Anti-rheumatic diets have been around for decades but many assume changing their diet won’t improve a serious affliction like fibromyalgia or rheumatoid arthritis. In these circumstances, hospital consultants regularly prescribe disease-modifying anti-rheumatic drugs (DMARDs), like the chemo drug methotrexate. If diet could play an important role in pain management, surely these doctors would be advocating for it? Sadly, society’s reliance on pharmaceutical “silver bullet” medications leads us to see simple solutions as either ineffective or primitive, despite the fact that sophisticated drugs like methotrexate are known to cause real harm to your liver and kidneys. Additionally, there is a general blindness of the medical establishment to see diet as impacting on health. If you’ve ever visited your GP with acid reflux or irritable bowel, you will likely have found that you weren’t interrogated regarding what you eat or the times you eat, despite your symptoms clearly being evident of digestive upset.

How exactly is musculoskeletal pain connected with diet?

Rheumatism refers to any disease marked by inflammation and pain in the joints, muscles, or fibrous tissues – an umbrella term that encompasses osteoarthritis, rheumatoid arthritis, fibromyalgia, tendonitis, and others. The term fell out of fashion in the late 20^th century when the underlying causes of each condition – wear and tear, autoimmune disease, genetics, injury, etc. – were believed to be so different as to prevent grouping them together. Recent research, however, has shown all these diseases to have a significant metabolic element.

What does it mean to say that a disease is metabolic? Metabolism refers to the bodily process of converting food into energy: carbohydrate is broken down into glucose, protein into amino acids, and fat into fatty acids. When these processes are disrupted the underlying disease is classed as metabolic. For example, disruptions in glucose metabolism affect the body’s acid-base balance, dysregulation in protein metabolism causes immune cell dysfunction, and dyslipidaemia and hyperlipidaema (abnormal or high levels of blood fats) lead to inflammation. These pathological changes are common to diabetes, hypertension, obesity, etc, but have now also been recognised to be strong factors in the rheumatic diseases mentioned earlier.

As you might expect with metabolic diseases, diet has a significant impact on symptoms. General advice is to avoid refined sugar, white-flour products, and processed foods, and to consume less red meat, dairy, and alcohol. All these foods either cause mild acidosis or lead to inflammation.

Acidosis

Arthritis is associated with an abnormal acidic microenvironment in the joint capsule and synovial fluid.^[1] The kidneys filter waste products in order to maintain the acid/alkaline balance of the blood and tissues. This is critical to life because it affects homeostasis – the conditions under which normal cellular metabolism can occur. While the physiology remains unclear, raised blood glucose is associated with acidosis – even in non-diabetics.^[2] Likewise, diets with too much red meat and dairy have an acidic effect on the body due to the nitrogen-containing wastes these foods create (urea, creatinine, and uric acid). Eating more vegetables, fruit, seeds, pulses, and whole grains provides the body with minerals that have an alkalising effect.

Inflammation

There is a strong link between dyslipidaemia, inflammation, and rheumatism. Some research argues that an abnormal profile of blood fats is due to immune-cell dysfunction, but since 70% of our immune cells reside in the gut, it seems likely that diet plays a part. Inflammatory foods are processed meats, refined sugar, refined grains, and unhealthy fats, like trans or hydrogenated fats, or plant oils that have been processed at high temperatures.

The Bottom Line:

Foods that are acidic or have an acidic effect on the body:

• Red meat
• Eggs
• Dairy
• Fizzy drinks
• Refined sugar and processed foods containing refined sugar
• Condiments that contain white or malt vinegar, such as pickles or mayonnaise
• White flour products (bread, pasta, pastry, pizza, biscuits, cakes)
• Citrus fruits
• Tomatoes
• Chocolate
• Coffee

Foods that have an inflammatory effect on the body:

• Processed meats (chorizo, bacon, sausages, gammon, sandwich meats)
• Refined carbs, e.g. white flour products (see earlier)
• Fried foods
• Trans fats/hydrogenated oils
• Oils high in omega 6 (sunflower oil, vegetable oil, cheap rapeseed oil, palm oil)
• Refined sugar and processed foods containing refined sugar
• Artificial sweeteners, like aspartame and saccharine
• Alcohol

It’s interesting to consider that the above foods are often linked to other diseases, such as cardiovascular disease, respiratory disease, and skin diseases, and that holistic practitioners regularly advise omitting wheat, sugar, dairy, and alcohol to improve all kinds of health conditions.

In view of this, it’s of vital importance for individuals with rheumatism to avoid foods that cause them a digestive, respiratory, or skin reaction, e.g. acid reflux, abdominal pain, extra mucus, sinus pain, rashes, eczema, etc. Reactions such as these show that your body is under stress: ignoring the signs is likely to lead to a worsening of symptoms.

Perhaps the best approach to diet is to prepare all your meals from scratch, and generally increase your consumption of vegetables, fruit, whole grains, and good fats.

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^[1] The pH of synovial fluid in a normal joint cavity is 7.4 but in arthritis synovial fluid pH can reach as low as 6.0; see Liao, S. et al, ‘Advancements in pH-Responsive nanoparticles for osteoarthritis treatment’, https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2024.1426794/full and Goldie & Nachemson, ‘Synovial pH in Rheumatoid Knee Joints’, https://www.tandfonline.com/doi/pdf/10.3109/17453677008991521

^[2] In a study of 157 adults, high serum glucose levels were associated with mild acidosis even in non-diabetic patients; see Lee, KM, ‘Influence of Blood Glucose Level on Acid-Base Balance’, https://accjournal.org/upload/pdf/kjccm024010017.pdfhttps://www.sciencedirect.com/science/article/pii/S0008874918300327.