Insights & Discussion
Dietary strategies, such as caloric restriction and ketogenic diets, can alleviate chronic pain and enhance quality of life.
This systematic review selected 16 articles from various databases including PubMed, Web of Sciences, ProQuest, and Scopus that were published within the last 6 years. These consisted of randomized clinical trials (RCTs), observational studies, and systematic reviews evaluating the effectiveness of different dietary strategies in the treatment of chronic pain. A range of assessment scales—PEDro, PVI, QUALSYT and the Quality Assessment Tool of Systematic Reviews scale— were utilized to gauge the risk of bias in these studies.
The findings indicate an inconclusive consensus on the impact of an intermittent fasting (IF) diet on pain improvement. However, a caloric restriction diet emerged as a potential long-term treatment option for pain. Additionally, time-restricted food and ketogenic diets showed promising results in improving life quality in chronic conditions. Despite some studies indicating opposite results, the majority of the selected articles exhibited good methodological quality on their respective assessment scales.
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Intermittent fasting may potentially influence autoimmune diseases like type 1 diabetes and rheumatoid arthritis, by reducing inflammation and supporting cellular repair mechanisms.
2023 Autoimmunity Reviews Intermittent fasting: A promising dietary intervention for autoimmune diseases Barati M, Ghahremani A, Namdar Ahmadabad H
Systematic Review Autoimmune Diseases Intermittent Fasting Rheumatoid Arthritis
Extensive research was done through several electronic databases such as PubMed, Scopus, Embase, and Web of Science. Rigorous inclusion criteria were applied to filter the most relevant studies on the effects of intermittent fasting on autoimmune diseases. No reference to further research trials was mentioned in the methodology.
The results indicate a potential link between intermittent fasting and the management of certain autoimmune diseases. Autoimmune diseases like type 1 diabetes, rheumatoid arthritis, and systemic lupus erythematosus exhibited improvements owing to the reduction in inflammatory markers, improvement in gut microbiota, and enhanced cellular repair resulting from autophagy induced by intermittent fasting. However, results concerning other autoimmune diseases like multiple sclerosis, systemic lupus erythematosus, thyroid diseases, and psoriasis were inconclusive.
Fasting followed by a plant-based diet positively impacts disease activity and cardiovascular risk factors in rheumatoid arthritis patients.
2022 Annals of the Rheumatic Diseases POS0583 RHEUMATOID ARTHRITIS BENEFITS FROM FASTING AND PLANT-BASED DIET: AN EXPLORATORY RANDOMIZED CONTROLLED TRIAL (NUTRIFAST) Hartmann AM, Kandil FI, Steckhan N, Häupl T, Kessler CS, Michalsen A, et al.
Randomised Controlled Trial Intermittent Fasting Plant-Based Diet Rheumatoid Arthritis
In the pilot study, patients with rheumatoid arthritis (RA) were split into two groups: one underwent a 7-day fast (consuming no more than 250 calories per day), followed by 11 weeks of a plant-based diet; the other was provided with conventional nutritional counseling according to the recommendations of the German Society for Nutrition for a total of 12 weeks. Disease activity and treatment responses were evaluated at the beginning of the experiment, day 7, week 6, and week 12.
The results showed improvements in disease activity in both the fasting and conventional nutritional counseling groups. Noteworthy was the fact that the fasting group started showing improvements by day 7 as opposed to week 6 in the conventional group. Additionally, cardiovascular risk factors, such as weight and total cholesterol levels, showed more marked improvement in the fasting group compared to the conventional group. These improvements were found to be independent of any antibody status, intervention delivery method, or previous eating habits.
Intermittent fasting during Ramadan can lead to rapid improvement of rheumatoid arthritis activity, with positive effects lasting up to three months.
2021 Clinical Rheumatology Sustainable positive effects of Ramadan intermittent fasting in rheumatoid arthritis Ben Nessib D, Maatallah K, Ferjani H, Triki W, Kaffel D, Hamdi W
Cohort Study Intermittent Fasting Rheumatoid Arthritis
In this prospective study, 35 patients with rheumatoid arthritis participated in fasting during Ramadan 2019. Their disease activity was assessed at three different time points: six months prior to the beginning of Ramadan, during the month between the seventh day of fasting and seventh day post Ramadan, and approximately 3.4 months after fasting. The disease activity score 28 was used to evaluate the activity of the disease.
A significant decrease in all disease activity parameters was observed from the time six months prior to Ramadan to the time during fasting, followed by a gradual increase of clinical and biological outcomes between the end of fasting and the months following. However, the decrease of specific disease indicators that resulted from the Ramadan fast was maintained until the time point 3.4 months after fasting, despite the increasing trend. Thus, the overall improvements from fasting were found to be sustained for at least 3 months after the end of the Ramadan fasting period.
The ketogenic diet, by reducing carbohydrate intake, shows potential in weight loss, insulin requirement reduction, and mitigation of inflammatory symptoms in patients with inflammatory arthritis.
2021 Frontiers in Medicine The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review Ciaffi J, Mitselman D, Mancarella L, Brusi V, Lisi L, Ruscitti P, et al.
Review Article Cardiovascular Disease Ketogenic Diet Rheumatoid Arthritis
The ketogenic diet operates on the principle of substantially limiting carbohydrate consumption with a daily calorie percentage between 5-10%, facilitating a metabolic switch towards the use of ketone bodies. Studies indicate promise in a variety of applications including weight loss, insulin requirement minimization in diabetes, cancer protocol supplementation, neurological treatment, and control optimization for metabolic and cardiovascular diseases. Although literature on the anti-inflammatory properties of the ketogenic diet on rheumatic diseases is somewhat limited, their beneficial effects on weight loss are evidenced by related biomechanical and biochemical factors.
Obesity is recognized to stimulate macrophage activation and generate pro-inflammatory cytokines including TNF-α, IL-1b, and IL-6. Furthermore, scientists believe that the ketogenic diet’s primary clinical effect could be linked to the enhancement of insulin sensitivity. Insulin resistance demonstrates a correlation with increased TNF-α, IL-1α, IL-1β, IL-6, and leptin. Additionally, reduction in body adipose tissue and weight loss contribute to the anti-inflammatory effects and their impact on cardiovascular health.
Within the context of rheumatoid arthritis, fasting has been shown to reduce disease symptoms, potentially through the production of a key ketone body, β-hydroxybutyrate, which may also stifle IL-17. This, combined with intermittent fasting, was shown to provide symptomatic improvements in psoriatic arthritis. However, the current literature does not allow for definitive conclusions regarding the effects of a ketogenic diet on ankylosing spondylitis.
Ramadan fasting can induce rapid improvement in rheumatoid arthritis and spondyloarthritis activity without significantly affecting medication compliance or tolerance.
2020 Clinical Rheumatology Impact of Ramadan diurnal intermittent fasting on rheumatic diseases Ben Nessib D, Maatallah K, Ferjani H, Kaffel D, Hamdi W
Cohort Study Intermittent Fasting Rheumatoid Arthritis
In the methodology, this study was a prospective, monocentric one that included patients with either rheumatoid arthritis or spondyloarthritis who partook in Ramadan fasting in 2019. The disease activity and management of chronic medications were assessed and compared in two visits - one six months before Ramadan fasting began and a second one after at least seven days of fasting.
In the results, the study found that both rheumatoid arthritis and spondyloarthritis activity, as measured by Disease Activity Scores, decreased after patients fasted during Ramadan. In contrast, compliance with chronic medications and tolerance did not significantly change. These findings suggest fasting can be a potentially effective approach to improving disease activity in patients with rheumatoid diseases. Moreover, these findings provide reassurance to patients who may have fears about medication intake during Ramadan, which could improve adherence to treatment.
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