Rheumatoid Arthritis



Rheumatoid arthritis (RA) is an autoimmune disease which can lead to inflammation 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 form of arthritis.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Related Info
  • Success Stories

Overview


RA is one of the most common forms of autoimmune disease. It has been estimated that approximately 0.5-1% of the world’s population has RA. In the U.S., the prevalence of RA is estimated to be 0.7% and is more common in women than men.1

Common symptoms of RA may include joint pain that commonly affect the hands, wrists, and feet, although any joint may be affected. Joint inflammation over time can cause permanent damage leading to deformity of the joints. In some with RA, the disease may also affect the skin, heart, lungs, and eyes. Symptoms of RA may fluctuate due to a variety of factors.

Little is known about what exactly causes RA in individuals, but experts believe it is a combination of genetic, infectious, and other environmental factors, such as diet, toxin exposures, and intestinal bacteria imbalance.

 
References
  1. Myasoedova E, Crowson CS, Kremers HM, et al. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Arthritis Rheum 2010, 62:1576-1582.

Action Plan


Diet

  • Identify food triggers to symptoms to reduce or remove (which is individual). Many with RA will find they are sensitive to gluten, processed foods such as sugar, and animal products. Other foods are less common triggers, such as certain nuts, soy, nightshades, or corn, for example. A vegan, gluten-free diet has shown to be quite helpful for many with RA.1
  • Maximize the intake of immune-system-regulating, anti-inflammatory foods such as high-fiber, high micronutrient-dense foods including green vegetables. Cruciferous vegetables, in particular, are recommended to be eaten every day.
  • Fruit intake may need to be reduced to low or moderate amounts.
  • Anti-inflammatory spices such as turmeric, ginger, cayenne pepper, black pepper, cloves, garlic, and cinnamon should be used in seasoning dishes.
  • Talk to your doctor before and after making changes to your diet and supplement regimen if you have a chronic disease or if you are taking any medication, as medication and/or unique dietary modifications may be necessary.

Probiotics

Research has suggested that healthy bacteria in our intestines may be protective and help to keep a normal functioning immune system. Although eating a fiber-rich diet helps to build up healthy bacteria over time, many with RA find it helpful to take supplemental probiotics.2 Ask your doctor to discuss if taking probiotics is right for you.

Omega-3 Supplementation

Many with RA feel better if they take omega-3 fatty acid supplements due to their anti-inflammatory effects. High doses may be necessary to experience a difference in symptoms.3 If considering higher doses of omega-3 supplementation, please discuss this with your doctor first as it is not appropriate for everyone.

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References
  1. Hafström I, Ringertz B, Spångberg 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.
  2. Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A, et al. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition 2014, 30:430-435.
  3. Proudman SM, James MJ, Spargo LD, et al. Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use. Ann Rheum Dis 2013.

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I have RA and have followed the autoimmune protocol 100% for 4 months now. The results came slow, but are impressive. Sed rate is back to normal, very little pain, medication greatly reduced. Hopefully I’ll be a success story sometime soon. There was a recent bump in my journey. In the past 4 months, I ate tomatoes every day and eggplant once or twice a week (and never noticed any problems); but in the last 2 weeks I added potatoes (with skin) and mini-Mexican bell peppers almost every day. MY PAIN WENT UP for the first time! This leads me to the following questions:

Is nightshade avoidance a must for RA? Maybe I just had an overload of nightshades, is this possible? What should I do to test for nightshade intolerance?

A.

I agree with you. You overdid the nightshades and paid a price. Avoid them for the next few weeks then only have small amounts. About 20 percent of RA patients are nightshade sensitive. Many with nightshade sensitivity can still tolerate a small amount, but when they go overboard they can get into trouble.

 
Q.

What are the common food allergens/sensitivities for someone with RA who follows a nutritarian vegan diet? From my clinical experience I found: Gluten, nightshades (about 20% of patients, based on prior thread), citrus, nuts, corn (rare), beans (rare).

Your thoughts (adds/deletes) would be appreciated. Thanks.

A.

I don’t think nuts are a common sensitivity in RA patients. That would be pretty rare too. Too much fruit in general is usually not advised as some are just somewhat fructose sensitive. Rarely some are sensitive to beans, and even though mostly Lupus patients are sensitive to sprouts (especially alfalfa sprouts), some people with RA do not do well with sprouts either.

 
Q.

I have had minor joint pain for the past two years. Seven days ago, after taking hydrocodone for some oral surgery pain, all my joints began to really hurt. I immediately went on the autoimmune protocol. I have a CRP and anti-CCP blood test scheduled for tomorrow, after which I plan to fast for 7-10 days. Unfortunately, in the last week, several small nodules have appeared on my knuckles. My sister (who has RA) thinks I should get right on the methotrexate to prevent further joint damage. I’m not sure what to do since the nodules are forming even though I’m following the protocol exactly. What do you think?

A.

That is great you are tackling this with nutrition and not with highly-toxic drugs that cause cancer. Drugs should be the last resort treatment, not the first. This works for the broad majority of individuals, but it can take a few months. The nodules and inflammation can improve. Incorporating fasting as you are planning usually speeds up the benefits. Keep me posted with your progress and blood test results. This sounds more like osteoarthritis and not rheumatoid, so that is not as severe a condition, however it can take longer to see benefits from dietary excellence.

 
Q.

My mother has suffered from rheumatoid arthritis for many years; she is 78 years old and the disease has advanced significantly. She has been on medications to treat the condition and has experienced significant disfiguration in her hand/feet joints. That said, about 6+ months ago I converted her to a vegan diet, and she has experienced significant weight loss and an improvement in her general biomarkers. I was thinking it might be a good idea to put her on Dr. Fuhrman’s multivitamin for women, fish oil supplements, and a probiotic to help her out.

  1. Do you think these supplements are a good idea?
  2. Anything else you can recommend?
A.

A vegan diet is usually very helpful, but you should review my autoimmune protocol in my book, Super Immunity. A nutritarian diet specifically targets immune system repair that can make the dietary protocol even more effective. Not all patients with RA respond exactly alike. Some benefit from limiting certain fruits, wheat, or beans. Others are fish oil responsive and benefit from higher amounts that others do not. If she has no medical contraindication to high dose fish oil, she can give it a trial for a few months and track if it helps. I usually recommend about 4,000-6,000 mg of a high EPA content fish oil daily–make sure it is purified, so free of contaminants. Likewise, probiotics are helpful for some and not others. She can use the one we carry here in double the typically recommended dose, and test it for a few months on and off to see if it has a positive effect. My women’s multivitamin assures that various essential nutrients are present that could be relatively low in one’s diet. With RA it is particularly important to make sure no deficiencies exist in zinc, B12 or Vitamin D.