The role of diet and gut health in rheumatoid arthritis
Gluten and dairy intolerance:
Research shows that many rheumatoid arthritis symptoms improve when gluten is taken out of the diet. Gluten is a protein found in wheat, barley, rye, and other common grains. Gluten is also added to many processed foods, beauty products, medications, and supplements.
The rates of celiac disease and non-celiac gluten sensitivity have been rising steadily for the past several decades due to the new type of wheat being grown, which has been hybridized and deamidated. While statistics vary, some studies suggest that up to 30% of the population is now gluten sensitive, and somewhere between 50-99% of people with celiac disease or gluten sensitivity are never diagnosed.
When gluten reaches our gut, it’s broken down into the proteins gliadin and glutenin. In people who are gluten sensitive, the immune system sees gliadin as dangerous and produces antibodies to attack it. In people who have celiac disease, those anti-gliadin antibodies also cause gut permeability (leaky gut), which allows toxins, microbes, food particles, and the anti-gliadin antibodies to leak out of the intestines and travel through the body.
Anti-gliadin antibodies often attack other things in the body besides just gliadin, and can trigger the immune system to attack its own tissues; this is how autoimmune conditions result from gluten sensitivity and celiac disease. The presence of anti-gliadin antibodies is associated with rheumatoid arthritis, Hashimoto’s thyroiditis, IgA-nephritis, psoriasis, sickle-cell anemia, and hepatic disorders. Gluten sensitivity and celiac disease can also lead to neurological symptoms including dysregulation of the autonomic nervous system, cerebella ataxia, hypotonia, developmental delay, learning disorders, depression, migraine, and headache.
In one small study, 18 out of 18 patients with rheumatoid arthritis improved on a gluten-free diet, often after just two weeks on the diet. Another small study showed that removing gluten from the diet can improve symptoms of rheumatoid arthritis, even in patients who are resistant to conventional drug therapies. A larger study of 121 RA patients found that anti-gliadin antibodies were more prevalent in RA patients than in the general population.
Like gluten, research consistently shows that dairy consumption is linked to an increase in autoimmune symptoms. Casein accounts for 80% of the protein in milk, whey accounts for about 20%, and other minor proteins like lactoglobulin, lactalbumin, serum albumin, immunoglobulins, and glycomacropeptides make up the rest. Casein in particular is difficult to digest for many people, and often leads to an inflammatory autoimmune response. Dairy consumption has been linked to a number of autoimmune conditions, including rheumatoid arthritis, type 1 diabetes, inflammatory bowel disease, multiple sclerosis, and others.
Some studies show that removing gluten, dairy, and meat from the diet reduces the symptoms of RA. In a study of 66 patients, 40.5% of the RA sufferers who ate a vegan, gluten-free diet for nine months or more improved, and their improvement was consistent with a reduction in anti-gliadin and anti-beta-lactoglobulin antibodies. Another study of 40 RA patients showed that removing gluten, dairy, and meat from the diet for three months significantly reduced inflammation and pain.
Since gluten and dairy are consistently associated with an increase in autoimmune symptoms, it is often advised that anyone with an autoimmune condition do an elimination diet in which gluten and/or dairy are removed from the diet completely for at least one month. If you feel significantly better without gluten and/or dairy in your diet, or if you feel noticeably worse after reintroducing either one, then you are likely sensitive to one or both.
If you want to learn more about which foods and other environmental factors may be causing or contributing to your rheumatoid arthritis, I recommend reading The Autoimmune Solution by Dr. Amy Myers and Beat Autoimmune by Palmer Kippola.
Insulin resistance and hyperinsulinemia are hallmarks of type 2 diabetes, but they’re surprisingly common among RA sufferers as well. When synovial joint fluid is exposed to high levels of insulin, immune cells invade the area, causing inflammation in the joint and reduction of the production of synovial fluid. And as Dr. Benjamin Bikman writes in Why We Get Sick, “Rheumatoid arthritis is heavily associated with insulin resistance to the point that those individuals who experience the worst inflammation also experience the greatest insulin resistance.”
Some research shows that the insulin resistance experienced in RA sufferers is actually caused by the inflammation associated with RA, instead of the other way around. However, in most of us, insulin resistance and hyperinsulinemia are the direct result of the food we eat. Diets high in added sugar and refined carbohydrates raise our insulin levels, and over time lead to insulin resistance. To learn more about how diet leads to insulin resistance and hyperinsulinemia, I highly recommend Dr. Jason Fung’s phenomenal books The Obesity Code and The Diabetes Code.
A significant body of research shows that the bacterium Proteus mirabilis, which is responsible for urinary tract infections, is strongly correlated with and potentially causative of rheumatoid arthritis. P. mirabilis infection can lead to inflammation and joint damage in RA by the mechanism of molecular mimicry. This means that when the body produces antibodies to P. mirabilis, these antibodies may mistakenly attack cells in the synovial tissues that are similar in structure to P. mirabilis. Some researchers recommend that RA sufferers be treated early on with anti-P. mirabilis antibiotics as well as biological agents. You can also address this infection with diet; P. mirabilis feeds on refined carbohydrates, which may be one reason why RA symptoms tend to improve on diets that restrict or eliminated refined carbohydrates.
In a study of 114 people, 75% of RA patients had the bacteria Prevotella copri in their intestines as opposed to just 21% of healthy controls. Higher levels of P. copri correlated with a reduction of Bacteriodes and a loss of beneficial microbes in the RA patients. Other research shows that people with RA have higher levels of antibodies that target P. copri in their bloodstream. While P. copri helps to digest fiber and is commonly found in the gut, it is also linked to insulin resistance, high blood pressure, and inflammation. Researchers suggest that P. copri may bind to the mucous lining of the gut and escape into the bloodstream, where it provokes an immune response. The bacteria may also invade the joints and cause inflammation and damage to the synovial lining.
Some research has been carried out to test the efficacy of therapeutic fasting, both intermittent and extended, for relieving rheumatoid arthritis. Fasting can benefit RA sufferers for several reasons.
If any foods being consumed are contributing to RA symptoms, fasting immediately and completely removes them. This can lead to rapid improvement of symptoms. However, research shows that if RA patients resume their normal diet after their fast, their symptoms return. Some research suggests that the positive effects of the fast can be prolonged by following the fast with a vegetarian diet or more healthful diet than they had previously been eating.
While research has not yet shown this benefit for RA specifically, fasting can allow harmful gut bacteria to die off. Fasting also significantly improves insulin resistance by lowering insulin levels, which as previously mentioned tend to be higher in people with RA.
Fasting, especially extended fasting, has also been shown to “reset” the immune system. While fasting, the body eliminates old or damaged immune system cells through a process called autophagy, and regenerates new cells.
If you’re interested in learning more about therapeutic fasting, I highly recommend reading The Complete Guide to Fasting by Dr. Jason Fung.