whitebox header

Condition - Rheumatoid arthritis

By Nutri People

Rheumatoid arthritis (RA) is a form of arthritis known as ‘inflammatory arthritis’, because it causes pain, stiffness, swelling and loss of joint motion, as a result of inflammation of the lining of the joints. The small joints of the hands, wrists, feet and knees are typically inflamed in a symmetrical pattern. This means that if one wrist is involved, the other is too. About 70% of those affected are women. RA can also affect other parts of the body, besides the joints, including eyes, mouth and lungs. 

RA is an example of an autoimmune disease, which means your immune system mistakenly attacks the tissue that lines your joints. Conventional treatment includes the use of disease-modifying anti-rheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs (NSAIDs) and immunosuppressive medication. However, these treatments are not without side effects. The cause of RA remains unknown but a number of factors may contribute to the disease.  

Contributing factors

  • Food allergy. There is some evidence that food allergy plays a role in a small percentage of sufferers. This is likely to be the case if there is a flare-up of arthritis after eating certain foods. Food allergy can be caused by leaky gut syndrome and changes in gut bacteria.
  • Leaky gut syndrome (increased intestinal permeability). This affects the lining of the intestines. As a result, things that would not normally get through, i.e. some bacteria and partially digested proteins, now ‘leak’ out of the intestine and into the bloodstream. This can trigger autoimmune reactions that can lead to gastrointestinal symptoms and joint pain.
  • Genetics.Researchers believe that genetics plays an important role and is likely to account for about 50% of the risk of developing RA. 
  • Hormones. Because RA is more common in women than in men, sex hormones have been implicated as potential causative factors. 
  • Stress.Stress is recognised as a risk factor in the development of RA and some researchers believe that long-lasting (chronic) stress can lead to inflammation.
  • Environmental triggers. Environmental factors may contribute to the development of RA. A well-established risk factor for RA is tobacco smoking, which has been shown, in a number of studies, to be associated with an increased risk of RA. Diet (high intake of red meat and low intake of fruits and vegetables), caffeine intake, alcohol consumption and the amount of body fat have also been implicated as risk factors. Infectious organisms have attracted attention as potential environmental triggers for developing RA. In layman’s terms, an infectious organism attacking us is counter-attacked by our immune system. But, if this infectious organism closely resembles part of the lining of our joints, our immune system may then become confused, not be able to discriminate between the two and, as a result, end up attacking both the infectious organism and our joints. This is known as an autoimmune reaction. Imbalanced gut bacteria may also have a role to play in RA. 

Nutritional considerations

A study, reported in The Journal of Rheumatology, showed that patients with RA commonly consume diets that are deficient in micronutrients (vitamins, minerals and trace minerals). In addition to a good multivitamin/mineral combination, the following supporting nutrients may be of benefit: 

  • Probiotics. Our gut is filled with thousands of species of bacteria and, according to studies, many of them actually aid in the development of a healthy immune system. Probiotics are “live” bacteria, similar to those found in the human gut, and are also called friendly bacteria or good bacteria.
  • Collagen. Hydrolysed collagen (collagen hydrolysate) may help to support joint function and the production of healthy joint tissue.
  • Ginger.Pungent substances called gingerols may help support normal anti-inflammatory processes. Gingerols are components of ginger.
  • Devil’s claw root. Chemicals called harpagosides may help to support normal anti-inflammatory processes. Flavonoids are plant-based chemicals with potent antioxidant properties, that help to mop up free radicals naturally produced by the inflammatory process. Devil’s claw root is a source of harpagosides and flavonoids.
  • Boswellia. Boswellic acids may help support anti-inflammatory processes, by keeping levels of the inflammation-creating enzyme (called 5-lipoxygenase) within a normal, healthy range. Boswellic acids are components of Boswellia.
  • Ashwagandha root. Studies suggest that compounds called withanolides may help to support normal anti-inflammatory processes and healthy functioning of our immune system. Withanolides are present in roots of Ashwagandha.
  • Rhodiola rosea. Rosavin and salidroside may help support the body’s natural ability to deal with stress. Salidrosidemay also help support anti-inflammatory processes.  Rhodiola roseais a good source of rosavin and salidroside.
  • Fish oil. Studies have demonstrated an improvement in the symptoms of RA following the use of omega 3 fatty acids (including EPA and DHA). Many of these studies have reported a substantial reduction in the duration of morning stiffness or in the number of tender joints on physical examination. Omega 3 fatty acids may help to support the natural production of anti-inflammatory substances in the body and keep levels of the inflammation-creating enzymes, 5-lipoxygenase and COX-2, within a normal, healthy range. Fish oil is a good source of omega 3 fatty acids. 
  • Gamma-linolenic acid (GLA) is a fatty acid present in certain oils, including starflower (borage) oil. GLA may help support the body’s natural production of anti-inflammatory substances. Recent studies have also shown that GLA may help to keep levels of an inflammatory substance, called tumor necrosis factor-alpha, within a normal, healthy range. Tumor necrosis factor-alpha has been shown to be present at high levels in the rheumatoid joint.
  • Glutamine is an amino acid that helps to maintain normal intestinal cell growth and function.
  • Antioxidants. RA is associated with increased free radical production, which may arise from an overactive immune system and also from the changes in blood flow to the joints associated with RA. Antioxidants help to mop up these free radicals.
  • Folic acid. Methotrexate is a drug commonly used in the treatment of RA. However, methotrexate has the potential to interfere with the functions of folic acid. Folic acid is an important B vitamin that has been shown to reduce some of the side effects associated with methotrexate use in RA.
  • Vitamin B6. A study from Tufts University suggests that the chronic inflammation associated with RA may lower vitamin B6 levels.
  • Vitamin C. Research suggests that people with RA have lower blood levels of vitamin C.
  • Vitamin D. A greater incidence of RA is found in geographic regions with low supplies of vitamin D (low sunlight exposure and low dietary intake). Studies suggest that vitamin D may help support normal T-cell function. Abnormal T-cell function is associated with autoimmune conditions.

Dietary advice

  • Add turmeric and fresh ginger to your foods and drinks. Turmeric is rich in polyphenolic compounds, known as curcuminoids, which give turmeric its bright yellow colour. Curcumin, the main curcuminoid found in turmeric, may help support anti-inflammatory processes.
  • Increase your intake of soluble fibre. A new study from the University of Illinois suggests that soluble fibre reduces inflammation, by increasing the production of an anti-inflammatory protein called interleukin-4. Good sources of soluble fibre are fruits (like apples and strawberries),vegetables (like carrots), nuts, seeds, rolled oats, oat bran, oatmeal, barley, legumes (beans, peas and lentils), and flax seeds (preferably organic and cold milled).
  • Eat a variety of brightly coloured fruits and vegetables that are rich in antioxidants. Red grapes, apples, berries (including blueberries, blackberries, bilberries and blackcurrants) and green tea are good sources of flavonoids.
  • When preparing foods, grill, bake, or stir-fry with olive oil.
  • Reduce your consumption of foods of animal origin. If you eat meat,favour free-range meat and lean cuts (free range meat is actually a good source of omega 3 fats). Studies suggest that vegetarian diets may have beneficial effects in a subset of patients with RA. A Norwegian study, involving a group of people with RA, showed that a vegetarian diet that eliminated dairy products, eggs, refined sugar, citrus fruits and foods containing gluten (a protein found in wheat, oats, rye and barley) resulted in significant relief from pain. The improvements may have been related to changes in the type of fats present in their body, as a result of cutting out most animal foods, and to a reduction in their exposure to food allergens (substances in food that can cause allergic reactions).
  • Eliminate known food intolerances or food allergies. One particular survey, which looked at the effects of diet on rheumatic symptoms, showed that one third of patients with RA reported a worsening of symptoms with specific foods. The foods most frequently cited were meat, wine, alcohol, coffee, sweets, sugar, chocolate and citrus fruits. If you suffer from RA and note a flare-up of your arthritis after eating certain foods, avoid the offending items. You could also try eliminating, one at a time, the following food categories for two months and then reintroduce the eliminated items to your diet to determine if they influence your symptoms: (1) sugar, (2) citrus fruits, and (3) wheat, corn, and soy.
  • Eliminate milk and milk products, including foods made with milk.
  • Eliminate fried foods and processed/refined foods.
  • Avoid alcohol and coffee, which have been linked to an increased risk of RA.
  • Avoid vegetable oils, including margarines and vegetable shortening, and foods that contain trans-fatty acids, including hydrogenated fats and oils (read the food labels). Replace them with extra virgin olive oil and cold-pressed flax seed oil.
  • Cold-water oily fish(sardines, mackerel and salmon) are good sources of omega 3 fatty acids and vitamin D.
  • According to a study from the Harvard School of Public Health, a diet rich in cooked vegetables and olive oil may help to reduce the pain and swelling of RA. The researchers suggested that cooked vegetables and olive oil contain fats (polyunsaturated fats and monounsaturated fats) that are used by the body to make hormone-like substances that may help to block pain and swelling. They are also rich in antioxidants that could have beneficial effects. 

Lifestyle advice

  • Stop smoking. Smoking has been linked to an increased risk of RA.
  • Lose weight, if you are overweight, and exercise. Weight loss may have a beneficial effect in RA and help to reverse joint stiffness. Susan Roberts, director of the Energy Metabolism Laboratory at Tufts University in Boston and rheumatologist Ronenn Roubenoff conducted a study in 20 healthy women and 20 women with RA and found that the lower levels of physical activity exhibited by women with RA resulted in a reduction in the total amount of calories burnt in a day. This can lead to gains in fat that can worsen RA. The researchers recommended that, in addition to consuming a nutrient-rich diet, people with RA should incorporate some form of physical activity. Low-impact aerobic exercises help to strengthen your bones and muscles. They include stair climbing, walking, dancing, swimming and use of a stationary exercise bike. Swimming is a great way to increase conditioning for all your joints. Remember to rest more when your RA is active and exercise more when it is not active.
  • There is evidence that t’ai chi, a practice used in China as an arthritis therapy, may be of benefit in RA. A Korean study showed that eight weeks of t’ai chi classes, followed by eight weeks of home practice, resulted in a significant improvement in joint flexibility. In another study, t’ai chi was shown to improve the range of motion of the ankles, hips and knees.
  • Massage the affected areas. Double-blind, placebo-controlled studies have found that regular application of a cream containing a mixture of fats, called cetylated fatty acids, may help to reduce joint pain in those with arthritis.
  • Sunshine. Regular exposure to sunlight will help to boost your body’s production of vitamin D. Vitamin D scientist Dr Michael Holick at Boston University School of Medicine recommends five to 15 minutes of sunlight exposure on the hands, face and forearms, two to three times per week (in the morning or late afternoon and during spring, summer and autumn). You can put your sunscreen on after exposure. This minimises the risk of skin damage.

Printable versionSend to a friendShare

Related articles

whitebox footer

Nutrient list Nutrient list info

Recently added nutrients:

Related nutrients list empty

What should I take?

Click here to see which nutrients may be beneficial

Question Mark