Between 2013-2015, around 58.5 million U.S. adults annually reported having been told they had some type of arthritis, lupus, gout, rheumatoid arthritis, or fibromyalgia.  These days, everyone either knows someone with arthritis or has arthritis–and it doesn’t just affect the elderly. Young people and even children and teens are also dealing with arthritis. If you’re interested in the ketogenic diet, you might wonder whether keto can improve arthritis. Let’s delve into the research.
Arthritis is a broad term that describes numerous medical conditions involving inflammation in one or more of your joints. Symptoms of arthritis include:
Arthritis can lead to joint deformities over time. 
The cause of arthritis isn’t definitive, but a multitude of factors could be involved, such as:
If you have a family history of arthritis, you have a higher risk of developing it.
There are different types of arthritis, including rheumatoid arthritis, inflammatory arthritis, and osteoarthritis.
Gradual wear and tear and damage to the cartilage in the joints is called osteoarthritis. An infection or injury can worsen osteoarthritis. Severe osteoarthritis can lead to bone grinding on bone, which is particularly painful and restricts movement of the affected joint.
Conditions like rheumatoid arthritis and ankylosing spondylitis involve your immune system and widespread inflammation that can also affect the muscles and organ systems like the eyes. With these inflammatory conditions, the body’s own immune system attacks your joints, and they become swollen and inflamed. Over time, the disease process can destroy cartilage and bone. Inflammatory arthritic conditions could be associated with bacteria, genetics, and environmental factors.
Typical treatments for arthritis include:
Some doctors suggest alternative methods or therapies like:
In more severe cases of joint deterioration, some doctors recommend surgery, such as joint replacement surgery.
It’s true that your diet can exacerbate or increase your risk of developing arthritis. 
Research shows a ketogenic diet tends to:
Researchers know that less oxidative stress correlates with less pain.
A ketogenic diet is being looked at as a preventive and treatment option for osteoarthritis.  One study compared a low-fat diet to a low-carb diet and concluded that a low-carbohydrate diet reduced the oxidative stress responsible for inflammation and arthritis. 
Some people with arthritis experience success with elimination-style diets or removing other possible problem foods like gluten, dairy, or the nightshade family of vegetables. Nightshades have been linked to increased gut permeability, which could lead to arthritis pain and inflammation. Gut permeability is a measure of the health of the inside lining of your gut. If your gut lining is too permeable and compromised, it allows toxins, undigested food particles, and larger particles to pass through into your bloodstream where they aren’t supposed to be, possibly provoking an inflammatory immune reaction. 
Anti-Inflammatory Keto Foods
Most of the anti-inflammatory foods doctors recommend for someone dealing with arthritis are also keto-friendly or keto staples, such as:
Studies suggest eating 10 grams of collagen protein daily could improve joint discomfort in people with arthritis. The collagen you eat travels to damaged tissue sites and aids repair. Lots of keto dieters consume bone broth or collagen supplements. Add a collagen powder to your smoothie or try a keto chicken bone broth.  
The mitochondria are like the powerhouses or engines of your cells. Cartilage from osteoarthritis patients has more significant oxidative damage and mitochondrial dysfunction compared to healthy cartilage. Studies show a ketogenic way of eating benefits mitochondria. 
Researchers also discovered people with arthritis may have different gut bacteria that contribute to inflammation and increase the risk of the condition. 
Fermented keto foods like sauerkraut and kimchi help feed the friendly bacteria in your gut and restore a harmonious balance in your gut microbiome. Probiotic supplements and foods have shown promise for treating arthritis and diminishing pain and stiffness. 
Sugar feeds opportunistic bacteria in the gut, which worsens the problem of imbalance and gut dysbiosis. The bad news for those pesky opportunistic bacteria is that sugar is off the keto menu, so they start dying off. Studies reveal the ketogenic diet positively affects gut bacteria and favors more beneficial types of gut bacteria. One reason keto works so well for managing epilepsy could be due to positive changes in the gut microbiome (the microorganisms in the gut). 
Inflammation, Carbs, and Sugar
Inflammation is a key driver of a plethora of chronic diseases, including inflammatory arthritis like rheumatoid arthritis. Sugar is known to be inflammatory. High blood sugar levels and inflammation resulting from processed foods and a standard Western diet increase the risk and symptom severity of arthritis.  
Mounting research continues to prove that a ketogenic diet is anti-inflammatory. 
One animal study found that the carbohydrate composition of diets increased the risk of osteoarthritis. Interestingly, fiber and sugar were the primary culprits that increased osteoarthritis. A high-fiber diet resulted in unhealthy changes in cellular stress-response pathways and the genes that regulate cartilage production and repair. 
While some research shows fiber helps with pain and arthritis, other studies differ. Many people may find relief with a fiber-rich or plant-based ketogenic diet, while others find relief with a lower fiber or even a keto carnivore approach. Bodies are different, and what works for someone else might not be your ideal option. It’s always best to visit your doctor or healthcare practitioner before starting any new diet.
Healthy Fats and Omega-3s
Omega-3 fatty acids in the form of supplements or from foods like grass-fed beef and fatty fish are commonplace on keto. Going keto means saying goodbye to problematic sugar and hello to healthy natural fats. Be mindful that you’re not eating too many trans fats and processed keto junk foods in place of these healthy natural fats.
The ratio of omega-6 to omega-3 fatty acids affects inflammation levels and arthritis risk. You need more omega-3s and fewer omega-6s.  Check out our informative article for more details on the ratios and different types of omegas.
Scientists believe the Mediterranean way of eating correlates with lower levels of arthritis and inflammation largely due to the olive oil. Consuming olive oil has been shown to lower arthritis risk, promote repair, protect bone cells, and reduce oxidative stress and inflammation.   Research even shows rubbing olive oil directly onto arthritic joints seems to decrease stiffness and pain. 
Remember to go for extra virgin olive oil rather than non-virgin oil, which is lower in anti-inflammatory phenolic compounds and antioxidants. It’s best to cook with olive oil at a lower temperature, use it for salad dressings, or drizzle it onto your food after cooking. 
Being obese or overweight boosts your risk of arthritis by a shocking 300-400 percent! Less body weight means less strain and pressure on your bones and muscles. Going keto is one of the most effective diets for weight loss. It makes sense that going keto and implementing appropriate exercise is a great way to improve arthritis or lower your risk of getting it in the first place.  
Has going keto improved your arthritis symptoms? Did you experience success treating arthritis with a ketogenic lifestyle? Chat with the keto community here at Ketogenic.com.
Centers for Disease Control and Prevention (CDC). Arthritis Related Statistics. Arthritis Related Statistics | CDC
Mayo Clinic. Arthritis. Arthritis - Symptoms and causes - Mayo Clinic
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH). What is Arthritis & What Causes It? What is Arthritis & What Causes it? | NIAMS (nih.gov)
Jiang, X., Frisell, T., Askling, J., Karlson, E. W., Klareskog, L., Alfredsson, L., & Kallberg, H. (2015). To what extent is the familial risk of rheumatoid arthritis explained by established rheumatoid arthritis risk factors. Arthritis Rheumatol, 67(2), 352-62. DOI: 10.1002/art.38927
Ciaffi, J., Mitselman, D., Mancarella, L., Brusi, V., Lisi, L., Ruscitti, P… Ursini, F. (2021). The effect of ketogenic diet on inflammatory arthritis and cardiovascular health in rheumatic conditions: A mini review. Front Med (Lausanne), DOI: 10.3389/fmed.2021.792846
Kong, G., Wang, J., Li, R., Huang, Z., & Wang, L. (2022). Ketogenic diet ameliorates inflammation by inhibiting the NLRP3 inflammasome in osteoarthritis. Arthritis Research & Therapy, Ketogenic diet ameliorates inflammation by inhibiting the NLRP3 inflammasome in osteoarthritis | Arthritis Research & Therapy | Full Text (biomedcentral.com)
Strath, L. J., Jones, C. D., George, A. p., Lukens, S. L., Morrison, S. A., Soleymani, T… Sorge, R. E. (2020). The effect of low-carbohydrate and low-fat diets on pain in individuals with knee osteoarthritis. Pain Med, 21(1), 150-160. DOI: 10.1093/pm/pnz022
Smith, K. J. (2021). Ketogenic diet as a preventative measure or treatment option for osteoarthritis targeting NFL athletes as a high-risk group. Honors Theses. "Ketogenic Diet As a Preventative Measure or Treatment Option for Osteo" by Kelsi J. Smith (seu.edu)
Gundry, S. R. (2020). Abstract P219: The vast majority of people who eat ‘gluten free’ for IBS, celiac, or autoimmune disease have markers of leaky gut that resolve when ‘gluten free’ foods containing lectins, like corn, other grains, beans, and nightshades are removed from their diet. Circulation, https://doi.org/10.1161/circ.141.suppl_1.P219
Basu, A., Schell, J., & Scofield, R. H. (2019). Dietary fruits and arthritis. Food Funct, 9(1), 70-77. DOI: 10.1039/c7fo01435j
Berenbaum, F. (2014). Does broccoli protect from osteoarthritis? Joint Bone Spine, 81(4), 284-6. DOI: 10.1016/j.jbspin.2014.04.001
Benito-Ruiz, P., Camacho-Zambrano, M. M., Carrillo-Arcentales, J. N., Mestanza-Peralta, M. A., Vallejo-Flores, C. A. (2009). A randomized controlled trial on the efficacy and safety of a good ingredient, collagen hydrolysate, for improving joint comfort. Int J Food Sci Nutr, DOI: 10.1080/09637480802498820
McAlindon, T. E., Nuite, M., Krishnan, N., Ruthazer, R., Price, L. L., Burstein, D., Griffith, J., & Flechsenhar, K. (2011). Change in knee osteoarthritis cartilage detected by delayed gadolinium enhanced magnetic resonance imaging following treatment with collagen hydrolysate: A pilot randomized controlled trial. Osteoarthritis Cartilage, DOI: 10.1016/j.joca.2011.01.001
Vidali, S., Aminzadeh, S., Lambert, B., Rutherford, T., Sperl, W., Koefler, B., & Feichtinger, R. G. (2015). Mitochondria: The ketogenic diet: A metabolism-based therapy. The International Journal of Biochemistry & Cell Biology, 63, 55-59.
Horta-Bass, G., Romero-Figueroa, M. D., Montiel-Jarquin, A. J., Pizano-Zarate, M. L., Garcia-Mena, J., & Ramirez-Duran, N. (2017). Intestinal dysbiosis and rheumatoid arthritis: A link between gut microbiota and the pathogenesis of rheumatoid arthritis. J Immunol Res, DOI: 10.1155/2017/4835189
Vaghef-Mehrabany, E., Alipour, B., Homayouni-Rad, A., Sharif, S-K., Asghari-Jafarabadi, M., & Zavvari, S. (2014). Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition, 30(4), 430-5. DOI: 10.1016/j.nut.2013.09.007
Ulamek-Koziol, M., Czuczwar, S. J., Januszewski, S., & Pluta, R. (2019). Ketogenic diet and epilepsy. Nutrients, https://doi.org/10.3390/nu11102510
Kokkonen, H., Stenlund, H., & Rantapaa-Dahlqvist, S. (2017). Cardiovascular risk factors predate onset of symptoms of rheumatoid arthritis: A nested case-control study. Arthritis Res Ther, DOI: 10.1186/s13075-017-1351-8
Tedeschi, S. K., Frits, M., Cui, J., Zhang, Z. Z., Mahmoud, T., Iannaccone, C…Solomon, D. H. (2017). Diet and rheumatoid arthritis symptoms: Survey results from a rheumatoid arthritis registry. Arthritis Case Res (Hoboken) DOI: 10.1002/acr.23225
Masino, S. A., & Ruskin, D. N. (2020). Nutritional recommendations to address pain: Focus on ketogenic/low-carbohydrate diet. Minimally Invasive Surgery for Chronic Pain Management, Nutritional Recommendations to Address Pain: Focus on Ketogenic/Low-Carbohydrate Diet | SpringerLink
Donovan, E. L., Lopes, E. B. P., Batushansky, A., Kinter, M., & Griffin, T. M. (2018). Independent effects of dietary fat and sucrose content on chondrocyte metabolism and osteoarthritis pathology in mice. Dis Model Mech, DOI: 10.1242/dmm.034827
Lankinen, M., Schwab, U., Erkkila, A., Seppanen-Laakso, T., Hannila, M-L…Oresic, M. (2009). Fatty fish intake decreases lipids related to inflammation and insulin signaling: A lipidomics approach. PLoS One, 4(4), e5258. DOI: 10.1371/journal.pone.0005258
Saidane, O., Semerano, L., & Sellam, J. (2019). Could omega-3 fatty acids prevent rheumatoid arthritis? Joint Bone Spine, DOI: 10.1016/j.jbspin.2018.05.007
Simopoulos, A. P. (2002). The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother, 56(8), 365-79. DOI: 10.1016/s0753-3322(02)00253-6
Oliviero, F., Spinella, P., Fiocco, U., Ramonda, R., Sfriso, P., & Punzi, L. (2015). How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Biomedical Intelligence, DOI: https://doi.org/10.4414/smw.2015.14190
Linos, A., Kaklamani, V. G., Kaklamani, E., Koumantaki, Y., Giziaki, E., Papazoglou, S., & Mantzoros, C. S. (1999). Dietary factors in relation to rheumatoid arthritis: A role for olive oil and cooked vegetables? American Journal of Clinical Nutrition, 70(6), 1077-82. DOI: 10.1093/ajcn/70.6.1077
Hekmatpou, D., Mortaji, S., Rezaei, M., & Shaikhi, M. (2020). The effectiveness of olive oil in controlling morning inflammatory pain of phalanges and knees among women with rheumatoid arthritis: A randomized clinical trial. Rehabil Nurs, 45(2), 106-113. DOI: 10.1097/rnj.0000000000000162
Aparicio-Soto, M., Sanchez-Hidalgo, M., Rosillo, M. A., Castejon, M. L., & Alarcon-De-La-Lastra, C. (2016). Extra virgin olive oil: A key functional food for prevention of immune-inflammatory diseases. Food Funct, DOI: 10.1039/c6fo01094f
King, L. K., March, L., & Anandacoomarasamy, A. (2013). Obesity and osteoarthritis. Indian J Med Res, Obesity & osteoarthritis - PMC (nih.gov)
Crowson, C. S., Matteson, E. L., Davis, J. M., & Gabriel, S. E. (2013). Contribution of obesity to the rise in incidence of rheumatoid arthritis. Arthritis Case Res (Hoboken), DOI: 10.1002/acr.21660