Arthritis sufferers have been trying for centuries to rid themselves of their debilitating pain. They have covered themselves in cow manure twice a day, stood naked under a full moon, kept two sesame seeds in their navel overnight while sleeping, worn radioactive devices, endured scores of bee stings, tolerated venoms of snakes, and recently have even rubbed on the mechanical lubricant WD-40. If these measures helped, it was probably because the sufferers wanted them to so desperately. Some scientists today credit such a “placebo effect” with the pain relief gained from special arthritis diets. Others believe dietary manipulation can truly ease pain; but even they say we need more long-term scientific studies.
Nearly one in six, or 43 million Americans, suffers from the more than 100 types of arthritis, making it one of the most common diseases in the United States. Osteoarthritis, the most common form of the disease, afflicts more than 21 million Americans. Rheumatoid arthritis plagues about 2 million more. The Arthritis Foundation has warned that, as the average age of the U.S. population rises, arthritis could become the epidemic of the future. The Centers for Disease Control and Prevention (CDC) project that by the year 2020, arthritis will affect nearly 60 million Americans.
Even though “arth” means joint and “itis” means inflammation, some types of arthritis don’t involve inflammation or the joints. One type, ankylosing spondylitis, involves inflamed ligaments attached to the bone. Lupus, another type of arthritis, is a connective tissue disease. Osteoarthritis, the most common type, is the result of a breakdown of cartilage in the joint; rheumatoid arthritis (RA) involves an inflamed joint membrane; and gout involves deposits of uric acid crystals in the joint fluid.
How Arthritis Disables the Joints
|Normal joint: Where two bones meet, our bodies normally provide a simple and effective lubricating system. Ligaments binding the bones together form a capsule within which a thin membrane called the synovium exudes a fluid lubricant. For good measure, the ends of both bones are cushioned by a smooth layer of cartilage.
Osteoarthritis: In this form of arthritis, trouble begins when the protective cushion of cartilage between the bones slowly degenerates. As it disappears, the synovium and the ends of the bones thicken within the joint, leading to the aching stiffness that characterizes the disease.
Rheumatoid arthritis: The culprit here is the synovium, which for unknown reasons becomes swollen and inflamed, leading to irreversible damage to the joint’s capsule and protective cartilage. Eventually the unprotected ends of the bones themselves begin to erode.
Inflammation—heat, swelling, pain, redness and/or loss of motion—is the common link between most of the more than 100 types of arthritis. Scientists are just beginning to understand the inflammatory process. They know that it begins with a trigger such as an infection or tissue damage. In response to this trigger, white blood cells rush to the affected area and release chemicals to begin the repair process. Among them are prostaglandins —which can both reduce and promote swelling, and leukotrienes—which quickly intensify inflammation. The white blood cells also release digestive enzymes to remove bacteria and other foreign agents in the area. The white cells recognize these invaders as antigens and focus their attack on them. However, the enzymes the white cells release can also digest cartilage, bone, ligaments, muscle, and other tissues. In inflammatory rheumatic diseases like arthritis, this attack on the tissues becomes chronic.
So how could diet become involved in this process? There does seem to be a connection between joint inflammation and stomach inflammation, although it has yet to be fully explained. Some scientists speculate that the trouble may start in the intestines, where foreign antigens can slip through the layer of mucus coating the intestinal wall, enter the bloodstream, and travel to a joint. The presence of antigens there attracts the white blood cells that launch the inflammatory process.
If these invading antigens are byproducts of a particular food to which you are allergic or sensitive, eliminating it from your diet could reduce swelling in the joint and cut down on arthritis pain. However, very few people have a true food allergy. Another explanation offered is the presence of lectins, food molecules that can act like antigens. Recent studies in both the British Journal of Rheumatology, and the British Journal of Nutrition point out that many foods commonly mentioned in discussions of food allergy, such as peanuts, beans, peas, lentils, barley, rye, oats, corn, and wheat, are particularly rich in lectins. Lectins are known to cause changes in the wall of the digestive tract that can allow inflammatory antigens to leak into the system and perhaps trigger rheumatoid arthritis. However, the studies’ authors agree that more research on the effects of lectin-rich vs. lectin-free diets is needed before any definitive conclusions can be drawn.
These researchers also suggest that arthritis patients may experience a greater transfer of antigens through the intestinal wall because of damage to the intestinal lining from the prescription medications such as nonsteroidal anti-inflammatory drugs that many arthritis sufferers take. They say that dietary manipulation, including fasting for short periods of time, could reduce the number of antigens available to breach the intestinal lining.
The two researchers doubt that the placebo effect is the only explanation why many arthritis sufferers are helped by changing their diet. They believe that hope provided by a new therapy can buoy patients enough for them to believe their pain has been mitigated, but that it is “insufficient to explain significant improvement” seen in the available studies. Furthermore, if a placebo effect were responsible for the improvements, one would expect them to be temporary. But this, they say, is not always the case.
Other specialists take an entirely different point of view about dietary therapy for arthritis. Cody K. Wasner, MD, a practicing rheumatologist and former chairman of the Arthritis Foundation’s Committee on Alternative Therapies, along with other doctors, believes that while a small number of people may be helped by avoiding certain foods, altering the diet by reducing food intake—that is, fasting in some form or another—usually doesn’t help the disease. He thinks that one reason arthritis may improve when food is restricted is a temporary malfunction of the immune system that for a time disables its inflammatory attack on the body’s own tissues.
Arthritis is the kind of disease that encourages people to try unproven remedies. Although it lasts a lifetime, its symptoms may come and go without warning. It’s therefore hard to tell whether a period of relief is due to a new remedy or merely to coincidence. Worse yet, even the most effective remedies tend to have a variable impact. Treatments vary for each type of arthritis, they work differently from one person to the next, and their effects change as the disease progresses. Doctors often have to search for the combination of therapies that works best for a particular patient—a time-consuming and frustrating process. Given all these uncertainties, it’s all too easy to become discouraged and look for easy answers.
The media are quick to take advantage of this situation, producing a seemingly endless series of books on special diets, foods, and supplements that supposedly relieve arthritis. Too often these works lack any solid scientific basis. Indeed, they often contradict each other. Yet arthritis sufferers continue to seek them out.
Doctor Wasner thinks that one of the reasons the self-treatment industry does so well among people who have arthritis is that they don’t take the disease seriously enough. “If you had breast cancer, people aren’t going to say, ‘oh, you don’t need therapy or radiation, what you need to do is eat more bran.'”
Perhaps the lack of awe over this chronic illness is because it isn’t life threatening. It could also be due to arthritis’ position as a “non-flashy” disease. Wasner points out that it has only recently begun to receive attention from the medical community, whereas “we have 2,000 years of culture that says we don’t even treat it, that it’s just like getting gray hair, that you just have to live with it.”
Even if the few scientific studies conducted so far on the link between diet and arthritis were all clear cut, it would still take many more to wring acceptance from the medical community. Long-term side effects must be established first, says Jeffrey C. Delafuente, MS, a professor of pharmacy and director of the geriatric program at Virginia Commonwealth University. The traditional drug therapy available to treat arthritis has been studied for as long as 50 years, so doctors are bound to recommend it over any dietary therapy about which little is known.
Gout and Food: A Proven Link
Gout is the only form of arthritis that is unquestionably linked to diet, although the number of people whose gout can be blamed entirely on what they eat is small. For a victim of gout, foods high in substances called purines, such as liver, kidney, fish roe, mussels, anchovies, peas, beans, pancreas and brain, add to the existing problem of elevated levels of uric acid in the blood. Drinking too much alcohol and crash dieting can also raise the level of this acid. The uric acid that the body either overproduces or can’t get rid of forms into tiny crystals like shards of glass which float in the joint space. When the immune system attacks these crystals, inflammation occurs.
Still, many arthritis sufferers have challenged a conservative medical community. In a nationwide survey of 1,051 people with osteoarthritis or RA, nearly half of the respondents admitted to changing their diet to see if it would help their condition, even if their doctors were against the idea. Some respondents simply started eating healthier foods, avoiding fats, and increasing their intake of vegetables. Others tried systematically eliminating foods from their diet and discovered some that they thought they could associate with flare-ups of their arthritis. Still others added vitamins, minerals, and other supplements like fish oil to their diets.
Every person is unique; what works for you might not work for someone else. What follows is a brief overview of the dietary manipulations that others have tried. If you do decide to experiment with one of these changes, remember that it’s still important to consult your physician, no matter how conservative he may be. Depending on your medical condition, a particular diet could be dangerous for you, or could interact badly with your medication. You’re always free to make the final decision; but do it with your doctor’s help.
Elimination diets are a way of identifying a hypersensitivity to a particular kind of food. First a specific food or food group suspected of causing a reaction (such as milk, meat, or processed foods) is removed from the diet. Then the withheld foods are reintroduced one at a time to see whether any are harmful.
Researchers have found that in some rheumatoid arthritis patients, specific foods do make symptoms worse. However, avoiding these foods or food groups has been shown, for the most part, to have only limited, short-term benefits. One interesting study in England found that 10 out of 17 people benefited from any diet recommended by their doctors, pointing to a placebo effect.
Nevertheless, fad diets based on elimination of various “trigger” foods are common for arthritis, especially rheumatoid arthritis. There are claims, for example, that foods from the nightshade family—tomatoes, potatoes, green peppers, and eggplant—can make arthritis worse. One especially strict program called the “Dong Diet” eliminates all additives, preservatives, fruits, red meat, herbs, alcohol, and dairy products. When undertaking such extreme diets, remember that there’s no conclusive evidence that any of them can be relied on to work, and that some of them may result in deficiencies of important nutrients like folic acid.
Researchers have uncovered other patterns while investigating the effects of diet. One study found that simply eating too many calories appeared to aggravate rheumatoid arthritis. A few other studies have shown that some people who reduce their fat intake, especially vegetarians who eat no dairy or animal products, report less pain than those with high meat consumption. (About 5 percent of people with rheumatoid arthritis experience a flare-up of symptoms after drinking milk.) In these 1991 studies, when patients were fasting or on a severely restricted diet, their symptoms improved significantly. And when dairy or animal products were reintroduced, episodes of pain, swelling, and stiffness increased.
The strict vegetarian diet underwent further testing in 1998, when Finnish researchers put a group of rheumatoid arthritis sufferers on a regimen that consisted of raw fruits and vegetables supplemented with lactobacillus, one of the healthy bacteria found in many yogurts. The findings were basically positive. Patients reported improvement in their symptoms during the study, then suffered flare-ups when they went back to their regular diet. However, the regimen is clearly not for everyone: About half the volunteers suffered nausea or diarrhea and dropped out of the experiment.
Still, the notion that lactobacillus may have a place in the treatment of arthritic diseases may yet prove valid. Animal experiments tend to support the idea. Mice given lactobacillus in one recent study proved less likely to develop arthritis, and their immune system was better at handling the disease.
Recent human trials continue to suggest that a vegetarian diet—sometimes following a fast—may help relieve rheumatoid arthritis, at least in some patients. However, it’s worth remembering that protein is lost during the inflammatory process, and one study has suggested that high amounts of protein could be protective. If you choose to eliminate meat and dairy products from your diet, be sure to replace them with plenty of fish or vegetable proteins, such as soy products. In fact, a recent animal study suggests that a diet rich in soy may actually bring pain relief.
A 1987 study of 48 rheumatoid arthritis patients attempted to pinpoint other particularly troublesome foods. After six weeks of dietary elimination, 41 were able to identify foods that had caused a flare in their symptoms. Cereal foods like corn and wheat were considered a problem by more than half of the study participants. Here is a list of foods the patients found troublesome (some of which contradict Dong’s recommendations), and the percentage of symptomatic patients affected by the food:
Participants in the national survey on arthritis also reported cutting out some foods. Of the 1,051 people who were sent detailed questionnaires in the mail, 10 percent reported being sensitive or intolerant to certain foods. Red meat turned out to be the culprit most often associated with a flare-up of arthritis pain for this group. In addition, survey respondents mentioned as triggers sugar (and sweets in general), fat and fried foods, salt, caffeine, dairy products, nightshade vegetables (tomatoes, white potatoes, eggplant, and bell peppers), pork and smoked or processed meats, alcohol, junk food, starches, additives and preservatives, acidic foods, and chocolate.
People with arthritis often have vitamin and mineral deficiencies, but these deficiencies are thought to be a result of the disease rather than its cause. Such problems are associated with other immune system diseases as well. Studies involving vitamin and mineral supplements have shown conflicting results with few hard conclusions. If you eat poorly overall, then take vitamin supplements and see an improvement in your condition, does it mean that the lack of a specific vitamin caused your arthritis? More than likely, the supplement merely boosted a taxed immune system, making you feel better overall. Still, there is some evidence that certain supplements may work directly on the inflammation that causes painful joints.
The latest supplement to bring hope to arthritis patients is fish oil. This oil contains what scientists refer to as omega-3 fatty acids, a type of polyunsaturated fat. Research is showing that, unlike saturated animal fat, omega-3 fatty acids may reduce cholesterol buildup, lower blood pressure, prevent blood clots, and even cut the risk of some types of cancer. A number of recent studies also suggest that altering the types of fat in the diet can affect the immune system’s inflammatory response, and that fish oil in particular may aid in the treatment of arthritis. Two of the acids contained in the oil—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—reduce production of the prostaglandins and leukotrienes that promote inflammation.
The beneficial effect of fish oils on arthritis was seen as early as 1959, when arthritic patients taking cod liver oil showed clinical improvement in their symptoms. After several other small studies, a formal trial was launched in which some patients received fish oil capsules and others received olive oil capsules. Olive oil currently has no known role in arthritis treatment; it was used as a placebo against which to measure the effect of the fish oil. The researchers carrying out the study noted that after 14 weeks of treatment the patients taking fish oil reported significantly fewer tender joints and a delay in the onset of fatigue. A similar trial, also using olive oil as a placebo, found that patients taking fish oil supplements had fewer painful joints and increased grip strength after 12 weeks. Morning stiffness and overall pain relief improved in both groups of patients, but curiously, more so in the group receiving olive oil.
So far, only high doses of fish oil in capsule form have been studied, and only for short periods of time. Scientists are concerned about long-term toxicity. They’d also like to know whether fish oil in smaller doses will impart similar benefits. High dose fish oil concentrates are available only by prescription and can be fairly expensive. Low dose capsules are available over-the-counter in health food stores, supermarkets, and pharmacies. They have been known to cause side effects such as upset stomach, gas, and a fishy aftertaste in the mouth. Fish oil also thins the blood, which is why it is being studied in heart disease patients.
A better way to increase the amount of omega-3’s in your diet may be to eat more cold-water ocean fish. Here is a list of fish (6 ounce servings) with high omega-3 content (in grams):
Other oils produce similar effects for arthritis sufferers, and for similar reasons. Evening primrose oil, for example, which is high in gamma-linolenic acid (GLA), has been shown to inhibit the formation of leukotrienes. Research suggests that borage seed oil, also rich in GLA, suppresses inflammation and appears to give pain relief similar to that of NSAIDs in arthritis suffers. Blackcurrant seed oil and flax seed oil, which are high in linolenic acid, can reduce the body’s level of inflammation-inducing prostaglandins. All of these oils, however, need more study before we can be certain of their value in arthritis treatment.
Remember, too, that both fish oils and oils high in GLA can thin the blood, which could become a problem for people who take NSAIDs, since these drugs also suppress blood clotting. Be sure to check with your doctor before trying any of the oils as a treatment for arthritis.
Alcohol and (Arthritis) Drugs Don’t Mix
|Not only do alcoholic beverages add troublesome extra pounds because of their high calorie content, they can also affect how well some arthritis drugs work. If you drink while you are taking nonsteroidal anti-inflammatory drugs, aspirin, or gout medication, you’re more likely to experience stomach problems. Acetaminophen combined with large amounts of alcohol can cause liver damage. Alcohol can also increase the level of uric acid in the blood, making gout medication less effective.
Here are a few of the drugs that don’t mix with alcohol:
|Datril, Panadol, Tylenol
|Advil, Motrin, Nuprin, Rufen
|Anacin, Bayer, Bufferin, Ecotrin, Empirin, Zorprin
Deficiencies of a single substance, as opposed to an overall nutritional deficiency, are uncommon. Some studies have shown improvement in arthritis patients given supplements of individual vitamins or minerals, while other studies have disputed those findings. Research with animals has shown that vitamins A, B, C, D, and E are all related to immune system functions, either by supporting immune response or otherwise regulating the system. Iron deficiency can seriously impair the immune system, reducing its ability to digest bacteria and produce enough of the “T cells” that direct immune response and attack infection. Zinc, copper, magnesium, and selenium also play a role in immune response.
Since rheumatic diseases are often characterized by abnormal immunologic activity as the body “turns on itself,” attacking healthy cells, it’s natural to assume that strengthening the body with added nutrients could blunt these responses. Unfortunately, supplementation doesn’t work on the principle that “if a little is good, more is better.” In fact, you can damage your immune system if you take some supplements at too high a dose. So if you choose to add selected supplements to your diet, always consult your doctor first. Here are a few of the vitamins and minerals that have been studied in arthritis sufferers:
Vitamin B. Studies have shown that some people with arthritis are deficient in the B vitamins, including B6, thiamin (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), cobalamin (B12), folic acid, pantothenic acid, and biotin. In 1983, a group of researchers studied the diets of 24 patients with rheumatoid arthritis and 12 with osteoarthritis and found that most were consuming far less B vitamins than they should. In 1987, the diets of 52 people with rheumatoid arthritis (RA) were also found to be vitamin B-deficient. Some foods rich in B vitamins, like liver and kidney, are off limits to arthritis sufferers because of the high levels of purines they contain. Other foods containing vitamin B, such as whole-grain cereals, fish, and green leafy vegetables, are recommended for arthritis sufferers. One reason why arthritis patients may be deficient in B vitamins is that the drugs they use, including aspirin, can actually deplete the body of B vitamins.
Vitamin C. Along with vitamins E and beta-carotene, vitamin C is a leading antioxidant. In the body, antioxidants help to neutralize certain oxygen-reactive molecules called free radicals that are thought to contribute to disease and tissue damage. Laboratory studies show that cells from osteoarthritic knee cartilage can release excessive amounts of these free radicals. And studies in 1988 and 1989 found that osteoarthritis patients with the most antioxidants in their diets had significantly lower chances of disease progression. Those who had a high vitamin C level, for instance, enjoyed a two-thirds reduction in the risk of further osteoarthritic damage to their knees.
The body’s stores of vitamin C and other antioxidants are often depleted by inflammation. Taking 500 milligrams a day of this water-soluble vitamin has been known to improve the spontaneous bruises which often accompany RA, and it may also improve the effectiveness of aspirin in the body. At the two extremes, the Food and Drug Administration sets the recommended daily allowance (RDA) for adults at 50 milligrams, while the well-known scientist Dr. Linus Pauling recommended 18 grams a day as a preventive measure. You can get vitamin C naturally by increasing your dietary intake of citrus fruits, melons, green leafy vegetables, tomatoes, and green peppers.
Vitamin D. Osteoarthritis can cause thinning of the bones, so patients with this disease may need additional vitamin D and calcium. In addition, steroid medications, like prednisone, which are often given to arthritis sufferers because they are powerful anti- inflammatories, can cause bone deterioration. In 1974, some British scientists published information about 17 elderly women with RA. Five of the women had suffered fractures in their leg bones, while the other 12 had not. Upon interviewing the study subjects, the researchers found that the women with the fractured bones all had diets deficient in vitamin D. These five women were also housebound and therefore unable to spend time in the sunshine, which produces vitamin D.
In the same study that examined the effect of antioxidants on osteoarthritis of the knee, researchers also evaluated the effects of vitamin D. They found that patients taking vitamin D or eating a diet high in the vitamin could expect a three-fourths reduction in the risk of disease progression. Greater blood levels of the vitamin were also associated with lower risk of progression.
Current guidelines recommend 400 IU of vitamin D per day and 600 IU per day above age 61. Lack of sunlight and unhealthy diets contribute to deficiencies in vitamin D. Good dietary sources include fortified milk, sardines, herring, salmon, tuna, liver, dairy products, and egg yolks. Although supplements are often necessary, vitamin D can be toxic in high doses, and no one should take more than 1,200 IU per day.
Vitamin E. Because vitamin E is an antioxidant, it may work similarly to vitamin C. In the study of the antioxidants’ effects on osteoarthritis of the knee, patients with higher levels of vitamin E had a one-third reduction in the risk of disease progression. In a few small studies from Germany, vitamin E has also been shown to relieve arthritis pain. Corn oil, sunflower seeds, wheat germ, nuts, whole grains, and legumes are sources of vitamin E.
Calcium. If you’re worried about your bone density, you should increase your intake of calcium along with vitamin D. In addition to natural aging, drugs often given to arthritis patients can reduce calcium levels. Supplements can help fight osteoarthritis, but they shouldn’t take the place of foods high in calcium. Make sure you add some of these calcium-rich foods to your diet: low-fat milk, yogurt; calcium-fortified juice; sardines, salmon and mackerel (canned with bones); tofu (with calcium sulfate); cheese (cheddar, Muenster, American, part-skim mozzarella).
Copper. The ancient Greeks believed copper had mysterious powers to heal aches and pains. Some arthritis sufferers wear copper bracelets as a folk remedy; and small traces are actually absorbed into the body. But those with RA usually have higher than average levels of copper in their blood, not lower. This is important because high levels of copper can make you feel sick. Most experts believe that copper has no place in causing or treating the disease.
Selenium. Patients with RA seem to have lower levels of the trace mineral selenium than people without it. Selenium deficiency does cause a type of arthritis known as Kashin-Bek disease, which is more common in areas where the soil is particularly low in the mineral. Generally though, studies of selenium supplementation have been contradictory. If you choose to enrich your diet with selenium, eat more fish, organ meats, whole grains, beans, and nuts.
Zinc. Too much copper in the body can lead to zinc deficiency because the two minerals balance each other. In some studies patients taking zinc supplements have seen improvement. Half of the 24 people involved in a study conducted in the 1970s took 220 milligrams of zinc 3 times a day and found they experienced less morning stiffness, less swelling, and felt better overall, compared to the other half of the patients who were given placebos. Unfortunately, other studies conducted since then have had conflicting results. If you choose to increase zinc in your diet, good sources include oysters, ground beef, veal, pork, fish, soybeans, granola, cheddar cheese and tofu.
Seven Guidelines for a Healthy Diet
The Arthritis Foundation suggests following these seven rules to maintain a healthy diet.
|Eat a variety of foods
|Maintain ideal weight
|Avoid too much fat and cholesterol
|Avoid too much sugar
|Eat foods with enough starch and fiber
|Avoid too much sodium
|Drink alcohol in moderation
Recently, over-the-counter supplements of glucosamine and chondroitin have gained popularity with consumers in the U.S. because of a new book called The Arthritis Cure by Jason Theodosakis, MD, an Assistant Clinical Professor at the University of Arizona College of Medicine. Glucosamine and chondroitin are substances produced by the body to repair and maintain joint cartilage. Although scientists don’t yet know exactly how they work, European and Asian studies suggest that synthetic forms of these substances are indeed capable of relieving arthritis symptoms, and may possibly slow the breakdown of cartilage in the joints. Further research by the National Institutes of Health is being conducted to confirm these findings and determine the effects of long-term use. Glucosamine and chondroitin are not found in food, and therefore must be taken in supplement form.
Another promising line of research indicates that the polyphenolic compounds in green tea may be effective in treating and preventing rheumatoid arthritis. Studies funded by the Arthritis Foundation showed a significant decrease in the incidence of RA and a reduction in the severity of the disease when these compounds, which have antioxidant properties, were given to mice in their water. Scientists have yet to confirm similar results in humans, but if you want to try out the remedy for yourself, three to four cups of green tea a day will supply an amount roughly equivalent to that given the mice. Don’t, however, expect this to serve as a replacement for more traditional treatments.
Arthritis on the Internet
The nonprofit Arthritis Foundation is the only national, voluntary health organization working for people with arthritis. It is actively exploring many different options for arthritis treatment, including diet. It maintains a databank, tracks research involving all types of therapies, and is in the process of making information available through personal computers.
You can access articles from the Foundation’s magazine, Arthritis Today, on the Internet. The Foundation is also working with America Online to provide arthritis-related information. You can find articles on arthritis in America Online’s Better Health and Medical Forum, where you can communicate directly with other arthritis sufferers. A forum is an electronic meeting place where interested parties can “talk” to one another by typing messages and posting them on a “bulletin board.” America Online subscribers can also log on to Peapod, a service that allows shoppers to purchase groceries and drug store items electronically and have them delivered to their homes.
No matter which Internet service provider you use, you can network with other arthritis sufferers through a variety of bulletin boards. For instance, Prodigy subscribers can exchange messages through the Medical Support Bulletin Board, where many arthritis-related topics are covered.
The Arthritis Foundation has a wealth of information about the disease. Among the pamphlets available is “Diet: Guidelines and Research.” A new book from the foundation offers detailed information on the various alternative therapies which have become so popular recently. These or any other of the foundation’s publications may be ordered by contacting the foundation at PO Box 19000, Atlanta, GA 30326 (phone: 1-800-283-7800).
Some studies have suggested that an unbalanced diet could be one of the triggers for the development of rheumatic diseases such as RA. Although we don’t know this for sure, we do know that a balanced diet provides nutrients essential to your well being. Naturally, it’s important for everyone to eat properly, but it’s especially important if you have arthritis because of the many barriers to good nutrition that you may face.
Arthritis pain can make hunger seem relatively insignificant and can easily interfere with food shopping or cooking, leaving you with an inadequate diet. You may pass up some necessary foods, like vegetables, because they require more effort to prepare and would therefore tax swollen and aching joints.
Your medications can also interfere with a good diet. Some drugs can upset the stomach, causing nausea, diarrhea, and other reactions that result in either a lack of appetite or an inability to digest food properly. In addition, some medications can rob your body of essential vitamins and minerals. For example, steroid medications cause the body to lose potassium and retain sodium; if you have gout and are taking colchicine, it affects how well your body absorbs vitamin B12; and penicillamine, often given to people with RA, lowers the body’s levels of copper.
One of the most important things you can do is to avoid foods high in saturated fats. Such foods are high in calories that would be better coming from a wider variety of nutritious foods. Scientists in Moscow recently showed that an overall healthy diet, with only small quantities of saturated fats (but with higher levels of polyunsaturated fatty acids than many of the people in the study usually consumed), brought about improvement in many arthritis patients. Within the first two weeks of the study, more than two-thirds (67.6 percent) saw a marked decrease in painful joints, and 82 percent saw an improvement in morning stiffness. Nearly one quarter (24 percent) of the patients were able to reduce their dosage of antirheumatic drugs; for example, they lowered their intake of ibuprofen by 400 to 600 milligrams per day, and lowered their intake of prednisolone by 1.25 to 2.5 milligrams daily.
The authors of the study contend that the whole nutrient mix in the test diet, which restricted saturated fats while increasing the amount of polyunsaturated fats (including omega-3’s) was responsible for the improvement in the subjects’ arthritis symptoms. They believe it was also responsible for lowered blood pressure in patients who were mildly hypertensive, and contributed to weight loss in patients who were obese. Here is the nutrient content of the daily diet they followed:
(including 50 grams animal protein)
(including 30 grams vegetable fat)
(including 15 grams refined carbohydrates)
Today, you should be able to prepare nutritious foods without putting too much strain on painful joints. Prepared vegetables—raw carrots, cabbage, lettuce, cucumbers, and squash—are available already sliced, diced, and peeled in the produce sections of many supermarkets. If stores near you don’t yet carry these products, speak to the manager. Frozen vegetables are almost as good as fresh ones and can be much simpler to prepare. Use canned vegetables only if fresh or frozen produce is unavailable, because canned foods often contain unwanted sodium and preservatives.
You can now select your groceries, household items, and prescription medications from your home computer, and have them delivered directly to you. You can learn other labor-saving cooking techniques from an occupational therapist. Ask your doctor to recommend someone for you. You can also check with your local Cooperative Extension Service or local chapters of the Arthritis Foundation about cooking classes or demonstrations with helpful hints.
Some experts believe overweight people are more susceptible to certain kinds of arthritis. As with almost all the other aspects of this disease, however, more studies are needed to explain and verify this theory. Still, there are many benefits to losing a few pounds if you are overweight and troubled by arthritis pain. For example:
|Those extra pounds burden joints that already protest against stress, like the knees and hips.
|Tendons and ligaments can become separated by layers of fat. This padding can interfere with the leverage your muscles and tendons apply to your joints, helping to cause bursitis and tendonitis.
|Many older adults with arthritis also are troubled by hypertension or heart disease. Extra weight can make these two conditions worse.
|If you are overweight you are probably less active than you should be. Physical activity strengthens bones and muscles; lack of activity weakens them.
A healthy diet can help you shed some of those extra pounds. In addition, check with your doctor about starting an exercise program that will be right for you. For example, jogging may not be a good idea, but walking every day might be perfect. If walking is too uncomfortable, hydrorobics, a type of aerobics that uses gentle water exercises, might be the answer. Most health clubs and spas offer these aquatic programs, and local chapters of the Arthritis Foundation often set them up at swimming pools operated by the YMCA.