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FACT SHEET:
Rheumatoid Arthritis & Diet
How to prevent and treat RA with nutrition

Key points

  • Global incidence and prevalence rates are increasing.(1)

  • International guidelines(3) focus on treatment with disease-modifying antirheumatic drugs (DMARDs), which are not without significant risks and side effects.

  • It is more common in women, smokers, and those with poor dental health, poor sleep, unhealthy diets, obesity, and/or family history of RA (2).

  • Optimal diets are high in fruits, vegetables, whole grains, omega-3 fats, and nuts while low in other fats, salt, sugar, red, and processed meats (4).

  • An optimal diet is anti-inflammatory, and reduces the risk of comorbidities.

 

Rheumatoid arthritis (RA) causes significant disability (1) and increases risk of all-cause mortality, cardiovascular disease, infection, respiratory illness, osteoporosis, and cancer (2).

Pathomechanisms That Are Influenced by Diet:

Inflammation

Obesity

  • Visceral adipose tissue increases cytokine production and chronic systemic inflammation
  • Increased clearance diminishing bioavailability of anti-TNF drugs
  • Increased ESR values
  • Increased risk of CVD comorbidity

Plant-based diet

  • Reduced neutrophils, monocytes, and platelets
  • Increased dietary fiber
  • Decreased risk of CVD comorbidity

 

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) (5).
  • 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.” (6)

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 (7).
  • 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 (8).

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.

HIDE
Sources
(1) Safiri S, et al. Ann Rheum Dis 2019;0:1–9. doi:10.1136/annrheumdis-2019-215920
 
(2) Sparks, JA, Ann Int Med 2019; 170(1): ITC 1-22. doi:10.7326/AITC201901010
 
(3) Mian et al. A Systematic Review of guidelines for managing rheumatoid arthritis. BMC Rheumatology (2019) 3:42. https://doi.org/10.1186/s41927-019-0090-7
 
(4) Chehade L, et al. Curr Rheumatol Rev 15(3): 209-214
 
(5) Xu and Lin (2017), Characteristics and risk factors of rheumatoid arthritis in the United States: an NHANES analysis. PeerJ 5:e4035; DOI 10.7717/peerj.4035
 
(6) Pattison, DJ, et al. Arth & Rheumat 2004; 50(12): 3804-3812 DOI: 10.1002/art.20731
 
(7) Hafström, B et al. Rheumatology 2001; 40: 1175-1179
 
(8) Lederer A-K et al., Vegan diet reduces neutrophils, monocytes and platelets related to branched-chain amino acids – A randomized, controlled trial, Clinical Nutrition, https://doi.org/10.1016/j.clnu.2020.02.011