So, with all the conflicting evidence, what’s the best thing to advise RA patients regarding diet? “The day-to-day recommendations for people with RA are to get a balanced diet but focus primarily on a plant-based diet,” says Sandon. “Get plenty of fruits and vegetables, whole grains, and get enough protein from lean meat but don’t go overboard. Aim for fish more often than other kinds of protein,” she says. Other foods to include are almonds and other nuts, which provide healthy fats.
These foods will help provide patients with vitamins A, C, and E, which can be important in targeting systemic inflammation. “They help protect the body against inflammatory damage,” says Sandon. “If they’re eating foods high in those nutrients, they’re also getting other compounds in plant foods believed to affect inflammatory pathways.”
If this sounds like the Mediterranean diet that’s discussed frequently nowadays, it’s because it basically is. Sandon calls it a Mediterranean-style diet. “A Mediterranean-style diet is not just helpful for inflammation, but also for heart disease,” she says.
In fact, the review from Dr. Smedslund and coresearchers of various diets and RA found that a Mediterranean eating plan and fasting followed by a vegetarian eating plan seemed to improve pain when compared with an ordinary diet. Still, they also point out that there were no effects on physical function, stiffness, or other important outcomes. Their review also included only a limited number of studies.2
“It is possible that simply changing from an unhealthy to a healthier diet during the study period could explain some of the positive changes in symptoms of RA,” the study authors wrote.
Similar to Sandon, Dr. Zashin tells patients to eat foods that are generally thought to be healthy, such as fruits, vegetables, beans, soy, seafood, healthy grains, red wine, and dark chocolate, and avoid saturated fats and too much red meat.
Gluten-free diets are widely discussed nowadays, but evidence as it relates to RA is not that strong. Although it’s anecdotal evidence, Dr. Zashin observes that eliminating gluten from one’s diet seems to help a number of RA patients who are sensitive to gluten. For a number of others, he observes that the elimination of dairy can help. Using an elimination trial approach with gluten, dairy, beef, or alcohol can be helpful for certain patients if they are willing to give it a try, he says. Still, he realizes that every patient is different and this doesn’t provide blanket recommendations for everyone with RA.
