Written by: Bonnie Feldman, DDS, MBA, Mariella Lodi, Ellen M. Martin
As knowledge about nutrition and food as medicine expands, using foods as health enhancers and therapy agents has become increasingly popular. Many patients, including autoimmune, are now following dietary guidelines to help mitigate symptoms, based on a growing understanding that diet and nutrition can either exacerbate or reduce symptom severity.
Rheumatoid Arthritis (RA) is an autoimmune disease that affects the synovial lining of joints, resulting in painful swelling. RA is one of the most common autoimmune diseases, with approximately 1.5 million people diagnosed in the United States. Statistics show that not only are 132,000 people in the United States diagnosed with Rheumatoid Arthritis each year, but also that RA is diagnosed two to three times more frequently in women than in men.
What is RA?
Rheumatoid Arthritis occurs when the body’s immune system incorrectly attacks cells in the joints, causing the synovial tissue that lines the joints to thicken. The resulting joint swelling causes pain in and around the joints themselves. When left untreated, the inflammation may damage not only the cartilage surrounding the ends of the bones, but also the bones themselves. Over time, the loss of cartilage can lead to the joints becoming loose and painful, presenting a risk of losing joint mobility (1). Though RA typically affects joints of the feet, wrists, knees, ankles, and hands, it is a systemic disease, meaning it can also affect tissues in the cardiovascular or respiratory systems. Unfortunately, there is no current “cure” for Rheumatoid Arthritis. However, with early diagnosis and holistic treatment, RA symptoms can be managed.
Are there best foods for RA?
Certain foods and food components may help manage RA symptoms. The Internet offers an overwhelming amount of diet recommendations, including the Autoimmune Protocol and GAPS diets for inflammatory diseases, as well as low-FODMAP diets that can aid in identifying trigger foods. Head over to our recent article comparing different diet protocols to learn more about both of these diets! Additionally, diets such as the Mediterranean diet, which is full of antioxidants, veggies, healthy fats, beans, and fish, has been shown to be beneficial for RA patients (2). While we do believe that following a diet that emphasizes Omega-3 fatty acids, anti-inflammatory and antioxidant-rich foods should help people with RA, we don’t believe in a one-diet-for-all approach, because RA affects people differently and symptoms vary among patients. For this reason, it could be beneficial to first try a low-FODMAP diet to identify your specific trigger foods, then transition back to your normal diet with new personal modifications. Check out our article on immune boosting foods to learn more.
That being said, you have to start somewhere, and there is some scientifically backed evidence to support certain foods over others for RA patients. This table has been constructed to highlight the abundant information on food and RA, and we believe it to be a great starting point for any RA patient. In addition to a wide variety of scientific articles, we used information from Personal Remedies, which harnesses a knowledge base backed by science to suggest which foods to avoid and consume based on specific diseases. This service is free and shows individual food items and supplements that are the “best” for RA patients, in order of strength of scientific support. Combining their guidelines with our own knowledge, scientific research, and other scholarly tables we’ve crafted our best food recommendations for RA patients.
In general, following a generic autoimmune diet, which broadly focuses on eliminating processed foods, dairy, and added sugar, while increasing consumption of vegetables, fruits, fish and other whole foods may be important for RA patients. Drinking plenty of fluids is important in keeping your body functioning as best it can. We recommend keeping a food diary to uncover any foods that trigger your symptoms, as well as foods that your body responds well to.
Besides these general tips for managing joint pain, there are some dietary guidelines that are more specific to RA patients. Implementing fish oil supplements (18 grams/day), which are high in the omega-3 fatty acids DHA and EPA, has been shown to decrease inflammation. Introducing antioxidant supplements, such as vitamin E (800 iu/day) and selenium (300 mg/day), into your diet may further help to control RA symptoms. Additionally, studies have found that curcumin, which is the active component of turmeric, can be effective in treating RA symptoms by acting as a powerful anti-inflammatory agent (3). Curcumin is believed to be effective because not only is it a potent antioxidant, it also acts through multiple pathways to suppress the inflammation that underlies RA. Bromelain and papain enzymes are also strong anti-inflammatory agents that can be found in pineapple and papaya respectively (4).
The Worst Foods for RA
In contrast to these anti-inflammatory foods, there are also proinflammatory foods that should be avoided. These proinflammatory foods include processed meats, sodas and sugary beverages, salty snacks, packaged sweets, and refined carbohydrates. Unfortunately, these foods are also easy to reach for when stress eating or snacking. If you suffer from RA, these types of food are likely to increase inflammation, thus intensifying joint pain and other RA symptoms. Casein, the most common protein found in dairy products, has also been found to be a trigger for pain associated with RA. Therefore, we recommend avoiding dairy products as much as possible.
Because inflammation plays a role in all autoimmune diseases and RA is a disease that fits in overlapping categories, avoiding pro-inflammatory foods is our best recommendation. In addition to the generic pro-inflammatory foods listed in the table below, there are some specific foods that might be harmful to RA patients. Consuming too much processed food may also be harmful to RA patients, because it could lead to becoming overweight or obese. The extra fat causes increased inflammation throughout the body and the extra weight can place increased strain on the body’s joints, increasing the likelihood of pain and injury. Therefore, we recommend sticking to a nutritious diet, low in processed foods and high in fruits and vegetables.
Other Tools for Managing RA
Engage in Mindful Eating
Other aspects of eating are important to be cognizant of besides the best and worst foods for your body. Eating smaller, nutritionally-balanced meals could help ease digestion and help fight flare-ups. Chewing your food slowly and engaging your jaw can help activate your robust oral microbiome and promote beneficial oral health. A key aspect of mindfulness is paying attention to your body’s short and long-term response to a food.
What you drink matters too! RA patients specifically, should try to incorporate tart cherry juice into their diets, since tart cherries are found to be rich in antioxidants that combat inflammation. When drinking tea, coffee, juice, or alcohol we recommend drinking water alongside, for optimal oral health. Water normalizes the pH of mouth – healthy human saliva has a pH of 7.4. When we consume acidic foods and beverages, such as fruit juice and soda, oral pH is thrown out of balance (not to mention the additional sugar and calorie intake). When the pH within our mouths falls below 5.5, demineralization occurs, making us more susceptible to oral diseases, such as dental caries and periodontal disease. Drinking plenty of water daily can help maintain a healthy mouth pH, in addition to keeping you hydrated.
Exercise, Exercise, Exercise
Staying active is incredibly important to maintain healthy living, especially for those with RA since not moving can result in the joint becoming stiffer and ultimately less functional. Exercise can take many forms, from higher intensity training like running, weightlifting or playing sports, to lower intensity exercises like walking, yoga, Pilates or gentler movement therapies. Get our free ebook on movement therapy to explore more options!
Relax and Reduce Your Stress
Constant stress is one of the negative by-products of modern life. While our stress responses were beneficial in helping our ancestors avoid predation and other life-threatening situations, constant but not life-and-death stressors brought about by modern society can be extremely harmful to our bodies. While helpful in short bursts, our flight-or-fight responses (part of our sympathetic nervous systems), can have harmful consequences when constantly upregulated by non-life-threatening stress. These include triggering or exacerbating autoimmune flare-ups. It is therefore important for those with RA to reduce overall stress.
One of the easiest ways to do this is to make sure you are getting enough sleep. Most people do not get the recommended 7-9 hours of sleep daily. Whether taking an afternoon nap, going to bed earlier, or (if scheduling permits) sleeping in later, emphasis should be on consistent, restful sleep. Make sure your bedroom is dark enough to help with circadian entrainment and melatonin production. Morning sunshine can also help improve night-time sleep.
Relaxation throughout the day is also important. This could mean an early morning workout, an afternoon yoga class, even taking 15 minutes in the middle of the day just to focus on your breathing. Figure out what works best for you and do it. Take the time to be the best version of yourself: your stress will go down, your body will feel better, and your productivity may even increase!
Rheumatoid Arthritis is a systemic autoimmune disease that most directly affects the body’s joints. However, the disease may begin without any obvious symptoms in the joints. Though there is no cure for RA, following some sort of anti-inflammatory diet or implementing the Mediterranean diet may help mitigate your symptoms. What worked for your friends, family, or spouse might not work for you. Everyone is unique and experimenting with food therapy for RA may not be an easy fix. Try not to be overwhelmed by all of the recommendations and information out there, go slowly and trust yourself. At the end of the day, you are your greatest advocate and you know your body best. Fearlessly experiment with your dietary options and be mindful of your reactions.
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- Hikal, Ahmed H., and Ethel M. Hikal. “Pathogenesis and treatment of rheumatoid arthritis.” Drug Topics, 6 May 1996, p. 130+. Business Collection, http://link.galegroup.com/apps/doc/A18271189/GPS?u=pasa19871&sid=GPS&xid=5787f7f7. Accessed 14 Nov. 2018.
- Kane, Emily A. “Joint account: the right combination of supplements, diet, and lifestyle changes can treat–and even reverse–rheumatoid arthritis without side effects.” Better Nutrition, Mar. 2013, p. 36+. General OneFile, http://link.galegroup.com/apps/doc/A320734798/GPS?u=pasa19871&sid=GPS&xid=6296f2ad. Accessed 14 Nov. 2018.
- Evans, Susan. “Safely manage joint inflammation: curcumin.” Life Extension, Aug. 2012. Academic OneFile, http://link.galegroup.com/apps/doc/A300995676/GPS?u=pasa19871&sid=GPS&xid=e07e41bf. Accessed 14 Nov. 2018.
- Kallenbach, Laurel. “Joint Resolution.” Vegetarian Times, May 1999, p. 20. General OneFile, http://link.galegroup.com/apps/doc/A54450665/GPS?u=pasa19871&sid=GPS&xid=6c06310d. Accessed 14 Nov. 2018.