To eat or not to eat—an exploratory randomized controlled trial on fasting and plant-based diet in rheumatoid arthritis (NutriFast-Study)

Abstract

BackgroundFasting is beneficial in many diseases, including rheumatoid arthritis (RA), with lasting effects for up to 1 year. However, existing data dates back several decades before the introduction of modern therapeutic modalities.ObjectiveThis exploratory RCT compares the effects of a 7-day fast followed by a plant-based diet (PBD) to the effects of the dietary recommendations of the German society for nutrition (Deutsche Gesellschaft für Ernährung, DGE) on RA disease activity, cardiovascular (CV) risk factors, and well-being.MethodsIn this RCT we randomly assigned 53 RA patients to either a 7-day fast followed by an 11-week PBD or a 12-week standard DGE diet. The primary endpoint was the group change from baseline to 12 weeks on the Health Assessment Questionnaire Disability Index (HAQ-DI). Further outcomes included other disease activity scores, body composition, and quality of life.ResultsOf 53 RA patients enrolled, 50 participants (25 per group) completed the trial and were included into the per-protocol analysis. The primary endpoint was not statistically significant. However, HAQ-DI improved rapidly in the fasting group by day 7 and remained stable over 12 weeks (Δ-0.29, p = 0.001), while the DGE group improved later at 6 and 12 weeks (Δ-0.23, p = 0.032). DAS28 ameliorated in both groups by week 12 (Δ-0.97, p < 0.001 and Δ-1.14, p < 0.001; respectively), with 9 patients in the fasting but only 3 in the DGE group achieving ACR50 or higher. CV risk factors including weight improved stronger in the fasting group than in the DGE group (Δ-3.9 kg, p < 0.001 and Δ-0.7 kg, p = 0.146).ConclusionsCompared with a guideline-based anti-inflammatory diet, fasting followed by a plant-based diet showed no benefit in terms of function and disability after 12 weeks. Both dietary approaches had a positive effect on RA disease activity and cardiovascular risk factors in patients with RA.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03856190, identifier: NCT03856190.

Post Hoc Analysis of a Randomized Controlled Trial on Fasting and Plant-Based Diet in Rheumatoid Arthritis (NutriFast): Nutritional Supply and Impact on Dietary Behavior

“…We have previously reported on the benefits of fasting followed by a plant-based diet (PBD) on disease activity and cardiovascular (CV) risk factors in RA. The positive impact was comparable to that of an anti-inflammatory diet based on the recommendations of the German Nutrition Society (Deutsche Gesellschaft für Ernährung, DGE) [ 10 ]. The similar performance of the two groups prompted us to question (i) whether the nutritional counselling provided was reflected in actual dietary behaviors and (ii) whether it actually resulted in the two distinctively different behavioral groups that were intended by randomization.…”

“…This does not necessarily indicate the inefficacy of the interventions or the dietary counselling. First, our study interventions improved RA disease activity to similar degrees in both groups [ 10 ]. Second, previous studies also support dietary interventions’ effectiveness and their impact on eating behaviors.…”

“…The present study is a post-hoc analysis of a randomized controlled clinical trial (NutriFast) that we reported earlier [ 10 ]. The study design has been described elsewhere in detail [ 17 ].…”

Fasten – ein potentes Therapeutikum der Moderne

“…Allerdings gibt es keine Daten darüber, ob auch die Progression der Gelenkdestruktion und Prognose der Erkrankung durch Fasten verbessert werden kann. Auch aus neueren Daten lässt sich ableiten, dass ein therapeutisches Fasten über mindestens 7 Tage, gefolgt von einer Umstellung auf eine möglichst pflanzenbasierte Ernährung, bei der Behandlung von rheumatoider Arthritis unterstützen kann [7].…”

“…Einerseits kann es als Einstieg in einen gesünderen Lebensstil genutzt werden, unter anderem, weil Fasten Gewohnheiten durchbrechen und die Selbstwirksamkeit stärken kann 6 . Andererseits hat sich gezeigt, dass mit Fasten bei den genannten Erkrankungen eine schnelle Beschwerdelinderung erreicht werden kann 7 . Diese kurzfristige klinische Symptomverbesserung kann, gepaart mit einer Ernährungsumstellung, auch längerfristig aufrechterhalten werden 8 .…”