Nutrition for Rheumatoid Arthritis and Ankylosing Spondylitis

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By Julie Chen, M.D.

This month, I would like to talk about rheumatoid arthritis and ankylosing spondylitis. Last month, we discussed gout and osteoarthritis, which are two other rheumatological diseases. But the thing that these four disease states have in common are that they are known to be highly susceptible to the positive influences of supplements and healthy lifestyle changes (3).

In my clinic of integrative medicine in San Jose, California, I find that many rheumatological diseases respond very well to diet and supplements. This month, one of the big categories of rheumatoid arthritis will be addressed. While we can always benefit from further research, the information we’ll talk about this month should get us going in the right direction for all those of you interested in how to better improve your health in this arena.

When you think about rheumatoid arthritis, you should look at it from the perspective of what you should take in or eat and what you should remove from your life and diet in regards to helping your body become healthier (3). In other words, what inflammatory factors should you remove and what anti-inflammatory factors should you include (3).

In various studies, omega-3 fatty acids have been seen to be beneficial for rheumatoid arthritis (6). The studies suggest reduction in joint tenderness and reduced usage of anti-inflammatory medications (6). The general recommendation is about 2 to 3 grams per day of EPA and DHA found in fish oil (6). In some studies, vegetarianism has been seen to be associated with relief of rheumatoid arthritis symptoms (6). There is some suggestion that coffee may not be ideal for patients who suffer with this disease and could worsen symptoms (7).

A diet rich in antioxidants such as selenium, vitamin C and vitamin E have been suggested to be beneficial for RA and also avoidance of alcohol may be helpful (4). Food sensitivities or allergies may play a role in RA symptoms such that processed starches, animal dairy, and red meats may worsen RA symptoms (5). Since evidence suggests that micronutrient deficiencies are common in patients with RA, patients should focus on eating foods rich in nutrients that are anti-inflammatory such as many of the vegetables you’ve been hearing about since you were children (5).

When it comes to the patients in my clinic with rheumatoid arthritis, I always recommend that they eat diets high in vegetables and low in processed starches and red meats with a focus of avoiding sugars and alcohol (3,7). This diet recommendation has worked very well with my patients including many patients who have achieved significant enough improvement that they have been able to be tapered down or off their medications by their rheumatologist.

Despite hearing this, I caution the readers to not take yourselves off medications and if you are doing much better on a cleaner diet, that you approach your rheumatologist to inquire about medication dosage changes… but do not come off medications on your own.

I always say to my patients a safe approach is a good team approach, so make sure to keep your “teammate” physician in the loop and have them hear about your great progress and decide together about your medication dosages.

Ankylosing spondylitis is a disease where the joints and ligaments of your spine become inflamed and may eventually fuse (1). HLA-B27 positivity on testing can frequently suggest some version of this disease but you would need to have your doctor make that lab evaluation and diagnosis to confirm or refute your suspicions (1). In small studies, starch restriction seems to reduce serum immunoglobulin A and symptoms seem to improve (2). While the research on this topic warrants further investigation, in my clinical practice, I have seen this to be true of many of the rheumatological diseases.

In regards to supplement therapy for these disease states, I always use supplements as a second line of natural therapy since the foundation of natural therapy in my opinion is diet (3). It is important to always remember that these diseases can be severe and debilitating and postponing medication therapy should only be done if you have consulted your physician and you should not make therapeutic decisions purely on your own… it is not safe.

I am a big fan of patients taking their own health into their own hands but only in the way such that you take ownership for making healthy lifestyle changes. But you need the guidance of physicians to help you understand where your disease severity is and once you have discussed all of your therapeutic options with your doctor is when you AND your doctor can come up with the safest plan for you.



2. Ebringer R, et al. A possible link between Crohn’s disease and ankylosing spondylitis via klebsiella infection. Clin Rheumatol 2007;26:289-297.

3. Katz DL. Nutrition in Clinical Practice. 2nd Edition. 2008. Lippincott Williams & Wilkins. Philadelphia, PA.

4. Stone J, et al. Inadequate calcium, folic acid, vitamin E, zinc and selenium intake in RA patients. Semin Arthritis Rheum. 1997;27:180-185.

5. Pattison DJ, et al. The role of diet in susceptibility to RA: systematic review. Arthritis Rheum. 2004;50:3804-3812.

6. Adam O. Anti-inflammatory diet in Rheumatic disease. Eur J Clin Nutr 1995;49:703.

7. Karlson EW, et al. Coffee Consumption and risk of rheumatoid arthritis. Arthritis Rheum. 2003;48:3055-3060.

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