How Diet and Supplements Can Help Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory disease that affects the whole body and leads to cartilage, joint, and bone destruction.

RA is a very debilitating disease that may lead to difficulty doing daily activities. The pain and stiffness can be frustrating and challenging. 

Two percent of the global population suffers from this disease; however, there is significant variation among different populations. More than 50 million Americans are thought to be living with RA, with over 300,000 children suffering from the disease.

RA is caused by genetic and environmental factors and takes many years before the onset of the disease is observed.

The environmental factors that lead to this disease include cigarette smoking, air pollution, dust, infections, and diet. 

Diet and nutrient status have been found to have a central role in disease risk and progression. [1-8]. 

An extensive prospective study followed 170,000 women at baseline free from RA to establish the relationship between healthy eating patterns and RA risk. The study concluded that a better quality diet for women aged under 55 years was associated with a lower RA risk [9].

There are higher numbers of RA patients in Western world countries than in Eastern and developing countries [10]. 

Depending on the properties of foods, dietary habits can represent both disease risk and protective factors. 

A high red meat intake often characterizes the Western world diet. It is also high in saturated and trans fats, has a low ratio of omega-3 to omega-6 fatty acids, and high levels of refined carbohydrates, leading to increased body mass index. These are all associated with an increased RA risk principally due to high inflammation, insulin resistance, and obesity [11,12].

Diet is also a significant factor influencing microbiota composition, which has been involved in RA disease development.

So what does the research prove you should eat to reduce RA disease risk and development? 

1. Consume foods rich in polyphenols

Polyphenols are the most abundant antioxidants in the diet. Fruits, vegetables, fungi, and spices are rich in polyphenols, lowering levels of pro-inflammatory cytokines connected with rheumatoid arthritis [13]

Phenolic compounds have antioxidant, antimicrobial, and anti-inflammatory properties. 

Flavonoids inhibit enzymes that are involved in the production of inflammatory mediators; they also increase antioxidant defenses. [14-16].

The most effective flavonoids to reduce RA risk and development include:

  • Genistein, the primary active compound found in soybeans, features anti-inflammatory, anti-angiogenesis, immunomodulatory, analgesic, and chondroprotective properties in RA.
  • Mangiferin found in mangoes
  • kaempferol found in grapefruits
  • resveratrol found in red grapes
  • p-coumaric acid found in grapes, apples, oranges, spinach, tomatoes, potatoes, oats, wheat, and corn
  • Hesperetin found in citrus fruits
  • Quercetin found in onions and apples

The spices riches in polyphenols include black pepper, ginger, caraway seeds, bay leaves, cinnamon, paprika, clove, nutmeg, and chili pepper.

2. Reduce foods that cause inflammation

Many studies indicate a positive effect of an anti-inflammatory diet on disease activity in patients with RA. A non-inflammatory diet controls inflammation and reduces discomfort.

Foods that contain refined carbohydrates, gluten, and red meat are inflammatory and should be avoided or eaten in moderation.[17]

The glycemic index of carbohydrates has a strong influence on systemic inflammation. The higher the glycemic index, the more inflammatory the carbohydrate. Whole grains have a lower glycemic index and are rich in fiber. Fiber decreases carbohydrates absorption and decreases mediators of inflammation [18]; therefore, whole-grain carbohydrates should be consumed daily.

However, it is advised that the whole grains consumed are gluten-free. Since gluten, a mixture of hundreds of proteins found in wheat grains triggers an altered immune response in RA. [20]. 

A few studies show that a gluten-free, vegan diet followed for one year was associated with anti-inflammatory properties and a significant decrease in RA disease activity [21,22].

Also, a high total protein supply has been associated with an increased risk of inflammation in RA patients. [19] Therefore, protein from plant sources such as legumes is the best protein source for people suffering from RA. Legumes have also been shown to have anti-inflammatory properties.  

Red meat intake should also be limited (1-2/month), 

The foods with the highest anti-inflammatory properties include: 

  • Fruits especially berries, and tart cherries.
  • Vegetables especially spinach, potatoes, [23] and tomatoes rich in lycopene, one of the most potent antioxidants [24-25]
  • Whole grains, especially oats, whole grain rice, and teff nuts and seeds.

All of these decrease markers of inflammation (CRP, IL6)

In a survey, 24% of patients reported that their diet had perceived effects on their RA symptoms; 19% observed adverse effects of sugary drinks and sweets, while 15% reported beneficial impact of some foods’ consumption, most often berries and spinach [26].

3. Consume a low sodium (salt) diet

A low-sodium diet seems to have anti-inflammatory potential.

A high sodium diet, typical in Western countries, has been associated with an increased risk of RA [27].

A clinical study [28], where RA patients underwent three weeks of a low-sodium dietary regimen followed by two weeks of a normal-sodium dietary regimen, concluded that a low-sodium diet might lower the inflammatory response in RA patients.

High levels of salt could potentiate the detrimental effect of other environmental factors, mainly smoking, leading to enhanced autoimmunity [29-30]. To consume a low salt diet, go for natural foods; unlike processed foods, these are not bathed in salt. Also, when you add salt to your foods, aim to use vegetable salt. This type of salt takes the natural salts in certain vegetables to flavor foods with a salty taste. This is not only the healthiest salt because it provides added nutrients from the dried vegetables; it is also delicious. You can get used to consuming less salt after three days of lowering your salt content.

4. Consume omega-3 fatty acids

Several nutrients, such as omega-3 polyunsaturated fatty acids, present anti-inflammatory and antioxidant properties. These have a protective role in preventing RA development due to their action on pro-inflammatory cytokines.

Omega–3 fatty acid supplementation in RA patients seems to reduce concentrations of inflammatory mediators [31-41]. A recent systematic review and meta-analysis on the effects of PUFAs concluded a significant positive impact on several outcomes for RA [42].

A prospective, randomized study concluded that daily omega-3 fatty supplementation has beneficial effects in lowering the disease activity [43].

Another systemic review found that in human and animal studies, omega-3 fatty acid supplementation prevented RA in subjects at risk and alleviated the pain, lowered the tender joint count, shortened the morning stiffness duration, and reduced the frequency of NSAID use in RA patients. [44].

Another study showed a reduction of 35% of RA risk in women with a dietary intake of omega-3 fatty acids higher than 0.21 g/day [45]. 

The best omega-3 fatty acid supplements are those from plant-based sources because they will not lead to the opposite effect in high doses. Also, adding foods rich in plant-based omega3 fatty acids is very beneficial. These foods include seaweed, natural walnuts, chia, and flax seeds.

5. Consume prebiotic-rich foods. 

Significant modifications of the intestinal microbiota occur in RA. RA patients present a reduced gut microbial diversity in comparison to healthy controls [46-48]

I talk about changing this and improving microbial diversity in more detail in my sinusitis article; check it out here: XXX.

Lifestyle Habits:

It is best to combine physical activity and a healthy lifestyle with dietary patterns to reach an optimal body weight and reduce RA disease activity, remission, and treatment efficacy.

Weight control should also be a relevant target [49-50]

One study found an increased risk for RA in consumers of 4 or more cups of coffee/day, while consumers of more than 3 cups of tea per day presented a reduced risk [51]. 

On the contrary, specific molecules and products used in coffee processing and preparation may have a role in increasing RA risk: diterpene cafestol, found in unfiltered coffee brews, could increase the risk of RA. Moreover, the solvent used to extract caffeine from beans has been related to RA risk and other connective tissue diseases [52-56].

Smoking must also be stopped as soon as possible to prevent disease progress and development.

Supplements 

Scientific evidence has shown that supplements have reduced symptoms such as pain, joint stiffness, swelling, tenderness, and disabilities linked to RA. Here are a few of those supplements that have anti-inflammatory benefits and have been shown to benefit people suffering from RA.

  • Turmeric contains curcuminoids that have been shown to prevent RA, perhaps due to their potent anti-inflammatory effect. [57].
  • Green tea has many benefits for RA patients. It has anti-inflammatory abilities and is also an excellent weight management supplement. Epigallocatechin-3-gallate (EGCG), the main phytochemicals present in green tea, is beneficial to people with RA. ECGC reduces bone and cartilage destruction through the downregulation of enzymes involved in the breakdown of the extracellular matrix [58-60].
  • Boswellia is a herbal extract that has strong anti-inflammatory properties. Its ability to reduce inflammation, relieve pain, reduce bone degradation, and improve joint functions makes it an excellent supplement for RA patients. [61]

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