Home Auto-immune disease Rheumatoid arthritis and diet – what worked for 10 people

Rheumatoid arthritis and diet – what worked for 10 people


Foods that cause reactions for 10 people with Rheumatoid Arthritis (RA)

(Please read my earlier post also – case studies where eliminating certain foods put RA into remission)

For information on how to follow an auto-immune protocol:

Last year I carried out a qualitative research project as part of my Post Grad Diploma in Human Nutrition. I interviewed 10 people who had experienced a significant reduction in their RA symptoms and improvements in clinical markers as a result of changing their diet to a paleo or auto-immune paleo protocol.

The aims of the study:

  1. To find out what motivated people to change their diet in the first place.
  2. To discover which challenges they encountered changing and maintaining the diet.
  3. To learn how they managed those challenges.
  4. To find out which foods they consumed and which presented symptoms on reintroduction.

To qualify for the study:

  • Participants had positive RA clinical markers
  • The minimum duration of their RA was 6 months
  • Participants credited the paleo diet to reducing their symptoms and clinical markers
  • They had been on a paleo diet for a minimum of 6 months.

Important Note: this group is self selected, which was the intention of this study. The fact that a paleo diet worked for these people does not mean it will work for everyone with RA, much further research needs to be done. For example there need to be interviews with people for whom AIP did not work, and interviews with people for whom other diets worked for example plant based or vegan diets. An intervention study with a control group is needed to clarify the extent to which an AIP diet works.

Please do not take this research as proof that AIP is the diet everyone with RA should be doing, or that it is going to cure you. I present this as what it is – it worked for these 10 people and this is their experience. Note also – it reduced symptoms and markers of disease, it is not a cure for RA. If the diet is not followed symptoms return. If you do wish to try it, use the resources listed above, and carefully monitor your clinical markers. If you have success and wish to reduce your medication, do so only while working with your medical specialist.


The 10 people interviewed (9 female, 1 male) were from NZ (2), USA (7) and Australia (1) aged from 28 to 60 years, mean 41.7, the time on this diet ranged from 6 months to 5 years, mean 2.9 years.

As part of the interview I asked each person specifically what they ate and what they cut out on their version of the paleo diet. I asked when and how they re-introduced foods, and what they experienced as a result; how long it took for the flare to come on, how intense it was and how long it took to go away again.

In this post I will give an overview of the diet each person ate that afforded their success, what foods were particularly problematic on re-introduction, and what foods each person found were safe.

Starting the paleo or auto-immune paleo (AIP) diet

Most people in this group spent time learning about the diet, collecting recipes, and buying and preparing food in advance. They picked a start date where there were no celebratory holidays, vacations or other distractions. Kitchens were prepared – food not on the diet was removed, and AIP compliant food stocked. Some in the group made food in bulk, others found a number of recipes and planned meals ahead.

Once prepared 8 out of 10 changed their diet completely overnight to an AIP or strict paleo diet such as Whole 30.

Adherence to the paleo diet

Adherence to the diet that worked for them was described as 85% by one person and 95 – 100% by the other 9. The primary motivation to stay on the diet was stated as lack of pain, being able to reduce or eliminate medication and greatly increased quality of life. When asked about the changes in pain levels before paleo and as a result of diet changes – most (7) described their pain as being 10 out of 10, with debilitating fatigue. As a result of diet changes all described their pain levels as 0 to 1 out of 10.

Be prepared to follow AIP for at least 3 months strictly

While many of the participants experienced improvements in the first few weeks, others did not get relief from symptoms until around the 3 month mark.

Be prepared to follow AIP strictly for 3 months in order to see results. This means being physically prepared, having food for all meals for a few days ahead. Be psychologically prepared, know that for 3 months minimum you won’t stray from a strict diet.

Challenging situations to follow AIP

Traveling, eating out, at both restaurants and friends & family’s places presented the greatest challenges to staying on AIP. Be aware that these will present a problem, for these participants friends and family often did not understand the need for the strict diet, and restaurants inadvertently put non-compliant ingredients in the meals. I’ll write more about these challenges and tips to deal with them in another post.

Problem foods are discovered by re-introduction challenge

After being on the diet for at least 3 months, some but not all the participants did careful re-introductions of food to gauge what effect it would have.

Re-introduction protocol

Each person used a slightly different protocol, however foods that were least likely to cause a problem were re-introduced first. For example egg yolks or seeds. Typically a small amount of the food was eaten and then they wait for 2 – 3 days, this is important as some people have a delayed reaction. If there is no reaction they ate a lot of the food over 1-2 days and again waited 3 days to see if there is a reaction. If no reaction at all they continued to eat that food. (Re-introduction protocol for AIP)

Reactions to foods varied between people

Some foods elicited a strong inflammatory reaction or flare, where joints would become swollen and painful in the hours after the food was eaten, whereas other foods caused a small flare and only if eaten in larger amounts.

Some foods caused a painful flare if eaten in a tiny amount.

In the chart below these are listed as “problem food in any amount”. Note that foods deemed safe in a normal paleo diet cause painful flares for some people in this group – for example eggs and nightshade group of vegetables (potatoes, tomatoes, eggplant and peppers).

Some foods were recognized as a problem through accidental re-introduction, for example one woman changed a brand of supplement and had a painful flare as a result of wheat / gluten in the food.

Participants had different reaction times.

The most common reaction time frame to eating a trigger food was 12 – 24 hours, so typically it was noticed on rising the next day – increased stiffness and pain. One had a flare within 20 minutes, others 3 – 6 hours, while a few had a flare 36 or even 48 hours later.

Normal elimination diets DO contain foods that people with RA react strongly to

It is useful to note also that foods considered safe on other elimination diets were very problematic for some in this group, of note dairy (kefir is included in GAPS diet), corn (included in many gluten free diets) and rice (considered a safe grain in many elimination diets).

A food that causes a strong flare in one person can have no effect in another

Some participants had no problems with rice, nightshades or eggs, whilst for others these caused an acute RA flare.

Some foods are a weak trigger

Certain foods only trigger a minor flare, and need to be eaten regularly or in larger amounts before a flare is noticed. These foods are listed in the last column. Eggs for some, and nuts for many fell into this group.

Some foods remain untested

You will note that the first column contains foods that are untested, i.e. they have not been re-introduced.  Once a person is well, they are reluctant to re-introduce foods they suspect cause most problems, gluten grains in particular were the least likely to be introduced. Those who discovered gluten grains caused a flare only found this our through accidental re-introduction.

Foods most likely to be re-introduced

A person is more likely to re-introduce a food they would like to eat, and a food which they think is less likely to cause a flare, for example chocolate (cocoa), nuts and seeds (including seed spices) fall into this category.

The chart below shows the individual reactions to foods with respect to RA

Participant numberDiet that gave remission
Food NOT re-introduced, effect not knownFoods removed and re-introduced – no problem in any amount

Only introduced in small amount (sm)

Problem food in any amountTime to flare


Reaction to food if too much or too frequent intake
01AIPSoy, legumes, nightshades, seed oilsEggs, all dairy, rice, all spices, quinoa, spirits, peanuts (sm) gluten free beer (sm)Gluten grains,6 hrsTree nuts, carbs over 100g/day, corn, sweet potato, gluten free baking

Other Elimination

[Feels very well no pain on strict paleo, not keen to introduce any food]Cocoa, coffee, nightshades, rice, wine (sm), nuts, eggsAll dairyNext morning within 24hrsSugar
03AIPSoy, peanuts, legumes, pseudo-grains except quinoa, gluten and non-gluten grains, dairy except gheeSeeds, coffee, cocoa, night-shades (sm), ghee, seed spices, macadamia oil,Eggs, beer,Next morningWine, tree nuts
04Paleo plus rice, no nightshadesDairy, grains except rice, nightshadesLegumes, eggs, nuts, peanuts, quinoa, rice, spirits (sm)Wine36 hrs.
05AIPPseudo-grains, seedsCocoa, coffee, seed oils, seed spices, all nightshades, tree nuts wine, real farm eggs, spirits & GF beer (sm)Soy, peanuts, Gluten

grains, Rice

12 – 24 hrs

Corn 2-3 days

Corn, dairy
06AIP no cranberries or yeastCranberries, yeast, nightshades, nuts, peanuts, all grains, legumes, soy, pseudo-grains, rice, beer, dairy except gheeSeeds, spirits, seed spices, sunflower oil, cocoa, ghee & eggs tried – not clear.Shrimp, corn, sweet potato, fermented foodsNext morningApples, dried fruit,
07AIPFood with additives, pseudo-grains except chia, corn, grains except rice, alcohol except wine, legumes except sprouted lentils, peanuts, soyNut oils, seed spices, citrus fruit, wine (sm), eggs, riceAll dairy, all nightshades, sweet potato,36 hrsTree nuts, seeds, plantains,
08PaleoAll grains, all legumes, all dairy

[Is well and pain free on strict paleo]

Vodka (sm)Not knownN/ANot known
09AIPAll legumes, some nightshades, all grains, pseudo-grains except rice, seed oilsghee, Nuts (sm), wine (sm) brandy (sm), seed spices, coffee(sm) cocoa (sm)Grains, wheat, gluten grains worst3-4 hrs.Eggs, dairy, rice, nightshades – chilli, tomato, potato
10AIPPseudo-grainsCoffee, nut oils, butter, seed spices, potatoes, non-grain spirits, fresh seeds, cold pressed fresh seed oils, egg yolksDairy, legumes, gluten grains, non-gluten grains, corn, gluten free bakery, heated or rancid seed oilsCorn 20min

Legumes 24-48hrs, Oils 1hr,  All others 12-24 hrs

Tree nuts, egg whites, white rice, tomatoes


  1. Hi. I just tested positive for RA. If you ever need anyone for a new study I would be interested. I’m 47 years old and a mother of three ages 7-25. I’m always tired and sore. I’m very interested in changing my lifestyle to improve my life. I’m 5’3″ and weigh around 130. Highest weight I’ve ever had including during pregnancy. I’m a 4H leader, ride and take care of horses and work full time in project management on roadway and bridge projects. I’ve never smoked or done drugs. Thank you for publishing your results. Very informative.

    • Those who have one autoimmune disorder often have multiple disorders that may or may not be detected. Your tiredness and soreness for example may be Chronic Fatigue and Fibromyalgia or Thyroid issues. Sounds like your plate is over full. You could need much more sleep and much less stress. This is just as important as diet and often overlooked.

    • Massey University,School of Food and Nutrition – shall I put you in touch with my supervisor?
      This is a small segment / overview of part of the interview results. It was a small part of my PGDip, a preliminary qualitative study into the experience of people with RA who are currently successfully using a paleo diet. The study was done in order to set up parameters for a much larger Master’s study and thesis.
      The study was approved by the university ethics approval and I was awarded an A- for the work, my supervisor saying it was a nice piece of research.
      This is not the entire thesis – that is 130 pages long with over 140 references and covers a literature review on the pathophysiology of RA, a review of dietary case studies and intervention studies on diet and RA, a review of other qualitative studies like this that look at starting and maintaining restrictive dietary protocols. And then there is an overview and detailed analysis of 10 interviews which each took 1.5 hours. This was for 30 credits or 2 papers of 8 which make the PG Dip. This is a blog post, it is not a clinical paper or a thesis.

  2. All research is valid if structured, controlled, reliably recorded and considered in context and purpose. Piaget after all set much early develomental learning theory fron obsrvation of hos own children!
    Thank you for your reflective effort julianne. I was diagnosed coeliac 15 years ago and then sjorgrens (rheumatoid lupus symptoms) a year ago. I am my own study and am researching research often to make sense of how a fit healthy women in her 40s then 50s can develop such auto immune issues.
    It often seems to come back to 2 contributing factors. Diet & stress. Stress & diet.
    I have recently listened to an expose on the role of mechanised production applications with wheat – move from stone grinding to steel and the impact on altered nutrition, diet and health issues (sensativity and allergies to gluten). Genetic modification to i crease yeilds across all agrarian pursuits, plant and animal seem to imact the developed world most. Even whole foods can be compromised. Add modern day living stress and it is all very toxic.
    Thank you for you investigation.

    • Yes – stress and diet are both so important with respect to auto-immune disease. I’ve seen a number of clients who can pinpoint the start of AI problems to an severe gastrointestinal infection. Gut bacteria is becoming a very important topic as well. In one of the studies I looked at improvement in gut bacteria as a result of a high plant fibre and fermented food diet, showed it tracked with improvement in symptoms of RA.

  3. I found this a great article to have come across considering I have recently seen a clinical hypnotherapist and nutritionist. Any research, and surveys conducted are interesting to read about regardless of how many participants. It is all relevant any anyone looking to improve their condition it can only be a good thing to try. Myself having seen a RA specialist for 2.5 years ( 37 years old) , not once have been advised to consider my diet when I have asked numerous times what could I be doing to change my diet to assist inflammation. My hypnotherapist recently assisted me in reading about auto immune diets/ paleo and considering gluten free diet. Gluten has everything to answer for. For the past 6 weeks, I have not eaten bread, starch, and am cooking a high protein diet. My energy levels have been through the roof, and my RA is not bothering me, I have no inflammation in either hand. I am hoping by change of diet I will soon be free of the disease. I have enjoyed the challenge in change of diet – it’s not entirely Paleo but it is clean eating, gluten free and just not mixing sugars and starch (having minimal of )- this is the chemical im-balance that the auto immune reacts to for auto immune diseases/ Eczema, Rheumatoid Arthritis & Psoriasis.
    Anyone looking to improve their wellbeing, and condition of the disease, this information is invaluable. Diet has everything to do with the diseases and wellbeing. Thank you

    • Thanks for your feedback and great to hear of your success.

      Massey University is highly regarded. My research proposal had to go through the usual judging channels to gain ethics approval, every aspect of the structure had to be validated with research. The number of participants was questioned and this type of qualitative study typically has a small number of participants, researchers state 5 – 25 is a good number.

    • Hi Leticia. I had had great results for first 10 years of following a gluten free coeliac diet. Was fit, active and healthy full of energy, until 6 years ago when a series of stressful life situations and events began to culminate in utter exhaustion then recurring illness, flu, diaheorea, then extreme physical pain that was diagnosed as sjorgrens which involves RA and Lupus symptoms. It was difficult to improve me diet as it as already basically Paleo. A medical practitioner specialising in women\\\\\\\\\\\\\\\’s health and incorporating a natural and medical approach, take on stress counselling, relaxation clinics and had me include combination of vitamins and mineral supplements has really helped. Thorough analysis of bloods revealed deficiencies in vitamin A, zinc, calcium, salt, iron and various other elements. This combination therapy seems to be working and I have been incrementally reducing the serious drugs like prednisolon and metatrexate. I am gaining energy and reducing pain incrementally. Palates has been great too. Good luck with your recovery, I really thing combination therapies are the way to go but everybody responders differently to different combinations.

      • Thanks for sharing your experience. Everyone like yourself that learns by trial and error what works and shares it makes a difference for others. We all learn from this.

  4. While diet does help you feel better and lose weight, it does not cure RA. There is NO cure for RA. Please use diet in conjunction with seeing your rheumatologist and getting on the meds. People read the junk science provided here,10 people a study does not make, and blindly follow this advice and end up in a wheelchair. I\\\’ve seen it 5 times in real life. Eating good food helps, but will NEVER cure autoimmune diseases. Oils, holistic meds, and the rest of the snakeskin oils out there without treatment by a rheumatologist will not cure you and the damage RA can do to your joints and organs. He is selling a book people. He wants your money.

    • Firstly I wish to point out that I am not a he, if you are referring to me as the author. Secondly what is your evidence that this is junk science? Thirdly I have NEVER said that this is a cure for RA. I would NEVER tell anyone to go off medication and try diet as an answer.
      Next there are numerous clinical studies showing that diet has an effect in RA. I reviewed some 50 studies as part of this project.

      The reason I did this research in the first place is to find out more about anecdotal reports of success using a paleo diet, but do so using standard qualitative research methods in a University structured and supervised research protocol.

      I would also like to clarify some points which are important:
      First the aims of the study:

      To find out what motivated people to change their diet in the first place.
      To discover which challenges they encountered changing and maintaining the diet.
      To learn how they managed those challenges.
      To find out which foods they consumed and which presented symptoms on reintroduction.

      Also important: This group is self selected, which was the intention of this study. The fact that a paleo diet worked for these people does not mean it will work for everyone with RA, much further research needs to be done. For example there need to be interviews with people for whom AIP did not work, and interviews with people for whom other diets worked for example plant based or vegan diets. An intervention study with a control group is needed to clarify the extent to which an AIP diet works.

      Please do not take this research as proof that AIP is the diet everyone with RA should be doing, or that it is going to cure you. I present this as what it is – it worked for these 10 people and this is their experience. Note also – it reduced symptoms and markers of disease, it is not a cure for RA. If the diet is not followed symptoms return. If you do wish to try it, use the resources listed above, and carefully monitor your clinical markers. If you have success and wish to reduce your medication, do so only while working with your medical specialist.

      • First, there are never large studies done on things like nutritional medicine concepts until there is a huge body of anecdotal evidence to justify the money being spent. After all, who would fund them? There is no profit involved for the pharmaceutical industry, the fast food industry, or any of the other big spenders. I was diagnosed with RA six months ago and started the AIP diet nearly 3 months ago. For the first months I had significant reduction in pain and swelling in my hands and wrists, then I seemed to hit a brick wall and began having increased problems. I went back to The Paleo Approach and tweeked my program – added more liver, cold water fish, increased magesium, and began making my own Kombucha and my improvement LEAPED forward. The book is not just a text, its a guide for this journey. The blogs and stories from people like Eileen and Mickey are a daily inspiration (plus the wonderful recipes!). The work that has been done first by Sarah, and then by the bloggers has been HUGE for me. This is my third autoimmune disease – though I did not realize it at the time. I spent YEARS suffering horribly from polycystic ovarian syndrome and struggling to follow the accepted protocol at the time, which was Provera. Finally, after gaining 45 lbs and becoming severely clincally depressed, I decided I would rather die than take any more of that medication. I quit the med, spent months doing my own research in that pre-internet day, and then spent 15 years happily treating my condition naturally by using Progesterone cream (just as I hit menopause I noticed that my then GYN had started posting signs for natural progesterone in her office!!!! Standard medicine is ALWAYS lagging behind). At present I am trying to start a facebook support group for AIP followers in the Gulf Coast area. Things here are pretty much behind the times
        (they don\’t call it the redneck riviera for nothing). Both my pcp and my rheumatologist have told me that there is no evidence to support this diet. I have an appointment with a chiropractor on Monday who seems pretty open to new ideas so we will talk. In the meantime, thank you Sarah, Eileen, Mickey, and now Julianne. You have certainly rocked my world!

        • Thanks Janet, so great to hear you have found a solution to your health issues. The Paleo Approach is excellent, and gives a lot of science which I like. I’ll post more about studies that support diet for auto-immune disease

  5. My goodness, some of you, mostly women, are so rude, libellous and insulting. You can talk the talk but can any of you walk the walk? Perhaps read up,on the requirements for qualitative research and those for quantitative. I am sure you have heard of quality over quantity. !!!!!!

    Thank you Julianne for an informative piece, and I will take it and use what I want from it. Selling a book, honestly. And even if there was a book, don’t buy it. Not too hard.

  6. The issue is that Chef Pete Evans shared your study and said this \\\”Here is a wonderful read from Julianne Taylor at Massey University on her her study on people with Rheumatoid Arthritis and how paleo and Auto-immune paleo put the RA into remission, which is what we promote in our 10 week paleo program to help relieve pain. http://www.thepaleoway.com\\\”. That is why RA patients have found your site and reacted angrily. When I posted on his page the difference between qualitative and quantitative research, and the importance of making changes with your doctor\\\’s knowledge while staying on prescribed meds, he blocked me. He is promoting your research as a way to put RA in remission In a bid to sell his latest book. That is where the anger comes from.

    • Oh – I understand now. I appreciate that my work reaches more people, but as you said it is inaccurate. He blocked you! I will try to contact to remedy – thanks

      • Thanks for being understanding. The way he posted, it was a bit confusing sorting out what info was “his” and what was yours. I read your comments and wonder if your thesis came to any immediate helpful conclusions for RA sufferers? Is it available online or anything? We are always hungry for well researched info. We just get testy when miracle cures (or remissions) are touted with no scientific basis.

  7. Well done Julianne. I use a modified Paleo approach (no starch/higher amounts of good fats) to keep the symptoms of my particular type of RA under control with great success (5 years ago I could barely walk). I can actually put myself into & out of remission (the latter I try & avoid but sometimes I fall off the wagon!)
    Your study should at the very least convince sufferers to give it a go.

    • Thanks for sharing your success. I think what is clear is that a number of people do respond to diet, and that it is worth persevering to find what might work for you.

      • This is awesome. Of course the rheumatologist says there is no science to back this up because there is no monetary incentive for researchers to study diet. We need one spot to collect hundreds of experiences in a controlled fashion. I have some type of seronegative arthritis that is autoimmune and I have the meds available but I\\\\\\\’m willing to try diet because I want to know the cause and avoid side effects of drugs. There are many willing to do this for 3 months I am sure.

  8. How can anyone deny that diet is of huge importance to our good health, and preventative and curative for any ailment. I have followed a coeliac (GF) diet after medical identification of this auto-immune disease 16 years ago. I remained fit and in good health until suddenly experiencing excruciating muscle and joint pain all over my body. The diagnosed was Sjorgrens and rheumatoid arthritis . I believe prolonged stress created or activated this hat-trick of auto-immune issues. After 2 years of standard medical treatment and a variety of supplements I nave found the addition of Curcumin to my regime to show a marked improvement in lessening of the pain severity and frequency.
    I am now ready to reduce, to nothing (I hope), the pharmaceutical supports and let my body adjust to healing with more natural inputs. I have started modifying my diet to become more Paleo as I decrease the dependence on drugs. If that is successful I will begin assessing the value of various supplements (i.e. zinc, magnesium etc). It will be interesting to see what works for me as I have been very dependent on methotrexate and cortisones and anti- inflammatories.

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