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Lecture 10a 21 November 2016
Arthritis, Dermatitis, Migraine
Osteoarthritis (OA)
-involves swelling of the joints
-overweight – causes wear of cartilaginous
surfaces
-such wear results in loss of chondroitin
sulphate and glucosamine which are
carbohydrate polymers
Rheumatoid arthritis (RA)
-autoimmune attack that in part involves loss of
chondroitin sulphate and glucosamine
Nutrition approaches to Arthritis
-appropriate nutrition and exercise may
prevent weight gain thus avoiding that cause of
osteoarthritis
Nutrition approaches to Arthritis
nutraceuticals
-chondroitin sulphate
-glucosamine
-both of these nutraceuticals are
meant to replace lost
chondroitin sulphate and
glucosamine
-both readily available over the
counter (OTC) and are useless
for osteoarthritis and
rheumatoid arthritis
Nutrition approaches to Arthritis
Nutraceuticals
-fish oils reduce arachidonic derived proinflammatory eicosanoids while producing antiinflammatory eicosanoids in RA but not OA
-evening primrose oil, blackcurrant oil, and borage
oil reduce arachidonic derived pro-inflammatory
eicosanoids while producing anti-inflammatory
eicosanoids in RA but not OA
-more on nutraceutical applications to RA later in
lecture
Comments specific to rheumatoid
arthritis
Nutritional imbalance
a) protein energy malnutrition
b) anorexia
c) gastrointestinal involvement
Comments specific to rheumatoid arthritis
Nutritional imbalance in RA
Protein energy malnutrition
Widespread in RA patients- poor
prognosis and rehospitalisation
and increased mortality rate
Anorexia- patients do not feel
like eating
Comments specific to rheumatoid arthritis
Nutritional imbalance
Gastrointestinal tract involvement
-malabsorption of nutrients giving
rise to a decrease in nutrient
uptake
Comments specific to rheumatoid arthritis
Selenium
-anti-inflammatory and immunomodulatory
-down in rheumatoid arthritis patients’
plasma
however- most Se supplementation
trials no real improvement in disease even
when normal plasma levels restored
Comments specific to rheumatoid arthritis
Vitamin C
Essential to collagen synthesis -RA leads to
collagen breakdown faster than collagen
synthesis
Vitamin C supplementation leads to no clinical
improvement in RA
Comments specific to rheumatoid arthritis
Vitamin B6
decreased in RA patients’ plasma
Decreased plasma B6 correlated with degree of
inflammation and levels of pro-inflammatory
cytokines
However B6 supplementation- no clinical
improvement in RA
Comments specific to rheumatoid arthritis
Vitamin E
some studies lower serum levels of vitamin E
compared to healthy controls
other studies suggest lower levels in synovial
fluid compared to paired serum samples in RA
patients
vitamin E supplementation shows no clinical
improvement in RA
Comments specific to rheumatoid arthritis
Histidine
low serum levels in RA correlates with disease
activity (clinical and laboratory measures)
histidine supplementation does not work
Comments specific to rheumatoid arthritis
Dietary therapy
Elimination therapy
Dong diet
Eliminating additives preservatives red
meat, herbs, dairy products, spices,
carbonated drinks and ethanol
Eat seafood, vegetables and rice
No difference in RA clinical outcome
between dong and placebo diets for RA
patients
Comments specific to rheumatoid arthritis
Dietary therapy
Elimination therapy
Other dietary elimination studies have come
up with same thing
Role of diet is controversial because existing
studies do not give clear cut results
Comments specific to rheumatoid arthritis
Dietary therapy
Novel functional foods
New Zealand green lipped mussel extract
Devil’s claw
(Harpagophytum root extract)
Sea kelp
Ginseng
Lactobacillus
Novel functional foods are all unproven
Comments specific to rheumatoid arthritis
Dietary therapy
Functional foods
FISH- only fish oils supported for clinical use
SULPHUR CONTAINING FOODS
Asparagus, eggs, onion, garlic- sulphur
necessary for building bone cartilage and
connective tissue-no evidence to support
clinical use in RA
Comments specific to rheumatoid arthritis
Dietary therapy
Functional foods
PEPPERS
Capsaicin- from hot peppers like cayenne
-anti-pain-reduces neural
sensitivity
-no clinical evidence to support the
use of peppers in RA or OA
though capaiscin containing
cream are used clinically and
this cream works for pain in RA
(also works for pain in OA)
Dietary therapy
Supplementation therapy-Nutraceuticals
Evening primrose oil
Borage oil
Blackcurrant oil
Fish oils
w6 and w3 fatty acids to reduce
inflammation via increased production of
anti-inflammatory prostaglandins and
leukotrienes and the reduction of levels
of pro-inflammatory prostaglandins and
leukotrienes
Class activity-what is the best nutritional approach
to arthritis? Why?
Dermatitis
Atopic (eczema)
-skin inflammation that is due to an
immune response
-can be due to a food allergy
-solution -avoid food allergen
Dermatitis-nutraceutical
-fish oils reduce arachidonic derived proinflammatory eicosanoids while producing antiinflammatory eicosanoids
-evening primrose oil and borage oil reduce
arachidonic derived pro-inflammatory eicosanoids
while producing anti-inflammatory eicosanoids
-as with RA many of these trials include subjects
that are on anti-inflammatory prescribed drugswhat is the impact of this?
Dermatitis
Sebborheic (scaly)
-can be due to biotin deficiency
solution: avoid biotin deficiency
- can be due to riboflavin deficiency
solution: avoid riboflavin deficiency
Scaling eczema-like dermatitis
-can be due to linoleic or a-linolenic acid
deficiency
-this may be a problem with long term
TPN
Nutritional remedy for dermatitis (types above) in
general
-topical application of retinoids (similar in
structure to vitamin A)
-reduces dermatitis
-avoid linoleic or a-linolenic acid deficiency
Dermatitis herpetiformis
-causes skin lesions
pruritic-itching
vesicular-vesicles
papular-solid elevation of the skin
- all of these lesions are consistent with
coeliac disease and are relieved by a
gluten-free diet
Migraine
Foods contributing to migraine:
Citrus foods
Tea(flavonoids)
Coffee
Pork
Chocolate
Milk
Nuts
Vegetables
Cola
Migraine
-food components affecting vascular tone and
causing migraine (highly individual):
tyramine, phenylalanine, phenolic flavonoids,
alcohol, food additives (sodium nitrate,
monosodium glutamate), aspartame, caffeine
Migraine
-foods thought to trigger migraines subsequent to
hypoglycemia are:
chocolate, cheese, citrus fruits, bananas, nuts,
cured meats, dairy products cereals, beans,
hot dogs, pizza, food additives coffee, tea, cola
drinks, alcoholic drinks such as red wine, beer
or whiskey distilled in copper stills
Migraine
-solution to all this is trial and error elimination
of foods including meticulous record keeping