Rheumatoid arthritis fat

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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At the British Society for Immunology Annual Congress in Brighton, England in 1997, Dr. Richard Sperling of the Brigham and Women's Hospital in Boston, MA described how altering the type of fat in the diet could alter the immune system's inflammatory response, with benefits for the patient.

Neutrophils are the most common type of white blood cell. They are found in large numbers at the site of inflammation in rheumatoid arthritis (RA) and inflammatory bowel disease. They have a number of pro-inflammatory effects.

Neutrophils produce a substance called leukotriene B4 (LTB4) which plays an important role in promoting inflammation. The building block they use is a polyunsaturated fatty acid called arachidonic acid, which is derived from the types of polyunsaturated fatty acids found in land-based plants and animals.

Marine plants and animals contain quite different fatty acids from their land-based equivalents, for example eicosapentaenoic acid and docosahexaenoic acid. These fatty acids can take the place of arachidonic acid in the neutrophil's LTB4 manufacturing process, resulting in slightly different end products. These products have a less inflammatory effect than LTB4 itself.

Dr. Sperling and his colleagues showed that dietary eicosapentaenoic acid reduces the production of LTB4 by neutrophils, both from healthy donors and patients with inflammatory disorders.

In addition, a diet rich in eicosapentaenoic acid and other marine-derived fatty acids has been shown to have other beneficial effects on neutrophil activity: neutrophils are less likely to migrate to the site of inflammation, and to release other molecules and enzymes which cause damage at the site of inflammation.

A number of studies have shown that diets enriched in marine fish oils have a modest beneficial effect in patients with diseases such as RA and inflammatory bowel disease. Sperling's results suggested that this is because of the suppressant effect these oils have on neutrophil activity.

The best anti-inflammatory fat is fish oil, also known as omega-3 fat. It depresses the production of a highly inflammatory agent much research has shown. Moreover, 10 well-conducted studies find that consuming fish oil helps relieve rheumatoid arthritis, says Joel Kremer, head of rheumatology at Albany Medical College in New York. In a recent Belgian study, about half of a group of rheumatoid arthritis patients taking fish oil were able to cut their doses of painkillers.

Just eating fish also can suppress inflammation. Swiss investigators measured cellular changes and concluded that four to six meals of fish each week equaled the benefits of therapeutic doses of fish oil.

A daily dose of 3,000-5,000 milligrams of omega-3's (about 10-17 capsules) is generally effective, producing noticeable benefits in three months, Kremer finds. Studies also show you're not as apt to develop the condition if you eat a lot of fish.

Specific vegetable oils (black currant, evening primrose, flaxseed, borage seed) counter inflammation, but they are less potent than fish oil.

Eating good fat is not enough; it's imperative also to cut down on "bad" fat that incites the production and accumulation of inflammatory chemicals in joints. Villains that trigger inflammation are omega-6 fats - especially corn oil, regular safflower and sunflower oil, plus products made with those oils - and saturated animal fat in dairy products and meat.

In 1981, Lucas found a fat-free diet produced complete remission in 6 patients with rheumatoid arthritis. Remission was lost within 24-72 hours of eating a high-fat meal, such as one containing chicken, cheese, safflower oil, beef, or coconut oil. The authors concluded, "...dietary fats in amounts normally eaten in the American diet cause the inflammatory joint changes seen in rheumatoid arthritis." (Clin Res 29:754, 1981).

Int J Obes Relat Metab Disord. 1994 Dec;18(12):812-9.

Int J Obes Relat Metab Disord 1995 May;19(5):359.

Changes in fat free mass in overweight patients with rheumatoid arthritis on a weight reducing regimen. A comparison of eight different body composition methods.

Heitmann BL, Kondrup J, Engelhart M, Kristensen JH, Podenphant J, Hoie H, Andersen V.

Institute of Preventive Medicine, Copenhagen Health Services, Municipal Hospital of Copenhagen, Denmark.

The aim of this work was to compare and validate seven different methods for estimating changes in fat free mass, in patients suffering from rheumatoid arthritis. Measurements were made of fat and fat free mass before and after 12 weeks on an energy restricted, protein rich diet and physical training. The subjects were sixteen female and three male overweight out-patients (mean body mass index at baseline: 30 kg/m2) suffering from rheumatoid arthritis, according to the criteria of the American Rheumatism Association. Fat free mass was estimated by eight different body composition methods (a four-compartment model, total body water, total body potassium, impedance, near infrared interactance, creatinine excretion, body mass index and skinfold measurements). Mean weight loss was 2.7 kg fat and 1.7 kg fat free mass. There was no difference between measurements of mean change in fat free mass by the four-compartment model and the other methods, except for the creatinine method (P = 0.03). Compared to the four-compartment method, the total body water method gave the most accurate estimate of individual fat free mass changes (residual Mean Square: 0.4 kg), second to this method, the impedance method, seemed most valid (residual Mean Square: 0.8 kg). Accuracies of the other methods were lower (residual Mean Square between 4.2 and 8.2 kg [corrected]). Of eight methods for estimating changes in FFM, the TBW method gave the most accurate estimate of individual FFM changes, compared to a four-compartment model used as reference.

PMID: 7894520 [PubMed - indexed for MEDLINE]

Recent research has also indicated that being overweight is a problem as well. Fat cells produce leptins, proteins that aggravate inflammation.

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