How to reduce your risk for rheumatoid arthritis

September 22, 2020 by Joel Fuhrman, MD


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.
  • 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
 

 
References
  1. Kurko J, Besenyei T, Laki J, et al. Genetics of rheumatoid arthritis - a comprehensive review. Clin Rev Allergy Immunol 2013, 45:170-179.

  2. Arthritis Foundation. Arthritis By The Numbers Book of Trusted Facts & Figures. Arthritis Foundation; 2019.

  3. American College of a Rheumatology. Rheumatoid Arthritis. [https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis]

  4. Zaccardelli A, Friedlander HM, Ford JA, Sparks JA. Potential of Lifestyle Changes for Reducing the Risk of Developing Rheumatoid Arthritis: Is an Ounce of Prevention Worth a Pound of Cure? Clin Ther 2019, 41:1323-1345.

  5. Sparks JA, Costenbader KH. Rheumatoid arthritis in 2017: Protective dietary and hormonal factors brought to light. Nat Rev Rheumatol 2018, 14:71-72.

  6. Alunno A, Nikiphorou E, Philippou E, et al. Nutrition in RMDs: is it really food for thought? Focus on rheumatoid arthritis. BMC Rheumatol 2020, 4:10.

  7. Di Giuseppe D, Discacciati A, Orsini N, Wolk A. Cigarette smoking and risk of rheumatoid arthritis: a dose-response meta-analysis. Arthritis Res Ther 2014, 16:R61.

  8. Hu Y, Costenbader KH, Gao X, et al. Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. Am J Clin Nutr 2014, 100:959-967.

  9. Lu B, Hiraki LT, Sparks JA, et al. Being overweight or obese and risk of developing rheumatoid arthritis among women: a prospective cohort study. Ann Rheum Dis 2014, 73:1914-1922.

  10. Pattison DJ, Symmons DP, Lunt M, et al. Dietary risk factors for the development of inflammatory polyarthritis: evidence for a role of high level of red meat consumption. Arthritis Rheum 2004, 50:3804-3812.

  11. Wu C, Yosef N, Thalhamer T, et al. Induction of pathogenic T17 cells by inducible salt-sensing kinase SGK1. Nature 2013.

  12. Manzel A, Muller DN, Hafler DA, et al. Role of "Western diet" in inflammatory autoimmune diseases. Curr Allergy Asthma Rep 2014, 14:404.

  13. Liu X, Tedeschi SK, Lu B, et al. Long-Term Physical Activity and Subsequent Risk for Rheumatoid Arthritis Among Women: A Prospective Cohort Study. Arthritis Rheumatol 2019, 71:1460-1471.

  14. Di Giuseppe D, Wallin A, Bottai M, et al. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis 2014, 73:1949-1953.

  15. Hu Y, Sparks JA, Malspeis S, et al. Long-term dietary quality and risk of developing rheumatoid arthritis in women. Ann Rheum Dis 2017, 76:1357-1364.

  16. Shi N, Li N, Duan X, Niu H. Interaction between the gut microbiome and mucosal immune system. Mil Med Res 2017, 4:14.

  17. McDermott AJ, Huffnagle GB. The microbiome and regulation of mucosal immunity. Immunology 2014, 142:24-31.

  18. Kau AL, Ahern PP, Griffin NW, et al. Human nutrition, the gut microbiome and the immune system. Nature 2011, 474:327-336.

  19. Gioia C, Lucchino B, Tarsitano MG, et al. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients 2020, 12.

  20. Hagen KB, Byfuglien MG, Falzon L, et al. Dietary interventions for rheumatoid arthritis. Cochrane Database Syst Rev 2009:CD006400.

  21. Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc 2010, 110:727-735.

  22. Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol 2001, 30:1-10.

  23. McDougall J, Bruce B, Spiller G, et al. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med 2002, 8:71-75.

  24. Fuhrman J, Sarter B, Calabro DJ. Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune disease. Altern Ther Health Med 2002, 8:112, 110-111.

  25. Hafstrom I, Ringertz B, Spangberg A, et al. 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. Rheumatology (Oxford) 2001, 40:1175-1179.

  26. Yahfoufi N, Alsadi N, Jambi M, Matar C. The Immunomodulatory and Anti-Inflammatory Role of Polyphenols. Nutrients 2018, 10.

  27. Moroni L, Farina N, Dagna L. Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clin Rheumatol 2020, 39:1039-1047.

  28. Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of omega-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis. Nutrition 2018, 45:114-124 e114.

  29. Mohammed AT, Khattab M, Ahmed AM, et al. The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol 2017, 36:2697-2707.

  30. Lerner A, Matthias T. Rheumatoid arthritis-celiac disease relationship: joints get that gut feeling. Autoimmun Rev 2015, 14:1038-1047.

  31. Paimela L, Kurki P, Leirisalo-Repo M, Piirainen H. Gliadin immune reactivity in patients with rheumatoid arthritis. Clin Exp Rheumatol 1995, 13:603-607.

     

     

Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
 
For over 25 years, Dr. Fuhrman has shown that it is possible to achieve sustainable weight loss and reverse heart disease, diabetes and many other illnesses using smart nutrition. In his medical practice, and through his books and PBS television specials, he continues to bring this life-saving message to hundreds of thousands of people around the world.

 

Comments (0):

 View

jdvegan

09/25/2020 04:00 PM

I have a friend who has rheumatoid arthritis. She doesn't believe that your diet can make the difference. I have tried so many times to tell her about red meat and diary. She continues to believe it's all in her genes!

 

pesaram

09/25/2020 04:23 PM

Thanks for the info.  The information on RA is very helpful.  I don't have RA, but have oesteoprosis. 

TA