Pizza-led RA treatment strategy on the menu

4 minute read

Yes, there is actual data here, although it really depends on how you slice it.

An Italian study has revealed a positive link between pizza consumption and rheumatoid arthritis disease activity.

And by positive, we mean good.

The researchers found that those eating half a pizza at least once a week had a significant 70% reduction in disease activity when compared with people eating pizza no more than twice a month. Those with more severe RA recorded an 80% reduction in disease activity when eating pizza at least once a week versus less than twice a month.

“These beneficial effects were likely driven by mozzarella cheese and, to a lesser extent, by olive oil, even though we were unable to assess the possible contribution of tomato sauce,” wrote the authors in Nutrients.

The cross-sectional study on dietary habits and disease activity included 365 people with RA, aged 18-65 (average 58 years) with a disease duration of at least three months and a median of around 13 years.  

Disease activity was measured using the Disease Activity Score on 28 joints with C-reactive protein (DAS28-CRP) or the Simplified Disease Activity Index (SDAI). Potential confounders that were adjusted for included age, sex, education, total energy intake, BMI, smoking, alcohol consumption, medication, disease duration and severity.

Researchers collected detailed data on patients’ food intake using a validated and reproducible survey which included pizza and pizza components – refined grains, mozzarella cheese and olive oil. Tomato sauce consumption wasn’t included in the food frequency questionnaire, so this component wasn’t assessed.

The authors then went into a bunch of stuff about statistical regression modelling something something something which, frankly, was difficult to digest when all one could think about was pizza.

Anyhoo, the upshot, as per above, was that eating more pizza is better for RA than eating less pizza. Probably.

The obvious caveat is that there’s pizza and there’s pizza. The authors pointed out that typical Italian pizza is made from “fresh high-quality ingredients” including mozzarella (“far from pre-shredded mixed cheese”), tomato sauce, cherry tomatoes, fresh basil, extra virgin olive oil and a lean dough (flour, salt, water, yeast). And not a party-pie-stuffed crust in sight.

On the other hand, pizza in some countries, where multinational chain outlets and frozen pizzas are popular, can be high in saturated fat, sodium and energy and is generally considered “junk food”. Imagine.

As such, the authors acknowledged that “although our results shed light on an interesting research hypothesis, their generalisability is likely limited to those European countries that show similar RA prevalence and therapy protocols, and benefit from a similar culinary tradition and pizza ingredients’ availability”.

“This study was conducted in Italy – the birthplace of pizza, and second-top consumer country of pizza worldwide – where access to the best pizza ingredients in their freshest state, and certified recipes provide the greatest likelihood of identifying the protective anti-inflammatory and antioxidant effects that pizza is believed to exert,” extolled the authors.

Bizarrely persisting with the notion that pizza-eating actually needs selling, the authors went on to point out that apart from its apparent clinical benefits, it’s also relatively cheap, widely available and delicious, with a good balance of protein, carbohydrate and fat, making it an ideal anti-inflammatory meal.

While there have been studies looking at the effect of the Mediterranean diet on RA, this was the first study, to the authors’ knowledge, investigating whether a higher consumption of pizza specifically could reduce RA disease activity.

“These results require confirmation based on properly designed cohort studies that implement an assessment of diet with reproducible and valid tools, and employ internationally recognised measures of RA activity, to find the expected small dietary effects, and to adjust for the large set of confounders typical of RA,” concluded the authors.

“As our results are mostly based on patients with optimal disease control, the extent of the beneficial effect observed could be even greater if RA patients with active disease were primarily considered within these studies.”

Nutrients 2023, 4 August

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