Features November 2004 Issue

Diet and RA: The Link Remains Elusive

A balanced diet and portion control still top the menu.

There are few subjects as eagerly discussed and disagreed upon as diet and its relation to rheumatoid arthritis. People enjoy sharing personal stories about what foods to eat less of, or more of, in order to help keep their symptoms at bay. But when it comes time to back such talk with scientific proof, they soon discover that the clinical evidence is missing or inconclusive.

“For most people with rheumatoid arthritis, the best dietary advice is to eat a balanced diet and maintain a healthful weight with the help of portion control and exercise,” says Cindy Moore, director of nutrition therapy at The Cleveland Clinic.

This doesn’t mean that medical experts dismiss elimination diets altogether, or discourage you from pursuing a menu fortified with foods rich in anti-oxidants or omega-3 fatty acids. It’s just that they want you to keep the possible impact of diet on RA in perspective.

“There are a lot of unsupported ideas out there,” says Moore, “The most important one to dispel is that diet can cure or prevent arthritis. At best, it may help you manage your symptoms.”

Elimination diets are based on the following premise: By removing a food that you have a general sensitivity toward, you can eliminate substances that might irritate your immune system and lead to inflammation. Some RA patients claim that by removing wheat and other rough-grain products from their diet they can get rid of the gluten proteins they believe are making their disease worse. Others claim that by avoiding a wide assortment of grains and legumes they can avoid lectins, a glycoprotein that can bind to lymphocytes and possibly affect the immune system.

“Although such reactions to these foods are possible, true food allergies are relatively rare, and probably play a role in no more than 5 percent of people with RA,” says Moore.

Interpreting the impact of elimination diets gets tricky when you consider the vagaries of RA symptoms. Rheumatoid arthritis naturally goes through periods of spontaneous remission and flare-up, independent of anything you might do. And these remissions are unpredictable, lasting for a few days, weeks, or months. So if you begin your dietary experiment at the same time your arthritis goes into remission, it’s easy to attribute any improvement to dietary change, instead of to chance.

Further muddying the waters is the fact that almost any food you might eliminate likely contains at least a half-dozen other nutrients in addition to the one you think might be aggravating your arthritis. Such a rich mix of nutrients increases the possibility that, when trying to get rid of just one suspect, you end up getting rid of other innocent bystanders that could play an important role in your nutrition.

If you try an elimination diet, make sure to follow a few of these important steps....

Keep it to a single food. Don’t try to eliminate an entire food group—you could seriously undermine your nutritional needs. Grains, for example, are an essential source of B vitamins that are critical for helping you maintain your energy level and fight infection.

Make sure you stick with your diet for four to six weeks. This will help you determine if any change is due to the dietary adjustment, and not to the natural waxing and waning of symptoms. In addition, keep a daily diary of what you eat and how you feel throughout the day. Be sure to tell your doctor what you’re doing, and don’t stop taking any medications you may be on.

Be prepared to accept what you discover. If you find that eliminating tomatoes has no affect on your RA, you need to accept that and welcome them back into your diet.

The good stuff
Although there is little scientific evidence behind beliefs about what foods to avoid, there are several small-scale studies that support theories about what foods or nutrients you should get more of to help combat rheumatoid arthritis. The leading players in these studies are omega-3 fatty acids and antioxidants.

Preliminary studies seem to suggest that eating foods rich in a substance called omega-3 fatty acid can help your body better fight inflammation and, perhaps, reduce the frequency or intensity of RA flare-ups. Omega-3s are found in foods such as cold-water fish (tuna, salmon, herring, sardines, mackerel) as well as soybeans, flax, green leafy vegetables, and olive oil. They are also found in supplements such as fish oil and flax oil. (Moore cautions that omega-3 supplements make it easy to overdo it and increase the risk of bleeding. People on blood thinners should avoid such supplements.)

The other RA dietary buzzword often heard today is antioxidants. The theory is that cells produce free-oxygen radicals (negatively charged oxygen molecules), and that arthritic tissue produces a level of free radicals that is too high for the body to naturally counteract, leading to potential joint damage. A diet rich in antioxidants supposedly restores this balance and protects joints.

In a 10-year study, researchers at the Arthritis Foundation found that women who consumed higher levels of certain antioxidants (those in citrus fruits) were less likely to develop RA than those who consumed lesser amounts. They also suggest that those who eat ample amounts of cruciferous vegetables (broccoli and cabbage) may be similarly protected. It’s important to note that the antioxidants played a preventive role here, and were not shown to ease symptoms of those who already had RA.

Keeping it real
Whether you’re looking to boost your consumption of antioxidants or omega-3s, it’s better to get them through real foods than through supplements. Supplements are manufactured, and there is no guarantee that their nutrients are in the same proportion as found in natural foods. “The balance of nutrients in real food,” says Moore, “can provide an additional benefit, providing the right mixture of vitamins and minerals needed to help with vital body processes, such as absorption in the intestine.”

Rather than bother with supplements or elimination diets, Moore suggests a much easier way to use what you eat to help you fight RA—eat like a Greek. That is, consider a Mediterranean diet that relies largely on fruits, vegetables, fish, beans, and olive oil, as well as a little wine and cheese.

In a small Swedish study of people with RA, those who followed a Mediterranean diet had less inflammation and pain and increased function after 12 weeks compared to those who ate a diet high in saturated fats and processed foods. And this study considered the other benefit of a Mediterranean lifestyle—regular exercise.

Diet is neither a cure nor a preventative for rheumatoid arthritis, though research may one day conclusively show that it has a role to play in helping you manage your symptoms. Until such studies are undertaken and results are known, the best advice is still to eat a well-balanced diet, maintain a healthy body weight through portion control, and exercise to ease the stress on your joints.