Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that leads to progressive joint erosion and destruction and affects 0.5–1 % of the population.

RA is caused by mostly unknown environmental triggers leading to the immune system identifying body tissues as foreign and mounting and inflammatory response that does not turn off.

Recent advances in high-throughput genome scanning have enabled the identification of many genetic risk factors that contribute to RA susceptibility. However, it has been estimated that the genetic factors account for only 60 % of the risk for RA susceptibility, while environmental and other non-genetic factors account for the remaining 40 %.

The microbiome and rheumatoid arthritis

Among environmental factors, while only smoking is currently considered to be an established risk factor for RA, other factors, such as diet and food sensitivities may contribute to RA susceptibility. We now know that the bacteria in the gut ( the microbiome) interacts with the immune system that lie beneath the lining of the bowel and it is this interaction that is likely to be a driver of the rheumatoid arthritis processes.

What we eat influences the state and diversity of the microbiome.

Diet is an environmental factor that affects all aspects of inflammation. In the coming years we will learn what happens when the microbiome is ” out of balance” and how to restore the balance.

At present there are lots of ideas but the science is yet to catch up and provide definitive answers.

What has stood the test of time is that eating a nutrient -dense diet, low in sugar and refined carbohydrates and high in healthy fats and fibre is beneficial.





Refined grains are white bread, white rice, and anything baked with white flour. These carbohydrates turn into sugar more quickly and sugar is highly inflammatory.

What about other grains? There is a theory that going grain-free might be beneficial and this is based on the fact that grains contain lectins, carbohydrate-binding proteins found in grains. Some research suggests lectins bind to carbohydrate-specific receptors on immune cells called lymphocytes, triggering an inflammatory response. The theory is that eliminating lectin-containing foods (notably grains) might reduce symptoms in certain people with rheumatoid arthritis (RA).

Research has not confirmed any connection between whole grains and inflammation but there are a lot of anecdotal reports for benefit in going grain free.

On the other hand, whole grains are rich in antioxidants, which protect cells from damage. They are high in fibre. They also “feed” the microbiome.

Omega 3 is essential.

Having a diet high in Omega 3 fatty acids and low in Omega 6 fatty acids is an anti-inflammatory strategy. The ratio of omega 3:6 can be measured. An anti-inflammatory ratio is 1: 5. A standard diet in the majority of people is 1:25 and this ratio is postulated to be one of the reasons for an increase in autoimmune and inflammatory disorders.

A 2-year study on the effects of the Mediterranean diet on RA patients revealed that the consumption of cereals, vegetables, legumes, fruits, and olive oil decreased the risk of new onset of inflammatory polyarthritis.

In the coming year how diets interact with the microbiome will lead to therapy. There are many exclusion diets and alternate eating plans such as the Autoimmune Paleo Diet that is beneficial to many.

Some individuals have food sensitivities that promote inflammation. There is no one diet for everyone but experimentation is worthwhile.

The information about this is changing rapidly and updates information will be posted regularly. Read more about healthy oils and an anti- inflammatory diet here.