Rheumatoid arthritis is a chronic inflammatory condition — manifesting mostly as joint pain — that affects around 1% of the global population[*]. But the cause of this autoimmune disorder isn’t entirely clear.
Because of this, finding an effective rheumatoid arthritis diet — a diet that reduces pain, stiffness, and inflammation — has been a challenge for sufferers and practitioners alike.
There is, however, promising research on two dietary strategies: fasting and ketosis.
The mechanisms of keto and fasting are similar. Both reduce inflammation and both increase ketone levels in your blood.
In this article, you’ll learn how ketosis reduces pain and inflammation — and how the ketogenic diet might help with rheumatoid arthritis.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) affects millions of people worldwide — causing chronic pain, decreased quality of life, and huge medical bills.
Rheumatoid arthritis is an autoimmune disease — a condition in which the immune system attacks otherwise healthy tissue. This immune reaction, marked by high levels of rheumatoid factor (RF) antibodies, causes joint inflammation and damage.
RA symptoms include:
- Tender, swollen joints
- Morning stiffness or stiffness after inactivity
- Joint stiffness
- Weight loss
But not everyone with rheumatoid arthritis has elevated antibodies[*]. Only about 50%, which makes diagnosis tricky.
Uncovering the cause of rheumatoid arthritis is also tricky. Along with the presence of RF antibodies, there are many environmental factors — known and unknown — that increase the risk of developing the condition[*].
Known environmental factors include:
- High birth weight
- Bottle (rather than breast) feeding
- Tobacco smoke
- Infectious disease
In all cases, a low level inflammatory immune response underlies this chronic illness. But does inflammation cause RA? Or does RA cause inflammation? Maybe a bit of both.
Either way, to treat the symptoms of rheumatoid arthritis, you need to address the inflammation — and the standard approach is to use disease-modifying antirheumatic drugs (DMARDs) for this purpose. DMARDs work by suppressing the immune system and reducing joint inflammation[*].
More recently, doctors are starting to use a new class of anti-inflammatory drugs called tumor necrosis factor alpha (TNF-α) inhibitors for rheumatoid arthritis.
TNF-α is an inflammatory particle, so reducing it can help with chronic inflammation. There are, however, concerns over the toxicity and potential side effects of these drugs[*].
Fortunately, drugs aren’t the only way to lower inflammation. Diet, sleep, and exercise can lower inflammation too.
Chronic Inflammation and Rheumatoid Arthritis
What do autoimmune disorders like rheumatoid arthritis, multiple sclerosis, and celiac disease have in common? Chronic, systemic inflammation.
Chronic inflammation isn’t the same as acute inflammation. Acute inflammation is how your body recovers from exercise, fights off viruses and bacteria, and heals wounds. Acute inflammation is normal.
Chronic inflammation, on the other hand, occurs when your immune system is always on high alert and starts to attack molecules and tissues it shouldn’t attack.
And this can cause major damage.
Chronic inflammation underlies most chronic disease: diabetes, heart disease, cancer, Alzheimer’s, autoimmune conditions like rheumatoid arthritis[*].
Many, many things cause chronic inflammation. Here’s a partial list:
- Tobacco smoke
- Sedentary lifestyle
- Genetic factors
- Consuming vegetable oils
- Processed foods
- Inadequate sleep
- Inadequate omega-3s
- High-sugar intake
- High-carb diets
So no, there’s no “easy button” for reducing inflammation. It’s a lifestyle commitment.
And of all the lifestyle factors, diet is the one most within your control. It’s also one of the most impactful changes you can make.
Take the ketogenic diet. The keto diet is best known for weight loss, but did you know it’s anti-inflammatory too?
How The Keto Diet Reduces Inflammation
Reducing your carbohydrate intake and adding plenty of healthy fats and high-quality protein is the cornerstone of an anti-inflammatory diet.
Here are just a few ways that getting into ketosis may help lower inflammation and help decrease rheumatoid arthritis symptoms.
#1: Keto Lowers Blood Sugar
When you eat a high-carb diet, your blood sugar stays elevated[*]. High blood sugar triggers the release of insulin, which has to work on overtime trying to usher all that glucose into your cells.
When your cells can’t handle any more glucose, they become insulin resistant.
Insulin resistant cells don’t listen to insulin. They refuse to store blood sugar. And so that sugar stays in your blood, creating a high-blood sugar state called hyperglycemia.
Meanwhile, your pancreas gets confused and keeps pumping out insulin to handle your high blood sugar. This high-insulin state is called hyperinsulinemia, and it puts you into fat storage mode.
Here’s the thing about hyperglycemia and hyperinsulinemia: They’re both highly inflammatory states linked to diseases of inflammation like heart disease, cancer, and diabetes[*].
The ketogenic diet, on the other hand, prevents, and can even reverse, this high-blood sugar, high-insulin, pro-inflammatory state[*].
A few reasons why:
- Keto is low-carb, so it prevents spikes in blood sugar
- Keto is high in healthy fats, which also helps regulate blood sugar and insulin levels
- Ketones suppress blood sugar levels[*]
And so by keeping blood sugar low, keto helps prevent chronic inflammation.
Keto also reduces reactive oxygen species (ROS) — an inflammatory molecule that worsens rheumatoid arthritis symptoms.
#2: Keto Reduces ROS
Compared to sugar, ketones are a cleaner burning energy source.
That means that your cells create fewer reactive oxygen species (ROS) from ketones than from glucose when they’re producing ATP (cellular energy)[*].
ROS are molecules produced by your cells — by your mitochondria, specifically — as a byproduct of energy metabolism. Some ROS are good. They act as signaling molecules for your immune system[*].
Excess ROS, however, are not good. They cause oxidative stress and inflammation[*].
A ketogenic diet can help.
In a mouse model of multiple sclerosis (an autoimmune disease like RA), a ketogenic diet improved symptoms — probably because of a reduction in ROS[*].
In another rodent model, researchers fed mice either a standard diet or ketogenic diet, then measured ROS levels and mitochondrial respiration[*].
In the ketogenic group, not only were ROS reduced, but the maximum mitochondrial respiration (energy output) nearly doubled! More energy, less inflammation.
#3: Keto Boosts Adenosine
Your body is resourceful. It can produce all sorts of chemicals that reduce pain, heal wounds, and reduce inflammation.
Adenosine is one such chemical. Adenosine is a compound that reduces pain and inflammation. When you’re injured, your body releases adenosine to protect the wounded tissue.
But you needn’t injure yourself to get more adenosine. A ketogenic diet boosts this natural painkiller too.
For instance, mice fed a ketogenic diet showed increased adenosine receptor activity — and this reduced seizures[*].
More research is needed on how keto-induced adenosine activity impacts autoimmune disorders like rheumatoid arthritis, but the area seems promising.
#4: BHB Inhibits The Inflammasome
When you go on a ketogenic diet, your body starts producing the ketone bodies acetone, acetoacetate, and beta-hydroxybutyrate (BHB). Of the three, BHB is your the most important for energy production.
It’s also the most anti-inflammatory. That’s because BHB inhibits the NLRP3 inflammasome — or, for simplicity: “the inflammasome”[*].
Think of the inflammasome as your red alert system. When the inflammasome gets activated, inflammatory cells — ASC specks, macrophages, antibodies, and cytokines — rush to the site of apparent infection.
An active inflammasome is useful when you have a wound or viral infection — but it’s harmful when you have an autoimmune disorder like rheumatoid arthritis.
That’s where BHB comes in. BHB regulates the inflammasome — reducing ASC specks, cytokines and other inflammatory particles[*].
How? One theory involves potassium. Potassium flowing out of immune cells activates the immune system, and BHB suppresses this potassium outflow. This mechanism, by the way, is probably how ketosis reduces seizures[*].
Bottom line? BHB is an anti-inflammatory signaling molecule.
The Keto Diet For Pain
Where there’s inflammation, there’s usually pain.
In the case of acute inflammation, pain can be useful. It’s your body saying: hey just wanted to let you know, something’s wrong here.
But in the case of chronic inflammation, pain can become a burden. Chronic inflammation can become chronic pain.
The most common painkillers — nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Advil, etc. — work by reducing inflammation. But NSAIDs come with side effects that range from liver toxicity to gastrointestinal bleeding[*] — not a good long-term pain management strategy.
Similar to fasting, the ketogenic diet also reduces inflammation by:
- Lowering blood sugar
- Lowering insulin
- Reducing ROS
- Boosting adenosine
- Inhibiting the inflammasome
Keto’s anti-inflammatory effect also appears to reduce pain.
In one rodent study on pain, rats were fed a high-carb control diet, while others were fed a high-fat low-carb ketogenic diet[*].
The animals were put on warm plates of varying temperatures, then observed for signs of discomfort like licking or hindpaw raising.
The keto-fed rats could handle higher temperatures for longer, suggesting that pain tolerance is higher when you’re in ketosis.
In other words: something about the ketogenic diet increased pain tolerance. Keto, the researchers theorized, may decrease pain by:
- Decreasing excitability of neurons (as with seizures)
- Boosting the pain-killing neurochemical adenosine
- Decreasing glycolytic metabolism (using glucose for energy production)
Yet more research — human trials specifically — are needed before keto becomes medically approved to treat the chronic pain of inflammatory conditions like rheumatoid arthritis.
Inflammatory Foods To Avoid
What inflammatory foods should you avoid?
Maybe you’re not ready for the keto diet. Still, there are two foods that you should avoid if you’re concerned about obesity, weight gain, and inflammation.
# 1 Refined Sugar (And Excess Carbs)
Sugar is everywhere. It’s in bread, sauces, cookies, crackers, dressings, and — most commonly — in beverages. Sugar-sweetened beverage (SSB) consumption, in fact, has been linked to obesity, diabetes, and heart disease[*].
According to a recent review, each SSB consumed per day equates to an additional 10-20% risk of heart disease[*]. Pretty significant.
The mechanism? Inflammation.
High glycemic diets (read: high-carb, high-sugar diets) have been linked to elevated levels of C-reactive protein, an inflammatory particle that tracks with heart disease risk[*].
Even starchy carbs can be pro-inflammatory. Recall that when your body runs on glucose, your mitochondria produce more reactive oxygen species (ROS). And more ROS means more inflammation.
And so to reduce inflammation, you’ll probably want to avoid a high-glycemic diet.
#2 Vegetable Oils
In the 1970s, per the advice of the American Heart Association, Americans started eating more vegetable oils and less animal fat[*].
But this was bad advice, and the rise of vegetable oils — canola oil, soybean oil, sunflower oil, peanut oil, and the rest of the gang — has mirrored the rise of obesity and diabetes in the United States[*].
Obesity and diabetes are both diseases of chronic inflammation. Here’s how vegetable oils contribute to this problem:
- Vegetable oils are high in linoleic acid, an omega-6 polyunsaturated fatty acid
- Linoleic acid converts to arachidonic acid (another omega-6) in your body[*]
- Arachidonic acid stimulates the production of eicosanoids — inflammatory signaling molecules which generate a chronic immune response[*]
Plus, all those omega-6 fatty acids from vegetable oil throw off the omega-6 to omega-3 fatty acid ratios, which leads to even more inflammation[*].
#3: Excessive Alcohol
Another food to limit if you’re looking to lower inflammation is alcohol.
In one human study, alcohol consumption was closely related to higher inflammatory markers[*].
Heavy drinking is also related to negative changes in your gut microbiome, which can lead to inflammation and organ damage[*][*]. If you have existing gut issues, consider eliminating alcohol entirely.
Foods That Can Help RA Symptoms
Now that you’ve learned what foods to avoid, you’ll want to know what anti-inflammatory foods to favor. Here’s a partial list:
- Healthy fats like fish oil, extra virgin olive oil, coconut oil, MCT oil, red palm oil, avocados, butter, egg yolks, ghee, lard, and cocoa butter
- High-quality meats (grass-fed and pasture raised) like beef, chicken, bison, lamb, and organ meats
- Fatty fish rich in anti-inflammatory omega-3 fatty acids like salmon, sardines, and anchovies
- Non-starchy vegetables like kale, spinach, broccoli, asparagus, collards, cabbage, dandelion greens, chard, and mushrooms
- Spices and herbs like turmeric, cinnamon, rosemary, and oregano
For more anti-inflammatory ketones, you might want to consider trying a ketogenic diet. That involves keeping daily carbs under 10% of calories, fat at 60% of calories, and protein at 30% of calories.
Or, to find out your unique macronutrient ratios, check out this keto macro calculator.
The Keto Diet For Rheumatoid Arthritis
The truth is, the best rheumatoid arthritis diet remains unknown. There are promising rodent studies on keto’s role on inflammation and pain tolerance, but human trials are currently lacking.
Same goes for the Paleo diet or the Mediterranean diet. We simply need more human trials.
Consider this though. Rheumatoid arthritis is an inflammatory autoimmune disease — and going keto boosts adenosine, lowers blood sugar, reduces reactive oxygen species, and inhibits the inflammasome. Simply put: keto is an anti-inflammatory diet.
And so the ketogenic diet may represent a tool, along with other therapies, to treat diseases of chronic inflammation. Stay tuned.
Ready to get started on keto? Check out the Keto Kickstart, a 30-day step-by-step program that will get you into ketosis with real, whole foods.