Rheumatoid Arthritis and Nutrition

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 18 June, 2011

Many people around us suffer from rheumatoid arthritis. How does nutrition affect their condition and what should they be careful of, so as not to aggravate their condition? How can nutrition improve their quality of life?

It is wise to follow up our body weight and accordingly regulate the energy we receive, in order to achieve the desirable weight. Desirable weight is defined as the weight that is at least within the healthy range. It has been observed that many are the patients with rheumatoid arthritis facing undernutrition problems because during exacerbation periods of their disease there is increase of their basic metabolism and protein catabolism.
A common way to evaluate and control our body weight is by using the Body Mass Index (BMI), which is calculated as follows:
Body Weight (kilos)/ Height2 (m2).
A desirable Body Mass Index usually ranges between values 20 – 25. If it is above 25, it is better to lose weight; if below 18,5, it is better to gain weight.

Patients who do not receive the essential ingredients through their nutrition or are going through the inflammatory stage of their disease, have higher needs for proteins. In order to fully understand the extent of this increase, we should consider that under normal circumstances the usual recommended protein values per kilo of body weight range between 0,8 – 1 gr daily. So, in the case of patients mentioned above, the need for protein ranges between 1,5 and 2 gr/kg.day.

Diets with very low fat content are not indicated for rheumatoid arthritis, for they may lead to reduced levels of vitamins A and E in the blood and aggravate the condition.
Instead of simply decreasing fats in the nutrition, it would be better to change the type of lipids consumed so that it is more beneficial for the body. Ω-3 fatty acids seem to have a very positive effect on patients with rheumatoid arthritis.
Some other types of fat of seafood and vegetable origin, particularly olive oil and the so-called “Evening Primrose”, seem to have indirect anti-inflammatory effects.
As a conclusion, we should prefer ω-3 and ω-6 fatty acids which seem to have anti-inflammatory effect but do not present restorative effect on basic immune procedures involving arthropathies.

Metals, Vitamins and Antioxidants
Animal studies have shown that vitamin E, along with ω-3 and ω-6 fatty acids may cause improvement of rheumatoid arthritis.
Other trials have demonstrated that young patients with rheumatoid arthritis have low concentration of antioxidants in their blood and that they can benefit from consuming more vegetables and fruit.

European clinical trials have demonstrated that there is pain reduction in patients with rheumatoid arthritis receiving vitamin E and other antioxidants.

More vegetables and fruit are recommended: at least 5 portions daily (1 portion = 1 cup of tea)
It has been observed that patients with rheumatoid arthritis frequently receive less calcium, folic acid and magnesium than the recommended values.
In more advanced stages of the disease, there is often malabsorption of calcium and vitamin D  and reduction of bone density, which may lead to osteoporosis. Thus, nutritional enhancement with vegetables and fruit – or even with nutritional supplements- is advisable when there are signs that the body is in need for them. Vitamin D is received either through appropriate nutrition or by daily exposure to the sun (always with caution), for example by going out for a walk.

Other data
Scientific literature refers to the investigated effect of controlled fasting on improvement of joint inflammation. According to clinical and laboratory studies, such fasting followed by a vegetarian diet may bring good results. Of course, this should be done only with the assistance of experts.
Even more difficult is following a vegetarian diet with gluten-free products, which seems to be beneficial for several patients. This improvement may be due to the fact that the immune reaction to food antigens is reduced, as antigens are eliminated with changes in nutrition.
High consumption of vegetable fibres also seems to bring good results. In other words, some types of food (mainly of animal origin and dairy products) have proven to aggravate the symptoms of the disease in some patients. Avoiding such food or food groups seems to have at least short-term benefit. So, until further research is conducted, the most valuable piece of information is to observe whether there are any food allergies or intolerances and identify what are their causes in order to avoid them .

Patients should be encouraged to follow a healthy, balanced nutrition aiming at achieving or maintaining a desirable weight. They should also get informed about any developments related to rheumatoid arthritis and adopt recommendations that are based on scientific evidence showing  improvement of their condition.

Choose a variety of food

  • Control your energy balance, combining appropriate nutritional habits and physical activity, in order to maintain or improve your body weight
  • Follow a nutrition rich in vegetables and fruit
  • Choose a nutrition with low saturated fat (avoid animal fat, full-fat dairy products)
  • Choose a nutrition rich in fish and seafood
  • Choose products rich in vegetable fibres
  • Choose a nutrition with moderate amount of sugar and sweets
  • If you consume alcohol drinks, you should drink with moderation