Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation and swelling, pain, stiffness, and reduced functionality in previously healthy joint tissue. Your RA may not always affect your daily life, but flares happen and can slow you down. In addition to your health care provider’s treatment plan for you, knowing how to manage your RA symptoms can help ease the discomfort of this disease.
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Rheumatoid arthritis, much like other autoimmune diseases, begins in the body long before signs and symptoms of inflammation become noticeable. Though it is not crystal clear where the inflammation begins, studies have shown that the health of mucosal linings in the mouth, lungs, and gastrointestinal tract plays a role. Genes and environmental triggers for disease eventually impact hormones, infections, and aging, all of which are affected by the health of your gut microbiome. (Source, Source)
Gut bacteria are responsible for hosting a large percentage of your immune system, which determines your body’sresponse to invading pathogens. An ideal gut environment should be ever-changin with diverse bacteria, fungi, viruses, and microbes to harmoniously harbor good health and protect you from infectious pathogens. However, factors such as poor diet, stress, and antibiotic overuse may increase the permeability of the gut lining, which may be detrimental to whole body health and even increase the risk of developing an autoimmune disease. Thriving gut health is a huge piece of the puzzle to living well with this disease. Strategic dietary and lifestyle changes made at any time can impact your health enormously. (Source)
Research has shown that the presence of specific bacterial strains in the gut may be an indicating factor in developing RA. In one study, mice that were colonized with Subdoligranulum didolesgii showed immune responses and joint swelling similar to patients who suffer from rheumatoid arthritis. A follow-up study found S. didolesgii in the gut microbiome of 20% of people already diagnosed with or at risk of developing RA. The results of this study showed that S. didolesgii, as well as strains from the Lachnospiraceae and Ruminococcaceae families, may activate immune responses that trigger the development of RA antibodies in humans, increasing the risk of developing this rheumatic condition. A healthy gut microbiota, which is so important in lowering the risk of chronic disease, can be nurtured through diet and lifestyle. (Source, Source)
You may be wondering why RA is so incredibly painful, and how it is possible to manage the pain long term. Symptom management all boils down to controlling and reducing your body’s response to the excess inflammation that causes painful and swollen joints and joint damage, and reduces quality of life.
Rheumatoid arthritis may affect your overall daily life functionality due to the effect it has on the joints of the hands, wrists, feet, elbows, shoulders, neck, knees, and hips. Over time receptors in the central nervous system may increasingly react to the overstimulation of pain in the joints, causing increased sensitivity and intolerance. Research has shown that even with anti rheumatic medication, patients may still face fair amounts of discomfort. Many people with RA find that working on an anti-inflammatory diet and lifestyle habits can help manage their condition. (Source)
If you have rheumatoid arthritis, you may be able to reduce systemic inflammation and manage symptoms by altering what you are eating. Anti-inflammatory foods may boost your immune system and nourish a healthy digestive tract full of thriving bacteria, a good start in controlling arthritic pain and swelling and protecting joint function. In addition to treatment with disease modifying anti rheumatic drugs, you may be able to manage RA pain by establishing a diet plan with proper supplementation and by reducing your stress, ditching poor health habits that slow progress, and being aware of your physical boundaries.
Diet, in conjunction with complementary management options, is one of the most affordable and convenient means you have to manage chronic disease. Genetic predisposition and development of autoantibodies are thought to be 50% responsible for onset of RA, while environmental factors, such as diet, are responsible for the other half. The health of your gut microbiome comes back to what you’re eating and how you’re living, so read on to find out which foods have been studied to show improvement of symptoms, and which foods to avoid. (Source)
A study reported in Arthritis Care Research found that participants who reported their RA symptoms were affected by the foods they ate found blueberries to be particularly beneficial.Including fresh or frozen organic berries in a smoothie or on top of a salad each day is an easy and tasty way to get your servings in! (Source)
Consuming fatty fish such as salmon, mackerel, and tuna a few times a week may help reduce overall inflammation and pain. If you can’t stomach fish, consider a fish oil supplement.Although supplements will not provide the same benefits and nutrients as eating fish itself, they have the potential to help reduce inflammation levels because they are high in omega-3 fatty acids. (Source, Source)
Color is key when it comes to choosing vegetables, but it doesn’t get any better than the dark green and leafy vegetables such as spinach, kale, Swiss chard, bok choy, broccoli, and Brussels sprouts. The cruciferous vegetables of the bunch — broccoli, brussels sprouts, and bok choy — contain a natural compound called sulforaphane, which has been shown to block inflammation and may help prevent RA from developing in the first place. Dark and leafy green vegetables are also valuable sources of vitamins E and C, which may reduce inflammation and build up collagen for strong cartilage and joint flexibility. Include any of these vegetables in a daily salad, smoothie, or green juice. (Source, Source, Source)
Avoiding any of the following foods that may cause inflammation is recommended:
Processed, refined, and packaged foods: These include but are not limited to bread, cereal, pasta, doughnuts, cookies, breakfast bars, candy, fast foods, and frozen or microwaveable meals. These foods may contain gluten (in wheat, barley, and rye) that are thought by some to damage the gut lining and microbiota even if you are not gluten sensitive. Additives often found in these convenience foods are also thought to break down the gut barrier.
Dairy: Most dairy products contain casein, a protein that has been found to promote inflammation.
Fatty foods: Trans fats found in processed, fried, and fast foods damage your health, but consuming healthy fats found in avocados, olive oil, nuts, and fish promotes good health.
Refined sugars: These are found in sugary drinks and sodas as well as packaged and processed snacks and meals, candy, and other sweet treats.
Any foods that you know you are sensitive or allergic to should be avoided even if they are whole foods. Nightshades are a group of foods that includes tomatoes, eggplant, potatoes, and peppers that are eliminated in the first phase of the autoimmune protocol(AIP) diet. Some notice avoiding these foods makes a noticeable difference in symptoms, whereas others do not notice any changes. Keep track of your symptoms when consuming these foods and avoid them if needed.
Many participants of a large RA study reported increased rheumatic symptoms after consuming some of the foods categorized above. Most foods that are packaged and processed are stripped of nutrients and are high in sugar and fat, producing an environment ripe for breeding inflammation and chronic disease. (Source, Source, Source, Source)
Supplements can be great additions to a healthy diet and lifestyle plan, but must be taken correctly so as not to cause further issues or interact with medications you are taking. Talk to your healthcare provider about which supplements might be best for you. The following are supplements that have been studied specifically in patients with rheumatoid arthritis.
Omega-3 fatty acids are found in fatty fish such as salmon, mackerel, and tuna, and can also be taken in supplement form for extra nutrition (or if you don’t enjoy seafood). Diets high in omega-3 fatty acids have been shown to improve pain levels in those with RA, and may even reduce the risk of developing the condition. A study done in 2017 found participants to have improved pain tolerance with use of omega-3s with little to no side effects. There are many brands and combinations of fish oil, so consult with your provider before choosing a supplement. These supplements may not be right for you if you are allergic to fish or shellfish. (Source, Source, Source)
Probiotics can help keep your gut bacteria balanced, providing a more stable internal environment to keep your immune system and overall health thriving. There have been studies done specifically on RA sufferers and the use of probiotics but the results were varied, possibly because differing bacterial strains were used. There are many strains of probiotics that can be helpful to manage specific conditions and improve gut health, so it is best to talk to your provider about which strains might help keep your RA manageable. Most probiotics don’t cause side effects, but you could experience some mild digestive upset. (Source)
Additional dietary supplement studies have been done on:
Due to little research and possible side effects, there’s no conclusive evidence that these help manage RA, although future studies may be more promising! (Source)
Managing your stress on a consistent basis is key to reducing your risk of developing chronic diseases, but what if you have already been diagnosed? Stress management is just as important to living well with your diagnosis as it is to prevention! Working from the inside out to control inflammation through diet and lifestyle is a good start. When cleaning up your habits try to ditch alcohol and smoking, too. Alcohol, one of the most widely abused and addictive substances, wreaks havoc on the immune system, gut lining, and microbiota, while smoking increases the risk of developing RA and its severity of it as well. (Source, Source)
Oftentimes we turn to poor habits as a crutch to get through the moment, but the truth is that these habits can reduce your quality and quantity of life, making you feel worse in the long term. Instead, check out our list of healthy hobbies that can help occupy your time and mind!
These are all great ways to reduce stress and chronic inflammation overall. Making time and providing opportunities to unwind may help you manage pain and other accompanying symptoms of RA. (Source)
Exercise, or daily movement, is an approach to health everyone should be taking, but if you have a rheumatic disease physical activity can make a huge difference in how your body functions. Whether you work with a physical therapist, or a personal trainer, or have the know-how to teach yourself, the right movement is beneficial for joint health. The benefits of proper stretching, strength training, and cardiovascular exercise include reducing inflammation, pain, and fatigue, while increasing resilience, energy, and functionality. (Source, Source)
Slow, deliberate movements that do not tax or overburden the body, such as tai chi and yoga, may be a smart move for those with RA.
Classes can be found online for both of these gentle physical activities, and in-person classes may be offered near you as well. (Source, Source)
Alternative methods of pain management may provide relief from flares and pain, as well as helping manage stress. These methods include the Ayurvedic practices of massage and acupuncture.
Find an experienced alternative medicine practitioner to work with as you explore how to best manage your RA. (Source, Source)
There is no cure for rheumatoid arthritis, but it is possible to manage symptoms and slow down the progression of the disease. Here’s how you can allow your body the time and space it needs to heal:
There will always be flares that come and go with autoimmune diseases, but following a whole foods diet and holistic lifestyle paired with your health care provider’s care plan, will better help you manage your chronic pain and enjoy daily activities on a regular basis. To be confident your plan is suited to fit your unique needs, connect with WellTheory’s Care Team and get a nutrition and lifestyle plan personalized to you.
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Lycopene is the phytochemical that gives fruits and vegetables their red color. Lycopene is a potent antioxidant and has anti-inflammatory properties that protect the body from oxidative stress. Lycopene has also been found to decrease “bad” low density lipoprotein (LDL) and increase “good” high density lipoprotein (HDL) cholesterol.
Lycopene may also protect the skin against ultraviolet (UV) damage from the sun. One small study found that participants who added 16milligrams of lycopene to their diet every day had less severe skin reactions to UV light over 10 weeks than a control group without the added lycopene. (Of course, consumption of lycopene-rich foods doesn’t replace sunscreen!)
Carotenoids are responsible for yellow, orange, and red color in many fruits and vegetables. Research suggests that one carotenoid in particular, beta-carotene, may protect against decline in lung function. A study done in 2017 also suggested that eating fruits and vegetables rich in carotenoids such as beta-carotene, alpha-carotene ,and beta-cryptoxanth in had protective effects against lung cancer.
Like lycopene, dietary intake of beta-carotene has protective effects against diseases that are mediated by oxidative stress, such as diabetes, cancer, and autoimmune diseases. High levels of alpha carotene are associated with longevity — one large U.S. study found that high levels of alpha-carotene in the blood were linked with a reduced risk of death over a 14 year period. Aside from its antioxidant effects, the carotenoid beta-cryptoxanthin may prevent bone loss and may have anti-inflammatory and anticancer properties.
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Lutein and zeaxanthin are also part of the carotenoid family, along with beta-carotene, alpha-carotene, and beta-cryptoxanthin. Lutein and zeaxanthin are the only dietary carotenoids that reach the retina, the thin layer of tissue that lines the inside on the back of the eye. They are known to support eye health and have preventative effects against age-related macular degeneration, an eye disease that can lead to the loss of vision as we age. However, lutein and zeaxanthin also have strong antioxidant and anti-inflammatory capabilities. Zeaxanthin can also help to recycle glutathione, another important antioxidant in the body. (9, 15)
Dark green, leafy cruciferous vegetables are a good source of sulfur (isocyanate, sulforaphane, glucosinolate). Our body needs sulfur in order to synthesize certain essential proteins. These sulfur compounds break down into isothiocyanates and indoles in the gut, which are known to have antibacterial, antiviral, antifungal, and anti-inflammatory effects. (36, 52, 33)
Research suggests that sulforaphane may support heart health by reducing inflammation and lowering blood pressure. It may also have antidiabetic effects. One study found that sulforaphane reduced fasting blood sugar in patients with type 2 diabetes. (55, 41, 47)
Glucoraphanin, a glucosinolate that’s found in some cruciferous vegetables, has been found to protect the blood–brain barrier in mice with induced experimental autoimmune encephalomyelitis (used to study MS, which can’t be induced in the same way), suggesting it may reduce the risk of developing MS. (16, 40)
Anthocyanins are phytochemicals that give red, blue, and purple plants their vibrant coloring. Anthocyanins have antioxidant properties that may boost heart health and reduce the risk of developing cardiovascular-related and other chronic diseases. (26)
Anthocyanin-rich foods have been linked to reductions in inflammation and reduced blood sugar concentrations, suggesting they may also have antidiabetic effects. Anthocyanins have also been found to protect eye health. One study found that daily supplementation with pharmaceutical anthocyanins improved the visual function of individuals with normal tension glaucoma (where the optic nerve is damaged despite pressure in the eye being normal). (30, 43)
Other phytochemicals called stilbenoids are typically found in grapes and blueberries. Like anthocyanins, stilbenoids have been shown to have a variety of benefits such as protective effects on the heart and brain, as well as antidiabetic, anticancer, and anti-inflammatory properties. (4)
Allicin, a phytochemical produced when garlic is chopped or crushed, has been associated with a lower risk of coronary events in older adults. Research suggests allicin may help reduce LDL and total cholesterol levels when consumed for more than 2 months. (8, 39)
Garlic is well known for its antimicrobial effects and has historically been used to combat infectious diseases. It is also known to be effective against a variety of bacteria, such as Salmonella, Escherichia coli, and Staphylococcus aureus. (8)
Another phytonutrient that is found in many white, tan, and brown foods is quercetin. Quercetin has anti-inflammatory properties and may be effective against obesity, cancer, viruses, allergies, and high blood pressure. (5)
Serum C-reactive protein (CRP) levels are a biomarker of inflammation in the body. High CRP levels are associated with heart disease, obesity, and lupus. One study done in 2008 found that the intake of foods rich in flavonoids, such as quercetin, is associated with lower serum CRP concentrations. (12)
The thousands of phytochemicals produced by plants for their own protection may also help prevent and treat many of our own medical conditions and diseases. Phytonutrients give fruits, vegetables, grains, nuts, and other plant foods their variety of colors, so “eat the rainbow” to maximize the health benefits offered by these plentiful chemical compounds.
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