Hi all
We recently came across a general article on diet and RA, which we thought might be of interest to you. As I mentioned in a recent post, our main article on diet is being re-written this year, but this article, written by a dietician in the US might be a useful article to take a look at in the meantime for anyone interested in how diet can affect RA:
Are There Ways Diet Can Influence Rheumatoid Arthritis?
The goal should be to eliminate inflammation. Plans such as the Mediterranean diet may help.
By Maureen Donohue, Contributor | April 5, 2017, at 10:23 a.m.
Figuring out what foods affect your symptoms can help to reduce inflammation. "You are what you eat." We've all heard this phrase so many times that it often goes in one ear and out the other. What does it mean? And is it even true?
Diet clearly plays a significant role in overall heath. There is overwhelming evidence that the typical high-fat, high-sugar American diet can be harmful. Consider cardiovascular disease – the No. 1 killer of both men and women in the U.S. According to the World Heart Federation, a diet low in saturated fats and high in vegetables and fruit reduces the incidence of heart disease by 73 percent compared with the typical diet in the developed world.
While the effects of diet on cardiovascular disease are clear, does diet similarly affect rheumatoid arthritis?
"There aren't a lot of great studies to strongly recommend particular eating habits in RA," says Dr. Kristen Demoruelle, a rheumatologist specializing in RA in Denver.
But because RA is caused by inflammation, the main goal in treating the disease is to reduce the inflammatory response as much as possible. There are a few different pathways to do this, says Sonya Angelone, a registered dietitian in the San Francisco Bay Area.
"Physicians prescribe strong medications for inflammation, which is essential, but 'cleaning up' the diet is also important," advises Angelone, who is a spokesperson for the Academy of Nutrition and Dietetics.
The first step is to eliminate foods that are known to increase inflammation, such as sugar and processed foods that contain high levels of saturated fats. "Patients often tell me that their joints feel better when they cut back on sugar," says Demoruelle, who is an assistant professor of medicine at the University of Colorado.
The next step is to add anti-inflammatory foods.
Omega-3 fatty acids are recognized anti-inflammatory compounds, and they may be the most powerful anti-inflammatory agents found in food, according to Ruth Frechman, a registered dietitian in Burbank, California, and author of the book, "The Food Is My Friend Diet." Oily, cold-water fish such as salmon, tuna, mackerel, trout and herring are excellent sources of omega-3 fatty acids. Studies have shown that increased consumption of fish can decrease joint tenderness, pain and morning stiffness.
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Fish oil capsules are widely advertised as a good substitute for fish, but you should discuss this option with your doctor first. They can interact with several medications, including cholesterol-lowering statins and some blood pressure drugs, and they can interfere with the blood's ability to clot, which can increase the risk of bleeding in the brain.
That doesn't mean that fish oil supplements should never be used. According to Angelone, they may be especially helpful for elderly RA patients who either don't cook much or cannot cook, or people who cannot open cans because of limited dexterity or strength in their hands.
"But it's important to take fish oil supplements that contain both EPA and DHA fatty acids, in an appropriate dose," says Angelone, who works in concert with physicians to ensure there are no reactions with a patient's medication.
Extra-virgin olive oil may also have anti-inflammatory properties. Specifically, it contains a chemical compound called oleocanthal, which has been shown to inhibit the creation of pro-inflammatory COX-1 and COX-2 enzymes, similar to nonsteroidal anti-inflammatory drugs like ibuprofen, Celebrex and Bextra. Oleocanthal has been shown to decrease inflammation and help reduce cartilage damage in the joints.
High-fiber foods may help lower blood levels of C-reactive protein, one of the RA-associated indicators of inflammation. Fruit, vegetables, legumes, beans and whole grains such as oatmeal, brown and wild rice, barley and quinoa are all excellent sources of fiber. One study showed that people who ate Mediterranean-type diets and lost weight were able to lower their CRP levels by up to 54 percent.
A vegetarian or vegan diet may also decrease the inflammation of RA. Several small studies have shown that people with RA who adopt either plant-based diet experience improved joint tenderness, less swelling, pain and morning stiffness and better overall health.
A diet that mainly consists of fish, olive oil, vegetables, fruit, nuts, seeds, whole grains and beans may have significant anti-inflammatory effects. These foods are the staples of a Mediterranean-style diet. Small studies examining the effect of a Mediterranean diet on the symptoms of RA have shown improvements in pain, morning stiffness, disease activity and physical function.
Several studies have also shown that a Mediterranean diet rich in omega-3 fatty acids may lower the risk of getting RA. "So if someone like a first-degree relative is trying to lower their risk, this may be a reasonable dietary adjustment to consider," Demoruelle says.
Just as some foods may ease inflammation, others are known to be pro-inflammatory.
Beef, chicken or other meats that are fried or grilled at high temperatures can increase blood levels of advanced glycation products. Although researchers have not established a direct link between AGEs and arthritis, high levels of AGEs have been detected in people with inflammation.
Omega-6 fatty acids – found in corn, sunflower, safflower and soybean oils, as well as many snack and fried foods – can also induce inflammation. Although omega-6 fatty acids provide essential nutrients, too much has been shown to raise the risk of joint inflammation and obesity, especially if you eat more omega-6 fatty acids than omega-3s.
Many RA sufferers also report that eating specific foods can aggravate their symptoms. "You can react to anything," Angelone says, "so it's important to determine what a person reacts to and individualize their diet." Gluten, dairy and foods from the nightshade family – which includes potatoes, eggplant, tomatoes and peppers – are some commonly reported offenders.
If you suspect that gluten is the culprit, ask your rheumatologist for a blood test for celiac disease. If you test negative for CD, you may have gluten sensitivity, although this is a topic of considerable debate in the medical community.
To determine if you're sensitive to a particular food, dietitians recommend eliminating it from your diet for at least a week and then gradually reintroducing it. Keeping a food journal can help track what you eat and how it affects you. "I call it a 'symptom journal,'" says Angelone, "because you're really trying to figure out how specific foods affect your symptoms."
The bottom line is that people with RA should pay careful attention to diet. "I usually recommend a well-balanced, healthy diet," says Demoruelle.
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