Chili Peppers, Turmeric, Chocolate and Red Wine

The consumption of chili peppers, turmeric, chocolate and red wine could possibly control immune hyperactivity associated with some rheumatic diseases, shows a scientific review published in Nature Reviews Rheumatology. 

The review, published online April 3, examines the clinical evidence of several nutritional components of diet and their effects on rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (SLE).

The development of autoimmune disease is most likely associated with a combination of genetic, hormonal, immunological and environmental factors, such as lifestyle and diet. Some studies have shown an association between the microbiome and the development of rheumatoid arthritis, SLE, multiple sclerosis, type 1 diabetes mellitus and inflammatory bowel disease.

Links between imbalances in the intestinal microbiota (dysbiosis) have been shown both n RA and SLE patients.

“Interactions between gut microbiota and the immune system are complex and utilize many molecular mechanisms, including the suppression of anti-inflammatory regulatory T (Treg) cells and the induction of T helper 17 (TH17) cell differentiation (as seen in mice), leading to a susceptibility to autoimmunity.

“The pivotal role of diet in determining the composition of the gut microbiome and the implied role of the microbiome in rheumatic autoimmune diseases give rise to an interesting hypothesis. We suggest that the microbiome represents the common underlying mechanism for the effects of dietary components on the immune system and autoimmunity in general,” the authors wrote.

Omega-3 Fatty Acids

While some essential fatty acids can promote pro-inflammatory immune responses, omega-3 polyunsaturated fatty acids produce the opposite effect inhibiting cytokine production and decreasing the production of reactive oxygen species.

Clinical trials show that omega-3 fatty acids in patients with rheumatoid arthritis reduced the number of swollen joints, reduced joint pain and morning stiffness, and decreased the use of non-steroidal anti-inflammataory drugs (NSAIDs).

Other clinical trials of varying lengths and size have shown benefits in patients with SLE, but some showed no statistical benefits.

Salt (sodium chloride)

Salt modulates the production of interleukins and influences the differentiation of T cells, which are implicated in rheumatoid arthritis, multiple sclerosis, psoriasis and systemic lupus erythematosus.

Basic science research has found that salt aggravated autoimmune encephalitis and multiple sclerosis.

There appears to be a relationship between sodium intake, smoking and developing rheumatoid arthritis, which further points to a combination of genetic and environmental factors leading to auto-immune disease.

Capsaicin (chili peppers)

Randomized trials have shown that capsaicin relieved mild to moderate pain in patients with hand and knee osteoarthritis.

Several research groups have investigated the influence of capsaicin on the pathogenesis ofrheumatic diseases. Capsaicin-sensitive peptidergic sensory neurons are connected to the synovium and joint capsule and thus, mediate the pain pathway. A randomized controlled trial found that capsaicin had a beneficial effect 31 patients withrheumatoid arthritis. Topical capsaicin (0.025% cream) applied to knees four times a day for four weeks led to a 57% reduction in pain as compared to placebo. Topical capsaicin was also effective short-term in patients with severe fibromyalgia. A randomized trial of 130 patients with fibromyalgia showed that topical capsaicin (0.075%) three times daily for six weeks improved several pain measurements (myalgic score and the pressure pain threshold) as compared to controls. 

Curcumin (turmeric)

 A 2012 international clinical trial on the effectiveness and safety of curcumin in rheumatoid arthritis patients found that after eight weeks of treatment, RA patients treated with curcumin alone (as compared to diclofenac separately, or both in combination) had the greatest improvement in disease activity - although the differences between the groups were not statistically significant. A preliminary clinical trial found benefits for patients with lupus nephritis who were treated with turmeric.  In this trial, 24 patients received a capsule three times a day containing either turmeric or starch. After three months, the group who received turmeric showed a decrease in proteinuria, systolic blood pressure and haematuria. The group who received starch showed no change. Nelson et al. suggests that curcumin is substantially less effective than assumed due to its low bioavailability and its unstable, reactive nature. However, the authors write that curcumin could still provide benefits by acting on the gut microbiota. 

Coffee

High-quality studies on the effects of coffee consumption on rheumatic diseases are sparse, but evidence that exists shows coffee may have a detrimental effect in SLE and RA, but it could be correlated with a reduced risk of multiple sclerosis or ulcerative colitis.

There is some preliminary evidence showing that coffee consumption can contribute to the production of rheumatoid factor. A study of 30,000 women showed an increased risk for the development of RA among coffee drinkers, with no increased risk among those who drank caffeinated coffee over those who drank decaffeinated coffee.

In SLE, a cross-sectional study of 300 patients with risk factors associated with cardiovascular disease showed that coffee consumption was a significant (P = 0.009) risk factor.

Cocoa (chocolate)

The active extracts of cocoa have a promising regulatory role in both the innate and acquired immune systems. This role includes downregulating the proinflammatory cytokines IL‑1β and IL‑2 and upregulating the anti-inflammatory cytokine IL‑4 in peripheral blood mononuclear cells.

Cocoa also modulates the balance of TH1 cells and TH2 cells in lymphocyte cultures, favoring TH1 cells and reducing antibody secretion.

Although there are no studies that show cocoa has anti-inflammatory effects, the authors of the recview write that “a cocoa-enriched diet might serve as an adjuvant therapy for disorders with an inflammatory, autoimmune pathogenesis.”

Resveratrol (red wine)

There have been no clinical trials on the effects of resveratrol and autoimmune disease, but in animal models, it has reduced knee swelling, reduced cartilage destruction and synovial inflammation and lowered serum uric acid levels in cases of gouty arthritis.

References:

Shani Dahan, Yahel Segal, Yehuda Shoenfeld. “Dietary factors in rheumatic autoimmune diseases: a recipe for therapy?” Nature Reviews Rheumatology. First published online April 13, 2017. doi:10.1038/nrrheum.2017.42

Miles, E. A. & Calder, P. C. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. Br. J. Nutr. 107 (Suppl 2), S171–S184 (2012).

Lee, Y. H., Bae, S. C. & Song, G. G. Omega‑3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch. Med. Res. 43, 356–362 (2012).

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Ramos-Romero, S. et al. Effect of a cocoa flavonoidenriched dieton experimental autoimmune arthritis. Br. J. Nutr. 107, 523–532 (2012).