In the course of her research, Dr. Guma and fellow investigators asked patients what they were eating. They found many are well educated, having already done some research about diet because it might help their RA. Many of these same people were rarely eating meat or gluten if those foods led them to experience more inflammation.
Nutrition research within RA has not always had a strict study design, making it harder to interpret the results, Dr. Guma says. Some trials focus on supplements, such as curcumin and omega 3 as anti-inflammatory. Some of these studies have good results, but the number of studies available to analyze is small, she says.
Another problem with the research is that it can be hard to change what people eat because it involves changing habits, Dr. Guma says. This difficulty in changing habits may be why literature results are sometimes contradictory.
The Microbiome
A major focus in diet and RA, as well as health in general, is examining the role of the microbiome. This area is ripe for research and exploration for people with RA.
Although some general perceptions of foods as good or bad for the gut exist, Dr. Guma explains to patients that each individual may react differently to a food because of the way each person metabolizes that food. “You are giving the same ingredient to different people, and they’re going to respond differently,” she says.
In some patients, it’s easy to modify the microbiome and make changes within a month or so. In others, the microbiome seems to be very fixed, Dr. Guma says.
These types of results indicate the potential need for a personalized medicine approach to changing diet, Dr. Hausmann says.
The ITIS Diet
During the podcast episode, Dr. Guma addressed the ITIS diet she helped design.1 The information for the ITIS diet came from patient feedback, a dietitian on their study team and research findings. The goal was to build a diet that removed pro-inflammatory ingredients, such as meat and sugar, and added as many anti-inflammatory ingredients as possible in a way that was easy for patients.
The ITIS diet is similar to the Mediterranean diet, with some modifications. It focuses on not eating meat, but does not tell patients they have to completely avoid it. “[Patients] have some flexibility. Otherwise, it’s difficult for somebody to follow the diet,” Dr. Guma says. Instead of red meat, the diet encourages eating fatty fish, chicken and turkey.
