Ketogenic diets have grown in popularity, both among people wanting to lose excess body weight and those managing chronic conditions like rheumatoid arthritis (RA). Following a ketogenic diet (keto) can be a big commitment, but many people with RA find that this anti-inflammatory way of eating supports better RA symptom control. The key is to choose healthy options that fit into your diet and provide the right balance of nutrients to prevent side effects and help improve your quality of life.

Here are five things you should know before “going keto” with RA.

1. Ketogenic Diets Are More Than Just Low-Carb

The ketogenic diet is often mistaken for Atkins or a high-protein, low-carbohydrate diet. These other meal plans are similar to keto, but they’re not quite the same.

Ketogenic diets focus on fat as the primary nutrient, including saturated fatty acids from high-fat meats, cheese, and eggs. Keto is moderate in protein, providing just enough to meet your needs — it doesn’t call for extra protein shakes or a high intake of lean meat. Carbohydrates are tightly restricted on a ketogenic diet, usually kept to under 50 grams per day. As a result, even traditionally healthy foods like bananas, beans, cashews, and oatmeal can be difficult to fit into your day.

Because people with RA have double the risk of heart disease compared with the general population, it’s essential to plan your ketogenic diet carefully and incorporate plenty of heart-healthy choices.

2. Lots of Healthy Foods Fit Into a Ketogenic Diet

Ketogenic diets are high in fat, but that doesn’t mean you can only eat bacon and butter. It’s possible to get plenty of fiber, antioxidants, and omega-3 fatty acids on a keto diet by choosing nonstarchy vegetables and fruits, along with seafood and nuts. Examples of nutritious ingredients in a ketogenic meal plan include:

• Asparagus
• Avocado
• Blackberries
• Blueberries
• Broccoli
• Brussels sprouts
• Cauliflower
• Eggplant
• Kale
• Olives and olive oil
• Pumpkin and pumpkin seeds
• Raspberries
• Romaine lettuce
• Sardines and salmon
• Spaghetti squash
• Spinach
• Strawberries
• Walnuts
• Zucchini

Additional benefits of the ketogenic diet for people with RA might include losing weight (if your doctor has advised this) and eliminating gluten (if that’s a trigger for you). One myRAteam member shared: “I have been gluten-free since 2012. I lost 30 pounds in 3.5 months, and that weight loss alone helped my joints. Last fall, I cut out sugar, dairy, and white potatoes. That made a big drop in pain for me. I stand for 12 hours a day, and it used to be excruciating. Now, it’s tolerable.”

Ketogenic diets can also encourage people to eat fewer processed foods and experiment with new recipes. Some report that eating fewer preservatives helps improve their RA symptoms by lowering chronic inflammation.

“I have thrown out all sugar, processed foods, and bread,” one myRAteam member said. “I saw results within three days, including no more hand or foot swelling. I wish I could make RA go away, but at least I can control the inflammation in my body with my diet to feel more comfortable.”

3. Opinions on Keto Vary — Even Among Health Care Providers

Low-carb and ketogenic diets remain somewhat controversial, and there’s no one-size-fits-all plan for people with autoimmune diseases like RA. Keeping an open line of communication with your health care providers and trying different approaches to your diet can help you figure out what changes are worth making.

One member shared, “My dietitian proposed that I try the keto diet. I eat fat and protein and avoid bread, pasta, and sugar. I have bacon and three eggs in the morning, bone broth, fatty fish (like tuna), butter, 1 percent yogurt with blueberries or strawberries, and avocado. I’ve used this diet for the last four weeks and feel a difference. I have less pain, and my fingers are not stiff. I am not sure whether it will work for everyone, but it is helpful for me.”

However, not everyone will have the same experience and feel the same effects of a ketogenic diet. Another member wrote, “I always hear that keto works wonders — NOT for me. It sends me into a spiral of pain from the nitrates in the bacon.”

If the food options on a ketogenic diet don’t appeal to you or don’t agree with your digestive system, you can consider other types of anti-inflammatory diets like the Mediterranean diet or a vegan diet. There’s no official dietary prescription for RA, so you can shop around for an eating style that works for you. Also keep in mind any other health conditions you may have. For example, for a person who has RA and gout, keto may not be the best fit because red meat and shellfish can trigger gout flares.

4. Eating Less Sugar Is Generally a Good Idea

Whether or not you decide to follow a strict ketogenic diet, any dietary interventions that cut down on refined sugar stand to offer health benefits for more than just arthritis symptoms. Lots of people on myRAteam have described the anti-inflammatory effects of eating less sugar (and the negative consequences of eating too much).

For example, one member said, “I do notice that pain intensifies when I eat too many sweets.” Another shared, “When I intake more sugar than normal, my body feels awful.”

Still another explained, “I finally identified most of my triggers and have been working to learn how effective each change in my diet has been. I believe the most damaging is sugar, and after eliminating it, my RA has settled down considerably. I wasn’t eating that much sugar, but getting rid of it made a big difference almost immediately.”

If you follow just one element of a ketogenic diet, go with reducing sugar and refined carbs — that’s a good takeaway that most health care providers will support.

5. Ketogenic Diets Mimic Fasting

Fasting has been used for thousands of years to treat various ailments. And a ketogenic diet isn’t that far off from fasting, metabolically speaking. During fasting, when only water is consumed for a period of time, the body eventually turns to body fat for energy. Fat is changed into compounds called ketones, which fuel the brain and body, just like with a ketogenic diet. However, with keto, the fat comes from food. As a result, a ketogenic diet is sometimes referred to as a “fasting-mimicking diet.”

There are many variations of fasting. Evidence suggests that fasting may improve clinical measures of body function and symptoms of RA, leading researchers to suspect that ketogenic diets could offer similar benefits. Although more research is needed, some members of myRAteam have mentioned a positive experience with fasting. One member said, “I am kinda shocked that people do not mention fasting for relief or even consuming small portions instead of meals.” Another noted that they “seem to have remission-like effects when intermittent fasting is practiced.”

One member discussed focusing on small portions: “Beyond alcohol and processed foods, my body seems to handle everything pretty well, as long as it is in small portions. Typically, a single serving or less is fine.”

Intermittent fasting is also known as time-restricted eating. People who practice intermittent fasting follow a schedule of planned eating times, such as only eating between noon and 8 p.m. or consuming a restricted number of calories every other day and eating freely otherwise.

If you have a history of disordered eating, it’s best to avoid intermittent fasting, as it can become a trigger for overly restrictive behaviors and thought patterns. When living with a chronic condition like RA, it’s always smart to discuss changes to your eating habits and lifestyle with your rheumatology provider. Make sure you’re not missing out on essential nutrients or neglecting to take your medications and other health conditions into account.

Talk With Others Who Understand

On myRAteam, the social network for people with RA and their loved ones, more than 199,000 members come together to share advice, offer support, and discuss daily life with rheumatoid arthritis.

Have you made changes to your diet because of RA? If you’ve tried a ketogenic diet, what was your experience like? Share your thoughts in the comments section or by posting on your Activities page.