“Not too many people are following good dietary recommendations,” says Lona Sandon, MEd, RD, LD, assistant professor in the department of clinical nutrition at the University of Texas Southwestern in Dallas.
She sees some patients with RA who find information on the Internet that recommends eliminating gluten, dairy, “nightshade” plants (including healthy items such as potatoes, tomatoes, and peppers), and more. “There’s no solid evidence to support that,” she says. Such a diet is too restrictive and potentially unhealthy, says Sandon.
Although there may not be one be-all, end-all dietary approach to help those with RA beyond a generally balanced diet, there are still some reasons why the diet discussion might be an important one to broach with patients.
Considering Comorbidities
Excessive body weight. Cardiovascular disease. Osteoporosis.
These three health problems can be more common in RA patients—so even if the jury’s still out on the ideal RA diet, these comorbidities alone are enough reason to advocate for a balanced diet, says Sandon.
“A lot of people with RA are also obese. They need nutritional counseling because obesity aggravates RA,” she says.
Although Dr. Panush notes that there is no good, consistent evidence that certain foods or special diets can affect the symptoms of most people with RA, he does emphasize that extra weight can affect one’s joints. For this reason, he advocates a balanced, healthy diet with RA patients.
Then there’s heart disease, which is well known to be a higher risk for those with RA than the general population. An association between heart disease and RA was what prompted research on fruit and vegetable consumption led by Michael Crilly, MD, MPH, senior lecturer in clinical epidemiology at the University of Aberdeen Medical School in Aberdeen, Scotland. The study focused on arterial dysfunction in 114 patients with RA and how it correlated with daily fruit and vegetable consumption.3
“We found those with higher vegetable consumption had lower arterial dysfunction,” says Dr. Crilly. However, higher fruit consumption did not correlate to lower arterial dysfunction—a surprising finding, he says. Still, he and fellow researchers noted that the findings are consistent with the association between vegetables and nitrate along with the enterosalivary circulation of nitrate and its influence on arterial function. Dr. Crilly is working on new research with RA patients that will get more specific about fruit and vegetable consumption.
The fear of decreased bone health and subsequent osteoporosis or osteopenia are what lead Sandon—who is not only a dietitian, but who has had RA for 20 years—to focus on calcium and vitamin D intake for herself and her clients with RA.
What To Advise Patients Regarding Diet
There have been a number of studies that address diet and RA, but there’s no clear-cut “winner” that seems to improve RA symptoms in large numbers of patients.
