Can a vegan diet treat rheumatoid arthritis?

I recently became aware of a study suggesting a the vegan diet is an effective treatment for rheumatoid arthritis.

Although it sounded intriguing, another claim made in a study interview really caught my attention: the lead author of the study said doctors should encourage people with rheumatoid arthritis to try changing their eating habits before turning to medication.

Before to turn to drugs? Now wait a minute. This runs counter to decades of research convincingly demonstrating the importance of early drug treatment of rheumatoid arthritis in preventing permanent joint damage. A growing number of effective treatments can do just that.

In fact, there is no convincing evidence that dietary changes can prevent joint damage in rheumatoid arthritis. And that includes this new study.

So what did this research find? We’ll take a look.

A vegan diet for rheumatoid arthritis

The researchers recruited 44 people with rheumatoid arthritis into the study. All were women, mostly white and highly educated. They were randomly assigned to one of two groups for 16 weeks:

  • Vegan diet. The participants followed a vegan diet for four weeks, followed by additional dietary restrictions that eliminated foods that the researchers believed to be common arthritis trigger foods. These foods included cereals containing gluten (wheat, barley and rye), white potatoes, sweet potatoes, chocolate, citrus fruits, nuts, onions, tomatoes, apples, bananas, coffee, alcohol and table sugar. After week seven, these foods were reintroduced, one at a time. Any reintroduced foods that seemed to cause pain or other rheumatoid arthritis symptoms were eliminated for the remainder of the 16-week period.
  • Usual diet plus placebo. These participants followed their usual diet and took a placebo capsule every day for 16 weeks. The capsule contained insignificant doses of omega-3 fatty acids and vitamin E.

After the first 16 weeks, participants took four weeks off, and then the groups swapped food assignments for another 16 weeks.

What did the study find about the vegan diet?

The vegan approach seemed to help alleviate arthritis symptoms. Study participants reported improvement during the vegan diet, but no improvement during the placebo phase.

For example, the average number of swollen joints fell from 7 to 3.3 in the vegan diet group, but actually increased (from 4.7 to 5) in the placebo group. Additionally, during the vegan diet, participants lost an average of 14 pounds, while those on the placebo gained almost 2 pounds.

What else should we consider?

Although the results seem excellent, the study had important limitations:

  • Cut. Only 44 study subjects enrolled and only 32 completed the study. With such small numbers, it only takes a few to alter the results. Larger studies (with several hundred or more participants) tend to be more reliable.
  • Lack of diversity. This trial did not include men and had mostly highly educated white participants.
  • No standard diagnosis of rheumatoid arthritis. A doctor’s diagnosis was required, but nothing required standard criteria to be met.
  • Duration of the study. Four months of treatment may seem like a long time, but for a chronic condition like rheumatoid arthritis that can wax and wane on its own, it’s too short to draw definitive conclusions.
  • Self-reported diet. We don’t know how well the study subjects adhered to their diet.
  • Use of drugs. The study subjects were taking arthritis medication, although no information about specific medications was offered. Some made dosage adjustments during the trial. Although the researchers attempted to capture this through a separate analysis, the small number of participants could make this analysis unreliable.
  • Weightloss. Losing weight, rather than following a vegan diet, could have helped improve symptoms.
  • No assessment of joint damage. No X-rays, MRI results or other assessment of joint damage were provided. This is important because we know that people with arthritis can feel better even when joint damage continues to worsen. Steroids and ibuprofen are good examples of treatments that reduce rheumatoid arthritis symptoms without protecting the joints. Without information about joint damage, it is impossible to assess the true benefit or risk of using a vegan diet to treat rheumatoid arthritis.

Finally, it is unclear how a vegan diet would improve rheumatoid arthritis. This raises the possibility that the results may not hold.

Should everyone with rheumatoid arthritis go vegan?

No, there is not enough evidence to support recommending a vegan diet – or any restrictive diet – for everyone with rheumatoid arthritis.

That said, a plant-rich diet is healthy for almost everyone. As long as your diet is nutritionally balanced and palatable to you, I see little harm in adopting an anti-inflammatory diet. But in the case of rheumatoid arthritis, the diet must be combined with medicationto prevent joint damage, not used in its place.

The bottom line

Mounting evidence suggests diet may play a role in treating rheumatoid arthritis. But it’s one thing for a person to feel better on a particular diet; it’s quite another to say that food is self-sufficient.

In case of high cholesterol or high blood pressure, dietary changes are the first choice of treatment. But rheumatoid arthritis is different. Disabling joint damage can occur early in the disease, so it is important to start taking effective medications as soon as possible to prevent this.

We will undoubtedly see more research exploring the impact of diet on rheumatoid arthritis, other forms of arthritis, and other autoimmune diseases. Perhaps we will learn that a vegan diet is very effective and can replace medication in some people. But we are not there yet.