Dietary taboos for rheumatoid patients

During active inflammation, try to avoid high-sugar, high-fat and highly processed foods. Patients with high uric acid or kidney stones need to limit high-purine and high-oxalic acid foods. Allergenic foods that are known to cause discomfort should be completely avoided. Drinks containing alcohol and excessive caffeine should be avoided as much as possible. Most of the widely circulated statements on the Internet such as "all foods cannot be eaten" and "cold vegetables should be avoided" have no evidence-based medical basis and are misunderstandings.

I just met a 32-year-old female patient in the outpatient clinic last week. She had been taking medication regularly for more than half a year, and her C-reactive protein and erythrocyte sedimentation rate were both within the normal range. She had hot pot and milk tea with friends for three consecutive days during the National Day. Just after the holiday, she came for a follow-up check with her wrist swollen into a small bun, and found that the inflammation indicators tripled. This is not to say that milk tea hot pot is a "scourge". The 2022 European League Against Rheumatism guidelines do mention that trans fatty acids and added sugars in highly processed foods can significantly increase the levels of inflammatory factors. However, there are also small clinical cohorts that show that patients in the stable phase eating such foods 1-2 times a week will not cause index fluctuations. To put it bluntly, it’s just to be patient during the active period, and it’s perfectly fine to satisfy your cravings occasionally during the stable period. Don’t hold on to the mentality of “anyway, it’s okay to eat just one bite” and just do it once in a while.

The first thing many patients ask when they sit down is "Doctor, can I not eat seafood or mutton?" ”, this issue is actually still controversial. The traditional Chinese medicine system does believe that when the redness, swelling, heat and pain are obvious in the acute phase, food such as mutton, shrimp and crab will aggravate the heat in the body, and it is not recommended to eat more. ； But the judgment standard of Western medicine is much simpler: as long as you don’t have aggravated joint pain, no rash or allergies after eating it, and your uric acid is within the normal range, you can eat it normally. I have an old aunt who has been suffering from rheumatoid arthritis for 12 years. I heard from my neighbor that seafood is a disease. She hasn’t touched shrimp for two years. Last year, her albumin was as low as 32g/L. Her immunity was so bad that she caught a cold once every half month. Later, she tried to eat boiled prawns twice a week, paired with lean beef twice a week. Not only did her joints not hurt, but after the nutritional indicators were improved, even the frequency of recurrences dropped a lot. Of course, if you have high uric acid, you still need to keep your mouth shut, otherwise gout and rheumatoid will attack together, and the pain will really make you restless.

There is also a taboo that is completely personal and has no general reference value. There was a 28-year-old male patient whose elbow joints swelled every time he ate crayfish. His uric acid was checked several times and was within the normal range. Later, a food intolerance test revealed that he was allergic to a certain protein in crayfish. This was his "exclusive taboo" and others did not need to use condoms at all. If you are not sure which food you are allergic to, here is a stupid way for you. Buy a small book and keep a food diary. What you ate today and whether you have any discomfort such as joint pain or rash within 24 hours after eating. Keep it for two or three months. You will know what you are not allowed to touch. It is more effective than listening to any "expert list".

To be honest, after so many years of clinical practice, the most common pitfall is not eating "should not eat" food, but drinking medicinal wine indiscriminately. Last year, I took in a 60-year-old man. I heard from relatives that drinking medicated wine can cure rheumatoid arthritis. I brewed a jar of it myself and drank it for three months. His joints were not healed, but his skin turned yellow like orange peel. When he was sent for a test, his liver enzymes were more than ten times the normal value, which is a typical drug-induced liver injury. Methotrexate and leflunomide, which are often consumed by rheumatoid patients, have a certain burden on liver metabolism. Adding alcohol to the liver will completely strengthen the liver. Even the so-called "a small amount of red wine softens blood vessels" is not necessary. As long as alcohol is used, it will increase inflammatory factors. It is really not as good as drinking a warm drink. There are also people who are used to drinking three or four cups of strong tea or strong coffee every day to refresh themselves. This should be done in moderation. Rheumatoid patients are more likely to develop osteoporosis than ordinary people. Excessive caffeine will affect calcium absorption. It is perfectly fine to drink a cup of American coffee in the morning to wake up. Just don’t drink it as water.

There are also rumors on the Internet that "cold vegetables" such as eggplant, spinach, and cabbage cannot be eaten. This is really nonsense. As long as you don’t have kidney stones, it’s okay to eat spinach normally if you blanch it to remove most of the oxalic acid. The vitamins in dark-colored vegetables can also help fight inflammation. Don’t scare yourself and cut out everything you can eat. In the end, you will become malnourished, which is not conducive to disease control.

In fact, the rheumatoid diet does not have so many rules and regulations. The core is "moderate and adaptable". Don't make it difficult for yourself. Don't dare to eat this or touch that. Not to mention, most of the fun in life will be lost, and it is easy to fail to keep up with nutrition. After all, the purpose of treating diseases is to live a good life, not to become an ascetic, right?