Diet and Arthritis
There is no doubt that certain compounds in food modify both the onset and severity of a variety of forms of arthritis as will be discussed later in this article. Turmeric, ginger pineapple, herbs, vitamin D and omega 3 oils all seem to be profoundly beneficial. The good news is that even moderate changes in diet can lead to significant beneficial changes in onset, severity and progression of symptoms of arthritic disease.[i] [ii] As well increasing intake of certain food stuffs it is clear that exclusion diets may be of considerable benefit. In one double blind randomised controlled study 36% of patients showed improvement in their clinical condition after removing certain foods from their diets. The foods most likely to be contributing to the arthritic conditions are shown in the table [iii]
Fasting also seemed to bring about an improvement, but return to normal dietary practise caused a return of symptoms . Hover if subsequently a vegan/vegetarian or Mediterranean diet was adopted, then the improvement was much more likely to be maintained.[iv]
It is known that the adverse effect of obesity on osteoarthritis is not simply due to increase load bearing by the joints but the association of high level inflammatory mediators which seem to be associated with particularly visceral fat. Weight loss by have a direct and significant anti-inflammatory effects. Studies suggest that supplementation of Omega 3 oils at 1000mg to 3500mg per day are likely to help both rheumatoid and osteoarthritis. (approx six servings of oily fish per week), thus supplementation is likely to be the best way of obtaining this quantity of omega 3 oils.
It is also suggested that one should reduce consumption of sunflower and corn oil and increase try instead olive oil and rape seed oil in attempt to increase the antinflammatory omega 3 component in the diet compared to pro-inflammatory omega 6.
Low levels of anti oxidants and vitamins in the diet seem to be associated with increased symptoms of arthritis and supplementation seem to help reduce symptoms, though mega doses of standard viatmins are not recommended[v]. The supplements that have been shown to be helpful include Vitamin C, caretenoids(present in a wide range of fruit and vegetables) vitamin E (in nuts, seeds,and whole grain cereals ), and particularly selenium ( in brazil nuts liver/kdney and fish), low levels of which has been shown to be associated with both inflammatory and osteo arthritis and seems to be particularly deficient in western diets. The role of copper and zinc deficiency is also being recognized and these present in meat and fish in particular . see table [vi]
Vitamin D deficiency has been shown to contribute to disease on set and severity in inflammatory arthritis and more controversially osetoarthrits. It has been recommended that because there are so so few dietary source and due to the high incidence of vitamin D deficiency in the population (and lack of exposure to sunlight ) (see later) that dietary supplementation between 400iu per day generally and possibly upto 2000iu per day in inflammatory arthritis (until blood levels reach at least 75nmol/l). [vii]
Foods found to exacerbate rheumatoid arthritis
| Food | patients affected (%) | Food | patients affected (%) |
| Corn | 57 | Malt | 27 |
| Wheat | 54 | Cheese | 24 |
| Bacon/pork | 39 | Grapefruit | 24 |
| Oranges | 39 | Tomato | 22 |
| Milk | 37 | Peanuts | 20 |
| Oats | 37 | Sugar | 20 |
| Rye | 34 | Butter | 17 |
| Eggs | 32 | Lamb | 17 |
| Beef | 32 | Lemons | 17 |
| Coffee | 32 | Soya | 17 |
N.B. Dietary intolerances varied between patients
Food that may help rheumatoid arthritis/osteoarthritis.
| Vitamin C | Vitamin E | Carotenoids | Selenium | Copper | Zinc |
| Blackcurrants, kiwi fruit, strawberries | Vegetable oils | Carrots, mange tout peas, curly kale, sweet potato | Brazil nuts | Crab, prawns, lobster, mussels | Red meat |
| Citrus fruits | Margarine | Red/green capsicums | Liver/kidney | Liver/kidney | Liver/kidney |
| Fruit juice | Wholegrain cereals | Tomato products | Fish shellfish | Plain chocolate | Fish and shellfish |
| Vegetables: especially curly kale, spring greens, Brussels sprouts, green | Nuts and seeds | Melon (orange), apricots, pumpkin | Lentils and pulses | Beans and lentils | Milk and milk products |
[i] McKellar G, Morrison E, McEntegart A, et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in
[ii] Dietary Manipulation in Musculoskeletal conditions by Rayman and Pattison. In Best Practice & Research Clinical Rheumatology. 2008;22 no 3 :535-561 . This is a brilliant current state of the art review and I am indebeted to the authors .
[iii] Lancet. 1986 Feb 1;1(8475):236-8. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Darlington LG, Ramsey NW, Mansfield JR and Br J Rheumatol. 1993 Jun;32(6):507-14 Review of dietary therapy for rheumatoid arthritis. Darlington LG, Ramsey NW. G. McKellar, E. Morrison and A. McEntegart et al., A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow, Annals of the Rheumatic Diseases 66 (2007), pp. 1239–1243.
[iv] H. Müller, F.W. de Toledo and K.L. Resch, Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review, Scandinavian Journal of Rheumatology 30 (2001), pp. 1–1012 L. Sköldstam, L. Hagfors and G. Johansson, An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis, Annals of the Rheumatic Diseases 62 (2003), pp. 208–214
[v] M. Reijman, H.A. Pols and A.P. Bergink et al., Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study, Annals of the Rheumatic Diseases 66 (2007), pp. 158–162 P. Creamer and M.C. Hochberg, Osteoarthritis, Lancet 350 (1997), pp. 503–508. H. Hauner and Z. Hochberg, Endocrinology of adipose tissue, Hormone and Metabolic Research 34 (2002), pp. 605–606. H. Hauner, Secretory factors from human adipose tissue and their functional role, The Proceedings of the Nutrition Society 64 (2005), pp. 163–169. L. Fontana, J.C. Eagon and M.E. Trujillo et al., Visceral fat adipokine secretion is associated with systemic inflammation in obese humans, Diabetes 56 (2007), pp. 1010–1013. Y. Toda, T. Toda and S. Takemura et al., Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program, The Journal of Rheumatology 25 (1998), pp. 2181–2186. Y. Wang, A.E. Wluka and D.R. English et al., Body composition and knee cartilage properties in healthy, community-based adults, Annals of the Rheumatic Diseases 66 (2007), pp. 1244–1248. O. Adam, Anti-inflammatory diet in rheumatic diseases, European Journal of Clinical Nutrition 49 (1995), pp. 703–717. P.C. Calder and R.B. Zurier, Polyunsaturated fatty acids and rheumatoid arthritis, Current Opinion in Clinical Nutrition and Metabolic Care 4 (2001), pp. 115–121. C.H. MacLean, W.A. Mojica and S.C. Morton et al., Effects of omega-3 fatty acids on lipids and glycemic control in Type II diabetes and the metabolic syndrome and on inflammatory bowel disease, rheumatoid arthritis, renal disease, systemic lupus erythematosus, and osteoporosis Summary, Evidence Report/Technology Assessment No. 89. (prepared by the Southern California/RAND Evidence-based Practice Center, Los Angeles, CA.) AHRQ Publication No. 04-E012, Agency for Healthcare Research and Quality, Rockville, MD (March 2004). M.J. James, S.M. Proudmann and L.G. Cleland, Dietary n-3 fats as adjunctive therapy in a prototypic inflammatory disease: issues and obstacles for use in rheumatoid arthritis, Prostaglandins, Leukotrienes, and Essential Fatty Acids 68 (2003), pp. 399–405. P.C. Calder, N-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases, The American Journal of Clinical Nutrition 83 (Suppl.) (2006), pp. 1505S–1519S. R.J. Goldberg and J. Katz, A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain, Pain 129 (2007), pp. 210–223.L.J. Leventhal, E.G. Boyce and R.B. Zurier, Treatment of rheumatoid arthritis with gamma-linolenic acid, Annals of Internal Medicine 119 (1993), pp. 867–873. C. Little and T. Parsons, Herbal therapy for treating rheumatoid arthritis, Cochrane Database of Systematic Reviews (Online) 1 (2001) R. Ariza-Ariza, M. Mestanza-Peralta and M.H. Cardiel, Omega-3 fatty acids in rheumatoid arthritis: an overview, Seminars in Arthritis and Rheumatism 27 (1998), pp. 366–370 L.G. Darlington and T.W. Stone, Antioxidants and fatty acids in the amelioration of rheumatoid arthritis and related disorders, The British Journal of Nutrition 85 (2001), pp. 251–269.J.M. Kremer, n-3 fatty acid supplements in rheumatoid arthritis, The American Journal of Clinical Nutrition 71 (2000), pp. 349S–351S. P.R. Fortin, R.A. Lew and M.H. Liang et al., Validation of a Meta-Analysis: the effects of fish oil in rheumatoid arthritis, Journal of Clinical Epidemiology 48 (1995), pp. 1379–1390. D. Volker, P. Fitzgerald and G. Major et al., Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis, The Journal of Rheumatology 27 (2000), pp. 2343–2346. O. Adam, C. Beringer and T. Kless et al., Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis, Rheumatology International 23 (2003), pp. 27–36.
[vi] Modified from Dietary Manipulation in Musculoskeletal conditions by Rayman and Pattison. In Best Practice & Research Clinical Rheumatology. 2008;22 no 3 :535-561 . This is a brilliant current state of the art review and I am indebeted to the authors .
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