediterranean diet in patients with rheumatoid arthritis (RA). For vegetarian diets, experimental evidence shows significant anti-inflammatory effects while clinical studies underline its value in the prevention and treatment of cardiovascular and metabolic diseases. The value of gluten-free elimination diets remains unclear. Several studies and a systematic review point to the effectiveness of periods of 7 to 10 days of modified fasting on symptoms and function in RA. Fasting followed by a vegan and lactovegetarian diet leads to a prolonged beneficial effect over one year. The potential benefit of distinct nutrients and nutritional supplements as green tea, pomegranate, ginger, curcuma, linseed oil is not proved sufficiently by clinical trials so far, however data for curcuma/turmeric are promising. Preliminary data show associations between alterations of the gut microbiome and rheumatic diseases. So far there is no sufficient evidence supporting the recommendation of specific probiotic treatments or prebiotic diets in the treatment of rheumatic diseases.


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Interessenkonflikt

Der Autor gibt an, dass kein Interessenkonflikt vorliegt.

  • Literatur

  • 1 Kerekes G, Nurmohamed MT, González-Gay MA. et al. Rheumatoid arthritis and metabolic syndrome. Nat Rev Rheumatol 2014; 10: 691-696.
  • 2 Masuko KA. Potential Benefit of “Balanced Diet” for Rheumatoid Arthritis. Front Med (Lausanne) 2018; 05: 141.
  • 3 Darlington LG, Ramsey NW. Review of dietary therapy for rheumatoid arthritis. British journal of rheumatology 1993; 32: 507-514.
  • 4 Sparks JA, Barbhaiya M, Tedeschi SK. et al. Inflammatory dietary pattern and risk of developing rheumatoid arthritis in women. Clin Rheumatol. 2018 Aug 14. [epub ahead of print].
  • 5 Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Annals of the rheumatic diseases 2003; 62: 208-214.
  • 6 McKellar G, Morrison E, McEntegart A. et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Annals of the rheumatic diseases 2007; 66: 1239-1243.
  • 7 Tracy SW. Something new under the sun? The Mediterranean diet and cardiovascular health. The New England journal of medicine 2013; 368: 1274-1276.
  • 8 Samaha F. Effects of a Mediterranean-style diet on cardiovascular risk factors. Annals of internal medicine 2007; 146 (73) author reply – 4.
  • 9 Berkow SE, Barnard ND. Blood pressure regulation and vegetarian diets. Nutrition reviews 2005; 63: 1-8.
  • 10 Fraser G, Katuli S, Anousheh R. et al. Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study-2. Public health nutrition 2015; 18: 537-545.
  • 11 Kwok CS, Umar S, Myint PK. et al. Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: a systematic review and meta-analysis. International journal of cardiology 2014; 176: 680-686.
  • 12 Yokoyama Y, Nishimura K, Barnard ND. et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA internal medicine 2014; 174: 577-587.
  • 13 Kjeldsen-Kragh J, Haugen M, Borchgrevink CF. et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991; 338: 899-902.
  • 14 Shim HS, Longo VD. A protein restriction-dependent sulfur code for longevity. Cell 2015; 160: 15-17.
  • 15 Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell metabolism 2014; 19: 181-192.
  • 16 Fontana L, Partridge L. Promoting health and longevity through diet: from model organisms to humans. Cell 2015; 161: 106-118.
  • 17 Fontana L, Partridge L, Longo VD. Extending healthy life span – from yeast to humans. Science 2010; 328: 321-326.
  • 18 Mattson MP. Energy intake, meal frequency, and health: a neurobiological perspective. Annual review of nutrition 2005; 25: 237-260.
  • 19 Michalsen A, Li C. Fasting therapy for treating and preventing disease – current state of evidence. Forsch Komplementmed 2013; 20: 444-453.
  • 20 Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scandinavian journal of rheumatology 2001; 30: 1-10.
  • 21 Hafstrom I, Ringertz B, Spangberg A. et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford) 2001; 40: 1175-1179.
  • 22 Al-Okbi SY. Nutraceuticals of anti-inflammatory activity as complementary therapy for rheumatoid arthritis. Toxicology and industrial health 2014; 30: 738-749.
  • 23 Ramadan G, Al-Kahtani MA, El-Sayed WM. Antiinflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis. Inflammation 2011; 34: 291-301.
  • 24 Ramadan G, El-Menshawy O. Protective effects of ginger-turmeric rhizomes mixture on joint inflammation, atherogenesis, kidney dysfunction and other complications in a rat model of human rheumatoid arthritis. International journal of rheumatic diseases 2013; 16: 219-229.
  • 25 Anand R, Kaithwas G. Anti-inflammatory potential of alpha-linolenic acid mediated through selective COX inhibition: computational and experimental data. Inflammation 2014; 37: 1297-1306.
  • 26 Riegsecker S, Wiczynski D, Kaplan MJ, Ahmed S. Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis. Life sciences 2013; 93: 307-312.
  • 27 Roy S, Sannigrahi S, Vaddepalli RP. et al. A novel combination of methotrexate and epigallocatechin attenuates the overexpression of proinflammatory cartilage cytokines and modulates antioxidant status in adjuvant arthritic rats. Inflammation 2012; 35: 1435-1447.
  • 28 Shukla M, Gupta K, Rasheed Z. et al. Consumption of hydrolyzable tannins-rich pomegranate extract suppresses inflammation and joint damage in rheumatoid arthritis. Nutrition 2008; 24: 733-743.
  • 29 Singh S, Nair V, Gupta YK. Linseed oil: an investigation of its antiarthritic activity in experimental models. Phytotherapy research 2012; 26: 246-252.
  • 30 Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. The Cochrane database of systematic reviews 2014; 05: CD002947.
  • 31 Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res 2012; 1719-1725.
  • 32 Amalraj A, Varma K, Jacob J. et al. Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study. J Med Food 2017; 20: 1022-1030.
  • 33 McLean MH, Dieguez Jr D. Miller LM, Young HA. Does the microbiota play a role in the pathogenesis of autoimmune diseases?. Gut 2015; 64: 332-341.
  • 34 Scher JU, Abramson SB. The microbiome and rheumatoid arthritis. Nature reviews Rheumatology 2011; 07: 569-578.
  • 35 Taneja V. Arthritis susceptibility and the gut microbiome. FEBS letters 2014; 588: 4244-4249.
  • 36 Yeoh N, Burton JP, Suppiah P. et al. The role of the microbiome in rheumatic diseases. Current rheumatology reports 2013; 15: 314.
  • 37 Zhang X, Zhang D, Jia H. et al. The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment. Nat Med 2015; 21: 895-905.
  • 38 Stoll ML, Cron RQ. the microbiota in pediaric rheumatic disease:epiphenomen or therapeutic target ?. Curr Opin Rheumatol 2016; 28: 537-543.
  • 39 Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A. et al. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition 2014; 30: 430-435.

Korrespondenzadresse

Univ.-Prof. Dr. med. Andreas Michalsen
Abteilung für Naturheilkunde
Klinik für Innere Medizin
Immanuel Krankenhaus Berlin
Am kleinen Wannsee 5D, 14109 Berlin

  • Literatur

  • 1 Kerekes G, Nurmohamed MT, González-Gay MA. et al. Rheumatoid arthritis and metabolic syndrome. Nat Rev Rheumatol 2014; 10: 691-696.
  • 2 Masuko KA. Potential Benefit of “Balanced Diet” for Rheumatoid Arthritis. Front Med (Lausanne) 2018; 05: 141.
  • 3 Darlington LG, Ramsey NW. Review of dietary therapy for rheumatoid arthritis. British journal of rheumatology 1993; 32: 507-514.
  • 4 Sparks JA, Barbhaiya M, Tedeschi SK. et al. Inflammatory dietary pattern and risk of developing rheumatoid arthritis in women. Clin Rheumatol. 2018 Aug 14. [epub ahead of print].
  • 5 Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Annals of the rheumatic diseases 2003; 62: 208-214.
  • 6 McKellar G, Morrison E, McEntegart A. et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Annals of the rheumatic diseases 2007; 66: 1239-1243.
  • 7 Tracy SW. Something new under the sun? The Mediterranean diet and cardiovascular health. The New England journal of medicine 2013; 368: 1274-1276.
  • 8 Samaha F. Effects of a Mediterranean-style diet on cardiovascular risk factors. Annals of internal medicine 2007; 146 (73) author reply – 4.
  • 9 Berkow SE, Barnard ND. Blood pressure regulation and vegetarian diets. Nutrition reviews 2005; 63: 1-8.
  • 10 Fraser G, Katuli S, Anousheh R. et al. Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study-2. Public health nutrition 2015; 18: 537-545.
  • 11 Kwok CS, Umar S, Myint PK. et al. Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: a systematic review and meta-analysis. International journal of cardiology 2014; 176: 680-686.
  • 12 Yokoyama Y, Nishimura K, Barnard ND. et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA internal medicine 2014; 174: 577-587.
  • 13 Kjeldsen-Kragh J, Haugen M, Borchgrevink CF. et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991; 338: 899-902.
  • 14 Shim HS, Longo VD. A protein restriction-dependent sulfur code for longevity. Cell 2015; 160: 15-17.
  • 15 Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell metabolism 2014; 19: 181-192.
  • 16 Fontana L, Partridge L. Promoting health and longevity through diet: from model organisms to humans. Cell 2015; 161: 106-118.
  • 17 Fontana L, Partridge L, Longo VD. Extending healthy life span – from yeast to humans. Science 2010; 328: 321-326.
  • 18 Mattson MP. Energy intake, meal frequency, and health: a neurobiological perspective. Annual review of nutrition 2005; 25: 237-260.
  • 19 Michalsen A, Li C. Fasting therapy for treating and preventing disease – current state of evidence. Forsch Komplementmed 2013; 20: 444-453.
  • 20 Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scandinavian journal of rheumatology 2001; 30: 1-10.
  • 21 Hafstrom I, Ringertz B, Spangberg A. et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford) 2001; 40: 1175-1179.
  • 22 Al-Okbi SY. Nutraceuticals of anti-inflammatory activity as complementary therapy for rheumatoid arthritis. Toxicology and industrial health 2014; 30: 738-749.
  • 23 Ramadan G, Al-Kahtani MA, El-Sayed WM. Antiinflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis. Inflammation 2011; 34: 291-301.
  • 24 Ramadan G, El-Menshawy O. Protective effects of ginger-turmeric rhizomes mixture on joint inflammation, atherogenesis, kidney dysfunction and other complications in a rat model of human rheumatoid arthritis. International journal of rheumatic diseases 2013; 16: 219-229.
  • 25 Anand R, Kaithwas G. Anti-inflammatory potential of alpha-linolenic acid mediated through selective COX inhibition: computational and experimental data. Inflammation 2014; 37: 1297-1306.
  • 26 Riegsecker S, Wiczynski D, Kaplan MJ, Ahmed S. Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis. Life sciences 2013; 93: 307-312.
  • 27 Roy S, Sannigrahi S, Vaddepalli RP. et al. A novel combination of methotrexate and epigallocatechin attenuates the overexpression of proinflammatory cartilage cytokines and modulates antioxidant status in adjuvant arthritic rats. Inflammation 2012; 35: 1435-1447.
  • 28 Shukla M, Gupta K, Rasheed Z. et al. Consumption of hydrolyzable tannins-rich pomegranate extract suppresses inflammation and joint damage in rheumatoid arthritis. Nutrition 2008; 24: 733-743.
  • 29 Singh S, Nair V, Gupta YK. Linseed oil: an investigation of its antiarthritic activity in experimental models. Phytotherapy research 2012; 26: 246-252.
  • 30 Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. The Cochrane database of systematic reviews 2014; 05: CD002947.
  • 31 Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res 2012; 1719-1725.
  • 32 Amalraj A, Varma K, Jacob J. et al. Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study. J Med Food 2017; 20: 1022-1030.
  • 33 McLean MH, Dieguez Jr D. Miller LM, Young HA. Does the microbiota play a role in the pathogenesis of autoimmune diseases?. Gut 2015; 64: 332-341.
  • 34 Scher JU, Abramson SB. The microbiome and rheumatoid arthritis. Nature reviews Rheumatology 2011; 07: 569-578.
  • 35 Taneja V. Arthritis susceptibility and the gut microbiome. FEBS letters 2014; 588: 4244-4249.
  • 36 Yeoh N, Burton JP, Suppiah P. et al. The role of the microbiome in rheumatic diseases. Current rheumatology reports 2013; 15: 314.
  • 37 Zhang X, Zhang D, Jia H. et al. The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment. Nat Med 2015; 21: 895-905.
  • 38 Stoll ML, Cron RQ. the microbiota in pediaric rheumatic disease:epiphenomen or therapeutic target ?. Curr Opin Rheumatol 2016; 28: 537-543.
  • 39 Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A. et al. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition 2014; 30: 430-435.