Anecdotal evidence suggests certain eating styles may help ease rheumatoid arthritis symptoms. True? We asked the pros.
by Marygrace Taylor Health Writer
Brian LaMoreaux, M.D.
You may have read online or heard from a friend that intermittent fasting—a way of eating based on time instead of calories—can help manage symptoms of rheumatoid arthritis (RA). But can going for longer stretches without eating really make a difference in your joint pain?
RA is a chronic inflammatory disease that occurs when the immune system mistakenly attacks healthy joint tissue. This can cause joint pain, swelling, stiffness, and loss of function and potentially increase the risk for problems beyond the joints, including the heart, lungs, and nerves. There’s no cure for the condition, and there certainly isn't one eating plan that is prescribed to treat RA. But lately, there’s been buzz in the RA community about the potential benefits of dietary changes like intermittent fasting (IF).
Experts can’t say for sure whether IF can improve RA symptoms, but anecdotally, some people seem to benefit. “Fasting can be very effective for some people navigating chronic illness, and it can be detrimental to others,” says Jenna Volpe, a registered dietitian in private practice based in Austin, TX.
So what exactly is IF? That's when you consume your daily intake of food within a compressed window of time (often between six and 12 hours) and fast for the remainder of the day and night. Giving the body an extended break from food is thought to support its ability to rest and repair, plus, it can encourage fat breakdown and help with weight loss.
Here’s what the science says so far on how a fasting-style diet may be helpful (in addition to sticking with your prescribed RA treatment plan), the downsides to consider, plus how to start intermittent fasting if you’d like to give it a try.
The Benefits of Intermittent Fasting
There’s not a ton of evidence looking at how people with RA could see an improvement in their condition from intermittent fasting directly. That said, some of IF’s known benefits show potential for addressing RA symptoms and related complications.
Intermittent Fasting Can Support Healthy Weight Loss
One of the biggest benefits of intermittent fasting is that it can help you lose weight, and quickly. Overweight adults who adopt an IF-style diet tend to lose an average of seven to 11 pounds in 10 weeks, one review concluded. That’s important, since RA pain is often exacerbated by excess weight, which puts more pressure on inflamed joints.
“Intermittent fasting can improve symptoms of arthritis through weight loss, which can reduce pressure on the knees and other joints,” says Jacob Hascalovici, M.D., Ph.D., clinical assistant professor of medicine at the Albert Einstein College of Medicine in New York City and chief medical officer for Clearing, a telehealth platform for chronic pain. (That said, if you gain it all back once you stop fasting and go back to regular eating, the benefits are short-lasting.)
IF May Reduce Inflammation and Pain
The main driver of RA-related joint pain is inflammation, which causes the linings of the joint to become swollen and uncomfortable. Fasting-style diets can support healthy blood sugar levels, which in turn can keep markers of inflammation lower and potentially reduce pain, per findings in a study on RA and beverages published in the journal Nutrients. Decreased inflammation from fasting might slow the progression of RA, too, findings suggest.
Intermittent Fasting May Improve Insulin Sensitivity
Research shows that intermittent fasting diets can improve blood sugar control and reduce insulin resistance among the general population, a benefit that's often driven by weight loss. That could mean big benefits for people with RA, who may be at higher risk for becoming insulin resistant. “When intermittent fasting helps ‘reset’ insulin responses, it brings the body’s energy and inflammation management systems in better alignment, reducing disease risks and rheumatoid arthritis inflammation,” says Dr. Hascalovici. (Intermittent fasting isn’t a good idea for people who already have diabetes, though. More on that in a bit.)
Time-Restricted Eating Can Lower Blood Pressure
Five weeks of time-restricted feeding, a type of intermittent fasting, lowered blood pressure as effectively as hypertension medications in prediabetic men, one study found. That could be significant for people with RA: The disease causes arteries to become narrow and lose elasticity, which raises the risk for high blood pressure, which can lead to a list of serious heart problems. Some RA meds can cause an increase in blood pressure, too.
IF May Promote Healthier Aging
The reduced inflammation and improved insulin resistance that come with fasting-style diets could translate to a lower disease risk—and longer lifespan—overall. A review on intermittent fasting concluded that restricting eating to six hours per day is associated with greater longevity and decreased risk for cancer. Evidence also suggests that intermittent fasting may reduce the risk for Alzheimer’s disease, multiple sclerosis, and stroke.
Intermittent Fasting Risks
Intermittent fasting may have proven benefits for the general population. But there’s no guarantee that it will improve RA symptoms, and fasting-style diets aren’t for everyone. Here are the downsides you should know about.
IF Is Not a Proven RA Treatment
Only a small number of studies have looked directly at how intermittent fasting might improve RA symptoms, so there’s not enough evidence to say whether it’s truly helpful for everyone with the condition. The research that has found benefits suggests that the improvement only lasts for short periods, and that a person’s symptoms tend to come back as soon as they stop fasting.
“If someone wants to try it, it’s OK but I’m not a big proponent,” says Lisa Young, Ph.D., R.D.N., adjunct professor of nutrition at New York University in New York City. “The best way to reduce symptoms would be to choose foods that reduce inflammation, like a Mediterranean-type diet.” The Mediterranean diet centers around eating fresh fruits and vegetables, whole grains, legumes, lean meats, and healthy fats, like olive oil. In other words: What you eat may be more important than when you eat.
Fasting Can Lead to Nutrient Deficiencies
Fewer opportunities to eat throughout the day could mean fewer opportunities to get the vitamins and minerals you need, especially if you tend to stick to the same foods. “If someone with RA wants to try intermittent fasting, it’s important to eat a balanced diet and include healthy foods from all food groups and to limit ultra-processed foods,” Dr. Young says. IF you go ahead with intermittent fasting, it might be a good idea to ask your doctor about supplementing with a multivitamin.
IF Is Not Safe for People With a History of Disordered Eating
Fasting-style diets have the potential to trigger or exacerbate disordered eating in people with a history of the condition. “If someone is prone to disordered eating or is underweight, those are red flags that intermittent fasting is not going to be a healthy choice,” says Volpe.
Skip IF if You Have Diabetes
Intermittent fasting may support more stable blood sugar levels among the general population, but it’s not a good idea for people with RA who already have diabetes. Going for long stretches without eating can lead to low blood sugar, which could cause shakiness, dizziness, weakness, or even seizures or loss of consciousness. According to Dr. Young, those with diabetes should steer clear of intermittent fasting. “The best way to keep blood sugar steady is to include some protein, fiber, and/or healthy fat and eat every few hours,” she says.
Intermittent Fasting Could Cause Dehydration
“During the initial days of IF, the body tends to lose a lot of water. Also, many people initially following IF often tend to forget to drink enough fluids,” Dr. Young notes. Dehydration can leave you weak or dizzy; you might notice your RA symptoms seem worse, too. Adequate water intake is a must for well-lubricated joints, and it help keep inflammation levels lower by flushing toxins out of the body.
Fasting May Not Be Compatible With Your Medication Schedule
Many medications used to manage RA, like steroids, should be taken with a meal. That can be harder to do when you’re limiting eating to a short number of hours each day, Young points out.
Still Curious? Tips for Getting Started
Thinking about trying intermittent fasting to help manage your RA? Before beginning your new diet, keep this advice in mind.
Talk With Your Doctor First
Get the green light from your physician before adopting a fasting-style diet. “IF should be individualized to a person’s medical history and lifestyle. It’s always best to check with your provider first,” says Alisa Bloom, a registered dietitian in private practice based in Chicago. Together you can weigh the pros and cons of intermittent fasting for you and confirm that a fasting schedule will work with your medication regimen.
Consider Fasting On and Off
Some people find it hard to stick with a fasting-style diet long-term. What’s more, the limited evidence on intermittent fasting for RA suggests that any benefits you might reap may actually peak within a few days to a few months. Rather than staying on an IF diet permanently, “this implies that repeating intermittent fasts multiple times a year may be ideal for rheumatoid arthritis control,” Dr. Hascalovici says.
Start With a Shorter Fasting Window
Different versions of IF call for different fasting windows, but most involve refraining from eating for anywhere between eight and 16 hours in a 24-hour period. Going from grazing all day long to fasting for long periods in one fell swoop can be challenging, so start small. “Beginning with a 12-hour fast, for example from 9 p.m. to 9 a.m., is a way to slowly and safely explore intermittent fasting,” Volpe says. You can consider an even milder approach if a 12-hour fast wouldn’t work with your medication schedule. “You can limit snacking between meals which will still allow a beneficial respite from food,” says Bloom.
Eat a Variety of Wholesome Foods
Just because you’re limiting eating to a short window doesn’t mean you should limit the types of foods that you eat (or pig out on “forbidden foods” as a way to reward yourself for fasting). Aim to have a range of fresh fruits and vegetables along with whole grains, lean proteins, healthy fats, and low-fat dairy, recommends Volpe. You’ll be less likely to fall short on key vitamins and minerals. Plus, many of these foods boast anti-inflammatory properties that could potentially helpful for an RA diet, research suggests.
Drink Enough Water
Make it a point to sip throughout the day, even when you’re not eating. Men should strive to take in 15.5 cups of fluids per day and women should get 11.5 cups, according to the U.S. National Academies of Sciences, Engineering, and Medicine. Set reminders on your phone if you have trouble getting your fill, or download a free water tracking app like Aqualert.
Don’t Use Fasting to Replace Your Standard RA Treatment
No diet has been determined to be an effective treatment for RA. Even if you find that IF makes a difference in your RA symptoms, you should never make changes to your current treatment regimen without consulting your doctor. “Fasting should never be used as a stand-alone intervention,” Volpe says.
IF and Weight Loss: Mollecular and Cellular Endocrinology. (2015.) “Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials.”https://www.sciencedirect.com/science/article/abs/pii/S0303720715300800
Fasting and Inflammation (1.): Nutrients. (2020.) “ Beverages in Rheumatoid Arthritis: What to Prefer or to Avoid.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602656/
Fasting and Inflammation (2.): Mediterranean Journal of Rheumatology. (2019.) “ Fasting mimicking diets: A literature review of their impact on inflammatory arthritis.”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241659/
IF and Insulin Sensitivity: Journal of Clinical Medicine. (2019.) “The Effectiveness of Intermittent Fasting to Reduce Body Mass Index and Glucose Metabolism: A Systematic Review and Meta-Analysis.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832593/
IF and Blood Pressure: Cell Metabolism. (2018.) “Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes.” https://pubmed.ncbi.nlm.nih.gov/29754952/
IF and Aging: The New England Journal of Medicine. (2019.) “Effects of Intermittent Fasting on Health, Aging, and Disease.” https://www.nejm.org/doi/full/10.1056/NEJMra1905136
Short Benefits of IF for RA: Clinical Rheumatology. (2022.) “ Sustainable positive effects of Ramadan intermittent fasting in rheumatoid arthritis.”https://link.springer.com/article/10.1007/s10067-021-05892-4
Anti-inflammatory Foods for RA: Rheumatology International. (2018.) “The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies.” https://pubmed.ncbi.nlm.nih.gov/29256100/
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Intermittent fasting may reduce inflammation by reducing the release of monocytes in the blood. During periods of fasting, monocytes go into a "sleep mode" and have less inflammation compared to fed monocytes. This can lead to short-term improvements in symptoms of RA.
One study found that fasting for more than 24 hours lowered inflammation by reducing oxidative stress in the cells. Another study found that both intermittent fasting and alternate-day fasting were both effective at reducing insulin resistance, which is the precursor to type 2 diabetes (an inflammatory condition).
Merad and colleagues showed that intermittent fasting reduced the release of pro-inflammatory cells called “monocytes” in blood circulation. Further investigations revealed that during periods of fasting, these cells go into “sleep mode” and are less inflammatory than monocytes found in those who were fed.
Making healthy food choices can help reduce inflammation from rheumatoid arthritis. Diet won't cure rheumatoid arthritis (RA), but the right food choices can help by controlling the inflammation that wreaks havoc in the body, delivering nutrients your body needs and helping you maintain a healthy weight.
Abstract. Total fasting induces within a few days a substantial reduction of joint pain, swelling, morning stiffness, and other arthritic symptoms in patients with rheumatoid arthritis. This remission subsides slowly after discontinuation of fasting.
- Stretching. Stretch when you get started to warm up. Stretch when you're done to cool down.
- Low-impact aerobic exercise. These are exercises that keep your heart strong without hurting your joints. ...
- Strengthening. These exercises help keep your muscles strong.
Fasting is extremely helpful to boost the immune system, especially for autoimmune disorders and cancer.
To reduce inflammation fast, limit your intake of sugar and processed foods. Perhaps, more importantly, though, pursue exercise, stress-reducing behaviors, a good night's sleep, and a diet full of colorful, anti-inflammatory foods.
Don't restrict calories during the eating period
The purpose of the eating period is to give your body the energy it needs to function. It can be tempting to restrict calories during this eating period but that can derail your progress and cause your body to crave more food and break your fast before you're ready.
“[Intermittent fasting] is working if there is a reduction in abdominal fat — waist size, an increase in insulin sensitivity as indicated by reduced fasting glucose and insulin levels, reduced resting heart rate and blood pressure.”
- Baking soda + water. A recent study in the Journal of Immunologyfound drinking a tonic of baking soda and water may help reduce inflammation. ...
- Parsley + ginger green juice. ...
- Lemon + turmeric tonic. ...
- Bone broth. ...
- Functional food smoothie.
Essentially, fasting cleanses our body of toxins and forces cells into processes that are not usually stimulated when a steady stream of fuel from food is always present. When we fast, the body does not have its usual access to glucose, forcing the cells to resort to other means and materials to produce energy.
One of the main proven treatments to reverse rheumatoid arthritis is exercises and physical therapy. It's safe and effective when done properly, and under the supervision of a physical therapist. It can build up your strength to help you better control and manage your joint or muscle pain.
Certain foods and additives are believed to increase inflammation in the body, such as sugar, saturated fats, trans fats, omega-6 fatty acids, refined carbohydrates, monosodium glutamate (MSG), gluten, aspartame, and alcohol.
RA Fall Breakfast Pick: Quick or Overnight Oatmeal
Top oatmeal with fruit or a nut or seed butter. For extra anti-inflammatory benefits, mix in blueberries and powdered ginger, which gives the meal “a nice punch,” Foroutan says. Top with crumbled walnuts, which are high in omega-3 fatty acids, for extra benefits.
Intermittent fasting reduced the release of pro-inflammatory cells called 'monocytes' in blood circulation. During periods of fasting these cells go into 'sleep mode' and are less inflammatory than monocytes found in those who were in a fed state.
Losing weight can take stress off of arthritic joints. It's also been shown that a lower BMI can reduce RA risk. Adults with RA who are obese often become disabled more quickly than people with RA who have a healthier weight. This paradox can be difficult for people living with RA and other similar painful conditions.