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Talk Over RA: The Worst Foods for Rheumatoid Arthritis

The #TalkOverRA campaign encourages Canadians living with Rheumatoid Arthritis (RA) to find their own voice to come up with a realistic plan with their health care providers to reach the specific goal treatments.

Eileen Davidson, a passionate RA patient advocate and I discussed the most common misconceptions and diet trends around those living with Rheumatoid Arthritis for this campaign. Read her full blog post "Talk Over RA: Diet, Myths and Rheumatoid Arthritis with The Arthritis Dietitian." I am breaking down the information on four separate blogs:

Let's continue this series with some of the worst foods for Rheumatoid Arthritis. Although the relationship between diet and risk of Rheumatoid Arthritis is not as strong as other modifiable risk factors, such as smoking, the emerging role of inflammation in many chronic conditions is leading to more research about the role of specific nutrients and components with pro and anti-inflammatory properties. More studies show the significant influence of diet on the gut microbiota composition, which has been involved in RA development. That old saying, “we are what we eat,” may as well apply to foods that could trigger inflammation when living with Rheumatoid Arthritis.

The Western diet characterized by a high intake of red meats, saturated and trans fats, low ratio Omega-3:Omega-6 fatty acids, low consumption of complex carbohydrates and fibre has been associated with increased RA risk by causing low-grade inflammation, insulin resistance and obesity. More research is showing how the Western diet alters the microbiota and may promote intestinal increased permeability and low-grade inflammation. In general, people with rheumatoid arthritis have a reduced gut microbial diversity in comparison to their counterparts, which further exuberates their inflammation when they eat traditional Western diet foods.

Ultra-processed foods: baked goods and prepackaged meals/snacks contain trans-fats, which are unsaturated fats created through hydrogenation. The hydrogenation process adds hydrogen to liquid vegetable oil to solidify at room temperature and extend its shelf life. Trans fats trigger systemic inflammation. Vegetable oils also have different smoke points, which is the temperature when an oil begins to deteriorate by changing its taste and chemical composition. When you heat a vegetable oil above its smoke point, it creates harmful compounds, and the health benefits may be limited. Such is the case of extra virgin olive oil; when heated above its smoke point, there is a decrease in antioxidants, vitamin E, and oleocanthal, which have anti-inflammatory effects. Check out the smoking point of common oils.

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 pro-inflammatory chemicals such as arachidonic acid. Arachidonic acid is mainly found in the fatty parts of meat and fish; it is released and oxygenated by enzymes leading to inflammatory mediators, such as eicosanoids known to cause acute inflammation in the body. It's all about balance!

Refined sugars: pastries, chocolate bars, candy, soda beverages, energy drinks and fruit juices trigger the release of a protein called cytokines. Cytokines are signalling molecules that regulate inflammation. Studies have shown that an increase in the consumption of refined sugars leads to an increase in visceral adipose tissue (central obesity), which is metabolically active and produces cytokines, thus affecting the adequate function of the pancreas and colon. Make sure to look out for corn syrup, fructose, or maltose in the nutrition labels as they are hidden sources of sugar. Refined carbohydrates such as white pasta, bread and crackers cause a spike in blood glucose leading to insulin resistance known to cause inflammation.

Sugar alternatives: aspartame and sucralose often contained in diet sodas, gum or reduced-fat products can cause an inflammatory response in the body because our bodies cannot process these substances well. Aspartame may lead to the production of pro-inflammatory molecules such as interleukin, adiponectin and c-reactive protein. These molecules trigger systemic inflammation, resulting in insulin resistance, meaning muscle, fat, and liver cells do not respond well to insulin. They cannot efficiently take up glucose from your blood.

Red meats are high in saturated fats and contain high levels of advanced glycation end products that stimulate inflammation, especially when it is grilled, roasted, fried or broiled. Saturated fats trigger adipose (fat tissue) inflammation, which can worsen inflammation caused by inflammatory arthritis. A few animal studies showed that saturated animal fat causes our gut lining to become leaky, allowing gut bacteria to enter the bloodstream. Red meats also contain N-glycolylneuraminic acid (Neu5Gc), which humans cannot produce- when it enters the body, it is recognized as a foreign and invading substance. The immune system creates antibodies against it, causing inflammation.

Moreover, high-fat dairy like butter, cream cheese and mayonnaise are high in saturated fats and advanced glycation end products, which triggers inflammation.

Alcohol increases inflammation and health risks like liver disease. Excessive alcohol consumption weakens the liver and disrupts interactions with other organs, causing inflammation. Alcohol consumption decreases bone density, and people with arthritis are already at increased risk of developing osteoporosis. Methotrexate is a Disease-Modifying Anti-Rheumatic Drug (DMARD), a medication often used in people with RA. There is a link between alcohol and methotrexate because this interaction can damage the liver and impair liver function; the damages can range from benign elevations in blood tests to fibrosis or fatal hepatic necrosis (acute toxic liver injury).

Sodium: a high salt diet is associated with increased inflammation. Studies have shown that high salt diets may elevate the expression of inflammatory biomarkers, including tumour necrosis factor-alpha. Prednisone is an anti-inflammatory steroid medication that is used to decrease inflammation in autoimmune conditions such as RA. This medication may cause salt 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.

A common question I get: How do I transition from a Western diet to an anti-inflammatory way of eating?

It can be challenging, especially if you have been used to eating the Standard American Diet for a long period of time. Remember even the word IMPOSSIBLE says “I’M POSSIBLE”.

One way is to start with small changes; even one or two substitutes once a week can make a difference. Instead of a beef burger on a white bun three times a week, switch to once a week or every two weeks on a whole grain bun. Add extra veggies as toppings. You can still enjoy these foods but alter them to fit your new way of eating.

Don't forget to check out "The Best Foods for Rheumatoid Arthritis" for more ideas on how to incorporate anti-inflammatory foods into your diet.

To learn more about Talk Over RA and how to engage in meaningful conversations with your health care provider, download the Talk Over RA discussion guide and check out their website.



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