A number of joints are most commonly involved in rheumatoid arthritis: the wrists, hands, feet, elbows, knees and ankles. The tissues lining the inside of the joint (known as the synovial membrane, or synovium) become inflamed, which results in swelling and joint pain.
Inflammation can damage your cartilage and bones too. As the cartilage is what covers the ends of the bones in a joint, loss of cartilage will result in the joint space between bones becoming narrower. This can cause the joints to become unstable, resulting in a decrease of overall mobility, and potential joint deformities. Often, the damage which occurs cannot be reversed.
So what should I do?
That was the bad news. The good news is there are numerous methods of treating and alleviating symptoms of rheumatoid arthritis. Conventional and holistic treatments of RA aim to:
- Reduce inflammation
- Relieve symptoms such as pain
- Prevent further joint damage
- Improve physical function and mobility
- Reduce or prevent long term complications
There’s no specific diet prescribed to people with rheumatoid arthritis, but dietary changes can help to suppress inflammation.1 The conventional medical treatment of RA involves early and aggressive treatment with disease-modifying anti-rheumatic drugs (DMARDs) that stop inflammation as quickly as possible.2 The inflammatory process is the underlying driving factor which causes disease progression and symptoms such as pain, swelling, stiffness, and more.
From a dietary perspective, specific nutrients and phytochemicals (plant compounds) have the ability to reduce pain by biochemically dampening specific inflammatory processes. On the other hand, there are also food products which has the potential to drive inflammation. Such foods can actually exacerbate the pain and symptoms associated with RA. 3
Gut health is an important factor to consider when tackling RA. As the development of RA includes a large immune component, gut health plays a major role when treating rheumatoid arthritis holistically. This is because gut microbiota, the microbe population within the intestine, are responsible for maintaining the body’s immunity, so they’re absolutely essential to address in any autoimmune condition.4,5
Nutritional approaches may help to reduce the progression of rheumatoid arthritis. For example, the National Institute for Health and Care Excellence (NICE) recommend following a Mediterranean style diet with plenty of fruit, vegetables, and fish; but less meat and butter.6
Fats or oils can influence inflammation in the body in a significant manner. They achieve this by by either increasing (up-regulating) or decreasing (down-regulating) the production of enzymes that cause inflammation.
Certain oils, in particular, are known for their anti-inflammatory action, such as omega 3 essential fatty acids. These polyunsaturated fats, including eicosapentaenoic (EPA) and docosahexaenoic acids (DHA), are able to suppress problematic inflammatory signals. Foods high in these anti-inflammatory fatty acids should be incorporated into a diet, in order to alleviate the symptoms of RA.7
Some of the highest sources of these fatty acids include:
- Fish such as salmon, sardines, mackerel, anchovies, herring, tuna, cod liver oil, caviar, and fish roe
- Organic eggs
Additionally, avocado, flaxseeds, chia seeds, walnuts, whole soybeans and hemp seeds all provide ALA, a short-chain Omega-3 that can be helpful for those following a plant-based diet. You can also find omega 3s in fortified foods; they appear in some dairy products, in fruit juices, eggs, margarine, and more.
Whilst most foods are fortified with short-chain ALA omega 3s, some are fortified with DHA and EPA which can sometimes be derived from microalgae which has an extremely fishy flavour. In these cases, food producers reduce or completely eliminate the fishy flavour by putting the food through an extensive purification process. As this occurs, the resulting form of omega 3 in these fortified foods make them less preferable compared to the unadulterated, whole food sources like those mentioned above.8
Below are some food ideas to help increase omega 3 content in your diet:
- Eating fish rich in omega 3 at least 3 times per week (preferably wild caught, not farmed fish)
- Using flaxseed oil as a salad dressing base or pouring it over soup and stews (at the end of cooking and before serving, do not cook with it).
- Snacking on avocado and adding it to salads and other raw dishes.
- Sprinkle chia seeds on salads, soups, and add them to smoothies.
- Snacking on raw nuts and seeds.
Antioxidants aid in ‘quenching’ the effects of oxidative damage, which occurs as a result of inflammation in RA. Colourful fruits and vegetables are your main sources of vitamins A, C, E, antioxidant phytochemicals, and minerals like selenium and zinc. If you’re looking to get a healthy number of antioxidants, ensure that the following are a regular part of your diet:
- Leafy greens
- Cruciferous vegetables like broccoli and cabbage
- Kiwi fruit
- Green tea
- Medicinal mushrooms (shiitake, reishi, maitake, chaga)
Sulphur containing foods
Foods which are high in sulphur contain a compound called Methylsulfonylmethane (MSM). It’s an anti-inflammatory compound with specific affinity for the musculoskeletal system. In arthritic conditions, MSM can be beneficial, by acting on the nervous system to reduce nerve signals which transmit pain, as well as reducing joint inflammation.9 Foods high in sulphur include garlic, onion, asparagus, and cruciferous vegetables.
Probiotic and Prebiotic Foods
The gut microflora plays a huge role in maintaining immunity, and as RA is an autoimmune condition the health of the gut should not be overlooked. Eating a variety of prebiotic and probiotic food ensures that bacteria is replenished in the intestinal tract, and that they are supplied with their ideal source of nutrients.10 Probiotics — ‘good’ bacteria — feed off prebiotics. Fermented foods such as yoghurt, sauerkraut, kimchi, kefir, kombucha, tempeh and natto are examples of probiotic foods. Prebiotic foods include garlic, onions, asparagus, cruciferous vegetables, fruits and whole grains.
Some phytochemicals (plant chemicals) act as potent anti-inflammatory agents by blocking specific enzymes involved in the production of inflammatory mediators. Herbs such as turmeric and ginger root are rich in anti-inflammatory phytochemicals; these are two great examples of easily accessible and potent anti-inflammatory herbs. Curcumin, the main anti-inflammatory constituent found in turmeric is more easily absorbed when combined with either black pepper or a fat/oil.
Inflammatory foods to avoid
Just as foods can curb inflammation by down-regulating inflammatory pathways, they can also induce these pathways and drive inflammation. The consequence of this is an increase in the production of inflammatory mediators, which you’re looking to avoid. More inflammatory mediators essentially mean more oxidative stress, pain, swelling, and an overall increase in RA symptoms.
Sugar, eaten in excess, can aggravate and worsen your symptoms. Sugar has the ability to trigger the release of inflammatory mediators, further driving inflammatory processes throughout the body. Processed and refined food products almost always contain sugar in some form and should be avoided.11
Omega 6 can also drive inflammation. You should aim to consume these in a balanced ratio to omega 3 fats. A standard Western diet contains an excess of omega 6 and not enough omega 3, so oils like safflower, rapeseed, sunflower, grapeseed and corn oil should be avoided.
Refined carbohydrates which are usually “white foods”: things like most breads, pastas, and fried potatoes generally have a high glycaemic index, and can elicit a similar effect as sugar in the body. They stimulate the production of advanced glycation end (AGE) products which is a driver of inflammation.12
Monosodium glutamate (MSG) is a flavour enhancer, often added to Asian food products and sauces. However MSG is also found in fast foods, cold cut/deli meats, and most pre-prepared and packaged foods. Unfortunately, MSG can trigger two major inflammatory pathways so try to feature this only sparingly in your diet.
The take home
Ultimately, if you’re experiencing RA symptoms, then you should avoid processed refined “white foods”, sugary foods, and foods which contain flavourings and additives. If you are concerned about how to integrate this advice into a typical diet, we’ve prepared a sample meal plan below with some simple, healthy recipes that are optimised for combatting RA symptoms — with the added bonus of tasting absolutely delicious!
- Super anti-inflammatory smoothie: kale, almond milk, berries, flaxseed oil, hemp seeds, and coconut water
- Bircher muesli with pineapple, papaya and kiwi fruit, topped with chia seeds
Poached eggs and sautéed garlic greens
- Salmon patties, roasted sweet potato chips, cabbage and kale slaw dressed with flaxseed oil
- Roasted cruciferous vegetables with a side of free range/ organic meat
- Turmeric, coconut vegetable curry on brown rice
- Grilled fish, ginger and garlic cruciferous greens, and Asian mushrooms
- Turmeric, lemongrass and ginger brew
- Roasted nut and seed mix
- Mixed berries on coconut yoghurt sprinkled with chia seeds
If you’re interested in learning more about how to keep your joints healthy, head over to our advice centre for more information.