Case studies – diet changes reverse rheumatoid arthritis

Case studies – diet changes reverse rheumatoid arthritis

This is the first of a series of posts where I will be posting results from my research project. In this post I look at documented case studies where diet changes have eliminated or reduced symptoms of RA. I’ve given a summary of the studies as well as a chart with the findings. You will note that there is a range of foods that cause exacerbation of symptoms.

Important: RA is a complex disease, these documented case studies show successes, where RA is managed and symptoms reduced or even reversed in RA. This does not  mean that RA can be cured. It does not mean that all people with RA will necessarily respond to diet. Overall the range of improvements to RA in diet studies was between 5 and 70% of participants. We also know that fasting ameliorates disease for almost all with RA. So diet matters, but finding trigger foods can be a time consuming process, and food triggers vary between participants.

Rheumatoid arthritis (RA) is the second most common form of arthritis in New Zealand estimated to affect 0.74% – 3.2% of the population or approximately 40,000 New Zealanders. It affects 3 times more women than men (Pezzullo, 2010). RA is a chronic complex systemic auto-immune disease characterised by severe inflammation of the synovial lining of the joints. This chronic inflammation causes pain, swelling, inflammation and stiffness of the joints, eventual destruction of cartilage and bone causing loss of function and joint deformity. RA severely affects mobility and quality of life. Rheumatoid arthritis also has many non-joint manifestations including inflammatory conditions in the lungs, eyes, skin, heart, brain and nerves (Scott, Wolfe, & Huizinga). RA is also associated with an increased risk of cardiovascular disease (Myasoedova & Gabriel, 2010), type 2 diabetes (Su, Chen, Young, & Lian, 2013) and osteoporosis.

Typical joint deformity seen in long term rheumatoid arthritis, this deformity is not common now with modern drug therapy (source)

RA hands

The Arthritis New Zealand website carries a brochure about nutrition and arthritis. Inside it states “Gout is the only type of arthritis that can be improved by changing your diet and lifestyle”. For those with RA “Do I need to avoid specific foods?” The answer is that although “Some people feel that cutting out acidic fruit such as oranges and grapefruit, and vegetables from the nightshade family, there is no scientific evidence that leaving out either of these foods does help and such diets may have he undesired effect of reducing beneficial nutrients” (NZ Arthritis, 2014)

Despite this information, many people with RA believe that diet can make an impact. In my research project I found around 45 case studies, intervention, and elimination diet studies specifically showing the impact of diet on RA.

Here is an overview of case studies of the effect of diet on RA

Twelve case studies from 1948 through to 2012 are presented. In most of these studies, problem foods were tested by eliminating and then re-introducing the to see what effect they had on symptoms.

Zeller (Zeller, 1948) presents 4 case studies. To identify potential food triggers for RA he took an extensive history of allergies, noting that “foods that were productive of other allergic symptoms often also cause arthritic symptoms.” He also notes that skin tests, both scratch and intradermal did not have value for finding trigger foods for RA, however positive tests were linked to other problems; allergic reactions like hay fever or rhinitis. Potential problem foods were identified, then excluded from the diet and tested with a challenge. He found the most effective diagnostic measure was food ingestion followed by white blood cell responses. Leukocyte counts dropped significantly over 40 minutes after problem food ingestion. Each person reacted to a specific food or foods, and once these were removed from their diets, symptoms resolved and measurements related to disease severity reduced, for example erythrocyte sedimentation rate (ESR). Zeller also noted that deformity and ankyloses reversed in two people over time. Foods identified in these four included milk (2), beef (2), eggs, pork(2), tomatoes, white potatoes, fish (2), banana, whiskey, beer, green beans, lettuce and nuts. Another observation of interest is the time to an inflammatory joint response after food ingestion. From the time food is ingested joint pain and swelling was noted as being 1 hour in case 1, 4-6 hours with maximum intensity at 16 hours in case 2, in case 3 response to milk was 45 minutes and other foods 3 hours, persisting for 24 – 36 hours. In case 4 pain, swelling and fatigue took 4 -5 hours persisting 36 hours.

Three case studies showed patients reacted strongly to a single food or food group and when the food was completely removed RA went into remission. The foods were dairy products; milk and cheese (Parke & Hughes, 1981), corn or maize starch (Williams, 1981), and cereals (Lunardi et al., 1988). Another case study identified milk as a trigger and this was confirmed with blinded testing (Panush, Stroud, & Webster, 1986). The patient went into complete remission whilst fasting or on Vivonex, an elemental liquid diet replacement. After milk ingestion it is notable that like the Zeller case studies, post ingestion symptoms began at 6 – 12 hours, peaking at 24 to 48 hours. Whilst this response time to a trigger is similar in these case studies, another case study of a 15 year old female with juvenile RA where dairy foods was confirmed as the trigger, response time was far slower, after eating dairy products daily in 4 separate challenges, she developed arthralgia, fatigue and arthritis in 10 to 23 days. Once dairy was removed symptoms resolved in 10 days to 3 weeks (Ratner, Eshel, & Vigder, 1985).

O’Banion used another method to find trigger foods in 3 case studies (O’Banion, 1982). Patients kept a food and drink diary, took their pulse hourly and recorded the severity of their arthritis pain and sleep quality. Two patients had elevated pulse rates after a number of foods. In the next phase the patients ate a diet which tested vegetables, meats and fruits one food per meal, 3 foods tested per day. Changes in pulse rate and joint responses were noted, this continued until a diet of non- reactive foods was found and patient was pain free. Food challenges continued and the most triggering foods were identified. All 3 reacted to dairy, wheat, cane sugar, corn and beef, and individually to a number of other foods.

The most recent case study (Denton, 2012) and the only one found after 1988, used a more modern elimination diet which removes common inflammatory foods. After a few days the patient’s pain reduced on this diet and food challenges began. Corn and nightshade vegetables were identified as trigger foods, once removed the patient went into remission and came off all medication.

 

Scroll down to the bottom of the page to see the chart of results for more information – I have placed it so it can be viewed without distraction of adverts at right

(If you find this useful, you might consider a donation – at right – that would be really appreciated- Julianne)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Denton, C. (2012). The elimination/challenge diet. Minnesota medicine, 95(12), 43-44.
Lunardi, C., Bambara, L. M., Biasi, D., Venturini, G., Nicolis, F., Pachor, M. L., & Desandre, G. (1988). Food Allergy and Rheumatoid-Arthritis. Clinical and Experimental Rheumatology, 6(4), 423-424.
Myasoedova, E., & Gabriel, S. E. (2010). Cardiovascular disease in rheumatoid arthritis: a step forward. Current Opinion in Rheumatology, 22(3), 342-347. doi: 10.1097/BOR.0b013e3283379b91
NZArthritis. (2014). Rheumatoid Arthritis. In A. N. Zealand (Ed.).
O’Banion, D. R. (1982). Dietary control of rheumatoid arthritis pain: Three case studies. Journal of Holistic Medicine, 4(1), 49-57.
Panush, R. S., Stroud, R. M., & Webster, E. M. (1986). Food-Induced (Allergic) Arthritis – Inflammatory Arthritis Exacerbated by Milk. Arthritis and Rheumatism, 29(2), 220-226. doi: 10.1002/art.1780290210
Parke, A. L., & Hughes, G. R. V. (1981). For Debate … Rheumatoid-Arthritis and Food – A Case-Study. British Medical Journal, 282(6281), 2027-2029.
Pezzullo, L. (2010). The economic cost of arthritis in New Zealand in 2010. [Report]. Access Economics Pty for Arthritis New Zealand.
Ratner, D., Eshel, E., & Vigder, K. (1985). Juvenile rheumatoid arthritis and milk allergy. Journal of the Royal Society of Medicine, 78(5), 410-413.
Scott, D. L., Wolfe, F., & Huizinga, T. W. J. Rheumatoid arthritis. The Lancet, 376(9746), 1094-1108. doi: 10.1016/s0140-6736(10)60826-4
Su, C.-C., Chen, I.-C., Young, F.-N., & Lian, I.-B. (2013). Risk of Diabetes in Patients with Rheumatoid Arthritis: A 12-year Retrospective Cohort Study. Journal of Rheumatology, 40(9), 1513-1518. doi: 10.3899/jrheum.121259
Williams, R. (1981). Rheumatoid-Arthritis and Food – A Case-Study. British Medical Journal, 283(6290), 563-563.
Zeller, M. (1948). Rheumatoid arthritis. Food allergy as a factor. Ann Allergy, 7((2)), 200-1949.

 

 

 

 

 

 

 

 

 

Study
Age F/M
Disease duration
Diagnostic tests if known/ symptoms
Medication

 
How foods that cause symptoms were diagnosed
Dietary treatment that reduced RA symptoms
Outcome of diet changes
Longer term
Food implicated as triggering RA
(Zeller, 1948) Case study 1
Female, 39
9 years
RA Joint symptoms
Fatigue
Diarrhoea
constipation
Nausea
Nasal congestion
sneezing
Coal tar products partial relief
Elimination and food challenges
Symptoms exacerbated after ingestion of foods. Milk caused diarrhoea, nausea, headache & fall in leukocyte count 7400 to 5400 cells. Onset of joint pain, swelling from 1 hour.
Chocolate and banana – headache.
Beef, banana, fish, nuts on challenge produced fatigue, joint pain and swelling. Exclusion of foods gave relief of symptoms
Exclusion of foods: milk, beef, banana, fish, nuts
Exclusion of foods produced relief of joint symptoms.
Ingestion produces reactions

 

Remains symptom free except for some finger swelling
ESR reduced from 20mm to 8mm/hour
Milk, beef, banana, fish, nuts
(Zeller, 1948) case study 2
Male, 67 25 years
RA Joint pain and swelling in hands, knees and ankles
fever
fatigue
“every therapeutic measure exhausted”
Patient observed whiskey and beer caused swelling and pain in joints.
Ingestion tests showed wheat, eggs, fish, tomatoes, pork produced joint pain and swelling and fatigue 4 – 6 hours post eating. Maximum intensity 16 hours before subsiding
Exclusion of Wheat, eggs, fish, tomatoes, pork, whiskey , beer
On exclusion of foods, symptoms decreased 80% in 3 months
Ingestion tests at 3 and 6 months again produced symptoms
2 years later some deformity and ankyloses reversed. ESR May 1946: 80mm/hr, March 1948 38mm/hr
Wheat, eggs, fish, tomatoes, pork, whiskey, beer
(Zeller, 1948)case study 3
Female 41
6 years
RA Joint symptoms, pain and swelling
Low grade fever
Abdominal distension, wind,
Cramps diarrhoea daily
Sore throat
Therapy ineffective
Salicylates, bee venom
Ingestion tests (food challenges) with most frequently eaten foods
Pork – nasal congestion, abdominal bloating 40 mins
Milk – coughing, fatigue, painful joints in 45 mins, sore throat, fever 3 hours. Diarrhoea during night.
Lettuce, white potatoes, string beans, sore throat, joint pain and swelling 3 hrs, persisting 24 – 36 hours
Exclusion of these foods resulted in remarkable improvement
Deliberate ingestion causes symptoms
Exclusion of Lettuce, white potatoes, string beans, milk, pork
Food exclusion “Remarkable improvement”
Deliberate ingestion causes symptoms
Not stated
Lettuce, white potatoes, string beans, milk, pork
(Zeller, 1948)Case study 4
Female, white, 42
20 years
RA Joint symptoms
Nasal congestion
Pruritus ani
headaches
Not stated
Ingestion tests
Exclusion diet and re-introduction
Ingestion tests: Milk: sneezing, headaches, in 20 minutes lasting 24 hours. Leukocyte count 5900 to 3900 cells in 40 mins.
Wheat: sneezing in 15min, eggs- nausea in 5 mins (also leukocyte count drops 5400 to 4400 in 40min)
Placed on exclusion diet with no reactive foods. Challenge with one food at a time, 2 days apart
Beef- join pain & swelling, fatigue 4-5hrs, persisting for 36 hrs.
Eggs, pepper, garlic – vaginal itching and eruption in 2 hours
Pork, rectal itching
Wheat, nasal symptoms
Milk, nasal congestion
Problem foods excluded.
Beef   for RA, egg, pepper, garlic, pork, wheat, milk for other health concerns
Not stated but assumed that no symptoms on exclusion diet
Deformity of hands disappeared,
Wheat was eliminated for 3 months now tolerated once day
Beef only caused arthritis
Eggs, pepper, garlic -vaginal itching and eruption in 2 hours
Pork, rectal itching
Wheat, nasal symptoms
Milk, nasal congestion
(Parke & Hughes, 1981)
38, Female
25 years
Erosive seronegative RA.
ESR 110mm/h
Fatigue
Dry eyes & mouth
Salicylates NSAIDS, (not effective) prednisolone 10mg/d failed to relieve intense synovitis and stiffness
Elimination and food challenge with milk and cheese
Inadvertent consumption of dairy, symptoms returned in 12 hours
Monitored food challenge- in 24hours pronounced deterioration of arthritis, pronounced increase in synovitis, increase in Ritchie index, morning stiffness, 5mm increase in ring size, positive RAST to dairy IgE antibodies, heat-damaged red cell clearance rates
Elimination of milk, cheese, and butter
In 3 weeks – decreased synovitis and morning stiffness. Improved Richie index, VPAS,
ESR
Prolonged improvement in previously unresponsive RA
Morning stiffness completely disappeared
Synovitis completely resolved
“Well fully mobile, minimal residual disease activity.”
Off prednisone
Milk and cheese

 

(Williams, 1981)
Female, age not known
25years
“Active RA” pulmonary involvement
Aspirin, azathioprine
Removal of maize starch- dramatic improvement in 1 week
Accidental ingestion of corn-starch thickened gravy at 6 weeks “arthritis flared badly”
Exclusion diet, elimination of corn and maize starch, including starch filler in medications
“Dramatic improvement” after 1 week of exclusion diet, off all medication. ESR fell from 75 to 31. Chest xray clear, lung function normal
Off all tablets
Looking and feeling better than ever
Chest xrays clear, lung function ‘normal’
Maize / corn starch
(O’Banion, 1982) case study 1
Female 21
7 years
RA joint symptoms
Grand and petty mal seizures, headaches, fatigue, sleeping problems, depression,
Dilantin for seizures, alcohol for pain
Diet reactions observed, followed by elimination diet and re-introduction of foods.
Phase 1: Patient recorded severity of arthritis pain 1- 10, pulse rate hourly and all food and drink consumed. Sleep quality recorded from 1 – 10 for 18 days.
Phase 2: water only, testing of fresh fruit vegetables and meat, 3 foods tested each day, 1 food eaten at a time. 4 day rotation of foods. Food from same Biological family not eaten more than every 2 days. Reactions to foods noted – physical and behavioural
When 3 pain free days, returned to normal diet to test. Day 44 normal diet resumed: result – pain returned to baseline levels within 7 to 10 days
Resumed non-reactive diet of meats, vegetables, fruits. On return to non-reactive food diet became symptom free in 11 days
Day 88 tested commercial and organic pork immediate and severe arthritis pain
Treatment diet: Vegetables, meats and fruits, “non-reactive foods”
Tolerated foods: Apples, pears, watermelon, grapes, peaches, pineapple, carrots, lettuce, celery, cabbage, tuna, eggs, green beans, salmon, crab , shrimp, walnuts, Brazil nuts, coconuts, sunflower seeds avocado, sesame seeds
Pain elimination 19 days into diet testing and elimination. She reported sleeping ‘sleeping extremely well’
Daily pulse rate decreased
Patient had remained pain-free for 1.5 years, pain free at time of report.
She consistently reacted to: peanuts, beef, pork, oranges, dairy products, poultry, wheat, honey cane sugar, potatoes, coffee, corn barley, pecans.
Glue and paint fumes triggered epilepsy.
(O’Banion, 1982) case study 2
Female 18years
8 years
RA, primarily knee pain, periodically other joints.
Also headaches, temper, crying moodiness, confusion sinus problems, allergies.
6 aspirin a day, minimal effect
Phase 1: Baseline data collected for 35 days. Diet response to food recorded eating normal diet.
Phase 2: day 36 – rotary diet fresh meats, vegetables and fruits. First symptom free day – day 9. Food testing- Irregular pulse or physical or behavioural reaction to that food noted. Reactive foods eliminated and questionable foods re-tested. Normal baseline diet resumed after 4 pain free days, result: pain returned to baseline levels
No pulse rate changes to foods
Elimination diet of meats, vegetables and fruits
testing for problem foods continued.
Food removed permanently if caused a reaction
Arthritis pain eliminated, reported sleeping well, not moody. Sinus discomfort and allergic symptoms completely eliminated.
Not stated
Wheat, beef, pork, cane sugar, milk, corn and a few other foods
(O’Banion, 1982) Case study 3
Female 36
Duration not stated
Periodic RA in several joints.
headaches, bowel disturbances frequent sleepiness, sinus problems, emotional problems, obesity.
Phase 1: 13 day baseline data on normal diet
Phase 2: Testing and elimination day 14 to 32. Foods producing irregular symptomology eliminated
Rapid decrease in pain, one test food cantaloupe marked increase in pain and pulse rate
Phase 3: Day 33 normal diet resumed – this resulted in a gradual increase in pain. Reactive foods tested several times to confirm.
Some foods consistently increased pulse by 10 – 20 beats/min which also caused physical and emotional responses
Elimination diet of meat vegetables and fruits
No pain on day 32.

 

Not stated
Wheat, corn, tomatoes, cane sugar, milk products, eggs, apples, beef, lettuce, peanuts, cantaloupe, peas
(Panush et al., 1986)
Female, 52, white
11 years
Class I stage I, active disease. MSD 30 – 60 min, 9 tender joints, 3 swollen joints, objective assessment 87% on normal diet
ESR 27 – 42mm/hr
Vivonex meal replacement and food challenges
Un-blinded challenge noted exacerbations with milk, beans, meat
Normal diet 6 days- 30 min MSD, 9 tender joints, 3 swollen joint 87% subjective assessment
Vivonex 2 days, fasting 3 days, No MS, swollen joint score 0, tender joint 1, assessments 100%
Vivonex 33 days – no symptoms
Blinded milk challenge – MSD 30 min, 14 tender joints, 4 swollen joints, objective assessment 80%, symptoms began 6 – 12 hours peaking at 24 – 48 hours. IgG and IgG4 anti-milk level increase marked.
Beef, chicken, rice challenge was possible reaction but unclear
Fasting, Vivonex Vivonex meal replacement 33 days
Fasting or Vivonex – no symptoms of RA

 

Not stated
Milk.
Shellfish – urticaria
(Lunardi et al., 1988)
Not stated
Serum positive RA ARA criteria
High IgE
ESR 120mm/h
Pleuritis, vasculitis, cutaneous ulcers

 

Methylprednisolone 24mg/die 10m
Gold salts 6mg/die
Penicillamine 200mg/die 3m
Clinical condition worsening
Positive skin prick for cereals
3 week elimination diet then Challenge test: cereals triggered arthralgia, articular tumefaction, morning stiffness, vasculitis
Removal of cereals from diet

 

Patient went into remission ESR fell to 20mm/h
Waaler Rose and Rheuma test negative (now known as Rheumatoid factor)
Total IgE became normal
1 year still in complete remission
Cereals
(Denton, 2012)
Female 65
15 years
RA, gastritis, eczema, rhinitis, dry eyes, anxiety, poor sleep
fatigue
Medication not effective, methotrexate produced side effects.
Trazadone for sleep
tramadol
Elimination and food challenge
Modified Elimination diet removing most common causes of inflammation – wheat, corn, cow’s milk dairy products, nightshade vegetables (white potatoes, tomatoes, eggplant, peppers) followed by food challenges
Improvement reported after a few days. More energy, bowels normalised, pain ‘dramatically reduced’
On re-introduction corn caused eye dryness, joint inflammation and colitis. Nightshades – burning pain in back, arms, and hands, very achy, plus bloating and nausea.
No reaction to cow’s milk or wheat
For next 5 months avoided all corn and nightshade vegetables
Completely off methotrexate, trazadone and tramadol. Able to do treadmill training
Able to go on hiking trip to Asia.
In remission
Corn,   nightshade vegetables (white potatoes, tomatoes, eggplant, peppers)

 

Leave a Reply

  1. So is the message from these studies that RA can be food-induced (and reversed if those foods are avoided), but that the foods that provoke an inflammatory response are unique to the individual? In other words, every individual with RA could benefit from an individual analysis of their response to a variety of food? Are you able to provide information about practitioners who can perform these kinds of analysis? This would be very helpful.

    I note that some of the foods listed as causing inflammation are also foods recommended on a Paleo diet – very confusing.

    • I’m not sure you can say RA is food induced, but it does appear to contribute, and how this happens is debated. l’l be providing answers in further posts. Some with RA respond to paleo – I don’t know how many, that is future research.

      • As an RA sufferer who has modified my diet many times in line with current theories, without any evident change, I am wary of articles/websites etc that confidently state that certain diets can take the disease into remission. I’ve read many academic journal articles on the subject, and most are cautious about the connection – or else the study samples were too small to draw any firm conclusions. Obviously what we eat has a profound effect on our health, but no one has yet conclusively demonstrated a diet that takes RA into remission for sufferers en masse. But of course research in this area is essential, and I live in hope that something more definite will make itself known in the not-too-distant future. In the meantime, I urge those out there who believe they have found answers to exercise a little caution in their statements – out of respect to sufferers,

        • I completely agree. En mass there has been no study that shows diet puts all or most RA sufferers into remission. We have numerous anecdotes, a bunch of case studies – which of course are success stories, and intervention studies which have variable results. Also results are individual – and I will talk about this in future posts. Whereas a sprinkle of chilli pepper is an instant trigger for one person, it isn’t for another. We know too little. I intend to keep researching this topic, for Masters or further.

    • Can you supply a clinical study for this assertion please – makes a difference if you make such a strong statement to provide clinical evidence – thanks

  2. Thank you for this well-organized information. I have already noticed that too much grain in my diet means joint pain and I absolutely try to avoid any soy or corn products. Now I just need to work on the self-discipline to find further triggers and avoid the ones I already know.

  3. Thank you for posting this. Fascinating work. It’s interesting how many of the subjects reacted to beef! I wonder if grass-fed would be better tolerated. I have been paleo for five years, completely AIP for most of the past few years. While everything was great the first year or so and I saw clear improvement with my RA on paleo, since then the benefits seem to have gone away. I keep trying different things hoping to finally find whatever the heck my trigger foods are, but so far unsuccessful. If it’s beef, my diet is really going to narrow!

    • I don’t think grass or grain fed it the issue, it seems to be beef. Anecdotally I’ve heard of several people who react to red meat. And when they leave it out, their pain and inflammation reduces.