Menopause has been increasingly recognised as a pivotal factor influencing the onset and progression of RA. This blog delves into the intricate relationship between rheumatoid arthritis and menopause, exploring how hormonal changes during menopause may exacerbate RA symptoms and affect its management, including how to change your diet and introduce fasting if you are currently suffering.
Hormonal Influence on Rheumatoid Arthritis
The hormonal environment plays a crucial role in the immune system's functioning. Oestrogen, a key female hormone, has been shown to modulate immune responses, often exerting anti-inflammatory effects. During the reproductive years, higher levels of oestrogen are believed to provide a protective effect against the development and progression of autoimmune diseases like RA. However, as women approach menopause, oestrogen levels decline, potentially reducing this protective effect and altering immune system behaviour.
A study published in Arthritis Research & Therapy found that women who experienced early menopause (before the age of 45) had a higher risk of developing RA compared to those who underwent menopause at a later age .
For women already diagnosed with RA, menopause often brings about changes in the severity and nature of their symptoms. Many women report an increase in joint pain, stiffness, and overall disease activity during and after menopause.
Furthermore, menopause is associated with an increased risk of osteoporosis, a condition characterized by weakened bones. Women with RA are already at a higher risk for osteoporosis due to chronic inflammation and the use of corticosteroids, a common treatment for RA.
Managing Rheumatoid Arthritis During Menopause
Given the complex interplay between menopause and RA, managing the disease during this life stage requires a comprehensive approach.
While some studies suggest that HRT may have a beneficial effect on RA symptoms, others raise concerns about the potential risks. In addition to HRT, lifestyle modifications, such as maintaining a healthy diet, engaging in regular physical activity, and ensuring adequate intake of calcium and vitamin D, are crucial for managing both RA and menopause-related symptoms. Weight-bearing exercises, in particular, can help strengthen bones and reduce the risk of osteoporosis, while also improving joint function and reducing RA symptoms.
However, in my experience, the game-changer for women suffering from RA is fasting. Fasting, particularly prolonged fasting or 'block fasting' such as the fasting-style approach of my Champneys retreats, has gained attention as a strategy to reduce inflammation, including in conditions like rheumatoid arthritis (RA). Research suggests that fasting can help reduce inflammatory markers, improve immune function, and alleviate symptoms in people with RA.
Fasting and Inflammatory Markers:
- Fasting has been shown to reduce levels of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), which are typically elevated in RA. These cytokines play a critical role in driving the inflammatory processes that cause joint damage in RA.
- A study published in Cell Metabolism found that intermittent fasting led to a reduction in systemic inflammation, as measured by C-reactive protein (CRP) and IL-6 levels. Lower levels of these markers are associated with reduced disease activity in RA.
Autophagy and Immune System Regulation:
- Fasting induces a cellular process called autophagy, where the body cleans out damaged cells and regenerates new ones. Autophagy helps regulate the immune system by reducing the accumulation of defective or harmful immune cells that can exacerbate RA.
- This process also contributes to the removal of misfolded proteins and damaged mitochondria, which can lead to a reduction in oxidative stress and inflammation.
Metabolic Changes:
- During fasting, the body shifts from using glucose as its primary energy source to using fat, leading to the production of ketones. Ketones have anti-inflammatory properties and may help modulate immune responses in RA.
- Fasting can also improve insulin sensitivity and reduce oxidative stress, both of which are linked to lower levels of inflammation.
Clinical Evidence in RA:
- Some studies have explored the effects of fasting on RA symptoms. A clinical trial published in Scandinavian Journal of Rheumatology found that patients who underwent a 7-10 day fasting period followed by a vegetarian diet experienced a significant reduction in RA symptoms, including joint pain and swelling. The improvements were sustained when participants continued with the vegetarian diet after fasting.
- Another study indicated that short-term fasting followed by a Mediterranean diet could lead to reduced disease activity in RA patients.
Fasting is an intervention, which, managed well, can revolutionise the day to day experience of women living the RA. The longer-term dietary approach should focus on the introduction of anti-inflammatory foods alongside the elimination of pro-inflammatory foods.
Anti-inflammatory foods:
- Omega-3 Fatty Acids: Found in fatty fish (like salmon, mackerel, and sardines), flaxseeds, and walnuts, omega-3s have anti-inflammatory properties that may help reduce joint inflammation and pain.
- Fruits and Vegetables: Rich in antioxidants, these foods help combat oxidative stress and inflammation. Berries, leafy greens, and colorful vegetables are particularly beneficial.
- Whole Grains: Foods like brown rice, quinoa, and oats are recommended for their fiber content, which can help reduce inflammation.
- Olive Oil: A staple of the Mediterranean diet, olive oil contains oleocanthal, a compound with anti-inflammatory effects similar to ibuprofen.
Foods to Limit or Avoid:
- Processed Foods: High in trans fats, refined sugars, and salt, processed foods can increase inflammation and should be minimized.
- Red and Processed Meats: These can contribute to inflammation and should be limited. Lean proteins like fish or plant-based sources are better alternatives.
- Sugary Drinks and Snacks: Excess sugar can trigger inflammatory processes, so it's best to reduce consumption of sugary beverages and snacks.
Additional Nutrient Considerations:
- Vitamin D and Calcium: These are essential for bone health, especially in individuals with RA who are at higher risk for osteoporosis. Foods like fortified dairy products, leafy greens, and fatty fish are good sources.
- Iron: Some women with RA may experience anaemia, so iron-rich foods like lean meats, beans, and fortified cereals are important.
Weight Management:
- Maintaining a healthy weight is crucial for people with RA, as excess weight puts additional strain on joints, especially weight-bearing ones like the knees and hips. A balanced diet rich in whole foods, combined with regular physical activity, can help achieve and maintain a healthy weight.
Alcohol and Caffeine:
- Low to moderate alcohol consumption may be acceptable for some people with RA, but I always er on the side of caution, reducing alcohol intake in most instances. Excessive caffeine intake should also be limited as it may interfere with bone health.
References
- Arthritis Research & Therapy. "Hormonal Influences on the Onset and Progression of Rheumatoid Arthritis: The Role of Estrogen." 2016.
- Rheumatology. "Menopause and Rheumatoid Arthritis: Impact on Disease Severity and Joint Damage." 2018.
- Zoli, A., et al. "Effects of Menopause on Rheumatoid Arthritis: An Update." Clinical and Experimental Rheumatology, 2020.
- Journal of Rheumatology. "Hormone Replacement Therapy and Rheumatoid Arthritis: Benefits and Risks." 2017.
- Osteoporosis International. "The Increased Risk of Osteoporosis in Postmenopausal Women with Rheumatoid Arthritis." 2019.
- Pikwer, M., et al. "Early Menopause and the Risk of Rheumatoid Arthritis: A Population-Based Study." Arthritis Research & Therapy, 2017.
