The most troubling symptoms of rheumatoid arthritis — pain, stiffness, and swelling — stem from the same source: inflammation. What to do? Part of the answer may involve your diet.
Findings from a study published in April 2021 in Arthritis Research & Therapy, showed that patients with rheumatoid arthritis (RA) had significantly more pro-inflammatory diets, and those individuals with RA who were able to lower diet-associated inflammation between 2011 and 2017 were also able to maintain low disease activity. “That particular result was extraordinarily strong and consistent as indicated by more than 3.5 times greater odds of maintaining good control over the disease compared with those who did not adopt a more anti-inflammatory diet,” said study coauthor James R. Hébert, MSPH, ScD, Health Sciences Distinguished Professor and director of the Cancer Prevention and Control Program at the University of South Carolina in Columbia.
Even more important, since the study was conducted over a number of years, it shows that the beneficial effect of a low inflammatory diet is long-term. “Because such a diet can be extraordinarily diverse and sensually pleasing, it can be very easy to maintain over very long periods of time,” added Hébert, via email.
There’s additional evidence that diets high in polyunsaturated fatty acids and plant fiber — think omega-3 fatty acids and lots of fruits and vegetables — may decrease the risk of RA. It’s also thought that both fiber and polyunsaturated fatty acids can lower levels of C-reactive protein (CRP), which is an indicator of joint inflammation.
Researchers theorize that fiber in particular is beneficial, but it may be that the phytonutrients in fiber-rich fruits, vegetables, and grains contribute to lessening it. Studies have also found that regularly eating fish high in omega-3s, such as salmon, herring, mackerel, trout, and tuna, may decrease swollen joints and tenderness.
Researchers have become interested in the anti-inflammatory benefits of olive oil because people who eat a traditional Mediterranean diet, which is rich in olive oil, seem to have fewer health conditions related to inflammation, such as degenerative joint diseases or diabetes.
Researchers have found that oleocanthal, a compound found in extra-virgin olive oil, appears to suppress the same pain pathway as nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, which makes it a great oil for use in cooking foods, or in recipes like salad dressings as part of your daily management plan when living with pain.
Vitamin C is a dietary component necessary for the synthesis of collagen, which helps build and repair blood vessels, tendons, ligaments, and bone, and is therefore helpful for people with osteoarthritis, Sandon says.
Aim for a total vitamin C intake of 75 milligrams (mg) per day for women, and 90 mg per day for men, the current U.S. recommended dietary allowance. If you’re pregnant, aim for 85 mg and if you’re lactating, 120 mg.
Citrus foods, such as oranges, grapefruit, lemon, and limes, are rich in vitamin C, and are also good sources of inflammation-fighting antioxidants, which are beneficial for those with rheumatoid arthritis. Citrus, however, may interfere with the body’s ability to process certain RA medications, such as oral cyclosporine and possibly methotrexate. Research has shown that regular consumption of grapefruit juice blocks the protein known as CYP3A4 that helps the body metabolize cyclosporine; other research has suggested that other citrus juices, like those made from Seville oranges, limes, and pomelos, may also affect how CYP3A4 works in the body.
If you’re taking meds that can be affected by citrus, you may need to get vitamin C from other sources such as tomatoes, peppers, melons, strawberries, kiwi, or potatoes, Sandon suggests. A half cup of cooked broccoli, for example, has over half of the recommended vitamin C daily value.
“Another option,” notes Sandon, is to avoid taking your medication with citrus juices. “Instead, have the juice or citrus fruit at another time of day.” Talk with your healthcare provider to figure out what’s best for your diet and medication routine.
Sandon recommends that you make one or more servings of fresh or frozen berries, such as blueberries, raspberries, strawberries, blackberries, or huckleberries, part of your daily diet. These little fruits pack powerful antioxidant compounds, like proanthocyanins and ellagic acid, which fight inflammation and cell damage. The amount and combination of the compounds vary by the type of berry, Sandon says, so make variety your goal.
Add carrots, squash, and sweet potatoes to your anti-arthritis shopping list, too, Sandon says. These and other orange-hued vegetables are rich in vitamin A and beta-carotene, both of which are believed to fight inflammation. Cooking seems to increase the availability of these compounds. For the biggest benefit, eat these vegetables on a regular basis in recommended serving sizes rather than overdoing it by eating them in large quantities. A single serving of carrots is ½ cup, or about 1 large carrot or 7 to 10 baby carrots.
Pineapple is rich in vitamin C and the enzyme bromelain, which has been linked to decreased pain and swelling in both osteoarthritis and rheumatoid arthritis, Sandon says. So, add this tropical fruit to your diet every chance you get. Try it cubed in fruit salad, baked in savory dishes, blended into a smoothie, or added to stir-fries to give a sweet-and-sour zing.
Bromelain is also available in supplement form, but check with your doctor before taking it because it can increase the risk of bleeding, especially if you also take blood thinners such as Plavix (clopidogrel bisulphate), Coumadin, or aspirin. Bromelain may also interfere with the action of antibiotics and sedatives.