Rheumatoid Arthritis is a complex disease, diet is a complex phenomenon. Their interaction is inevitably also complex. Over the years I have heard as many types of dietary advice for RA as I have had patients asking about it.
We will discuss diet for RA in this blog, I have shamelessly gotten the idea and information and elsewhere so please go here for a quiz and see what you know already! https://www.rheumatologynetwork.com/view/rheumatoid-arthritis-quiz-what-constitutes-a-healthy-diet
Rhematoid Arthritis features in my Rheumatology At A Glance Booklet and Clinical Scenarios eBook, you can find them both in my SHOP. Do consider these resources both for your own learning and to support me to continue to create these blogs and resources!
As usual feedback is greatly appreciated and any further reading for me please send it my way!
PLEASE REMEMBER – THIS BLOG IS NOT A REPLACEMENT FOR CLINICAL REASONING, IF YOU ARE UNSURE GET ADVICE
Introduction
Here are some things I have heard over time:
Acidic foods make RA worse – I have never seen any evidence for this
Cider vinegar makes RA better – I have never seen any evidence for this
Anti-inflammatory foods (garlic and others) help Rheumatoid Arthritis – I haven’t seen any evidence for this either
None of this really surprises me, individuals with RA are as unique as their diets and I see no biologically plausible reason for people to react in a uniform way to certain foods. Overeating is “pro-inflammatory” in that processed foods and excessive calorie intake cause increased body fat which release inflammatory cytokines into the system. This MAY increase disease activity, reducing this MAY decrease disease activity.
Mediterranean Diet
This diet is the one I see mostly recommended for RA patients (ironically they eat tons of tomatoes in the Med which is acidic). It is essentially a balanced diet with veg and protein. Even this though doesn’t seem to have a direct affect on disease activity but probably helps with general health.
Other Supplements
Meh. I have never seen anything that suggests RA patients should be concerning themselves with other supplementation.
Clearly if someone has something like a Vit D. deficiency then this needs addressing but it wont really assist with disease activity.
How do we make sense of this?
It is annoying that we can’t specifically help peoples arthritis with diet but it doesn’t mean optimising diet is not important. As mentioned above, a healthy balanced diet will help with general health (RA patients are at a higher risk of CardioVascular Disease and have a higher BMI than the rest of the population). Plus protein supplementation may be appropriate to maintain muscle bulk in some.
Other supplements are an interesting conundrum. Some people attend already taking them and find them helpful. It doesn’t really matter if this is a true biological response or a placebo or a combination. I have no issue with them continuing (who am I to take away something helpful) as long as they have optimised medications. Another consideration is financial, is it a good use of their money to pay for these? It would be much better to use the money towards a gym membership for example. I discuss this with them and come to a joint conclusion as to whether its worth continuing.
Specific foods can be implicated by individuals, again this depends on them. Its differs if its an entire food group (meat or something), their favourite food in the world or a food they couldn’t care less about. If its in the former two then suggesting reintroduction in a controlled manner or even a dietician if it potentially has a big impact on health.
End
I hope this has been useful, consider general dietary advice but specifics for individuals is a challenge. Lets be the best clinicians we can be for each patient by knowing as much as we can!
Get me any feedback you might have so that I can grow and improve.
We go into a lot of depth on Rheumatoid Arthritis on my Online and In-Person courses
See you next time!
References
Gioia, C.; Lucchino, B.; Tarsitano, M.G.; Iannuccelli, C.; Di Franco, M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients 2020, 12, 1456.
