It can be beneficial to drop extra weight when you have joint pain, but it’s important to shed it wisely. The nutrients you eat, whether you’re on a diet or not, are the essential ingredients for good health. The ketogenic diet, the buzzworthy high-fat, low-carb plan commonly called keto, is based on the idea that cutting out carbohydrates — the body’s primary source of energy — forces the body to burn fat for fuel, supercharging your weight loss.
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But eliminating grains, fruits, many vegetables, as well as other healthy foods from your diet depletes your body of the vitamins and minerals you need to stay in balance. “It’s not a good choice for people with systemic inflammatory conditions, because it completely goes against the science we know that prevents inflammation in the body,” says Lona Sandon, PhD, RDN, an associate professor in the department of clinical nutrition at UT Southwestern in Dallas, who also has rheumatoid arthritis.
Why Keto Isn’t Joint-Friendly
Extra weight isn’t ideal for anybody’s joint health, so deciding to shed some pounds if you're overweight is a wise choice. But the keto diet is very high in saturated fat — which can help you feel satisfied but can increase inflammation markers, or signs of inflammation measured by blood tests. "The type of fat you eat matters. Poly- and monounsaturated fats that come from foods such as fish, walnuts, and olive oil are best to help decrease inflammation, which is the root cause of joint pain. This diet is higher in the fats that promote inflammation,” says Dr. Sandon. “If your keto diet contains a fair amount of red meat, you will be eating more of the types of saturated fats that increase the inflammatory compounds that make you feel worse.” One type of fatty acid that’s found in higher amounts in red meats promotes the cytokines and leukotrienes that cause more damage and inflammation in the body, according to Sandon.
Plus, if you eliminate entire food groups from your diet — and in turn essential nutrients — you'll deprive your body of optimal nutrition. “It is absolutely terrible for people with RA,” says Sandon. “People with RA need more antioxidant vitamins [which are found in fruits and vegetables] than those who do not live with a chronic inflammatory disorder.”
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Why Keto Is a Short-Term Weight Loss Fix
The goal of the keto diet is to get your body into a state of ketosis, which is when you don't have enough carbohydrates to burn for energy, and you start to burn fat instead. “If you can get through the first three days to get into ketosis, it can help shut down appetite and control cravings,” says Sandon. “From a weight loss perspective, it can be effective in the short term. But eventually you do get hungry, and you need to get back to eating regular food again.”
The Better Way to Eat to Control Inflammation
Many experts agree that the Mediterranean diet is advised for people who have RA, as well as other types of arthritis. It emphasizes a plant-based eating approach, loaded with vegetables and healthy fats, including olive oil and omega-3 fatty acids from fish.
It is the only diet suggested in the American College of Rheumatology’s draft guidelines for integrative treatment of RA. It’s also the dietary approach with the most solid data behind it. Research published in the journal Frontiers in Nutrition in November 2017 investigated dietary interventions for rheumatoid arthritis and determined that an ideal meal would include raw or moderately cooked vegetables (lots of greens and legumes), with the addition of spices like turmeric and ginger, seasonal fruits, and probiotic yogurt — all of which are good sources of natural antioxidants and deliver anti-inflammatory effects. They also recommend avoiding processed foods, foods with high sodium levels, oils, butter, sugar, and animal products.
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The ITIS Diet May Help Ease Fatigue, Joint Swelling, and Other RA Symptoms
Research presented at the 2021 American College of Rheumatology Convergence virtual conference found that the ITIS, or inflammation diet, which is based on the Mediterranean diet but pinpoints specific foods known for their anti-inflammatory and pain-reducing qualities, helped study participants report less pain, swelling, and for some, about half the fatigue they typically experience while living with RA.
Is There a Perfect Diet for People With Rheumatoid Arthritis?
When it comes to minimizing the symptoms of RA, no one diet works for everyone. “It depends on the person,” says Christine Palumbo, RD, a nutrition expert in Naperville, Illinois. “For some people, gluten can be a trigger. For others, salmon, nuts, or eggplant can be inflammatory.” She suggests that people who have joint pain associated with RA should consider food sensitivity testing or try an elimination or exclusion diet where you avoid common culprit foods, such as dairy, gluten, nightshade vegetables (which include tomatoes, white potatoes, and bell peppers), and alcohol.
