Integrative Recommendations for Rheumatoid Arthritis

An integrative approach to autoimmune illness, including rheumatoid arthritis, includes general measures to reduce inflammation in the body.  Simultaneously reducing stress and improving stress management maximizes your healing response and can help reduce flares, because stress is expressed as inflammation in the body.  

Mind- Body Techniques

Meditation is highly recommended for all patients with severe generalized inflammation. Consider enrolling in a Mindfulness Based Stress Reduction program, or learning vipassana meditation. Mindfulness has been shown to measurably reduce salivary cortisol and plasma DHEAS (“Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS)….Carlson et al, Psychoneuroimmunology 2004.

Relaxation exercises and the development of improved methods to cope with stress are also believed to be helpful, through the use of Tai Chi, Yoga, or a similar body based meditative practice.

Reflective or disclosure journaling is helpful, particularly writing regarding emotionally charged events in your life.


Removing toxins

Eliminate coffee and tobacco.  Make alcohol are rare treat, if at all. Consider elimination of commonly offending foods, with or without IgG food sensitivity testing.  Dairy, wheat, citrus, and nuts are common culprits.  Total elimination of suspected foods from your diet for three weeks followed by reintroduction of each food separately may be revealing.

Shift to an organic based diet, including dairy, eggs, and meat products.  At least avoid the more pesticide laden foods – see to learn which foods are more important to get organic. Limited research suggests a substantial improvement for some people with rheumatoid arthritis with a change to a vegan diet.  Improvement is seen only after several months.



Increase omega-3 fatty acid intake by eating more cold water fish, adding ground flaxseeds, or fish oil.  See for information to help you avoid excessive mercury exposure. Consider the recommendations of the anti-inflammatory diet and gradually incorporate as many of these as make sense to you.



Helpful for many people with Rheumatoid Arthritis; less likely to be beneficial for those taking corticosteroids such as prednisone.



Fish oil supplements are recommended.  Look for high quality brands like Nordic Naturals or Carlsons.  Determine your dose not by the total amount shown on the front of the bottle, but with the sum content of DHA plus EPA.  Start with a daily dose of 1000 mg  of DHA + EPA, and increase every five days or so until you take a total of 25 mg DHA and 15 mg EPA / lb of body weight, or 3-5 g/day, ideally split between morning and evening doses, with food.

GLA (Gamma Linolenic Acid), as GLA 1.4-2.8 gm/day) or Evening Primrose Oil (12-22 gm/day). Start two weeks after beginning fish oil, and use ONLY IF TAKING MODERATE DOSE OF FISH OIL AS WELL!

Vitamin D, 2000 IU/day or as indicated by testing.

Calcium 1000 mg daily, ideally as Ca Citrate

Magnesium 400 – 750 mg daily, as tolerated.

Selenium 100 mg  (not to exceed 400 microgram/day) and less if you eat many nuts (one brazil nut provides an average of 100 micrograms of selenium.)

AND PERHAPS: Vitamin C, 250 mg twice daily.

Botanicals:  (each are included in the supplement Zyflamend)

Ginger, starting with 1 gm twice daily, increasing weekly up to total of 2 gm twice daily. Turmeric, ½ gm twice daily, increasing to 1 gm twice daily.  To absorb it, cook it must be cooked in oil.



A personalized well balanced exercise program has numerous and significant benefits.


Avoid herbal supplements that stimulate the immune system, such as Echinacea, Astragalus, Alfalfa Sprouts, Iron, St. Johns Wort. Alfalfa sprouts contain the amino acid L-canavanine, which can stimulate the immune system in people with lupus and increase inflammation. Other legumes are safe to eat as they have a much lower concentration of L-canavanine.  It’s probably best to also avoid iron unless you are anemic and iron deficient.  (Keep in mind some menstruating women will need appropriate doses of iron to prevent anemia.)  St. John’s Wort can cause many other medicines to be less effective.



As recommended by your rheumatologist.