Beverages: You Are What You Drink!

Rheumatoid arthritis (RA) is a whole-body inflammatory syndrome that targets the lining of synovial joints. It can affect multiple organ systems, and by the time we diagnose the joint swelling and pain as rheumatoid arthritis, we have identified the end-organ damage of an immunological process that may have started years to decades ago. Cigarette smoking, infections, hormonal changes, environmental pollution, chronic stress, and emotional trauma are all factors that have been linked to the development of rheumatoid arthritis. Dietary habits, particularly the Western diet, plays a role in rheumatoid arthritis onset and activity as well, and this includes not only what we eat, but what we drink as well.

The role of beverages in the development of rheumatoid arthritis was highlighted in the Nurses Study, one of the largest prospective investigations into the risk factors for major chronic diseases in women. In the Nurses’ Health Study, where 200,000 women were followed between 1991 to 2009, regular consumption of sugar-sweetened soda, but not diet soda, was associated with increased risk of rheumatoid factor positive RA in women, independent of other dietary and lifestyle factors (2). In another study of 300 RA patients at a university medical center, sweetened carbonated beverages and desserts were amongst the foods most often reported to worsen RA symptoms (1).

High fructose corn syrup (HFCS), a commonly used sweetener in carbonated beverages and juices, is thought to be the culprit in triggering rheumatoid arthritis disease activity. One theory is that regular consumption of HFCS causes fructose malabsorption contributes to fructose reactivity in the gut which causes the formation of advanced end glycation products, or AGEs. AGEs commonly found in the diabetic blood vessels contribute to the development of atherosclerosis. In separate studies, the accumulation of advanced glycation end-products has been associated with joint inflammation in RA(4).

Unfortunately, diet soda is not the solution. Although diet soda was not associated with the same risk of rheumatoid arthritis in the Nurses Study, many of these artificial sweeteners do change the composition and function of the gut microbiome-the collection of bacteria, viruses, and fungi that normally live in the gut. The gastrointestinal microbiota plays a role in host physiology, metabolism, and nutrition. Alterations in the gut microbial community is linked to several inflammatory conditions, including cancer, obesity and a variety of bowel disorders, and rheumatoid arthritis. Artificial sweeteners are also associated with diabetes and obesity, both of which contribute to inflammation, and likely worsen RA symptoms.

Enjoy small amounts of pomegranate juice on its own or combined with hot hibiscus tea and sliced ginger. It can also be made into a refreshing spritzer when combined with sparkling water. Beetroot juice is good with fresh ginger and can be enjoyed hot or cold.

​Kitchen-Prescription Recipe: Pomegranate Hibiscus Tea with Ginger and Honey

Ingredients:

1 tablespoon of loose, organic hibiscus tea, or 1 hibiscus tea bag

2 ounces of pomegranate juice

2 slices of fresh ginger

Honey to taste

12 ounces of simmering, filtered water

Place the hibiscus tea into a large mug, add the pomegranate juice and ginger slices. Pour the hot water over these ingredients and allow to steep for 5 minutes. If using loose tea, strain the mixture into a clean, heat-proof glass. Add honey to taste and enjoy.

Medical Mentions:

Drink filtered water. Install a Reverse Osmosis Water Filtration System. Unfortunately, there are many chemicals in the public water supply that may trigger rheumatoid arthritis. From industrial waste and heavy metals to medications, microplastics, pesticides and bacteria, if we are not proactive about filtering our water, we may be ingesting compounds that harm us and may make RA worse. One study reviewing over 32,000 adults found that exposure to perfluorooctanoic acid, a byproduct of industrial waste which is now ubiquitous in residents of industrialized countries, was associated with a higher incidence of rheumatoid arthritis and ulcerative colitis (7). Increasing evidence has linked environmental exposures, including trichloroethene (TCE), silica, mercury, pristane, pesticides, and smoking to higher risk for autoimmune diseases in general (8).

Drink Green Tea. EGCG is a bioflavonoid present in green tea, which exerts an anti-inflammatory effect through several mechanisms, including the inhibition of IL-6 synthesis (11). (IL-6 is a pro-inflammatory cytokine prevalent in active rheumatoid arthritis.) Several studies have suggested that the prophylactic consumption of green tea may be beneficial in ameliorating inflammation and reducing cartilage destruction associated with different forms of arthritis (1). Numi, an organic tea, is delicious and is not sprayed with herbicides.

Eat Ginger. Studies show that ginger reduces inflammatory factors CRP and IL-1 in patients with active RA, and it seems that ginger can improve joint pain as well (10). Also well known in Traditional Chinese Medicine, ginger is warming, and a good treatment for dampness, and inflammation.

Incorporate Small Amounts of Pomegranate and Beet Juice, Preferably in Glass Bottles. Pomegranates and beets contain polyphenolic compounds, which are naturally occurring plant pigments that have been found to be effective in the management of several chronic conditions like diabetes, cancer, cardiovascular diseases, and rheumatoid arthritis as well. Studies have shown that pomegranate juice contains punicalagin, a polyphenolic compound that alleviates arthritis severity and bone destruction and decreases inflammatory cytokine production in mice(5). Betalain pigments in beetroot juice are also helpful in controlling the symptoms of Raynaud’s phenomenon-present in 20% of people with rheumatoid arthritis.

References:

1. Tedeschi et al. Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry. Arthritis Care Res (Hoboken). 2017 Dec;69(12):1920-1925.
2. Yang et al. Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. Am J Clin Nutr. 2014 Sep;100(3):959-67.
3. Suez et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Oct 9;514(7521):181-6. doi: 10.1038/nature13793. Epub 2014 Sep 17.
4. DeChristopher et at. Nutr Diabetes. Intake of high-fructose corn syrup sweetened soft drinks, fruit drinks and apple juice is associated with prevalent arthritis in US adults, aged 20-30 years. 2016 Mar 7;6(3):e199.
5. Huang et al. Punicalagin Inhibited Inflammation and Migration of Fibroblast-Like Synoviocytes Through NF-κB Pathway in the Experimental Study of Rheumatoid Arthritis. J Inflamm Res. 2021 May 12;14:1901-1913
6. Aryaeian et al. The effect of ginger supplementation on IL2, TNFα, and IL1β cytokines gene expression levels in patients with active rheumatoid arthritis: A randomized controlled trial. Med J Islam Repub Iran. 2019 Dec 27;33:154.
7. Riegsecker et al. Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis. Life Sci. 2013 Sep 3;93(8):307-12.
8. Ryan et al. Fructose content in popular beverages made with and without high-fructose corn syrup, Nutrition, Volume 30,, 7-8, July-August 2014, Pages 928-935.
9. Steenland et at. Environmental Health Perspective. Ulcerative colitis and perfluorooctanoic acid (PFOA) in a highly exposed population of community residents and workers in the mid-Ohio valley. 2013 Aug;121(8):900
10. Kahn et al. Environmental Exposures and Autoimmune Diseases: Contribution of Gut Microbiome. Frontiers in Immunology. 2020 Jan 10;10:3094.
11. Cohen and vom Saal. “Nontoxic.” Oxford University Press, New York, 2020.
12. Aryaeian et al. The effect of ginger supplementation on IL2, TNFα, and IL1β cytokines gene expression levels in patients with active rheumatoid arthritis: A randomized controlled trial. Medical Journal Islam Republic of Iran. 2019 Dec 27;33:154.
13. Ahmed et al. Epigallocatechin-3-gallate inhibits IL-6 synthesis and suppresses transsignaling by enhancing soluble gp130 production. Proc Natl Acad Sci U S A, 2008 Sep 23;105(38):14692-7.