Acute starvation appears to have a beneficial effect on clinical and laboratory markers of rheumatoid arthritis disease activity (60-62). This effect does not appear to be related to avoidance of specific food items (63,64). However, since carbohydrate restriction mediates much of the hormonal change observed in starvation (65), it follows then that the KD may also be associated with clinical improvement in arthritis. In a study of 13 subjects afflicted with rheumatoid arthritis placed on a carbohydrate-restricted (<40 g/day) but not protein-restricted ketogenic diet for 1 wk, Fraser and colleagues found no beneficial effect on either clinical (46) or laboratory (46,47) parameters of rheumatoid arthritis disease activity. Longer duration of diet and use of carbohydrate- and protein-restricted KD have not been studied.
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