Many people with rheumatoid arthritis (RA) experiment with dietary interventions like following the Mediterranean diet or cutting back on inflammatory foods, red meat, or gluten. In addition to eating well for RA, people prescribed biologics to manage inflammatory diseases need to take specific dietary precautions because of their medication.

Biologics are a type of RA treatment that targets inflammatory proteins to improve arthritis symptoms and slow disease activity and joint damage. Examples include methotrexate, B-cell inhibitors like rituximab (Rituxan), and tumor necrosis factor (TNF) or TNF-alpha antagonists like adalimumab (Humira).

Unfortunately, biologics can also lead to a higher risk of food poisoning because they suppress the immune system. If you’re on a biologic for RA symptoms, these are some of the top foods you should avoid to stay safe.

1. Mold-Ripened Soft Cheeses

Soft cheeses that are ripened with mold are safe for most people to consume. However, biologics for RA can increase your risk of a fungal infection from cheeses like:

• Blue cheese
• Brie
• Camembert
• Feta
• Goat cheese

Instead, opt for hard cheeses made from pasteurized dairy, like cheddar or Parmesan. If you notice mold starting to grow on a block of cheese, it’s best to throw it out and avoid the risk.

2. Unpasteurized Dairy Products

Raw or unpasteurized milk poses a significant health risk for everyone, especially people on biologics. The pasteurization process is an essential step to eliminate harmful bacteria from cow, goat, or sheep products. If you’re unsure, check the food label for the word “pasteurized” to ensure the product is safe to consume. Avoid buying milk products (including cheese and ice cream) from farmers markets or stands where you may not be able to verify their safety.

3. Raw Eggs

Eggs are a great source of protein, but if you’re on a biologic for RA, be sure to cook them thoroughly. Avoid runny yolks or eggs over easy. Instead, make scrambled or fried eggs that are fully cooked and eat them while they’re still hot off the pan.

Watch out for other foods that may use raw eggs as an ingredient, such as some salad dressings, homemade mayonnaise, or raw cookie dough. If you’re at a restaurant and unsure about a certain menu item, ask your server for more details on how it’s prepared.

4. Undercooked Red Meat, Poultry, or Seafood

If you prefer rare steaks or raw sushi, you might be disappointed to learn that undercooked meat and seafood are never safe to consume. People with a compromised immune system from biologics must be particularly cautious to ensure that animal products are cooked to the right temperature.

Undercooked meat or seafood can contain dangerous bacteria and parasites, even when it’s from a fancy restaurant. When cooking at home, a meat thermometer is the best way to know if your food is ready to eat.

Cook animal products until they reach these internal temperatures to reduce your risk of foodborne illness:

• Fish — 145 degrees Fahrenheit
• Ground meat and sausage — 160 F
• Ham — 135 F for raw, 165 F to reheat precooked
• Pork chops — 145 F
• Turkey and chicken (whole bird or legs/thighs/wings) — 165 F

Clams, oysters, and mussels should be cooked until the shells open from the heat. For other seafood, like shrimp, scallops, crab, or lobster, heat well until the flesh becomes opaque.

5. Leftover Rice

The safest time to eat rice is shortly after you finish cooking it. If cooked rice has been sitting in the refrigerator for 24 hours or more, you’ll need to thoroughly reheat it before eating. To prevent the risk of food poisoning from leftover rice, cook rice in small batches or try steam-in-the-bag rice that’s individually portioned and fast to prepare.

6. Well Water

Most home well water systems go through an extensive filtration system. But it’s always best to be on the safe side when taking biologics. If you’re traveling to a different country or visiting a rural area, make sure the water is safe to drink. When in doubt, choose bottled water or bring water to a boil for 1 minute and let it cool before drinking. The same rules apply to ice, so you may choose to skip the ice if you’re not sure whether it was prepared using properly filtered water.

7. Fresh Sprouts

Sprouts naturally contain beneficial antioxidants and fiber, but unfortunately, they can also be a source of bacteria. The shape and texture of sprouts can make them difficult to clean and easy for bacteria to grow and hide. Therefore, raw sprouts, like alfalfa sprouts, may not be worth the risk if you’re on biologics that suppress the immune system and put you at a higher risk of food poisoning.

Additional Food Safety Tips

Following general food safety tips, such as washing your hands before cooking and storing food at the proper temperature, can help you avoid infections while taking biologics. Talk to your rheumatologist about your medical history, current medications, supplements, and eating and drinking habits.

You don’t necessarily need to avoid alcohol with biologics, but it’s a good idea to discuss alcohol consumption with your health care provider. Some biologics like infliximab (Remicade) can cause side effects like heartburn or skin flushing that may be worse with alcohol.

Additionally, not all biologics are the same. Your individual guidelines may vary, especially if you have allergies or other risk factors. Overall, no food is completely off-limits. However, it is important to understand the risks involved with different food groups and how best to take precautions. For extra help creating an individualized meal plan, ask your rheumatology provider for a referral to a registered dietitian nutritionist.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 199,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Do you avoid certain foods because of your rheumatoid arthritis treatment? If you’re on biologics, do you notice a difference in your flare-ups or daily RA symptoms, like morning muscle stiffness and joint pain? Share your experience in the comments section or by posting on your Activities page.