Diet and nutrition in rheumatoid arthritis and other chronic inflammatory diseases

A greater understanding of the etiology of rheumatoid and other inflammatory diseases, their association with reactive oxygen species (ROS), and the role of environmental chemicals as antigens, has opened the way to new approaches in disease prevention and treatment by dietary modulation. Normal protection against the inflammatory effects of ROS (antioxidant defense) and environmental chemicals (detoxication) requires constant dietary replenishment to provide the redox buffer, glutathione (GSH), the antioxidant vitamins, E, C, and A, and other essential components such as selenium for the GSH peroxidase enzymes. Fasting and some environmental chemicals (haloalkanes) induce the ROS-generating enzyme cytochrome P4502E, as also does inorganic iron; and the various dietary lipids provide prostanoids of different inflammatory potentials. Adequate calories (NADPH) are essential for maintaining the two defense systems, but caloric excess may lead to changes in membrane composition, electron leakage, ROS generation, and exacerbation of the inflammatory condition.