Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease in which the lining of the joints becomes inflammed to such an extent that pain and inability to function are the result. Because the cells of the immune system play an important role in this chronic inflammatory process, rheumatoid arthritis is typically classified as an autoimmune disease.

The disease begins in cycles as symptoms first come and go, but eventually they become constant. Over time, the joints may become deformed and unable to move. In addition to causing a great deal of pain, rheumatoid arthritis also causes significant disability and interferes with normal living.

The good news is that dietary changes can help reduce the pain and may prevent much of the disability associated with rheumatoid arthritis.

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Description

What is Rheumatoid Arthritis?

Rheumatoid arthritis, a crippling disease that affects approximately 2-3% of the world's population, usually starts between the ages of 20-40 years. However, some forms of the disease can occur in children. Around three times as many women as men are afflicted. As many as 70% of sufferers show signs of joint damage on X-ray within three years of developing the condition.

Though symptoms start out mild and may go unnoticed for some time, the disease eventually progresses, causing joint damage and disability. Standard treatments, including pain killers and anti-inflammatory medications, have not been shown to halt the damage.

At least half of rheumatoid arthritis patients are disabled to the point of being unable to continue in their jobs within ten years of the start of the disease. Some studies even indicate that the disease may reduce life expectancy by a few years, though it is not clear why. Fortunately, studies have also shown that certain eating habits and nutrients may be able to reduce the pain and disability that come with this debilitating condition.

Symptoms

Symptoms of rheumatoid arthritis tend to start out very mild and may go unnoticed for months. As time goes by, however, the symptoms become more and more uncomfortable. For some patients, the pain and discomfort may come and go, with only mild symptoms between flare-ups.

Joint symptoms of rheumatoid arthritis include:
Other symptoms that may also occur include:

Rheumatoid arthritis patients usually take pain-killers, like aspirin, ibuprofen, acetaminophen, or similar medications to help reduce symptoms. Unfortunately, many of these medications can cause side-effects, ranging from mild stomach upset to more severe problems like ulcers. Long-term use of these medications can lead to bleeding of the stomach or other parts of the digestive tract. These symptoms add to an already uncomfortable condition.

Anyone taking pain-killers who begins to experience severe stomach pain or vomiting or whose stools have become very dark in color or are tinged with blood should report this to their doctor. Although dietary changes may not completely eliminate all symptoms for all patients, they may be able to help people reduce the amount of potentially harmful medications they take. This alone may have a great impact in the lives of rheumatoid arthritis sufferers.

The Disease Process

How does a normal, functioning joint become painful and debilitated? It's a slow process that may take many years to fully develop.

A healthy joint consists of several different parts. Since joints are places where two bones meet, the joint consists primarily of the ends of the two bones being connected by the joint. The ends of these bones are coated by cartilage, which is softer and more flexible than bone.

Like the rubber pads on a car's brakes, cartilage keeps the bones from grinding together and damaging each other. Since it is somewhat springy, it acts as a cushion and keeps the bones from smashing into each other during movement.

The joint is held together by connective tissue, which is a bit like white tissue paper, but much, much stronger. This connective tissue, which is also made up of tendons and ligaments, holds the end of the bone together so that the joint is stable and strong.

Lining the inside of the joint is something called the synovial membrane, which produces synovial fluid. Synovial fluid not only lubricates the joint so that it glides and moves better, it also supplies the joint cartilage with nutrients and oxygen.

In rheumatoid arthritis, this efficient system falls apart. Rheumatoid arthritis is an autoimmune disease, which means that the immune system, which is supposed to protect the body from infection, instead turns on certain cells of its own body.

In patients with rheumatoid arthritis, the cells of the immune system begin to produce antibodies which target and bind to the cells of the synovial membrane. When immune cells see antibodies bound to these cells, they rush over and attack them, causing great amounts of inflammation and free radicals. The synovial membrane becomes very swollen and the joint itself becomes red, painful, and enlarged.

The free radicals then start to damage the cartilage and the ends of the bones, leading to reduced joint mobility. Eventually the damage spreads to the connective tissue, tendons, and ligaments, causing joint deformity.

This process may occur very rapidly, leading to severe joint deformity and dysfunction in a very short amount of time, or the process may come and go, slowly causing joint problems over many years. In this situation, patients may have mild or even no symptoms between attacks. The attacks start to get closer and closer together, though, eventually becoming constant.

Causes

The cause of rheumatoid arthritis is still unknown. Genetics may make some people more prone to the disease than others, but does not thoroughly explain why some people develop it while others do not.

Fortunately, researchers have identified certain factors that seem to be linked to the condition. Surprisingly, many of these are related to food and the digestive tract. Food allergies, adverse food reactions, intestinal inflammation, certain eating habits, and harmful bacteria in the digestive tract have all been associated with rheumatoid arthritis.

The digestive tract is the part of the body responsible for the break down and absorption of food. Normally, the lining of the intestines, which is where absorption takes place, is very specific about what it allows into the bloodstream and what must stay in the digestive tract for further digestion or elimination.

Typically, only very tiny particles that have been thoroughly broken down are permitted to pass. When the lining of the intestines becomes inflamed, however, larger particles leak through and enter the body. The immune system mistakes these particles for foreign invaders and attacks them, leading to general inflammation in the body. Sometimes these particles confuse the immune system and cause it to attack normal body cells by accident. This can contribute to, or even cause, rheumatoid arthritis in the joints.

Several things can cause inflammation in the digestive tract. Some people react to certain proteins in foods. The cells of their immune system produce antibodies against these proteins and attack them when they are eaten, leading to inflammation.

Some of the main proteins targeted are gluten, which is found in many different grains including wheat, oats, barley, and rye, and milk proteins. Since most people eat grains and dairy on a daily basis, the intestines are always inflamed, leading to a state of perpetual inflammation.

Harmful bacteria also contribute to problems in the gut. Normally, the intestines contain a number of beneficial bacteria that live on the fiber in our diets and protect us from harmful bacteria.

If harmful bacteria get a foothold, for example during an infection or after a course of antibiotics, which can kill the beneficial bacteria, they can start to grow and produce toxins. These toxins can also cause intestinal inflammation. As a matter of fact, a majority of rheumatoid arthritis patients have been shown to have Clostridium perfringens, a very harmful bacteria, in their digestive tract. Many others have evidence of another toxic bacteria, called Proteus.

The use of certain medications can also lead to inflammation in the intestines. Unfortunately, these are commonly the same pain-killers that patients take to reduce the symptoms of rheumatoid arthritis. Medications like aspirin, acetaminophen, and ibuprofen may do wonders for joint pain, but they are much less kind to the digestive tract. They tend to be very irritating to the cells of the stomach and intestines and may cause inflammation and even damage to the lining of the gut.

This may be the reason why these medications have not been shown to prevent the progression of damage and dysfunction that occurs in this condition, even though they may help to temporarily reduce pain.

Fortunately, some fairly simple dietary changes can help reduce inflammation in the digestive tract that may be contributing to joint problems. Eliminating foods that are activating the immune system or causing the overgrowth of harmful bacteria can be helpful. In addition, certain foods can support the growth of the beneficial bacteria and reduce inflammation in general.

Dietary Causes

Diet may be your friend or foe in the fight against rheumatoid arthritis. Diets that seem to be linked to rheumatoid arthritis are high in saturated fats, meat, dairy, and omega-6 fatty acids, which are found in animal products, refined vegetable oils, such as corn oil, safflower oil, and margarines made from these oils. With respect to dairy, it's the risk of allergy and the presence of contaminants in non-organic milk that are most likely connected to rheumatoid arthritis. Provided that no dairy allergy is present, organic milk products may sometimes be beneficial for persons with rheumatoid arthritis, partly because of their vitamin D content.

Some patients also find that certain artificial food additives, like yellow dye #5 (tartrazine), make their symptoms worse. Diets low in fruits, vegetables, and other good sources of fiber can encourage the growth of the more harmful bacteria that may be contributing to symptoms.

Adverse food reactions may also play a big role in rheumatoid arthritis symptoms. Some patients find that eating specific foods can cause a flare-up of their condition. Researchers have even found that many patients are actually allergic to certain proteins. The proteins found in wheat and cow's milk are included in this group of proteins. By eliminating or greatly reducing intake of these foods, individuals may significantly reduce their levels of inflammation.

In contrast, many dietary habits can actually help reduce the effects of rheumatoid arthritis. Diets high in cold water fish have been associated with lower rates of rheumatoid arthritis. In addition, many patients have experienced a significant relief in their symptoms by switching to a high fruit and vegetable vegetarian or vegan diet. Certain nutrients, including omega-3 fatty acids, zinc, selenium, vitamin E, vitamin C, vitamin A, and copper, may also be helpful for reducing the symptoms of rheumatoid arthritis.

Nutrient Needs

Foods That May Help Include

Cold Water Fish

A nice, juicy piece of baked halibut fillet is not only tasty, it may be one of the best foods for helping out the sore joints of rheumatoid arthritis. Populations who enjoy a good amount of fish in their diets also enjoy fairly low rates of rheumatoid arthritis.

People with rheumatoid arthritis who start consuming the beneficial omega-3 fatty acids found in fish report a great improvement in their symptoms. Studies have shown that eating fish regularly can elevate the levels of the anti-inflammatory omega-3 fatty acids in the body. Researchers recommend eating 4-6 servings of fish per week as a great way to get those good fats as well as a healthy amount of protein in your diet. Cold water fish include salmon, halibut, mackerel, tuna, herring, sardines, and cod.

Vitamin D-rich Foods

Consuming foods rich in vitamin D such as salmon, tuna, shrimp, sunflower seeds, eggs and vitamin D-fortified milk products, provides protection against developing rheumatoid arthritis (RA), suggests a study published in the January 2004 issue of Arthritis and Rheumatism. The data was drawn from a prospective study of 29,368 women who were followed for 11 years and ranged in age from 55 to 69 when the study began in 1986. Women consuming the most foods naturally rich in vitamin D were found to have a 27% lower risk of RA. Those consuming the most foods fortified with vitamin D, i.e., milk products, had a 34% lower risk of developing RA. Researchers speculate that vitamin D is not only a potent regulator of calcium use in the body but may also have positive affects on maintaining normal immune function. It's important to remember that dairy foods - while high in vitamin D - contain proteins that are commonly involved in food allergy. If dairy allergy is suspected or confirmed in a person's health history, dairy foods should be avoided in the case of rheumatoid arthritis, and vitamin D should be obtained from other food sources. Non-organic cow's milk may also contain a variety of substances that increase inflammation and would be problematic for individuals with rheumatoid arthritis. For this reason, organic dairy products are especially recommended for any person with rheumatoid arthritis who is considering dairy as a regular part of his or her meal plan.

Fruits and Vegetables

Steamed, baked, stir-fried, roasted, grilled, or even shish-kabob, vegetables can be a colorful and flavorful part of any healthy diet plan. Fruits make sweet desserts and between-meal snacks, or can be added to cooked meals for a delightful change of pace.

Fresh fruits and vegetables contain important anti-inflammatory antioxidants like vitamin C and vitamin E, as well as fiber. The fiber found in fruits and vegetables can help to restore the balance of beneficial bacteria in the gut, thereby reducing the general inflammation in the body.

Studies have shown that many rheumatoid arthritis patients who start following a produce-rich vegetarian diet find their symptoms improve or even disappear completely. They're often able to reduce or stop their use of pain-killers. Spending time in the produce section of the grocery store may reduce the amount of time and money you have to spend in the pain-medicine section.

Olive Oil

In parts of the world, including Greece, Italy, Sicily, and other Mediterranean countries, the traditional cuisine is rich in fruits, vegetables, whole grains, robust spices, and pure, extra-virgin olive oil. These areas of the world also tend to have much lower rates of rheumatoid arthritis than other areas, as much as 75% less.

The fats in olive oil are used by the body to produce prostacyclin, a very powerful anti-inflammatory substance. Research studies have shown that rheumatoid arthritis patients who increase their intake of olive oil experience a dramatic reduction in symptoms.

Replacing the pro-inflammatory fats found in vegetable oils like corn oil, safflower oil, and sunflower oil and margarine with pure olive oil can help switch your body from a state of general inflammation to one of general good health.

Yogurt

Provided that no dairy allergy is suspected or confirmed, and provided that certified organic products are selected, yogurt can be a helpful addition to a rheumatoid arthritis meal plan. Be sure to look for organic yogurt that specifically says it contains live, active cultures, since some yogurts are heat-treated to kill the bacteria before being sold. A variety of soy-based yogurts are available for those who are allergic to, or choose not to consume dairy.

Fasting

Fasting refers to a time period during which no food is eaten. This naturally happens during sleeping, which is why the first meal of the day, which ends the nighttime fast, is called break fast, or breakfast. While the true definition of fasting means that only water is consumed, the term has been modified over time to apply to periods of time where only certain foods are eaten. Modified food fasts are worth consideration as a supportive step in rheumatoid arthritis, but we recommend pursuing any fast-related food modifications with the help of a licensed healthcare practitioner.

Nutrients From Food That May Help Include

Omega-3 Fatty Acids

The balance of fatty acids in the body can be a strong determinate of health versus illness. When the body has plenty of omega-3 fatty acids from a good diet to work with, it can produce healthy cells, a functional immune system, and substances that limit the amount of inflammation that occurs. The body is then able to more readily fight off bacteria, viruses, and other harmful invaders, without getting out of control and attacking itself.

Fortunately, the right dietary choices can ensure that you get all of the omega-3 fatty acids that your body needs. Cold-water fish, such as salmon, halibut, mackerel, herring, sardines, tuna, and cod, are rich sources of these fats and have been shown to increase the levels of omega-3 fats in the body.

Researchers recommend around 4-6 servings of these fish every week in order to significantly help with rheumatoid arthritis symptoms. It may, however, take a few weeks for the fatty acid balance to be altered enough to see a big difference.

Some concentrated food sources of omega-3 fatty acids are flax seeds, walnuts and cold water fish, like salmon, cod, and halibut.

Vitamin C

Vitamin C is one of the main antioxidants in the body. Its job is to scour the body looking for free radicals. When it comes into contact with a free radical, it eliminates it so that it can't do any more harm. Since free radicals are responsible for the joint damage that occurs in rheumatoid arthritis, it is important that there be plenty of vitamin C available to reduce damage.

Unfortunately, studies show that many rheumatoid arthritis patients have very low levels of vitamin C in their bodies because it is being used up so quickly. Rheumatoid arthritis patients, therefore, need to get extra vitamin C in their diets.

Excellent food sources of vitamin C include broccoli, parsley, bell peppers, strawberries, cauliflower, lemons, mustard greens, Brussels sprouts, papaya, kale, cabbage, spinach, kiwifruit, cantaloupe, oranges, grapefruit, tomatoes, chard, collard greens, raspberries, peppermint leaves, asparagus, celery, fennel bulb, pineapple, and watermelon.

Vitamin E

Vitamin E is another important antioxidant in the body. Like vitamin C, it acts to eliminate free radicals and reduce the damage caused in rheumatoid arthritis. Studies show that rheumatoid arthritis patients also have very low levels of vitamin E in their bodies, and thus need extra amounts. Increasing their intake of vitamin E may help to significantly reduce symptoms. Mustard greens, chard, turnip greens, and sunflower seeds are a few excellent sources of vitamin E.

Selenium

The antioxidant system of the body is especially dependent on selenium for normal function. When antioxidants like vitamin C and vitamin E attack free radicals, they become inactive. Selenium is needed to reactivate them so they can go out and eliminate more free radicals.

Like vitamin C and vitamin E, selenium levels tend to be low in rheumatoid arthritis patients. Studies have shown that the combination of selenium and vitamin E is especially potent in reducing free radicals and rheumatoid arthritis symptoms.

Some excellent sources of selenium include crimini mushrooms, cod, shrimp, salmon, snapper, yellowfin tuna, and calf liver.

Vitamin A

Low levels of vitamin A are associated with rheumatoid arthritis. Vitamin A is needed by the body for many things. It helps the body to produce and maintain healthy membranes, like the synovial membrane found in joints. It's also necessary for the proper function of the immune system.

When vitamin A levels are low, we may wind up with an immune system that is weak, leaving us more susceptible to infection, or one that is overactive, leading to auto-immune disease. Adequate amounts of vitamin A in the diet may help to restore the healthy function of the immune system.

Excellent food sources of vitamin A/beta-carotene include sweet potatoes, carrots, calf liver, kale, winter squash, collard greens, chard, cantaloupe, mustard greens, romaine lettuce, spinach, parsley, cayenne pepper, peppermint leaves, Brussels sprouts, tomatoes, broccoli, asparagus, and apricots.

Zinc

Like vitamin A, zinc is also needed for the maintenance of healthy membranes and a normal immune system. It's a vital part of the antioxidant system of the body. Unfortunately, rheumatoid arthritis patients tend to be low in this important nutrient. Increasing the amount of zinc in your diet may help to reduce the negative effects of rheumatoid arthritis. Calf liver and crimini mushrooms are two excellent sources of zinc.

Copper

The age-old folk remedy of wearing copper bracelets for rheumatoid arthritis has been studied lately and found to be valid. Researchers found that rheumatoid arthritis patients who wear copper bracelets absorb some of the copper through their skin and tend to have less joint pain when they are using the bracelets.

Copper is necessary for the production of connective tissue, something that is damaged in rheumatoid arthritis. It also plays a role in the antioxidant system to reduce free radicals. Some researchers believe that copper deficiency may be a cause of some cases of rheumatoid arthritis. Increasing your intake of copper may help to manage or even prevent the problems of this condition.

Excellent food sources of copper include calf liver, crimini mushrooms, turnip greens, and blackstrap molasses.

Calcium and Vitamin D

People with rheumatoid arthritis tend to have bone loss as a result of their condition and are at an increased risk of ending up with osteoporosis. This may be a result of the excessive inflammation or it may be a result of certain anti-inflammatory medications. Whatever the cause, research has shown that getting adequate amounts of calcium and vitamin D in the diet can help to prevent or even reverse this bone loss.

Calcium and vitamin D work together as a team to build healthy and strong bones. Increasing your intake of both of these nutrients may protect you from the debilitating long-term consequences of this bone loss. Mustard greens, collard greens, turnip greens and spinach are some excellent food sources of calcium. Shrimp and fortified milk are two very good sources of vitamin D. In the case of dairy products, it's important to make sure that no cow's milk allergy is present, and that certified organic products are selected to avoid exposure to contaminants in milk that might trigger increased inflammation.

Nutrient Excesses

Substances To Avoid

Omega-6 Fatty Acids

Excess intake of omega-6 fatty acids can make your rheumatoid arthritis worse, because too many of these substances will be converted into messaging substances that increase inflammation. You'll want to balance your intake of fats that contain these omega 6s with other types of fat including omega 3 and omega 9 varities.

The best way to do this is by limiting your consumption of feeddlot beef, refined cooking oils, and margarines, and increasing your intake of cold water fish like salmon, halibut and cod, nuts and seeds like pumpkin seeds and walnuts, and oils such as extra virgin olive oil and flaxseed oil.

Saturated Fats

Most saturated fats are associated with increased production of pro-inflammatory substances in the body. Saturated fats are found mainly in whole dairy products like whole milk and cheese, and in animal products such as red meats and poultry. It's easy to replace these fatty foods with low-fat dairy products, lean meats, and omega-3-rich cold water fish.

Wheat

Some rheumatoid arthritis patients have been determined to have antibodies against proteins found in wheat. For these individuals, it's important to eliminate or greatly reduce intake of wheat products. Oats and rye can sometimes be tolerated under these circumstances, though not always. Spelt - a grain ancestor of wheat - can also sometimes be tolerated. Millet, quinoa, and buckwheat almost always make good wheat substitutes from an allergy perspective.

Dairy

Some rheumatoid arthritis patients have antibodies against milk proteins. For these individuals, it's important to eliminate or greatly reduce intake of cow's milk products. Cow's milk proteins are found mainly in dairy products such as milk, cheese, yogurt, and sour cream. Milk proteins may exist in some processed foods in the form of whey, powdered milk, and caseine or sodium caseinate, which appears in many "non-dairy" foods, like coffee creamers and whipped toppings.

Dairy proteins may also appear in many baked goods, breakfast drink mixes, and even non-Kosher lunch meats. People who suspect a milk protein allergy must be very careful about reading labels to avoid a worsening of their symptoms from these products.

If a person is not allergic to cow's milk, and if organic dairy products are selected, these products may actually make a helpful contribution to a rheumatoid arthritis diet, partly because of their vitamin D content.

Meat

A high intake of meat may worsen the symptoms of rheumatoid arthritis. This connection between meat intake and rheumatoid arthritis involves some unique aspects of meat digestion, particularly the production of bile acids by the liver in response to high levels of meat intake. Under certain circumstances, bacteria in the digestive tract can get hold of these bile acids and convert them into inflammation-increasing substances. Shaping the diet in a more vegetarian direction may often be helpful in decreasing the symptoms of rheumatoid arthritis for this reason.

When it comes to rheumatoid arthritis, fish should not be placed in the same general category as most meats. Cold-water fish like salmon, halibut, and cod may help decrease rheumatoid arthritis symptoms because of their omega-3 fatty acids.

Adverse Food Reactions

Besides the foods mentioned above, some rheumatoid arthritis sufferers have found that their symptoms are worse after they eat certain foods. Adverse food reactions vary, meaning that different people may have problems with completely different foods. A food and symptom diary or allergy elimination diet may help to reveal if adverse food reactions are contributing to rheumatoid arthritis symptoms.

Recommended Diet

The study, published in the Annals of the Rheumatic Diseases, involved 130 female patients (aged 30 to 70) from different hospitals in Glasgow, UK, who had suffered from RA for eight years. Half the women—the intervention group—attended weekly two-hour sessions for six weeks, including hands-on cooking classes backed up with written dietary information. The control group received written dietary information only. Both groups completed food frequency questionnaires (FFQs), and clinical and laboratory measures were taken at baseline, 3 and 6 months.

Analysis of the FFQs showed significant increases in weekly total fruit, vegetable and legume consumption and improvement in the ratio of monounsaturated:saturated fat intake and systolic blood pressure in the intervention group only. Correspondingly, women in the intervention group, but not controls, experienced significant benefit as shown in the Health Assessment Questionnaire score at 3 months, pain score at 3 and 6 months, early morning stiffness at 6 months, and patient global assessment at 6 months. As an added benefit, women in the intervention group lost an average of 2 pounds over the 6 month period, while the control group gained 6.6 pounds.(McKellar G, Morrison E, et al., Ann Rheum Dis.)

The best place to start your healthy diet is at the fresh fish counter of your local grocery store. Skip the red meat and poultry. Instead reach for the fresh salmon steaks or halibut fillets. Four to six servings of these or mackerel, tuna, sardines, herring, or cod may help those sore joints.

Vegetable oils like corn, sunflower, and safflower oils may taste heavy and bland, and margarine can taste greasy and salty. Pure extra-virgin olive oil on the other hand, can have a wonderful delicate flavor that mixes well with spices or balsamic vinegar and goes great on a mixed-green salad or with warm, fresh-baked, gluten-free bread.

Olive oil and spices can also add flavor to a hot plate of freshly steamed vegetables. Maybe the vegetables are just fine all by themselves. Either way, including plenty of fresh, lightly cooked vegetables in your diet can be a real help with symptoms. With the number of vegetables commonly available these days, you can really add excellent variety to meal plans.

Instead of snacking on sugary cookies or candy bars, delight in the aroma and taste of fresh ripe melon, a juicy peach, or a beautiful red strawberry? You could also try the delicate blend of an organic, live culture yogurt with fresh fruit (provided, of course, that no dairy allergy is present or suspected).

Experimenting with a vegetarian or vegan diet may be an interesting experience that winds up having a dramatic effect on your joint symptoms. If you want to solicit the help of a licensed healthcare practitioner and set up a modified food fast, that step might also turn out to be very helpful.

Diet may be your best friend in the battle against rheumatoid arthritis symptoms. A diet filled with vegetables, fresh fruit, fish, olive oil, and other supportive foods may really help you put away the pain-killers and start living a functional, healthy life again.

References

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