Healthy body, healthy planet

Diet and lifestyle choices not only benefit rheumatology patients, but also the planet.

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Diet and lifestyle choices can positively impact the health of rheumatology patients and the planet.

Simon – a case study presented by Dutch researchers at EULAR, the European Congress of Rheumatology held virtually this month – is a 46-year-old school teacher who tries to live a healthy life. He doesn’t smoke, only drinks the occasional glass of wine, and rides his bike to work.

Recently, he has been pondering whether to transition to a vegetarian diet after hearing that this is better for the environment and his own health.

Simon has been experiencing stiffness and pain in the joints for some time. He worries he might develop rheumatoid arthritis, like his mum. When Simon visits his GP, he gets sent to have some blood tests. Results show high CCP antibodies, indicating he is at risk of developing RA.

There are no approved drugs for patients like him, but lifestyle changes can considerably reduce his risks, said Professor Dirkjan Van Schaardenburg, a rheumatologist at the University of Amsterdam, during his presentation.

Professor Van Schaardenburg said many lifestyle factors promote inflammation through many different pathways. Some of these lifestyle factors are physical inactivity, visceral obesity and poor diet, but also isolation, stress, disturbed sleep and environmental pollution.

He suggested a stress-free and physically active life has been associated with a lower incidence of inflammatory diseases. But diet is one aspect of life that can profoundly impact both people’s and planetary health.

In 2019, the EAT-Lancet Commission on Food, Planet, Health released a report on healthy diets from sustainable food systems, indicating that a healthy diet for both humans and the planet is one containing very little animal food.

If everyone adopted the EAT-Lancet diet and trees replaced pastureland, these would capture over 300Gt of CO₂ by 2050. If everyone went vegan, almost 550Gt of CO₂ could be sequestered.

Some hospitals across the world have started offering patients more sustainable, meatless menus that exclude “the very food that may have contributed to their health problems in the first place.”

“The role of environment on health is very well documented,” said Dr Dara Khalid, a research lecturer at the University of Oxford who also presented at EULAR. “Environmental factors, including climate change, are linked with the majority of diseases in the world today, including both infectious and chronic diseases.”

Professor Dani Prieto-Alhambra, an epidemiologist at the University of Oxford, agreed. He presented research that indicated an association between rising temperature, pressure and pain. However, he said it is challenging to make medical recommendations with the current evidence, and more research in this field is needed.

“The big question now is, if we were able to eliminate these inciting environmental factors, is it possible to reverse the disease or the risk of disease?” said Professor Van Schaardenburg, who is running a pilot randomised control trial called Plants for Joints in Amsterdam.

The study consists of multidisciplinary lifestyle intervention over 16 weeks. Participants in the intervention group eat a whole food plant-based diet, exercise according to personal goals and learn stress management techniques. The control group undergoes standard care. “We think that these efforts will also help the environment,” said Professor Van Schaardenburg.

So, what can Simon do?

“After hearing this, Simon will take out the tiles in his garden and replace them with plants. He will eat more plant-based healthy whole foods. He will sit less, move more and relax more.”