Dr. Kimberly Sanders, ND
@_drkimsanders

Rheumatoid arthritis is defined as inflammation of the joints caused by an autoimmune reaction. This means that the immune system is attacking itself, which causes pain, swelling, and deformity of the fingers, wrists, toes, and other joints. The inflammation of rheumatoid arthritis can also impact the heart and cause heart disease. Heart disease includes high cholesterol and high blood pressure, and complications from these conditions are one of the leading causes of death in the United States. Due to a high amount of inflammation, patients with rheumatoid arthritis are at an increased risk for heart disease.¹ Naturopathic physicians who manage patients with rheumatoid arthritis will also focus on prevention of heart disease as a major therapeutic goal. Ideally, a naturopathic physician will recommend treatments that can both reduce the pain and inflammation of rheumatoid arthritis while also protecting the heart. One of the ways that both of these goals can be achieved is through the introduction of certain functional foods into the diet. Functional foods are foods that have a medicinal benefit when consumed in high doses. Patients with rheumatoid arthritis who are also interested in protecting the heart may benefit from increasing the consumption of certain functional foods in the daily diet.

Green Tea

Green tea contains a polyphenol called epigallocatechin gallate (EGCG). This component of green tea is well-studied for reducing heart disease. It has specifically been studied in patients with rheumatoid arthritis and has been shown to reduce heart and artery inflammation in these patients.² EGCG may also help with the pain and inflammation of rheumatoid arthritis by reducing markers of inflammation and joint destruction within the joint fluid.³ Some ways that patients can incorporate green tea into the diet include drinking hot green tea throughout the day, adding matcha green tea powder to smoothies, or even adding matcha green tea powder to yogurt or soups. Pomegranate juice is another powerful functional food. Studies have shown that pomegranate juice intake reduces disease activity in those with rheumatoid arthritis after 12 weeks.⁴ In addition, pomegranate juice consumption also improves blood pressure and may protect the arteries from damage.⁵ Pomegranate juice can be made at home by simply blending the seeds in a high-powered blender in order to avoid the excess sugar found in some pomegranate juice preparations. Pomegranate seeds can be also be added to salads, smoothies, oatmeal, and yogurt throughout the day.

Polyphenols

Polyphenols found in dark cocoa have also been studied for their benefits on heart disease. Studies reveal that cocoa intake may reduce the risk of heart disease by reducing insulin resistance and blood pressure.^6,7 Unsweetened cocoa powder can be added to smoothies, made into a homemade hot cocoa beverage, or mixed with almond butter for a heart-healthy dessert. Fish consumption is also associated with a reduced risk of rheumatoid arthritis due to the high content of anti-inflammatory omega-3 fatty acids.^8,9 Fish intake is also associated with decreased risk of heart disease.¹⁰ Fish is best served grilled or broiled without the use of any added oils. The use of turmeric may also have a positive effect on inflammation and pain in rheumatoid arthritis. Turmeric extracts have shown benefit for the treatment of arthritis pain in the knee at doses of 1 gram per day.¹¹ Turmeric extracts have also been shown to help reduce cholesterol levels, which may help reduce the risk of heart disease.¹² Turmeric can be used to flavor any soup or sauce, mixed with scrambled eggs, or simmered with coconut milk and served as a hot beverage.

Like many other autoimmune diseases, rheumatoid arthritis may be associated with digestive imbalances and imbalances between pathogenic and probiotic gut flora. The use of probiotics has been associated with decreased joint pain and swelling, as well as a decrease in the markers of inflammation in those with rheumatoid arthritis.¹³ Probiotics have also been shown to reduce cholesterol levels in patients with high cholesterol.¹⁴ Increasing probiotics from dietary sources may help reduce both the pain and swelling of rheumatoid arthritis while also supporting a healthy heart. Probiotics can be obtained through food sources such as yogurt, kefir, kombucha, sauerkraut, kimchi, and tempeh.

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Kimberly M. Sanders, ND, is a licensed naturopathic physician in Connecticut. She graduated from the University of Bridgeport and completed her CNME-accredited residency training there, as well. She was named 3-time MVP of the ZRT Cup Competition as a medical student. Dr Sanders currently owns ArthroWell Naturopathic, a specialty practice in rheumatology. She has undergone extensive pediatric and rheumatology training, and has lectured on the topic of autoimmunity and autism at the annual CNPA and NHAND conferences. Her passion in practice is finding the underlying cause of immune dysfunction and restoring balance to the immune system with functional medicine.

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References:

1. Schur PH, Connolly HM. Coronary artery disease in rheumatoid arthritis: Diagnostic and therapeutic implications. UptoDate. 2015. Available at: http://www.uptodate.com/contents/coronary-artery-disease-in-rheumatoid-arthritis-epidemiology-pathogenesis-and-risk-factors. Accessed May 13, 2015.).
2. Riegsecker S, Wiczynski D, Kaplan MJ, Ahmed S. Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis. Life Sci. 2013;93:307-12.
3. Yun HJ, Yoo WH, Han MK, Lee YR, Kim JS, Lee SI. Epigallocatechin-3-gallate suppresses TNF-alpha-induced production of MMP-1 and -3 in rheumatoid arthritissynovial fibroblasts. Rheumatol Int. 2008 Nov;29(1):23-9.
4. Balbir-Gurman A, Fuhrman B, Braun-Moscovici Y, Markovits D, Aviram M. Consumption of pomegranate decreases serum oxidative stress and reduces disease activity in patients with active rheumatoid arthritis: a pilot study. Isr Med Assoc J. 2011;13:474-9.
5. Asgary S, Sahebkar A, Afshani MR, Keshvari M, Haghjooyjavanmard S, Rafieian-Kopaei M. Clinical evaluation of blood pressure lowering, endothelial function improving, hypolipidemic and anti-inflammatory effects of pomegranate juice in hypertensive subjects. Phytother Res. 2014;28:193-9.
6. Mastroiacovo D, Kwik-Uribe C, Grassi D, et al. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study–a randomized controlled trial. Am J Clin Nutr. 2015;101:538-48.
7. Paillard F. [Effects of chocolate consumption on physiology and cardiovascular diseases]. Presse Med. 2014;43:848-51.
8. Di Giuseppe D, Wallin A, Bottai M, Askling J, Wolk A. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis. 2014;73:1949-53.
9. Rosell M, Wesley AM, Rydin K, Klareskog L, Alfredsson L. Dietary fish and fish oil and the risk of rheumatoid arthritis. Epidemiology. 2009;20:896-901.
10. Nestel P, Clifton P, Colquhoun D, et al. Indications for Omega-3 Long Chain Polyunsaturated Fatty Acid in the Prevention and Treatment ofCardiovascular Disease. Heart Lung Circ. 2015. [Epub ahead of print]
11. Madhu K, Chanda K, Saji MJ. Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial. Inflammopharmacology. 2013;21:129-36.
12. Mirzabeigi P, Mohammadpour AH, Salarifar M, Gholami K, Mojtahedzadeh M, Javadi MR. The Effect of Curcumin on some of Traditional and Non-traditional Cardiovascular Risk Factors: A Pilot Randomized, Double-blind, Placebo-controlled Trial. Iran J Pharm Res. 2015;14:479-86.
13. Alipour B,Homayouni-Rad A,Vaghef-Mehrabany E, et al. Effects of Lactobacillus casei supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: a randomized double-blind clinical trial. Int J Rheum Dis. 2014;17:519-27.)
14. Rerksuppaphol S,Rerksuppaphol L. A Randomized Double-blind Controlled Trial of Lactobacillus acidophilus Plus Bifidobacterium bifidum versus Placebo in Patients with Hypercholesterolemia. J Clin Diagn Res.2015:9.