Rheumatoid arthritis is one of the most common autoimmune diseases.
It affects up to 1.3% of the population worldwide, mostly women.
New research indicates that diet may influence traditional treatments for rheumatoid arthritis. This article summarizes the current science and recommendations.
- What is Rheumatoid Arthritis?
- Symptoms of Rheumatoid Arthritis
- Possible Foods to Avoid with Rheumatoid Arthritis
- Foods and Nutrients That May Help
- What Is the Best Diet or Eating Pattern for Rheumatoid Arthritis?
- Sample 3-Day Diet Plan for Rheumatoid Arthritis
- Summarizing The Best Diet For Rheumatoid Arthritis
What is Rheumatoid Arthritis?
Rheumatoid arthritis affects the structure and function of the joints.
A membrane called the synovium lines the joints, creating space and fluid for lubrication and movement.
In rheumatoid arthritis, the immune system attacks the synovium. This leads to an inflammatory immune response that causes pain, joint deformity and disability as it progresses (1).
The exact cause of rheumatoid arthritis remains unknown, but genetics and health of our gut bacteria appears to play a strong role.
That said, those who carry the genes may never develop the disease.
Summary: Rheumatoid arthritis is a condition in which the immune system attacks the lining of the joints. The exact cause is unknown.
Symptoms of Rheumatoid Arthritis
Common signs and symptoms of rheumatoid arthritis include:Joint pain or tenderness
- Redness or swelling in the joints
- Joint stiffness, especially in the morning
- Low-grade fever
- Anemia (low red blood cell count)
- Firm lumps under the skin
- Poor joint mobility.
Rheumatoid arthritis symptoms may occur in “flares”, during which symptoms appear or worsen for a period of days to weeks.
If you’re experiencing two or more of these symptoms please speak with your doctor. Left untreated it can cause permanent bone and joint damage within the first year.
Summary: There are numerous symptoms of rheumatoid arthritis. Early diagnosis and treatment is key to preventing permanent damage to the joints.
Possible Foods to Avoid with Rheumatoid Arthritis
Medication is the first line of treatment for rheumatoid arthritis.
This includes non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs (DMARDs), and corticosteroids.
However, early research and patient anecdotes suggest some pharmaceuticals and eating patterns can influence disease activity as well. This includes drugs such as adderall, and foods such as gluten and dairy.
Foods and Nutrients That May Help
The addition of certain foods and nutrients may help reduce rheumatoid arthritis inflammation.
Most studies have used supplements rather than whole food sources, as a high nutrient dose is often required.
Note that patients should not add supplements without medical supervision due to the risk of drug interactions and side effects.
Omega-3s Fatty Acids
In a study of 140 rheumatoid arthritis patients, one group had 5.5 grams of fish oil per day while the second group (control) had only 0.4 grams of fish oil per day. All participants were also given several anti-rheumetic drugs throughout the study.
Both groups experienced a decrease in disease activity, but the first group had higher rates of remission (relief from symptoms) (7).
Change in rheumatoid arthritis activity (DAS28-ESR) and modified Health Assessment Questionnaire (mHAQ) over 1 year. Lower score is better. Click to enlarge.
So it appears that a fish oil dose of at least 2.7 grams of DHA plus EPA daily can boost the effectiveness of anti-rheumetic, at least in the first 6 months.
Note that fish oil supplements may interact negatively with certain rheumatoid arthritis drugs, so always speak with your doctor first.
New research suggests a specific form of vitamin K2 (also called MK-7) can help improve the effectiveness of rheumatoid arthritis medication.
Out of 84 rheumatoid arthritis patients, the first group received 100 mcg/day of MK-7 for 3 months, while the second group received dummy pills.
The first group had large improvements for markers of inflammation and disease activity score assessment. Additionally, MK-7 use increased the level of the active form of osteocalcin, an important marker of bone health (9).
It’s currently unknown if food sources of vitamin K2 have the same effects.
Vitamin D and Calcium
Those with rheumatoid arthritis are at increased risk of bone disease because of chronic inflammation, decreased physical activity, and use of corticosteroids.
Vitamin D is fundamental for good health and yet is the number one nutrient deficiency in the Western world.
Where adequate sun exposure is not possible, vitamin D + calcium supplements are strongly recommended. Food sources are also recommended, including fatty fish, egg yolks, fortified milk, and offal.
Summary: There are several foods and supplements likely to influence symptom management of rheumatoid arthritis. Fish oil and vitamin K2 have the strongest evidence so far.
What Is the Best Diet or Eating Pattern for Rheumatoid Arthritis?
The Mediterranean diet consists of traditional foods that those in countries like Croatia and Greece ate before the 1970s.
It emphasizes fruits, vegetables, legumes, whole grains, olive oil, and seafood.
It’s shown promise for treating rheumatoid arthritis, possibly due to its favorable ratio of omega-3 fats to arachidonic acid (13).
In a 3-month study of 51 rheumatoid arthritis patients, one group followed a Mediterranean diet while the control group ate a standard Western diet.
As you can see in the graph below, the Mediterranean diet group showed large improvements in physical function and vitality (16).
Rheumatoid arthritis disease activity (DAS28 score) at baseline and at weeks 6 and 12 of Mediterranean diet vs control diet. Lower score is better. Click to enlarge.
Summary: Limited evidence indicates a vegetarian diet is uniquely beneficial for rheumatoid arthritis. A Paleo diet may be beneficial for patients who are sensitive to gluten or dairy, but the additional food restrictions are unnecessary. The Mediterranean diet is quite well-studied in this area an appears the most useful.
Summarizing The Best Diet For Rheumatoid Arthritis
There is compelling evidence that diet changes can complement traditional medical treatment of autoimmune disease.
The Mediterranean diet in particular appears the most useful and well-studied diet for rheumatoid arthritis.
Fish oil and vitamin K2 supplementation may also help combat inflammation, and are certainly worth a try alongside rheumatoid arthritis medications.