Optimizing Your Diet for Rheumatoid Arthritis Relief
The foods you eat and the type of diet you choose to follow can make a big difference when you have rheumatoid arthritis (RA), a chronic condition in which your immune system mistakenly attacks and damages the lining of your joints, causing inflammation and pain.
In people with a genetic predisposition to RA, consuming foods with anti-inflammatory and antioxidant effects can alleviate RA symptoms, while diets high in saturated fat and sugar have been shown to increase inflammation.
The following nutritional approaches, when employed along with appropriate medication and physical therapy, may help you manage RA. But before you try any diet for symptom relief, check with your rheumatologist to make sure it's medically safe for you.
There’s strong evidence that the Mediterranean diet — rich in vegetables and fruits, whole grains, seafood, nuts and legumes, and healthy fats, including olive oil and omega-3 fatty acids from fish — lowers the risk of overall mortality, cardiovascular disease (CVD), cancer incidence, neuro-degenerative disease, and diabetes. The antioxidant and anti-inflammatory nutrients in the Mediterranean diet provide this protective effect. In theory, this high-fiber, anti-inflammatory diet should have some benefits for RA, and the Arthritis Foundation calls it the “ultimate arthritis diet” for people with RA.
But the data on RA, specifically, is limited and sometimes contradictory. Some studies have found that the Mediterranean diet helped reduce pain and increase physical function in people with RA. But other studies show no significant difference in disease activity between people with RA who followed the Mediterranean Diet and those who didn’t.
What has been established, per the American Heart Association, is that the Mediterranean Diet plays a role in preventing cardiovascular disease and reducing risk factors for it such as obesity, diabetes, high cholesterol, and high blood pressure. People with RA are almost twice as likely to develop cardiovascular disease as people who don’t have the condition. Adhering to the Mediterranean diet could help lower this risk.
Given the existing evidence, one review of research recommends that in addition to medical treatment, “nutrition therapy for RA should be based on an anti-inflammatory Mediterranean Diet supplemented with at least twice a week consumption of oily fish and/or omega-3 PUFA supplements at 2 grams/day.”
Some people with RA follow a diet that avoids meat (vegetarianism) or even all animal-derived products, including honey and dairy products (veganism). The thinking — with respect to inflammatory arthritis — is that plant-based diets low in saturated fat can reduce inflammation and thereby help manage symptoms.
There’s some research that suggests a positive link between these diets and reduced inflammation. In one study, 600 participants followed a vegan diet for three weeks, and most of them experienced a drop in their level of C-reactive protein, a marker for inflammation. But the study didn't show a corresponding reduction in RA symptoms.
Studies showing a beneficial effect have mostly been limited in size. A study of 44 women with RA found that those who adhered to a vegan diet for 16 weeks experienced weight loss and less joint pain. Another study focused on a gluten-free vegan diet, in a group of 38 RA patients, while a control group of 28 people ate a balanced nonvegan (and non-gluten-free) diet. Those on the gluten-free vegan diet experienced a modest improvement in their symptoms and lower levels of LDL (“bad”) cholesterol.
If you decide to try a vegetarian or vegan diet, pay close attention to balancing your nutritional intake to avoid nutritional deficiencies. Experts say it’s important for healthcare providers to supervise RA patients on a vegan diet and provide guidance on the correct intake of critical nutrients (such as protein, vitamin D, vitamin B12, omega-3 fatty acids) to avoid impairment of physiological functions.
As gluten-free diets have gained in popularity, people without celiac disease often report “feeling better” when they stop eating foods containing gluten — though they can’t explain exactly why that is. This includes people with RA. Theories linking gluten to RA symptoms go back decades, and while studies suggest some kind of connection, research hasn’t yet confirmed a proven association.
In a review of literature, researchers looked at 16 articles, dating back to 1991, on gluten-free diets in people with rheumatoid arthritis and concluded that “no scientific evidence has been found to promote the exclusion of gluten in rheumatoid arthritis patients without celiac disease or NCGS [nonceliac gluten sensitivity].” They noted the need for clinical trials, where gluten was the only eliminated dietary factor, to demonstrate whether gluten elimination improves RA symptoms.
With a gluten-free diet, you do run a risk of nutritional deficiencies. If you’re interested in going gluten-free to help manage RA, talk with your doctor first.
Intermittent fasting (IF), which involves some periods of normal eating and other periods of calorie restriction or fasting, has become popular recently. There’s evidence that it supports weight loss and can have an anti-inflammatory effect, which can be helpful for people with RA. But much of this is based on small studies and anecdotal experience.
In one study of 53 people with RA, subjects either followed a seven-day fast with a few months on a plant-based diet or three months of a conventional anti-inflammatory diet recommended for people with RA. The fasting group did see a rapid improvement in their symptoms after the fasting week, while the other group exhibited a slower, steadier improvement. After three months, there was no difference between the two groups in terms of RA function and disability — meaning an IF diet may be helpful, but not more than the anti-inflammatory diet generally recommended.
The latest dietary recommendations for people with rheumatic diseases, from France’s Society for Rheumatology encourage a Mediterranean diet instead of fasting diets, due to a lack of solid data.
If you have RA and want to try IF, you need to be particularly careful as fasting may conflict with your medication schedule. Certain rheumatoid arthritis medicines, like hydroxychloroquine and oral steroids, are prescribed to be taken with meals. As always, talk with your doctor before you try an IF diet.
A number of foods have an anti-inflammatory effect because they contain polyunsaturated fatty acids, fiber, or phytonutrients (beneficial substances that occur naturally in plants). Regularly consuming the following foods may help alleviate RA symptoms, easing joint pain and inflammation.
Fruits and Vegetables
Berries, citrus fruits, and leafy greens are high in antioxidants that help neutralize inflammation-triggering molecules called free radicals. Fruits and veggies are also loaded with vitamins, minerals, and polyphenols (antioxidant compounds found in plants), which may help lower C-reactive protein (CRP), a marker of inflammation.
Healthy Fats
Omega-3 fatty acids — found in oily fishes such as salmon, mackerel, herring, and tuna — have shown potential efficacy in reducing inflammation and thereby potentially preventing or modulating several chronic diseases like RA. Another healthy fat: extra virgin olive oil. It contains oleocanthal, among other polyphenols that have been shown to lower inflammation. Some experts believe olive oil is the leading reason the Mediterranean diet is so effective in preventing chronic disease, according to the Arthritis Foundation.
Whole Grains
Whole grains — like quinoa, brown rice, whole oats, and whole wheat — are rich in B vitamins and in antioxidants and they’re also high in fiber, which can reduce cholesterol. Eating whole grains may decrease your risk of type 2 diabetes, high blood pressure, and heart disease, says the Arthritis Foundation. This is important for people with RA, who have almost twice the risk of cardiovascular disease compared with people without RA. Whole grains also promote beneficial bacteria in your gut microbiome — and gut health and RA increasingly appear to be connected.
Refined grains, on the other hand, like white bread and white rice, have been shown to promote inflammation.
Nuts and Seeds
Walnuts and flaxseeds are other good sources of omega-3, as are chia seeds.
Chia seeds are also high in fiber, which can help with weight control.
Almonds not only contain more fiber than most nuts, they’re also a good source of vitamin E, an antioxidant, and studies suggest the monounsaturated fats from almonds lower some markers of inflammation.
One serving a day — about an ounce of nuts or one to two tablespoons of seeds — will provide the nutrients you need.
Lean Protein
Loss of muscle mass, which can cause weak bones, joint stiffness, poor posture, falls, and frailty, is more common in adults who have rheumatoid arthritis (RA) than in those who don’t. Research shows that higher protein intake is associated with less muscle loss and increased strength when combined with exercise like resistance training.
Lean protein sources, such as fish and legumes (beans, peas), are recommended for people with RA.
Just as certain foods provide beneficial nutrients for people with RA, other foods promote inflammation and can worsen RA symptoms. Here’s what to avoid:
Processed and Fried Foods
Processed foods, like grocery-store snacks and packaged meals, are often full of ingredients that cause inflammation: sugar, refined flour, and saturated fats.
Studies have shown that fried foods can raise the amount of advanced glycation end products (AGEs) in the blood — AGEs are thought to increase inflammation in the body. Fried foods are also high in fat and can contribute to obesity.
Sugars and Refined Carbohydrates
Eating simple carbohydrates — white-flour bread and pasta, white rice, and sugary snacks and drinks — can cause blood sugar levels to surge. This, in turn, leads the body to produce pro-inflammatory chemicals called cytokines.
Consuming refined carbs can also lead to weight gain, which can put added pressure on inflamed joints.
Saturated and Trans Fats
Saturated fats are found in red meat and full-fat dairy, and can raise your total cholesterol and your LDL, or “bad,” cholesterol levels. Studies suggest that saturated fats stimulate an inflammatory response in the body.
While you should limit your intake of saturated fats, you should simply avoid trans fats. They’re often found in commercial baked goods, fried foods, and margarine. Trans fats increase LDL and lower HDL (“good”) cholesterol, raising your heart disease risk.
Excessive Alcohol
Consuming more than two drinks a day (for men) or one drink a day (for women) isn’t recommended for anyone. But excessive drinking can be especially dangerous for people with RA. While it’s unclear just how alcohol itself impacts RA, a number of RA drugs can potentially increase your risk of liver damage and adding alcohol to the mix compounds the problem.
Heavy drinking is also associated with lower bone density, and people with RA are already at a greater risk of osteoporosis.
Several dietary supplements may help people manage their RA symptoms. Check with your doctor, though, before taking any supplements as they may interfere with prescription medications. Your doctor can also discuss proper dosage with you.
Omega-3 fatty acids, as noted earlier, have an anti-inflammatory effect. People with RA who took fish oil supplements — a common source of omega-3 supplementation — along with a disease modifying anti-rheumatic drug (DMARD) had a better response to their medication and achieved remission sooner. Several clinical studies have found that fish oil supplements containing omega-3 fatty acids may improve the symptoms of some autoimmune diseases like RA.
Curcumin (a major active component of turmeric) has anti-inflammatory properties that may make it helpful for RA. One meta-analysis of studies found that the antioxidant activity and anti-inflammatory effects of curcumin are beneficial for RA treatment and that curcumin supplementation improves inflammation levels and clinical symptoms in patients with RA.
Ginger has been shown to suppress inflammation and may play a protective role in gut health. While research into ginger for RA specifically is limited, a couple of studies suggest that ginger may benefit RA by improving immune system function and decreasing inflammation.
Vitamin D deficiency is more common in people with RA — possibly causing the condition to develop or worsening it. In addition to getting a safe amount of sun and eating foods rich in vitamin D, taking a supplement can help you boost your levels.
Modifying your diet can be an effective strategy to help manage rheumatoid arthritis (RA), alongside medical treatment.
Following the Mediterranean diet, in particular, and consuming a variety of anti-inflammatory foods like fruits, vegetables, fish rich in omega-3 fatty acids, and whole grains may reduce inflammation and ease RA symptoms.
As you make changes to your diet, always consult your healthcare provider to make sure this nutritional approach is right for you.
