‘No disease that can be treated by diet should be treated with any other means,’ is a well-known quote from the medieval philosopher Maimonides. And while rheumatoid arthritis usually can’t be treated by dietary changes alone, people who live with RA may find significant symptom relief by adopting a plant-based diet.
Evidence backs the effects of vegetarian, vegan or plant-heavy diets, like the Mediterranean diet, for at least some people who struggle with RA. Plant-based diets for rheumatoid arthritis help on two levels:
- The foods they encourage – fruits, veggies, legumes, whole grains – have positive effects for symptom relief.
- The foods they discourage or limit – animal products like meat and dairy – can make RA symptoms worse.
Tweaking your eating plan can be a natural way to possibly improve joint swelling, stiffness and debilitation. If you have RA, want to feel better and are considering a plant-based diet, here’s why experts advise you to go for it.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disease. With autoimmune conditions, your immune system becomes overactive and works against you. Normally, a healthy immune system presents a strong line of defense against germs like viruses and bacteria. In autoimmune conditions, the immune system instead attacks your body from within. Of the more than 80 autoimmune conditions now identified, rheumatoid arthritis is the most common.
In rheumatoid arthritis, linings of the joints – particularly in the hands, wrists and knees – become inflamed, causing joint damage. Rheumatoid arthritis symptoms include chronic pain, joint stiffness, swollen, misshapen joints and fatigue. In some cases, RA affects other parts of the body including organs like the lungs, heart and eyes.
Rheumatoid arthritis treatment involves a combination of medications and self-management. Disease-modifying antirheumatic drugs, which slow disease progression and prevent joint deformity, are the primary medications used. However, they may cause a number of side effects. Lifestyle interventions including hand exercises and diet can help manage and reduce RA symptoms.
What Is a Plant-Based Diet?
Plant-based diets emphasize foods from plants such as fruits, vegetables, legumes, whole grains, beans, nuts, seeds and oils. Some plant-based diets exclude animal food sources altogether, while other eating patterns consist largely of plant foods but also allow smaller proportions of meat, fish or dairy.
The U.S. News Best Diets rankings include a variety of healthy plant-best diets including:
Registered dietitian-nutritionists can help people connect diet options to symptom management, says Melissa Prest, a national spokesperson for the Academy of Nutrition and Dietetics. It might be that someone with RA follows a vegan, vegetarian or plant-based diet 90% of the time, while still making room for personal choices, she says.
“Maybe once a week they’re really enjoying having an animal protein, maybe a salmon they’ve broiled,” Prest says. “So, they’re still allowed to work that into their diet. And salmon is actually great because it has omega-3 fatty acids, which are beneficial for heart health and an anti-inflammatory diet.”
Dietary Effects on RA Symptoms
For some people with RA, following a plant-based diet may contribute to:
- Easing joint pain.
- Reducing joint swelling.
- Diminishing morning stiffness.
- Boosting energy and well-being.
- Increasing hand grip strength.
- Restoring range of motion.
- Facilitating activities of daily living.
- Enhancing overall quality of life.
- Lessening chronic disease risk factors.
Different types of plant-based diets can help. Switching to a vegan diet in particular can have a notable impact on RA symptoms, says Dr. Hana Kahleova, director of clinical research for the Physicians Committee for Responsible Medicine. A recent study conducted by PCRM compared symptoms in people with RA who transitioned to a vegan diet along with eliminating common trigger foods.
“Some of our study participants, when they entered the study, were not even able to tie their shoelaces,” Kahleova says. “And just a few weeks into the study, they were able to do everyday activities (as someone without RA would). So, that was a huge improvement in the quality of their life.”
A healthy plant-based diet means more than just cutting back on meat. A whole food plant-based diet is more beneficial than a diet that’s heavy on processed foods, sweets or salty snacks.
Evidence for Plant-Based Diets
Several studies give evidence in support of plant-based diets improving RA. Other research has shown positive effects on autoimmune conditions in general:
- A plant-based diet may be effective for people with RA in four key ways, according to a review by PCRM, published in September 2019 in the journal Frontiers in Nutrition. Plant-based diets reduce markers of inflammation, reduce RA pain and swelling, reduce BMI (body mass index) and promote healthy gut bacteria, based on evidence gleaned from multiple studies.
- A vegan diet, in conjunction with eliminating other trigger foods, may help minimize joint pain from rheumatoid arthritis, according to the small PCRM study also co-authored by Kahleova and published in April 2022 in the American Journal of Lifestyle Medicine. Participants who adhered to a vegan diet for four weeks, then added an elimination diet removing known trigger foods, experienced significant improvements in pain, a decrease in swollen joints and weight loss of about 14 pounds.
- The Adventist Health-Study 2 included self-reported dietary, lifestyle and medical history data from more than 65,000 church members. It found that excluding all animal foods, including dairy products, was protective for Grave’s disease, an autoimmune hyperthyroid condition. However, lacto-ovo (milk and eggs allowed) and pescatarian vegetarian diets (fish allowed) were associated with less, only “intermediate” protection, according to the study published in the June 2015 issue of the journal Public Health Nutrition.
- The Mediterranean diet may suppress RA disease activity by increasing daily intake of monounsaturated fats, according to a study published in the April 2018 issue of the journal Clinical Nutrition. However, more evidence is needed to support the Mediterranean diet’s effectiveness in preventing or improving RA symptoms, according to a review published in September 2020 in the Mediterranean Journal of Rheumatology.
Additional Health Benefits
In addition to reducing joint pain, swelling and morning stiffness, plant-based diets have other important health benefits for people with RA.
“One thing to keep in mind is that people with rheumatoid arthritis are at risk for heart disease,” Prest points out. “So, following a more anti-inflammatory, plant-based diet is great for reducing heart disease risk and reducing the chronic inflammation and the symptoms that go along with that.”
Although losing weight may not be the primary reason to adopt a plant-based eating pattern, it can be a welcome result. “Weight loss is another aspect that helps people with rheumatoid arthritis independently” of its other effects, Kahleova says. “The joints suffer when we’re overweight. So, many people find that their symptoms improve by weight loss itself. Vegan diets have been shown to be super-efficient for weight loss.”
Your overall health can improve as you reduce risk factors for multiples conditions like heart disease, such as lowering your blood pressure or cholesterol levels, says Dr. Michael Greger, founder of NutritionFacts.org and a member of the U.S. News Best Diets expert panel.
How Plant-Based Diets May Work
Inflammation reduction is a key benefit of plant-based diets for people with autoimmune conditions like RA. “Rheumatoid arthritis, like any autoimmune disease, is characterized by elements of systemic inflammation, whether inflammation by C-reactive protein or other markers,” Greger says. “It’s indeed possible that the generic anti-inflammatory effect of a plant-based diet may be alleviating symptoms.” That’s why conditions such as multiple sclerosis, Type 1 diabetes, autoimmune thyroid disease and RA may be improved by eating this way, he says.
A complicated theory connects the dots among RA, the gut microbiome and bacteria that can cause antibody reactions that may damage joint tissues. “The first clue was that women get rheumatoid arthritis about three times as frequently as men,” Greger says, noting that women are also more vulnerable to UTIs. “Researchers tested the urine of arthritis sufferers and, lo and behold, they found this bacteria called Proteus mirabilis.”
This Proteus bacteria may possibly elicit an autoimmune reaction in the body that also involves the joints. “Anti-Proteus antibodies against bacteria may inadvertently be damaging all the joint tissue, so this eventually leads to joint destruction that characterizes the disease,” he says.
Altering the bacteria in your colon might help, Greger explains. “What changes the bugs in the colon is your diet,” he says. “What (researchers) found is when they put people on plant-based diets, you get a significant reduction in the anti-Proteus antibodies.” The jury is still out on precisely how that works.
“The Proteus explanation is controversial but the fact that a plant-based diet helps with rheumatoid arthritis is not controversial,” Greger says. “There’s also been benefits found with Mediterranean diets – plant-heavy diets although not necessarily plant-based. Benefits were found in both vegetarian and full-vegan diets, as well as with fasting.” Rheumatoid arthritis gets better when people go on a brief period of prescribed fasting, he says, but unfortunately, if they return to a standard unhealthy diet, their symptoms come right back.
Tweaking Diets to Ease RA
Prest says that rather than limiting diet options to vegan or vegetarian, “It’s more about: Are we focusing on more plants in the diet, and food sources from plants versus animal sources?” She, too, notes that a Mediterranean diet can help. “You can still include some meat in your diet,” she says. “You can also just go 100% plant-based. So, it’s really up to individual preferences and choice.”
Adapting your diet is daunting at first, as Kahleova has heard from RA study participants. “We are all creatures of habit,” she says. “So the first few weeks are usually challenging for people. Most families have five or 10 recipes that they rotate.” Oftentimes, a few simple food swaps can make these standard recipes vegan, she says. “Sometimes, you can also discover new recipes, not only finding vegan substitutes for whatever your favorite meals are, but also experiment a little bit with healthier options.”
Broaden your food-group horizons if needed. “Some people don’t consume any legumes: beans, lentils or peas,” Kahleova says. “Those are super-healthy foods that have been shown to be beneficial for our immune system and for reducing cardiovascular disease and the risk of diabetes. They have been found to be helpful for weight loss.”
Eliminating Inflammatory Foods
Sometimes it’s a matter of winnowing out specific foods or ingredients that may trigger RA symptoms. Even within a plant-based diet, there are certain pro-inflammatory foods that susceptible people can aim to avoid. Trying an elimination diet is another option.
“A good start would be the vegan diet because that eliminates most of the food triggers and most of the allergens that people usually react to,” Kahleova says. “Once people switch over to the vegan diet, most of their symptoms will improve automatically. But if someone still struggles with remaining symptoms, then in that case I would encourage them to try an elimination diet where we eliminate (certain) foods from the vegan diet, such as gluten-containing grains, soy foods, nuts and seeds.”
After eliminating such foods for three weeks, they would gradually be reintroduced, perhaps starting by adding back onions or apples, she says.
Chocolate and sugar are actually among the most problematic choices for people with RA, Kahleova notes. “A lot of people react to these foods, as well,” she says. “Although they are technically vegan, these would be ones to eliminate for a few weeks and reintroduce them back and see if they could be potential triggers for the pain in the joints.”
Nightshade vegetables – including eggplant, tomatoes, potatoes and peppers – are thought to exacerbate symptoms for some people with autoimmune conditions. However, “there’s really no research that supports that nightshade vegetables are harmful for people with rheumatoid arthritis,” Prest says. “But it goes back to symptoms.”
Pinpointing personal food issues can be challenging. “You might be someone who notices that they’re having symptoms if they’re including certain foods,” Prest says. “So it’s always good to work with a registered dietitian-nutritionist to see what kinds of food may be triggering symptoms for you and really working on ways to help adapt your diet and do the best that you can.”
Just Try It
For people with debilitating RA symptoms, giving some version of a plant-based diet a chance can’t hurt and may help enormously.
“I would really like to encourage (everyone) to give it a try, because the plant-based diet has power for many health conditions,” Kahleova says. “It’s not only about one particular condition, but it can improve the health of your heart, it can improve your metabolism and it can improve your immune function and your ability to fight cancer – and it can also help with autoimmune conditions such as rheumatoid arthritis. You have so much to gain if you’re willing to try the vegan diet.”
Greger asks: What do you have to lose? “The message I would leave is: Try this at home,” he says. “Think of all the benefits of a plant-based diet. The worst that can happen, well, your cholesterol gets a little better, your blood pressure gets better. It just has good side effects. Try it like an experiment – just like a free trial.”