7 Foods to Avoid When on Biologics for Rheumatoid Arthritis

Biologics can affect your food choices due to their effects on your immune system. Leftovers, raw eggs, and even some fresh vegetables are some foods to keep in mind.

Biologics are a type of medication used to help manage rheumatoid arthritis (RA). They are a newer type of disease-modifying antirheumatic drug (DMARD), sometimes referred to as biologic DMARDs or bDMARDs.

Some common biologics you may have heard of are Humira, Enbrel, and Rituxan.

They work by suppressing specific parts of your immune system. This means you can be more susceptible to infections, including foodborne ones. As a result, you might need to take certain precautions with the foods you eat while taking biologics.

Some foods pose a higher risk of infection than others. Keep reading to learn about the foods you may want to avoid. But be sure to speak with your doctor or a dietitian about diet choices when taking biologics for RA.

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1. Raw eggs

When baking as a child, you might remember your parents exclaiming, “Don’t lick the bowl; there’s raw egg in there!” That’s because raw eggs have the potential to cause an infection in your stomach.

So, if you like eating raw cookie dough or licking the batter off beaters, you may want to reconsider.

The United States Department of Agriculture (USDA) recommends avoiding foods with raw eggs including foods with underdone, runny eggs, such as eggs cooked over-easy.

This advice is even more important for those who are immunosuppressed — like if you’re using biologics for RA.

Eggs, in general, may pose some health risks, but they also have health benefits. If you are using biologics, you will want to make sure that any eggs you’re eating are fully cooked.

2. Unpasteurized milk and dairy products

According to the Food and Drug Administration (FDA), raw or unpasteurized milk can pose a risk to anyone’s health. Pasteurization refers to a mild heat treatment, which helps to eliminate potentially harmful bacteria and other organisms found in food.

You should still be able to drink or eat products containing milk as long as it’s pasteurized and not raw.

This shouldn’t usually be an issue, as the FDA says that anything labeled as “milk” must be pasteurized.

But be aware if you’re traveling or have access to raw milk from a farm. You should also keep an eye out for products — such as cheeses — that may contain unpasteurized milk.

3. Mold-ripened soft cheeses

Soft cheeses ripen through mold. While most people can eat them, they do pose a risk of fungal infections if your immune system is compromised from taking biologics.

Soft cheeses include:

• feta
• blue cheese
• brie
• goat cheese
• Camembert

Hard cheeses, such as Parmesan and emmental, have lower moisture contents and a reduced microbial risk, so they may be a better option. The FDA notes that all processed cheeses have to be made with a pasteurization process. So, cream cheese and cottage cheese could be good options.

4. Undercooked or raw meats, poultry, and seafood

Similar to raw eggs, eating undercooked or raw meats, poultry, and seafood can pose a health risk if you are taking biologics.

You will want to make sure you cook all to a food-safe internal temperature. Safe minimum internal temperatures vary based on the type of food:

• Pork chops: 145°F (62.8°C)
• Fish (such as salmon, tuna, cod, etc.): 145°F (62.8°C)
• Ham: 145°F (62.8°C) for raw, 165°F (73.9°C) for reheated, precooked types or 140°F (60°C) for those packaged in USDA-inspected plants
• Ground meat and sausage: 160°F (71.1°C)
• Turkey and chicken (whole bird, legs, thighs, or wings): 165°F (73.9°C)

This chart is a particularly good resource for temperature guidelines and includes more categories of food, such as other seafood and beef.

Resting time after cooking certain meats is also important. This resource provides information about resting times and more detail about cooking temperatures for different cuts of meat.

When eating out, it’s best to ask for any meats and seafood to be cooked well-done, as opposed to medium or raw.

If you like sushi, try to avoid types with raw fish to reduce your chances of infection, and instead, try some with cooked fish or vegetarian options.

5. Untreated water

The majority of homes in the United States have water that is safe to drink for everyone.

But if you plan to travel outside the United States or to areas where the water may not be clean, your best bet is to use bottled water. This helps reduce your risk of germs from drinking water that is not thoroughly cleaned.

6. Leftovers

Leftovers, even when refrigerated and reheated, can become a breeding ground for bacteria that can make you sick.

You can eat leftovers, but you should follow careful instructions to make sure you don’t increase your chances of food poisoning. The USDA recommends that any type of leftover should be cooked to 165°F (73.9°C).

How you choose to store leftovers is important, too. For example, the USDA recommends cooling food rapidly and wrapping leftovers well.

7. Certain fresh veggies

You may have heard that some veggies are not good for RA.

For example, sprouts, like alfalfa, have a higher chance of carrying bacteria because they need warm, humid conditions to grow, which is also ideal for germs.

This is true for other sprouted seeds, such as bean sprouts and radish sprouts. Eating them raw or undercooked can increase your chances of food poisoning.

The FDA funded the Sprout Safety Alliance, which helps sprout producers identify and implement best practices for safe sprout production.

Other fresh veggies, such as lettuce and leafy greens, can also be contaminated, and it can be harder to wash them completely clean.

If possible, your best option is to thoroughly clean all fresh veggies and cook them.

Some FAQs

How can I boost my immune system with biologics?

You can take steps to help strengthen your immunity and prevent infection. For example:

• try to reduce your stress levels
• exercise regularly
• avoid people you know are sick
• get enough sleep at night

A doctor or nutritionist may recommend supplements to help support your immune system or help with filling in nutritional gaps.

Do biologics affect my weight?

Certain biologics may increase your risk of weight gain. For example, a 2020 review of studies showed that a type of biologic called TNF inhibitors have a potential side effect of increased body weight and BMI. But not everyone will experience these side effects.

If you start biologics and notice your weight is increasing, you may want to speak with a doctor about managing this side effect. You can discuss whether switching medications is an option or see if they have recommendations for maintaining a healthy weight for you while taking biologics.

Takeaway

Biologics can affect your food choices due to the effects they can have on your immune system. Certain foods contain a higher risk for foodborne illnesses, which means you might want to avoid them.

Most of these foods to avoid have easy alternatives or may be addressed by cooking the foods thoroughly.