Are Diets and Fasting Effective for Rheumatoid Arthritis?

For more than 10 years, for professional reasons (I am a physiotherapist) and personal reasons (there are inflammatory diseases in my family and in-laws), I have been interested in the effects of diets and fasting on rheumatoid arthritis . .

You can read tons of things about them.

In magazines or on certain websites, we are sometimes promised wonders thanks to the diet : relieving pain, reducing inflammation and sometimes even… healing!

On forums or social networks, we can also read very sincere testimonies from people who have really had an improvement in their health following a gluten-free diet , a Seignalet diet or other.

And who recommend following this or that diet.

However, I place moderate trust in these types of promises and testimonials. I like to rely on the results of scientific studies (when there are any) to make decisions in terms of health.

And that’s good: the effect of diet on rheumatoid arthritis has been studied for several decades !

So I created this article which I update regularly. My goal is to summarize our current, non-controversial knowledge on the impact of diets and fasting on rheumatoid arthritis .

I hope this knowledge will be useful to you!

Summary

Why do we think that diet can affect rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by systemic inflammation and joint destruction.

Some patients have active disease, despite pharmacological treatment .

Persistent disease activity leads to the destruction of bone and cartilage and negatively impacts quality of life due to pain, fatigue, depression, and decreased function.

Many RA patients (you?!) report that their diet impacts their disease symptoms and seek dietary advice to complement their current treatment.

Several nutrients and dietary components interact with the immune system and could theoretically affect disease activity in RA. These include:

omega-3 fatty acids: they can reduce the production of inflammatory eicosanoids, adhesion molecules and cytokines,
antioxidants: they can reduce oxidative stress and therefore possibly the symptoms and inflammation of RA,
vitamin D,
vitamin B6,
zinc,
selenium;
dietary fiber, prebiotics or probiotics could have beneficial effects on disease activity in RA by modifying the microbiota.

Weight loss resulting from dietary intervention could be beneficial for RA patients, as obesity is associated with more rapid progression of disabilities. But an energy deficiency could also put patients at risk of malnutrition .

That’s the theory. Now we need to look at whether, in fact, diets really have an impact on pain or other daily symptoms.

Source: Nelson 2020

What are the most popular diets for rheumatoid arthritis ?

Here are the names of the diets that are most searched for on the internet in association with the terms “rheumatoid arthritis”:

the Seignalet diet :
intermittent fasting . More rarely that induced by Ramadan;
gluten-free diet .

I will say a few words about them before taking stock of their relevance to rheumatoid arthritis.

The Seignalet diet

The Seignalet Diet is a diet that was developed by Dr. Jean Seignalet, a French physician, in the 1970s .

The Seignalet diet is based on the idea that the “modern Western” diet can contribute to the appearance of certain chronic diseases, such as arthritis and asthma, and that a diet closer to that of traditional societies can help relieve these conditions.

The Seignalet diet advocates not eating certain foods that Dr. Seignalet says could be difficult to digest and contribute to inflammation. These foods include:

the cereals,
legumes,
dairy products,
sugar,
and processed foods.

Intermittent fasting

Intermittent fasting consists of alternating periods of fasting (you eat nothing at all) and periods where you eat normally.

There are several intermittent fasting protocols, but one of the most common involves only eating during a certain period of the day (e.g., 8 hours) and fasting the rest of the time (e.g., 16 hours).

Intermittent fasting has been suggested as a way to:

losing weight ;
reduce the risk of certain chronic diseases, such as type 2 diabetes, rheumatic diseases and heart disease.

Gluten-free diet

The gluten-free diet excludes gluten , a protein found in certain grains, such as wheat, barley and rye, from the diet .

The gluten-free diet is used to treat celiac disease , an autoimmune condition that occurs when gluten is ingested and causes a reaction that damages the lining of the small intestine.

It is suggested for other pathologies such as rheumatoid arthritis.

The gluten-free diet involves not eating all foods that contain gluten, including:

breads,
pasta,
the cereals
bakery products,
many other foods that may be contaminated with gluten during production or processing.

It is possible to eat gluten-free grain-based foods, such as rice, corn and quinoa.

The 3 most talked about diets for rheumatoid arthritis are the Seignalet diet, the gluten-free diet and intermittent fasting . Here is now whether they are effective, and if so, on what parameters.

Are there many studies on rheumatoid and diets?

More than 400 studies on the effects of certain diets on rheumatoid arthritis have been published in major medical journals.

The first already dates from 1909 !

studies on diets and fasting in cases of rheumatoid arthritis

We have observed a significant increase in studies on the subject:

since the early 1980s;
and even more since the end of the 2010s.

Let’s now see what these studies tell us about the benefit or otherwise of diets and fasts on rheumatoid arthritis

How effective are diets or fasting on rheumatoid arthritis?

As there are many studies on the subject, some research teams do what are called systematic reviews. They select the best quality, least biased studies and summarize their results.

Here is what they say:

Diet type	Conclusion of the researchers	Reference
Vegetarian or vegan, Mediterranean, elemental and elimination diets	It has not been established with certainty that the diets relieve pain, stiffness, and the ability to move better . On the other hand, diets can be difficult to follow and can cause patients to lose weight (up to 3 kg) , even if they did not intend to do so.	Cochrane 2009
Mediterranean diet	The Mediterranean diet may make little or no difference in pain or disease activity and may slightly increase weight in patients with rheumatoid arthritis, but the certainty of the evidence is low. On the other hand, it was not possible to clearly establish whether the Mediterranean diet has an effect on functionality, morning stiffness or quality of life, because the certainty of the existing evidence was assessed as very low.	Porras 2019
Mediterranean diet, raw vegetable diet and anti-inflammatory diet	Studies of the Mediterranean diet have shown moderate strength evidence for positive effects on disease activity in RA . Not the others.	Nelson 2020
Mediterranean diet , Cretan Mediterranean diet, vegan diet, fasting 7 to 10 days followed by 1 year of vegetarian diet, ketogenic diet, allergen-free diets by eliminating certain foods that commonly cause allergies like wheat, eggs, dairy and spices, diet rich in polyunsaturated fatty acids, diet low in polyunsaturated fatty acids, energy-adjusted diet, diet	Some dietary interventions, including anti-inflammatory diets, vegetarian diets, the Mediterranean diet, and elemental diets, may help alleviate symptoms significantly, others only slightly, while it appears that a certain group of food continues to make symptoms worse. Despite the numerous studies that have been carried out in this area, there remains a lot of heterogeneity and bias both in terms of interventions and the results of clinical trials.	Raad 2021
Mediterranean diet	The identified studies suggested protective effects of fish, vegetables, and Mediterranean-type diets , although study results and methods were heterogeneous. There is no consistent evidence on the role of diet in the development of RA, partly due to differences in study quality and methodology.	Backlund 2022
Gluten-free diet	No scientific evidence was found to recommend gluten exclusion in RA patients.	London 2022
Vegetarian, vegan, Mediterranean, ketogenic diet = anti-inflammatory diet	All studies were at high risk of bias and the evidence was very weak. The main finding is that anti-inflammatory diets resulted in significantly lower pain than regular diets (-9 points on a scale of 0 to 100).	Schönenberger 2021

The results of the summaries of studies on diets, fasting and rheumatoid arthritis

Vegan diets : no meat, no fish, no eggs and no dairy products.

Vegetarian diets: no meat or fish.

Mediterranean diets: a limited amount of meat, a greater amount of fish, fruits and vegetables and olive oil.

Elemental Diets: Liquid diets that contain nutrients that are ground down to aid digestion.

Elimination diets: foods suspected of being the cause of certain symptoms are identified. We eliminate them from the diet, then reintroduce them one by one to determine which one is the cause.

Ketogenic diet: also called “very low carbohydrate diet” contains mainly fat (lipids) and very few carbohydrates.

What to conclude?

The evidence is in all cases of low quality , because it is difficult to assess the effectiveness of a diet, independent of other things people do. The diet for which the data is most favorable is the Mediterranean diet . If there is an effect, it is small , on the order of a 10% reduction in pain.
There is really no quality evidence supporting the gluten-free diet in RA (without associated celiac disease). Just like the Seignalet diet or intermittent fasting.
All diets have the potential to cause weight gain or loss . In some cases this can be considered a side effect. This is an element to take into account when trying to assess the benefit-risk balance for yourself.

Maybe it still works for some people?

You will always find testimonials from people who have really seen an exceptional improvement in their condition following the implementation of a diet, regardless of which one.

Just as you will find testimonials from people who have had significant health complications following this or that diet.

This is why I personally attach more importance to the results of clinical studies, even if they have their limits. This allows us to access a larger, controlled sample of people.

What diet should you adopt based on these clinical study results?

As I have explained throughout this article, there is no specific diet that has been proven to be beneficial specifically for people with arthritis, with strong evidence.

Even if the Mediterranean diet is the one that stands out the most.

General dietary recommendations

The general dietary recommendations therefore apply!

Eat a variety of foods from all food groups , including fruits, vegetables, whole grains, lean proteins, and healthy fats. (This is similar to what we often put behind the Mediterranean diet.)
Limit foods and drinks high in added sugars, saturated fat, and sodium .
Eat reasonable portions and avoid skipping meals.
Drink plenty of water and hydrating drinks.
If you need to lose weight, focus on reducing the amount of calories you consume (and/or increasing energy expenditure through physical activity) rather than completely eliminating certain foods or food groups.

What if you don’t want to make an effort on your diet?

Does this seem impossible to implement, too restrictive, frustrating ? This is completely understandable, and you are not the only person in this situation.

Living with a chronic illness like rheumatoid arthritis can be stressful and frustrating enough.

And the impact of diet remains limited : this is not what will drastically change the course of your life, at least in the short or medium term. And probably even in the long term.

It is therefore also entirely understandable that you decide not to follow these recommendations.

It’s up to you to weigh the pros and cons, depending on what YOU consider to be a priority ! We, health professionals, are here only to offer you the different options. It’s then up to you to decide… In any case, that’s how I see things!

My testimony of gluten-free diet and inflammatory rheumatism

Now that I’ve really outlined what we know about the effects of dieting in general, let me tell you about my own experience with it . It is of course there for purely illustrative purposes.

But I know that it is often more meaningful to have personal anecdotes to better retain more general information.

My partner has ankylosing spondylitis ( a rheumatic disease very similar to rheumatoid arthritis). In 2011, when he was in his twenties, he had a very significant flare-up . Leading him to have to stop working (he could no longer walk more than a few dozen meters, even with crutches).

He therefore tried “all out” by trying to eat gluten-free, quite strictly . We had literally mountains of boxes of rice cakes at home and at our loved ones’ homes to replace bread.

Sometimes he noticed (and so did I) that his big toes were much more red, swollen and painful . He then tried to remember what he had eaten the day before, and realized that he had eaten a food that contained gluten , or traces of it.

This lasted several months. His general condition was improving, but at the same time he had also started biotherapy with anti-TNF alpha drugs.

He then began to doubt the effect of gluten on his occasional inflammations. Were these just coincidences ? Because it is difficult to be sure of each food that contains gluten or not.

Was his brain making causal connections where there were really only correlations? Or maybe there were also times when he ate gluten without impact, and his brain didn’t pick up on them?

As the gluten-free diet is quite restrictive, he finally decided to stop. Without significant change in his inflammation and his general condition.

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In this article, I do not deal with food supplements, which will be the subject of a future article. You can enter your email below to be kept informed of the publication of future articles.

Are Diets and Fasting Effective for Rheumatoid Arthritis?

Why do we think that diet can affect rheumatoid arthritis?