Talk Over RA: Diet, Myths and Rheumatoid Arthritis with The Arthritis Dietitian

Rheumatoid Arthritis (RA) is a chronic, progressive, and often debilitating inflammatory disease that causes pain, stiffness, swelling, and loss of function in the joints. It can affect people of any age but often begins between the ages of 30 to 50. About 300,000 Canadians live with RA

During this #TalkOverRA campaign I wanted to bring in other Canadians living with RA to discuss what has significantly helped them with their rheumatoid arthritis journey. I previously spoke about medications and achieving remission in the last Talk Over RA campaign, so this campaign I wanted the focus to be on what has helped others throughout their diagnosis.

Living well with rheumatoid arthritis takes more than the advice of a medical doctor, sometimes hearing it from others who live with the condition because we speak a certain language together and can be a wealth of knowledge for each other. 

One of those Canadians who offer a wealth of knowledge is Cristina Montoya, a Registered Dietician and someone living with rheumatoid arthritis. She not only has the education to speak about diet, but she also lives with RA. Your rheumatologist may not have all the answers about diet and RA, but Cristina has a few for you. I’ve asked her the most common questions I see about diet and RA in RA support groups and from personal experience. 

I discuss with Cristina some of the misconceptions and diet trends around living with a chronic illness like RA. I think just about anyone living with arthritis or most chronic illnesses have experienced an overwhelming amount of advice when diagnosed, while they often are in good intentions they are not necessarily as helpful as the person giving the advice wishes. Cristina breaks down some of those while offering useful diet advice that will help lower your inflammation. 

There is no such thing as a miracle diet that will cure your Rheumatoid Arthritis (RA). The best diet is the one that makes you feel your best! This could be different for everyone, so it helps to seek an RD’s advice. They will help you explore your trigger foods and what eating style works best for your lifestyle.

However, dietary patterns with anti-inflammatory properties may augment the effect of the therapies used to manage RA. 

There is a saying in Colombia, “en la variedad, está el placer” there is pleasure in variety. RA patients typically have a low gut microbiota diversity, which can trigger inflammation. Growing evidence shows how the Mediterranean Diet components are favourable to maintain a healthy gut balance.

In general, an anti-inflammatory way of eating includes daily consumption of fruits, vegetables, whole grains, pulses, healthy fats, and herbs and spices. There is moderate consumption of fish, seafood and dairy (mostly yogurt, cheese), eggs, and poultry, with minimum consumption of refined sugars and red meats. Most meals are prepared from fresh ingredients, and little processed food is used. 

Cold-water fatty fish, such as salmon, tuna, herrings, sardine, mackerel, are rich in essential Omega 3 fatty acids, such as Eicosapentaenoic Acid (EPA) and docosahexaenoic acid (DHA). Omega 3s may have a role in attenuating inflammation and regulating autoimmunity. One 3-oz serving of Atlantic salmon contains about 1240mg DHA and 590 mg EPA. No need to take that fish oil cap at dinner time! 

Seeds such as flax seeds, hemp seeds and chia seeds are an excellent source of plant-based Omega 3- alpha-linolenic acids (ALA). ALA can be converted to the more bioavailable fatty acids EPA and DHA by the liver, but the mechanism is not as efficient. These seeds are an excellent source of magnesium, manganese, thiamin. The latter being an essential vitamin involved in the metabolism of carbohydrates and energy supply in the body.  DHA+EPA supplements derived from algae, such as  NutraVege , are an alternative option Omega 3 fatty acids option for those following a vegetarian or a vegan diet.

Extra virgin olive oil (EVOO) is high in oleocanthal, which has similar properties to non-steroidal, anti-inflammatory drugs. It also contains anti-inflammatory polyphenols, antioxidants and unsaturated fatty acids. Classic olive oil or light Olive oil is a good start if you can’t tolerate the strong taste of EVOO. 

Other unsaturated oils with anti-inflammatory properties are made from avocado, chia seeds, flaxseed, hemp seed, and tea seed. Keep in mind that chia and hemp oils must be kept refrigerated. 

Berries such as cherries, blueberries, blackberries, strawberries and raspberries have an antioxidant called anthocyanin, which has anti-inflammatory effects. 

Yogurt and cheese are rich in calcium, vitamin D, phosphorus and protein, which are essential nutrients for bone and muscle strength. 

Legumes such as chickpeas, black beans, white beans, red kidney beans have a low glycemic intake, meaning that their carbohydrates break down slowly, minimizing the rapid rise of sugar in the blood. They are also known to lower CReactive Protein (CRP) levels, a biomarker of inflammation. 

Let’s talk about nuts. When it comes to nuts, almonds are high in monounsaturated fats and vitamin E, which is an excellent antioxidant. Brazil nuts and cashews are high in selenium, another potent antioxidant. Cashews contain less fat than other nuts, and their content of anacardic acid may help improve insulin sensitivity and lower inflammation. Walnuts are an excellent source of plant-based omega 3-fatty acids and a natural source of melatonin, which is vital in regulating sleep.  

Whole grains such as wheat, corn, rice, oats, barley, quinoa, sorghum, spelt, and rye provide anti-inflammatory phytochemicals and antioxidants often not found in fruits and vegetables. They also contain B vitamins, vitamin E, and magnesium, and fibre. If you follow a gluten-free diet, most whole grains are gluten-free, such as wild rice, amaranth, millet, quinoa, teft, millet, buckwheat, certified gluten-free oats. Here is a guide to cooking with whole grains from the whole-grains council.

Green tea is high in polyphenols, particularly Epigallocatechin Gallate (EGCG), an antioxidant with the potential to reduce inflammation by blocking the production of molecules that causes joint damage in people with RA. Remember, when preparing green tea, boil the water and let it rest for a minute or so, then steep your loose tea or tea bag for only one minute to preserve the polyphenol content and reduce the bitter taste. 

 A rainbow of seasonal fruits and vegetables will provide a wide range of polyphenols and antioxidants. For instance, in Ontario during May and June, there is more access to locally grown fruits and produce, such as asparagus, green beans, broccoli, cauliflower, radish, mushrooms, peppers, radishes, spinach, sprouts, summer squash, sweet potatoes.  

Herbs and spices with anti-inflammatory properties include ginger, curcumin, black pepper, garlic, cinnamon, cayenne, parsley, mint, oregano, basil, rosemary and thyme for their higher content of phytochemicals.

Other nutrients of interest are cocoa powder, nano powdered red ginseng, and probiotics. 

Although the relationship between diet and risk of Rheumatoid Arthritis is not as strong as other modifiable risk factors, such as smoking, the emerging role of inflammation in many chronic conditions is leading to more research about the role of specific nutrients and components with pro and anti-inflammatory properties. More studies show the significant influence of diet on the gut microbiota composition, which has been involved in RA development. That old saying, “we are what we eat,” may as well apply to foods that could trigger inflammation when living with Rheumatoid Arthritis.

Processed foods: baked goods and prepackaged meals/snacks contain trans-fats, which are unsaturated fats created through hydrogenation. The hydrogenation process adds hydrogen to liquid vegetable oil to solidify at room temperature and extend its shelf life. Trans fats trigger systemic inflammation. Vegetable oils also have different smoke points, which is the temperature when an oil begins to deteriorate by changing its taste and chemical composition. When you heat a vegetable oil above its smoke point, it creates harmful compounds, and the health benefits may be limited. Such is the case of extra virgin olive oil; when heated above its smoke point, there is a decrease in antioxidants, vitamin E, and oleocanthal, which has anti-inflammatory effects. Check out the smoking point of common oils. 

Omega-6 fatty acids: high intake of corn, peanut and soy oils, and most meats, especially red meats, can trigger the body to produce pro-inflammatory chemicals such as arachidonic acid. Arachidonic acid is mainly found in the fatty parts of meat and fish; it is released and oxygenated by enzymes leading to inflammatory mediators, such as eicosanoids known to cause acute inflammation in the body. 

Refined sugars: pastries, chocolate bars, candy, soda beverages, energy drinks and fruit juices trigger the release of a protein called cytokines. Cytokines are signaling molecules that regulate inflammation. Studies have shown that an increase in the consumption of refined sugars leads to an increase in visceral adipose tissue (central obesity), which is metabolically active and produces cytokines, thus affecting the adequate function of the pancreas and colon. Make sure to look out for corn syrup, fructose, or maltose in the nutrition labels as they are hidden sources of sugar. Refined carbohydrates such as white pasta, bread and crackers cause a spike in blood glucose leading to insulin resistance known to cause inflammation. 

Sugar alternatives: aspartame and sucralose often contained in diet sodas, gum or reduced-fat products can cause an inflammatory response in the body because our bodies cannot process these substances well. Aspartame may lead to the production of pro-inflammatory molecules such as interleukin, adiponectin and c-reactive protein. These molecules trigger systemic inflammation, resulting in insulin resistance, meaning muscle, fat, and liver cells do not respond well to insulin. They cannot efficiently take up glucose from your blood.

Red meats are high in saturated fats and contain high levels of advanced glycation end products that stimulate inflammation, especially when it is grilled, roasted, fried or broiled. Saturated fats trigger adipose (fat tissue) inflammation, which can worsen inflammation caused by inflammatory arthritis. A few animal studies showed that saturated animal fat causes our gut lining to become leaky, allowing gut bacteria to enter the bloodstream. Red meats also contain N-glycolylneuraminic acid (Neu5Gc), which humans cannot produce- when it enters the body, it is recognized as a foreign and invading substance. The immune system creates antibodies against it, causing inflammation. Moreover, high-fat dairy like butter, cream cheese and mayonnaise are high in saturated fats and advanced glycation end products, which triggers inflammation. 

Alcohol increases inflammation and health risks like liver disease. Excessive alcohol consumption weakens the liver and disrupts interactions with other organs, causing inflammation. Alcohol consumption decreases bone density, and people with arthritis are already at increased risk for developing osteoporosis. Methotrexate is a Disease-Modifying Anti-Rheumatic Drug (DMARD), a medication often used in people with RA. There is a link between alcohol and methotrexate because this interaction can damage the liver and impair liver function; the damages can range from benign elevations in blood tests to fibrosis or fatal hepatic necrosis (acute toxic liver injury). 

Are you wondering if your glass of wine with dinner or those beers on the patio are increasing your joint pain and swelling? There is no conclusive evidence suggesting that alcohol must be avoided for those of us with RA. However, if you find that your joints feel sore or are swelling after a drink or two, you might consider cutting down or eliminating it from your diet.

Be sure to speak with your doctor if you are taking any medications. Some prescribed medications like Methotrexate and over-the-counter drugs such as anti-inflammatory NSAIDs have the potential for adverse interactions.

Sodium: a high salt diet is associated with increased inflammation. Studies have shown that high salt diets may elevate the expression of inflammatory biomarkers, including tumour necrosis factor-alpha. Prednisone is an anti-inflammatory steroid medication that is used to decrease inflammation in autoimmune conditions such as RA. This medication may cause salt and fluid retention, meaning your body is holding onto extra water. Water retention can raise blood pressure and contributes to inflammation and swelling of particular body parts, mainly the eyes and ankles. 

The Western diet characterized by a high intake of red meats, saturated and trans fats, low ratio Omega-3:Omega-6 fatty acids, low consumption of complex carbohydrates and fibre has been associated with increased RA risk by causing low-grade inflammation, insulin resistance and obesity. More research is showing how the Western diet alters the microbiota and may promote intestinal increased permeability and low-grade inflammation. In general, people with rheumatoid arthritis have a reduced gut microbial diversity in comparison to their counterparts, which further exacerbates their inflammation when they eat traditional Western diet foods. 

This vibrant spice has been shown to have anti-inflammatory and antioxidant properties that may help to reduce the pain and stiffness associated with rheumatoid arthritis. Turmeric contains curcumin, which is a compound that has been shown to have anti-inflammatory and antioxidant properties.

While curcumin has been shown to help reduce inflammation, it is not easily absorbed by our bodies. To increase the uptake of curcumin, it is recommended that it be consumed with black pepper as it contains the compound piperine, which aids in absorption. Oils such as olive, Fish, seed and avocado are also recommended because curcumin is more easily absorbed when fats are present. Curcumin can be found in supplement form, but exploring new recipes that include turmeric would be more delicious and fun! 

I love carbs! Not all carbs are created equal! When we think of carbohydrates, we often think of refined carbs such as fluffy white bread or pastas, but many of the foods we eat contain carbohydrates such as fruits, veggies, legumes, and whole grains. Refined carbs lose much of their vitamins, minerals, and fibre during processing. Fibre is vital for maintaining gut health, which may help reduce inflammatory biomarkers (3). Additionally, the vitamins and polyphenols found in many of these carbohydrates act as antioxidants in your body.

Choosing carbohydrates that are high in fibre and low on the glycemic index (low GI) can also help to reduce inflammation and the associated pain. The Glycemic Index helps you to understand which foods will cause a sharp rise and fall in blood sugar and which will digest more slowly, causing a more gradual increase in blood sugar and release of insulin. 

While most carbs are an important part of your anti-inflammatory diet, some carbs such wheat, barley, and rye contain gluten. Gluten may increase the inflammatory response and joint pain if you have celiac disease or gluten sensitivity. If you think you may have either, please speak with your healthcare professional.

The ketogenic diet has gained popularity over the last few years as a miracle weight loss, cure-all diet. While there has been some initial research into whether this diet may help reduce pain and inflammation, there is not enough evidence to support the hypothesis at this time.

In fact, restriction of carbohydrates, particularly whole grains, fruits, and vegetables, eliminates essential nutrients and fibre from your diet. I discussed the keto and carnivore diets in my post On Trend: Is the carnivore diet an option for arthritis?. The main takeaway is that the risks often outweigh the benefits of this high-fat, low fibre diet. If you think you could benefit from the keto diet, please speak with your healthcare professional and a Registered Dietitian (RD) to see if it is right for you.

Nightshade vegetables have a bad reputation, partly because of the alkaloid solanine found in them that can be toxic. However, the dose makes the poison. Solanine is only harmful in large quantities, not the amount consumed from a typical diet that includes nightshade veggies. Be sure to avoid green potatoes, though, because they have high levels of solanine.

As for nightshades aggravating your arthritis symptoms? Well, the research does not support this claim. In fact, some research is showing that the capsaicin found in some nightshades, such as peppers, may help relieve arthritis pain through topical use.

Additionally, nightshade vegetables (eg. tomatoes, potatoes, peppers, eggplant) contain many vitamins and minerals that can benefit your health! If you find that after consuming nightshades pain or swelling increases, you may consider avoiding them and seeking the advice of an RD.

Living in the era of diet culture, we can easily fall into the trap of eliminating entire food groups from our diet in an attempt to control our disease.

Nutrition is being recognized as an essential modulator of chronic inflammation. Therefore, a wholesome nutrition approach appears more effective than single dietary components. I promote a sustainable nutrition approach that combines the principles of the traditional Mediterranean diet and the inclusion of foods that promote gut health.

5 steps to get you started with anti-inflammatory nutrition:

  1. Plan your meals or snacks on a day you feel less pain and fatigue. Choose a meal where you need to add more variety (i.e. breakfast vs. dinner)
  2. Include a vegetable or fruit in every meal. Cook a meatless dinner or lunch once a week.
  3. Enjoy some fermented dairy products. Add plain Greek yogurt or Kefir to your smoothies.
  4. Switch to whole grains or pseudo-grains (i.e. whole grain wheat, wild rice, quinoa, amaranth, hulled barley).
  5. Enjoy extra-virgin olive oil, nuts, sunflower seeds, olives, avocados as primary sources of fats.

My first step to living well with rheumatoid arthritis was accepting that this disease would be my long-life companion. Self-pitty and guilt will further affect my mental and physical health.

As a newly diagnosed patient, I advise putting together your dream health care team and disease management toolkit. Imagine a Maple tree. The roots represent the complexities and connection of rheumatoid arthritis with your body. You are the expert on how your body feels and what worsens your symptoms.

The trunk is your rheumatologist and family physician; they will be the pillar of your primary care. The branches are your extended support network, including allied health care providers in mental health, physical rehabilitation, medical cannabis, nutrition, pharmacy, fellow patients, your family and friends.

The colour-changing leaves represent how rheumatoid arthritis goes through different seasons. Recently, with early detection and treatment, the disease can get under control and allow you to flourish. From time to time, an infection, hormonal changes, job loss or any stressful event can lead to falling leaves and the emptiness of winter trees.

On the bright side, you know that Spring is just around the corner to bring the leaves back to life. Don’t let Rheumatoid Arthritis overshadow your inner beauty and life projects. Sure, you will need to make changes and adapt. This disease also teaches you to be a  more resilient and stronger individual.

Be sure to follow Cristina on social media to continue to learn more about healthy eating with rheumatoid arthritis. 

Cristina’s blog The Arthritis Dietitian




To learn more about Talk Over RA and how to have a meaningful conversation with your doctor download the Talk Over RA discussion guide today and browse their website.

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