Diet for rheumatoid arthritis update

This is a very thorough study that was published frontiers in Nutrition on 8 November 2017: Managing Rheumatoid Arthritis with Dietary Interventions from the Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India. 
It seems that they have gathered together the growing body of research evidence showing that food and diet can improve the symptoms of Rheumatoid Arthritis.

"Patients suffering from rheumatoid arthritis should switch from omnivorous diets, drinking alcohol, and smoking to Mediterranean, vegan, elemental, or elimination diets, as advised by their doctor or dietician."said Dr. Bhawna Gupta one of the report authors.

Many reports have stated that the population of gut microbes gets altered in a person affected with RA, and other autoimmune diseases,  and several animal studies have already proved that any alteration in gut microbiota corresponds to initiation of RA.  Self-help by means of dietary interventions can help in management of various disorders including rheumatoid arthritis (RA), a debilitating autoimmune disease. 

Mediterranean Diet

Dietary suggestions are appealing to patients as they are affordable, accessibile, and scientific evidences show they have substantial benefits in reducing disease symptoms such as pain, joint stiffness, swelling, tenderness and associated disability with disease progression.

In the review they have included all the dietary interventions that clearly indicate clinically and statistically significant and beneficial long-term effects for relieving symptoms, delay in disease progression and associated damages in RA patients.

Here are the recomendations from the study. I have not included all the supporting studies which you can see in detail in the report but just the simple dietary suggestions. Please keep in mind you do not have to do them all but just pick one to try:

Seven Days Fasting Followed by Vegan Diet. A fasting of 7–10 days with partial nutrient intake of vegetable broth, herbal teas, parsley, garlic, and decoction of potatoes; juice extracts from carrots, beets, and celery; and a controlled daily energy intake followed by 1 year of a vegan diet as compared to omnivorous diet was studied in different trials. Together these studies observed remarkable decrease in swollen and tender joints, pain, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Carrot, celery and beetroot juice

Vegan Diet. A diet including intake of only fruits and vegetables, eliminating any animal product or by-products is vegan diet.

Mediterranean Diet is rich in oleic acid, omega-3 fatty acids, unrefined carbohydrates, and phytochemicals . MD involves high consumption of olive oil, cereals, fruits, vegetables, fish, and legumes; less red meat; and inclusion of moderate amount of red wine in diet. Studies have also shown that incorporation of olive oil in diet decreases the risk of developing RA.

Elemental Diet provides food in simplest form consisting of glucose, vitamins, trace elements, and essential amino acids, is hypoallergenic, contains all nutrients for daily requirements, and is thought to be less immunogenic. 

Elimination Diet Certain food and food components may worsen the disease conditions in RA . Thus, an elimination diet plan may as well be considered wherein we eliminate those food related antigens that may possibly aggravate the disease symptoms. 

Individual Food Items in Diet and Their Relevance to RA

In an average diet comprising of breakfast, lunch, and dinner, there are several food items which are rich source of some phytochemicals and their efficacy in eradication of diseases has been known and is included under traditional medicines on which 80% of the world population relies . Food items such as dietary fibers, cooking oil, polyphenols, bioactive compounds from several herbs and beverages like tea are among the cheapest sources of medication; however, their bioavailability has always been a matter of concern.

Dietary Fibers and Whole Grains

Most of the staple food consumed all over the world are comprised of dietary fibers and whole grains. A definitive explanation for dietary fibers can be put as remnants of food not digested in small intestine, which then moves to large intestine and gets fermented by the microflora and induces several health promoting effects. Insoluble fibers such as cellulose and lignin are found in fruits, vegetables, and whole grains; and soluble fibers including pectin, guar gum, and mucilage.

Spices. Ginger, Turmeric and Cinnamon bark are recommended.

Ginger root and ginger powder

Cinnamon bark

Essential Fatty Acids

Omega-3 or omega-6 fatty acids have shown their potential as immunosuppressants and anti-inflammatory agents. Borage seed oil provides high amount of omega-6 fatty acid or gamma-linolenic acid (GLA) and significantly reduce tender and swollen joints.

Gamma-linolenic acid and omega-3 fatty acid alpha-linolenic and stearidonic acid from black currant seed oil (BCSO) gives significant positive effects in pain relieving and reducing joint tenderness.

Fish oils provide high amount of omega-3 fatty acids, and their efficacy to treat RA has been checked in several controlled trials. RA patients were provided with fish oil with 3.6 g of omega-3 fatty acids per day. 

Synbiotics

Synbiotics are composed of probiotics and prebiotics (the non-digestible food products beneficial for growth of helpful bacteria in large intestine and provides health promoting effects)

Bifidobacterium and Lactobacillus are the key strains widely used as probiotics in commercial, pharmaceutical, and nutraceutical products. 

Yoghurt with probiotics and berries

Tea
Green tea. Epigallocatechin-3-gallate (EGCG) has proved its therapeutic potential and is a main phytochemical present in green tea that is obtained from dried leaves of Camellia sinensis and C. assamica of Theacease family.  The protective effects of green tea have been well proved in neurodegenerative disease, inflammatory disease, cardiovascular disease, and several types of cancer.

Herbs

Sallaki (Boswellia serrata) is widely recommended as an anti-inflammatory herb as prescribed in Ayurveda. it lowers inflammation.

Ashwagandha (Withania somnifera) is one of the plants being described in Ayurveda as a potent anti-inflammatory plant which reduced stiffness, disability to move knee and joints, and pain score.

These diets may  not cure the RA  but an effective incorporation of these food items in the daily food plan may help to:

•  reduce their disease activity, 
• delay disease progression, 
• reduce joint damage, 
• eventually mean a decreased dose of drugs administered for therapeutic treatment of patients.

SOURCE: 

Managing Rheumatoid Arthritis with Dietary Interventions
Shweta Khanna, Kumar Sagar Jaiswal and Bhawna Gupta

Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India