Some findings have been reported suggesting that a gluten-free diet may help to improve the symptoms associated with RA.
Gluten is a general term that is used to describe a family of proteins found in grains such as wheat, rye, barley, spelt, durum, and emmer. By far, the most commonly consumed gluten-containing grain is wheat. Gluten is present in various types of food and acts like glue, holding foods together and helping them maintain their shape. Interestingly, the name glu-ten comes from the glue-like consistency of wet dough.
For years now, researchers have been exploring the link between diet and rheumatoid arthritis (RA). More specifically, the link between gluten and joint pain and inflammation. Like RA, gluten sensitivity is common among individuals of northern European descent. Celiac disease is an extreme form of gluten sensitivity. “Unlike other proteins, we don’t digest gluten completely. 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” said Alessio Fasano, Director of the Center for Celiac Research at Massachusetts General Hospital.
Individuals with celiac disease are more prone to developing autoimmune disorders like RA and one area in particular that remains debatable is whether a gluten-free diet is legitimately helpful for RA.
Gluten and RA: What’s the connection?
Some findings have been reported, suggesting that a gluten-free diet may help to improve the symptoms associated with RA, as well as type 1 diabetes and irritable bowel syndrome. These findings go back to more than 50 years ago, when the work of an Australian physician, Ray Shatin, was published in the Journal of the American Medical Association. Dr. Shatin believed there to be a genetic similarity between individuals with RA and those with celiac disease. He proposed that in RA, minor inflammation occurs with the consumption of gluten, yet the reaction is not as strong as the inflammation that occurs with celiac disease. He put his theory to the test on 18 patients with RA and found that all 18 showed symptom improvement on the gluten-free diet.
In 2015, a study was conducted on 121 patients with RA and 30 patients with primary Sjogren’s syndrome. The study, published in the polish journal Wiadomosci lekarskie, found that anti-gliadin antibodies were far more frequent in the patients with RA and primary Sjogren’s syndrome, as opposed to that of the general population. Gliadin is one of the two main proteins in gluten and it is responsible for most of the negative health effects.
In 2017, important facts were revealed in the journal Minerva Gastroenterologica Dietologica, linking 50% of individuals with non-celiac gluten sensitivity to anti-gliadin antibodies. However, the antibodies were not specific to gluten sensitivity. And while anti-gliadin does not define gluten sensitivity, it is considered supportive evidence.
Going on a gluten-free journey
Cathy Kramer, a mother of two, was diagnosed with RA back in 2004. Her treatment plan involved a combination of steroids and methotrexate; however, her condition seemed to only be getting worse. She met with a naturopath who suggested that she try following an elimination diet to alleviate her symptoms. This meant no dairy, no nuts, no citrus, no nightshades, and no gluten.
After a whole year of following a gluten-free diet, Kramer started seeing positive results. “My inflammation went down and joint pain was reduced, but not eliminated. Going gluten-free improved my diet overall. I stopped eating processed food and started eating fresh fruits and vegetables and farm-raised beef” she said.
Although she had not been tested for gluten sensitivity, Kramer recalled that when she ate gluten, she experienced a lot of digestive issues, as well as a lot of joint pain. “They seemed to go hand in hand. I’d get fluid in my stomach and then get fluid in my joints” she said. In addition to following a gluten-free diet, Kramer takes RA medication as prescribed by her rheumatologist, gets plenty of sleep, remains active by exercising on a regular basis, as well as tries to reduce stress in her life to the best of her ability. “Overall, I would say it’s not a cure, but it could relieve other symptoms like stomach issues and make life easier” she said.
No grain, no pain?
Research shows that a gluten-free diet may be beneficial for individuals with RA. Still, it cannot be considered harmless due to its potential for nutritional deficiencies. This is why it is so important to talk with a doctor about the pros and cons of this type of diet. He or she may recommend being screened for celiac disease and gluten sensitivity (some patients diagnosed with RA may actually have celiac disease instead). Additionally, the doctor’s advice and guidance can help those with RA to remain vigilant of nutritional deficiency, as well as to experience the most beneficial impact of a gluten-free diet.
To date, what is known is that all of the foods that go through the gastrointestinal tract affect the immune system. Some individuals are more sensitive to foods containing gluten and it causes them to experience inflammation. “Patients with arthritis are always looking for non-drug related ways to manage inflammation. We know that certain foods are pro-inflammatory and that includes gluten-containing grains and the thousands of foods made from them. When some, but not all, people with celiac disease or gluten sensitivity eliminate these from their diet, they find their arthritis improves” said Rochelle Rosian, a rheumatologist at Cleveland Clinic.
Going gluten-free can often be overwhelming and challenging for some individuals. The most important thing in staying healthy and managing RA is to eat more of the good foods (fruits and vegetables, non-processed meats, fish, and eggs) and to eliminate most of the bad foods. Keeping a food log may be beneficial in tracking what foods are helpful and identifying potential trigger foods. And from an emotional standpoint, being aware of what heightens or alleviates symptoms can help an individual to feel more in control and to enhance their quality of life. After all, doing whatever works for the body is what can keep it free from pain.