Rheumatoid Arthritis: Nutritional Considerations

The following factors are under investigation for their role in reducing the risk of rheumatoid arthritis or for improving its course:

• Vegetarian diets: Evidence indicates that patients who follow vegan or vegetarian diets may experience significant improvement in rheumatoid arthritis symptoms. Conversely, higher intakes of meat and cholesterol are associated with an increased risk of developing this disease.
  
• Eliminating diet triggers: Studies have shown that eliminating certain foods brings symptomatic improvement for some people. The reason, apparently, is that certain foods trigger inflammation. Clinical tests have shown that consumption of allergenic foods increases inflammatory chemicals (cytokines) that may contribute to arthritis.
  
  To identify trigger foods, an elimination diet can easily be instituted as follows:
  
  Start with a simple baseline diet, excluding foods that are more common triggers (such as dairy products, corn, meats, wheat, oats and rye, eggs, citrus fruits, potatoes, tomatoes, nuts, and coffee), and including only those foods not implicated in arthritis, listed below:
  • Brown rice.
  • Cooked or dried fruits (cherries, cranberries, pears, prunes).
  • Cooked green, yellow, and orange vegetables (artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, squash, sweet potatoes, tapioca, and taro).
  • Plain or carbonated water.
  • Condiments (modest amounts of salt, maple syrup, vanilla extract).
  
  After approximately four weeks on this diet, if symptoms have improved or disappeared, patients may introduce previously eliminated foods one at a time, every two days. As they do so, patients should keep a food diary and add these foods in generous amounts to observe which cause arthritic symptoms. Foods listed above as common triggers should be added last. A newly added food associated with increased joint pain should be removed from the diet for one to two weeks, and reintroduced to see if the same reaction occurs. If no symptoms are experienced, that food can be kept in the diet. It is suggested that meats and dairy products not be returned to the diet, regardless of their effect on joint symptoms, due to their contribution to heart disease and other conditions.
• Fruits and vegetables: Studies have shown that a higher intake of certain carotenoids found in fruits and vegetables may protect against developing RA.
  
  The European Prospective Investigation of Cancer (EPIC) study of more than 25,000 individuals found that those consuming the highest amounts of carotenoids had half the risk for developing inflammatory arthritis, compared with those consuming the least amount.  Lower serum levels of vitamin E and selenium were also found to predict the development of rheumatoid arthritis.
• Caution regarding fats and oils: A diet low in arachidonic acid, an omega–6 fatty acid found in animal products, was found to decrease inflammation in arthritis patients. Further, supplementing with gamma–linolenic acid (GLA) and omega–3 fatty acids was found to be an effective strategy for reducing symptoms. These fatty acids appear to work by blocking production of inflammatory chemicals. Sources of GLA include evening primrose, borage, blackcurrent, and hemp oils. Flax oil is rich in omega–3 fatty acids.
• Folic acid supplementation: Folic acid supplementation is important for patients who are treated with methotrexate.