Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation and damage to not only joints, but also the skin, eyes, lungs, heart, and blood vessels. (R)
Autoimmune diseases are more prevalent in Westernized cultures, and are lower in countries that are still developing. This is really no surprise, since there is a clear correlation between a Western lifestyle and disease. A Western lifestyle basically consists of eating lots of fast food and overall having an unhealthy diet, and being sedentary. Alcohol, smoking, environmental toxins, stress, and genetics all play a role in the development of disease as well.
Obesity and metabolic syndrome can increase the risk of disease, including RA. Metabolic syndrome is characterized by having insulin resistance, high triglycerides, low HDL, high blood pressure, and systemic inflammation.
RA is an inflammatory condition, which means if you have RA, you should be focusing on things that reduce total body inflammation. Many people find at least some relief through diet and lifestyle modification, and/or supplementation.
*As always, be sure to work with a qualified health professional before embarking on any of the topics discussed.
Maintain a Healthy Gut
Persons with RA often have gut problems, such as bloating, postprandial fullness, nausea, early satiety, stomach pain, belching, mucosal ulceration, constipation and diarrhea. (R)
I believe that a lot of inflammation in general stems from the gut. Not only is the gut important for digesting and absorbing nutrients, but also acts as a protective barrier to keep microbes, undigested food, toxins, and other antigens out of the body. If the gut is damaged, it becomes more permeable, allowing antigens to enter the body and trigger inflammation.
Autoimmune diseases such as RA are associated with increased intestinal permeability, or better known as leaky gut. (R)
When the gut allows things in the body that it doesn’t recognize, it stimulates the immune system to destroy and remove the foreign object. The immune system can create antibodies to the foreign substance, and sometimes, tissues, cells, and proteins within our bodies have a similar biochemical structure to the foreign substance. When the antibodies are created to destroy it, the antibodies recognize healthy tissue and damage that as well. The antibodies that attack a person’s own tissue are termed autoantibodies.
Fixing digestive issues should be a top priority for anyone with chronic inflammation, and that includes RA.
I highly recommend you read more about leaky gut in a detailed post here.
Balance Gut Bacteria
Gut bacteria also play a large role in how our body functions, and can influence the immune system. Probiotic supplementation and a healthy diet may help reduce inflammation by shifting the gut bacteria to more beneficial. (R)
Compared to healthy peoples, persons with RA have higher amounts of Clostridium perfringens and a toxin they release known as alpha-toxin. (R)
Persons with RA also have more antibodies to Proteus. (R)
Priobiotics, specifically Lactobacillus casei, has been found to reduce joint swelling and pain, and improve inflammatory markers in persons with RA. (R)
Since gut bacteria is strongly associated with the integrity of the gut, be sure you have read the post on leaky gut, which covers this topic more in detail.
Determine The Best Diet For You
We should all understand by now that diet is not a one size fits all. However, we should look at foods that people commonly react to, and experiment with diets that people have healed on. People who have healed their autoimmune conditions or at least significantly reduced inflammation should be used at least as a good starting point. I’ve experimented with just about every diet, and I can tell you that I’ve found benefits and negatives to a lot of them. More importantly, I learned a lot about what foods work best for me. You must track your food, nutrition, and symptoms if you want to determine exactly which foods cause you inflammation.
Next, I’ll discuss some diets that have helped people, and you’ll notice that they are different. My guess is that the reason different diets work for different people is due to genetics, gut microbes and infections, severity of disease, and reactivity of immune system.
Consume Less Lectin Rich Foods
Lectins in foods can cause an allergic T-cell response by binding to lymphocytes and stimulating an immune response. (R)
A lot of people have issues with lectin rich foods, particularly wheat and other grains, nuts, seeds, and nightshades.
Foods High in Lectins:
- Wheat and other grains
- White Potatoes
You may want to try eliminating lectin rich foods from your diet for a period of time, and then add them back one at a time.
High Histamine Foods
High histamine and citrus foods have been found to increase disease severity. (R)
You can read more about histamine and mast cells here.
A vegan diet has been shown clinically to help manage symptoms of RA. A gluten-free vegan diet seems to be particularly helpful. (R)
Not everyone is sensitive to lectins, which is why a whole foods plant based diet (fruits, vegetables, legumes, and grains) has been shown to significantly reduce pain in as little as two weeks, compared to a normal/omnivorous diet. (R)
The thought is that the pain reduction is due to a reduced intake of arachidonic acid from animal products. Arachidonic acid (omega-6) is metabolized to proinflammatory mediators. (R) Some plant oils are high in arachidonic acid as well, so we can’t entirely rely on just removing animal products to reduce omega-6s. Interestingly, those who consume a whole foods plant based diet have higher levels of serum omega-3s than both omnivores and fish eaters. (R)
Animal protein has been found to increase intestinal permeability, which allows bacteria to stimulate the immune system and lead to inflammation. (R)
Persons with rheumatoid arthritis who reintroduce meat into their diet after eliminating it have increased aggravation of symptoms. Sweets, refined sugar, and coffee have also been found to increase symptoms. (R)
People who have improvements by following a vegan diet are likely reactive to meat, dairy, fish, and avoiding gluten is always a good idea, because it’s likely the most, or one of the most inflammatory lectin rich foods. Patients with RA have been found to have increased levels of IgG antibodies against the gluten protein gliadin. (R)
A vegan diet may also help shift gut bacteria to a more favorable balance.
The Mediterranean diet is high in oleic acid, omega-3s, unrefined carbohydrates, and phytochemicals. The diet is focused on consuming less red meat, and more olive oil, grains, fruits, vegetables, fish, and legumes, as well as a little red wine. (R)
The Mediterranean diet has been found to reduce inflammation, and improve physical function in persons with RA. Olive oil is high in antioxidants, and contains oleic acid that is metabolized to eicosatrientoic acid, which has anti-inflammatory properties. Olive oil has also been found to inhibit pro-inflammatory mediators, such as TNF-α, IL-17, and IL-6. The Mediterranean diet encourages the consumption of more seafood, which will help to raise omega-3 intake, and thus, help to reduce inflammation. (R)
An elemental diet is a liquid diet that only contains glucose, vitamins, minerals, trace elements, and essential amino acids. It’s not really food, but rather, the nutrients that we use from food. It’s completely hypoallergenic, and has been found to reduce symptoms in persons with RA. It has actually been found to be as effective as 15 mg/day of oral steroids (prednisolone). Unfortunately, when real food is consumed again, symptoms reappear. (R)
An elemental diet is still allowing a person to consume adequate nutrients, but it won’t contain anything inflammatory, and will give the bowel a rest. It will also starve bacteria in the gut, which could help remove pathogenic microbes. An elemental diet can help give the gut time to repair itself. If I were to do the elemental diet, I would add back each real food one at a time every 4-7 days to see if it causes inflammation; instead of just going back to whatever food I wanted to eat.
Patients with RA who went on a 7-10 day fast had reduced pain, stiffness, needed less medication, and had lower T cell activation. (R)
This isn’t exactly practical, but intermittent fasting, or significantly reducing food consumption a couple days a week may provide some benefit. Just be careful if you are underweight or get hypoglycemic.
Fasting coupled with a vegan diet has been shown to decrease swollen and tender joints, pain, erythrocyte sedimentation rate (ESR), and C-reactive protein. (R)
Persons with RA Need More Nutrients
Persons with RA have been found to have lower serums levels of vitamin A and E, selenium, and zinc. It might not be due to decreased intake of specific nutrients, but rather, an increased need for the nutrients. (R)
Be mindful and track your nutrients, it’s likely that you need more than the average person.
Omega-3s and Fish Oil
Omega-3s have been found to significantly reduce symptoms of RA, including reduced morning stiffness, as well as swollen and tender joints. These patients were consuming 1.8 grams of EPA and 2.1 grams of DHA daily. Some people are able to reduce or eliminate the use of pain medications. 1.8 grams of EPA and 1.2 grams of DHA may be enough, since these amounts have also been shown to improve symptoms of RA.
Higher omega-3 intake reduces the inflammatory response of arachidonic acid (omega-6) binding to cell membranes. Omega-3s also decrease the production of pro-inflammatory cytokines and enzymes that degrade cartilage. (R)
Consuming less omega-6 while consuming fish oil has been shown to decrease inflammation in persons with RA. (R)
Fish and fish oil are high in anti-inflammatory omega-3 essential fatty acids, specifically EPA and DHA. Western diets are very high in inflammatory omega-6, and low in omega-3. The recommended ratio is about 4:1 of omega-6 : omega-3, but a typical American diet is about 15:1 (yikes…). Higher omega-6 and lower omega-3 intakes are associated with increased levels of proinflammatory cytokines. (R)
Be careful with taking too much fish oil, as it can thin your blood.
You can read more about fish oil here.
Epigallocatechin-3-gallate (EGCG) is a phytochemical found in green tea, which has anti-inflammatory properties. EGCG has been shown to reduce IL-6 production by synovial fibroblasts in animal models, which could potentially help persons with RA inflammation. (R)
Curcumin, like omega-3s, is a powerful anti-inflammatory supplement. Curcumin has been found to reduce inflammation in many conditions, including autoimmune conditions like inflammatory bowel disease. (R)
About 1000 mg/day of curcumin for 8-12 weeks has been found to reduce symptoms of arthritis, and has similar efficacy as NSAIDs. (R)
Curcumin is found in the spice turmeric, so it’s worth adding turmeric to your food dishes.
Curcumin can also thin the blood, so be careful.