Diet and RA
Dietary advice is abundant in the arthritis community. Despite years of interest and research, our knowledge about the impact of dietary therapy on disease activity in RA has not changed much since the editorial “Diet therapy for the patient with rheumatoid arthritis?” appeared in the journal Rheumatology in 1999.
A number of small studies have utilized restricted diets (such as fasting followed by vegan diet, lactovegetarian diet, or vegetarian diet) or diets that eliminated specific foods (such as diary products, red meat, citrus, fruits, tomatoes, alcohol or coffee) then reintroduced individual foods to note any objective or subjective changes in RA symptoms. Most of these studies were of short duration and too small to determine statistical significance, although a number of patients did report subjective improvements in symptoms during the restricted portion of the trials.
A more comprehensive 13-month study in 57 patients with RA found that 12 patients (44%) in the diet group responded to dietary elimination of specific foods combined with a vegetarian diet with improvement as measured by objective and subjective disease variables. Ten patients (37%) in the diet group reported aggravation of symptoms after reintroduction of one or more food items.
A follow-up study conducted 2 years later in the same patients found that responders had continued with the diet and still had significant reduction in clinical disease variables including ESR. In the follow-up study, 13 patients (59%) in the diet group reported an increase in disease symptoms after intake of meat, and 10 patients (45%) after intake of sugar and coffee. Of the 10 responders examined in the follow-up study, eight reported an increase in disease symptoms after intake of different kinds of meat, and six after intake of coffee, sweets and refined sugar.
This implies that a number of RA patients may be sensitive to meat, coffee, and sugar. With that in mind and knowing that RA patients have an increased risk of cardiovascular disease, what should we eat?
A Mediterranean-type diet is rich in oily fish, fresh fruits and vegetables, nuts, beans and legumes, poultry, olive oil, wholegrain cereals and low in saturated fats. It contains foods rich in omega-3 polyunsaturated fatty acids (n-3 PUFAs) and antioxidants. Studies suggest that some dietetic elements of the Mediterranean-type diet (polyunsaturated fatty acids, mediterranean diet and antioxidants) have anti-inflammatory effects and decrease RA disease activity (González Cernadas, 2014).
A recent meta-analysis suggests that the use of omega-3 fatty acids at dosages >2.7 g/day for more than 3 months reduces NSAID consumption by RA patients (Lee, 2012; Park, 2013). Natural sources of omega-3 fatty acids are oily fish such as mackerel, sardines, herring, salmon, trout and fresh tuna (not canned tuna). Eating oily fish 2 or 3 times a week provides a reasonable level of the omega-3 fatty acids EPA and DHA known to be beneficial. However, it is also important to reduce consumption of omega-6 fatty acids, commonly found in sunflower oils and margarines, which may increase inflammation.
A small pilot study found significant clinical benefits in patients who followed a modified Mediterranean diet for 3 months compared with those who followed their usual diet. They had reduced swollen and tender joints, reduced duration of morning stiffness and improved general wellbeing (McKellar, 2007). This is generally a heart-healthy way to eat and has health benefits beyond improving RA such as reducing the risk of some cancers and heart disease.
The antioxidants found in brightly colored fruits and vegetables produce an anti-inflammatory effect by reducing the damage of free radicals produced in the body. The most common antioxidants are vitamins C, E and A, and carotenoids such as βb -carotene, b -β-cryptoxanthin, luteins and lycopenes. The vitamins and minerals found in fruit and vegetables, in addition to antioxidants, support the immune system which is important for people with RA who commonly take immunosuppressant medications.
Fruit and vegetables are also low in calories and can help support a healthy diet and weight loss. Excess weight is bad for joints and overall health. As the pressure on your knee joint is 5-6 times your body weight when you walk, even small amounts of weight loss can greatly reduce stress on joints. Obesity increases inflammatory cytokines in the blood and has been implicated in a higher risk of developing RA. However, one study associated high BMI with less severe disease activity for RA patients who were anti-CCP positive. The evidence is mixed with regards to the effect of obesity on RA.
Basically it is important to eat a well-balanced, heart-healthy diet rich with the vitamins, minerals, antioxidants, and protein our body needs to build and repair tissues. For a list of healthy foods which contain many of the nutrients mentioned above, check out this list compiled by Kelly Young.
See More Helpful Articles:
“Diet and Rheumatoid Arthritis” by Dorothy J Pattison, 10 Oct 2007; updated by Victoria Mann, 11 Jan 2014. National Rheumatoid Arthritis Society. Accessed 26 Mar 2014
"Diet and Arthritis." Arthritis Research UK. Accessed 26 Mar 2014.
“Healthy Eating Strategies & Rheumatoid Arthritis Food” by Kelly Young. Rheumatoid Arthritis Warrior. Accessed 26 Mar 2014.
Abendroth A, Michalsen A, et al. Changes of Intestinal Microflora in Patients with Rheumatoid Arthritis during Fasting or a Mediterranean Diet. Forsch Komplementmed. 2010;17(6):307-13. doi: 10.1159/000322313. Epub 2010 Dec 7.
Ajeganova S, Andersson ML, Hafström I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term followup from disease onset. Arthritis Care Res (Hoboken). 2013 Jan;65(1):78-87. doi: 10.1002/acr.21710.
Crilly MA, McNeill G. Arterial dysfunction in patients with rheumatoid arthritis and the consumption of daily fruits and daily vegetables. Eur J Clin Nutr. 2012 Mar;66(3):345-52. doi: 10.1038/ejcn.2011.199. Epub 2011 Nov 30.
Dolphus R, Dawson III, et al. Dietary modulation of the inflammatory cascade. Periodontology 2000. 2014 Feb;64(1):161-197. doi: 10.1111/j.1600-0757.2012.00458.x. Epub 2013 Dec 9.
Ghorbanihaghjo A, Kolahi S, Seifirad S, et al. Effect of fish oil supplements on serum paraoxonase activity in female patients with rheumatoid arthritis: a double-blind randomized controlled trial. Arch Iran Med. 2012 Sep;15(9):549-52. doi: 012159/AIM.007.
González Cernadas L, Rodríguez-Romero B, Carballo-Costa L. Importance of nutritional treatment in the inflammatory process of rheumatoid arthritis patients; a review. Nutr Hosp. 2014 Feb 1;29(2):237-45. doi: 10.3305/nh.2014.29.2.7067.
Hayashi H, Satoi K, Sato-Mito N, et al. Nutritional status in relation to adipokines and oxidative stress is associated with disease activity in patients with rheumatoid arthritis. Nutrition. 2012 Nov-Dec;28(11-12):1109-14. doi: 10.1016/j.nut.2012.02.009.
Issazadeh-Navikas S, Teimer R, Bockermann R. Influence of dietary components on regulatory T cells. Mol Med. 2012 Feb 10;18:95-110. doi: 10.2119/molmed.2011.00311.
Jhun JY, Yoon BY, Park MK, et al. Obesity aggravates the joint inflammation in a collagen-induced arthritis model through deviation to Th17 differentiation. Exp Mol Med. 2012 Jul 31;44(7):424-31. doi: 10.3858/emm.2012.44.7.047.
Lahiri M, Morgan C, Symmons DP, Bruce IN. Modifiable risk factors for RA: prevention, better than cure? Rheumatology (Oxford). 2012 Mar;51(3):499-512. doi: 10.1093/rheumatology/ker299. Epub 2011 Nov 24.
Lee YH, Bae SC, Song GG. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012 Jul;43(5):356-62. doi: 10.1016/j.arcmed.2012.06.011. Epub 2012 Jul 24.
McKellar G, Morrison E, McEntegart A, et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis. 2007;66:1239–1243. doi: 10.1136/ard.2006.065151.
Park Y, Lee A, Shim SC, et al. Effect of n-3 polyunsaturated fatty acid supplementation in patients with rheumatoid arthritis: a 16-week randomized, double-blind, placebo-controlled, parallel-design multicenter study in Korea. J Nutr Biochem. 2013 Jul;24(7):1367-72. doi: 10.1016/j.jnutbio.2012.11.004. Epub 2013 Jan 17.
Patterson E, Wall R, Fitzgerald GE, et al. Health implications of high dietary omega-6 polyunsaturated Fatty acids. J Nutri Metab. 2012;2012:539426. doi: 10.1155/2012/539426. Epub 2012 Apr 5.
Vaghef-Mehrabany E, Alipour B, et al. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition. 2014 Apr;30(4):430-5. doi: 10.1016/j.nut.2013.09.007. Epub 2013 Dec 17.
Wardhana, Surachmanto ES, Datau EA. The role of omega-3 fatty acids contained in olive oil on chronic inflammation. Acta Med Indones. 2011 Apr;43(2):138-43.