lecture 9b 16 november 2015 arthritis, dermatitis, migraine
TRANSCRIPT
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Lecture 9b 16 November 2015 Arthritis, Dermatitis, Migraine
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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
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Rheumatoid arthritis (RA) -autoimmune attack that in part involves loss of chondroitin sulphate and glucosamine
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Nutrition approaches to Arthritis
-appropriate nutrition and exercise may prevent weight gain thus avoiding that cause of osteoarthritis
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Nutrition approaches to Arthritisnutraceuticals
-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
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Nutrition approaches to ArthritisNutraceuticals
-fish oils reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory 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
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Comments specific to rheumatoid arthritis
Nutritional imbalance a) protein energy malnutrition b) anorexia c) gastrointestinal involvement
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Comments specific to rheumatoid arthritisNutritional 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
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Comments specific to rheumatoid arthritis
Nutritional imbalance
Gastrointestinal tract involvement
-malabsorption of nutrients giving rise to a decrease in nutrient uptake
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Comments specific to rheumatoid arthritis Selenium
-anti-inflammatory and immunomodulatory
-down in rheumatoid arthritis patients’ plasma
however- most Se supplementationtrials no real improvement in disease even
when normal plasma levels restored
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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
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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 clinicalimprovement in RA
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Comments specific to rheumatoid arthritisVitamin 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
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Comments specific to rheumatoid arthritis
Histidine
low serum levels in RA correlates with disease activity (clinical and laboratory measures)
histidine supplementation does not work
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Comments specific to rheumatoid arthritisDietary 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
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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
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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
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Comments specific to rheumatoid arthritisDietary 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
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Comments specific to rheumatoid arthritisDietary 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)
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Dietary therapy
Supplementation therapy-Nutraceuticals
Evening primrose oilBorage oilBlackcurrant oilFish 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
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Class activity-what is the best nutritional approach to arthritis? Why?
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Dermatitis
Atopic (eczema)
-skin inflammation that is due to an immune response
-can be due to a food allergy
-solution -avoid food allergen
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Dermatitis-nutraceutical
-fish oils reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory 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 drugs- what is the impact of this?
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Dermatitis
Sebborheic (scaly)
-can be due to biotin deficiency
solution: avoid biotin deficiency
- can be due to riboflavin deficiency
solution: avoid riboflavin deficiency
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Scaling eczema-like dermatitis
-can be due to linoleic or a-linolenic acid deficiency
-this may be a problem with long term TPN
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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
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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
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Migraine
Foods contributing to migraine:
Citrus foodsTea(flavonoids)CoffeePorkChocolateMilkNutsVegetablesCola
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Migraine
-food components affecting vascular tone and causing migraine (highly individual):
tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate), aspartame, caffeine
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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
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Migraine -solution to all this is trial and error elimination
of foods including meticulous record keeping