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FAQ in Clinical Practice
• อาหารเสริมกับโรคข้อ
• แคลเซี่ยมกับกระดูกงอก
• Gout กับการกินอาหาร
• ไข่ลวกกับโอวัลตินเป็ นอาหารบารุงหรือไม่
• ชาเขียวมีประโยชน์จริงหรือ (separate file)
• น้ าลูกยอมีประโยชน์จริงหรือ (separate file)
Suggestion diet in RA
Balance, healthy diet for ideal weight
evidence support
reduce red meat
eat more fish (eg. mackerel, sardines) three or four times a week.
Suggestion diet in Gout
reduce purine rich diet especially from animal protein
consume low fat daily product eg. skim milk, yogurt
avoid alcohol consumption particularly beer
drink more water
evidence support
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Scientific Backgroud
Diet for RA
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Diet and arthritis
Little scientific evidence confirming the benefits of modified diets for patients
with arthritis, and mostly focus on diet and RA
Consumption of large amounts of red meat  linked to development of RA
Possible explanations:
• proinflammatory property of meat fats from iron accumulated in syn tissue
• collagen sensitization from a high level of protein intake
• the role of nitrite and nitric oxide
• infectious mechanisms such as alterations in intestinal flora
Pattison DJ, Symmons DPM, Lunt M et al. Dietary risk factors for the development of
inflammatory polyarthritis. Evidence for a role of high level of red meat consumption. Arthritis
Rheum 2004; 50: 3804-3812.
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Diet and arthritis
increase in intake of 30 g fat fish per day  49% reduction in the risk of RA
Whereas medium fat fish (3-7 g fat/100 g fish)  significantly increased risk
Intake of fruit and coffee was not associated with risk of RA
no associations were found between risk of RA and other dietary factors:
(long chain FA, olive oil, vitamins A, E, C, D, zinc, selenium, iron, and meat.
J Rheumatol. 2005 Jul;32(7):1249-52
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Fish oil could help ?
essential fatty acids (EFAs)
Prostaglandins, leukotrienes
inflammation in RA
the right balance of EFAs is important to control inflammation.
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There are two groups of EFAs:
omega-3  found naturally in oily fish (mackerel, sardines, pilchards, salmon)
main omega-3 = EPA & DHA
fish liver oil (cod or halibut) also contains these EFAs & vit D,
 helps the body to absorb calcium
omega-6  the best known source is evening primrose oil,
also in sunflower oil.
main omega-6 = GLA
Back
Scientific Backgroud
Diet for RA
Next
Diet and Gout
association of purine-rich foods with gout had long been suspected
but never proven
Health Professionals Follow-up Study
47,150 men with no history of gout at baseline
12-year FU (1986-1998)
730 men developed gout
N Engl J Med. 2004;350:1071-1073, 1093-1103
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Diet and Gout
• Incidence of gout = 1.0-1.8 / 1,000
• high intake of meat & seafood consumption   risk of gout (RR 1.4-1.5)
• high intake of low-fat dairy products (skim milk,yogurt)   risk. (RR 0.5)
• for seafood intake  risk of gout was stronger for men with BMI < 25
beef, pork, and lamb were the worst offenders in the meat group
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Diet and Gout
for this population
purine-rich vegetables (peas, beans, mushrooms, cauliflower, and spinach)
over all protein intake, alcohol, and BMI
did not associated with an increased risk of gout.
there was a potential protective effect from vegetable and dairy proteins
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Diet and Gout
Milk proteins (casein and lactalbumin)
reduce serum uric acid levels in healthy subjects
( uricosuric effect )
four weeks of a dairy-free diet
 associated with a significant increase in uric acid levels
June 1995 issue of the European Journal of Epidemiology,
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Diet and Gout
"Dietary manipulation and behavioral modification to reduce risk of gout
may have a much more substantial impact than currently believed “
Individual who have family history of gout are at high risk
"Reducing red meat consumption may be recommended because it also
has been associated with such problems as colon cancer and diabetes”
healthy foods such as vegetables do not need to be restricted
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Gout and alcohol consumption
The risk of gout is significantly raised with alcohol intake as low as
10.0 to 14.9 g / day with a dose-response relationship.
Risk is 2.5 times higher in men who consume 50 g or more / day
independent of BMI and other dietary factors
Beer and liquor consumption carry the greatest risk, while moderate
wine consumption does not increase risk of incident gout.
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Gout and alcohol consumption
• For alcohol consumption of 5.0 to 9.9 g per day, the RR of gout was 1.3
• For daily consumption of 50 g or more per day, the RR was 3.02
for every 10 g increase in daily alcohol consumption
increase in RR = 1.17
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Mechanism of ethanol in inducing
hyperuricemia
Both increased urate production and decreased urate excretion
Beer having predominantly guanosine as its high purine content
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Calcium and Osteophytes in OA
In OA patients, no data supports the relationship between
osteophyte formation and calcium supplement
evidence support
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Mechanism of osteophyte formation in OA
Although osteophyte is viewed as a remodelling and reparative
feature of OA, the factors that determine osteophyte formation
and growth are unknown.
Growth factors (TGF-b, IGF-1) influence both chondrocyte
synthesis and osteophyte formation in experimental joint damage.
Evidence from animal and human studies shows that cartilage damage
initiates "secondary" osteophyte growth.
However, osteophyte may also develop as an isolated feature
associated with age and precede rather than follow cartilage loss in
animal studies.
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Mechanism of osteophyte formation in OA
Joint instability has been emphasised as a biomechanical trigger to
osteophyte formation, with osteophyte and bone remodelling being
viewed as an attempt to stabilise and broaden the compromised joint
to better withstand loading forces.
Chondrocalcinosis due to calcium pyrophosphate crystals has also been
suggested to be associated with a tendency to osteophyte formation and
a "hypertrophic" form of OA. Possibly, multiple factors may influence
osteophyte formation and contribute to the marked heterogeneity of OA.
กลับเมนูหลัก
ไข่ลวก กับ โอวัลติน
High calorie diet with lower protein
Raw egg
 incomplete protein digestion
Mainly carbohydrate
Ovaltin :
nutritional fact
 Sugar added
Small amount of protein
กลับเมนูหลัก
high calories