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Q Many patients feel diet has a role in established rheumatoid arthritis (RA). Is there evidence for this?

A RA is seen in virtually every part of the world regardless of diet. Eskimos who eat fish three or four times a day and virtually no red meat and the Indian vegetarian communities have just as bad RA as people who eat a Western world diet.

There are exceptions. Rheumatoid disease is less severe in perhaps some of the north African Arab communities – but it is difficult to see how the diet in those parts differs from the diet in other comparable communities. In essence, we believe it is the genetic make-up that is different and this is a very important determinant of phenotypic expression.

Having told the patient there is no role for any meaningful diet effect, I would add that whatever rule we come up with in medicine, there are always exceptions. Different foods will have a different effect on all of us; and it is reasonable to assume that an 'allergic' response to certain foods will make us feel worse and that will have an impact on the underlying rheumatoid disease.

My advice to patients is to experiment for themselves. If certain foods have a deleterious effect, avoid them!

If, by contrast, other foods have a beneficial effect, then go for it. I would never disagree with a patient who told me that certain foods make them feel worse or better – even in the absence of any compelling scientific support.

I would, however, beg the patient not to waste money on buying books on the best diet for arthritis. These books almost always contradict other books on the same subject.

Dr Andrei Calin,

consultant rheumatologist,

The Bath Clinic, and

Royal National Hospital for Rheumatic Diseases, Bath

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