- Can a Gluten-Free Diet Ease Arthritis Symptoms?
- Gluten and RA: Any Connection?
- Elimination Diets and RA
- A Gluten-Free Journey With RA
- Listen to your body
- Anti-inflammatory diet
- The Pros and Cons of a Gluten Free Diet for RA
- The Connection Between Gluten and Arthritis
- How Gluten Can Cause Joint Pain
- Other Signs of Celiac Disease or a Gluten Sensitivity
Can a Gluten-Free Diet Ease Arthritis Symptoms?
Cathy Kramer has found that a gluten-free diet helps ease her RA symptoms.
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 rheumatoid arthritis 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,” says Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City and associate clinical professor of medicine at Weill Cornell Medical College.
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 says.
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 link 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 may resemble rheumatoid arthritis. But they are two separate conditions caused by separate immune reactions. “The antibody profiles are different for rheumatoid arthritis,” Goodman says.
Eliminating gluten from your 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 says 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 says. “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 says.
A Gluten-Free Journey With RA
Cathy Kramer, a mother of two in Naperville, Illinois, was diagnosed with rheumatoid arthritis in 2004. Combination drug treatment with steroids and methotrexate (Rheumatrex, Trexall) didn’t help, and she seemed to be getting worse. That’s when she met with a naturopath who suggested an elimination diet — no dairy, citrus, nuts, nightshades, or gluten — to ease her RA symptoms.
After following a gluten-free diet for about a year, Kramer started to see some benefits. “My inflammation went down and joint pain was reduced, but not eliminated,” she says. “Going gluten-free improved my diet overall. I stopped eating processed food and started eating fresh fruits and vegetables and farm-raised beef.”
Kramer says she’s frustrated by rheumatologists who say that diet doesn’t help rheumatoid arthritis because, “if you are eating an overall healthier diet, that has to be good.”
Although she hasn’t been tested for gluten sensitivity, Kramer noticed that when she had a lot of digestive issues from eating gluten, she also had a lot of joint pain. “They seemed to go hand in hand,” she says. “I’d get fluid in my stomach and then get fluid in my joints.”
In addition to following a gluten-free diet, Kramer takes RA medication prescribed by her rheumatologist, stays active with regular exercise, gets plenty of sleep, and tries to reduce stress to manage her rheumatoid arthritis.
“Overall, I would say it’s not a cure,” she says, “but it could relieve other symptoms like stomach issues and make life easier.”
Anyone with undiagnosed celiac disease who doesn’t eliminate gluten completely from his or her diet risks intestinal damage leading to malabsorption of essential nutrients, fatigue, malnutrition and muscle-skeletal problems, she warns.
Recent research indicates patients with untreated celiac disease or non-celiac gluten sensitivity have higher-than-normal levels of zonulin in their intestines. This protein controls the permeability of the gut lining for large molecules such as gliadin, a component of wheat gluten. Montoya holds out hope that an indicator such as zonulin may soon help identify patients with autoimmune diseases who are also gluten sensitive. However, more research is required, she says.
Murray maintains there is no data to support the argument that everyone with an autoimmune disease should avoid eating gluten.
“Thyroid disease is one of the most common autoimmune diseases,” Murray says. “It’s also the most common autoimmune disease seen in patients who also have celiac disease. They commonly overlap, probably because of some genetic predisposition. But that doesn’t mean celiac disease causes the thyroid disease.”
“I’ve seen people with celiac disease who go on to develop autoimmune thyroid disease although they’re on a gluten-free diet already. I’ve seen patients who have thyroid disease diagnosed with celiac disease and doesn’t change their thyroid disease.”
Listen to your body
Espinoza says she was tested for celiac disease along with rheumatoid arthritis. To her surprise, the blood tests were negative. A genetic test ruled out any possibility of celiac disease.
But on occasion, when she has cheated or accidentally eaten something with gluten, she says she immediately has felt inflammation in her body. The gluten-free diet has helped her manage rheumatoid arthritis without medication.
To people struggling with a new diagnosis, Espinoza has this advice: “Listen to your body. Each person diagnosed with a disease reacts differently to certain things. Unfortunately for me, medication didn’t work, but luckily diet has.”
Most importantly, she says, pay attention to your diet. She recommends keeping a food log to track what foods help or hurt you.
“Do whatever works for your body, whatever makes you pain free,” Espinoza advises.
But Murray argues, “We want to blame something we’re eating, because it’s something we have control over. I think it’s human nature.”
Van Waffle is a freelance journalist based in Waterloo, Ontario, Canada. He is a regular contributor to Gluten-Free Living and Edible Toronto. He blogs about local food, nature and gardening at vanwaffle.com.
Cristina Montoya, R.D., recommends the Mediterranean diet as a “useful adjunct therapy” for inflammatory conditions such as rheumatoid arthritis. It also supports cardiovascular health. A 2007 study found it decreased pain and morning stiffness in rheumatoid arthritis patients. The diet emphasizes use of:
- Extra-virgin olive oil
- Nuts and seeds, particularly those rich in omega-3 fatty acids, such as walnuts, hemp, flax and chia
- Legumes: soybeans, lentils, beans and chickpeas
- Small amounts of fermented dairy, such as yogurt, kefir and aged cheeses
- Colorful, in-season fruits and vegetables
- Herbs and spices: Ceylon cinnamon, garlic, turmeric and ginger
- A variety of whole grains
- No refined sugars, processed grains, processed meats, high trans fats or saturated fats
- Limited red meats, fluid milk and fruit juices
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The Pros and Cons of a Gluten Free Diet for RA
Many people are wondering if they should try a gluten-free diet. Even if you haven’t been diagnosed with celiac disease or gluten intolerance, there still may be benefits to trying it. But to balance that out, there are some negatives as well.
Pros: You might start feeling better with less pain. A study by Hafstrom et. al. (2001) showed that some people with rheumatoid arthritis benefited from a gluten-free diet and had fewer flare-ups. It might be worth a try to see if you’re one of the people sensitive to gluten. But remember, just like you can’t be half-pregnant, you can’t give up gluten half of the time and expect to see any results. A good way to really see if it would benefit you is to go 30 days on a strict gluten-free diet, and then eat some food with gluten and see how you feel.
On a gluten-free diet you may be more likely to try some new grains that you probably haven’t tried before. There’s a long list of gluten-free whole grains that we don’t often hear about including sorghum, buckwheat (don’t let the name fool you, it’s gluten-free), amaranth, millet, as well as the more popular quinoa and rice. Most of them are quite tasty and offer a variety of nutrients too.
You’ll probably eat a lot more fruits and vegetables and fewer overly processed foods on a gluten-free diet. Gluten is in a lot more products than you realize and if you’re going to be gluten-free that means finding healthy substitutes for some of your favorite gluten containing foods. It might be difficult in the beginning, as any change would be, but it’s worth a try if it helps you feel better.
Cons: You might try something new and it doesn’t work. Well, don’t be upset about this! Each person is unique and has unique solutions. Not everything will work for everyone and the research isn’t conclusive. So think about the decision and how it will impact your life, especially your social life before you make the change. Plan your food budget, and purchase whole foods that are naturally gluten free like fruits, vegetables, beans, lean meats, brown rice, nuts and seeds instead of gluten-free ready to go meals and snack foods, which may cost more.
Another reason why a gluten-free diet may not work is that there are a lot of gluten-free processed foods, so while someone may be hoping to see health improvements, they could still be eating a lot of foods that do not promote a healthy body and contain too many omega 6 fatty acids. Overly processed food is not health promoting, whether it contains gluten or not. It was once thought that you might lose weight going gluten-free, but with all these new packaged gluten-free foods, it’s not as common any more.
When considering the pros and cons, the pros seem to outweigh the cons. If you try it for a month, the worst thing that happens is you miss some of your favorite foods. Set yourself up for success by making an appointment with a registered dietitian who specializes in gluten free diets or celiac disease. With a referral from your primary care physician, your insurance may cover the cost of the appointment. In addition, many grocery stores have registered dietitians on staff so call and ask if they offer a shopping tour that features gluten free products. Get educated before you start, because to measure intolerance you need to be 100% gluten free first. If you try it and like it, a gluten-free diet could become the life-changer for you that it has become for many other people.
The Connection Between Gluten and Arthritis
By Linda Rath
Joint pain and inflammation can be common symptoms for the estimated 3 million adults and children in the U.S. who have celiac disease (CD) and possibly for millions more who may be sensitive to gluten. But what if you have arthritis? Will a gluten-free diet help? Doctors are still debating this point, but some experts say it might.
What is Celiac Disease?
Like many types of arthritis, celiac disease is an autoimmune disease. With these disorders, the immune system mistakenly attacks healthy tissue instead of viruses, bacteria and other pathogens. In people who have CD, gluten – a complex of proteins found in grains such as wheat, barley and rye – triggers a powerful autoimmune response that damages the small intestine and affects its ability to absorb nutrients. This can lead to gastrointestinal symptoms, such as diarrhea, abdominal pain and bloating.
People who are sensitive to gluten can have symptoms anywhere in the body when partially digested fragments leak from the intestine into the bloodstream, says Alessio Fasano, MD, who directs the Center for Celiac Research at Massachusetts General Hospital in Boston.
“Unlike other proteins, we don’t digest gluten completely,” he says. “In some people, the immune system sees gluten as the enemy and will unleash weapons to attack it, causing inflammation in the intestines as well as in other organs and tissues.”
This can cause serious problems outside the gut, including weight loss, anemia, osteoporosis, infertility and miscarriage, skin rashes, headache, depression, fibromyalgia and joint pain. This is partly due to inflammation and partly due to poor absorption of vital nutrients.
Getting a CD Diagnosis
Celiac disease is diagnosed with a blood test that looks for antibodies to gluten. Antibodies are proteins produced by the body’s immune system when it detects harmful substances. If the test is positive, it’s followed by an endoscopic biopsy to check for small intestine damage.
“The inside of a healthy small bowel resembles a deep-pile carpet, but in untreated celiac disease, it looks like a tile floor,” explains Joseph A. Murray, MD, who directs the Celiac Disease Program at Mayo Clinic’s campus in Minnesota. CD damages villi – finger-like protrusions that aid in the absorption of nutrients from the small intestine – and prevents them from doing their job.
Although awareness of CD has never been greater, it remains underdiagnosed. One reason is that CD symptoms are subtle and can look like many other things, from irritable bowel syndrome and migraines, to arthritis. Another is that a growing number of people with CD don’t experience classic gut problems, and a few with severe intestinal damage have no clinical symptoms at all. It can take five to seven years for some patients with celiac disease to be diagnosed.
Also, having one autoimmune disease increases the likelihood of having another, says Dr. Murray. A few studies have shown that people with Sjogren’s syndrome, psoriatic arthritis and lupus may also have an increased likelihood of having celiac disease.
So, people with autoimmune conditions like rheumatoid arthritis (RA) or type 1 diabetes should talk to their doctors about being screened for CD, says Dr. Murray.
Less is known about gluten sensitivity. People who are gluten sensitive have a different type of immune response to grain proteins, says Rochelle Rosian, MD, a rheumatologist at Cleveland Clinic. They don’t develop antibodies to gluten or have small intestine damage, but they do have CD symptoms, especially outside the gut. But since there is no test for gluten sensitivity, some doctors are skeptical of it.
“There is controversy among experts and in the literature as to whether non-celiac gluten sensitivity actually exists,” says Maria Vazquez Roque, MD, a gastroenterologist at Mayo Clinic, who is studying the relationship between leaky gut and gluten sensitivity. “But many medical experts consider patients to have gluten sensitivity when celiac disease and wheat allergy have been ruled out and symptoms improve on a gluten-free diet.”
Gluten-Free Diet and Joint Pain
According to Dr. Rosian, inflammation outside the gut is especially likely to affect the joints. She adds that many of her RA patients who are sensitive to gluten notice less joint pain when they don’t eat it.
“We know that certain foods are pro-inflammatory, which includes gluten-containing grains and the thousands of foods made from them,” says Rosian. “When some, but not all, people with celiac disease or gluten sensitivity eliminate these from their diet, they may find their arthritis symptoms also improve.”
For people with CD or gluten sensitivity, a gluten-free diet isn’t a fad – it’s medicine. The only treatment for diagnosed CD and gluten sensitivity is a gluten-free diet. If you wish to get tested for CD, it’s important not to try a gluten-free diet before because the test won’t be accurate.
For some with gluten-related joint pain, symptoms may improve within weeks after ditching gluten. For others, it may take a little longer, and for many, the problem may not be gluten at all.
“It could also be a wheat or lactose allergy or an issue with FODMAPs , which can also be pro-inflammatory and irritate the gut lining,” says Dr. Rosian.
No matter what the cause, always consult your doctor and/or a dietitian before embarking on a special diet. He or she can help you avoid any nutritional pitfalls, and together, help you determine if you have any food sensitivities or allergies.
How Gluten Can Cause Joint Pain
See What Are Anti-Inflammatory Foods?
See Ways to Get Exercise When You Have Arthritis
Diagnostic screening for celiac disease measures the body’s reaction to gluten proteins; therefore, people who want to be screened for celiac disease are advised to be screened before starting a gluten-free diet.
Other Signs of Celiac Disease or a Gluten Sensitivity
Many people who have celiac disease or a gluten sensitivity have more than one symptom. This can interfere with the absorption of nutrients from food, cause a host of symptoms, and lead to other problems like osteoporosis, infertility, nerve damage, and seizures.
If gluten is causing joint pain, it might also cause other symptoms, such as:
- Digestive issues, such as stomach aches, heartburn, bloating, and diarrhea
- Skin and hair problems, such as rashes
- Oral and dental problems, such as canker sores
- Brain and nervous system disorders, such as headaches and numbness and tingling in the feet, legs or hands
- Fatigue and mood disorders, such as depression and anxiety
- Hormone irregularities that can cause abnormal periods and infertility
- Other musculoskeletal issues
These symptoms may be severe or just annoying—or not even noticeable. For example, people with celiac disease do not absorb calcium well, resulting in weak bones. About 2/3 of people with celiac disease have either osteopenia or osteoporosis,7 but changes in bone composition are not immediately seen or felt.