Diet & Nutrition Affect Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder characterized by progressive joint cartilage and bone destruction, oxidative stress, lipid peroxidation, DNA damage, and compromised antioxidant systems.

Although RA has a significant genetic component, environmental factors affect the extent and severity of disease, a process that begins years before clinical manifestation. Factors that promote or worsen RA may be especially significant in those genetically susceptible.

Potential promoting factors:

• Air pollution
• Cigarette smoking
• Coffee, four or more cups/day, especially unfiltered coffee
• Decaffeinated coffee solvent
• Dust
• Dysbiosis, e.g.,
  • Increased Colinsella, Prevotella copri (TMAO producer)
  • Decreased Faecalibacterium, Bifidobacterium, and Bacteroides
• Gluten
• Infections
• Metabolic syndrome
• Muscle loss
• Obesity, high waist circumference
• Sarcopenic obesity
• Sugar-sweetened or high-fructose-sweetened beverages
• TMAO produced from choline and carnitine by GI bacteria
• Tomatoes, potatoes, and eggplant in sensitive individuals
• Western-style diet
  • Excess calorie intake
  • Low ratio of omega-3 to omega-6 foods
  • Low fiber
  • Microbiota imbalances
  • Omega-6:Omega-3 dietary ratio 10-20:1
  • Red meat
  • Refined carbohydrates
  • Excess salt
  • Saturated fats from animals
  • Trans fats

Role of diet in rheumatoid arthritis (RA) pathogenesis

Potential Protective Factors:

• Black tea, green tea
• Calorie restriction
• Healthy oils
• Exercise and regular physical activity
• Fatty fish, e.g., sardines, salmon, seabream, seabass, and trout, 1-2 times/week along with other fish intake
• Fiber
• Fruits and vegetables, five or more servings per day, preferably seasonal and local
• Maintaining a healthy weight and body composition
• Mediterranean diet
  • Extra-virgin olive oil
  • Fish
  • Fruit
  • Herbs and spices
  • Legumes
  • Low consumption of red meat and refined sugar
  • Moderate intake of eggs, poultry, and dairy
  • Red wine in moderation
  • Unrefined cereals
  • Vegetables
• Omega-3 fatty acids EPA and DHA, at least 210 mg/day
• Omega-6:Omega-3 dietary ratio of 1-4:1
• Vegetarian diet
• Vitamin D sufficiency

Nutrients and their food sources involved in the development and progression of Rheumatoid Arthritis

Optimal Takeaways

• Rheumatoid arthritis is an inflammatory disease
• A healthy anti-inflammatory diet based on the Mediterranean diet or a vegetarian diet can help reduce inflammation and symptomatology
• Consume an abundance of fruits, vegetables, fiber, fatty fish/omega-3s, extra-virgin olive oil, tea, and antioxidants
• Maintain a healthy gut microbiota
• Consume a 1-4:1 ratio of omega-6s to omega-3s
• Maintain a healthy weight and muscle mass
• Avoid pollution, smoking, trans fats, highly processed foods, gluten, and sweetened beverages
• Limit intake of red meat, refined carbohydrates, and coffee

Reference

Gioia, Chiara et al. “Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations?.” Nutrients vol. 12,5 1456. 18 May. 2020, doi:10.3390/nu12051456 This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).