A claim you hear on longevity podcasts

Does functional medicine help rheumatoid arthritis?

The claim checked: Arthritis patients do better with functional medicine, thanks to an elimination diet Hear it at 14:08

What do the studies say?

Not enough evidence

Only two studies test it. The Cleveland Clinic study on tape found small gains in pain and in physical and mental health scores over 12 weeks. Its patients added a functional medicine program to standard care. A trial in Amsterdam tested a lifestyle program for rheumatoid arthritis. Patients' own scores moved slightly in its favor, but not by a significant amount.

Computed from 2 studies that test this point, each judged by two readers, in full. Fewer than 3 sources so far.

The study behind the claim tested something else. See what it tested

What was said on the podcast?

“We did better on every single metric across the board in terms of outcomes and improvement for those patients than the rheumatology department.”

Mark Hyman, The Doctor's Farmacy · If I Could Only Do ONE Thing to Treat Chronic Disease, This Would Be It · 14:08 on YouTube

Episode check Modern wheat has much more gluten, the episode says. Seven of eight studies disagree. 5 claims checked against 36 studies · 10 chapters not checked yet See the whole episode →

The study behind the claim The retelling overstates it

What did the study actually test?

On tape: a Cleveland Clinic study in which rheumatology analysed rheumatoid and psoriatic arthritis patients at the Center for Functional Medicine against its own patients. This study matches those details. It measured three outcomes over 12 weeks (pain, physical health, mental health), the changes were small, the mental health gain depended on age, and the groups differed at the start. It did not show better results on every metric. The impact of functional medicine on patient-reported outcomes in inflammatory arthritis: A retrospective study. PLoS One, 2020. Retrospective, single-center study at Cleveland Clinic; 12-week outcomes compared with matched standard-of-care patients, Patients with rheumatoid or psoriatic arthritis who underwent a functional medicine program (n = 54) adjunctive to the standard of care, compared with patients who received standard of care alone.

What was saidWhat the study did

What was given Matches Care at the Center for Functional Medicine, including an elimination diet A 12-week functional medicine program added to standard care

Compared with Matches Patients in the rheumatology department Matched patients on standard rheumatology care alone

What was measured Matches Every single outcome metric Pain and PROMIS global physical and mental health scores at 12 weeks

Who took part Matches Rheumatoid and psoriatic arthritis patients Rheumatoid and psoriatic arthritis patients at one center

What it found

“Discussion In this retrospective study, the adjunctive treatment with a 12-week functional medicine program improved PROMIS physical and mental health scores as well as pain scores as compared to the standard of care.”

PMID 33031458

How the authors extend it

“Therefore, although the reductions in pain score in the functional medicine group were small, they were both clinically and statistically significant.”

PMID 33031458

The author(s) received no specific funding for this work. Two readers agreed on the label, and the paper was read in full.

Point 1 of 2 Not enough evidence

Patients with rheumatoid or psoriatic arthritis improve more under a functional medicine model of care than under standard rheumatology care

Agree 1

other primary study · 2020 · cited on tape

The impact of functional medicine on patient-reported outcomes in inflammatory arthritis: A retrospective study. PLoS One
Who: Adults with rheumatologist-confirmed rheumatoid or psoriatic arthritis on stable DMARD/prednisone doses, seen at the Cleveland Clinic Center for Functional Medicine (Aug 2016-Jan 2018) vs matched patients seen only in the Rheumatology Department
PMID 33031458

Partly agree 1

controlled trial · 2023

“All patient-reported outcome measures changed slightly (not statistically significantly) over time in favour of the PFJ group ( Table 2 ).”

A multidisciplinary lifestyle program for rheumatoid arthritis: the 'Plants for Joints' randomized controlled trial. Rheumatology (Oxford)
Who: Adults with RA (ACR/EULAR 2010) and low to moderate disease activity (DAS28 2.6-5.1), mean age 55, 92% female, Amsterdam
PMID 36617162

Disagree 0

None.

Point 2 of 2 Leaning for

Elimination or exclusion diets improve rheumatoid arthritis

All five studies were mixed. A Swedish diet trial found no clear change in disease activity. A pooled analysis of diet trials rated the evidence as low or very low certainty. Smaller studies saw less pain and better quality of life in some patients.

Computed from 5 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.

Agree 0

None.

Partly agree 5

controlled trial · 2020

“No significant difference between the intervention and control periods for the primary outcome DAS28-ESR was seen using linear mixed ANCOVA model analysis ( Table 5 ) (mean: −0.289; 95% CI: −0.652, 0.075; P = 0.116).”

Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr
Who: adults aged 18-75 with rheumatoid arthritis of at least 2 years and DAS28-ESR at least 2.6 from the Swedish Rheumatology Quality Register, Gothenburg (77% women)
PMID 32055820

controlled trial · 2021

“The results demonstrate that both diets, despite not affecting the disease activity, measured by the 4-parameter DAS28, had a tendency to reduce the arthritic pain perception and to improve the quality of life of the patients.”

Improvement of Inflammation and Pain after Three Months' Exclusion Diet in Rheumatoid Arthritis Patients. Nutrients
Who: Women aged 31-72 with long-standing, well-controlled RA on stable DMARD therapy, all overweight or obese, Chieti, Italy
PMID 34684536

other primary study · 2026

“6 Conclusions This pilot feasibility study provides preliminary evidence that the AIP dietary intervention was associated with improvements in patient‐reported outcomes of disease activity, pain, fatigue, and sleep in some individuals with RA.”

The Effect of an Autoimmune Protocol (AIP) Diet in Adults With Rheumatoid Arthritis: A Single Arm Crossover Pilot Feasibility Study. Musculoskeletal Care
Who: Self-selected adults in Auckland, New Zealand with clinically confirmed RA of at least six months on stable medication, about half with low baseline disease activity
PMID 41934283

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pooled analysis · 2021

“Consequently, the GRADE assessment resulted in very low or low certainty for all outcomes ( Appendix B ).”

Effect of Anti-Inflammatory Diets on Pain in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Nutrients
Who: adults with rheumatoid arthritis in trials and observational studies of Mediterranean, vegetarian or vegan diets versus an ordinary omnivorous diet (mainly women, 92%)
PMID 34959772

controlled trial · 2023

“On the other hand, because the study deliberately combined multiple lifestyle factors, the individual contribution of these factors on the results can unfortunately not be defined.”

Disagree 0

None.

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