I work as a registered nutritionist with the National Rheumatoid Arthritis Society and this is my article that they have published. See below for full article link.
Evidence suggests that nutrition can play an important role in the management of Rheumatoid Arthritis (RA) and Juvenile Idiopathic Arthritis JIA.
There is a lot of nutrition information out there and with that comes misinformation. Altering your diet to help your RA/JIA symptoms is very individual. Auto-immune conditions are complex. The effects they have on the body vary from person to person. This is the second blog on how to help RA/JIA with nutrition, the first is here.
Gut health – eat for your gut bugs
Why?
Our gut is home to trillions of bacteria, viruses and fungi. We call this our gut ‘microbiome’. The gut microbiome’s relationship with the immune system impacts autoimmune diseases. Emerging research highlights the importance of maintaining gut health in managing these conditions.
Dysbiosis is an imbalance of ‘friendly’ vs ‘unfriendly’ bacteria in the gut. This imbalance can lead to increased inflammation in the gut. This can worsen joint inflammation in RA/JIA as well as symptoms such as fatigue and brain fog.
Dysbiosis can also cause leaky gut syndrome. Leaky gut is a condition where the gut barrier becomes more ‘permeable’. This means that more water and nutrients can pass (or ‘leak’) through it. This can cause toxins, food, bacteria and other substances to enter into our blood system. Our immune system reacts to this, which in turn causes inflammation.
It’s vital to keep a healthy microbiome and what you eat matters. You are eating for two – for you and for your bacteria! Feed the helpful microbiota and they will help promote immune tolerance, lower inflammation.
How to do it
Increase fibre-rich foods (see Table 1), prebiotic foods and fermented foods. Fermented foods are probiotic foods which can feed the bugs we wish to increase and crowd out those we don’t want. The bugs we don’t want tend to feed on sugar and ultra-processed foods.
Take out refined carbohydrates, sugars and processed foods. These foods feed the ‘unfriendly’ bacteria, which can lead to inflammation and dysbiosis.
Probiotic foods
Probiotics are ‘friendly’ bacteria. They can improve our health by making our gut function better. They do this by restoring or maintaining a healthy balance in the gut. If you are on a biologic medicine and want to add fermented food to your diet, you should do so with caution. Look for shop bought and commercial sources of pro-biotics, rather than home-made. This is because people taking biologic medicines are more prone to infection. Fermentation can cause harmful bacteria to spread if not done under controlled conditions.
Examples of probiotic foods include:
Kefir
Kimchi
Sauerkraut
Natural yoghurt/Greek yoghurt
Kombucha
Prebiotic foods
Prebiotics are the food that fuels the friendly bacteria in your gut. They are types of carbohydrate that only gut bacteria can digest. Prebiotic containing foods include:
Garlic
Ground flax
Onions
Jerusalem artichoke
Leeks
Asparagus
Bananas
Oats
Apples
Avocado
Table 1. Whole Grains and Source of Dietary Fibre
Dietary fibre comes from plant-based foods. It is the part of these foods that your small intestine cannot digest of absorb. It is instead broken down by bacteria in the large intestine.
Dietary Fibre Sources:
Wholegrain pasta/bread
Porridge from steel cut oats or rolled oats (no instant porridge)
Oat bran
High fibre breakfast cereals
Potato skins
Sweet potato
Beans – cannellini beans, chickpeas etc.
Pulses
Vegetables
Fruits, especially where you eat the skin and seeds
Seeds, e.g. linseeds, chia seeds, sunflower
Nuts, e.g. almonds, hazelnuts, peanut butter
Note that anything that says ‘high in fibre’ = more than 6g fibre per 100g and a ‘source of fibre’ = at least 3g fibre per 100g.
Fish Oils and Omega-3 fatty acids
Omega 3 fatty acids play an important role in the inflammatory response in the body. Evidence suggests that omega 3 (from oily fish or supplements) can improve RA/JIA symptoms. It can take up to 3 months to see the benefits of taking regular Omega 3. These benefits can include a reduction in the number of swollen and tender joints.
Omega 3 Supplements
The amount of Omega-3 fats necessary to improve your RA/JIA symptoms is around 3g per day. The amount of omega 3 fats contained in a fish oil capsule varies. Check the amount per capsule when comparing prices. It is important to check that fish oil supplements are safe to take with any medications you are on. Ask a health professional such as your GP or a BANT registered Nutritional Therapist like myself.
Omega 3 in food
Omega-3 fats can also come from food. Natural sources of omega-3 fatty acids are oily fish such as mackerel and fresh (not tinned) tuna. Choose fish from sustainable sources where possible. Look for Marine Stewardship Council (MSC) certified products. You can also refer to The Good Fish Guide from the MSC for guidance. Some fish can contain higher levels of mercury and environmental toxins. Avoid older and larger fish (the type that may feast on smaller fish). These include shark, swordfish and king mackerel.
Smaller fish are better sources of omega 3. The following ‘SMASH’ acronym may help you to remember them:
Salmon
Mackerel
Anchovies
Sardines
Herring
Eating oily fish 2 or 3 times a week provides a reasonable intake of Omega 3. Omega 3 can also come from plant sources such as linseed and evening primrose. This has a weaker effect on inflammation than Omega 3 from fish oil.
Note: If taking fish oil supplements, please make sure that it is omega 3 EPAs and DHA.. Always use pure fish oil products and check that is is certified for purity, potency and safety. Fish oils can interact with some medications, e.g. Warfarin. Always seek medical advice before starting supplements.
Omega 3 fish oils can perish, so make sure you keep any liquids in the fridge and any capsules in a dark cupboard. Make sure the capsules have an added antioxidant such as vitamin E to also keep it more stable. I can help if you are unsure.
The omega 3:omega 6 ratio
Whilst Omega 3 fats reduce inflammation omega 6 fats may increase inflammation. It is important for you to reduce Omega 6 fats in the diet whilst increasing omega 3.
One of the best ways to reduce Omega 6 is to stop using sunflower oils/margarines/spreadable butters. Replace these with real, grass-fed butter or using olive oil. Most ‘spreads’ have a high volume of rapeseed oil with is a source of omega 6.
Omega-6 fats are present in:
vegetable/seed oils (not extra virgin olive oil)
margarines
ultra processed foods
seeds and nuts
spreadable butters
all deep fried food
crisps
confectionary
most ultra-processed foods and even the healthy looking foods in the deli. Look at the ingredients in your houmous, salsa and even the oil in the olives!
Nuts, seeds and poultry can contain Omega-6. Yet some benefits of these foods may outweigh the negatives. Concentrate on removing man-made ‘factory fats’ rather than fats that are ‘naturally’ present. Nature does fats right!
Reducing inflammation is not only important for improving your joint pain and stiffness. It will also reduce your risk of heart disease, which people with RA are at increased risk of.
Vegetables, fruits and antioxidants
Antioxidants are substances that can prevent or delay some types of cell damage. Fruits and vegetables contain antioxidants. Eating foods which are rich in antioxidants on a regular basis can benefit your health. They can reduce the symptoms of chronic diseases, including inflammatory arthritis.
Brightly coloured varieties of fruit and vegetables are particularly good sources of antioxidants. These include:
berries
leafy greens
red onions
oranges
apricots
carrots
peppers
tomatoes.
The most common antioxidants are Vitamins A, C and E but there are many more, some of which we do not know yet.
When inflammation occurs in RA, your immune system produces substances called ‘free radicals’. These can be harmful to your body. Antioxidants found in brightly coloured fruit and vegetables can help limit this damage. They can also have an anti-inflammatory effect. This is important for improving symptoms and reducing your risk of heart disease.
There are many ways to increase your vegetable intake. Aim to ‘eat the rainbow’ and have at least three colours of fruit or vegetables in each meal. More colours means more variety. This variety will help you to get all the different nutrients your body needs.
Other tips
Pick one new vegetable a week to cook with
Top your breakfasts with colourful berries
Swap pasta or rice for courgette or cauliflower rice
Batch cook a mix of roasts at weekends and add to weekly meals
Stack your freezer. Farmers pack fruit and veg for frozen foods within hours of picking. This helps to seal in the nutrients.
Vegetable smoothies can be a helpful way to increase your intake
Eat fruit as dessert
If this is a way of eating that is very far removed from where you are now, then make small and sustainable changes. You can start by adding protein, colour and whole grains to each breakfast and work from there.
Please see the link to blog 3 for how to and why you should:
Increase vitamins and minerals
Consider a gluten exclusion
Consider supplementation (safely checked against any medications)
Keep a food and symptom diary
In case you missed it, here is the link to blog 1
I am delighted to be the nutritionist for, and have an article published with, the National Rheumatoid Arthritis Society (NRAS), who endlessly look for the latest research in how to support RA. My full article is here in my blog, spread out in bitesize chunks!
How I can help with Nutritional Therapy
Using the functional medicine approach, I work to understand why you have RA and to see what factors are contributing to it. I can order and interpret functional tests where necessary, such at gut health and digestion, blood tests to look for nutrient deficiencies, inflammation, other contributing factors as well as co-existing auto-immune diseases. Contact me here and book a free 20 minute Reboot your Health call.
You can expect from me:
A personalised nutrition plan rich in nourishing foods to assist your joint function and inflammation
Test recommendations and full interpretation either privately or through your GP
Personalised supplement protocol - meticulously checked against medications
Regular consultations and coaching to support new choices
Note: as a Nutritional Therapist, I do not diagnose or prescribe, however I do use functional nutrition testing to help find the best way to support my client’s health.
My programmes are designed with people like you in mind. I see many clients with auto-immunity and they all have different symptoms, family health histories, lifestyles, work and family life which may may have contributed to where they are. This is why a personalised nutrition and lifestyle rather than a 'one size fits all' gets such good results. Book your free Reboot your Health 20 minute call to discuss your health goals and if working with me would benefit you.
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