By Terri Chrisman M.Nutr, Dip.ACLM from the PAN Academy – our online learning platform where you can learn all about nutrition and health. The purpose of this article is to clear the confusion surrounding rheumatoid arthritis. We will explain why it manifests in joints and what you can do to lessen its hold. Then we will share insights on food choices you can make to relieve symptoms and reduce pain.

Rheumatoid arthritis does not have to define you. You have the power to reduce symptoms and improve joint function by changing your nutrition. Whole food, plant-based nutrition can reduce inflammation and pain associated with rheumatoid arthritis.

What is Rheumatoid Arthritis?

Unless you are part of the 0.25% of people with rheumatoid arthritis (1), you probably don’t know much about it. Like other types of arthritis, rheumatoid arthritis attacks the body’s joints. However, unlike osteoarthritis where damage to the joints comes from repetitive mechanical stress forces, rheumatoid arthritis damages the joints via the body’s immune system.

The immune system senses foreign invaders in joint cavities and sends in the cavalry to destroy them. But, it’s a false alarm. There are no foreign invaders so the immune system destroys the cartilage and bone tissue inside the joint instead. Ouch! This creates painful, swollen joints, particularly in the feet and hands. Eventually, the damage can be so severe it can result in deformations and the inability to use the digits.

Why does this happen?

Unlike some other non-communicable diseases, rheumatoid arthritis is still somewhat of a mystery. Your inherited genes can explain up to 60% of the likelihood of developing the disease. The other 40% is largely set by your environment and lifestyle (2). As with diabetes and other lifestyle-based diseases, just because you carry the genes for rheumatoid arthritis, does not mean you will develop the disease. If you already have rheumatoid arthritis, you can make lifestyle changes to reduce the severity and symptoms of the disease. Genetic susceptibility does not paint the whole picture. There are other risk factors for developing rheumatoid arthritis that you have control over. Let’s look at a few.

What about airborne toxins and inflammation?

Smoking is one habit to ditch, as it is the strongest changeable risk factor for rheumatoid arthritis (3). Also, exposure to asbestos and textile dust can enter the lungs or gut and cause adverse immune reactions. All these toxins trigger inflammation in the joints. Even the gum disease, gingivitis, can be a trigger for rheumatoid arthritis.

Wait! Your gums affect your joints? I agree – that sounds weird and out of place, but there is nothing “normal” about rheumatoid arthritis because it has so many faces.

It’s happening in your gut

Let’s look at how the gut microbiome is linked to rheumatoid arthritis. Who would guess that what’s going on in our intestines has an effect on the health of our joints?

Dysbiosis is the name given to the gut when it is unbalanced in favour of non-beneficial or ‘bad’ bacteria. Dysbiosis can trigger inflammation and make rheumatoid arthritis symptoms worse (4). An unbalanced gut can also raise harmful substances such as trimethylamine oxide (TMAO) in your body. TMAO is key in preparing an environment ripe for rheumatoid arthritis (5).

Does obesity increase rheumatoid arthritis pain?

You probably already know that obesity is a risk factor for lots of non-communicable diseases including diabetes and heart disease. If this is new information for you, then read our article about obesity first. Fat tissue releases inflammatory molecules called cytokines that increase the risk of other diseases. As rheumatoid arthritis is an inflammatory condition, obesity makes it worse.

You are three times more likely to develop rheumatoid arthritis if you are obese (6). Plus, being obese makes the drugs used to treat rheumatoid arthritis less effective. A common drug type is anti-tumour-necrosis-factor (anti-TNF) medication that helps reduce inflammation and slow the progression of rheumatoid arthritis (7). A study followed six hundred patients taking anti-TNF medication for 12 months to see the effect of the drugs on rheumatoid arthritis symptoms. Obese patients experienced symptom relief at half the rate of normal-weight patients (8).

Can food sensitivities trigger rheumatoid arthritis?

Many food sensitivities are caused by food antigens found in animal products or chemicals from ultra-processed foods. As it is difficult to isolate food chemicals that trigger arthritis symptoms, it’s best to work with your doctor if you are considering a diet to eliminate food antigens.

How can my diet reduce my rheumatoid arthritis symptoms?

The human body is such an amazing machine, that by changing our diet we can rebalance the gut and improve symptoms and joint function. How do we do that? Eat a wide variety of whole, plant foods (9).

The fibre and other compounds in different plants assist in balancing the gut microbiome and increase the diversity of gut bacteria. More diverse bacteria, in turn, improve gut health. When the gut is happy, inflammation reduces and so do the symptoms of rheumatoid arthritis.

A whole food, plant-based diet also has a naturally low calorie-density which helps for weight loss or weight management. Losing weight can help reduce the symptoms of rheumatoid arthritis including decreases in painful, swollen and tender joints (9).

A plant-based diet further can be a great way to eliminate food sensitivities that cause arthritis flare-ups. Swapping out animal products and ultra-processed foods with whole plant foods may improve rheumatoid arthritis symptoms. This is because the immune system reacts negatively to food antigens (10).

How do I get started?

Whilst complete reversal of rheumatoid arthritis is not always possible, stopping further joint destruction and obtaining pain relief can be achieved. Give yourself the best chance of improved joint function by starting with the things you can change. Avoid trigger foods and replace them with whole plant foods as the first step.

If you already know which foods make your symptoms worse, find whole food plant-based alternatives. For example, if milk increases your symptoms, try a plant-based alternative such as soy or oat drink. There are so many different plant milk alternatives to choose from. Some you may like – others, not so much. But don’t give up. Keep trying them until you find your favourite.

As a next step, start to remove ultra-processed foods and animal products from your diet. Make sure to fill the void with healthy plant-based foods. Start with plant foods that you are already eating and eat them more often. Then experiment and eat a greater variety of plant foods. Did you know there are 16,000 different types of legumes (11)? You don’t need to try them all, but it doesn’t hurt to be a little adventurous. Try fruits and vegetables in season to find new favourites. Read our ‘Easy Plant-Based Swaps’ article for ways to incorporate more plants into your diet.

Omega-3 fatty acids have long been recommended as ‘heart-healthy’ fats to lower the risk of cardiovascular disease. They also decrease inflammation, which is fabulous if you are looking to reduce the symptoms of rheumatoid arthritis. A daily serving of walnuts, flax seeds or chia seeds can reduce inflammatory markers in the blood (12).

Will it work for me?

If you currently eat a diet high in animal products, sugar and ultra-processed food, switching to whole, plant-based food is the first step towards symptom relief. A whole food, plant-based diet gives you more fibre to keep your gut microbiome happy. It can help you lose weight and lower your inflammation. All these things can work together to reduce your symptoms. Please discuss any dietary changes with your rheumatologist first.

There has been some recent successful research using this dietary approach. The 2023 Plants for Joints study from the Netherlands compared a plant-based diet to a usual care diet over 16 weeks. The study participants on the plant-based diet improved their rheumatoid arthritis symptoms by 26%. They also improved their glucose control, blood pressure, cholesterol, weight and inflammation markers (13). Even just four weeks on a vegan diet improves markers of rheumatoid arthritis (9, 14). But, for lasting relief, it’s important to commit to permanent dietary change.

What can I eat?

• Maximise the intake of high-quality whole plant foods such as vegetables, whole grains, legumes, fruit, nuts, seeds, herbs, and spices

• Choose healthy omega-3 fat sources such as walnuts, flax and chia seeds

• Maximise fibre intake with whole-grain bread and pasta, quinoa, oats, and brown or wild rice for more gut microbiome diversity

• Fight chronic inflammation with powerful antioxidants in berries, cruciferous vegetables (like broccoli), dark green leafy vegetables, and beans

• Some people see improvements in rheumatoid arthritis by eliminating gluten (10)

• Some people see improvements by eliminating nightshade vegetables such as tomatoes, potatoes and eggplant

Practical tips for you

• Reduce inflammation by choosing whole plant foods

• Choose high-antioxidant fruits like berries

• Try removing gluten from your diet to see if it makes a difference

• Get your omega-3 fatty acids from whole foods including walnuts, chia seeds and flax

• Maintain a healthy body weight through diet and exercise

Conclusion

Whilst nutrition is not necessarily a cure-all for rheumatoid arthritis, choosing whole plant foods can lower inflammation, reduce symptoms and improve joint function. The added bonus of eating a whole food, plant-based diet is as you improve your rheumatoid arthritis, you are improving your overall health. Rheumatoid arthritis is connected to other metabolic diseases including obesity, diabetes and cardiovascular disease. When you reduce your risk of rheumatoid arthritis through a whole food, plant-based lifestyle, you also reduce your risk of these diseases.

Additional Information: