Nov. 19, 1999 (Boston) -- The debilitating effects of chronic rheumatoid arthritis can be softened -- if not always to a great degree -- by nutrition and exercise, according to Ronenn Roubenoff, MD, a nutritionist at the Tufts University School of Medicine. Roubenoff spoke to an audience of doctors here this week at a meeting of the American College of Rheumatology.
People with rheumatoid arthritis have twice the risk of dying compared to the general population, Roubenoff said. Reduced muscle mass contributes to that risk. The average 70-year-old has 30% less muscle than the average 25-year-old, said Roubenoff, and "if you lose 40%, you die."
Lack of muscle reserves, Roubenoff said, is one reason an elderly person who lands in the ICU after getting hit by a truck is so much more likely to die than a young person. "People who are acutely ill stop eating," said Roubenoff. But while fasting puts a normal, healthy person into a metabolic mode that burns fat and spares protein, under the stress of major trauma or illness, the body burns its own protein.
People with rheumatoid arthritis need to eat more protein than normal, healthy individuals, said Roubenoff, who recommends eating about 2.7 ounces of protein daily. That's roughly equivalent to one 4 ounce chicken breast or two servings of beans.
But simply eating more protein does not result in increased stores of protein in the body, said Roubenoff.
The problem is that the body stores protein as fat, because muscle is not being built. Resistance exercise -- which involves leg lifts and arm exercises using weights -- helps build muscle so that protein can be stored.
Also, certain important B vitamins are often deficient in people with rheumatoid arthritis, Roubenoff said. "The three we worry about are B6, B12, and folate. Supplements are important, particularly for elderly people, some of whom lose the ability to absorb B12 from food. "They can still absorb it from pills," said Roubenoff.
Much of the damage rheumatoid arthritis inflicts upon the body is probably the result of so-called "free radicals," said Roubenoff. Free radicals are fast-moving, destructive atoms -- created by smoking, inhaling pollutants, or being exposed to ultraviolet radiation from the sun. Free radicals circulate through the body, damaging cells, and are believed to cause many chronic diseases including rheumatoid arthritis, heart disease, cancer, Alzheimer's disease, and Parkinson's disease.
"European studies suggest that large doses of vitamin E have a good effect [in combating free radicals], Roubenoff said. "The rationale is that anything that increases free radical production lowers the body's ability to defend itself against damage. People with rheumatoid arthritis not only have increased free radicals, but reduced vitamin E, C, and beta carotene," which may result from using up these antioxidants. Vitamin E in particular has been shown to relieve pain in "a few small studies from Germany," Roubenoff tells WebMD. He recommends 200 mg/d.
But Roubenoff said that beta carotene can be damaging under certain conditions such as kidney and liver disease, and that with vitamin C, "you take a lot and pee most of it out." Nonetheless, "overall there is some evidence of benefit, and very little evidence of harm" from antioxidants generally, Roubenoff tells WebMD.
But supplements should not substitute for a diet high in fruits and vegetables. "The world's dumbest diet is as smart as the smartest nutritionist," he said, alluding to "extremely strong" data showing that diets high in fruits and vegetables prevent cancer.
For the typical rheumatoid arthritis sufferer, fish oil appears to reduce damage caused by the overactive immune system. "The intake that seems to work for rheumatoid arthritis is on the order of 6 grams [of protein] a day," said Roubenoff. This would equate to eating three fish meals a day. Instead, he recommends pills. "The downside: you burp fish. But borage seed oil is an alternative."
Certain foods, such as nightshade vegetables -- potatoes, tomatoes, and eggplant, for example -- frequently are blamed for causing arthritic flares, said Roubenoff. But studies have showed this occurs in only 1-2% of patients. But in most cases, any association of foods with flares is "pure coincidence." He advises patients to try any food several times -- to make sure it's the culprit -- before cutting back on it. "[People with arthritis] do not need unnecessary food restrictions," he said.
- People with chronic rheumatoid arthritis can improve the symptoms of their disease with proper nutrition and exercise.
- Because these patients have reduced muscle mass, they should eat more protein than a normal, healthy individual and do resistance exercises that help build muscle.
- Vitamins B, E, C, and fish oil supplements can also help these patients. Some patients associate certain foods with flare-ups, but in most cases this is purely a coincidence.