Editor’s Note: My father has rheumatoid arthritis (RA) and I have been researching diet change for relief in addition to medications. RA is an awful, debilitating condition. The Mediterranean Diet has already been shown to help so many ailments that it would also seem to help the immune system. Managing RA is not an easy thing, being an autoimmune disease, so adding diet management to medication is important. These aspects of the Mediterranean Diet seem to be an easy addition to anyone’s daily diet.
The traditional Mediterranean diet doesn’t just taste good, it offers a range of health benefits and may be a wise adjunct to other therapies in the treatment of rheumatoid arthritis. Rich in fruit, vegetables and whole grains, the Mediterranean diet also uses fish, poultry, pulses and nuts more predominantly for protein sources, as well as adding olive oil when extra fat is required. While it was originally thought that following a dietary regime such as this could help to prevent and manage heart disease, research now shows that the Mediterranean diet can help to reduce the inflammation associated with rheumatoid arthritis. One of the first pieces of evidence was a Swedish study from 2003, which showed that after following the traditional diet eaten in Crete for 12 weeks, a reduction in the number of swollen joints and inflammatory markers was seen in participants affected by the condition.
Then a review in 2009, which analyzed the results of 15 studies that had been conducted into a number of dietary interventions for rheumatoid arthritis, including the Mediterranean diet, found that this was indeed the most effective for its management. Here we consider three of the main components of the Mediterranean diet, why they are presumed to help reduce inflammation in the body and how they can be practically applied.
Fish such as sardines, whitebait and anchovies are commonly eaten in the Mediterranean. These oily fish are rich in the omega-3 fatty acids docosahexaenoic acid and eicosapentaenoic acid (often referred to as DHA and EPA). Numerous studies have shown these to have anti-inflammatory properties, reducing the production of substances in the body known to trigger inflammation such as cytokines and arachidonic acid-derived eicosanoids. Although evidence suggests that around 3g of omega-3 fatty acids may be needed to provide clinical benefits, consuming oily fish such as salmon, mackerel or trout twice a week may still provide reasonable benefit in rheumatoid arthritis. Although men and older women can safely eat up to four portions weekly, younger women who may have children one day are advised to keep their intake at twice weekly due to the small quantities of pollutants they contain, which could affect the development of a baby.
Rich in monounsaturated fats, olive oil is also thought to exert anti-inflammatory benefits in a similar way to oily fish. In the body, the oleic acids in olive oil are converted to another monounsaturated fat known as eicosatrienoic acid, which has also be shown to reduce inflammation. Unrefined virgin olive oil is additionally a very good source of antioxidants, such as hydroxytyrosol and oleocanthal, which act to reduce the inflammatory response by cytokines and directly help to prevent tissue damage in the joints. Although the overall fat content of the diet should not be increased, switch to olive oil in cooking and use an olive-based spread. Alternatively rapeseed oil could be used, which like olive oil has a high oleic acid content and is also a plant source of omega-3 fatty acids; potentially useful for vegetarians or anyone else who avoids fish.
Fruit and vegetables
These too are packed with antioxidants, such as Vitamin C and E, beta-carotene and luteins, and studies have shown these protect against the damaging effects of free radicals, generated by pollutants and within the body during reactions. While there is evidence that in populations with a diet rich in fruit and vegetables, the inflammatory response in rheumatoid arthritis is lower, clinical studies have not been conducted into the effects of fruit and vegetables alone on disease progression. Similarly, although following a vegetarian diet has been shown to provide benefits for those with rheumatoid arthritis, the exact reason for this has not been separated from the numerous components of the vegetarian diet. However, as a high consumption of fruit and vegetables are associated with a reduced incidence of heart disease, stroke and cancer, their intake should be encouraged, particularly as the former are more likely in rheumatoid arthritis. Increasing fruit and vegetable intake has also been shown to help aid weight loss, which in itself can benefit those with rheumatoid arthritis. Consuming four portions of vegetables and two of fruit daily is in line with the principles of the Mediterranean diet and aiming to include those displaying a range of colors will maximize your intake of different antioxidants, since these are largely responsible for their pigments.
While further research is needed into the impact of the Mediterranean diet on rheumatoid arthritis and the mechanisms through which it acts, the results of initial studies are promising and provide hope for those currently living with this debilitating condition.