Rheumatoid arthritis: More plants and less meat?

Rheumatoid arthritis (RA), the second most common arthritis, is an autoimmune disorder that affects approximately 1% of the world’s population. Through an inflammatory reaction, the body attacks joint tissues and can also affect the skin, eyes, heart, lungs, and blood vessels. 

The specific etiology of RA remains unclear but has been thought to be influenced by genetic predisposition, infection, smoking, gut bacteria, and diet. Primary symptoms of this disorder include joint stiffness or swelling, fatigue, appetite changes, and a fever. Long-term, this disease can be severely debilitating with bone and joint erosion and malformation or abnormalities in other body tissues. Since there is no available cure for RA, treatment involves medication, therapy, surgery, and diet modifications.   

Vegan diet: An overview³ 

United States statistics have shown a positive trend in individuals following a plant-based diet. More specifically, six percent have adopted a vegan lifestyle. With the inclusion of numerous plant-based foods, this diet approach eliminating all animal products can be a healthy alternative to the typical Western diet. The vegan diet emphasizes a balanced intake of fruits, vegetables, whole grains, nuts, seeds, legumes, healthy oils, and plant-based products. Foods with added sugars or refined grains should be eaten only in moderation. One common concern with eating strictly vegan is the risk of insufficient intake of vitamin B12, vitamin D, calcium, iron, protein, and omega-3 fatty acids. Experts recommend supplementation and dietary counseling, if intake is inadequate to meet nutritional needs.   

Benefits of a vegan diet with rheumatoid arthritis⁴

Limited research exists regarding RA and following a vegan diet. Intake higher in fat and animal products can cause pro-inflammatory or negative effects on RA symptoms. In a review of 15 trials that included 837 patients, researchers state that evidence to suggest that individuals with RA should follow a strict vegan diet is inconclusive. In comparison, many trials with this patient population highlight the positives of consuming a diet higher in fruit, vegetables, and fiber. Along with an anti-inflammatory protective effect from these foods, improvement in weight, BMI, and lipid panels has been demonstrated and is supportive of reducing RA symptoms. 

Medical nutrition therapy: Practical application^4,5 

The evidence recommending increased intake of fruits and vegetables isn’t new information, but for some, especially those with chronic disease, this may require a drastic overhaul to normal dietary intake. Providing an individualized plan with attainable patient goals has been shown successful in improving overall health. As registered dietitians, we have the unique opportunity to take the research available and apply it to our patient care. While eating 100% vegan may not be for all patients with RA, consider smaller dietary changes to increase plant-based foods with the goal of reducing inflammation and improving quality of life.  

Note to readers: The blog information discussed is not intended as medical advice. Discuss diet specifics with your physician and registered dietitian nutritionist. 

If you have more questions about rheumatoid arthritis, it’s always a great idea to speak with a registered dietitian. Registered dietitians are the only credentialed experts qualified to address your unique health questions.

References

 Mayo Clinic: Rheumatoid arthritis. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653. Accessed March 25, 2020. 

Nutrition Care Manual: Rheumatoid Arthritis. https://www.nutritioncaremanual.org.  Accessed March 10, 2020. 

U.S. News and World Report: Vegan Diet. https://health.usnews.com/best-diet/vegan-diet.  Accessed March 25, 2020. 

Alwarith J, Kahleova H, Rembert E et al. Nutrition interventions in rheumatoid arthritis: The potential use of plant-based diets. A review. Front Nutr. 2019;6(141):1-11. 

Gajewska D, Kucharska A, Kozak M, Wunderlich S, Niegowska J. Effectiveness of individual nutrition education compared to group education, in improving anthropometric and biochemical indices among hypertensive adults with excessive body weight: A randomized controlled trial. Nutrients. 2019, 11(12), 2921; https://doi.org/10.3390/nu11122921.