Inflammation and anti-inflammatory diets have been a hot topic for many health professionals, bloggers and influencers over the last few years. A growing body of research shows how diet can affect your body’s regulation of chronic inflammation. We can’t help but wonder if there is an anti-inflammatory diet that works for rheumatoid arthritis. 

Before diving in, let’s take a quick look at the body’s inflammatory response. If you want easy anti-inflammatory food swaps and meal ideas, jump to the end. 

What is inflammation?

When the body experiences injury or attack by foreign objects such as pathogens or toxins, the immune system launches an attack that triggers inflammation to eliminate the intruders and heal your body. This is the body’s normal inflammatory response. 

However, in the case of the chronic inflammation experienced by those with autoimmune diseases like rheumatoid arthritis, lupus, psoriatic arthritis, and ankylosing spondylitis, the immune system launches an attack on healthy tissues in the body, even though there are no foreign invaders that need to be fought off. Causing pain, fatigue, and swelling in the body.

What is an anti-inflammatory diet?

Believe it or not, the meaning of an anti-inflammatory diet has yet to be fully defined. 

In a 2019 review on anti-inflammatory diets and fatigue, anti-inflammatory diets should contain and combine several ingredients with anti-inflammatory properties, mainly fibre, antioxidants, flavones, isoflavones, and Omega 3s. They are believed to work better together than in isolating nutrients or foods. 

Think of plant foods like whole grains, seeds and nuts, legumes, fruits and vegetables, and spices. Foods are minimally processed and may include small amounts of lean animal products, low-fat fermented dairy and moderate amounts of fatty fish.

Anti-inflammatory foods and spices:

    • Vegetables (fresh or cooked): include a rainbow of vegetables such as dark leafy greens (massaged kale, Asian greens, and baby spinach), cruciferous vegetables like broccoli, cauliflower, Brussels sprouts, and beetroots. Aim for a minimum of three to five servings a day

A serving is 1 cup of raw or ½ cup of cooked vegetables.

    • Whole fruits in season when possible. Frozen fruits are also a great source of fibre and antioxidants, especially berries and cherries. Eat three to four servings of fruit a day.

A serving is ½ cup of fresh or frozen fruit or ¼ cup o dried fruit. 

    • Whole grains and pseudo-grains: barley, rice, corn, oats, buckwheat, quinoa, and amaranth. Look for the whole grain symbol on your bread and cereals – at least two to three servings per day.

A serving is one slice of bread or ½ cup of cooked grains, cereal or pasta. 

    • Fatty fish: salmon, sardines, mackerel, tuna and trout.

Eat minimum one serving of 3 oz two times a week. 

    • Legumes: lentils, chickpeas, white beans, soybeans and products, black beans.

A serving is ½ cup of cooked legumes a minimum of three to five times a week. 

    • Healthy fats: extra virgin olive oil is the hallmark oil of anti-inflammatory diets, avocado and fats from nuts, seeds, and fish are also good sources of healthy fats.

A serving is one teaspoon of olive oil, five olives, and ⅛ avocado. Enjoy four to six servings a day. 

    • Nuts and seeds: cashews, walnuts, and pistachios. Flaxseeds and chia seeds are excellent sources of plant-based Omega 3 fats.

Enjoy a minimum of one to two servings a day. A serving can be two tablespoons of sunflower seeds, one or two tablespoons of any nut butter, and seven or eight walnuts or pecans.

    • Low-fat dairy products, preferably fermented products such as cheese and yogurt. You may also enjoy plant-based products if dairy does not suit your body.

Enjoy one to two servings daily, such as ¾ cup of yogurt or 1 ½ ounce of cheese.

    • Spices and herbs: black pepper, cinnamon, cloves, cumin seeds, garlic, ginger, turmeric, cilantro, oregano, parsley, rosemary, sage, and mint. 

    • Beverages: water, herbal teas, green tea. One or two cups of organic coffee or hot cocoa.

    • Lean animal products: poultry (skinless if possible), eggs, lean beef (i.e. loin or round cuts, the eye of round roast, round steak), veal, goat/lamb.

A serving is 3 oz – about the size of a deck of cards or two eggs. Enjoy one serving per week or two to three servings per month.

    • Natural sweeteners: cane sugar, honey, maple syrup. Avoid artificial sweeteners.

A word on nightshades and arthritis 

Nightshade plants include commonly consumed fruits, vegetables, and spices such as cayenne, paprika, eggplants, peppers, potatoes, tomatoes and Goji berries. Blueberries are not nightshade but contain solanine. 

Solanine is an alkaloid isolated in all nightshades and can be toxic if you eat more than 200mg/kg, particularly from potatoes. Most commercial potatoes contain less than 0.2mg/kg of solanine. So I’d say it’s safe to consume. 

There is limited research on the effects of solanine and inflammation, let alone arthritis. When you eliminate nightshades from your diet, you miss out on essential nutrients with anti-inflammatory components such as vitamin C, beta-carotene, lycopene, fibre, capsaicin, anthocyanins, potassium, and low-glycemic carbohydrates from potatoes. 

Having a balanced diet that incorporates plant-based protein and fibre is the best route to go in terms of reducing inflammation!

Avoid these inflammatory or ultra-processed foods

    • Ultra-processed foods: baked goods and prepackaged meals/snacks contain trans-fats and saturated fats. Trans fats trigger systemic inflammation. 

    • Excessive intake of Omega-6 fatty acids: high intake of corn, peanut and soy oils, and most meats, especially red meats, can trigger the body to produce overproduction of pro-inflammatory compounds such as arachidonic acid. 

    • Refined sugars: pastries, chocolate bars, candy, soda beverages, energy drinks and fruit juices trigger the release of cytokines. Increases abdominal fat tissue, which is metabolically active and pro-inflammatory. 

Look out for dextrose, fructose, maltose, and corn syrup in the nutrition labels, as they are hidden sources of refined sugar. 

    • Sugar alternatives: aspartame and sucralose contained in diet sodas, gum, or fat-free products can cause intestinal inflammation and alteration of the gut microbiota.

    • Red meats: contain high levels of advanced glycation end (AGE) products that stimulate inflammation, especially when it is grilled, roasted, fried or broiled. 

Red meats are also enriched in N-glycolylneuraminic acid (Neu5Gc), which humans cannot fully synthesize.

A diet high in Neu5Gc induces changes in the gut microbiome and could exacerbate chronic inflammation-mediated diseases such as cancer, cardiovascular diseases and autoimmunity. Eat in moderation. 

    • Sodium: Studies have shown that high dietary sodium (salt) consumption may elevate inflammatory biomarkers’ expression

Taking corticosteroids like Prednisone may cause sodium and fluid retention, meaning your body is holding onto extra water. Water retention can raise blood pressure and contributes to inflammation and swelling of particular body parts, mainly the eyes and ankles.

Inflammatory Foods - Arthritis Dietitian

An update on anti-inflammatory diets and rheumatoid arthritis

Trendy diets such as the Autoimmune Protocol Diet (AIP), the Carnivore Diet, and Whole 30 claim to reduce chronic inflammation by eliminating entire food groups. 

The AIP protocol, for instance, is a stricter version of the paleo diet claiming that certain foods trigger gut inflammation and autoimmunity, particularly in autoimmune diseases such as RA, Hashimoto’s, Inflammatory Bowel Disease, Psoriatic Arthritis and Lupus.  The AIP eliminates ALL grains, legumes, dairy products, processed foods, seed oils, eggs, nuts and seeds, and alcohol. 

So, what is allowed in the AIP diet? All meats and vegetables- except for nightshades, coconut products, fermented foods, vinegar and sweeteners. You’re basically starving yourself for six weeks or more, followed by a reintroduction phase. 

With restrictive diets like the AIP, you will eliminate essential nutrients and vitamins your body needs for optimal health and energy, particularly whole grains and legumes.

Whole grains contain B vitamins such as thiamin, riboflavin, niacin, and folate; and minerals such as iron, selenium and magnesium, all of which are necessary for cell development and metabolism. 

Mediterranean diet and rheumatoid arthritis

The Mediterranean Diet (MedDiet) focuses on eating lots of fruits, vegetables, whole grains, nuts and seeds, and extra virgin olive oil, with moderate consumption of low-fat fermented dairy products (yogurt, cheese), fish, and lean proteins, and enjoying red meat and refined sugars with less frequency. 

The higher intake of anti-inflammatory and antioxidative foods promoted by the MedDiet may help to decrease swelling, stiffness, and disease activity and lessen the joint damage caused by Rheumatoid Arthritis and Psoriatic Arthritis. More quality and long-term studies are needed to determine the effects of MedDiet on other types of inflammatory arthritis.

A recent randomized controlled study identified that consuming an overall quality diet, particularly with the MedDiet principles, significantly improves pain, physical function, and quality of life in patients with rheumatoid arthritis

The 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet for Rheumatoid Arthritis also recognized the Mediterranean Diet as a conjunctive therapy in the integrative management approach for people living with RA. 

An anti-inflammatory diet (ITIS diet) and rheumatoid arthritis

In 2020, Bustamante et al. designed an anti-inflammatory diet (ITIS) for RA patients. This protocol is based on the Mediterranean Diet with a few modifications to improve nutrient absorption and diversity of the gut microbiome, such as;

    • Dissociation of grains from proteins to facilitate fast digestion

    • Low on gluten and red meats

    • Daily intake of enzymatic fruits (papaya, pineapple or mango)

    • Inclusion of whole grains and foods high in Omega 3s

    • High intake of fermented foods 

    • Replacement of coffee with green tea

    • Addition of condiments with anti-inflammatory properties (turmeric, ginger, black pepper)

This protocol has shown some exciting preliminary results in reducing joint inflammation and increasing gut microbiota diversity. However, application in larger populations living with rheumatoid arthritis is needed. 

Quick and easy food swaps and meal ideas 

Make small swaps using traditional or comfort foods. As a Colombian, olive oil was not part of my cultural heritage, and I found its taste bitter and unappealing. It took me a few years to get used to the taste until extra virgin olive oil (EVOO) became a staple in my home. 

No need to drink a glass of water with turmeric and olive oil on an empty stomach! Enjoy many anti-inflammatory recipes I developed for the Arthritis Society’s Flourish program.

Anti-inflammatory Breakfast

Instead of white bread, waffles, pancakes, processed packaged cereals and processed meats, try: 

Anti-inflammatory Lunch

Instead of grabbing a Subway sandwich with white bread and luncheon meats, frozen meals, caesar salads, or bagels with cream cheese, try: 

Anti-inflammatory Dinner

Instead of ordering pepperoni pizza or preparing mac and cheese, try:

Anti-inflammatory Snacks

Instead of grabbing a muffin and specialty coffee, build your anti-inflammatory snack with this formula: Whole Grains + Protein & Fat + Fruit/Vegetable.

Beverages 

    • Water with a slice of lemon or orange 
    • Flavoured water with berries and basil 
    • Sip on light green tea during the day 
    • Calming herbal teas such as chamomile, celery, peppermint and lavender

Is it possible to eat anti-inflammatory foods on a budget?

In June 2022, I was honoured to present a webinar for the Arthritis Society on Anti-inflammatory Arthritis Friendly Eating and did not get a chance to share these important tips for eating well while on a budget:

    • Use up foods that you already have on hand
    • Look for sales and grocery store member discounts
    • Make a grocery list and stick to it
    • Frozen vegetables and fruits can be less expensive than fresh
    • Buy canned vegetables. Drain and rinse to wash away the salt.
    • If you buy canned fruit, choose those packed in water (rinse before eating)
    • Stock up on dry or canned beans, peas, and lentils
    • Buy fresh fruits and vegetables in season, check out Foodland Ontario
    • Find out about food-buying clubs like food share in your area
    • Join local community gardens
    • Shop at local farmer’s markets
    • Fish or hunt for food. Game meats such as deer, rabbit, moose, buffalo, duck, cod, arctic char, and clams) are healthy choices, too *

* Art Napoleon, a seasoned hunter and cook, states that “for many indigenous people, hunting wild game and harvesting local plants provides a healthy, affordable, and sacred connection to their ancestors, and to the land itself.” 

Bottom line

Start healing your relationship with food and break free from diet culture. Influencers will dance out and persuade you to make extreme dietary and lifestyle changes to cure your arthritis symptoms. 

There is no known cure for autoimmune anti-inflammatory arthritis. You know your body best. If you feel an arthritis flare-up is triggered after consuming nightshades or other foods, try to eliminate or reduce their consumption for two to three weeks. Then, introduce one vegetable, food or spice every couple of days. 

Keep a journal and write down any new symptoms. Also, write down other external stressors in your life, such as changes in weather, physical and mental stress, poor sleep, or high disease activity.  

Special thanks to Emily Malfara, RD and Cheryl Anderson, RD2B, who originally assisted with the research for evidence on anti-inflammatory diets and nightshades. Updated December 2022. 

Arthritis Dietitian – your trusted source of mindful anti-inflammatory lifestyle for women living with Sjogren’s and autoimmune arthritis. 

Don’t know where to start on your anti-inflammatory lifestyle? We can help you: