Intestinal Flora

Anti-Proteus mirabilis antibodies elevated in RA

• Molecular mimicry

Prevotella copri and TMAO

• Thrive on choline and carnitine from meat, poultry, fish, eggs
• Reduced effectiveness of DMARDs
• Increased inflammation
• Increased risk of CVD comorbidity
• Decreased risk of CVD comorbidity

Plant-based diet

• Decreased TMAO
• Increased dietary fiber, SCFA
• Decreased risk of CVD comorbidity

The Scientific Evidence

Epidemiological Evidence

• 2017 NHANES Survey found multivariable odds ratios (OR) as follows: obese, 3.26 (P <0.001) and, interestingly, insufficient vitamin A intake 0.70 (P = 0.036). Univariate OR for excess (toxic) vitamin A intake was 4.22 (P = 0.048), and inadequate copper intake 1.42 (P = 0.019).⁷⁾
• While carotenoid conversion to vitamin A is adjusted based on need, preformed vitamin A from supplements and animal-derived foods may be absorbed in excess.
• In 2004, Pattison et al. found that, “Among patients, the level of red meat intake was higher (P = 0.04) and that of vitamin C was lower (P = 0.03) compared with intake among controls, but no difference in total energy intake was observed.”⁸⁾

Evidence from RCTs and Corresponding Meta-Analyses

• There are few RCTs for diet and RA. In a small 2001 RCT, 40.5% of patients randomized to 9 months on a vegan diet free of gluten met ACR20 improvement criteria, compared with just one patient in the non-vegan control group.⁹⁾
• Recently, Lederer et al. demonstrated significant decreases in markers of inflammation, including neutrophils, monocytes, and platelets in a small group of healthy omnivores after 4 weeks on a controlled vegan diet compared with a controlled mixed diet control group.¹⁰⁾

General Recommendations

Eat predominantly or entirely from a wide variety of whole plant foods:

• Maximize the intake of high-quality plant foods such as vegetables, whole grains, legumes, fruits, nuts, seeds, herbs, and spices; your health will benefit from every step towards more whole plant foods.
• Eliminate or limit all processed foods, refined carbohydrates, and sugar-sweetened foods and beverages.
• Eliminate or limit red and processed meat products (such as burgers, sausages, bacon, ham, salami, dried meat, canned meat, and pastrami).
• Eliminate or limit other animal products such as poultry, fish, eggs, cheese, and dairy.
• Make sure to cover potentially critical nutrients with a wide variety of plant foods, enriched foods/drinks, or supplements (especially vitamin B12 and vitamin D); find more information in our Nutrition Library.

Disease-Specific Recommendations

• Limiting sugar intake may be important for management of RA.
• While omega-3 fats appear to be beneficial, plant-based and algae-based sources may be preferable due to environmental contaminants and a possible role for TMAO in RA.
• Some RA patients may see improvement with elimination of dietary gluten.

For more details on how to implement a whole food, plant-based diet, have a look at our brochure.