Reply to “Role of Western Diet in Inflammatory Autoimmune Diseases” by Manzel et al. in Current Allergy and Asthma Reports (Volume 14, Issue 1, January 2014)

Part of the following topical collections:
  1. Topical Collection on Autoimmunity


Dietary Intervention Intestinal Permeability Human Data Ketogenic Diet Dietary Fatty Acid 
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To the Editor,

Regarding the recent review “Role of Western Diet in Inflammatory Autoimmune Diseases” [1], while I appreciate the importance of this topic and the authors’ review, I noted several shortcomings in this review and have questions about the omission of certain information. The authors failed to include relevant and important human data while instead relying on animal studies (their Table 1). The authors also include erroneous information, without appropriate citation.

The authors state that “a high-fat diet is a prominent factor in promoting obesity” but failed to provide citation for this. Importantly, other researchers have shown that high-fat ketogenic diets promote weight loss rather than obesity.

I found the reliance on animal data (especially their Table 1) and the exclusion of human data inappropriate for a review article of this nature and at this time in biomedical history. Several clinical trials have already documented the effectiveness of dietary intervention in human autoimmune diseases. For example, diets which emphasize increased consumption of plant foods (excluding gluten-containing grains) and dietary alteration of gastrointestinal flora have already shown clinical benefits [2]. Exclusion of gluten is of critical importance for some patients, and well established is gluten’s role in inflammation, alteration of gastrointestinal flora, increasing intestinal permeability, and direct stimulation of inflammatory pathways. The authors mentioned hypertension four times in their review but failed to mention the remarkable efficacy of therapeutic fasting for this condition [3]. Clinical trials showing the safety and efficacy of dietary fatty acid supplementation were also excluded from the review, despite showing remarkable clinical safety and antirheumatic efficacy [4]. Antiinflammatory mechanisms of dietary intervention not mentioned in their review include alleviation of oxidative stress, alleviation of dysbiosis, reduced reactivity to dietary antigens, normalization of intestinal hyperpermeability, and alleviation of proinflammatory mitochondrial dysfunction [5].


  1. 1.
    Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M. Role of “Western diet” in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014;14(1):404.PubMedCrossRefGoogle Scholar
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    Peltonen R, Nenonen M, Helve T, et al. Faecal microbial flora and disease activity in rheumatoid arthritis during a vegan diet. Br J Rheumatol. 1997;36(1):64–8.PubMedCrossRefGoogle Scholar
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    Goldhamer A, Lisle D, Parpia B, Anderson SV, Campbell TC. Medically supervised water-only fasting in the treatment of hypertension. J Manip Physiol Ther. 2001;24(5):335–9.CrossRefGoogle Scholar
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    Belch JJ, Ansell D, Madhok R, O’Dowd A, Sturrock RD. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis. 1988;47(2):96–104.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Vasquez A. Integrative rheumatology and inflammation mastery, Third Edition. Create Space Publishers; 2014.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.International College of Human Nutrition and Functional Medicine in BarcelonaBarcelonaSpain
  2. 2.Biotics Research Corporation in RosenbergRosenbergUSA

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