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FAQ in Clinical Practice • อาหารเสริมกับโรคข้อ • แคลเซี่ยมกับกระดูกงอก • Gout กับการกินอาหาร • ไข่ลวกกับโอวัลตินเป็ นอาหารบารุงหรือไม่ • ชาเขียวมีประโยชน์จริงหรือ (separate file) • น้ าลูกยอมีประโยชน์จริงหรือ (separate file) Suggestion diet in RA Balance, healthy diet for ideal weight evidence support reduce red meat eat more fish (eg. mackerel, sardines) three or four times a week. Suggestion diet in Gout reduce purine rich diet especially from animal protein consume low fat daily product eg. skim milk, yogurt avoid alcohol consumption particularly beer drink more water evidence support กลับเมนูหลัก Scientific Backgroud Diet for RA Next Diet and arthritis Little scientific evidence confirming the benefits of modified diets for patients with arthritis, and mostly focus on diet and RA Consumption of large amounts of red meat linked to development of RA Possible explanations: • proinflammatory property of meat fats from iron accumulated in syn tissue • collagen sensitization from a high level of protein intake • the role of nitrite and nitric oxide • infectious mechanisms such as alterations in intestinal flora Pattison DJ, Symmons DPM, Lunt M et al. Dietary risk factors for the development of inflammatory polyarthritis. Evidence for a role of high level of red meat consumption. Arthritis Rheum 2004; 50: 3804-3812. Next Diet and arthritis increase in intake of 30 g fat fish per day 49% reduction in the risk of RA Whereas medium fat fish (3-7 g fat/100 g fish) significantly increased risk Intake of fruit and coffee was not associated with risk of RA no associations were found between risk of RA and other dietary factors: (long chain FA, olive oil, vitamins A, E, C, D, zinc, selenium, iron, and meat. J Rheumatol. 2005 Jul;32(7):1249-52 Next Fish oil could help ? essential fatty acids (EFAs) Prostaglandins, leukotrienes inflammation in RA the right balance of EFAs is important to control inflammation. Next There are two groups of EFAs: omega-3 found naturally in oily fish (mackerel, sardines, pilchards, salmon) main omega-3 = EPA & DHA fish liver oil (cod or halibut) also contains these EFAs & vit D, helps the body to absorb calcium omega-6 the best known source is evening primrose oil, also in sunflower oil. main omega-6 = GLA Back Scientific Backgroud Diet for RA Next Diet and Gout association of purine-rich foods with gout had long been suspected but never proven Health Professionals Follow-up Study 47,150 men with no history of gout at baseline 12-year FU (1986-1998) 730 men developed gout N Engl J Med. 2004;350:1071-1073, 1093-1103 Next Diet and Gout • Incidence of gout = 1.0-1.8 / 1,000 • high intake of meat & seafood consumption risk of gout (RR 1.4-1.5) • high intake of low-fat dairy products (skim milk,yogurt) risk. (RR 0.5) • for seafood intake risk of gout was stronger for men with BMI < 25 beef, pork, and lamb were the worst offenders in the meat group Next Diet and Gout for this population purine-rich vegetables (peas, beans, mushrooms, cauliflower, and spinach) over all protein intake, alcohol, and BMI did not associated with an increased risk of gout. there was a potential protective effect from vegetable and dairy proteins Next Diet and Gout Milk proteins (casein and lactalbumin) reduce serum uric acid levels in healthy subjects ( uricosuric effect ) four weeks of a dairy-free diet associated with a significant increase in uric acid levels June 1995 issue of the European Journal of Epidemiology, Next Diet and Gout "Dietary manipulation and behavioral modification to reduce risk of gout may have a much more substantial impact than currently believed “ Individual who have family history of gout are at high risk "Reducing red meat consumption may be recommended because it also has been associated with such problems as colon cancer and diabetes” healthy foods such as vegetables do not need to be restricted Next Gout and alcohol consumption The risk of gout is significantly raised with alcohol intake as low as 10.0 to 14.9 g / day with a dose-response relationship. Risk is 2.5 times higher in men who consume 50 g or more / day independent of BMI and other dietary factors Beer and liquor consumption carry the greatest risk, while moderate wine consumption does not increase risk of incident gout. Next Gout and alcohol consumption • For alcohol consumption of 5.0 to 9.9 g per day, the RR of gout was 1.3 • For daily consumption of 50 g or more per day, the RR was 3.02 for every 10 g increase in daily alcohol consumption increase in RR = 1.17 Next Mechanism of ethanol in inducing hyperuricemia Both increased urate production and decreased urate excretion Beer having predominantly guanosine as its high purine content กลับเมนูหลัก Calcium and Osteophytes in OA In OA patients, no data supports the relationship between osteophyte formation and calcium supplement evidence support กลับเมนูหลัก Mechanism of osteophyte formation in OA Although osteophyte is viewed as a remodelling and reparative feature of OA, the factors that determine osteophyte formation and growth are unknown. Growth factors (TGF-b, IGF-1) influence both chondrocyte synthesis and osteophyte formation in experimental joint damage. Evidence from animal and human studies shows that cartilage damage initiates "secondary" osteophyte growth. However, osteophyte may also develop as an isolated feature associated with age and precede rather than follow cartilage loss in animal studies. Next Mechanism of osteophyte formation in OA Joint instability has been emphasised as a biomechanical trigger to osteophyte formation, with osteophyte and bone remodelling being viewed as an attempt to stabilise and broaden the compromised joint to better withstand loading forces. Chondrocalcinosis due to calcium pyrophosphate crystals has also been suggested to be associated with a tendency to osteophyte formation and a "hypertrophic" form of OA. Possibly, multiple factors may influence osteophyte formation and contribute to the marked heterogeneity of OA. กลับเมนูหลัก ไข่ลวก กับ โอวัลติน High calorie diet with lower protein Raw egg incomplete protein digestion Mainly carbohydrate Ovaltin : nutritional fact Sugar added Small amount of protein กลับเมนูหลัก high calories