Rheumatoid arthritis (RA) is a chronic inflammatory disease, in which the immune system attacks the joints and sometimes other parts of the body. The cause of RA remains unknown.

What are the symptoms of rheumatoid arthritis? The most common symptom of RA is joint pain and morning joint stiffness. Several joints on both sides of the body are usually affected, especially those of the hands, wrists, knees, and feet. Affected joints may feel warm or appear swollen. People with RA may have other symptoms, including weakness, fatigue, weight loss, and, occasionally, fever.

Dietary changes that may be helpful: Feeding a high-fat diet to animals who are susceptible to autoimmune disease has increased the severity of RA.1 People with RA have been reported to eat more fat, particularly animal fat, than those without RA.2 In short-term studies, diets completely free of fat have helped people with RA.3 Since at least some dietary fat is essential for humans, though, the significance of this finding is not clear.

Strictly vegetarian diets that are also very low in fat have been reported to reduce RA symptoms.4,5 In the 1950s through the 1970s, Max Warmbrand, a naturopathic doctor, used a very low-fat diet to treat people with RA. He recommended a diet free of meat, dairy, chemicals, sugar, eggs, and processed foods.6 A short-term (ten weeks) study employing a similar approach failed to produce beneficial effects.7 Long before publication of that negative report, however, Dr. Warmbrand had claimed that his diet took at least six months to achieve noticeable results. In one trial lasting 14 weeks—still significantly less than six months—a pure vegetarian, gluten-free (no wheat, rye, or barley) diet was gradually changed to permit dairy, leading to improvement in both symptoms and objective laboratory measures of disease.8 The extent to which a low-fat vegetarian diet (or one low in animal fat) would help people with RA remains unclear.

Preliminary evidence suggests that consumption of olive oil, rich in oleic acid, may decrease the risk of developing RA.9 One trial in which people with RA received either fish oil or olive oil, found that olive oil capsules providing 6.8 g of oleic acid per day for 24 weeks produced modest clinical improvement and beneficial changes in immune function. However, as there was no placebo group in that trial, the possibility of a placebo effect cannot be ruled out.10

Fasting has been shown to improve both signs and symptoms of RA, but most people have relapsed after the returning to a standard diet.11,12 When fasting was followed by a 12-month vegetarian diet, however, the benefits of fasting appeared to persist.13,14 It is not known why the combination of these dietary programs (i.e., fasting followed by a vegetarian diet) might be helpful, and the clinical trial that investigated this combination15 has been criticized both for its design and interpretation.16,17,18

Food sensitivities develop when pieces of intact protein in food are able to cross through the intestinal barrier. Many patients with RA have been noted to have increased intestinal permeability, especially when experiencing symptoms,19 and RA has been linked to allergies and food sensitivities.20 In many people, RA worsens when they eat foods to which they are allergic or sensitive and improves by avoiding these foods.21,22,23,24 In one study, the vast majority of RA patients had elevated levels of antibodies to milk, wheat, or both, suggesting a high incidence of allergy to these substances.25 English researchers have reported that one-third of people with RA may be able to control their disease completely through allergy elimination.26 Identification and elimination of symptom-triggering foods should be done with the help of a physician.

Lifestyle changes that may be helpful: Although exercise may initially increase pain, gentle exercises help people with RA.28,29 Women with RA taking low-dose steroid therapy can safely participate in a weight-bearing exercise program with many positive effects on physical function, activity and fitness levels, and bone mineral density, and with no aggravation of disease activity.30 Many doctors recommend swimming, stretching, or walking to people with RA.

Nutritional supplements that may be helpful: People with RA have been reported to have an impaired antioxidant system, making them more susceptible to free radical damage.31Vitamin E is an important antioxidant, protecting many tissues, including joints, against oxidative damage. Low vitamin E levels in the joint fluid of people with RA have been reported.32 In a double-blind trial, approximately 1,800 IU per day of vitamin E was found to reduce pain from RA.33 Two other double-blind trials (using similar high levels of vitamin E) reported that vitamin E had approximately the same effectiveness in reducing symptoms of RA as anti-inflammatory drugs.34,35 In other double-blind trials, 600 IU of vitamin E taken twice daily was significantly more effective than placebo in reducing RA, although laboratory measures of inflammation remained unchanged.36,37



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