High fiber diet for arthritis

High fiber diet for arthritis

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Arthritis and nutrition: more fiber

It has long been known that in addition to medicinal, physical and surgical therapy, nutrition can also be an important additional measure in the treatment of diseases from the rheumatic type. According to new findings, a high-fiber diet could also help with arthritis.

Several hundred diseases are summarized under the generic term "rheumatism". According to experts, rheumatoid arthritis (RA) is the most common inflammatory joint disease. Among other things, it is important for the patient how they eat. For example, the diet should include lots of fiber. This is suggested by a new study.

General condition improves

As the Friedrich Alexander University of Erlangen-Nuremberg (FAU) writes in a current communication, dietary fiber is not ballast - on the contrary. The largely indigestible food components are, according to the experts, a feast for the intestinal bacteria, which use them to produce short-chain fatty acids. These short-chain fatty acids have a positive effect on inflammatory diseases such as rheumatoid arthritis.

Among other things, the number of regulatory T cells that counter autoimmune reactions - reactions in which the body's defense is directed against its own organism - increases, among other things, when people with arthritis eat a diet rich in fiber. Researchers at the FAU also found that the general well-being of patients improved with a high-fiber diet. The results were published in the journal "Nutrients".

Gut flora needs fiber

As explained in the communication, the intestinal bacteria play a not inconsiderable role in the development of autoimmune diseases. These microorganisms, which make up around two kilograms of body weight in adults, rely on being well fed so that the intestinal flora remains intact. That means they need fiber.

However, today's diet is often low in fiber, which can lead to a disturbed intestinal flora. A disturbed bacterial composition in the intestine is in turn associated with autoimmune diseases, since the microorganisms then produce fewer short-chain fatty acids. These fatty acids, which include propionate and butyrate, are found, for example, in the synovial fluid, contribute to the functionality of the joints and, according to a study, prevent inflammation.

Another scientific study by the team led by Prof. Dr. Mario Zaiss, Chair of Immune Tolerance and Autoimmunity at the FAU, supports these results. The FAU scientists investigated how the protein zonulin can be inhibited in the intestine that promotes autoimmune diseases. The researchers found, among other things, that diet and intestinal bacteria influence zonulin production. The results of this study were published in the renowned journal "Nature Communications".

From freedom from symptoms to illness

In the Zonulin study, the FAU team led by Prof. Mario Zaiss examined the contribution of the intestinal flora to the process from symptom-free autoimmunity to disease activity. The researchers found that the intestinal epithelium, i.e. the covering tissue - the casing - of the intestine, releases more zonulin when the intestinal bacteria are disturbed.

Zonulin ensures that the so-called tight junctions - proteins that seal the spaces between the cells of the intestinal casing - become permeable, for example to peptides or parts of bacteria. The bacterial fragments resemble human body components, which is why the scientists suspect that the organism cannot differentiate between the foreign substances and its own body cells.

As explained in the communication, it attacks the intruders and forms antibodies that are also directed against the body's own cells. The consequence is autoimmune inflammatory reactions and the starting signal for the disease activity in rheumatoid arthritis.

With an increased zonulin concentration in the intestine, the study also increases the risk of arthritis onset in the following year, even in previously symptom-free patients with autoimmunity.

Through biopsies of the small intestine, the researchers showed that the tight junctions, the intestinal barrier, changed and became more permeable when the zonulin levels increased. According to the experts, permeability of the intestine to lactulose also indicated the beginning of active arthritis in both mice and humans.

The onset of arthritis was delayed

Because the researchers already knew the positive effects of the short-chain fatty acid butyrate on rheumatoid arthritis from their previous study, they also administered butyrate to mice in the Zonulin study. They found that this treatment delayed the onset of arthritis, lowered zonulin levels, and strengthened the intestinal barrier.

The scientists achieved an even stronger effect with the administration of larazotide acetate, a substance that is already used in clinical studies to treat celiac disease, i.e. gluten intolerance. With larazotide acetate, which inhibits zonulin production, inflammation in the joints decreased, bone strength increased and the onset of arthritis was delayed.

The researchers at FAU believe that the disease activity in arthritis can also be delayed in humans by blocking zonulin production with larazotide acetate. Since this substance is already being tested in phase III studies, it may soon also be possible to use it for rheumatoid arthritis.

Balance the intestinal flora

The FAU team also recommends balancing the intestinal flora through a high-fiber diet in order to enable the intestinal bacteria to produce larger amounts of butyrate and to strengthen the intestinal barrier. The scientists see the consumption of fiber as an additional treatment approach for rheumatoid arthritis and possibly other autoimmune diseases.

"Hippocrates already recognized the importance of nutrition for health and identified malnutrition as one of the main causes of the development of diseases: 'Your food should be your remedy and your remedy should be your food.' So if illness is caused by poor nutrition then we should take a closer look at it and research the relationships better, ”says study director Prof. Mario Zaiss. (ad)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Friedrich-Alexander University Erlangen-Nuremberg: Diet rich in fiber as an additional treatment for arthritis ?, (accessed: 05.07.2020), Friedrich-Alexander University Erlangen-Nuremberg
  • Julian Häger, Holger Bang, Melanie Hagen, Michael Frech, Pascal Träger, Maria V. Sokolova, Ulrike Steffen, Koray Tascilar, Kerstin Sarter, Georg Schett, Jürgen Rech, Mario M. Zaiss: The Role of Dietary Fiber in Rheumatoid Arthritis Patients: A feasibility study; in: Nutrients, (published: 07.10.2019), Nutrients
  • Sébastien Lucas, Yasunori Omata, Jörg Hofmann, Martin Böttcher, Aida Iljazovic, Kerstin Sarter, Olivia Albrecht, Oscar Schulz, Brenda Krishnacoumar, Gerhard Krönke, Martin Herrmann, Dimitrios Mougiakakos, Till Strowig, Georg Schett & Mario M. Zaiss: Short-chain fatty acids regulate systemic bone mass and protect from pathological bone loss; in: Nature Communications, (published: 04.01.2018), Nature Communications
  • Narges Tajik, Michael Frech, Oscar Schulz, Fabian Schalter, Sébastien Lucas, Vugar Azizov, Kerstin Dürholz, Franziska Steffen, Yasunori Omata, Andreas Rings, Marko Bertog, Aroldo Rizzo, Aida Iljazovic, Marijana Basic, Arnd Kleyer, Stephan Culemann, Gerhard Krönke , Yubin Luo, Klaus Überla, Udo S. Gaipl, Benjamin Frey, Till Strowig, Kerstin Sarter, Stephan C. Bischoff, Stefan Wirtz, Juan D. Cañete, Francesco Ciccia, Georg Schett & Mario M. Zaiss: Targeting zonulin and intestinal epithelial barrier function to prevent onset of arthritis; in: Nature Communications, (published: April 24, 2020), Nature Communications

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