How to reduce your risk for rheumatoid arthritis

There are three things you need to know about rheumatoid arthritis (RA), especially if you are a woman. First, 75 percent – that’s three out of every four people diagnosed with RA – are female. Second, 1 to 3 percent of all women will be diagnosed with RA during their lifetime. And third: Although the direct causes of the disease are unknown, there are known risk factors. Risk factors means RA is may have some genetic tendencies, but environmental factors, particularly diet, pulls the trigger.¹ And, in most cases RA can gradually disappear when the healing environment and diet is optimized. 

First: What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation, pain and damage to the joints, most commonly involving the wrists and fingers. RA is considered a type of inflammatory arthritis, in contrast to other types such as osteoarthritis, which is a more common (and non-autoimmune) form of arthritis. About 1.3 million Americans have RA.^1-6

Sources:
American College of a Rheumatology. Rheumatoid Arthritis.
Potential of lifestyle changes for reducing the risk of developing rheumatoid arthritis: is an ounce of prevention worth a pound of cure?
Rheumatoid arthritis in 2017: Protective dietary and hormonal factors brought to light.
Nutrition in RMDs: is it really food for thought? Focus on rheumatoid arthritis.

Diet and lifestyle-related factors linked to increased RA risk

• Smoking.⁷ 
• Drinking sugar-sweetened beverages.⁸ 
• Excess weight.⁹: Excess fat is pro-inflammatory.  
• Eating red meat.¹⁰
• Excess sodium intake also promotes autoimmune inflammation.¹¹

Overall, the typical Western diet, which contains plenty of white flour, sugar, oils, and animal products – is pro-inflammatory and thought to contribute to all autoimmune inflammation.¹²  The form it takes may be genetically influenced, but without years of poor nutrition and toxic food exposure autoimmune diseases would not appear.  Poor nutrition in the mother during and even before conception may be a significant contributor to early life autoimmune disease.

Diet and lifestyle-related factors linked to reduced RA risk

• Regular exercise.¹³
• Omega-3 fatty acids.¹⁴
• A healthful diet including vegetables, fruits, nuts, and whole grains.¹⁵

In the Nurses’ Health Study, a higher quality diet was measured by greater consumption of fruits, vegetables, whole grains, nuts, long-chain omega-3 fatty acids, etc., and lower consumption of sugar-sweetened beverages, red and processed meats, trans fats, and sodium. The researchers found the women in the highest quarter of diet quality had a 15% reduction in risk of RA compared to the lowest.¹⁵ 

The role of the gut microbiome

The human microbiome is composed of communities of bacteria, viruses and fungi. It basically functions as an essential organ, regulating everything from metabolism to fat storage to human behavior. The gut – or intestinal – microbiome, which modulates the activity of immune cells, counteracts inflammation, and maintains the integrity of the intestinal barrier,^16-18 is important to the origin and development of RA. That’s because intestinal permeability – often called “leaky gut” – is a major factor in autoimmunity and the microbiome helps prevent increases in intestinal permeability and promotes good immune function.¹⁹

Sources:
Role of "Western diet" in inflammatory autoimmune diseases. 
Long-Term Physical Activity and Subsequent Risk for Rheumatoid Arthritis Among Women: A Prospective Cohort Study. 
Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. 
Long-term dietary quality and risk of developing rheumatoid arthritis in women.
Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? 

How does diet help treat RA?

A few studies have shown that dietary interventions reduced symptoms in patients with RA. These eating styles included fasting; a vegan diet; a vegan and gluten-free diet; and fasting followed by a vegetarian diet.^20-25

Reducing inflammation is key to preventing a range of diseases, including autoimmune diseases, type 2 diabetes, heart disease, and cancer. An anti-inflammatory diet helps the body maintain the balance between pro- and anti-inflammatory signals, preventing chronic inflammation. Carotenoids, flavonoids, fiber, and other phytochemicals in plant foods have anti-inflammatory properties.^{19, 26} 

How can a Nutritarian diet help?

The Nutritarian diet is designed to maximize anti-inflammatory potential, with a focus on whole, fiber-rich plant foods, and avoidance of pro-inflammatory influences such as added salt and sugars and red meat. For more detailed information on my recommendations, read my Autoimmune Disease Position Paper.  In general:

• Follow a Nutritarian diet, rich in colorful vegetables and other phytochemical- and fiber-rich whole plant foods. 
• Achieve a healthy weight: excess fat is pro-inflammatory and may negatively affect treatment for RA.²⁷
• Consider repeated fasting at prescribed intervals.²⁴
• Certain supplements may be helpful:
  • Supplementation with omega-3 fatty acids has improved RA symptoms in several studies.^{19, 28}
  • Probiotics have been found to reduce inflammatory markers in RA.²⁹
  • Make sure you have sufficient vitamin D levels.¹⁹ I recommend taking my specific multivitamin (that excludes folic acid and Vitamin A) that includes B12, zinc and vitamin D. I recommend having blood 25(OH)D tested and aiming for 30-50 ng/ml.
• Avoid wheat and gluten: gluten is a common food trigger, and there may be a relationship between celiac disease and RA.^{30, 31}

Working with patients with autoimmune diseases is one of the most rewarding aspects of my medical career. Sometimes individual dietary modification and exclusions of certain trigger foods need to be identified nd eliminated. Borh fasting and elimination diets can be useful in enabling a recovery. The ability to achieve substantial improvement and, in most cases, complete remission of these supposedly incurable illnesses is exciting. 

Action item: Learn more about how to treat RA with nutritional intervention in my Autoimmune Disease Position Paper (free for members)

Sources:

Dietary interventions for rheumatoid arthritis. 
Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. 
Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review.
Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. 
Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune disease. 
A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens.