Number One Question The main thing is to avoid generalizations. Valuing things -the diet in this case- in its proper measure, which would be popularly said, in order not to create false hopes and perpetuate myths that often lead to misunderstanding.
This is what has come to be called the “perverse effect” or, what is the same, the tendency to place blind faith in interventions of dubious efficacy – the modification of eating habits, once again – to the detriment of forms of treatment. with a scientific basis, such as the traditional one -or perhaps not so much given the 180 degree turn experienced in the last two decades with the proliferation of biological therapies and the advancement of personalized medicine- pharmacological treatment (see DM of 3-XII -2010).
“There are no foods that can be classified as good, on the one hand, or bad, on the other,” José María Álvaro-Gracia, an Endocrinology specialist at Madrid’s La Princesa Hospital, was quick to make clear in the first of his interventions at the debate on rheumatoid arthritis, which was the second of the meetings organized by Diario Médico in collaboration with the Tomás Pascual Institute within the cycle on Inflammatory Diseases and Nutrition. And if the statement is so categorical, it is because “currently there is no solid scientific basis to support the recommendation of certain dietary guidelines beyond the suggestions included in the generic Mediterranean diet” (DM), assured José Luis Andreu, endocrinologist at Hospital Puerta del Hierro, in the capital, almost giving up on the matter before starting.
However, there is room for controversy. The main slit through which it sneaks is the internet, that kind of virtual agora where huge amounts of information converge, often in a chaotic way. Example: the first advice that the cyber patient receives when going to the Internet in search of solutions within their reach to face Crohn’s disease is to eliminate milk from the purchase. Now, “it is not true that lactose intolerance is greater among those affected by this autoimmune pathology that attacks the digestive tract,” said Virginia Robles, a researcher-in-training at the Hebron Valley in Barcelona.
Contrary to what can be read online, the relationship between dairy consumption and intestinal inflammation is not at all proven. Accepting per se the discredit of the precious white liquid, rich in vitamin D and calcium, would also carry the risk of developing osteoporosis. “What is obvious is that consumption of these products should be limited or even relegated to the past,” Robles continues, “if they were associated with an increase in watery stools during acute outbreaks of the disease.” The same goes for fiber (see DM of 4-X-2010).
In this sense, restrictions are not a priori desirable, since they can lead to extended states of malnutrition. Continuing with the Crohn’s example, nutritional deficiencies include four assumptions: poor absorption, increased energy expenditure, involuntary loss of protein – in the form of diarrhea – and a possible decrease in food intake, either due to lack of appetite or due to fear of worsening health status (see DM on 4-X-2010).
The main consequence of the conjugation of these factors with the misinformation that accompanies the diffusion of certain contents that circulate on the net -or the own reading lacking critical judgment- is the appearance of restrictions that take shape in what Ignacio Marín, deputy of the Gastroenterology Section of the Digestive System Service of the Gregorio Marañón Hospital in Madrid, branded as “poorly planned exclusion diets”. His conclusion is logical: “Eating well is crucial, since it strengthens the defenses, favors the intestinal function to be rehabilitated and improves tolerance to the medication as well as the healing of ulcers.”
Joaquín Hinojosa, head of the Digestive System Service at the Manises Hospital in Valencia, signed this statement: “The ideal is an adequate caloric intake and this is achieved with a diet as varied as possible and, provided that circumstances do not prevent it, orally”.
These initial notes do not exactly incite optimism regarding the role that diet can play in the treatment of this type of disorders. However, those who claim to recognize the interest in food control have a strength in their favor: the prevention of comorbidities, mainly cardiovascular.
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Genma Bonilla, from the Rheumatology Service of the Hospital La Paz, Madrid, maintained that “anticipating obesity, hypercholesterolemia and hypertension is, of course, desirable and for this there is nothing better than opting for our most international diet”, the one attributed to the Mediterranean coast, which in November of this year was declared Intangible Heritage of Humanity at the request of Spain, Greece, Italy and Morocco.
The Unesco intergovernmental committee that approved the proposal then cited olive oil, cereals, fresh or dried fruits and vegetables, a moderate proportion of meat, fish and dairy products, and abundant condiments as basic ingredients of the aforementioned dietary pattern. and spices, whose consumption at the table is accompanied by wine “, the latter paradigm of the French paradox, according to which its consumption -always in moderate amounts- has a cardioprotective effect.
According to a study signed by the Department of Medicine of the University of Umea, in Sweden, “DM reduces the inflammatory activity of rheumatoid arthritis helping patients to increase their physical activity, as well as improve their vitality and quality of life”.
The conclusions derive from the comparison established between two groups of patients, one who followed the dietary guidelines linked to the Mediterranean and the other who did the same with the western model. After three months, the first group reported less pain, lost weight, and had their cholesterol level decreased. The keys would be in the fatty acids of olive oil, fish and the large amount of antioxidant vitamins, minerals and phytochemicals incorporated into the body through the five daily servings of fruits and vegetables in which the infinitely mentioned DM is used.
But what about other more specific clinical trials? This is the case of the starch-free diet that, according to Luis Linares, from the Rheumatology Unit of the Virgen de La Arrixaca Hospital in Murcia, “starts from Alan Ebringer’s theories around the idea that unless Klebsiella pneumoniae -the bacteria identified as the cause of ankylosing spondylitis- in the intestine, less immune reactions (see DM of 9-XII-2010) .The logic is simple: why restrict this polysaccharide? Because it is the grass of the Klebsiella. problem, according to Jordi Gratacós, of the Rheumatology Service of the Hospital Parc Taulí, of Sabadell, in Barcelona, is that “these affirmations are based on the empirical method and not on the scientific one”.
A similar situation is the one that occurs with the exaltation of the benefits of omega 3, which are said to be beneficial due to their ability to modify inflammation as they are precursors of prostaglandins that act as mediators in this process. However, these suspicions have not been duly proven, so they must be taken as experimental practices, “said Álvaro-Gracia. And Gratacós added: diets are part of” alternative and complementary medicine, which advocates a margin of action. frequently undervalued by us, despite being a widely used resource. “Xavier Juanola, from the Bellvitge Rheumatology Service, also in Barcelona, agreed:” Diet should be kept in a discreet background and remain so as long as they are not found. scientific evidence to justify its inclusion in the comprehensive treatment of these diseases. “The cards are on the table. Help yourself.