In Europe, especially Scandinavian countries, the view that short periods of fasting and even vegetarian diets are beneficial in the treatment of rheumatoid arthritis is becoming increasingly popular and has become an everyday topic of conversation among patients with inflammatory joint disease.
Previous published studies claim to show that fasting may have positive effects on the symptoms. The purpose of the 1979 Swedish study was to investigate the effects of both fasting and a semi-vegetarian diet in patients with rheumatoid arthritis (RA).
Patients and Methods
26 patients with confirmed RA (using the criteria of the American Rheumatism Association), were involved in this 12 week study. All 26 patients were taking a non-steroidal anti-inflammatory drug daily. 5 of the patients were also taking additional anti-arthritic drugs. With the exception of the fasting period, all patients were encouraged to continue medication throughout the study. 16 randomly selected patients were subsequently started on a fast, lasting from 7 to 10 days, and the other 10 patients functioned as the control group. (One woman stopped the fast after only 2 days.) In order to mimic the practices of the so-called European “health farms” the investigators used a modified fast, encouraging a daily caloric intake of 800 Kcal from fruit and vegetable juices, plus tea derived from common herbs 4 times a day. Immediately after the fast, a plain vegetarian diet was begun and continued for the next 9 weeks at home. No animal or fish protein (including eggs) was allowed. Fresh milk and cream were discouraged, but yogurt was allowed freely. Grains were also allowed in smaller quantities. No alcohol, tobacco, coffee, or regular tea was permitted, and patients were asked to restrict the intake of salt, sugar, and white flour.
Just prior, and over the period of the study, blood chemistry and physical and functional measurements were performed.
Most of the 15 fasting patients said they felt better from the 5th or 6th day of fasting. At the end of the fast 10 reported reduction in pain, 5 reported no change, and none of the 15 showed or expressed an increase in pain. Stiffness was also reduced, but to a lesser degree than pain. Five of the 15 patients showed objective improvement within the 7 to 10 day period, defined as decrease in the sedimentation rate (ESR) of more than 10% and concomitant decrease in overall joint tenderness.
The fasting patients showed a statistically significant reduction in pain, stiffness, overall tenderness, and joint swelling, as well as an improvement in the ring-size test. The ESR was reduced in 8 patients, unchanged in 4, and increased in 3. Very few side effects were experienced during the short fasting period.
The 10 control rheumatoid arthritics showed no reduction in pain or stiffness and none showed any objective improvement according to the criteria alluded to above.
The semi-vegetarian diet group showed no change in pain, stiffness, or consumption of analgesics. The feeling of well-being experienced by the majority of the fasting subjects at the end of the fast lasted for about 2 to 3 weeks into the vegetarian diet that followed. Objectively only one of 14 was improved according to the above criteria.
Discussion and Comments
Even in healthy people the impact of short-term and long-term fasting has not been thoroughly investigated. The findings in the study clearly indicate that both subjectively and objectively many of the rheumatoid arthritics experienced improvement on a juice and herbal tea fast. Theories abound, but one increasingly popular theory, discussed at the recent Fifth International Symposium on Food Allergy (Atlanta, Georgia, Nov. 1984), is the possible causative or contributory role of delayed (Type II & III) food allergic reactions, secondary to food antigen-antibody immune complex deposition into arthritic tissues. If this proves to be a valid hypothesis, some comment is needed with regards to the structure and content of the above study. Food Allergy Update (Volume 2, Number 2, February 1985) discussed the abnormal permeability or “leakiness” to large molecules in association with continual use of NSAIDs (non steroidal anti-inflammatory drugs). If this is true, and it is also true that delayed food allergy is associated with such gut leakiness, all the patients in this study were made food allergy-prone throughout the study, since all of them were medicated with NSAIDs and other anti-inflammatory drugs. Secondly, the semi-vegetarian diet subsequently followed contained allergenic foods – milk and grains. If food allergy plays an important role in the etiology or exacerbation of RA, one would not expect or predict a continuous improvement after fasting with the reintroduction of common food allergens into the diet (milk and grain).
Skoldstam, I. Larsson, I., and Lindstrom, F.: Effects of fasting and lactovegetarian diet on rheumatoid arthritis, Scandinavian Journal of Rheumatology 8:249-255, 1979.
1) Josefsson, E., Lindahl, O. & Myrnerts, R.: Dietary treatment of rheumatoid arthritis. Excerpta Medica 299:XIII International Congress of Rheumatology. Suppl. 39: 10, 1973.
2) Lindbert, E.:Konnen Ernahrungsgaktoren die chronische Polyarthritis beeinflussen? Z Physiotherapie 25: 119-129, 1973.