It’s bikini-body season! JK. I’m not going to wear a bikini this season or any other season. But as summer approaches, I, like a lot of people, feel pressured to lose weight so I can squeeze into smaller, brighter clothing and stand in, or next to, water.

But since I was diagnosed  rheumatoid arthritis (RA) a decade ago, not only have I gained about 20 pounds — mostly in my stomach — I’ve also found it incredibly difficult to lose weight. I cannot and should not blame it entirely on my RA. It could be menopause, it could be a lack of walking since I moved to California from New York City, it could be Pasta Night every Friday at my mom’s old folks’ club. Who the heck knows?

What I do know is that shedding that extra weight is critical and I need to find a way. Not for vanity’s sake, but for a multitude of health reasons, and especially because I have rheumatoid arthritis.

RA alone significantly increases the risk of heart disease and stroke; being overweight further adds to that risk. Eating healthier and losing weight can help control inflammation and reduce pressure on my already strained joints. According to Douglas Roberts, MD, a rheumatologist in Sacramento, California and founder of PainSpot, every extra pound we carry on our bodies puts from three to five extra pounds of pressure on our joints. “Whether you’re carrying it around in a suitcase or around your middle, you’re subjecting extra weight to your feet and knees and ankles.” Ouch.

Excess weight also affects:

Arthritis disease activity: Several studies show weight loss in obese rheumatoid arthritis, psoriatic arthritis (PsA), and osteoarthritis patients may lead to improvement in disease activity or progression.

Medication effectiveness: Many medications are less effective if the patient is overweight, particularly with psoriatic arthritis. “It’s harder to control obese patients’ disease because there’s limited penetration of the medications into fatty tissue,” says Dr. Roberts. A 2016 study in Current Rheumatology Reports also found that “obesity was associated with poorer response to TNF inhibitors.” (Read more about how to eat a healthy diet with psoriatic arthritis.)

So, yes: Losing weight is definitely a priority but, man, it’s so hard. How to safely shrink down and keep extra pounds off permanently is one of the great, unanswered mysteries of the universe. If anyone discovered the secret potion, they’d be richer than Jeff Bezos and everybody on planet earth would look like Tom and Gisele.

For starters, dieting is confusing. There’s too many to choose from — keto, paleo, Weight Watchers, Military, Whole 30, 17-Day, Wild Diet, intermittent fasting, clean eating, intuitive eating, and on and on.

Then there’s so much competing and conflicting research on what we should and shouldn’t eat, and all of it makes seemingly scientifically backed claims from reputable doctors at reputable universities. But it seems as if it changes on a daily basis.

Eggs are bad!
Eggs are good!
Carbs are the devil!
Cutting out all carbs is dangerous!

What’s more, losing weight when you have inflammatory arthritis has its own set of considerations. Certain foods and supplements have been mythologized to hurt RA patients’ inflammation and may or may not be good for weight loss: in particular, dairy, sugar, and gluten.

But let’s face it: Some of that stuff is yummy and that’s why dieting sucks. Eating salmon and kale all the time is about as exciting as watching C-SPAN. I’m not the only one who thinks dieting is for the birds. A bunch of brand-new research basically says many diet plans are futile and might not even work long-term. I just read this in Newsweek not long ago: “Research suggests that restrictive dieting can lead to a higher body mass index (BMI) over time, and a greater future likelihood of being overweight. There is also evidence suggesting that food restriction can lead to a preoccupation with food, guilt about eating and higher levels of depression, anxiety, and stress.”

Another recent study from researchers at Columbia University Medical Center claims that yo-yo dieting takes a toll on women’s hearts and doesn’t even keep weight in a healthy range anyway. “Women who lost at least 10 pounds, but then put that weight back on within a year, were more likely to have risk factors for heart disease. The more times someone went on a yo-yo diet, the worse their heart health.”

Well, that’s not good either. I’m guilty of this for sure. I tried a pretty healthy-but-restrictive diet through my gym and, sure, I lost 15 pounds in six weeks. But within a year it all came roaring back and I still bear way too much of a resemblance to the Pillsbury Dough Boy.

Researching the Right Weight Loss Plan

So what’s a poor soul with an autoimmune disease, an affinity for bagels, and a plentiful belly to do? I turned to my go-to Facebook support groups and asked a pretty straight-forward question: “Has anyone lost weight and was able to keep it off?” I posted. “If so, how did you do it?”

I got tons of responses, and, not surprisingly, they were all over the map, since none of us know really know what we’re doing. Here’s what folks said:

Note: CreakyJoints encourages everyone with inflammatory arthritis to talk to a rheumatologist about the finding the right treatment plan for them. You should always talk to your doctor before making a significant change to your eating habits. Diets should not replace any medication plan recommended by your doctor. Prescription medications are often at the core of treatment due to the strong evidence supporting their success.

Keto Diet

After Amanda Mayer’s rheumatologist suggested she follow the low-carb, high-fat keto diet, she lost 30 pounds. “It’s the best thing that’s ever happened to me,” she says. “No inflammation or skin issues, no more GERD or blood pressure meds. But it can be dangerous if not done properly. You can’t live on bacon, which is a popular misconception. I eat meat; berries; green veggies; healthy fats like olive oil and avocado; butter, high-fat dairy; and nuts. I’ve never felt better in my 45 years of life. I am being watched by my rheumatologist, and he’s happy with my results.”

She says her psoriatic arthritis has improved drastically. “I haven’t had a psoriatic episode since I started. I’ve only had one flare in four months and it was after having a piece of bread. Everything about me has improved: my skin, my sleep. My energy is through the roof.” (Read more about whether the keto diet is good for gout.)

Gluten-Free Diet

Some arthritis patients swear by a gluten-free diet, even if they don’t have a gluten allergy. Some research has suggested that a gluten-free diet may be beneficial to people with inflammatory arthritis, but there’s no conclusive evidence yet. In the meantime, it’s not stopping people from trying it, even though if done wrong a gluten-free diet can cause weight gain and constipation.

Rene Faul, who has psoriatic arthritis but no gluten allergy, stopped eating dairy and meat — with the exception of seafood and eggs — then after a year of that, stopped eating gluten completely. She lost 35 pounds and has kept it off. “I am not allergic, but I swear my belly is much better without it. An added bonus is how flat my stomach is without gluten. It did not help my PsA like I hoped, but I feel so much better in different ways.”

Low-Carb Diet

After ankylosing spondylitis (AS) patient Maureen Sawick eliminated gluten from her diet, she started to cut down on all carbs. She uses the app “Carb Manager” to track carbs and calories. “I’ve certainly had more energy since I started the diet about two months ago,” she says. “I think my general pain levels are also down, but with the change of seasons, it’s hard to pinpoint causes. This is a personal experiment to see if I can improve things with a diet change. Certainly not eating gluten for the last two years has been a huge improvement for me. Now I want to see if I can do more.”

Steve Pulliam, who also has AS, I lost 84 pounds in five months by increasing his water intake, decreasing his carb intake, and stopping his late-night snacking habit. “That’s it. No exercise, nothing else but those three things.”

Portion Control Diet

Mendy Mendenilla, who has psoriatic arthritis, lost 40 pounds doing Weight Watchers last year and has kept it off since. “I’ve maintained for about nine months and now I’m working on taking off another 25. It’s all about portion control,” she says, though she acknowledges that she doesn’t think the weight loss has really helped her PsA. “I haven’t noticed any improvement in there, unfortunately.”

Eden Burrell, who also has psoriatic arthritis, went from a size 18 to a 10 and has remained that size for years, with good old-fashioned willpower. “I eat smaller portions and exercise to whatever my body will allow. Sometimes it’s five minutes, other times two hours. I play it day by day. I have real trouble trying to cut things out so I just went small. I use a side plate for my meals so it makes it look like more.”

AS patient Jim Weatherhead says there’s “no magic” to his new diet formula, which resulted in a 40-pound weight loss over three years. “Eat less, eat smart,” he says. “Food is fuel. My fabulous doctor of many years used to say, tongue in cheek, ‘Eat the same stuff you eat now, but just eat less of it.’”

Autoimmune Protocol (AIP) Diet

A much stricter version of paleo, the AIP is an elimination diet that cuts out foods that allegedly cause inflammation. Meat, fish, vegetables, leafy greens, and bone broth are okay. Grains, eggs, legumes, dairy, soy, seeds, nightshade vegetables, sugar, coffee, and artificial sweeteners, are forbidden. Charity Margaret, who has PsA, admits that AIP is very restrictive, but it’s not meant to last forever.

“To be honest I almost gave it up because I felt worse at first. But I stuck with it, I lost 30 pounds, and I’m nearly in remission. My labs showed no inflammation this last time. I followed the diet strictly for two months and then reintroduced foods gradually. I’ve kept the weight off and kept inflammation down since. I’ve completely changed how I eat. I make sure to eat nutrient-dense, whole foods and it’s made a huge difference. Since reintroducing foods, my diet looks more like a Mediterranean diet now — healthy fats, lots of veggies, fish and chicken.”

The Best Diet for Arthritis: What’s the Expert Opinion?

I found everyone’s candid responses reassuring in a way — it was helpful to hear that just because a given diet helped someone lose weight, it didn’t necessarily mean their arthritis would magically improve. But on the other hand, I felt even more confused.

I asked Dr. Roberts which diet he recommends for his RA patients. He thinks everyone — not just RA patients — should be on a version of the Mediterranean diet, which means eating primarily plant-based foods (fruits and vegetables, whole grains, legumes, and nuts), replacing butter with healthy fats such as from olive oil, eating animal protein like chicken, fish, eggs, and dairy a couple of times a week, and limiting red meat and sweets.

Reasonable enough. Then I found another interesting expert to speak with: a nutritionist who has rheumatoid arthritis herself. I had to ask Samantha Cassetty, RD, who was diagnosed with RA a year ago, for her take on this crazy diet landscape. Cassetty is a nutritionist for NBC News and was formerly the nutrition director for Good Housekeeping magazine.

She agrees that there are so many confusing diets out there, it’s hard to decide which one to do.

As for the AIP diet — which is very popular in arthritis circles — Cassetty doesn’t recommend it. “You hear powerful anecdotal evidence that it transforms lives, but the research is not there,” she says. “There’s not enough clinical evidence that it works, plus it’s so complicated and hard to follow, it robs the joy out of your life.”

That said, she understands why people want to try it. Fad diets like AIP may help you lose weight and cut out “a lot of the crap you’re eating that saps your energy, like processed foods and sugar.” These strict programs also help eliminate mental fatigue by providing clear rules to follow in a situation that feels overwhelming.

But bear this in mind: “You’ll feel better for those reasons, but that doesn’t necessarily mean you’re improving your joint health or lowering inflammation any more than you would by following a generally healthy but less restrictive plan.”

Now for the good news, at least where consensus is concerned: For those with inflammatory arthritis, Cassetty, like Dr. Roberts, favors a Mediterranean-style diet that is plant-focused (at least two cups of veggies per day) with fish, whole grains, herbs and spices, and fruit. Don’t let anyone tell you fruit has too much sugar, she says. “I eat blueberries, I eat mangos, I eat two to three servings of fruit per day.” Cassetty says it’s important to eat protein at every meal.

She herself follows a gluten-free diet to help her RA even though she admits the jury is still out on whether doing so helps people without a gluten intolerance.

The Diet Mindset: Progress, Not Perfection

More important than any specific food, supplement, or alternative therapy, Cassetty says, is letting go of a specific number on a scale and finding your own happy, healthy, sustainable place. “It’s not going to look like mine, or someone’s on TV. It takes some restriction and compromise, and it’s work. You might decide you don’t want to work that hard to keep it up, and that’s fine.”

And as both Cassetty and Dr. Roberts reminded me, your diet is not going to cure your RA. So take your meds and nourish your body to the best of your ability.

“I try to get my clients to focus on being self-loving and self-respectful,” Cassetty says. “I try to help people find a space they can live in and stay there. It’s hard to lose weight in general. You can make plenty of progress by shifting eating habits and with positive movement experiences. You don’t have to torture yourself at the gym and burn a million calories. It’s about showing your body love.”

After researching all of these diets, it’s pretty clear there’s not one path and that a diet should be individualized according to your body’s needs and issues. So I’ve decided I should cut back on carbs, add veggies, and probably try going gluten-free. This won’t be easy, but I’ll keep you posted on the progress of my protruding belly.

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