Eating to ease the pain of arthritis

Nutritionist Bronwen King offers practical advice to bring some relief to arthritis sufferers.

It is one of the leading causes of disability in New Zealand and there is no known cure. For the more than 670,000 Kiwis 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, gout and rheumatoid arthritis.

• Osteoarthritis is by far the most prevalent form of arthritis.  Previously thought to be the result of ‘wear and tear’ it’s now seen as a disease of the joint although injury and overuse can contribute to its development.  Osteoarthrosis involves damage to the cartilage which covers the ends of bones where they meet to form a joint. It is more commonly found in women, older and overweight people and in joints that have heavy use such as hips, knees and thumbs.  Other factors increasing the risk of developing osteoarthrosis include family history, injury to a joint and occupations or activities that involve repetitive movements to joints.
• 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.  Some people have a genetic predisposition to developing gout where they either overproduce uric acid or their kidneys cannot adequately eliminate it.  Maori and Pasifika and people who are overweight have a higher risk of developing gout.
• Rheumatoid arthritis is an autoimmune disease 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 50.  Smokers are at greater risk of developing rheumatoid arthritis.
• There are many other rarer forms of inflammatory arthritis including reactive arthritis, ankylosing spondylitis and fibromyalgia.

How can diet help arthritis symptoms?

A diet aimed at lowering uric acid levels in the blood can substantially reduce the likelihood of repeated gout attacks.  Scroll to the bottom for Gout: how diet can help

For other types of arthritis there is no one diet that will ease the pain but diet can definitely help.

1. Start with a healthy, balanced 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 vegetables and fruit, wholegrain breads and cereals, low-fat dairy products, legumes, nuts, seeds, poultry, fish, land small amounts of lean meat.

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 ease 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 can be 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 extra virgin olive oil
• Fruit
• Whole grains
• Olives and olive oil
• Legumes
• Nuts and seeds
• Cheese and yoghurt
• Fish and shell fish
• Eggs
• Small portions of meat and poultry
• Plenty of water

4. Increase your intake of omega-3 fats

Omega-6 and omega-3 fats are called essential as the body cannot make them and must obtain them from the diet. Most New Zealanders get more than enough omega-6 fats 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.  Unless you have gout, aim to 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 may give you a list of foods they believe worsen their arthritis symptoms. With the exception of gout (see below) there’s little evidence to support any specific foods making arthritis pain worse.  So don’t rely on what others experience or tell you Keep note of what you eat and the severity of your symptoms to help make your own connections. Try eliminating a food 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 will generally 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. (Use low-fat options to limit saturated fat intake.) 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 but in very small amounts. 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.

Can supplements help?

• 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. The US Arthritis Foundation suggest taking up to 2.6g twice a day.  There is also research suggesting omega-3 can help ease the pain of osteoarthritis, with lower doses being just as effective as high doses.
• Green lipped mussel extract, like fish oil, is a good source of omega 3 fats. 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. It is not effective in treating rheumatoid arthritis”. It is wise to seek professional advice before taking this supplement.
• Glucosamine and chondroitin are often found in combination in supplements labelled ‘joint formula’ – the theory is that because joint cartilage contains both these compounds, taking supplements may improve joint health.  Although glucosamine has been relatively widely studied, results are mixed and generally unconvincing. Chondroitin shows a little more promise in reducing pain and painkiller use, however with both of these the higher the quality of the trial, the less likely it was to show a benefit.  You may decide to give them a try, anyway.
• Ginger extract may be less commonly known but the UK Arthritis Society says trials have found it can have a moderately beneficial effect in reducing the pain of osteoarthritis.
• Borage seed oil may improve rheumatoid arthritis-related symptoms.  Borage seed oil is rich in essential fats that help regulate the immune system and fight joint inflammation.
• Evening Primrose Oil may help reduce joint pain in rheumatoid arthritis and reduce morning stiffness.

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

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 if needed
• Reduce alcohol intake, especially beer
• Reduce the intake of fructose-rich drinks eg soft drinks, energy drinks and fruit juice
• Drink plenty of water