How to Discuss Anti-Inflammatory Diets & Supplements with Your Patients

In vitro, spirulina has been shown to stimulate interferon (IFN) β, TNFα and IFNγ signatures in classical monocytes and monocyte-derived dendritic cells of patients with dermatomyositis, compared with healthy controls.²⁹ Given its potential to improve lipid profiles in some people, spirulina is found in many combination supplements and commercially sold smoothies for this purpose but should be avoided in dermatomyositis patients.³⁰

Conclusion

When you consider how little we know about the pathogenesis of rheumatic disease and how often patients feel a lack of understanding or control in their health, it is not surprising the idea of taking supplements or modifying diet plans would be appealing. It is an opportunity for patients who otherwise are at the mercy of their medical provider—or, often, their insurance company—for treatment, to take some control of their health in their day-to-day lives. Moreover, many of the treatments we offer in rheumatology are not benign and have their own laundry lists of risks. These risks can certainly propagate fear, an emotion many of these alternative treatments can exploit. In medicine, we understand that natural does not equate to safe, but this concept is not easily understood by many outside the field.

In no way would I ever advocate for diet/supplements instead of traditional therapy when indicated; supplements, by definition are supplemental. Nevertheless, having a basic understanding of the potential risks and benefits of what is available and appropriate lifestyle counseling are crucial for the overall health and well-being of our patients.

We would all benefit from more structure and curiosity when discussing and studying such a nuanced topic.

Emily Molina, MD, is a rheumatology fellow at Johns Hopkins University Hospital, Baltimore.

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