Patients with rheumatoid arthritis (RA) have increased cardiovascular disease (CVD) and
mortality. Several recent studies indicate an increased prevalence not only of cardiovascular disease (CVD) but also of atherosclerosis as determined by ultrasound of carotid arteries. The underlying mechanisms causing this increased risk are not wholly clarified but inflammation and disease duration are suggested to be of importance. Patients with rheumatoid arthritis RA also have a abnormal levels of LDL cholesterol, HDL cholesterol, and high triglycerides (TGs). Treatment with disease-modifying anti-rheumatic drugs has been shown to improve cholesterol levels some but not all patients. Studies suggest that the abnormal cholesterol levels are related to inflammation.
A gluten-free vegan diet during 1 year significantly reduced disease activity and decreased levels of antibodies to inflammation-causing proteins in patients with RA. Patients were allowed to continue on non-steroidal antiinflammatory drugs, oral glucocorticoids, and anti-rheumatic therapy.
The vegan diet contained vegetables, root vegetables, nuts, and fruits. As gluten was not permitted, the diet contained buckwheat, millet, corn, rice, and sunflower seeds. Unshelled sesame seeds in the form of sesame milk were a daily source of calcium.
The non-vegan diet contained a variety of foods from all food groups. Five or more daily servings of fruits and vegetables were recommended as well as increasing intakes of starch and other complex carbohydrates by eating potatoes, bread, and cereals and selecting whole-grain products as often as possible.
In the vegan group, total cholesterol, LDL, and the ratio LDL/HDL decreased significantly after both 3 and 12 months, whereas triglycerydes (TGs) and HDL did not change. In contrast, the non-vegan diet in the control group did not influence cholesterol and other lipid values significantly. There is now a large body of evidence indicating that this change of lipid profile is favorable in relation to atherosclerosis and CVD, and this diet therefore is likely to be protective also in RA. These findings are compatible with previous results of vegetarian/vegan dietary regimens in people without RA which have shown lower blood pressure, lower BMI (body mass index), and lower incidence of CVD. Furthermore, these individuals had lower total cholesterol and lower LDL.
In contrast to LDL and cholesterol values, TGs did not change as a consequence of vegan diet. In systemic lupus erythematosus, high TGs are characteristic of this rheumatic disease and that TGs are strongly associated with disease activity and inflammation.
Conclusion: A vegan diet in RA decreases LDL and oxLDL levels and raises levels of natural antibodies and can decrease risk of atherosclerosis.