What diet is good for rheumatoid arthritis?

Some diets advertise that they can cure rheumatoid arthritis - a false promise, because there is no special rheumatoid arthritis diet. However, various studies provide information on what you can pay attention to in your diet. The German Nutrition Society recommends using the food pyramid as a guide. It is recommended that you eat a variety of foods to cover a broad spectrum of vitamins, antioxidants and minerals.For patients with rheumatoid arthritis, there are some additional factors to consider that can help reduce inflammation and support bone health:Plant-based foods such as vegetables, fruit and pulses should form the basis of a healthy diet. Carbohydrate-rich products such as wholegrain cereals and potatoes form the second stage. However, the quantity is crucial here. A reduced consumption of carbohydrates can have a positive effect on the well-being of people with rheumatoid arthritis.

The next stage consists mainly of animal products. Compared to the general dietary recommendations, patients with rheumatoid arthritis should be cautious about animal products such as meat, milk, dairy products and eggs. This is because they contain the messenger substance arachidonic acid, which promotes inflammation of the joints. It is interesting to note that individual studies show a favorable effect for vegetarian or vegan diets. However, this cannot be seen as a general recommendation. Fish is considered a good food for those suffering from inflammatory rheumatic diseases - fish oil contains eicosapentaenoic acid (EPA), which can reduce inflammation. Oils and fats, preferably plant-based, form the top of the pyramid.

For rheumatism or rheumatoid arthritis, it is therefore recommended to

• lots of fruit and vegetables
• less carbohydrate-rich foods such as wholegrain cereals and potatoes
• less animal products such as meat, milk, dairy products and eggs
• more fish

to include more fish in the diet. It is also recommended,

• prepare food gently to retain as many nutrients as possible and
• and to avoid highly processed foods and refined sugar as far as possible.

as far as possible. [1-4]

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Foods that promote vs. prevent inflammation

Rheumatoid arthritis is a condition that causes systemic inflammation in your joints. As this can put increasing strain on the body and exacerbate pain, it can be helpful to avoid foods that further fuel inflammation. These include: red meat, convenience foods, especially those with refined sugar and carbohydrates (e.g. white flour products), fried foods and alcohol.In contrast, eating anti-inflammatory foods rich in antioxidants prevent inflammation in the body. These include olive oil, green vegetables, nuts, oily fish, dark chocolate and dark berries.

These foods form a large part of the Mediterranean diet that you have just learned about.‍You now know that there is no one rheumatism diet. Nevertheless, there are countless diets that promise health benefits: whether fasting, low-carb or keto diets. Some of these diets promise to prolong life, improve health or even cure diseases such as rheumatism through adapted eating. So that you don't lose track, here are some forms of diet and their benefits in the context of rheumatoid arthritis.

What types of diet are there and what benefits do they have for rheumatism?

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Mediterranean diet and rheumatism

The Mediterranean diet, also known as the Mediterranean diet, is based on the traditional eating habits of the Mediterranean region.

Although the diets in Mediterranean countries differ to some extent, they overlap in some respects:

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• Daily consumption of fruit, vegetables, non-whole grains and dairy products
• Olive oil as the main cooking and cooking fat
• Frequent consumption of fish
• Moderate consumption of poultry meat, nuts, potatoes and eggs
• Rare consumption of red meat

Meals are mainly freshly prepared, industrially prefabricated food is avoided.

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Scientific studies have shown that a Mediterranean diet has a number of health benefits for patients with rheumatoid arthritis.

These include, among others

1. relief of pain [5]
2. improvement in mobility [5,6]
3. reduction in disease activity [6]

The Mediterranean diet is characterized by a high proportion of antioxidants, monounsaturated fats, omega-3 fatty acids, fibre and other bioactive substances. Researchers believe that the benefits of this diet stem from the anti-inflammatory properties of the foods and preparation methods. A Mediterranean diet could also have a positive effect on the gut microbiome, which plays a role in rheumatoid arthritis.‍

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Ketogenic diet and rheumatism

The ketogenic diet is a special form of low-carbohydrate diet that aims to put the body into a state of ketosis. In ketosis, the body uses fat instead of carbohydrates as its primary source of energy. This is achieved by drastically reducing the intake of carbohydrates and increasing the intake of fats. The resulting ketone bodies (especially ß-hydroxybutyrate) are said to have anti-oxidative and anti-inflammatory effects [7,8].

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The main features and principles of the ketogenic diet include

• Low carbohydrate intake
  ‍Carbohydrate intake is typically limited to around 20-50 grams per day. This forces the body to use up its stored carbohydrates (glycogen reserves) and enter a state of ketosis.‍
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• High fat content
  ‍Around 70-75% of your daily calorie intake comes from fats. This includes healthy fats such as avocados, nuts, seeds, olive oil, butter, coconut oil and fatty fish.‍
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• Moderate protein content
  ‍Protein makes up around 20-25% of your daily calorie intake. Too much protein can prevent the body from entering ketosis, as excess protein can be converted into glucose.‍
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• Ketosis
  ‍This is the state in which the body begins to use ketone bodies from fat as its main source of energy. This can bring several health benefits, such as weight loss, improved mental clarity and stabilization of blood sugar levels.
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Studies have shown that a ketogenic diet is beneficial for weight loss. The anti-inflammatory effects of a ketogenic diet can also reduce inflammation in rheumatoid arthritis [9].

On the other hand, avoiding grains, fruit, many vegetables and other healthy foods deprives the body of the vitamins and minerals it needs. People with systemic inflammation such as rheumatoid arthritis are therefore not advised to follow a ketogenic diet. This is especially true as clinical studies on the effects of a ketogenic diet on rheumatoid arthritis are still lacking [9].

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Vegetarian diet and rheumatoid arthritis

A vegetarian diet describes a diet in which fish and meat are completely avoided. Within the vegetarian diet there are further gradations, including

• Lacto-ovo vegetarian: abstaining from fish and meat, consuming dairy products (lacto) and eggs (ovo)
• Lacto-vegetarian: abstaining from fish, meat and eggs, consuming dairy products
• Ovo-vegetarians: no fish, meat and dairy products, consumption of eggs
• Vegans: avoid all animal products, often including honey

A plant-based diet eliminates many potential triggers for inflammation such as saturated fats, processed meat and dairy products. In addition, the diet is rich in fiber and antioxidants, which supports the anti-inflammatory effect of a vegetarian diet [13].

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In principle, a vegetarian diet has many health benefits. Scientific studies have shown that a vegetarian diet in patients with rheumatoid arthritis can support

1. relief of pain [10]
2. reduction of joint swelling and inflammation [11]
3. reduction in the risk of severe RA through weight regulation [12]

among other aspects:

One study showed that a 4-week vegan diet led to a 53% reduction in RA pain and joint swelling and inflammation [11]. Another found that patients with rheumatoid arthritis who underwent a 7- to 10-day fast followed by a 3.5-month gluten-free vegan diet and a subsequent 9-month lactovegetarian diet showed significant improvements in symptoms such as tender/swollen joint count, pain, morning stiffness, grip strength and inflammatory markers compared to an omnivorous control group. These improvements were maintained after 1 year in patients who responded well to the vegetarian diet [10]. A study was also able to show that a vegetarian diet can help reduce obesity and thus lower the risk of severe RA [12].

However, dietary measures alone cannot treat RA without medication, and the benefits are individual. A balanced, anti-inflammatory diet is recommended as an adjunct to standard RA treatment. However, it is important to take a good look at the diet in order to prevent nutritional deficiencies.