Intermittent Fasting and Rheumatoid Arthritis: What to Know – Everyday Health

Experts agree that when you have rheumatoid arthritis (RA), a healthy diet that avoidsinflammatory foods such as cheese and red meat may help you feel better.

But what about shifting the times when you eat? This type of eating plan, known as intermittent fasting (IF), has become popular in recent years. Some people with RA have used IF for weight loss, and others say it helps them feel better overall.

Although there are many versions, each IF diet involves some periods of normal eating and other periods of severe calorie restriction or abstinence from food.

There isnt enough research to definitively say that people with rheumatoid arthritis should use an intermittent fasting approach, but several small studies hint at possible benefits, says Ellen Liskov, RDN, of Yale New Haven Hospital Center for Nutrition and Wellnessin Connecticut.

For most people, it can be safely done, but always check with your doctor, and consult a registered dietitian nutritionist to discuss the eating pattern that is best suited for your health profile and desired outcomes, she says.

Here are six things people with RA should know.

Intermittent fasting is an umbrella term that spans a variety of eating plans. On all plans, during fasting periods you are encouraged to drink water, teas (especially herbal teas), and black coffee.

Some of the most common IF types include:

A number of small studies on IF in the general population have shown that the method is somewhat effective as a weight loss tool.

According to a review published in JAMA Network Openin December 2021, some types of intermittent fasting, notably 5:2 or a similar modified alternate-day fast, result in a moderate amount of weight loss, according to moderate- to high-quality evidence.

When it comes to rheumatoid arthritis, some small studies have shown that restricting calories, as happens during a typical IF diet, may have an anti-inflammatory effect, although the exact mechanisms by which this occurs are unclear, says Betty Hsiao, MD, a rheumatologist at Yale Medicine and an assistant professor at the Yale School of Medicine.

While early trials showed improvement in RA symptoms with fasting, symptoms seemed to recur when the fasting stopped, she notes.

One especially intriguing study in people with rheumatoid arthritis took place during Ramadan, a holiday during which religious Muslims fast for 30 days from dawn to dusk (meaning a 12/12 or longer intermittent fast).

In this study, published in September 2021 in Clinical Rheumatology, 35 people with RA were assessed for disease activity before, during, and an average of three months after. Disease activity was found to be significantly decreased during the fasting month and in the months following, although the benefits began to fade around the three-month mark, leading researchers to recommend that people with RA might routinely do this type of fast every three months.

Researchers are eagerly awaiting the results of an ongoing study in Germany, which is randomizing 84 people with RA either to therapeutic fasting (followed by a plant-based diet) or to a conventional anti-inflammatory diet. Results are expected to shed further light on IFs impact on disease activity.

Largely because of the lack of solid research on fasting diets, when Frances Society for Rheumatology recently released recommendations for the best weight loss eating plans, they recommended that people with rheumatic diseases stick with a Mediterranean diet and avoid plans involving fasting.

In addition to potential weight loss and reduction of RA disease activity, limited research hints at the possibility that IF may help with heart and blood-sugar markers, both especially important to people with RA who are at increased risk of developing heart disease.

The JAMA Network Openreview found that adults on IF diets had some improvements in low-density lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, and blood pressure, as well as blood sugar and fasting insulin.

Some experts propose a modified type of fast known as a fasting mimicking diet. This diet allows for a normal amount of calories most days but restricts them severely for five days every month. Proponents say this is easier to follow than diets requiring more frequent calorie restrictions.

Scientists have found that in mice, this type of diet promotes anti-inflammatory effects, and some propose that it might do the same in people, too.

A company called Prolon sells plant-based energy bars, soups, snacks, beverages, and supplements to provide the nutritionally balanced, low-calorie foods that should be eaten during the five-day fast.

Some rheumatoid arthritis medicines are prescribed to be taken with meals.

Hydroxychloroquine, for example, is generally prescribed for once or twice a day with a glass of milk or a meal. This is done to decrease the chance of nausea. If a person generally takes this drug with breakfast, a 16/8 or perhaps even a 5:2 IF plan may not work.

Oral steroids are similarly recommended to be taken with food or milk to keep stomach upset at bay.

Still, if you are on oral medications it's possible to find an IF plan you can work with.

Its important to clear any new eating plan with your physician, and especially so for a plan that severely restricts calories on some days or some portion of every day.

Remember that what you eat is always going to be more important than when you eat it. A junk food diet crammed into 8 hours of the day is not going to be as beneficial for your RA as a low-inflammatory, healthy eating plan stretched over more time.

If more research bears out the benefits of IF for people with RA, doctors may one day prescribe it for their patients, Dr. Hsiao says. But for now, moreevidence is needed prior to being able to recommend a specific fasting diet to patients with RA, she says.

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Intermittent Fasting and Rheumatoid Arthritis: What to Know - Everyday Health