Going "gluten-free" is all the rage these days as evidenced by an increasing number of products advertised as such. If we are to believe the hype, a gluten-free diet is healthier for you and may improve a wide variety of symptoms. In fact, people who have sensitivities to gluten do benefit by eliminating it from their diets.
But can doing that help reduce RA symptoms?
What is gluten?
Gluten is a type of protein found in wheat (including spelt, couscous, semolina, kamut, farro, and bulgur) and other grains such as barley, rye and triticale (a cross between wheat and rye). Gluten is not found in other grains, such as rice, corn, quinoa, amaranth, buckwheat, millet, sorghum, teff, and oats (unless contaminated with wheat during processing). In many processed foods, gluten functions as a thickener, texture enhancer, and flavor or leavening agent. It can be found in products such as salad dressing, seasoning mixes, soy sauce, bread, pasta, soup, crackers, cakes, cookies, prepared meats, flavored coffee, beer, some candies and even lip balm.
Eliminating gluten from your diet goes way beyond avoiding wheat-based products or nutrient-packed grains. Naturally gluten-free grains (e.g. rice or corn) provide an important source of vitamins, minerals, antioxidants and fiber. In addition, meat, fish, poultry, fruits and vegetables do not contain gluten, but again be aware that the processing or cooking of these foods may involve the addition of gluten such as in breading or sauces.
Who should avoid gluten?
People who have a wheat allergy may be sensitive to foods containing gluten. However, it is important to note that it is the wheat contained in foods which causes an allergic reaction, not specifically gluten. Wheat allergies are acute–within minutes or hours of consumption–and can be very severe. Symptoms can include swelling, itching, or irritation of the mouth or throat; hives, itchy rash or swelling of the skin; nasal congestion; headache; itchy, watery eyes; difficulty breathing; cramps, nausea or vomiting; diarrhea; or anaphylaxis.
Approximately 3 million people in the United States have celiac disease, an autoimmune disorder of the digestive tract by which eating foods containing gluten results in damage to the finger-like villi of the small intestine and interferes with absorption of nutrients from food. Celiac disease is difficult to diagnose because the symptoms often mimic other diseases. More than 300 symptoms may be associated with celiac disease, including bloating or gas, itchy skin rash, headaches, depression, mouth sores, fatigue and joint pain.
Is gluten connected to rheumatoid arthritis?
A dietary link to rheumatoid arthritis has been suspected for decades and the effects of different diets on arthritis symptoms have been reported. A number of patients with RA may self-report adverse reactions to certain foods, such as cow’s milk or wheat, without showing objective reactivity to these foods upon testing, according to a 2008 study (LidÃ©n, 2008). Researchers found that perceived food intolerance is reported by RA patients in similar percentages to the general population. According to a study conducted over half a century ago, researchers determined that rheumatoid arthritis is not related to a gluten-induced intestinal defect (Binder, 1966).
More recent research, however, shows that a gluten-free vegan diet can improve the signs and symptoms of RA compared to a well-balanced, non-vegan diet. This benefit may be related to a reduction in the immunoreactivity to food antigens that were eliminated by the change to a gluten-free vegan diet (HafstrÃ¶m, 2001). For RA patients who also experience non-celiac gluten sensitivity, avoiding gluten may improve some of the overlapping symptoms such as joint pain, brain fog, and fatigue.
In another study, a gluten-free vegan diet in patients with RA decreased total cholesterol levels, low-density lipoprotein (LDL), and LDL/HDL ratio. It did not significantly change high-density lipoprotein (HDL) or triglyceride levels. The gluten-free vegan diet also induced lower body mass index (BMI) and higher levels of atheroprotective antibodies against phosphorylcholine (anti-PCs) of the IgA and IgM subclasses. Anti-PCs help to protect against heart disease with an inverse relationship between low levels of anti-PC IgM and increased development of atherosclerosis (Elkan, 2008).
Emrich, Lisa. "Mediterranean-type Diet and RA." HealthCentral.com, 31 March 2014. Retrieved from http://www.healthcentral.com/rheumatoid-arthritis/c/72218/168403/mediterranean
Esanderson. "Top 10 Gluten-Free Brands Worth a Try." HealthCentral.com, 16 April 2014. Retrieved from http://www.healthcentral.com/ibd/c/11407/168714/top-10-gluten-free-brands-worth/
Binder HJ, O’Brien WM, Spiro HM, Hollingsworth J. Gluten and the Small Intestine in Rheumatoid Arthritis. JAMA. 1966;195(10):857-858. doi:10.1001/jama.1966.03100100109033.
Elkan AC, SjÃ¶berg B, Kolsrud B, et al. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study. Arthritis Res Ther. 2008;10(2):R34. doi: 10.1186/ar2388. Epub 2008 Mar 18.
HafstrÃ¶m I, Ringertz B, SpÃ¥ngberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford). 2001 Oct;40(10):1175-9.
LidÃ©n M, KristajÃ¡sson G, Valtysdottir S, et al. Self-reported food intolerance and mucosal reactivity after rectal food protein challenge in patients with rheumatoid arthritis. Scand J Rheumatol. 2010 Aug;39(4):292-8. doi: 10.3109/03009740903379630.
Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012 Feb 7;10:13. doi: 10.1186/1741-7015-10-13.
What other health problems do people with celiac disease have? (2012 Jan 27). National Digestive Diseases Information Clearinghouse. Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#other
Non-Celiac Gluten Sensitivity. National Foundation for Celiac Awareness. Retrieved from http://www.celiaccentral.org/non-celiac-gluten-sensitivity/
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.