Nutritionist Bronwen King offers practical advice to bring some relief to arthritis sufferers.
It it is the greatest cause of disability in New Zealand and there is no known cure. For the more than half a million Kiwis who are affected by arthritis, however, there is good news, Symptoms can be hugely alleviated through clinical treatment and a range of self-management tools: physical activity, joint protection, stress management and heat/cold therapy. Diet, too, can play an important role.
What is arthritis?
The word arthritis literally means ‘inflammation within the joint itself’. This definition is misleading, however. While all arthritis is about joints, not all types are the result of inflammation. The three most common types of arthritis are osteoarthritis, rheumatoid arthritis and gout.
- Osteoarthritis is by far the most prevalent form of arthritis and is the result of ‘wear and tear’ on joints. It involves damage to the cartilage which covers the ends of bones where they meet to form a joint. It is commonly found in older and overweight people and in joints that have heavy use such as hips, knees and thumbs.
- Rheumatoid arthritis is an autoimmune condition where inflammation causes the tissues in and around affected joints to swell and stiffen causing pain. Inflammation is a normal healing reaction in the body but in people with this form of arthritis the inflammation happens for no apparent reason and becomes chronic. Rheumatoid arthritis is more common in women and usually starts between the ages of 20 and 55.
- Gout is caused by a build-up of uric acid in the blood. It affects men more than women and occurs mainly in the foot, particularly the big toe, where uric acid crystallises in the joints causing damage and severe pain.
Other, rarer forms of inflammatory arthritis include reactive arthritis, ankylosing spondylitis or arthritis associated with colitis or psoriasis.
How can diet help arthritis symptoms?
People with arthritis commonly swear by specific dietary strategies. Some cut back on alcohol while others drink apple cider vinegar. While no diet has been proven to cure arthritis, support organisations for arthritis agree that these strategies may help.
1. Eat a healthy diet
A diet that provides the nutrients you need to stay well can help prevent or slow the symptoms of arthritis. Even if you are on heavy medication, a healthy diet can help by alleviating potential side effects. If you are on steroids for example, your risk for osteoporosis will increase; ensuring sufficient intake of calcium and vitamin D will help reduce this risk. A healthy diet includes plenty of fruit and vegetables, wholegrain breads and cereals, lean meat, poultry and fish, low-fat dairy products, legumes, nuts and seeds.
2. Lose excess weight
This appears to help all forms of arthritis. It helps those with osteoarthritis by taking pressure off joints which in itself will alleviate symptoms. Because fat itself is pro-inflammatory (it produces chemicals called cytokines, some types of which promote inflammation), it reduces this effect and thus the symptoms in those with inflammatory forms of arthritis eg. rheumatoid arthritis. It helps those with gout by reducing uric acid levels which then helps alleviate painful symptoms.
3. Enjoy a Mediterranean diet
Research on arthritis suggests a traditional Mediterranean diet is anti-inflammatory so helpful for inflammatory forms of arthritis. Such a diet can also benefit those with other forms of arthritis by promoting good health and a healthy weight.
Traditional Mediterranean meals include:
- Vegetables — many serves of a wide range, their benefits are amplified by cooking or dressing with olive oil
- Whole grains
- Olives and olive oil
- Nuts and seeds
- Cheese and yoghurt
- Fish and shell fish
- Small portions of meat and poultry
- Plenty of water
- Wine in small amounts
4. Increase your intake of omega-3 fatty acids
Omega-6 and omega-3 fatty acids are called essential fatty acids as the body cannot make them and must obtain them from the diet. Most New Zealanders get more than enough omega-6 fatty acids as they are readily available in vegetable oils and margarines but getting enough omega-3 (found in oily fish, linseeds and walnuts) is not so easy. The body uses both these essential fatty acids to control inflammation, but the right balance is critical. Too much omega-6 promotes inflammation as does insufficient omega-3 (through reduced anti-inflammatory action). Arthritis NZ recommends we eat oily fish such as kahawai, tuna, salmon, sardines, herring and mackerel at least twice a week to ensure adequate omega-3 intake.
5. Keep a food diary and notice any food/symptom connections
Ask people with arthritis and they will give you a list of foods they believe worsen their arthritis symptoms. Common culprits are red meat, citrus fruit, sugar, fats, salt, food and drinks containing caffeine, and nightshade plants (eg. tomatoes, eggplant). Keeping note of what you eat and the severity of your symptoms will help you make your own connections. Try eliminating any foods you suspect and watch for signs of improvement. Seek advice before permanently eliminating foods, however, as it could compromise your intake of essential nutrients.
What vitamins and minerals are important?
A healthy diet should provide you with all the nutrients you need to stay well. However, arthritis sufferers need to pay particular attention to their calcium, vitamin D and iron intakes as insufficient amounts seem to be linked with arthritis progressing more quickly.
- Calcium is needed for healthy bones. Not enough increases the risk of osteoporosis particularly in post-menopausal women, as does long-term steroid use. Dairy products such as milk, cheese, yoghurt are rich sources of calcium. If you are dairy-free then calcium enriched soy, rice or oat milks are an alternative source. Fish with bones in them such as canned sardines and salmon are also useful sources of calcium.
- Vitamin D is needed by the body to absorb and use calcium. It is produced by the action of sunlight on the skin which means when you cover up in winter (or for religious/cultural reasons) you may not produce enough. It is naturally present in many foods with oily fish being a good source. Your levels can be checked with a simple blood test so if you are worried, consult your GP.
- Iron is important for prevention of anaemia which can be common in people with arthritis.Anaemia is a symptom of chronic disease such as rheumatoid arthritis and can be a side effect of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. Consult your GP if you are tired or suspect you have low iron levels. Foods rich in iron include red meat, oily fish, legumes (eg lentils and dried beans), eggs and dark green leafy vegetables. Vitamin C helps iron absorption so eating vitamin C rich fruit such as oranges, mandarins or kiwi fruit can help.
Do supplements help?
The following supplements are commonly taken to alleviate symptoms of arthritis.
- Fish oil: An adequate intake of omega-3 fatty acids may help reduce inflammation and relieve stiffness and joint pain in people with rheumatoid arthritis. If you are not a fan of fish, or worried you are not getting enough omega-3, fish oil supplements can be useful. Arthritis Research UK suggests you use at least 2.7g (2700mg) of long chain omega 3 fatty acids (described on the label as EPA and DHA) per day. If using supplements, make sure you purchase a reputable brand and use the directions to work out your dose.
- Green lipped mussel extract, like fish oil, is a good source of omega 3 fatty acids. As such it has shown some promise for the treatment of arthritis. Arthritis Research UK states: “Evidence suggests that it might be of some use to people with osteoarthritis when taken along with paracetamol or NSAIDs but it is not effective in treating rheumatoid arthritis”. It is wise to seek professional advice before taking this supplement.
- Glucosamine is often found in combination with chondroitin in supplements labelled ‘joint formulas’ – the theory is that because joint cartilage contains both these ingredients, taking supplements may improve joint health. Results from studies of glucosamine and chondroitin are not convincing and many health professionals believe they are little more than a placebo. You may decide to give it a try, anyway. It appears that there are no negative side effects so you may have nothing to lose. The UK Arthritis Society recommends that if you do, go for 1500 mg per day of glucosamine sulphate. If you don’t notice an improvement in four to six weeks, then there will be little benefit in taking it.
Should I go vegetarian?
Some people find a vegetarian diet helps arthritis. The reasons for this may include:
- The elimination of red meat, which is believed to promote inflammation and exacerbate symptoms of rheumatoid arthritis
- A higher intake of vegetables and fruit, which means a higher intake of the vitamins and antioxidants these contain
- Vegetarian diets are often lower in total fat and kilojoules; this promotes weight-loss which means less stress on joints.
- It is important to remember that it is not whether a diet is vegetarian, vegan or non- vegetarian that counts but the quality of the diet in total.
Gout: how diet can help
Gout is the only form of arthritis where diet can substantially control symptoms. Reducing the level of uric acid in the blood will reduce the symptoms of gout. The following strategies will help lower uric acid levels:
- Reduce intake of purine-rich foods such as meat, chicken and seafood. This means smaller portions and/ or using alternative proteins such as legumes (beans and lentils), eggs and low-fat dairy products
- Lose weight
- Reduce alcohol intake, especially beer
- Reduce the intake of fructose-rich drinks eg soft drinks, energy drinks and fruit juice
- Drink plenty of water