Rheumatoid arthritis

Arthritis is a group of diseases that cause painful and swollen joints. Arthritis is one of the most common health conditions in the United States, affecting approximately one in four adults. Osteoarthritis (OA) is a degenerative disease that typically develops gradually and can cause pain and stiffness. Rheumatoid arthritis (RA) is more aggressive and occurs when the body attacks the joints. RA causes painful, inflamed joints and can result in permanent damage. Certain genes also make some people more likely to develop RA.

Rheumatoid arthritis

While genetic factors are important, research shows that lifestyle factors, including diet, are also important in the prevention and management of RA. The Western diet, characterized by high intakes of red and processed meat, sugar-sweetened beverages, refined carbohydrates, and excess calories, has been associated with an increased risk of RA, largely through increasing inflammation in the body and causing weight gain.¹ On the other hand, the anti-inflammatory compounds found in fruits and vegetables have been associated with a reduced risk of RA.^2,3

Overweight and obesity increase the risk of developing RA, and being overweight at 18 years of age is associated with a 35% increased risk of developing RA later in life.^4,5 Two meta-analyses have found that vegan and vegetarian diets are an effective way to lose weight.^6,7 Research published by the Physicians Committee has shown that a low-fat, plant-based diet can result in an average weight loss of more than 12 pounds in 14 weeks.⁸

In those with established RA, a plant-based diet is effective at reducing RA symptoms. A low-fat vegan diet, without calorie restrictions, improves joint pain in patients with rheumatoid arthritis, according to a study conducted by researchers at the Physicians Committee and published in the American Journal of Lifestyle Medicine.⁹

Another randomized clinical trial that looked at the effects of a low-fat plant-based diet on people with moderate to severe RA found that after just four weeks on the diet, participants experienced significant improvements in morning stiffness, RA pain, joint tenderness, and joint swelling.¹⁰

The Plants for Joints randomized controlled trial published in 2023 used a whole food, plant-based diet, physical activity, stress-reduction techniques, and social support for a 16-week intervention.¹¹ The intervention resulted in a moderate improvement in RA symptoms, as well as an improvement in other health indicators, such as weight loss, improved blood sugar control, and lower cholesterol.

Another four-week randomized controlled trial found that a seven to 10-day fast, followed by a gluten-free vegan diet resulted in improvements in the number of painful joints, pain scores, morning stiffness, and blood markers of inflammation, and these benefits were still present at the participant follow-up a year after the intervention.¹²

Why does it work?

Plant-based diets are typically low in saturated fat and high in fiber, which can reduce inflammation and decrease pain and swelling. Plant-based diets are associated with a lower body mass index, as mentioned above. Studies show that excess body weight increases the risk for developing RA and decreases the likelihood of remission if RA is already present. A 2018 analysis found that RA patients who lost more than 5 kilograms of body weight were three times more likely to experience improvements than those who lost less than 5 kilograms.¹³

Osteoarthritis

Obesity increases the strain on weight-bearing joints, such as the knees and hips. As a result, it increases the risk of developing OA and requiring a hip or knee transplant.¹⁴ Vegans and vegetarians have lower BMIs than people who eat meat, and even eating meat one or more times per week is associated with an increased risk of OA.^15,16 Another study found that a high-fiber diet lowers the risk for knee osteoarthritis by up to 61%.¹⁷

People with osteoarthritis can also benefit from dietary changes. A 2015 study found that people eating a whole food, plant-based diet significantly decreased their osteoarthritis pain—in just two weeks!¹⁸ By the end of the six-week study, they reported more energy and better physical functioning, too. More recently, a 16-week lifestyle program based on a whole food, plant-based diet, physical activity, and stress management was found to improve symptoms of metabolic syndrome-associated osteoarthritis, in the Plants for Joints randomized controlled trial.¹⁹ Participants experienced decreased pain and stiffness and improved physical function.

Gouty arthritis

Gouty arthritis is an inflammatory type of arthritis, triggered by deposits of uric acid crystals in the joints. People who follow a vegetarian diet are at a significantly lower risk of developing this type of arthritis.^20,21 People who are overweight or obese are at a higher risk of developing gouty arthritis, and as shown above, a plant-based diet is an effective way to maintain a healthy body weight.²² Alcohol, meat, and sugar-sweetened beverages have all been found to increase uric acid levels.²³ People eating the highest amount of meat and seafood have been found to be 41% and 51% more likely, respectively, to develop gout than those eating the least amount of meat and seafood.²⁴

Try the Four-Week Anti-arthritis Diet

Here's how to get started on the Four-Week Anti-arthritis Diet. For four weeks:

1. Enjoy an abundance of foods from the pain-safe list below.
2. Avoid common triggers completely.
3. Foods that are not on either list can be eaten freely.

You may start feeling better earlier than four weeks, but it often takes at least four weeks for chronically inflamed joints to begin cooling down.

After four weeks, if your symptoms have improved or disappeared, the next step is to nail down which one or more of the trigger foods caused the problem. Simply reintroduce the foods you have eliminated back into your diet one at a time, every two days.

Have a generous amount of each newly reintroduced food and note if your joints flare up again. If so, eliminate the food that seems to have caused the problem, and let your joints cool down again. Then continue to reintroduce the other foods. Wait at least two weeks before trying a problem food a second time. Many people have more than one food trigger.

Pain-Safe Foods

Pain-safe foods virtually never contribute to arthritis, headaches, or other painful conditions. These include:

• Oats
• Quinoa
• Rice
• Buckwheat
• Millet
• Lentils
• Cooked green veggies such as artichokes, asparagus, broccoli, Brussels sprouts, spinach, kale
• Cooked yellow and orange vegetables such as carrots, zucchini, and squashes
• Cooked or dried noncitrus fruits such as pears, apricots, blueberries, and plums

Common Pain Triggers

Common triggers often cause pain in susceptible people. Certain drinks and additives are also common triggers, including alcoholic beverages (especially red wine), caffeinated drinks (coffee, tea, and colas), monosodium glutamate, aspartame (NutraSweet), and nitrites. Here are the common food triggers, also known as the “Dirty Dozen”:

• Dairy
• Chocolate
• Eggs
• Citrus fruits
• Meat
• Wheat
• Nuts and peanuts
• Tomatoes
• Onions
• Corn
• Apples
• Bananas

After four weeks on the elimination diet, you may find that a plant-based diet is the key to remaining pain free.