Ten people with Rheumatoid Arthritis (RA) share their insights into the foods that cause them flares and the foods that are safe

(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:

• The Paleo Mom – Sarah Balantyne
• Phoenix Helix – RA and AIP – Eileen Laird
• Auto-Immune paleo – Mickey Trescott
• Links to many AIP resources

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 needs 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.

Participants

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 number	Start diet	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	Response if too much or too frequent intake
01	AIP	Soy, legumes, nightshades, seed oils	Eggs, all dairy, rice, all spices, quinoa, spirits, peanuts (sm) gluten free beer (sm)	Gluten grains,	6hrs	Tree nuts, carbs over 100g/day, corn, sweet potato, gluten free baking
02	Paleo Other Elimination	[Feels very well no pain on strict paleo, not keen to introduce any food]	Cocoa, coffee, nightshades, rice, wine (sm), nuts, eggs	All dairy	Next morning within 24hrs	Sugar
03	AIP	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,	Eggs, beer,	Next morning	Wine, tree nuts
04	Paleo plus rice, no nightshades	Dairy, grains except rice, nightshades	Legumes, eggs, nuts, peanuts, quinoa, rice, spirits (sm)	Wine	36 hrs.
05	AIP	Pseudo-grains, seeds	Cocoa, coffee, seed oils, seed spices, all nightshades, tree nuts wine, real farm eggs, spirits & GF beer (sm)	Soy, peanuts, Gluten grains, Rice	12 – 24hrs Corn 2-3days	Corn, dairy
06	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	Next morning	Apples, dried fruit,
07	AIP	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,	36hrs	Tree nuts, seeds, plantains,
08	Paleo	All grains, all legumes, all dairy [Is well and pain free on strict paleo]	Vodka (sm)	Not known	N/A	Not known
09	AIP	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	3-4 hrs.	Eggs, dairy, rice, nightshades – chilli, tomato, potato
10	AIP	Pseudo-grains	Coffee, nut oils, butter, seed spices, potatoes, non-grain spirits, fresh seeds, cold pressed seed oils, egg yolks	Dairy, legumes, gluten grains, non-gluten grains, corn, gluten free bakery, heated or rancid seed oils	Corn 20min Legumes 24-48hrs Oils 1hr All others 12-24hrs	Tree nuts, egg whites, white rice, tomatoes