Question of the Week: Can IgG4-RD be controlled by diet?
Can IgG4-RD be controlled by diet?
A highly relevant question, and certainly among those that IgG4-RD experts hear most!
The short answer is that although diet often plays an important role in managing IgG4-RD and is particularly critical in patients with some types of organ involvement (especially pancreas or kidney disease), dietary alterations do not offer a way of impacting disease activity in a predictably positive way.
The longer answer, which is important, is as follows:
Patients are typically amazed and relieved once the diagnosis of IgG4-RD has been established. Once they become convinced that they do NOT have cancer, an infection, or some other inflammatory disease, they naturally want to take charge of their medical issues and partner with their medical team to do as much as they can to get their disease under control, to avoid organ damage, and to prevent disease flares.
And they begin to wonder about something they can certainly affect: diet.
Has something that I’ve been eating caused this?
Is there something I can eat more of (such as a vitamin) to keep this from getting worse?
There are examples of conditions in which diet plays a direct role in causing a disease or making it worse. The classic example is gluten enteropathy (celiac disease or sprue), a condition that is caused by gluten ingestion in the diet and treated effectively if gluten (a substance found in bread, beer, and other foods) is removed. Another is high blood pressure, in which excessive sodium consumption can make the condition worse.
This is not the case for IgG4-RD. (As a clinician, I wish it were that simple!) Unfortunately, there is no evidence and little reason to suspect that any element in the diet causes or contributes to IgG4-RD. There is also no basis for believing that eating more of any particular food or ingesting any particular types of vitamins or supplements will fundamentally alter the underlying inflammatory process. For these reasons, it’s wise not to put too much faith in the idea that dietary alterations or the ingestion of certain supplements will have a lasting, impactful effect on the basic immunology of IgG4-RD.
That is NOT to say, however, that diet is not important in IgG4-RD. There is one major setting in which diet plays an important role in effective IgG4-RD management and helps patients minimize the disruption that IgG4-RD can cause in their lives. This is the setting of pancreatic disease (exocrine pancreatic insufficiency).
Some patients with histories of pancreatic involvement benefit from pancreatic enzyme replacement in their diets – supplementing their meals and snacks with tablets that replace the body’s pancreatic enzymes normally produced by a healthy pancreas.
Patients with pancreatic involvement may also have negatively impacted micronutrients. The potentially impacted micronutrients are the fat-soluble Vitamins A, D, E, and K, along with Zinc, B12, folic acid and Iron. While clinical deficiency is uncommon, sub-clinical depletion of certain micronutrients may be present and patients may be unaware. A daily multivitamin with minerals may help, but testing blood levels when starting pancreatic enzymes, and yearly thereafter, would be recommended. Collaboration with a Registered Dietitian may also be helpful, especially if unexplained changes to skin, hair, nails, or vision are present.
We discussed many issues related to the involvement of the pancreas in our June 2024 Fireside Chat with Dr. Matthias Löhr and Dr. Guy Katz. We encourage a review of that webinar on the IgG4ward! YouTube channel.
The issue of “Eating well for patients with IgG4-RD and pancreatic involvement” will also be addressed in November at The JAM by Kevin Walton, a clinical dietitian at the Massachusetts General Hospital who regularly works with patients who have exocrine pancreatic insufficiency.
