How can nutrition and lifestyle support rheumatoid arthritis? Nutrition A debilitating condition that causes painful joints and low mood, rheumatoid arthritis (RA) affects an estimated 1% of the UK’s population. Although associated with later life, it can develop at any age, even in adolescence. This is because unlike osteoarthritis, which develops as a result of wear and tear on the joints, it is an autoimmune condition: meaning the immune system mistakenly attacks healthy cells. For reasons that are not fully understood, it is more likely to develop in women aged 40 and 60. While rarer, it can develop in men at a later age. Symptoms of rheumatoid arthritis RA can be both physically and emotionally draining, with symptoms including swelling, stiffness, and a throbbing, aching pain affecting the small joints in hands, wrists and feet. Symptoms are usually worse after inactivity or first thing in the morning and, according to the NHS, pain usually occurs on both sides of the body simultaneously — so, for example, both hands or feet at the same time. It can also affect other parts of the body such as skin, eyes (causing dry eyes), heart, lungs and blood vessels. Although swollen joints are typical, antibodies (known as ACPA) and pain can be present before any signs of swelling. If you suspect you have RA, consult your GP because early diagnosis is important. What causes rheumatoid arthritis? Currently, it is not fully understood what causes RA but genetics do play a part. Having a close relative with the disease increases risk, as do several lifestyle and environmental factors. Lung exposure to silica or cigarette smoke, obesity, gum disease, IUD contraceptive use, or exposure to environmental pollutants or toxins are all known risk factors. Risk factors may promote inflammation, which is a main characteristic of RA. Gum disease, contraception and RA It is also possible to have RA antibodies without any obvious symptoms. In the case of gum disease, one study found that individuals who tested positive for RA antibodies without clinical symptoms had higher levels of P gingivalis, a bacterium linked to gum disease. The good news here, however, is that most of us have control over our dental health. Improving symptoms of gum disease has been found to reduce RA symptoms such as arthritic pain, number of swollen joints and the degree of joint stiffness in the morning. In the case of contraceptives, it has been found that IUD-users who had a close relative with RA were at higher risk of developing the disease in the future. However, because these women were already at a higher risk because of the genetic aspect, that particular study could not be applied to the general population. There is a crossover between RA and gluten sensitivity, and even in non-sensitive individuals gluten can increase intestinal permeability (leaky gut), which can exacerbate the autoimmune process which drives RA... How can nutritional therapy help to manage rheumatoid arthritis? Paula Werrett, a registered nutritional therapist and head of undergraduate provision at ION, says there are various factors that can contribute to the development of RA. She lists exposure to certain viruses, chronic stress, hormonal imbalances, digestive problems, and nutritional deficiencies as all possible antecedents. Because of this, when working with clients with RA, she takes a personalised approach. “This would involve taking a case history to understand family history, stress, diet and lifestyle and other health issues to help direct further investigation,” she says. “I would then look at testing to explore hormonal balance and to look at how well the gut is working — to examine the bacterial balance and to identify any pathogens.” Putting in place a plan would be tailored to the client and clinical findings. “Often this would involve removal of problematic foods and [adding in] a Mediterranean-style wholefood, anti-inflammatory diet rich in plant foods, fish, olive oil and healing nutrients,” she says. Read more about personalised nutrition She adds that targeted supplements can also be helpful, including nutrients such as colostrum, l-glutamine and n-acetyl glucosamine to heal the gut. “Fish oils, probiotics, curcumin, ginger and bowellia can help to regulate the immune response. Finally, it can be helpful to supplement micronutrients to address deficiencies whilst the diet is improved.” Werrett says she would also often recommend clients with RA avoid foods with gluten. “There is a crossover between RA and gluten sensitivity, and even in non-sensitive individuals gluten can increase intestinal permeability (leaky gut), which can exacerbate the autoimmune process which drives RA.” Werrett says other foods that can generally drive inflammation include processed vegetable oils and trans fats found in some packaged goods and deep-fried foods. “Additionally, sugar and refined flour products are devoid of nutrients and have a similar effect in the body,” she says. “Intake of alcohol is best minimised as it increases gut permeability and adds toxic chemicals that exacerbate RA symptoms.” However, Werrett acknowledges that the emotional and psychological toll of RA can make change difficult at times. “Dietary change can be challenging when a client is very unwell,” she says. “Clients with RA often suffer from low mood, in addition to the other symptoms, which can make it hard for them to stay motivated.” Because of this, she says a “staged approach” works well, with clients making small changes. To stay motivated, rating the severity of symptoms is a useful strategy for tracking success, she says. “Reducing stress can often be difficult, depending on the root cause of the issue, but strategies such as deep breathing and mindfulness can be helpful in this regard.” For personalised nutrition advice, why not book an appointment with a registered nutritional therapist at the Optimum Nutrition Clinic?