Rheumatoid arthritis is an inflammatory disease in which the immune system turns on itself and attacks the joints. This progressive condition can strike at any age and most commonly starts in the joints of fingers and feet. It is three times as likely to affect women as men and can last for years with alternating attacks and remission. Changes in diet can help to alleviate symptoms to different degrees in individuals and may be more effective at different times. As the dietary advice is in line with current healthy eating principles, it should be followed at all times including during periods of remission.

Maintain a healthy weight

It is important to lose weight if you are overweight. Too much body fat increases the levels of inflammation in the body, making your joints more painful. A healthier body weight reduces inflammation and pain.

Change your fats

The types of fats and oils you eat can influence levels of inflammation and pain. Having too many foods high in saturated fats and omega 6 polyunsaturated fats can increase pain and inflammation in the body. Saturated fats are found in full fat dairy products, fatty meat products, pastries, cakes and other processed foods. Omega 6 polyunsaturates are found in oils and margarines made from corn or sunflower oils. Monounsaturates are ‘neutral’ fats and do not worsen inflammation, so use olive oil and olive-oil-based spreads. As body cells naturally renew, monounsaturates will replace the omega-6 polyunsaturates within the cell to reduce inflammation. It will take several weeks for any noticeable effect.

Follow a ‘Mediterranean’ type of diet

The Mediterranean diet includes plenty of colourful fruits and vegetables and foods rich in monounsaturates both of which can help reduce RA inflammation. Chemicals from the environment can attack the fats in cells causing inflammation. The antioxidants in the fruit and vegetables reduce this by ‘mopping up’ these chemicals. Eating more monounsaturates means that as the body cells naturally renew themselves more monounsaturates will be incorporated within the cell which will reduce inflammation. Aim for at least five portions of fruit and vegetables every day. Choose vegetables of different colours for a wide range of plant nutrients to help reduce inflammation. Use olive oil when cooking or add to salads and include foods such as nuts, avocados and olives.

Eat more oily fish

Oily fish are a rich source of long chain omega 3 polyunsaturated fats, which can actually help to reduce inflammation. Oily fish include mackerel, sardines, herring, fresh tuna, salmon, trout, and snapper. Aim to eat two to four portions a week. Omega-3-enriched eggs can be useful if you do not like oily fish. (Note: girls and women of child-bearing age, or who are pregnant or breastfeeding, shouldn’t eat more than two portions of oily fish a week. Older women, boys and men can eat up to four portions a week.)

Eat iron-rich foods

Anaemia is often associated with RA, so make sure you are eating adequate amounts of iron-rich foods. Liver and red meat are the richest sources, and should be included in small amounts once a week. Iron is also found in oily fish, pulses, eggs, green leafy vegetables and fortified breakfast cereals. Iron absorption is boosted by having a source of vitamin C at the same time, such as glass of orange juice.

Restrictive diets and food allergies

Fasting is an extreme way of controlling pain and inflammation in RA, and is not recommended. RA is the result of a change in how the immune system works, so common alternative practices often suggest food allergy as a cause. Diagnostic tests such as Applied Kinesiology, Vega testing and cytotoxic testing do not diagnose food allergy accurately. ELISA testing gives more reliable results, but simply restricting foods can cause nutritional deficiencies. If you want to change your diet in some way, a dietitian referral via your GP can help you make sensible dietary choices.

Nutritional supplements

Fish oil supplements can reduce background inflammation – select a supplement containing a total of 500-750mg of the fish oils EPA and DHA. Plant omega-3 fat (GLA) from linseed, evening primrose, and borage (starflower) oils have a weaker effect on reducing inflammation, and do not seem to be of great benefit.