What would be the best Indian diet for rheumatoid arthritis?

What foods are not good for rheumatoid arthritis?

What is the best vegetarian food for rheumatoid arthritis?

You may have many such questions at present. You are in pain. Constant dependency on others for daily activity may irritate you from time to time. You are looking for dietary relief to bring the situation under control.

Well, please note that no diet can cure rheumatoid arthritis completely. However, a well-planned diet may help you to reduce the pain, control other symptoms and improve the quality of your life. 

Here is the detailed Indian diet guide for rheumatoid arthritis. Read the blog till the end to clear your all possible doubts.

How to plan an Indian diet for rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disorder.

Now, what does it mean?

Your immunity is supposed to work against any foreign invaders in the body like bacteria, viruses, etc. But when your own immunity mistakenly starts attacking your own body parts called an autoimmune disorder.

In rheumatoid arthritis, your immunity attacks your joint which leads to inflammation – pain, redness, swelling, and loss of function of joints – depending on the stage of the disease you are in.

The reason for the autoimmune disorder is still not known. Therefore the objective of your arthritis diet is to minimize inflammation and control joint pain and other symptoms.

The objective of your diet should be –

• To keep the weight in control – adipose tissue may increase the inflammation and risk of diabetes and cardiovascular disease associated with obesity (5)
• To maintain a good gut health – Good gut health proved to be important determinants to control inflammation. Thus probiotic play a big role in RA diet. (6,7)
• To supply enough fiber and antioxidants – Antioxidants helps to keep the inflammation in control. Coloured vegetables, fruits, citrus fruits, pulses, whole grains are necessary to provide ample fiber and antioxidant in daily diet.(8,9)

Eat a nutritionally rich, wholesome, balanced diet considering your food choice. Plan to include all the 8 food groups in your daily diet in moderation –

• Grains
• Dal
• Vegetables and Fruits
• Milk and milk products
• Fish/ Egg/ Chicken/ Meat
• Nuts and seeds
• Sugar
• Oil

What should be the food choices? What to avoid? How to include these foods? Let’s discuss one by one –

Indian diet guide for rheumatoid arthritis – How to choose the right grain?

Keep your trust in whole grain. Eat-in moderation but eat in variety. Do not bank on one particular type of grain. Grains are the primary source of energy along with providing protein, fiber, and essential micronutrients.  Consider having 1-2 spoons of overnight soaked fermented rice as probiotics to improve the gut health

There are two key points to focus on once you choose the grain –

1. Fibre content of the grain  
2. Your gluten sensitivity

The fiber content of the grain and RA

Since it is evident that there is some degree of inflammation in Rheumatoid Arthritis (RA) patients, fiber-rich grains are always recommended (3).

It has been seen that a fiber-rich diet helps to keep the C-reactive protein (One of the inflammation markers) under control by modifying the pH and permeability of the gut. (1)

Apart from this, most of the RA patients are also having diabetes, high blood pressure, or overweight issues. Therefore, having a fiber-rich diet helps to keep you fit from various aspects.

However, too much fiber may not be well tolerated for everyone. Especially if you are already facing issues like constipation, diarrhea, indigestion, acid reflux, etc, you should be conscious of your total fiber intake.

So, what to do?

• Not too much or too less fiber should be your mantra to handle the situation.
• If you are a regular rice eater, instead of having brown rice (too much fibre) or white rice (too less fiber) pick semi polished or single polished rice.
• Do not make an overnight shift to millets (high fiber) from white rice (low fiber). Let millets be a part of your diet along with other grains.
• Always remember there is nothing called “the best grain for RA”. For most of the cases grains (grain products) like – rice (puffed rice, flaked rice, popped rice, idli, dosa etc), wheat (suji, dalia, atta, maida etc), jowar, bajra, ragi, buckwheat, corn, barley, rye, quinoa, oat works fine.
• Eat variety of grain to utilize it’s benefits and minimise the side effects. Depending on one particular type of grain may backfire any day.
• Try to choose 3 different grains in a day. For example – if you are having oats for breakfast have rice for lunch and consider having wheat or millet roti for dinner.
• Eat grain in moderation and keep a close watch on your weight.

Your gluten sensitivity –

If you have gluten intolerance and have RA, then there is a possibility to suffer from more inflammatory pain. (2) Check your gluten sensitivity and take the necessary steps.

Gluten is a protein that we found in wheat, rye, barley, and all its products.

Gluten may cause inflammation in the small intestine in people who have gluten sensitivity. So unless it is confirmed that you have gluten intolerance, avoiding gluten does not make any sense.

How will know if you are gluten-sensitive?

If you have gluten intolerance, you may experience bloating, stomach ache, diarrhea, constipation, smelly feces, skin reaction, brain fog, anxiety, body pain after consuming any wheat/ barley or rye products. (4)

The best way to understand gluten intolerance is by stopping all possible sources of gluten from the diet for at least 2-3 weeks and noticing the changes if any.

If you feel no difference, don’t avoid gluten just because others are telling you to do so.

Remember, a gluten-free diet does not only mean avoiding roti of atta or maida. It means you have to stop eating all types of biscuits, cake, bread, muffin, spread, etc.

What to avoid?

Avoid having refined cereals such as maida, super-polished rice, packaged breakfast cereals, processed cereal products like cookies, biscuits, instant pasta, instant noodles, etc. These products do not only contain refined flour as a primary ingredient but are also loaded with various forms of sugar.

Indian diet guide for rheumatoid arthritis –  Which dal is good for arthritis?

Dal is one of the major sources of protein in the Indian diet, especially for vegetarians. It is also a good source of vitamins, minerals, and fiber.

The best part is we have hundreds of varieties of dal cultivated in our country. Feel free to pick as many as you can.

You can have moong, masoor, tuer, arhar, chana, rajma, chole, lobia, kulthi, etc. If you are vegetarian consider having 2 bowls of thin dal in your daily diet.  If you consume egg/ fish/ chicken/ mutton etc, then having a bowl of thin dal is fine to supply all the essential nutrients.

You may consider having sattu (roasted Bengal gram flour) water/dhokla / besan (unroasted Bengal gram flour) chilla as a snack. But try to have not more than 2-3 dal items in a day.

Remember moderation and variety are the keys.

How to cook dal for RA patients?

• Don’t forget to soak dal overnight before cooking the next day.
• This will help to eliminate all the unwanted antinutritional factors present in dal.
• If you experience acidity, bloating, indigestion on a daily basis, it is a MUST for you.
• Wash the soaked dal in running water for 2 times before cooking.
• Avoid cooking dal in pressure cooker; rather use a open pot to boil the dal. Carefully remove the white scum coming on top of the dal while cooking.

Indian diet guide for rheumatoid arthritis – How to choose veggies and fruits?

Vegetables and fruits are rich sources of vitamins, minerals, fiber, bioactive compounds –such as antioxidants. They help to reduce inflammation and oxidative stress.  Since these are rich in fiber, it helps to improve the microbiome (the proportion of good and bad bacteria in your gut) and strengthen immunity.

Nutritionally there are 3 categories of vegetables –

• Green leafy vegetables (spinach, methi, amaranth, cauliflower, cabbage,, celery, lettuce etc)
• Roots and tubers (carrot, beetroot, potato, radish, tapioca, yam etc)
• Other vegetables (gourd, drumstick, papaya, tomato, tinda, cucumber, brinjal, pumpkin, parwar etc)

Make sure you add some vegetables from each category every day. Focus to make your plate as colorful as possible. Some form of green, red, purple, orange should be part of your daily plate.

A part of your daily vegetables should be cooked as well as in raw form. So having sabji with lunch or dinner or adding chopped veggies in breakfast or snack items are fine. But do not forget to consume raw vegetables like salad, smoothie, etc daily.

Try to drink a glass of vegetable smoothie every day on empty stomach. You may add a fruit with it to improve the taste. For example –  carrot- orange-cucumber smoothie or, beetroot- pomegranate – cucumber smoothie can be considered.

Can RA patients consume nightshade vegetables?

Potato, tomato, brinjal, bell papers, varieties of red chili (paprika, cayenne pepper) – are called nightshade vegetables. These vegetables contain a high concentration of alkaloids called solanine.

Some people believe that the consumption of nightshade vegetables aggravates RA pain and inflammation. Please note there is not enough evidence to support this assumption. However, some experienced elimination of these veggies from diet reduces pain.

What to do?

Whenever you are in doubt and have not experienced any such difference having nightshade veggies, consider having it in moderation. That means avoiding having potato or brinjal curry every day. Bring variety in your vegetable choices and eat everything but in moderation. (10)

Are fruits safe for RA patients?

Fruits can be categorized as-

• Citrus fruits  (lime, lemon, grapefruit, mosambi, orange, amla etc)
• Other fruits (banana, apple, chico, mango, watermelon, papaya, ber, pineapple etc)

The good news is you can enjoy whole fruits without any fear. Just like vegetables, fruits are also rich sources of fiber, vitamins, minerals, and antioxidants. (10)

Tips to have fruits –

• Make sure you have at least 2 whole fruits – one citrus fruit and one other fruit per day.
• Study shows, citrus fruits helps to reduce inflammation because of its vitamin C, bioactive compounds like flavonoid, limonoid etc (11)
• If you are diabetic make sure you consume fruit as a meal not as a part of a meal.
• Have fruits with it’s pulp to ensure the fiber intake. Avoid having only fruit juice.
• Do not consume instant packaged fruit juice as they are often loaded with sugar.

Indian diet guide for rheumatoid arthritis –Is milk good for RA patients?

Some studies show that milk and milk products are inflammatory in nature which makes the RA pain worse. Whereas other studies claim, milk helps to reduce inflammation.

There is not enough research to suggest avoiding milk for RA patients. It is completely case-specific.

Milk is one of the major sources of protein, especially for the vegetarian diet. Apart from protein it also supplies a good amount of vitamins and minerals.

 If you are comfortable drinking milk or having any milk products without any noticeable symptoms like gas, stomach ache, acidity, headache. Pain, diarrhea, etc, you should go ahead and have milk. Otherwise, avoid it.

Tips to add milk to RA diet –

• If you are vegetarian and find no difficulties in digesting milk, consider having 2 glasses of double toned milk or milk products daily.
• You may prepare curd, paneer, buttermilk etc as per your choice using 2 glasses of milk.
• Since gut health is important to reduce inflammation, try to consume 1 cup of homeset curd or buttermilk post meal as probiotic.
• Avoid having bottled milk shake or milk beverages as they generally contain a lot of sugar

Indian diet guide for rheumatoid arthritis – How safe is animal protein- fish/ egg/ chicken/meat?

There are always controversies with animal foods. Some will always suggest going vegetarian or vegan to reduce the inflammation in your body. However, there is not enough evidence that a vegetarian diet will make a significant difference in inflammation. Again these are very much case-specific.

Therefore the best way to go is to practice moderation. If you enjoy animal foods and elimination of these non-veg foods for 3-4 weeks makes no difference in any of your symptoms, continue to have it in moderation.

As mentioned before again moderation is the keyword here. If you eat non-veg foods following these tips –

• You may have one whole egg every day even if you have high blood pressure or any cardiac disease.
• Having 50-70 g of fish (small to medium size) is absolutely fine.
• Try to have fatty fish for 2-3 times a week. These are rich in omega 3 fatty acid which helps to reduce inflammation. (12) (13)
• Restrict consumption of red meat. You may have it once in a month in limited quantity.
• Avoid having processed meat like sausage, salami, hotdog and other ready to cook instant items

Indian diet guide for rheumatoid arthritis – How to eat nuts and seeds in RA?

Nuts and seeds are the most underrated but important part of your daily diet. They are a good source of protein as well as fat. These are generally rich in omega 3 fatty acids which are anti-inflammatory in nature.

Tips to add nuts and seeds to Indian diet for rheumatoid arthritis –

• Consume one fistful of nuts and seeds everyday
• Don’t overeat as it is high in calorie and may leads to weight gain
• Consider having walnut, flaxseed everyday without fail. (14)(15)
• You may consider having a teaspoon of flaxseed powder everyday. You can add this in your yogurt or in smoothie.
• Always soak the nuts and seeds overnight and have it on empty stomach as the first food of the day

Indian diet guide for rheumatoid arthritis – Is sugar safe?

If there is any food that is undoubtedly bad for RA patients is sugar. Sugar is inflammatory in nature and disturbs your microbiome.

Therefore you must stop consuming all possible packaged and processed foods like biscuits, cake, bakery items, instant pasta, instant noodles, instant popcorn, packaged juices, sauce, spread, salad dressing, etc. These foods are loaded with sugar and hidden sugar. There are 68 names of sugar that are used to make packaged food more addictive.

However, having 1-2 tsp of sugar/honey/jaggery in food (tea/ coffee/ curd/ milk, etc) per day is safe without causing any side effects.

How about salt consumption of RA patients?

Try to keep your daily salt intake within 1 tsp (5g). Many RA patients already may suffer from high blood pressure. Therefore salt restriction is a must for you. Avoid salty processed and packaged foods to reduce your salt consumption.

Indian diet guide for rheumatoid arthritis – Which is the best oil for cooking?

Avoid using refined oil – colorless, odorless, white oil – for cooking. These are high in omega 6 fatty acids and inflammatory in nature. Use cold-pressed oil, filtered oil, or kachhi ghani oil for Indian cooking.

Consider using kachhi ghani mustard oil, double-filtered groundnut oil or sesame oil, cold-pressed coconut oil, etc. You may add 1-2 tsp of good quality ghee or homemade butter to food. You may use olive oil for salad dressing but not for the Indian style of cooking.

The ratio of omega 3: omega 6 fatty acid in our diet should be 1:1 to control the inflammation. (16)  Please note omega 6 is pro-inflammatory and omega 3 is anti-inflammatory in nature. The study shows the ratio has become 1:15 analyzing our present diet pattern. To achieve a better ratio, one must reduce omega 6 (Refined oil) and improve omega 3 (walnut, flaxseed, fish oil, soy) sources in the diet.

Avoid having fried food as excess oil consumption may lead to weight gain and increase inflammation.

Indian diet guide for rheumatoid arthritis – Select the right spices

• Fried foods, spicy food are to be avoided to control your inflammation.
• However ginger, garlic, turmeric, cardamom, cinnamon, black pepper – helps to reduce the inflammation. So use these while cooking.(18)
• You may drink tea using some of these spices as mid morning or night tea.

Indian diet guide for rheumatoid arthritis – Small frequent meal or intermittent fasting –

Study shows intermittent fasting helps to reduce inflammation thus controlling joint pain. (17) However having small frequent meals has its own benefits. Therefore, follow the path you feel comfortable with. Either practice 16 hrs of fasting with 8 hrs of eating window or you may consider eating 5-6 small meals a day.

If you are diabetic, have high blood pressure or gastritis, etc consider consulting a nutritionist for expert advice.

Bottom line

Try to follow the detailed guide on the Indian diet for rheumatoid arthritis patients.  Focus on a doable, balanced diet. Eat wholesome, homemade food rich in fiber and micronutrients. Avoid excess sugar, salt, and fried foods. Rather bank on whole grain, probiotic, fresh veggies, fruits, and good quality fat.

Diet is not all. Try to fix your sleep pattern. You must sleep deep and manage your stress. Don’t forget to drink a lot of water. Stay active and exercise daily. Have patience, you will be fine.