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
References
- Levy JA, Ibrahim AB, Shirai T, et al. Dietary fat affects immune response, production of antiviral factors, and immune complex disease in NZP/NZW mice. Proc Natl Acad Sci1982;79:1974–8.
- Jacobsson I, Lindgarde F, Manthorpe R, et al. Correlation of fatty acid composition of adipose tissue lipids and serum phosphatidylcholine and serum concentrations of micronutrients with disease duration in rheumatoid arthritis. Ann Rheum Dis 1990;49:901–5.
- Lucas CP, Power L. Dietary fat aggravates active rheumatoid arthritis. Clin Res 1981;29:754A [abstract].
- Skoldstam L. Fasting and vegan diet in rheumatoid arthritis. Scand J Rheumatol 1987;15:219–21.
- Nenonen M, Helve T, Hanninen O. Effects of uncooked vegan food—“living food”—on rheumatoid arthritis, a three month controlled and randomised study. Am J Clin Nutr 1992;56:762 [abstract #48].
- Warmbrand M. How Thousands of My Arthritis Patients Regained Their Health. New York: Arco Publishing, 1974.
- Panush RS, Carter RL, Katz P, et al. Diet therapy for rheumatoid arthritis. Arthrit Rheum 1983;26:462–71.
- KjeldsenúKragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and oneúyear vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899–902.
- Linos A, Kaklamani VG, Koukmantaki Y, et al. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables. Am J Clin Nutr 1999;70:1077–82.
- Kremer JM, Lawrence DA, Jubiz W, et al. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis Rheum 1990;33:810–20.
- Hafström I, Ringertz B, Gyllenhammar H, et al. Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis. Arthritis Rheum 1988;31:585–92.
- Skoldstam L, Magnusson KE. Fasting, intestinal permeability, and rheumatoid arthritis. Rheum Dis Clin North Am 1991;17:363–71 [review].
- KjeldsenúKragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and oneúyear vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899–902.
- Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Forre O. Vegetarian diet for patients with rheumatoid arthritis–status: two years after introduction of the diet. Clin Rheumatol1994;13:475‚Äì82.
- KjeldsenúKragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and oneúyear vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899–902.
- Seignalet J. Diet, fasting, and rheumatoid arthritis. Lancet 1992;339:68–9 [letter].
- Abuzakouk M, O’Farrelly C. Diet, fasting, and rheumatoid arthritis. Lancet 1992;339:68 [letter].
- Panayi GS. Diet, fasting, and rheumatoid arthritis. Lancet 1992;339:69 [letter].
- Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins in rheumatoid arthritis. Br J Nutr 2000;83(3):207–17.
- Zeller M. Rheumatoid arthritis—food allergy as a factor. Ann Allerg 1949;7:200–5,239.
- Darlington LG, Ramsey NW, Mansfield JR. Placeboúcontrolled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet 1986;i:236–8.
- Beri D, Malaviya AN, Shandilya R, Singh RR. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis 1988;47:69–72.
- Panush RS. Possible role of food sensitivity in arthritis. Ann Allerg 1988;61(part 2):31–5.
- Taylor MR. Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 1983;8:28–38 [review].
- O’Farrelly C, Price R, McGillivray AJ, Fernandes L. IgA rheumatoid factor and IgG dietary protein antibodies are associated in rheumatoid arthritis. Immunol Invest 1989;18(6):753–64.
- Darlington LG, Ramsey NW. Diets for rheumatoid arthritis. Lancet 1991;338:1209 [letter].
- Heliövaara M, Aho K, Knekt P, et al. Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis. Ann Rheum Dis 2000;59:631–5.
- Kay DR, Webel RB, Drisinger TE, et al. Aerobic exercise improves performance in arthritis patients. Clin Res 1985;33:919A [abstract].
- Harkcom TM, Lampman RM, Banwell BF, Castor CW. Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthrit Rheum 1985;28:32–8