Date of Graduation
Sage Davis-Risen, PA-C
Annjanette Sommers, PA-C
Background: Research has shown that increased levels of C-reactive protein (CRP) are found in patients with heart disease, diabetes, and Alzheimer disease. In fact, some studies demonstrate that CRP may even have causal effects. The purpose of this systematic review is to look at the effects of whole diet on serum CRP levels. By simply changing what foods we eat, or what foods we don’t eat, is it possible to reduce our risk of these diseases?
Method: An exhaustive search of available medical literature was conducted using Medline-OVID, CINAHL, and Google Scholar using the keywords: C-reactive protein, diet, food habits, inflammation, anti-inflammatory, and cytokines. Inclusion and exclusion criteria were applied. The bibliographies of the articles were further searched for relevant sources. Relevant articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Results: Six studies met inclusion criteria and were included in this systematic review. A randomized, single blinded-controlled trial with 180 patients with metabolic syndrome demonstrated a statically significant drop in CRP levels in participants who were instructed to eat a Mediterranean-style diet compared to the control group. A second randomized study with 66 patients with moderate to severe rheumatoid arthritis (RA) demonstrated that patients who ate a gluten-free, vegan diet had statistically lower CRP levels than individuals who ate a non-vegan diet. A cross-sectional study of 732 women demonstrated that women who ate a more “prudent” diet compared to a more “western” one had statistically significant lower levels of CRP. A second cross-sectional study of 3042 men and women demonstrated that a greater adherence to a Mediterranean diet showed statistically significant decreases in serum CRP levels. A third cross-sectional study of 5089 patients demonstrated that levels of CRP were positively associated with consumption of fats and processed meats and inversely associated with ingestion of whole grains and fruit. An interventional study with 24 participants with moderate to severe RA demonstrated that there was no statistically significant drop in CRP levels in participants who consumed a very low-fat, vegan diet.
Conclusion: Serum levels of CRP appear to have a correlation to diet. A recommendation can be made to put all patients on a Mediterranean style diet regardless of health status, as it is a simple, low-cost, self-administered, and safe intervention. Furthermore, it can be recommended that patients with RA be placed on a vegan diet. Another consideration is if patients with RA are non-compliant with a vegan diet, then a recommendation that they try a Mediterranean style diet is reasonable.
Joshu, William, "The Effect of Whole Diet on Inflammation: A Close Look at How C-reactive protein Levels are Affected" (1987). School of Physician Assistant Studies. 433.