Dietetic Treatment of Chronic Arthritis and Its Relationship to the Sugar Tolerance

Abstract

The importance of diet in the treatment of chronic arthritis is a question on which there is today considerable difference of opinion. In practice, its effect, as a rule, is confused by the establishment of several forms of treatment at one time, such as the removal of infectious foci, rest in bed, electrotherapy and hydrotherapy and other hygienic measures. It is, however, the experience of many observers that improvement is often brought about by changes in diet alone. But as to the character of this change, difference of opinion also exists. Increase in diet is recommended by some and decrease by others, or reduction of proteins in one case and reduction of carbohydrates in another. Sometimes improvement has been so marked as to lead older clinicians to believe that the disease had a metabolic basis, but clinical and laboratory investigation has not offered much evidence to support this hypothesis. In fact, interest has been more directed toward the part played by bacteria in the causation of this disease, and recent work has resulted in the general belief that chronic arthritis\p=m-\withthe exception of those cases due to trauma, strain, gout, some neuropathy, scurvy and hemophilia-is the result of a bacterial process. It is, therefore, natural that the origin of such infection should be looked for, infectious foci removed, vaccines administered, and, if necessary, some form of nonspecific protein therapy utilized. These measures are often attended by marked success, but sometimes results are disappointing, and if improvement occurs, it is often of a temporary nature. In spite of this belief that the condition is a bacterial disease, there are still clinicians who insist on the importance of diet in its treatment. Pemberton,1 especially, has for many years advised careful dietetic regulation-recommending a general reduction of the food intake, and laying special stress on the restriction of carbohydrates. In our own clinic, we have been impressed with the value of this recommendation in many cases. And, further, in those cases which receive benefit from such treatment, there has been as much clinical evidence of infection as in those which are refractory to such measures.

Chronic Nonspecific Arthritis

“…As already noted, this finding has no special significance, since it has been reported in nonrheumatic as well as rheumatic cases. Furthermore, it must be borne in mind that both types of nonspecific arthritis have been produced experimen¬ tally by aseptic processes, such as ligation of the blood supply to the patella 42 This work received corroboration from Fletcher 46 and served as a basis for a marked restriction of carbo¬ hydrate intake to sufferers from rheumatoid arthritis. A careful analytic study 47 was conducted at the Cornell Clinic in 1929 to check Pemberton's results.…”

Changes in the Glucose Tolerance of Obese Subjects After Weight Reduction

“…One of these 3 patients was the only subject over 70 years old included, and her advanced age may have directly affected the glucose tolerance test (26,27). The fourth patient in the group was suffering from arthritis, and it has been repeatedly reported (28,29,30) that most of the patients with this disease have abnormal glucose tolerance curves. However, 3 other patients with arthritis showed an improvement in tolerance following the period of therapy, and it is probably not proper to place great emphasis upon the presence of this disease as an explanation of the failure in this instance.…”