Lecture 9b 16 November 2015 Arthritis, Dermatitis, Migraine

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

Rheumatoid arthritis (RA) -autoimmune attack that in part involves loss of chondroitin sulphate and glucosamine

Nutrition approaches to Arthritis -appropriate nutrition and exercise may prevent weight gain thus avoiding that cause of osteoarthritis

Nutrition approaches to Arthritis nutraceuticals -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

Nutrition approaches to Arthritis Nutraceuticals -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

Comments specific to rheumatoid arthritis Nutritional imbalance a) protein energy malnutrition b) anorexia c) gastrointestinal involvement

Comments specific to rheumatoid arthritis Nutritional 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

Comments specific to rheumatoid arthritis Nutritional imbalance Gastrointestinal tract involvement -malabsorption of nutrients giving rise to a decrease in nutrient uptake

Comments specific to rheumatoid arthritis Selenium - anti-inflammatory and immunomodulatory -down in rheumatoid arthritis patients’ plasma however- most Se supplementation trials no real improvement in disease even when normal plasma levels restored

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

Comments specific to rheumatoid arthritis Vitamin B 6 decreased in RA patients’ plasma Decreased plasma B 6 correlated with degree of inflammation and levels of pro-inflammatory cytokines However B 6 supplementation- no clinical improvement in RA

Comments specific to rheumatoid arthritis Vitamin 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

Comments specific to rheumatoid arthritis Histidine low serum levels in RA correlates with disease activity (clinical and laboratory measures) histidine supplementation does not work

Comments specific to rheumatoid arthritis Dietary 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

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

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

Comments specific to rheumatoid arthritis Dietary 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

Comments specific to rheumatoid arthritis Dietary 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)

Dietary therapy Supplementation therapy-Nutraceuticals Evening primrose oil Borage oil Blackcurrant oil Fish oils  6 and  3 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

Class activity-what is the best nutritional approach to arthritis? Why?

Dermatitis Atopic (eczema) -skin inflammation that is due to an immune response -can be due to a food allergy -solution -avoid food allergen

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?

Dermatitis Sebborheic (scaly) -can be due to biotin deficiency solution: avoid biotin deficiency - can be due to riboflavin deficiency solution: avoid riboflavin deficiency

Scaling eczema-like dermatitis -can be due to linoleic or  -linolenic acid deficiency -this may be a problem with long term TPN

Nutritional remedy for dermatitis (types above) in general -topical application of retinoids (similar in structure to vitamin A) -reduces dermatitis -avoid linoleic or  -linolenic acid deficiency

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

Migraine Foods contributing to migraine: Citrus foods Tea(flavonoids) Coffee Pork Chocolate Milk Nuts Vegetables Cola

Migraine -food components affecting vascular tone and causing migraine (highly individual): tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate), aspartame, caffeine

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

Migraine -solution to all this is trial and error elimination of foods including meticulous record keeping