Rheumatoid Arthritis: 5 Changes You Can Make
What is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune condition in which the body’s own immune system attacks the membranes or lining inside the joints [1]. This leads to the joints becoming swollen, inflamed, painful and stiff [2]. Generally, rheumatoid arthritis will affect joints in a symmetrical manner — which means that if the left knee is experiencing symptoms the right knee will also be experiencing symptoms [2]. Although rheumatoid arthritis primarily affects the joints, other tissues (such as heart, kidney and lungs) can also be affected [2].
Joint pain and stiffness will generally be worse in the mornings and this tends to last for more than half an hour [2]. Symptoms go through periods of flare-ups — in which the symptoms are worse and more debilitating — and remission — in which there may be hardly any symptoms at all [2].
Rheumatoid arthritis is unfortunately (at the moment) incurable. What we know about conditions like this is that it is quite normal to have flare-ups — so if you have just had one (perhaps after a longer period of remission) — don’t be scared. It doesn’t necessarily mean you will go right back to how you felt when you were at your worst, or that things will get worse than they are. Making sure you take the best possible care of yourself (without panicking) during those periods is the best way to get through a flare-up with the least stress possible.
And that’s what this article is about — if you’re not interested in the science then scroll down to the bottom for 5 practical ways to support your body with diet when you have rheumatoid arthritis.
Why does Rheumatoid Arthritis develop?
Like most autoimmune conditions, rheumatoid arthritis seems to be the result of an interaction between genetic and environmental factors. Certain people seem to have a genetic predisposition to develop the condition, but not everyone with these genes develops it.
Rheumatoid arthritis is more common in women [3] and there also seems to be an increased risk of developing rheumatoid arthritis if you smoke [4]. Other risk factors, such as stress, exposure to mineral oils or silica dust, may also exist — but these are less well explored [4].
Diet may also be linked with the risk of developing rheumatoid arthritis. The nurse’s health study (a large scale, long-term study of female nurses) for example found a slight increased risk of developing rheumatoid arthritis in women who drank more sugar-y sodas [5]. Other studies found a reduced risk as a result of higher consumption of fruit, vegetables and oily fish [5], [6]. In general, however, it seems more likely that diet plays a role in the severity of the disease rather than the actual development of the illness [5].
So why does diet matter once I have Rheumatoid Arthritis?
About 70–80% of patients with rheumatoid arthritis will have elevated levels of an autoantibody known as Rheumatoid Factor (RF) [7]. Antibodies bind to binding sites (known as antigens) on cells that need to be destroyed or de-activated by the immune system [8]. The antibody can either do this itself or it sends signals to other immune cells to come and destroy the cell it has connected to [8].
This works well when the antibody reacts to an antigen on a virus for example. Autoantibodies, however, react to antigens on our own cells. Again, this works well if the cell is malfunctioning (such as a cancer cell) [8] but when it begins to bind to healthy cells, such as the lining of your joints, and triggers the immune system to destroy or de-activate these cells, there is a problem [8]. Unfortunately, RF does exactly this.
RF is thought to be triggered by antigens that could come from foods or bacteria/bacterial products [7] (this is known as molecular mimicry). Therefore, reducing the presence of these antigens could result in lower levels of RF being produced [7]. A reduction in RF may lead to a reduction in symptoms — especially in people with high levels of RF to begin with. And that’s where foods come in — to reduce RF we need to reduce foods that may either enter the bloodstream themselves (in undigested form) to trigger RF or that promote bacteria, which trigger RF.
But how do foods and bacteria enter the bloodstream to trigger RF?
In order for food or bacterial molecules to trigger an immune response they must have entered the bloodstream.
You may quite rightly be thinking ‘But how can that happen, only tiny digested particles pass through the gut lining into our bloodstream?’
In short, yes. In an ideal world, only tiny particles (such as glucose, amino acids or minerals and vitamins) should be passing through our gut into the bloodstream. However, a number of factors (including stress, smoking and nutrient deficiencies) can affect the integrity of our gut lining — making it more permeable to larger molecules passing through. These can then trigger RF.
Certain dietary factors can also play a role. Examples include:
Gluten: gluten contains something called gliadin that can trigger the release of something called ‘Zonulin’ which acts as a messenger to tell the cells lining the gut to move apart — creating larger gaps for molecules to pass through [9].
Lectins: lectins are glycoproteins found in most foods but especially in grains and legumes, they can cause irritation and inflammation in the gut, leading to greater permeability [7]. Lectins actually also encourage the growth of two types of bacteria (L. lactis and E. coli) that may exacerbate rheumatoid arthritis due to molecular mimicry.
Alcohol and NSAIDs: have both been shown to increase the permeability of the gut lining [10], [11].
Certain species of bacteria: species like E. coli, L. lactis, B. ovis and P. mirabilis have all been shown to increase the severity of rheumatoid arthritis, which may be due to molecular mimicry or their effect on the lining of the gut wall [7].
Don’t panic!
I know that reading this may sound quite scary! I mean — NSAIDs may be necessary for you to cope with day-to-day pain, cutting out gluten is challenging even when you are feeling well and whole-grains and beans are supposed to be healthy…
So here are 5 practical tips on how you can support your wellbeing with food without overwhelming yourself:
1. Relax when you eat
Once we start to worry about food making us unwell we can start to carry a heck of a lot of tension about choosing our foods and eating them. The problem with this is that stress actually impairs digestion — making it more likely that undigested particles get to places we don’t want them to. Stress, although essentially anti-inflammatory, can become inflammatory when it is chronic — meaning constant stress may actually make your immune system more likely to react to things (read more about this in my article on food and mood).
Have you ever heard of people who go on holiday and can suddenly eat way more foods (without any negative reaction) than they can at home? Yep — that’s how much stress can impact how we tolerate foods and how they affect our health!
I imagine me telling you to relax when you eat is about as helpful as someone telling me to relax while I’m waiting for the bus — knowing isn’t the same as doing. So here are a few things you can do to actually reduce stress:
- Take a moment to be grateful before each meal
- Take at least 2 minutes out of each day to do some deep breathing (apps like this one can be helpful)
- Take micro-breaks: we get so busy with our errands and to-do lists that a whole day can pass us by without a single intentional break. Practice taking 5–10 minutes a few times a day to simply sit and think, look out of the window, listen to music or sip on a cup of herbal tea.
2. Remember to chew
Chewing is the first step of digestion — when we don’t do this properly we put a huge burden on the rest of our digestive system to do the bulk of the work. This again increases the risk of undigested food particles getting to places we don’t want them to.
I mean think about it this way — if your teeth haven’t broken down the handful of nuts you’ve just eaten, then teeny tiny enzymes and bacteria have to do all that work. Take the time to chew and reduce the time your poor digestive system has to work on all that food.
3. Eat your rainbows (I mean vegetables)
Think about the past week — how many different types of vegetables did you eat? If you’re anything like I was a few years ago the answer would probably be four or five (I’m guessing carrots, some sort of salad leaf, potato, cucumber and onion) … although maybe I am being presumptuous and you eat a far wider variety.
I heard somewhere that we should actually be eating at least 30 different types of plants (so that’s vegetables but also fruits, grains, nuts, seeds and legumes) each week. Now I’m not exactly sure where that number comes from but one study found that those who ate 30 or more types of plants each week had a much more diverse microbiome (which means a wider variety of gut bugs) than those who ate only 10 types. Having a wider variety of gut bugs may not sound very good, but it has actually been associated with improved health, including less inflammation of the gut (which means a less permeable gut lining, which is good for anyone with autoimmune disease!) [12], [13].
The bacteria in our gut are also essential for the development and then regulation of our immune systems [14]. Low diversity of gut bugs (particularly in early life) is linked with dysregulation of the immune system [14]. By taking care of your gut in the best possible way (by feeding it a variety of fibrous foods) you are also taking care of your immune system.
4. Balance your fats
As you may have noticed — the recommendations I am giving focus on supporting your body in regulating the immune system and repairing the gut. Autoimmunity is enormously complex and there will be no one quick (or long) change that will fix everything. Instead, you should focus on helping each system in your body function at its best as this will reduce the load on your immune system, allowing your body to take better care of itself.
Fats are one of those things that can either help your body or get in the way of your body functioning optimally. The key fats (that you have probably heard about already) to help the body are omega-3s — simply because most of us don’t get enough of them in today’s day and age [15]. Research has consistently shown that omega-3s regulate inflammation in the body [16] and a number of studies have found that a higher omega-3 intake (and a lower omega-6 intake) reduces the likelihood and severity of rheumatoid arthritis [6], [17]–[20].
In terms of the gut — one recent study found that pregnant women with higher markers of intestinal permeability (zonulin) consumed less omega-3 than those who had lower markers. The author’s concluded that omega-3 can play an important role in maintaining a healthy gut lining. Actually, research also shows that omega-3s have a beneficial impact on the gut bugs [21]– which you now know may contribute to a healthier gut lining.
How do I increase my omega-3 intake I hear you ask? The best sources of omega-3s are oily fish and seafood [22]. If you don’t eat those for whatever reason you can try algal omega-3 supplements (I like this one — although beware, it tastes like algae).
Other things you can do is focus on eating pasture (grass) raised animal products as these will have less omega-6 and more omega-3 [15], reduce your intake of vegetable oils like sunflower oil (use extra virgin olive oil instead), and eat plant foods like walnuts, hemp and chia seeds.
5. Get to know yourself
Last — but definitely most important — get to know yourself! Every. Single. Immune. System. Is. Different. There are a multitude of factors that affect how your immune system developed and how it functions now. Your immune system will never be exactly like the immune system of another person.
That’s why there can’t be a one size fits all approach to treating autoimmune conditions like rheumatoid arthritis. I recommend working with a trained practitioner who can help you get to know yours. By knowing yourself you will know if your main triggers are dietary, bacterial, environmental (e.g. toxins) or viral or something else completely. By knowing that you don’t have to waste time and energy on protocols that promise you the moon but treat you as if your immune system functions in exactly the same way as somebody else’s (which it doesn’t!).
So here is a list of dietary changes that studies have found to help some people with rheumatoid arthritis:
- Cutting out common allergens like cereals, dairy products and yeast [7], [23].
- Cutting out sugar and sweetened foods [17].
- Reducing the intake of free fructose (fructose — fruit sugar — that comes without the fibre it is usually bound in. Examples include high fructose corn syrup or fruit juices) [24].
- Reducing the intake of sodium (salt) [24], [25].
- Cutting out nightshades (although this is based on patient experience reports and not scientific research) [17].
- Fasting [28], [29] — although I would not recommend this without the support of a trained practitioner! What you can do, is make sure that you leave at least a 12-hour period between your dinner and your breakfast in which you do not eat.
- Cutting out red meat [26] but there is conflicting research on whether rheumatoid arthritis is really affected by red meat intake [25], [27].
- Nevertheless, some studies have found that vegetarian, gluten-free or Mediterranean diets can lead to benefits [17], [18]. One study found that a combination of a vegan and gluten-free diet led to a reduction in symptoms by 40% [23].
Now DON’T go away and try to do all of this. Choose one or two changes that I have mentioned in this article, which feel manageable for you right now. Over a period of 2–4 weeks put them into practice really consistently. Keep a record of how you feel. If it helps — wonderful! If you want more improvement perhaps add a third change. If you feel like it didn’t help, perhaps try something else. Sometimes you may need to do a few things to start to experience a benefit. Play around with it, there is no point in implementing changes that you cannot sustain.
I would love to hear about your experience! Comment below to tell me what worked for you and ask me any questions if there is anything that you have found difficult.
Take care of yourself today ❤
Disclaimer: none of the information provided on this website is intended to diagnose, treat or cure any mental or physical health conditions. Resources are provided for information only. Be sure to speak to your health provider before making any significant changes to your diet, particularly if you have any pre-diagnosed health conditions.
References:
[1] “Rheumatoid arthritis — NHS.” [Online]. Available: https://www.nhs.uk/conditions/rheumatoid-arthritis/. [Accessed: 22-Oct-2019].
[2] “Rheumatoid arthritis — Symptoms — NHS.” [Online]. Available: https://www.nhs.uk/conditions/rheumatoid-arthritis/symptoms/. [Accessed: 22-Oct-2019].
[3] “Rheumatoid arthritis — Causes — NHS.” [Online]. Available: https://www.nhs.uk/conditions/rheumatoid-arthritis/causes/. [Accessed: 22-Oct-2019].
[4] L. Klareskog, L. Padyukov, J. Lorentzen, and L. Alfredsson, “Mechanisms of disease: Genetic susceptibility and environmental triggers in the development of rheumatoid arthritis,” Nature Clinical Practice Rheumatology, vol. 2, no. 8. pp. 425–433, Aug-2006.
[5] F. Oliviero, P. Spinella, U. Fiocco, R. Ramonda, P. Sfriso, and L. Punzi, “How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis,” Swiss Medical Weekly, vol. 145. EMH Swiss Medical Publishers Ltd., 2015.
[6] M. Pedersen, C. Stripp, M. Klarlund, S. F. Olsen, A. M. Tjønneland, and M. Frisch, “Diet and risk of rheumatoid arthritis in a prospective cohort,” J. Rheumatol., vol. 32, no. 7, pp. 1249–1252, Jul. 2005.
[7] L. Cordain, L. Toohey, M. J. Smith, and M. S. Hickey, “Modulation of immune function by dietary lectins in rheumatoid arthritis,” Br. J. Nutr., vol. 83, no. 3, pp. 207–217, Mar. 2000.
[8] K. Elkon and P. Casali, “Nature and functions of autoantibodies,” Nature Clinical Practice Rheumatology, vol. 4, no. 9. pp. 491–498, 2008.
[9] A. Fasano, “Leaky Gut and Autoimmune Diseases.”
[10] D. Y. Graham, A. R. Opekun, F. F. Willingham, and W. A. Qureshi, “Visible small-intestinal mucosal injury in chronic NSAID users,” Clin. Gastroenterol. Hepatol., vol. 3, no. 1, pp. 55–59, 2005.
[11] A. Keshavarzian et al., “Evidence that chronic alcohol exposure promotes intestinal oxidative stress, intestinal hyperpermeability and endotoxemia prior to development of alcoholic steatohepatitis in rats,” J. Hepatol., vol. 50, no. 3, pp. 538–547, Mar. 2009.
[12] K. Mokkala et al., “Gut Microbiota Richness and Composition and Dietary Intake of Overweight Pregnant Women Are Related to Serum Zonulin Concentration, a Marker for Intestinal Permeability,” J. Nutr., vol. 146, no. 9, pp. 1694–1700, Sep. 2016.
[13] S. Mörkl et al., “Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women,” Eur. J. Nutr., vol. 57, pp. 2985–2997, 2018.
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[15] A. P. Simopoulos, “Evolutionary Aspects of Diet: The Omega-6/Omega-3 Ratio and the Brain,” Mol. Neurobiol., vol. 44, no. 2, pp. 203–215, Oct. 2011.
[16] A. Simopoulos, Simopoulos, and A. P., “An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity,” Nutrients, vol. 8, no. 3, p. 128, Mar. 2016.
[17] S. K. Tedeschi and K. H. Costenbader, “Is There a Role for Diet in the Therapy of Rheumatoid Arthritis?,” Curr. Rheumatol. Rep., vol. 18, no. 5, p. 23, May 2016.
[18] C. Lourdudoss, L. Arnaud, A. Wolk, R. F. Van Vollenhoven, and D. Di Giuseppe, “Long-Term Dietary Changes after Diagnosis of Rheumatoid Arthritis in Swedish Women: Data from a Population-Based Cohort,” Int. J. Rheumatol., vol. 2018, 2018.
[19] L. K. Stamp, M. J. James, and L. G. Cleland, “Diet and rheumatoid arthritis: A review of the literature,” Semin. Arthritis Rheum., vol. 35, no. 2, pp. 77–94, 2005.
[20] O. Adam et al., “Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis,” Rheumatol. Int., vol. 23, no. 1, pp. 27–36, Jan. 2003.
[21] L. Costantini et al., “Impact of Omega-3 Fatty Acids on the Gut Microbiota,” Int. J. Mol. Sci., vol. 18, no. 12, p. 2645, Dec. 2017.
[22] A. P. SIMOPOULOS, “Omega-3 Fatty Acids and Antioxidants in Edible Wild Plants,” Biol. Res., vol. 37, no. 2, pp. 263–277, 2004.
[23] I. Hafstrom, “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, vol. 40, no. 10, pp. 1175–1179, Oct. 2001.
[24] E. Philippou and E. Nikiphorou, “Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis,” Autoimmunity Reviews, vol. 17, no. 11. Elsevier B.V., pp. 1074–1077, 01-Nov-2018.
[25] H. K. Choi, “Diet and rheumatoid arthritis: Red meat and beyond,” Arthritis and Rheumatism, vol. 50, no. 12, pp. 3745–3747, Dec-2004.
[26] W. B. Grant, “The role of meat in the expression of rheumatoid arthritis,” British Journal of Nutrition, vol. 84, no. 5. CAB International, pp. 589–595, 2000.
[27] E. Benito-Garcia, D. Feskanich, F. B. Hu, L. A. Mandl, and E. W. Karlson, “Protein, iron, and meat consumption and risk for rheumatoid arthritis: A prospective cohort study,” Arthritis Res. Ther., vol. 9, 2007.
[28] L. Sköldstam, L. Larsson, and F. D. Lindström, “Effects of fasting and lactovegetarian diet on rheumatoid arthritis,” Scand. J. Rheumatol., vol. 8, no. 4, pp. 249–255, 1979.
[29] J. Kjeldsen-Kragh et al., “Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis,” Lancet, vol. 338, no. 8772, pp. 899–902, Oct. 1991.
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