Rheumatoid Arthritis: Eating to Reduce Pain

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Some patients find relief from rheumatoid arthritis symptoms with dietary changes

By Heather Stringer

Jackie Orders remembers the morning she woke up with a swollen, aching left knee after cheerleading tryouts in high school. Jackie assumed she had torn a ligament, and the swelling and pain subsided within a few days. But two weeks later, the other knee ballooned and ached when she put pressure on the joint. Her doctor performed a series of blood tests and other diagnostics, and two months later she learned that her symptoms were the result of her immune system’s attack on her body. Jackie had rheumatoid arthritis.

The 15-year-old adapted as she battled with periods of fatigue, body aches and severe knee pain. She stopped cheerleading, used the elevator to access classes on the second floor and avoided school events that involved walking on bleachers. Then in her early 20s, her left knee swelled to the size of a cantaloupe and the pain was so severe she couldn’t stand up. Her doctor prescribed Enbrel, a biologic medication that targets specific parts of the immune system that cause inflammation, and her symptoms improved. But a year later, the symptoms returned in spite of the medication.

“I didn’t want to go back to the way it was before, so I started doing research about diet and rheumatoid arthritis,” says Jackie, 28, a hair stylist and esthetician. She discovered the autoimmune protocol (AIP), a diet aimed at cutting out foods that cause inflammation in the body. Gradually she started reducing the amount of gluten, dairy, soy, processed food and refined sugar in her meals, and increased her intake of organic chicken, vegetables, fruits and eggs. She started buying dairy and wheat substitutes like gluten-free bread, almond flour tortillas and almond milk yogurt.

“I began noticing improvements in my symptoms each day, and after a few months I could walk and exercise at the gym,” says Jackie, of Pinehurst, N.C. “For years, I hadn’t been able to put pressure on my knees, and for the first time I could kneel down to fold my clothes or play with my nieces and nephews.”

Although the correlation between diet and symptoms varies dramatically for the estimated 1.3 million Americans who have rheumatoid arthritis, researchers are striving to understand the underlying mechanisms that explain why food choices have the potential to influence inflammation in certain patients.

“People generally don’t realize how powerful diet can be,” says Dr. Victoria Maizes, MD, executive director of the University of Arizona Center for Integrative Medicine. “I think a lot of doctors feel like they gradually watch chronic conditions such as rheumatoid arthritis worsen over time, and the fact that someone could reverse the trajectory of a disease is very meaningful.”

Experimenting with diets

Although research about different diet strategies suggests that food choices can influence the progression of rheumatoid arthritis, studies have mixed results and are difficult to simplify into treatment recommendations. To make research findings more accessible to the public and medical community, Bhawna Gupta, PhD, and her colleagues from the Kalinga Institute of Industrial Technology in India reviewed nearly 200 studies about managing the disease with dietary interventions. In a paper published in the Frontiers of Nutrition they described several studies showing that the Mediterranean diet—which is rich in olive oil, cereals, fruits, vegetables, fish and legumes—can reduce inflammation by decreasing oxidative stress in the body. (1) They also examined studies focused on a vegan diet, and there was repeated evidence of disease remission in participants who avoided animal products and consumed only vegetarian food.

Gupta’s team also found several studies suggesting the possible benefit of an elimination diet in which individuals give up specific foods for a period of time to assess whether certain foods are triggers for the disease. When patients are interested in trying this diet, Emily Gesino, a registered dietitian and nutrition manager at Roger Williams Medical Center in Rhode Island, recommends that they eliminate the most common known food triggers—gluten, corn, dairy, citrus, soy and eggs—for 12 to 14 days and then slowly reintroduce one food at a time to observe any change in symptoms.

“Everybody is different, so there isn’t one formula that works for everyone,” Gesino says. She has noticed that the Mediterranean diet is generally more palatable for patients because it’s less restrictive than the AIP or vegan diets, though she encourages patients to seek advice from a registered dietitian before trying a new food regimen.

Symptoms of rheumatoid arthritis may not only be influenced by what people eat, but also when they eat, says Dr. Maizes. In a recent study, researchers explored how the frequency and timing of meals affected levels of metabolic and inflammatory biomarkers in women with breast cancer.(2) They found that women who ate less than 30 percent of their total daily calories in the evening experienced a significant reduction in C-reactive protein, a marker for inflammation in the body. The data also showed that this protein was lower in women who ate one additional snack or meal per day.

“Research suggests that a larger breakfast, smaller lunch, and even smaller dinner is most health promoting,” says Dr. Maizes. “And longer periods of overnight fasting, ideally 12 to 13 hours, allows the immune system to reset.”

Timing matters

Although it’s never too late to make dietary changes, “there is a window of time in the early stages of the disease when supplements and diet seem to have a greater impact on disease progression,” says Dr. Maizes.

Patty Carrier, 62, attributes the remission of her rheumatoid arthritis to meal modifications she implemented a year after her symptoms started. When she noticed her left hand was swollen and hurt when she tried to hold a cup or hairbrush. The pain subsided, but three days later her right hand was swollen and stiff. The pain migrated to her left hip and then her left ankle, and she was forced to stop activities like walking her dogs and folding laundry. Patty tried wearing compression socks and applying topical pain relievers like Bengay, but nothing helped.

One morning, she woke up to excruciating jaw pain and couldn’t open her mouth to brush her teeth. She made an appointment with her doctor, who prescribed Prednisone, a steroid medication that suppresses the immune system. Within two weeks she felt better, but a month later the bottoms of her feet were so sensitive she couldn’t sleep under the pressure of a sheet. “I felt like I was walking on pebbles every time I took a step,” says Patty, who was diagnosed with rheumatoid arthritis in 2017.

Determined to avoid another round of Prednisone, Patty started researching dietary options to reduce her symptoms. She stopped eating gluten, sugar and prepared foods, and started buying more vegetables. Instead of cereal for breakfast, she tried a turkey patty and two cups of greens such as kale or spinach with olive oil. Staples for lunches and dinners included salmon, carrots, green vegetables of all types, small amounts of fruit and pumpkin biscuits made with coconut oil, coconut flour, baking soda and applesauce.

“I was totally unaccustomed to eating this way,” says Patty, who lives in Albert, Kansas. “It took four months, but eventually my ankle, right shoulder, hands and wrists stopped hurting. I knew I was headed in the right direction.”

She was still suffering from moderate pain in her right shoulder and left foot, and a doctor specializing in regenerative medicine suggested that she try an elimination diet. This experiment revealed that eggs, nuts and dairy were also triggers for her disease.

Although Patty still can’t walk barefoot, the pain subsided significantly in her foot and shoulder when she eliminated the additional triggers. “I’m back to walking my dogs, and I’m helping my husband build our own home on a bluff—something I could never have done before,” she says.

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Growing interest among physicians

Patty and Jackie were two patients who took it upon themselves to research the connection between symptoms and diet. Dr. Katarzyna Gilek-Seibert, MD, a rheumatologist at Roger Williams Medical Center in Rhode Island, is eager to see more doctors take initiative with discussions about alternative treatment approaches.

“Physicians are starting to look more into these strategies because patients are already trying dietary approaches,” says Dr. Gilek-Seibert. “It’s important for patients to understand that dietary changes can complement traditional medicine. I’ve seen patients who start neglecting traditional medicine when they try an alternative approach, but this can lead to permanent damage if the disease progresses.”

Jackie was able to safely taper off Enbrel as a result of the food modification, though she still takes the medication on occasion when she can’t stick to her diet, like when she’s traveling. She’s experienced only one flare of symptoms during the six years since she started the new meal habits, and the symptoms subsided in a few days when she started juicing with kale, beets, celery and carrots.

“I love feeling like I am in control,” Jackie says. “I look back and wonder how I couldn’t see that eating Taco Bell and Wendy’s in high school was not helpful for rheumatoid arthritis. The pain significantly affected my body and my mood, and sometimes I can’t believe how happy I feel now.”

Foods that can reduce inflammation for rheumatoid arthritis

· Fruits: Dried plums, grapefruits, grapes, blackberries, pomegranate, mango, banana, peaches, apples

· Cereals: Whole oatmeal, whole wheat bread, whole flattened rice

· Legumes: Black soybean, black gram

· Whole grains: Wheat, rice, oats, corn, rye, barley, millets, sorghum, canary seed

· Spices: Ginger, turmeric

· Herbs: Sallaki, ashwagandha

· Oils: Olive oil, fish oil, borage seed oil

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References:

  1. Shweta K, Jaiswal KS, Gupta B, Managing rheumatoid arthritis with dietary interventions, Frontiers in Nutrition, 2017 November 8, 52. doi: 10.3389/fnut.2017.00052
  2. Marinac CR, et. al., Frequency and circadian timing of eating may influence biomarkers of inflammation and insulin resistance associated with breast cancer risk, PLoS One, 2015 Aug. 25, 10(8):e0136240. doi: 10.1371/journal.pone.0136240. Available at:
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