A vegan diet changes the intestinal flora

P. Toivanen and E. Eerola

Department of Medical Microbiology, Turku University, Turku, Finland

SIR, When discussing the potential mechanisms by which a vegan diet free of gluten alleviates the signs and symptoms of rheumatoid arthritis (RA), Hafström et al. [1] fail to mention the effect of the diet on the intestinal flora. In fact, we have reported two studies in this journal on diet-induced changes in the faecal flora in RA. When the flora of the patients in the study by Kjeldsen-Kragh et al. [2] (also cited by Hafström et al.) was analysed, significant differences were observed not only between baseline and later values and between periods of vegan and lactovegan diets, but also according to the clinical improvement of the patients. A statistically highly significant difference in the flora between patients with a high improvement index and those with a low index was found at 1 and 13 months of the study [3]. Similar results, with a significant difference between the high and low responders, was also observed when the faecal flora of RA patients receiving ‘living food’, a form of uncooked vegan diet, was examined [4].

The potential role of the intestinal flora in the pathogenesis of RA is emphasized by the finding that patients with early RA have a significantly different faecal flora than the controls [5]. One should also realize that the human intestine normally harbours Gram-positive bacteria whose cell walls are capable of causing chronic experimental arthritis [68], and that some of the experimental models of chronic arthritis only work in conventional conditions and not in germ-free animals [9, 10]. On these bases, when discussing the mechanisms of diet-induced improvement in RA, we find the potential role of intestinal bacteria hard to ignore.

Notes

Correspondence to: P. Toivanen, Department of Medical Microbiology, Turku University, FIN-20520 Turku, Finland. Back

References

  1. Hafström I, Ringertz B, Spa°ngberg A et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology2001;40:1175–9.[Abstract/Free Full Text]
  2. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet1991;338:899–902.[ISI][Medline]
  3. Peltonen R, Kjeldsen-Kragh J, Haugen M et al. Changes of faecal flora in rheumatoid arthritis during fasting and one-year vegetarian diet. Br J Rheumatol1994;33:638–43.[ISI][Medline]
  4. Peltonen R, Nenonen M, Helve T, Hänninen O, Toivanen P, Eerola E. Faecal microbial flora and disease activity in rheumatoid arthritis during a vegan diet. Br J Rheumatol1997;36:64–8.[ISI][Medline]
  5. Eerola E, Möttönen T, Hannonen P et al. Intestinal flora in early rheumatoid arthritis. Br J Rheumatol1994;33:1030–8.[ISI][Medline]
  6. Simelyte E, Rimpiläinen M, Lehtonen L, Zhang X, Toivanen P. Bacterial cell wall-induced arthritis: chemical composition and tissue distribution of four Lactobacillus strains. Infect Immun2000;68:3535–40.[Abstract/Free Full Text]
  7. Toivanen P. From reactive arthritis to rheumatoid arthritis. J Autoimmun2001;16:369–71.[ISI][Medline]
  8. Zhang X, Rimpiläinen M, Simelyte E, Toivanen P. Enzyme degradation and proinflammatory activity in arthritogenic and nonarthritogenic Eubacterium aerofaciens cell walls. Infect Immun2001;69:7277–84.[Abstract/Free Full Text]
  9. Taurog JD, Richardson JA, Croft JT et al. The germfree state prevents development of gut and joint inflammatory disease in HLA-B27 transgenic rats. J Exp Med1994;180:2359–64.[Abstract]
  10. Rehakova Z, Capkova J, Stepankova R et al. Germ-free mice do not develop ankylosizing enthesopathy, a spontaneous joint disease. Hum Immunol2000;61:555–8.[ISI][Medline]
Accepted 28 February 2002





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