Plant-based diet with exercise as effective as drugs in reducing RA symptoms

Plant-based diets are once again showing off their health benefits. This time it’s associated with reduced disease activity in people with rheumatoid arthritis (RA), especially when used in conjunction with physical activity and stress reduction.Researchers behind the 'Plants for Joints’ (PFJ) study even suggested that RA medication can be reduced in people with mild to moderate disease after they switch to a lifestyle that includes a plant-based diet and exercise.Other studies investigating the effect of multi-faceted interventions have been shown to help patients with coronary artery disease, low-grade prostate cancer, and to improve metabolic markers. Such interventions include increased intake of plant-based foods, little or no meat (especially red meat), increased physical activity, stress reduction and social support.But these approaches, in combination, “have not been tested in one integrated intervention in patients with RA,” said Dutch researchers in Rheumatology. Yet the RA population has a higher incidence of coronary heart disease and diabetes mellitus than the general population. It makes sense that introducing a healthier lifestyle might benefit these patients, too, they said. A plant-based diet was of interest because of the increased amount of fibre. Increasing numbers of studies show fibre plays important roles in supporting healthy gut flora and reducing inflammation.The PFJ study compared a multidisciplinary lifestyle program to usual care in patients with moderately active RA to determine whether the intervention decreased disease activity. The PFJ intervention consisted of a whole food plant-based diet, physical activity, stress-reduction techniques and sleep hygiene. The study ran for 16 weeks. It was a parallel arm, randomized controlled trial in which participants with RA were randomized to the PJF protocol, or to a control group.People were included if they had an RA diagnosis according to the ACR/ EULAR 2010 criteria with low to moderate disease activity, that is, between a disease activity score for 28 joints (DAS28) of 2.6 up to 5.1, and were on stable treatment with DMARDs or were off DMARD-treatment for at least three months. A total of 77 adults completed the study, had a mean age of 55 years and 92% were female. Of these, 40 were randomized to the PFJ group and there were 37 controls. At baseline, participants had an average BMI of 26 kg/m2, and 74% were seropositive for RF or ACPA. Overall, 56 (73%) participants used DMARDs and at baseline 17 did not use medications for RA.The PFJ group received theoretical and practical education from a dietician and physical therapist about a whole-food plant-based diet, physical activity and exercise, as well as stress management in groups of six to 12 people. They had in-person meetings and other supporting material.For the diet, the study used the 2015 Guidelines on Healthy Nutrition of the Health Council of the Netherlands, while physical activity followed the 2017 Dutch physical activity guidelines. Physical activity included 150 minutes per week of moderately intense physical activity, and two days per week muscle and bone-strengthening activities, as well as guidance and coaching. The control group continued with usual care and advised not to change their lifestyle habits during the 16-week study. Clinical visits were conducted at baseline, eight and 16 weeks.The results showed that by the end of 16 weeks, the PFJ group had a greater decrease in DAS28 than the control group. “At 16 weeks, 17 participants from the PFJ group and three participants from the control group met the criteria for EULAR Good Response,” the study said. And in the PFJ group, 18 participants had a DAS28 of less than 2.60 after 16 weeks.“The result exceeded the minimal clinically important improvement of 0.8 DAS28 points and is comparable to what is generally achieved in drug trials,” Wendy Walrabenstein, study co-author and is a PhD researcher at Reade rehabilitation and rheumatology at Amsterdam UMC, told the Medical Post. A small number of patients in both groups changed medication. “The net effect of all medication changes was a less intensive treatment in the PFJ group when compared with the control group,” she said. Weight loss and reduced fat mass were significantly larger in the PFJ than in the control group. The between-group differences were 3.9 and 2.8 kg, respectively, a difference that was statistically significant.As for metabolic measures, people in the PFJ group had a notably greater decrease HbA1c and LDL than the control group. Other metabolic parameters showed only minor differences between the groups.At the start of the study, the intake of saturated fat was high in both groups at an average of 13% of total energy intake; recommendations are for less than 10%. Fibre intake was low at an average of 13 g/1000 kcal with recommendations setting a goal of at least 14 g/1000 kcal.Halfway and at the end of the intervention, the PFJ group reached an intake of saturated fat of 8%-to-9% of total energy intake, and a range of fibre intake of 20 to 21 g/1000 kcal). The control group also improved although to a lesser extent and did not necessarily meet the levels recommended in guidelines.The results, overall, showed the combination of a plant-based diet, exercise and stress reduction “show that PFJ is a promising treatment for people with both seropositive and seronegative RA. It can also be combined with drug treatment, and the improvement was found in both seropositive and seronegative subgroups. This is an interesting study, said Dr. David Jenkins, a physician and professor of nutrition sciences at the University of Toronto. He was not involved in the study.“It sounds reasonable that a diet that reduces diabetes, CVD and certain cancers should improve rheumatoid arthritis,” he said. There would be “less heme iron and more plant phenolics all of which may reduce inflammation,” he said.

Plant-based diet with exercise as effective as drugs in reducing RA symptoms

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