RA and Your Diet

How to eat to avoid joint inflammation, increase bone and heart health, and feel better all over.

By Camille Peri
 
How much can what you eat help -- or hurt -- your rheumatoid arthritis (RA)? For decades, researchers have looked into whether there is a link between food and RA. For almost as long, various diets and supplements have claimed to relieve swollen joints and morning stiffness -- or even falsely "cure" RA and "end joint pain forever."
 
Though many diet claims that promise relief from pain are unproven, they can lure and confuse even the savviest women with RA. Kathy Lubbers, who has had rheumatoid arthritis for more than 20 years and is a CEO at a communications firm, sums up why it's easy to fall for false claims: "When I was in excruciating pain, I'd try anything," she says.

If you have RA, there's no question that a good diet is vitally important. But which diet? And why? Here's the latest on how to eat for your health with RA -- and enjoy every bite.

RA and Nutrition: What to Consider

To figure out what's the best diet for you, it helps to keep in mind some of the nutritional challenges you have with RA. If painful fingers or wrists make it tough to chop vegetables and cook healthy meals, you may be more likely to grab a burger from the drive-thru. If your medications give you an upset stomach or make you feel like you don't want to eat, you may wind up skipping meals. If you routinely have an upset stomach or no appetite, you may also be missing important nutrients.

Sometimes your medications, while they may provide relief from RA pain, can bring other nutritional challenges. Taking corticosteroids (like prednisone) may cause your body to get rid of too much potassium. Methotrexate can lower your folic acid levels.

It's common for women with RA to not get enough vitamin D and calcium. It's especially important that you get enough of those nutrients because having RA -- and taking certain treatments for it -- raises your risk of osteoporosis.

Do Some Foods Cause Joint Inflammation?

Should you cross some foods off your list? Although no scientific studies have found any definitive link between food and RA, some people with RA say that eating certain foods makes their RA worse. For Kathy Lubbers, it's white sugar and cheese. For author M.E.A McNeil, an organic farmer and beekeeper in San Anselmo, Calif., it's foods with chemical additives. For other people with rheumatoid arthritis, it may be vegetables in the nightshade family, such as eggplant and tomatoes.

"Some patients say that certain types of food seem to make their RA worse," says Tracey Robinson, MD, a rheumatologist in Redwood City, Calif., and clinical professor of medicine at the University of California, San Francisco. "It may be highly processed foods with a lot of chemicals, foods that are very fatty, red meat, or milk products. It tends to be very individual."

Although no diet can cure RA, research has shown some evidence of a link between certain foods and inflammation. For example, eating a lot of saturated fats (such as bacon, steak, and butter) can increase the chemicals in the body that are responsible for inflammation, pain, and swelling in the joints. Even so, many people with RA don't have any food problems.
 
Even McNeil and Lubbers say that they aren't sure if their "trigger" foods are really guilty of causing inflammation or whether it just seems that way.

"It's difficult to draw a conclusion about virtually anything that you do because the disease waxes and wanes so much," says McNeil.

Getting Rid of Problem Foods

If you think certain foods are making your RA worse, try eliminating them from your diet. The only real way to tell if the foods are at fault is to add them back in, slowly and one at a time, to see if your RA flares when you start eating a particular food again. For example, McNeil says she found that she feels better when she doesn't eat commercially produced red meat.

Eliminating foods from your diet is generally safe as long as you don't cut out whole food groups, say medical experts. But it can be hard to stick with an elimination diet. If you want to try it, your doctor or a registered dietitian can help you.

Robinson says she doesn't give blanket diet recommendations to her patients with RA. "But if a person finds that eliminating certain foods seems helpful, I encourage them to try it as long as they still maintain good nutrition, calcium intake, and vitamins," she says.

The Mediterranean Diet

One diet that is showing some promise for people with RA is also one of the tastiest. The Mediterranean diet is loaded with fruits and vegetables and includes healthy non-saturated fats (like olive oil and canola oil), nuts, whole grains, herbs and spices (instead of salt and butter), and heart-healthy fish (instead of red meat).

Eating fish such as salmon, sardines, and tuna may double your benefit. They help protect against heart disease, which is a risk when you have RA. And the omega-3 fatty acids they contain, in addition to being heart healthy, also help fight inflammation. If that isn't enough, the Mediterranean diet can also help you maintain a proper weight, which takes pressure off your joints.

"The best data we have is that a diet high in omega-3 fatty acids and antioxidants is good for RA," says Nathan Wei, MD, clinical director of the Arthritis and Osteoporosis Center of Maryland. "The Mediterranean diet is high in both, and it's also good for people who want to be careful about weight gain. Of course, it's also important to couple the diet with exercise."

Supplements and RA
 
Herbal remedies and dietary supplements are often touted to relieve RA pain. And some may indeed help. But keep in mind that no herb or supplements can "cure" RA, and there's no evidence that they can actually stop the disease from progressing, as certain prescription medications (called disease-modifying anti-rheumatic drugs, or DMARDs) can.

Supplements are not regulated by the FDA, so it's hard to know exactly what's in them. And they can react with prescription or over-the-counter (OTC) drugs. Always talk to your doctor about what supplements may be helpful -- or harmful -- for you.

Here are some that may help:

Fish oil. Scientific studies of fish oil or other omega-3 fatty acid supplements show promise in treating RA symptoms such as painful joints and morning stiffness, according to the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM). People with RA who take fish oil may sometimes be able to cut back on other pain medications, like nonsteroidal anti-inflammatory drugs (NSAIDs). Fish oil supplements may also help lower your risk of heart disease. Keep in mind that fish oil can cause stomach upset and some types of fish oils increase the risk of bleeding, especially if you also take blood-thinning medication.

The Arthritis Foundation suggests 2.6 grams of fish oil twice a day for people who are interested in supplementing their diet. It may take weeks, or even a few months, for you to tell if it's working.

Vitamins and Minerals. If you have RA, you may want to take a good multivitamin that also contains minerals. Ask your doctor about whether you need to take calcium and vitamin D supplements. "Vitamin D deficiency is a huge concern in general, and especially for women with RA because they have more bone health issues," says Robinson. "They're more susceptible to osteoporosis even without adding in factors like steroid use, and many people are on steroids, which is also a negative for bone health." Check with your doctor about how much vitamin D and calcium you need.

Selenium and vitamin E supplements may decrease damage to the joints, easing swelling and pain. People who take methotrexate may also need to take a folic acid supplement.

Turmeric and ginger. There is some evidence that turmeric may help to relieve joint inflammation. Ginger supplements may also reduce joint pain and stiffness in people with RA. However, both may increase the risk of bleeding, especially if you take blood-thinning medication, and should not be used if you have gallstones.

RA and Diet: The Bottom Line

McNeil says she feels best following a Mediterranean diet. For Lubbers, a basic balanced diet seems to work well.

"I also eat smaller portions more often to keep my blood sugar level even-keeled," Lubbers says. "When it's not, it's another opportunity for a bad physical response. And I feel better when I eat lighter -- more soy and vegetables, and less bread and meat."

Both women say they shifted to a healthier diet not so much to tame specific symptoms but as part of an overall plan to improve their health with rheumatoid arthritis. "When you have a chronic condition," says Lubbers, "you want to have every positive thing you can on your side."

SOURCES:
 
Johns Hopkins: "Nutrition and Rheumatoid Arthritis," "Complementary and Alternative Medicine for Patients with Rheumatoid Arthritis."

Arthritis Foundation: "Diet and Your Arthritis," "Alternative Therapies Overview."

Tracey Robinson, MD, rheumatologist, SOAR Medical Group, San Francisco; assistant clinical professor of rheumatology, University of California, San Francisco.

Mayo Clinic: "Rheumatoid arthritis diet: Do certain foods worsen symptoms?" "Mediterranean diet: Choose this heart-healthy diet option."

American Family Physician: "Omega-3 Fatty Acids."

Nathan Wei, MD, FACP, FACR, fellow of the American College of Rheumatology; clinical director of the Arthritis and Osteoporosis Center of Maryland, Frederick.

Arthritis Today: "Supplement Guide: Fish Oil, Turmeric, Ginger."

Kathy Lubbers, Key Biscayne, Fla.

M.E.A. McNeil, San Anselmo, Calif.; author, The First Year: Rheumatoid Arthritis: An Essential Guide for the Newly Diagnosed (De Capo, 2005).

Reviewed on January 15, 2010