Diet and Rheumatoid Arthritis

anti-inflammatory diet autoimmunity bone health casein chronic inflammation cytokines dairy elimination diets immune system joint health rheumatoid arthritis Sep 07, 2024

If you’re experiencing pain in both wrists and hands, or you’re struggling to move in the morning because of stiff or painful knees, ankles or feet, you may have rheumatoid arthritis (RA) — a condition that affects 1.3 million adults in the U.S.^1,2

If you do have RA, you’ll want to watch what you eat: Certain foods can worsen your symptoms or ease them, impacting your mobility and daily performance.³

In this article, we'll explore the connection between diet and RA:

Signs and symptoms of rheumatoid arthritis
Diagnosis and risk factors
Inflammation in RA
Autoimmunity in RA
Dietary triggers of RA
Anti-inflammatory diet for RA

We’ll start off with the basics: symptoms, diagnosis, and risk factors.

Signs and symptoms of rheumatoid arthritis

RA is a chronic, inflammatory condition that’s most noticeable as pain in your joints.^4,5

The pain affects your small joints first, then spreads to larger ones. You feel it on both sides of your body — that is, in both your left and right wrists, fingers, hands, knees, ankles, toes, and feet. This symmetric pain makes RA different from other types of arthritis.¹

RA pain can be mild, moderate, or severe. It can feel similar to a sprain or broken bone, or the affected areas of your body may be painful to touch.¹

Stiff joints are another symptom of RA. Usually, the stiffness is worse in the morning, lasting for 45 minutes or more after waking. Because your ankles, knees, or feet are stiff and painful, it may be hard for you to get out of bed or walk in the morning.¹

RA can also sap your energy, if the pain hinders you from sleeping well. Even if you do get enough sleep, you can still feel weak, tired, or fatigued because of the chronic inflammation.¹

Inflammation associated with RA can harm your other organs in the long term. For instance, it can make your eyes dry, red, and painful. What’s more, your eyes may become sensitive to light, and your vision may get blurry.⁴

Having RA can cause a dry mouth too. This happens when ongoing inflammation damages the glands that produce moisture inside your mouth.⁴

RA-related inflammation can scar your lungs as well. As a result, you may find it hard to breathe, or you may develop a chronic dry cough.¹

Plus, inflammation can make lumps of tissue form under your skin. It may also affect your blood vessels, giving you a rash of small red dots.^1,4

As chronic inflammation damages the lining of your blood vessels, they become more prone to buildup or blockage. As the vessels that supply blood to your heart and brain become affected, your risk of heart attack and stroke increases, and you may experience chest pain.⁴

Diagnosis and risk factors

Usually, the diagnosis of RA is made by a rheumatologist, a doctor who specializes in arthritis. Typically, they’ll do a physical exam, then ask you about your medical history and symptoms. They’ll also order blood and imaging tests.²

Blood tests for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) look for inflammation in your joints. You may also get tested for certain proteins related to RA — in particular, rheumatoid factors (RFs) and anti-cyclic citrullinated peptides (anti-CCPs).²

As for imaging tests, they’ll show if your joints are worn down. These tests may include X-rays, ultrasounds, and magnetic resonance imaging (MRI) scans.²

Sometimes, if these tests are inconclusive, the rheumatologist will observe you for a while before making a diagnosis.²

Who’s at risk of RA? Both genetic and environmental factors contribute to developing this disease.²

Certain genes help your immune system distinguish between the substances produced by your body and those that come from foreign invaders. Inherited variations in some of these genes can make you more likely to develop RA. You may not need genetic testing to find out if you have these variants. Shared genetic material means it’s likely that if someone in your family has it, you can develop it too.²

As for gender, you’re two to three times more prone to having RA if you’re female than if you’re male.²

When it comes to age, you’re most likely to develop RA when you’re between 30 and 60. That said, RA can affect people from all age groups — small children included.²

Smoking raises your risk of RA or worsens it if you already have it. Obesity is also associated with a higher chance of developing RA.²

Last but not least, your diet may trigger RA, or aggravate your symptoms. That’s because certain foods — particularly gluten and dairy — can promote both inflammation and autoimmunity.^3,6,7

Inflammation in RA

Inflammation in RA occurs through a cascade of events. First, immune cells called T-cells get activated. They infiltrate your synovial tissues and release cytokines. These pro-inflammatory molecules include tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), and interleukin-6 (IL-6). The cytokines then recruit and activate other immune cells, especially B-cells and macrophages.⁸

B-cells produce autoantibodies, specifically RFs and anti-CCPs. Autoantibodies are proteins that attack your healthy tissues.⁸

Macrophages play a vital role in the damage inflicted by RA. These cells are major producers of more cytokines, as well as enzymes that degrade your joint tissues. Plus, macrophages activate specialized cells in your synovial tissues. In effect, the number of cells in your synovial membrane increases, which manifests as swelling. Second, an abnormal, extra layer of tissue called pannus forms in your joints.⁸

As RA progresses, your inflamed synovial tissues swell and push further into your joints, destroying the cartilage and bone there.^5,8

The muscles, ligaments, and tendons that support your joints also weaken over time, leading to even more joint damage.⁵

Autoimmunity in RA

Ordinarily, your immune system helps protect your body from infection and illness. To do so, it attacks and destroys foreign invaders like bacteria and viruses. But in RA, your immune system confuses your own tissues for foreign invaders and attacks them. This situation is called autoimmunity.^9,10

In RA, your immune cells attack mostly your synovial tissues. These tissues, which line and lubricate your joints, become inflamed as a result.^10,11

Inflammation is your body’s natural response to illness and injury. As such, it’s supposed to promote healing. But when autoimmunity kicks in, inflammation can harm your body instead of protecting it — as is the case with RA.^12,13

Dietary triggers of RA

Gluten is a complex mixture of proteins found in grains like wheat, barley, and rye.¹⁴

When you eat gluten, your immune system gets activated. A localized inflammatory response in your small intestine releases cytokines and autoantibodies there. Over time, the lining of your small intestine can become damaged — a condition sometimes called “leaky gut” — making your intestine more permeable. If this happens, toxins can reach your bloodstream.^14,15

When gluten protein reaches your blood as a result of leaky gut, more immune responses are triggered. This systemic inflammation can cause serious problems with other parts of your body – your joints among others.^14,15

Dairy products contribute to RA in a similar way. Dairy contains casein, a protein with a similar molecular structure to gluten. Thus, casein can also trigger an immune reaction and promote inflammation.¹⁶

Plus, dairy products are a major source of trimethylamine-N-oxide (TMAO). TMAO — produced when you metabolize dairy — is another pro-inflammatory substance.¹⁷

Anti-inflammatory diet for RA

Obviously, removing gluten and dairy from your diet can help reduce inflammation associated with RA. Adding certain other anti-inflammatory foods and supplements may help as well.

Omega-3 fatty acids — for example, eicosapentaenoic acid (EPA) — may help inhibit pro-inflammatory pathways and cytokine release. Many doctors suggest taking a fish oil supplement for this reason.¹⁸

Another option is gamma-linoleic acid (GLA). Your body uses GLA to make anti-inflammatory agents. Evening primrose oil, black currant oil, and borage oil all contain GLA.¹⁹

Boron — a trace element in fresh fruits and vegetables and sometimes drinking water — has been shown to combat inflammation as well. It’s known to reduce RA-associated pain, swelling, and fever.¹⁹

S-adenosylmethionine (SAMe) is a naturally occurring substance in your body’s tissues. SAMe relieves pain, swelling and stiffness in your joints — with fewer side effects than prescription anti-inflammatory drugs.¹⁹

Turmeric, a member of the ginger family, contains curcumin. It also has anti-inflammatory properties, and studies have found it helps lessen pain and swelling in RA.¹⁹

Conclusion

Rheumatoid arthritis is a chronic disease that affects the joints on both sides of your body. RA is both an inflammatory and autoimmune condition.

Genetics and the environment both contribute to RA. Environmental factors include highly inflammatory dietary triggers, such as gluten and dairy.

By eliminating gluten and dairy, you can lower your risk of developing RA. And if you already have the disease, avoiding these food items will help improve your symptoms.

Of course, that’s much easier said than done. That’s why we're here to help you put together a personalized diet plan that addresses your unique health needs, including RA and other inflammatory conditions.

Find out more about how to Maximize Your Performance by Optimizing Your Diet here.

References

Diet and Rheumatoid Arthritis

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