Foods that cause reactions for 10 people with Rheumatoid Arthritis (RA)
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
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.
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.
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.
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
Diet that gave remission
Food NOT re-introduced, effect not known
Foods removed and re-introduced – no problem in any amount
Only introduced in small amount (sm)
Problem food in any amount
Time to flare
Reaction to food if too much or too frequent intake
Soy, legumes, nightshades, seed oils
Eggs, all dairy, rice, all spices, quinoa, spirits, peanuts (sm) gluten free beer (sm)
Tree nuts, carbs over 100g/day, corn, sweet potato, gluten free baking
[Feels very well no pain on strict paleo, not keen to introduce any food] Cocoa, coffee, nightshades, rice, wine (sm), nuts, eggs
Next morning within 24hrs
Soy, peanuts, legumes, pseudo-grains except quinoa, gluten and non-gluten grains, dairy except ghee
Seeds, coffee, cocoa, night-shades (sm), ghee, seed spices, macadamia oil,
Wine, tree nuts
Paleo plus rice, no nightshades
Dairy, grains except rice, nightshades
Legumes, eggs, nuts, peanuts, quinoa, rice, spirits (sm)
Cocoa, coffee, seed oils, seed spices, all nightshades, tree nuts wine, real farm eggs, spirits & GF beer (sm)
Soy, peanuts, Gluten
12 – 24 hrs
Corn 2-3 days
AIP no cranberries or yeast
Cranberries, yeast, nightshades, nuts, peanuts, all grains, legumes, soy, pseudo-grains, rice, beer, dairy except ghee
Seeds, spirits, seed spices, sunflower oil, cocoa, ghee & eggs tried – not clear.
Shrimp, corn, sweet potato, fermented foods
Apples, dried fruit,
Food with additives, pseudo-grains except chia, corn, grains except rice, alcohol except wine, legumes except sprouted lentils, peanuts, soy
Nut oils, seed spices, citrus fruit, wine (sm), eggs, rice
All dairy, all nightshades, sweet potato,
Tree nuts, seeds, plantains,
All grains, all legumes, all dairy
All legumes, some nightshades, all grains, pseudo-grains except rice, seed oils
ghee, Nuts (sm), wine (sm) brandy (sm), seed spices, coffee(sm) cocoa (sm)
Grains, wheat, gluten grains worst
Eggs, dairy, rice, nightshades – chilli, tomato, potato
Coffee, nut oils, butter, seed spices, potatoes, non-grain spirits, fresh seeds, cold pressed fresh seed oils, egg yolks
Dairy, legumes, gluten grains, non-gluten grains, corn, gluten free bakery, heated or rancid seed oils
Legumes 24-48hrs, Oils 1hr, All others 12-24 hrs
Tree nuts, egg whites, white rice, tomatoes