The Facts About Gluten and RA Diets

Everyday Health—May 15, 2014

Many people with rheumatoid arthritis have tried elimination diets — from ruling out dairy and nightshade vegetables to wheat and other gluten foods — to ease RA symptoms. But do any of them really help?

The link between diet and RA is a controversial one, and the relationship between gluten and joint pain and inflammation is a prime example. Proponents of a gluten-free diet for RA claim it can eliminate joint pain, while researchers are still looking for proof to back up those claims.

“We have studied it fairly extensively, and what becomes clear is that there aren’t a lot of relationships between diet and rheumatoid arthritis that withstand the test of time,” said Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City.

Gluten and RA: Any Connection?

Like rheumatoid arthritis, sensitivity to gluten — a protein found in certain grains — is common in people of northern European descent, Dr. Goodman said. Celiac disease is an extreme form of gluten sensitivity, or intolerance, in which the immune system reacts negatively to gluten and causes inflammation in the lining of the small intestine.

People with celiac disease are more likely to have autoimmune disorders like rheumatoid arthritis or lupus, but the exact relationship is still under investigation.

By eating foods containing gluten, people with gluten sensitivity or celiac disease can bring on gastrointestinal symptoms and joint inflammation that can resemble rheumatoid arthritis. But they are two separate conditions caused by separate immune reactions. “The antibody profiles are different for rheumatoid arthritis,” Goodman said.

Eliminating gluten from the diet can ease digestive and joint pain caused by gluten sensitivity in people who are genetically predisposed to gluten sensitivity, but it's not likely to benefit others. A blood test can tell if you have a gluten sensitivity or celiac disease.

Elimination Diets and RA

Rheumatoid arthritis is usually characterized by flare-ups of joint pain and other symptoms alternating with periods of remission. Many people feel certain foods may trigger these flares, but the effect of dietary restrictions on RA is still uncertain, and the studies on it are too small to draw firm conclusions.

Still, many people try elimination diets that restrict certain foods thought to trigger RA symptoms, such as dairy, citrus fruits, and nightshade vegetables like tomatoes, peppers, and eggplant.

Goodman said there’s nothing wrong with seeing what happens when you eliminate a food from your diet, as long as your daily energy and nutrition needs are still being met.

“Patients with chronic disease like to control some aspect of own lives, and it can be useful to try eliminating foods,” she said. “But other than adding fatty fish or fish oils, it’s really unclear that diet changes are beneficial.”

Goodman does recommend a heart-healthy Mediterranean diet, which is traditionally rich in fruits, vegetables, and fatty fish like salmon and tuna.

“People with RA have accelerated cardiovascular disease, so even if their arthritis symptoms aren’t improved, there are clearly many other reasons to adhere to that sort of diet,” she said.

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