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Arthritis Today

Can Vegan or Vegetarian Diets Help Reduce Arthritis Inflammation?

Small studies show some benefits and potential pitfalls.

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Science has long touted the inflammation-fighting benefits of a healthy diet: one low in saturated fats and added sugars, and high in fruits, veggies, lean protein (such as omega-3-rich salmon) and whole grains. It’s a long-standing belief among many that avoiding animal products altogether makes for a healthier diet.

As a result, people with inflammatory types of arthritis may be tempted to go vegetarian (no meat) or vegan (no animal products at all, including meat, eggs and dairy) in the hope that doing so will help them avoid painful flares.

There are various studies of the impact of these diets on inflammation. They are mostly small and the results are mixed. In the most recent study, published in Complementary Therapies in Medicine in 2015, 600 participants followed a vegan diet for three weeks which significantly reduced C-reactive protein, a key marker for acute and chronic inflammation. In two small studies published in the Journal of the American Dietetic Association in 2010, researchers observed 79 rheumatoid arthritis patients who did a vegetable fast for seven to 10 days, followed by a vegan diet or lacto-vegetarian diet (includes dairy and gluten). In the smaller study (26 participants), the patients followed a lacto-vegetarian diet for nine weeks. Researchers found no significant difference in pain or morning stiffness when compared with the control group. However, in the larger study (53 participants), the patients followed a vegan diet for three and a half months and experienced significant improvement in tender and swollen joints, pain, duration of morning stiffness and grip strength than the people in a control group who consumed an ordinary diet. The vegan group transitioned to a lacto-vegetarian diet for nine months. At the one year follow-up, they continued to have improved symptoms compared with the control group. In another study published in Arthritis Research and Care in 2008, 30 patients with active RA who followed a gluten-free vegan diet for three months experienced reduced inflammation.

Still, there are benefits to going meat-free that are unrelated to inflammation. Vegans and vegetarians are less likely than meat eaters to be overweight or obese, and they tend to have lower blood pressure and cholesterol levels, says Duo Li, PhD, professor of nutrition at Zhejiang University in China and author of a small study published in the Journal of Agriculture and Food Chemistry in 2011. The group in the Arthritis Research and Care study also saw reductions in body mass index and cholesterol.

But there are also potential pitfalls. Vegetarians, and especially vegans, have low blood levels of vitamin B-12 and D, calcium and essential fatty acids, according to Dr. Duo’s study, and another study published in the American Journal of Clinical Nutrition in 2014.  These vitamins and minerals play important roles in bone health and low fatty acids levels are associated with a number of cardiovascular risk factors. Vegans may also have higher levels of homocysteine, an amino acid that has been linked to heart disease, and lower levels of HDL, the “good” cholesterol, known to protect the heart.

If you plan on going vegan or vegetarian, it’s important to talk to your doctor first and also seek guidance from a registered dietician.

With these diets, it’s not just about what you’re not eating (meat, eggs and dairy), but about what you are eating. People who switch to either diet should fill up with more fruits, vegetables, legumes, nuts and seeds, and whole grains such as brown rice and barley instead of empty carbs like white pasta, bread or rice. The healthy alternatives are packed with phytochemicals (plant-based compounds) that include antioxidants, flavonoids and carotenoids, all of which help reduce inflammation and protect the tissues from oxidation which can damage them.

Also, any diet, including a vegan or vegetarian diet, can reap the anti-inflammatory benefits of adding certain oils.

“Most vegetarians, vegans and meat eaters don’t use enough extra virgin olive oil,” says Kim Larson, RDN, CD, CSSD, national spokesperson for the Academy of Nutrition & Dietetics. Extra virgin olive oil helps reduce inflammation and can have a similar effect of ibuprofen.  However, she advises using it at low temperatures because high heat destroys its beneficial compounds, called polyphenols – so use it in salad dressings or for tossing pasta, for example (not for frying and baking).

Going vegetarian or vegan diets doesn’t have to be an all-or-nothing proposition. Start with a “meatless Monday”, and gradually build up to more meat-free meals, advises Rene Ficek, RD, lead nutritionist at Seattle Sutton’s Healthy Eating. You can go vegan overnight, she adds, though doing it gradually often makes it easier both mentally and physically since suddenly cutting out meat can lead to crankiness, headaches and digestive changes.

Also consider that meat doesn’t have to be the central focus of a meal. It can be served in small amounts in a dish such as a stir fry, that’s full of vegetables, or with a salad. You can mix with a soy product such as tofu or tempeh, or with seitan (wheat gluten).

“It doesn’t have to be a full time commitment; it can be certain days or certain meals,” Ficek says.

If you take the step to go full or part vegetarian or vegan, you may need to take some supplements, says Larson. These include omega-3 fatty acids for your heart and to protect against inflammation, iron to protect against anemia, zinc for the immune system, vitamin D and calcium for strong bones, vitamin B-12 for energy and selenium for a healthy thyroid. But make sure to talk to your doctor first before adding supplements to your diet.

If you choose a modified vegetarian diet called the pescetarian diet (includes fish), omega-3s are not necessary provided you eat two or more servings per week of fatty fish such as salmon, mackerel, herring and sardines.

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