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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
  • Read & Watch
  • Success Stories
  • See Also

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

  • Hundreds of my patients over the last 25 years, have made dramatic recoveries from autoimmune diseases, including rheumatoid arthritis, lupus, connective tissue disease and psoriasis via a Nutritarian diet.  Many have achieved complete recoveries and no longer require any medications.  A vegan and gluten-free diet has shown to be quite helpful for many with rheumatoid arthritis.1,2  Since there is a relationship between celiac disease and rheumatoid arthritis,3,4 avoiding gluten may be beneficial. 
  • Vitamins, minerals carotenoids, flavonoids, fiber, and other phytochemical have anti-inflammatory effects that could help to normalize the immune response and reduce symptoms.5-7 Maximize the intake of immune-system-regulating, anti-inflammatory foods such as green vegetables, mushrooms, onions, squashes, parsnips, turnips and rutabaga, which have low allergic or reaction potential.  Eat both raw and cooked cruciferous vegetables every day.
  • Anti-inflammatory spices such as turmeric, ginger, cayenne pepper, cloves, garlic, and cinnamon should be used in seasoning dishes.8-11  
  • Research suggests that excess sodium may drive autoimmune inflammation.12-14 Minimize added salt. 
  • Identify food triggers to symptoms to reduce or remove (which is individual). Many with autoimmune disease will find they are sensitive to gluten, processed foods, sweets, and animal products. Other foods are less common triggers, such as certain nuts, soy, nightshades, beans, or corn. 
  • Fruit intake may need to be reduced to low or moderate amounts.
  • 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.  Medication reduction should be monitored by a physician.
  • Meal plan: Autoimmune Reversal

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:

  • Additional Supplements:
    • Probiotics: Research has suggested that healthy bacteria in our intestines may be protective and help to keep a normal functioning immune system. Eating a fiber-rich diet helps to build up healthy bacteria over time, and studies have found probiotics reduced inflammatory markers in patients with rheumatoid arthritis.15 Ask your doctor if taking probiotics is right for you.
    • Omega-3 DHA and EPA: Supplementation with omega-3 fatty acids has improved symptoms in patients with rheumatoid arthritis in several studies.6,16 High doses may be necessary to experience a difference in symptoms.17 If considering higher doses of omega-3 supplementation, discuss this with your doctor first as it is not appropriate for everyone.

Read

Other Considerations

Supervised, periodic water fasting can be used as an adjunct treatment for autoimmune conditions. I have documented remission of autoimmune diseases following supervised fasting in a published series of case reports.18 Additional studies have found that fasting (followed by a vegetarian diet) reduces pain in rheumatoid arthritis patients.19, 20 Continuing to follow a Nutritarian diet after completing the fast is essential for sustaining the benefits of the fast. Fasting puts the body into a repair mode, facilitating the elimination of damaged molecules, reducing inflammation, and resetting the immune system.21, 22 I generally recommend that patients adopt the dietary protocol for a few months prior to considering adding fasting to their protocol.  Fasting is not compatible with most medications. Fasting should be done under the supervision of a competent health professional. 

Find additional help

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References
  1. 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. doi: 10.1093/rheumatology/40.10.1175
  2. Alwarith J, Kahleova H, Rembert E, et al. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr 2019, 6:141. doi: 10.3389/fnut.2019.00141
  3. Lerner A, Matthias T. Rheumatoid arthritis-celiac disease relationship: joints get that gut feeling. Autoimmun Rev 2015, 14:1038-1047. doi: 10.1016/j.autrev.2015.07.007
  4. Paimela L, Kurki P, Leirisalo-Repo M, Piirainen H. Gliadin immune reactivity in patients with rheumatoid arthritis. Clin Exp Rheumatol 1995, 13:603-607. 
  5. Yahfoufi N, Alsadi N, Jambi M, Matar C. The Immunomodulatory and Anti-Inflammatory Role of Polyphenols. Nutrients 2018, 10. doi: 10.3390/nu10111618
  6. 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. doi: 10.3390/nu12051456
  7. McAlindon TE, Gulin J, Chen T, et al. Indole-3-carbinol in women with SLE: effect on estrogen metabolism and disease activity. Lupus 2001, 10:779-783. doi:
  8. Mazidi M, Gao HK, Rezaie P, Ferns GA. The effect of ginger supplementation on serum C-reactive protein, lipid profile and glycaemia: a systematic review and meta-analysis. Food Nutr Res 2016, 60:32613. doi: 10.3402/fnr.v60.32613
  9. Zhu C, Yan H, Zheng Y, et al. Impact of Cinnamon Supplementation on cardiometabolic Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Ther Med 2020, 53:102517. doi: 10.1016/j.ctim.2020.102517
  10. Singh S, Aggarwal BB. Activation of transcription factor NF-kappa B is suppressed by curcumin (diferuloylmethane) [corrected]. J Biol Chem 1995, 270:24995-25000. 
  11. Aggarwal BB, Yuan W, Li S, Gupta SC. Curcumin-free turmeric exhibits anti-inflammatory and anticancer activities: Identification of novel components of turmeric. Mol Nutr Food Res 2013, 57:1529-1542. doi: 10.1002/mnfr.201200838
  12. Kleinewietfeld M, Manzel A, Titze J, et al. Sodium chloride drives autoimmune disease by the induction of pathogenic T17 cells. Nature 2013. doi: 10.1038/nature11868
  13. Harmon K: Salt linked to autoimmune diseases. In Nature News 2013.
  14. Wu C, Yosef N, Thalhamer T, et al. Induction of pathogenic T17 cells by inducible salt-sensing kinase SGK1. Nature 2013. doi: 10.1038/nature11984
  15. 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. doi: 10.1007/s10067-017-3814-3
  16. 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. doi: 10.1016/j.nut.2017.06.023
  17. 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 2015, 74:89-95. doi: 10.1136/annrheumdis-2013-204145
  18. 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. 
  19. 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. 
  20. 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. doi: 10.1016/j.jada.2010.02.010
  21. Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell Metab 2014, 19:181-192. doi: 10.1016/j.cmet.2013.12.008
  22. Cheng CW, Adams GB, Perin L, et al. Prolonged Fasting Reduces IGF-1/PKA to Promote Hematopoietic-Stem-Cell-Based Regeneration and Reverse Immunosuppression. Cell Stem Cell 2014, 14:810-823. doi: 10.1016/j.stem.2014.04.014

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.