ABSTRACT
The majority of double-blind placebo-controlled trials have shown that 30-40% of rheumatoid arthritis (RA) patients can improve substantially by using an elimination diet to identify foods that precipitate symptoms and the avoiding of these foods. Some such patients have discontinued drug treatment and remained well for 12 years or more. Prior to the elimination diet, most patients had not recognised diet as a trigger for their symptoms, because the offending foods were eaten daily. (Foods eaten infrequently can also provoke sensitivity, resulting in episodic arthritis.) Additionally, many RA patients are sensitive to several foods, making a rigorous elimination diet essential for diagnosis. The pattern of response to an elimination diet (30-40% of RA patients respond well; response occurs within 10-21 days; benefits are maintained if offending foods are avoided) is markedly different from the pattern of response to a fast (almost all RA patients respond well; response occurs within 3-5 days; benefits are lost rapidly when a normal diet is resumed). Clearly fasting and the elimination diet have different therapeutic mechanisms. The effect of fasting may be mediated by the absence of dietary fat, leading to a shortage of pro-inflammatory prostaglandins and leukotrienes. The mechanism by which food sensitivity is involved in rheumatoid arthritis remains unknown, but weight loss is definitely not responsible for the improvement seen on an elimination diet. Some evidence implicates the gut flora. Food-sensitive RA patients may also show changes in immune parameters during an elimination diet, but no consistent universal change has yet been found.
