Rheumatoid Arthritis (RA)

Rheumatoid Arthritis

Rheumatoid Arthritis and Your Diet: What to Consider

Joseph Bennington-Castro
By Medically Reviewed by 
Reviewed:
Medically Reviewed
rheumatoid arthritis Mediterranean diet
Salmon and other inflammation-fighting foods may help improve RA symptoms.Nadine Greeff/Stocksy

Rigorous scientific studies that focus on the link between diet and rheumatoid arthritis (RA) are hard to come by. Much of the research is imperfect, having been conducted with few participants or with only highly motivated people — those who are able to stick to the diets.

What's more, such diets can be controversial because of adverse effects, such as unintended weight loss, according to a review of dietary treatments for RA.

Before you try any diet that has been used for symptom relief in RA, check with your doctor to make sure it's medically safe for you.

Some have claimed the following dietary approaches have helped people with RA.

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Seared Salmon With Rosé and Herb Pan Sauce

Use rosé to make a simple pan sauce for seared wild salmon, and then enjoy a glass or two! The salmon cooks quickly, leaving lots of time for rosé all day.

contains  Fin fish, Dairy
4.4 out of 150 reviews

SERVES

2

CALORIES PER SERVING

527

AUTHOR

The Feedfeed

PREP TIME

19 min

COOK TIME

35 min

TOTAL TIME

56 min

Ingredients

1½ cups rice, for serving
1 bunch trimmed asparagus, for serving
1 tbsp olive oil
2 6-oz portions skin-on wild salmon (center cut)
Kosher salt and freshly ground pepper, to taste
1 lemon, halved
2 tbsp unsalted butter, divided
1 shallot, minced
1 tbsp fresh tarragon, chopped
1 tbsp fresh dill, chopped
1 tbsp fresh parsley, chopped
1 tbsp capers, rinsed
⅔ cup Bonterra rosé

Directions

1

Cook the rice: Cook rice to desired doneness according to package instructions. Keep warm until ready to serve.

2

Roast the asparagus: Preheat oven to 400 degrees F.

3

Arrange asparagus on a baking sheet and drizzle with olive oil. Season with salt and pepper to taste. Roast until lightly caramelized and crisp-tender, about 18 to 20 minutes. Keep warm until ready to serve.

4

Prepare the salmon: Meanwhile, season salmon on both sides with salt and pepper and let sit at room temperature for about 10 minutes.

5

In a coated cast-iron skillet or heavy-bottomed frying pan, add the olive oil and heat over medium high heat until shimmering. Add salmon (skin side up) and halved lemon and cook for about 4 minutes, or until salmon is golden brown and can easily move around the pan. Remove lemon from the pan and set aside on a plate. Flip salmon and cook skin side down for another 3 minutes, then add to the plate with the lemon and tent loosely with foil.

6

Drain olive oil from the skillet and add 1 tbsp of butter. Once melted, add shallot and cook for about 2 minutes or until they start to soften. Deglaze the pan with the rosé, scraping up brown bits from the bottom of the pan. Bring wine to a boil, then reduce heat and simmer until the liquid has reduced by half. Season with salt and pepper, then remove from heat.

7

Add the capers, herbs, and remaining 1 tbsp of butter and mount the sauce by slowly swirling the butter around in the pan.

8

Serve the salmon on top of prepared rice with roasted asparagus and a spoonful of the rosé pan sauce.

Nutrition Facts

Amount per serving

calories

527

total fat

31g

saturated fat

10g

protein

40g

carbohydrates

9g

fiber

0.9g

sugar

5.2g

added sugar

0g

sodium

486mg

TAGS:

Fin fish, Dairy, Mediterranean, Gluten-free, Low-Carbohydrate, High-Protein, Anti-Inflammatory, Dinner

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Fish Oil and Omega-3 Fatty Acids for RA Symptom Relief

Though not a diet per se, fish oil — which is high in anti-inflammatory omega-3 fatty acids — appears to be helpful for people with RA. Other, less-concentrated dietary sources of omega-3 fatty acids include ground flax, flaxseed oil, and walnuts.

While more and larger studies are still needed, multiple clinical studies have shown that omega-3 fatty acid intake in the form of fish oil supplements may improve the symptoms of some autoimmune diseases, including RA.

Overall, omega-3 fatty acids from oily fishes such as salmon, mackerel, herring, and tuna modestly reduce joint swelling and pain, the duration of morning stiffness, and the need for anti-inflammatory drugs in people with RA, according to research.

One study found that RA patients who took fish oil supplements in addition to RA drugs called DMARDs (disease-modifying antirheumatic drugs) were more likely to achieve remission than those who took only DMARDs.

Furthermore, a study review found that marine oil supplements (all oils of marine origin, including from whole fish, seals, and mussels) can help reduce pain in patients with RA.

But omega-3 supplements, including fish oil, should be taken prudently, because they have certain side effects, such as reducing the blood's ability to clot, especially if you're taking a blood-thinning medication. There's also conflicting evidence about whether these supplements affect prostate cancer risk.

Vegetarian and Vegan Diets for Rheumatoid Arthritis

Some people with RA follow a diet that avoids meat (vegetarianism) or even all animal-derived products, including honey and dairy products (veganism).

But there isn't much research that shows a positive link between these diets and reduced RA symptoms.

In one study, 600 participants followed a vegan diet for three weeks, and most of them experienced a drop in their level of C-reactive protein, a marker for inflammation.

But the study didn't show a corresponding reduction in RA symptoms.

With the few studies that are available, it's difficult to draw any clear conclusions, scientists say.

One issue is the low number of participants in these studies. For example, research found that a gluten-free vegan diet provided some benefits for people with RA, but the study included only 22 people on the diet.

Another study that focused on a gluten-free vegan diet was a little more robust but also featured relatively low numbers of participants. In the research, a group of 38 RA patients ate a gluten-free vegan diet while a control group of 28 people ate a balanced nonvegan (and non-gluten-free) diet. Those on the gluten-free vegan diet experienced a modest improvement in their symptoms and lower levels of LDL (“bad”) cholesterol.

If you decide to try a vegetarian or vegan diet, pay close attention to balancing your nutritional intake to avoid nutritional deficiencies, such as a lack of vitamin B12, protein, and omega-3 fatty acids, which are important for bone health.

Gluten-Free, Lactose-Free, and Other Elimination Diets for RA

Some individuals report benefits when they exclude certain food groups from their diet. This suggests that an allergy or sensitivity worsens RA symptoms.

Very few studies have looked at the effect of elimination diets on RA symptoms, and those that do have found mostly short-term benefits.

In one older study, participants saw improvement in RA symptoms, both on objective and subjective measures, after eliminating specific foods from their diet, but the study was conducted over a very short period — six weeks. The research had additional issues, such as inadequate data reporting.

Another issue is that some studies on elimination diets don't control for confounding factors. For instance, trials of gluten-free diets for people with RA also involved vegan diets, making it difficult to determine the real effects of gluten on RA symptoms, according to a review of diet therapy for RA.

Another diet, known as the autoimmune protocol (AIP) diet, focuses on inflammation in the gut, which is thought to be associated with autoimmune disease, including RA. The diet that is thought to heal the immune system and the gut mucosa (lining) is considered by some to be a stricter version of the paleo diet. The principal behind this diet is that autoimmune conditions are caused by “leaky gut.”

On this diet, you eat foods that are rich in nutrients, like meat, fish, and some vegetables, and steer clear of foods that are pro-inflammatory, like grains, dairy, and nightshade vegetables (tomatoes, potatoes, eggplant, peppers).

While there is growing interest in the AIP diet for inflammatory diseases, there remains a need for larger, randomized clinical trials.

Researchers have been examining gut bacteria in an effort to one day identify those people at higher risk for RA. The thought is that if these patients are identified earlier, treatment can begin and there's potential to modify the gut microbiome and improve disease outcomes.

In fact, one study found that people with RA had less gut diversity than those who were disease-free.

Interestingly, research has found links between RA and specific strains of bacteria. One study showed a link between RA and the bug Prevotella copri. Researchers discovered this bacterium in the intestines of 75 percent of people with early untreated RA compared with 12 percent of people with chronic, treated RA, leading them to conclude that this bacteria crowds out beneficial microbiota that fight inflammation or itself promotes inflammation.

Another study found evidence to support a potential link between overexpansion of Prevotella copri in the gut and immune function and the development of RA.

Experts can’t claim that P. copri causes the disease, but it’s something that warrants further research.

Another study examined a different strain of the bacteria, Prevotella histicola, and found that it may decrease progression and symptoms.

In recent years, the ketogenic (keto) diet — which is a high-fat, very low-carb diet — has become popular. While the diet may help people lose weight, experts warn that the keto diet is bad for RA because it's high in fats that promote inflammation and low in grains, fruit, and many vegetables that keep the body in balance and reduce inflammation.

Benefits of the Mediterranean Diet for Rheumatoid Arthritis

Anecdotal reports indicate that the Mediterranean diet may help control RA symptoms. Sometimes called the anti-inflammatory or arthritis diet, it's considered the "ultimate arthritis diet" for people with RA by the Arthritis Foundation.

A look at the components of the Mediterranean diet would suggest that it has some benefits for RA.

For instance, it's high in seafood, a great source of omega-3 fatty acids, as well as heart-healthy olive oil and nutrient-rich vegetables. It's also high in fiber, which may be associated with decreased inflammation.

Several clinical studies have found that fish supplements containing omega-3 fatty acids may improve the symptoms of some autoimmune diseases, like RA.

A large study of 25,000 older adults found that people who took fish oil supplements along with vitamin D had a lower rate of RA than people who took a placebo.

Some evidence also suggests that this diet is associated with decreased pain in RA patients, though it may not affect morning stiffness, physical function, or other RA symptoms.

Another review found that the Mediterranean diet helped reduce pain and increase physical function in people with RA, but there isn't sufficient evidence that the diet can help prevent RA.

Fasting Diet for Rheumatoid Arthritis

Intermittent fasting (IF) which involves eating and fasting on a regular schedule, has become popular recently.

Both the safety and the efficacy of committing to periods of fasting are in question.

Though some research suggests that individuals experience a decrease in arthritis pain and swelling at some point during the fast, studies have not shown persistent improvement for more than 10 days.

One review found some evidence that fasting followed by a vegetarian diet improved RA pain.

Some small studies have shown that restricting calories, as happens during a typical IF diet, may have an anti-inflammatory effect. The exact mechanisms by which this occurs are unknown.

One study in people with rheumatoid arthritis took place during Ramadan, a holiday when religious Muslims fast for 30 days from dawn to dusk (meaning a 12/12 or longer intermittent fast).

Disease activity was found to be significantly decreased during the fasting month and in the months following, although the benefits began to fade around the three-month mark. This led researchers to recommend that people with RA might routinely do this type of fast every three months.

Do not fast or get your nutrition from juice alone without consulting a physician first.

Turmeric, Yogurt, and Other Specific Foods and Herbs to Consume When You Have RA

Well-designed studies are still needed to prove or disprove various claims made for specific diets. In the meantime, the most important thing is to be sure your diet is healthy and balanced.

In one study researchers reviewed the evidence for managing RA with dietary interventions.

Based on their review, they compiled a list of potential foods to consume and avoid to help with RA. An ideal meal, they found, includes:

  • Raw or moderately cooked vegetables (lots of greens and legumes)
  • Seasonal fruits
  • Probiotic yogurt
  • Spices like turmeric and ginger
Turmeric has anti-inflammatory properties, and curcumin, the active ingredient that gives the spice its color, has analgesic effects which may help ease RA symptoms according to research.

Other research suggests that ginger powder may improve RA symptoms by affecting the expression of certain genes.

Another study found that when women with RA consumed capsules of cinnamon powder daily for eight weeks, they had a significant decrease in blood levels of C-reactive protein (a marker of inflammation) and a reduction of disease, including less joint swelling and tenderness.

According to one study, thyme was found to be the most commonly used herbal medicine among people with RA.



The herb has been found to have antimicrobial and anti-inflammatory properties that researchers believe could be therapeutic in treating RA symptoms.


Benefits of Taking Specific Supplements

Other research has found that willow bark, taken as a supplement, reduces various markers for pain because of its anti-inflammatory properties. Experts stress that you should consult with your doctor before taking willow bark because it may increase the action of aspirin or an NSAID.



Other studies have found that some RA patients experience improvements in joint tenderness, swelling, and pain when taking daily supplements of borage oil.

A study has shown that ashwagandha, also called “Indian ginseng,” followed by treatment with siddha makardhwaj (another type of Indian medicine with herbal and mineral ingredients) eases pain and joint swelling in people with rheumatoid arthritis. The dosage will depend on the type you take.

Some medical experts recommend that patients increase their consumption of probiotics, the beneficial bacteria found in yogurt and other foods as well as supplements, because research has found that people with RA show some improvement with probiotic supplementation.

Benefits of Tea for RA 

Tea, which contains polyphenols, compounds that are packed with antioxidants, may help reduce the risk of inflammatory diseases, including rheumatoid arthritis.

One study found that those who drank more than two cups of tea a day were less likely to have rheumatoid arthritis than non-tea-drinkers or those who didn't drink tea regularly.

Some types of tea may be more beneficial than others in easing symptoms by reducing inflammation, protecting joints and triggering beneficial immune responses. One study compared the effects of green tea and black tea on arthritis. Green tea extract was found to have superior anti-inflammatory effects.

Specifically, green tea has an abundance of catechins that interrupt the expression of inflammation. Its effect on rheumatoid arthritis has been long studied; including one study that reported that “the consumption of green tea offers an overall anti-inflammatory effect.”

Other research has shown that a higher intake of green tea is associated with less disease activity.

Foods to Avoid When You Have RA

On the other hand, foods to avoid include processed and highly salted food, oils, butter, sugar, and animal products (but, as noted before, the research on the vegetarian and vegan diets may be problematic).

Other research found that cutting out soda improved RA fatigue and other symptoms.

Remember to always verify with your healthcare provider and rheumatologist that any dietary change is safe for you. If you have any dietary questions or concerns, consider consulting a licensed dietitian.

Editorial Sources and Fact-Checking

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