Can RA Symptoms Be Reversed with Diet?

Controlling rheumatoid arthritis (RA) symptoms through diet has gained traction as a complementary approach to traditional treatments. While diet cannot cure RA, it plays a significant role in managing symptoms and improving overall well-being.¹Philippou E, Petersson SD, Rodomar C, Nikiphorou E. Rheumatoid arthritis and dietary interventions: systematic review of clinical trials. Nutrition Reviews. 2020;79(4). doi:https://doi.org/10.1093/nutrit/nuaa033

Research suggests that certain dietary choices can influence inflammation, a hallmark of RA. Dietary changes that reduce inflammation could help manage RA symptoms while potentially reducing reliance on medications.¹Philippou E, Petersson SD, Rodomar C, Nikiphorou E. Rheumatoid arthritis and dietary interventions: systematic review of clinical trials. Nutrition Reviews. 2020;79(4). doi:https://doi.org/10.1093/nutrit/nuaa033

Foods proven to reduce or control rheumatoid arthritis symptoms

Nutritional strategies to reduce symptoms in RA focus on incorporating foods that help reduce inflammation and improve gut health.

Probiotics

Individuals with RA show alterations in the function and composition of gut bacterial species, which may contribute to the development of RA.²Horta-Baas G, Romero-Figueroa MDS, Montiel-Jarquín AJ, Pizano-Zárate ML, García-Mena J, Ramírez-Durán N. Intestinal Dysbiosis and Rheumatoid Arthritis: A Link between Gut Microbiota and the Pathogenesis of Rheumatoid Arthritis. J Immunol Res. 2017;2017:4835189. doi: 10.1155/2017/4835189.

Research indicates that the incorporation of probiotic foods, such as yogurt, kimchi, and sauerkraut, helps attenuate the changes in gut bacterial composition.³Bungau SG, Behl T, Singh A, Sehgal A, Singh S, Chigurupati S, Vijayabalan S, Das S, Palanimuthu VR. Targeting Probiotics in Rheumatoid Arthritis. Nutrients. 2021 Sep 26;13(10):3376. doi: 10.3390/nu13103376.

The precise mechanism of action of probiotics is not completely understood, but the microorganisms in probiotic foods are believed to directly or indirectly modulate the immune system to reduce inflammation.

See An Anti-Inflammatory Diet for Arthritis

Dietary fiber

The importance of dietary fiber is underscored by the results of a recent large-scale study showing that higher dietary fiber intake was associated with a 25% lower risk of developing RA.⁴Liu L, Xie S. Dietary fiber intake associated with risk of rheumatoid arthritis among U.S. adults: NHANES 2010-2020. Medicine (Baltimore). 2023;102(12):e33357. doi:10.1097/MD.0000000000033357.

Certain beneficial gut bacteria ferment dietary fiber within the intestines, resulting in the production of short-chain fatty acids. These fatty acids are released in the circulation and help⁵Zhao T, Wei Y, Zhu Y, et al. Gut microbiota and rheumatoid arthritis: From pathogenesis to novel therapeutic opportunities. Front Immunol. 2022;13:1007165. Published 2022 Sep 8. doi:10.3389/fimmu.2022.1007165.^,6Golpour F, Abbasi-Alaei M, Babaei F, et al. Short chain fatty acids, a possible treatment option for autoimmune diseases. Biomed Pharmacother. 2023;163:114763. doi:10.1016/j.biopha.2023.114763.:

• Maintain the integrity of the intestinal wall and prevent leaky gut
• Improve energy balance and metabolism
• Promote an anti-inflammatory environment

The consumption of a diet rich in fiber can increase the population of beneficial gut bacteria and inhibit the growth of harmful bacteria, thus normalizing the gut bacterial composition.⁷Seo YS, Lee HB, Kim Y, Park HY. Dietary Carbohydrate Constituents Related to Gut Dysbiosis and Health. Microorganisms. 2020 Mar 18;8(3):427. doi: 10.3390/microorganisms8030427.

Some of the classes of fiber-rich foods include:

• Whole grains, such as brown rice, whole wheat, barley, quinoa, and oats
• Fruits and vegetables, such as oranges, grapes, sweet potato, eggplant, and spinach
• Legumes, such as black beans, lentils, and chickpeas
• Seeds and nuts, such as flaxseed, sunflower seeds, and peanuts 

It is important to note that the consumption of high levels of refined carbohydrates and sugar causes a decline in the population of gut bacteria that break down dietary fiber, and it is recommended to avoid these foods.⁵Zhao T, Wei Y, Zhu Y, et al. Gut microbiota and rheumatoid arthritis: From pathogenesis to novel therapeutic opportunities. Front Immunol. 2022;13:1007165. Published 2022 Sep 8. doi:10.3389/fimmu.2022.1007165.

Whole grains, fruits, and vegetables

Fruits, vegetables, and whole grains are not only rich sources of dietary fiber but also contain compounds with antioxidant and anti-inflammatory properties.⁸Khanna S, Jaiswal KS, Gupta B. Managing Rheumatoid Arthritis with Dietary Interventions. Frontiers in Nutrition. 2017;4(52). doi:https://doi.org/10.3389/fnut.2017.00052.

For example:

• Whole grains contain vitamin E, phytic acid, selenium, and antioxidants, which help reduce inflammation. 
• Biologically active compounds isolated from fruits and vegetables may reduce the symptoms of rheumatoid arthritis in some individuals. Examples of such compounds include:
  • Resveratrol present in nuts, blueberries, and grapes 
  • Anthocyanin found in cherries, eggplant, berries, red sweet potatoes, and grapes
  • p-Coumaric acid found in pineapple and citrus fruits
  • Bromelain found in pineapple stem

Some of these bioactive compounds are known to interact with medications, and the intake of foods and supplements containing these compounds should be discussed with a doctor or registered dietitian before changing dietary habits.⁹Briguglio M, Hrelia S, Malaguti M, et al. Food Bioactive Compounds and Their Interference in Drug Pharmacokinetic/Pharmacodynamic Profiles. Pharmaceutics. 2018;10(4):277. Published 2018 Dec 14. doi:10.3390/pharmaceutics10040277

See What Are Anti-Inflammatory Foods?

Omega-3 fatty acids 

Humans cannot synthesize omega-3 fatty acids and are reliant on dietary sources for these essential nutrients. Omega-3 fatty acids help mediate an anti-inflammatory response. Since RA is an inflammatory condition, adequate omega-3 intake may be able to help control disease progression.¹⁰Kostoglou-Athanassiou I, Athanassiou L, Athanassiou P. The Effect of Omega-3 Fatty Acids on Rheumatoid Arthritis. Mediterr J Rheumatol. 2020;31(2):190-194. Published 2020 Jun 30. doi:10.31138/mjr.31.2.190.

A major objective of nutritional interventions for RA is to increase the levels of omega-3 fatty acids. Foods that are rich in omega-3 fatty acids include:

• Salmon
• Cod
• Tuna
• Mackerel
• Walnuts
• Chia seeds
• Flaxseed
• Soybean oil
• Canola oil
• Fish oil supplements

Studies have shown that fish oil supplements help elevate omega-3 fatty acid levels and reduce inflammation in individuals with RA.¹¹Tedeschi SK, Costenbader KH. Is There a Role for Diet in the Therapy of Rheumatoid Arthritis? Curr Rheumatol Rep. 2016 May;18(5):23. doi: 10.1007/s11926-016-0575-y.

While incorporating foods rich in omega-3 fatty acids is beneficial, including fish oil supplements in the daily regime can provide a relatively higher dose of omega-3 fatty acids that is necessary to elicit an improvement in rheumatoid arthritis symptoms. 

Omega-6 fatty acids, which are present in vegetable oils, play an important role in brain function and maintaining a normal lipid profile but have the potential to interfere with the anti-inflammatory effects of omega-3 fatty acids.¹²Innes JK, Calder PC. Omega-6 fatty acids and inflammation. Prostaglandins Leukot Essent Fatty Acids. 2018 May;132:41-48. doi: 10.1016/j.plefa.2018.03.004. The intake of omega-6 fatty acids tends to be much higher than omega-3 fatty acids in the general population. As a result, it is recommended that individuals with RA focus on increasing the intake of omega-3 fatty acids rather than eliminating healthy foods that contain omega-6 fatty acids from the diet.¹³Harris WS. The Omega-6:Omega-3 ratio: A critical appraisal and possible successor. Prostaglandins Leukot Essent Fatty Acids. 2018;132:34-40. doi:10.1016/j.plefa.2018.03.003

See Dietary Supplements for Treating Arthritis

Spices and tea

Ginger, turmeric, and cinnamon extracts have shown anti-inflammatory effects in RA.⁸Khanna S, Jaiswal KS, Gupta B. Managing Rheumatoid Arthritis with Dietary Interventions. Frontiers in Nutrition. 2017;4(52). doi:https://doi.org/10.3389/fnut.2017.00052.

Curcumin, the active ingredient in turmeric, may also be used as a supplement. Curcumin is generally used in combination with other ingredients, such as piperine, a compound present in black pepper, to improve its absorption.¹⁴Dei Cas M, Ghidoni R. Dietary Curcumin: Correlation between Bioavailability and Health Potential. Nutrients. 2019; 11(9):2147. https://doi.org/10.3390/nu11092147

Epigallocatechin-3-gallate, a biologically active compound present in green tea, has also been shown to exert anti-inflammatory effects on the body.⁸Khanna S, Jaiswal KS, Gupta B. Managing Rheumatoid Arthritis with Dietary Interventions. Frontiers in Nutrition. 2017;4(52). doi:https://doi.org/10.3389/fnut.2017.00052.

See Turmeric and Curcumin for Arthritis

Vitamin D supplements to manage RA symptoms

Vitamin D plays a vital role in modulating the function of immune cells. Individuals with RA typically have low vitamin D levels, and there is some evidence to suggest that supplementation with vitamin D improves health outcomes in these individuals.¹⁵Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients. 2020 May 18;12(5):1456. doi: 10.3390/nu12051456.^,16Guan Y, Hao Y, Guan Y, Bu H, Wang H. The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2020 Oct 30;7:596007. doi: 10.3389/fmed.2020.596007.

Dietary sources of vitamin D include: 

• Fortified dairy products and fortified non-dairy alternatives
• Eggs
• Fish
• Poultry
• Meat 

Vitamin D also reduces the risk of osteoporosis, which is usually elevated in individuals with RA.¹¹Tedeschi SK, Costenbader KH. Is There a Role for Diet in the Therapy of Rheumatoid Arthritis? Curr Rheumatol Rep. 2016 May;18(5):23. doi: 10.1007/s11926-016-0575-y.

Before taking supplements, patients are advised to talk to their doctors and make sure that the supplements are needed and will not interact negatively with existing medical conditions, prescription medications, or dietary restrictions.

Effective dietary patterns that help decrease RA flare-ups

Research suggests that following specific dietary patterns, such as a Mediterranean diet or medically supervised fasting followed by a vegetarian or vegan diet, can ameliorate symptoms in individuals with RA.¹⁵Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients. 2020 May 18;12(5):1456. doi: 10.3390/nu12051456.

1. Mediterranean diet

Studies examining the effectiveness of the Mediterranean diet have shown a modest improvement in the symptoms of RA.¹Philippou E, Petersson SD, Rodomar C, Nikiphorou E. Rheumatoid arthritis and dietary interventions: systematic review of clinical trials. Nutrition Reviews. 2020;79(4). doi:https://doi.org/10.1093/nutrit/nuaa033

The Mediterranean diet includes foods that are rich in omega-3 fatty acids, biologically active compounds from plant sources, and unrefined carbohydrates. Animal products are consumed in moderation. Some of the major components of a Mediterranean diet include: 

• Olive oil
• Fresh fruits
• Vegetables
• Legumes
• Beans
• Unrefined cereals
• Fish

The Mediterranean diet promotes the intake of certain protein-rich foods, such as dairy products, eggs, and poultry, while limiting the intake of red meat and sugar.

2. Vegetarian and vegan diets

Both vegetarian and vegan diets have shown promise in reducing the severity of RA symptoms.¹⁷Alwarith J, Kahleova H, Rembert E, Yonas W, Dort S, Calcagno M, Burgess N, Crosby L, Barnard ND. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr. 2019 Sep 10;6:141. doi: 10.3389/fnut.2019.00141. Vegetarian and vegan diets rich in dietary fiber have been shown to reduce levels of inflammation and aid weight loss, which is independently associated with lower RA symptom severity.

There is also some evidence to suggest that a high-fiber diet is more suited for individuals with RA than a diet rich in protein, especially from animal sources.¹⁷Alwarith J, Kahleova H, Rembert E, Yonas W, Dort S, Calcagno M, Burgess N, Crosby L, Barnard ND. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr. 2019 Sep 10;6:141. doi: 10.3389/fnut.2019.00141.

3. Low carbohydrate diet

Consumption of a low carbohydrate diet involving the restriction of total daily calorie intake stimulates specific processes in the body that potentially reduce inflammation.¹⁸Ciaffi J, Mitselman D, Mancarella L, et al. The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review. Front Med (Lausanne). 2021;8:792846. Published 2021 Dec 14. doi:10.3389/fmed.2021.792846

4. Fasting 

When the body is deprived of carbohydrates, it uses ketone bodies for energy instead of glucose. These ketones are associated with lower activity of immune cells, causing lesser inflammation.¹⁵Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations? Nutrients. 2020 May 18;12(5):1456. doi: 10.3390/nu12051456.

Similar to a low carbohydrate diet, complete or modified fasting involving limited calorie intake also leads to ketone body production and activation of other pathways that reduce inflammation.

While fasting can lead to short-term improvements in RA symptoms, most studies have found that RA symptoms tend to reemerge after the cessation of fasting.

5. Combining fasting and a vegetarian diet 

Studies have shown that 7-10 days of modified fasting followed by a vegetarian diet result in sustained improvements in RA symptoms.¹⁹Müller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001;30(1):1-10. doi:10.1080/030097401750065256. A modified fasting diet allows the intake of only 500 calories per day in the form of vegetable juices or broth.

A modified low-calorie fasting diet has the potential to cause nutritional deficiencies or exacerbate other health conditions, and such diets should be undertaken only under the supervision of a doctor. 

6. Identifying and eliminating trigger foods

Certain people may find relief by avoiding specific foods that trigger their symptoms.

Eliminating specific foods from the diet one at a time, such as dairy products, citrus fruits, meat, poultry, or coffee, that may aggravate RA symptoms may be beneficial.

A registered dietitian can help determine potential food sensitivities that could be contributing to symptoms. 

See The Ins and Outs of an Anti-Inflammatory Diet

Easing RA symptoms through healthy weight

Maintaining a healthy weight is crucial for RA management, as excess body fat can exacerbate joint pain and inflammation.²⁰Kreps DJ, Halperin F, Desai SP, Zhang ZZ, Losina E, Olson AT, Karlson EW, Bermas BL, Sparks JA. Association of weight loss with improved disease activity in patients with rheumatoid arthritis: A retrospective analysis using electronic medical record data. Int J Clin Rheumtol. 2018;13(1):1-10. doi: 10.4172/1758-4272.1000154. A balanced diet that supports weight maintenance or loss, combined with regular exercise, can have a positive impact on RA symptoms.

Next steps 

Collaborating with a healthcare professional who is trained in managing nutritional needs, such as a registered dietitian, is essential when designing a dietary plan for RA. A dietitian can help tailor a diet that meets individual needs, addresses nutrient deficiencies that RA medications might cause, and ensures a balanced approach that supports both overall health and symptom management.

See Rheumatoid Arthritis (RA) Treatment