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Writer's pictureGemma Westfold

Rheumatoid Arthritis - The importance of gluten, vitamins & a symptom diary (blog 3)

I work as a registered nutritionist with the National Rheumatoid Arthritis Society and this is my article that they have published. See below for full article link.


Evidence suggests that nutrition can play an important role in the management of Rheumatoid Arthritis (RA) and Juvenile Idiopathic Arthritis JIA.


There is a lot of nutrition information out there and with that comes misinformation. Altering your diet to help your RA/JIA symptoms is very individual. Auto-immune conditions are complex. The effects they have on the body vary from person to person. This is the third blog on how to help RA/JIA with nutrition, the first is here and the second is here.



Excluding Gluten


Coeliac disease is an auto-immune condition. It is a condition where the immune system attacks the body when you eat gluten.  Coeliac disease has a lot of features in common with RA and people with RA are more prone to developing it. 


Gluten-free diets can be of particular benefit to those with Coeliac Disease. They can also help those with a less severe sensitivity to gluten. A study in BMC Gastroenterology demonstrated the benefits of a gluten free diet.  The study found improved symptoms and lowered inflammation for those with gluten intolerances. This included those with Coeliac disease. If a gluten intolerance or Coeliac disesea is contributing to your symptoms then taking it out can be life changing.


Gluten is present in a lot of processed foods. It is a protein that is present in wheat, barley, and rye. Deciding whether a gluten free diet would benefit you is very individual. A food and symptom diary can help you to see whether you have a sensitivity to gluten. See below for more information on how to start a food diary.


How to do a gluten exclusion:

Take out all gluten containing grains for three weeks. This includes

  • Wheat (pasta, couscous, bread, biscuits, cake)

  • Rye

  • Barley

  • Malt


Read all ingredients and be strict for the three weeks. Pick a time when you don’t need to be dependent on others to cook (eg. Holidays, weddings).


After three weeks reintroduce one large portion of gluten-containing food (e.g. baguette). Stop eating it again for 72 hours but notice all symptoms. Should you have a bad reaction, you may have a sensitivity or coeliac disease. If you think you may have an issue with gluten then please speak to your GP.  They can test you for coeliac disease, as there is evidence that those with RA and JIA may be more prone to it. You should have this test whilst you are still on a gluten containing diet so it’s best to get the test and then exclude.


When excluding any types of food from your diet, it is important to get the right nutrients from other food. Seeking advice from a nutritionist such as myself can help you to do this.


Dietary Supplements

There is a lot of evidence to show that some supplements can help to improve RA/JIA. This may be through anti-inflammatory and anti-oxidation effects or by supporting the joints. Before taking any supplements you should seek the guidance of a health professional.


Check with your rheumatology team that the supplement won’t interfere with your medication. This includes medication taken for other conditions, whether prescribed or over the counter. 


Methotrexate lowers levels of a vitamin called ‘folic acid’. Folic acid supplements are usually prescribed alongside methotrexate to top these levels up. They can also reduce some of the side effects of methotrexate.


Your GP may recommend calcium and/or vitamin D supplement  if you are taking steroids. It is important to take only the recommended dose. A healthcare professional should review this every few months.


Making changes to diet and adding supplements is very individual. What  may work for some could either not work at all for someone else, or create more issues.



How to keep a food and symptom diary

A food and symptom diary can help you to identify food types that may worsen your RA/JIA symptoms. It can also help you to identify more general food intolerances or sensitivities.


A food and symptom diary should include a column for ‘gut symptoms’ if you suspect some foods may be irritating your stomach. Use the diary to track the foods you eat and the effects they may be having on your body. It is also good to have a column for ‘other important information’. This is a place for you to note non-dietary reasons your symptoms may be better or worse.


If you notice that certain foods are causing your RA/JIA symptoms to worsen, try leaving them out of your diet. Do this for several days to see if symptoms improve. You can also try re-introducing these  to see if symptoms return. You may need to do this more than once to be certain.


It can take a lot of trial and error to identify foods that might be causing you problems. It can be hard to separate the impact of food from that of other factors. Where possible, it is better to use a food and symptom diary under the care of a dietician or registered nutritionist like myself. They can help you to identify problem foods. They can also help you to get the right nutrients from other foods after cutting any foods out of your diet. 


Conclusion 

Making changes to your diet can help you to manage your RA or JIA.  Simple dietary changes can reduce inflammation and help support a healthy immune system. The Mediterranean diet shows strong evidence for reducing disease activity and improving symptoms. Excluding gluten may benefit certain individuals, especially those with gluten sensitivity. Vitamin D supplements can improve immune system function and bone health. Maintaining a healthy gut can help you to manage your RA/JIA. Probiotics and a diet rich in colourful vegetables will help keep your gut healthy. Nutritional therapy can improve quality of life and help you to manage your symptoms. It is an important part of your treatment plan and will help aid self-management of your RA/JIA.


If this is a way of eating that is very far removed from where you are now, then make small and sustainable changes. You can start by adding protein, colour and whole grains to each breakfast and work from there.


I am delighted to be the nutritionist for, and have an article published with, the National Rheumatoid Arthritis Society (NRAS), who endlessly look for the latest research in how to support RA.  My full article is here in my blog, spread out in bitesize chunks!


How I can help with Nutritional Therapy

Using the functional medicine approach, I work to understand why you have RA and to see what factors are contributing to it. I can order and interpret functional tests where necessary, such at coeliac disease, gluten intolerance, gut health and digestion, blood tests to look for nutrient deficiencies, inflammation, other contributing factors as well as co-existing auto-immune diseases. Contact me here  and book a free 20 minute Reboot your Health call.


You can expect from me:


  • A personalised nutrition plan rich in nourishing foods to assist your joint function and inflammation

  • Test recommendations and full interpretation either privately or through your GP

  • Personalised supplement protocol - meticulously checked against medications

  • Regular consultations and coaching to support new choices


Note: as a Nutritional Therapist, I do not diagnose or prescribe, however I do use functional nutrition testing to help find the best way to support my client’s health.

 

My programmes are designed with people like you in mind. I see many clients with auto-immunity and they all have different symptoms, family health histories, lifestyles, work and family life which may may have contributed to where they are. This is why a personalised nutrition and lifestyle rather than a 'one size fits all' gets such good results. Book your free Reboot your Health 20 minute call to discuss your health goals and if working with me would benefit you.


Article link with NRAS








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