Fasten und Ernährung bei rheumatischen Gelenkerkrankungen

Zusammenfassung

Viele Patienten mit rheumatischen Erkrankungen fragen nach den Möglichkeiten, ihre Erkrankung über die Ernährung zu beeinflussen. In der Naturheilkunde bilden Ernährungstherapie und modifiziertes Fasten eine Hauptsäule der klassischen Naturheilverfahren und es besteht eine umfangreiche klinische Erfahrung zur Ernährungstherapie bei rheumatischen Erkrankungen. Wie in der gesamten nichtpharmakologischen Therapie stehen nur in begrenztem Umfang Daten aus randomisierten Studien zur Evidenzbewertung zur Verfügung. Für die rheumatoide Arthritis belegen zwei randomisierte Studien die Wirksamkeit der mediterranen Ernährung. Für die vegetarischen Kostformen weisen experimentelle Daten auf grundsätzlich deutliche antientzündliche Effekte und klinische Studien auf günstige klinische Wirkungen bei kardiovaskulären Erkrankungen. Die Wirksamkeit glutenfreier Diäten ist fraglich. Mehrere Studien und eine systematische Übersicht belegen die Wirksamkeit eines siebenbis zehntägigen Fastens auf die Symptome und Funktion bei rheumatoider Arthritis. Folgt auf das Fasten eine vegane und vegetarische Ernährung sind nachhaltige Effekte von einem Jahr dokumentiert. Der mögliche Nutzen verschiedener spezifischer Nahrungsmittel und Nahrungsergänzungen wie Grüner Tee, Granatapfel, Ingwer, Leinöl, Gelbwurz ist klinisch derzeit nicht ausreichend belegt. Vielversprechend sind erste Daten zur probiotischen Therapie bei rheumatoider Arthritis. Für die Therapie der Arthrose steht die Gewichtsnormalisierung bei Übergewicht im Vordergrund. Nahrungsergänzungen mit Avocado/Soja sind moderat symptomatisch bei Arthrose wirksam.

Summary

There is an increasing interest for nutritional therapies in patients with rheumatic diseases. Nutritional therapies and therapeutic fasting are cornerstones of naturopathic and integrative medicine and there is longstanding experience in the nutritional treatment of rheumatic diseases. As generally with nonpharmacological 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. 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 rheumatoid arthritis. 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 sufficiently evaluated by clinical trials so far. Preliminary data showed promising results of probiotic treatment in rheumatoid arthritis. For the dietary treatment of osteo-arthritis weight reduction and weight normalization are primary goals. Among the nutritional supplements avocado/soy preparations show moderate symptomatic efficacy in osteoarthritis.

Schlüsselwörter

Rheuma - Ernährungstherapie - Fasten - Diät

Keywords

Rheumatic disease - nutritional therapy - fasting - diet

• Literatur

• 1 Darlington LG, Ramsey NW. Review of dietary therapy for rheumatoid arthritis. British journal of rheumatology 1993; 32: 507-514.
• 2 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.
• 3 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.
• 4 Tracy SW. Something new under the sun? The Mediterranean diet and cardiovascular health. The New England journal of medicine 2013; 368: 1274-1276.
• 5 Samaha F. Effects of a Mediterranean-style diet on cardiovascular risk factors. Annals of internal medicine 2007; 146: 73 author reply -74
• 6 Berkow SE, Barnard ND. Blood pressure regulation and vegetarian diets. Nutrition reviews 2005; 63: 1-8.
• 7 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.
• 8 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.
• 9 Yokoyama Y, Nishimura K, Barnard ND. et al Vegetarian diets and blood pressure: a meta-analysis. JAMA internal medicine 2014; 174: 577-587.
• 10 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.
• 11 Shim HS, Longo VD. A protein restriction-dependent sulfur code for longevity. Cell 2015; 160: 15-17.
• 12 Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell metabolism 2014; 19: 181-192.
• 13 Fontana L, Partridge L. Promoting health and longevity through diet: from model organisms to humans. Cell 2015; 161: 106-118.
• 14 Kapelle A, Stange R, Gromnica-Ihle E, Bühring M. A survey of nutritional habits and attititudes towards nutrition therapy in patients with rheumatoid arthritis. FACT 1997; 3: 124
• 15 Westhoff G, Stange R, Zink A. Use of Complementary and alternative medicine by patients with recent onset rheumatoid arthritis. Forsch Komplementmed 2007; 14: 47
• 16 Fontana L, Partridge L, Longo VD. Extending healthy life span - from yeast to humans. Science 2010; 328: 321-326.
• 17 Mattson MP. Energy intake, meal frequency, and health: a neurobiological perspective. Annual review of nutrition 2005; 25: 237-260.
• 18 Michalsen A, Li C. Fasting therapy for treating and preventing disease - current state of evidence. Forsch Komplementmed 2013; 20: 444-453.
• 19 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.
• 20 Schmidt S, Stange R, Lischka E. et al [Uncontrolled clinical study of the efficacy of ambulant fasting in patients with osteoarthritis]. Forsch Komplementmed 2010; 17: 87-94.
• 21 Michalsen A, Li C, Kaiser K. et al In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy. Evidence-based complementary and alternative medicine 2013; 2013 908610
• 22 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.
• 23 Al-Okbi SY. Nutraceuticals of anti-inflammatory activity as complementary therapy for rheumatoid arthritis. Toxicology and industrial health 2014; 30: 738-749.
• 24 Ramadan G, Al-Kahtani MA, El-Sayed WM. Anti-inflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis. Inflammation 2011; 34: 291-301.
• 25 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.
• 26 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.
• 27 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.
• 28 Roy S, Sannigrahi S, Vaddepalli RP. et al A novel combination of methotrexate and epigallocatechin attenuates the overexpression of pro-inflammatory cartilage cytokines and modulates antioxidant status in adjuvant arthritic rats. Inflammation 2012; 35: 1435-1447.
• 29 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.
• 30 Singh S, Nair V, Gupta YK. Linseed oil: an investigation of its antiarthritic activity in experimental models. Phytotherapy research 2012; 26: 246-252.
• 31 Wu D, Wang J, Pae M, Meydani SN. Green tea EGCG, T cells, and T cell-mediated autoimmune diseases. Molecular aspects of medicine 2012; 33: 107-118.
• 32 Christensen R, Bartels EM, Altman RD. et al Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? - a meta-analysis of randomized controlled trials. Osteoarthritis and cartilage/OARS, Osteoarthritis Research Society 2008; 16: 965-672.
• 33 Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. The Cochrane database of systematic reviews 2014; 5: CD002947
• 34 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.
• 35 Scher JU, Abramson SB. The microbiome and rheumatoid arthritis. Nature reviews Rheumatology 2011; 7: 569-578.
• 36 Taneja V. Arthritis susceptibility and the gut microbiome. FEBS letters 2014; 588: 4244-4249.
• 37 Yeoh N, Burton JP, Suppiah P. et al The role of the microbiome in rheumatic diseases. Current rheumatology reports 2013; 15: 314
• 38 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.