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The immune response in RA is triggered by cytokines and chemokines, which further activate B and T-cells, macrophages, and monocytes, leading to excessive swelling (12, 13)

Thus, the reduced insulin secretion induced by dietary adjustments is an attractive non-pharmacological treatment to prevent infertility, and a Mediterranean diet aimed at maintaining normal body mass may be effective in the preservation of ovarian health and physiology

Limited safety data: Long-term human safety data is limited

In general, a lower percentage of lymphocytes on the day of calving could be related to systemic immunosuppression, which can lead to the occurrence of postpartum inflammatory diseases after birth (48, 49)