With some 50 million Americans afflicted by arthritis, chances are that even if you dont suffer from the disease, your spouse or someone else close to you does. But theres hope for this painful condition. Arthritis patients have a range of medications available, and today most know the benefits of exercise for improving their condition. While once arthritis sufferers were told rest is best, research at Tufts and elsewhere has shown that strength training in particular can help prevent and reduce arthritis symptoms.
What many arthritis patients may not realize, however, is that diet can also play an important role in combating their symptoms and even preventing the progression of the disease. You might be surprised at how modifying your diet to protect your joints can potentially cut down on stiffness and inflammation, says Miriam E. Nelson, PhD. The director of Tufts John Hancock Center on Physical Activity, Nutrition, and Obesity, Nelson is also the author of the Strong Women book series, which includes Strong Women and Men Beat Arthritis (Perigee, available at bookstores and
The recommended changes in diet are not so drastic that youll have to eat differently from the rest of your family, Nelson goes on. In fact, anyone in your household can eat this way and will likely end up healthier for it.
THE WEIGHT EQUATION: Eating right, along with exercise, can also help you lose weight. This is a crucial step, says Nelson, since excess weight can add extra stress to joints in the knees and hips, making arthritis all the more uncomfortable.
Even a modest weight loss can make a big difference to your joints. Research has shown that a reduction of just two points in body-mass index (BMI)-about 11 pounds for most people-can decrease the symptoms of osteoarthritis, the most common type, by as much as 50%. To calculate your own BMI (Body Mass Index), use the easy online calculator at
Every time you take a step, the force, or pressure, across your knees and hips is two to three times your body weight, explains Nelson. When youre walking down stairs or rising from a chair, the pressure is even greater-six times your body weight.
MORE THAN 100 CONDITIONS: By far the most common type of arthritis, which weve already mentioned, is osteoarthritis. So common that lay people often refer to it simply as arthritis, osteoarthritis accounts for about 80% of all arthritis of any type. The other well-known form of arthritis is rheumatoid arthritis, or RA, which affects some 3 million to 5 million Americans.
But Nelsons co-author, Kristin R. Baker, PhD, who studies arthritis at Boston University, says, While the word arthritis is used by clinicians to specifically mean joint inflammation, it is used in public health to refer more generally to more than 100 rheumatic diseases and conditions that affect joints, the tissues that surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in or around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.
Nelson adds, The dietary recommendations for controlling the symptoms of arthritis are pretty much the same whether you have osteoarthritis or rheumatoid arthritis.
FOOD, NOT PILLS: Baker cautions, This research is still in its infancy. There is data supporting the importance of certain nutrients, but there are very few randomized clinical trials with results supporting or refuting specific nutrients. Similar to other nutrition studies pulling out single nutrients, it is likely true in arthritis that the whole foods with these nutrients provide the benefit.
For example, the Framingham Osteoarthritis Study, an outgrowth of the famed Framingham Heart Study that followed residents of that Massachusetts town beginning in 1948, found that the progression of osteoarthritis was reduced by more than half in people who consumed the most vitamin C-at least 152 milligrams a day. Although thats almost double the recommended amount, its not difficult to achieve in your diet, without resorting to supplements-its about the amount of vitamin C in two oranges.
Why might vitamin C be good for your joints? Nelson cites two possible reasons: First, vitamin C is important in the formation of the major components of cartilage, collagen and proteoglycans. Second, vitamin C is an antioxidant, which means it can help quench the free-radical oxygen compounds that can rip through cartilage like bullets, damaging its structure. As the damage occurs, theres inflammation at the joint, and inflammation is involved in osteoarthritis, too.
The Framingham study also found a benefit for vitamin D: Those with knee osteoarthritis who got 400 IU or more of vitamin D daily were at one-third to one-quarter the risk of disease progression of those with a vitamin D intake of 350 IU or less. Unlike the vitamin C findings, getting that much vitamin D is difficult from diet alone, especially in the winter or northern latitudes where limited sun exposure means the skin doesnt make the sunshine vitamin naturally.
It makes sense that vitamin D might be beneficial for patients with osteoarthritis, which damages not just the cartilage but also the bones. Vitamin D is crucial for building and preserving bone strength and structure, and essential for the body to utilize calcium for healthy bones. Vitamin D may also play a direct role in the cartilage itself, affecting the production of collagen and proteoglycans.
OTHER NUTRIENTS YOU NEED: Two other nutrients that may help osteoarthritis sufferers are beta-carotene and vitamin E. Both are antioxidants, like vitamin C. The Framingham study reported that people with knee osteoarthritis who consumed more than 9,000 IU daily of beta-carotene were at lower risk for progression of the disease than those consuming less than 5,000 IU. Their risk of future knee pain was also significantly less. Although Americans average only about 3,000-5,000 IU of daily beta-carotene, which the body converts to vitamin A, upping your consumption of fruits and vegetables could easily exceed the 9,000 IU mark. One medium sweet potato, for example, contains more than twice that amount.
The Framingham researchers also found a benefit from vitamin E: People with knee osteoarthritis who consumed 6-11 milligrams of vitamin E daily-an amount obtainable from a healthy diet-were 60% less likely to see the disease progress over a 10-year period than those getting only 2-5 milligrams. Although higher amounts did not boost protection further in the Framingham findings, subsequent German studies have found a benefit from vitamin E supplementation at 400 milligrams daily. (Smokers should not take extra vitamin E, or supplemental beta-carotene, because of increased lung-cancer risk.)
Antioxidants are also important for RA sufferers, whose bodily systems are on overdrive-depleting their antioxidants in the battle against free radicals. One German study, for instance, found as much morning pain-relief benefit from 1,200 milligrams of daily vitamin E as from conventional painkillers (NSAIDs). Studies have even shown that people with low blood levels of antioxidants such as vitamin E and beta-carotene are more likely to develop RA.
Another nutrient thats now being researched for arthritis benefits is vitamin K. Says Baker, Although research has yet to prove that consuming a diet rich in vitamin K will actually prevent osteoarthritis or repair damage that has occurred, it does suggest that vitamin K may help slow or stop the progression of OA. Foods that are good sources of vitamin K include spinach, leaf lettuce, broccoli, kale, asparagus and olive, soy bean and canola oils.
FAT SMARTS: Besides cutting down on saturated and trans fats, which contribute to unhealthy cholesterol and heart disease, arthritis patients should increase their intake of omega-3 fatty acids (also good for the heart) from fish, flaxseed and nuts. Other oils with some omega-3s are canola, soybean and olive oil, which is also high in omega-9 fatty acids that may fight inflammation.
More problematic are omega-6 fatty acids, found in otherwise heart-healthy liquid vegetable oils such as safflower, sunflower, cottonseed and corn oil. Whether these omega-6 fats promote inflammation remains controversial; a 2009 American Heart Association scientific advisory concluded they do not, at least when it comes to heart health. But there are nonetheless reasons arthritis sufferers may want to cut back on omega-6s-particularly from processed foods and fried foods, which are a good idea to de-emphasize in your diet, anyway.
Why should arthritis patients worry about fat intake? Fatty acids, Nelson explains, are precursors of compounds called prostaglandins, some of which suppress inflammation and some of which promote it. Of course, she says, someone with arthritis would want to consume oils that lead to the formation of prostaglandins that suppress inflammation, since inflammation in the joint is what causes so much of the pain and stiffness that are hallmarks of the disease.
Omega-3s seem to do just that. And the benefit may extend beyond current arthritis patients: A University of Washington study concluded that people who ate two or more weekly servings of baked or broiled (not fried) fish were 40% less likely to develop arthritis. The Arthritis Foundation
Although plant-derived omega-3s, such as those in flaxseed oil and nuts, dont convert to very much of the omega-3s found in fish (DHA and EPA), they may have other benefits. Unlike omega-6s, moreover, those omega-3s dont compete with the DHA and EPA you do consume.
Omega-6 fatty acids use the same metabolic pathways in the body as anti-inflammatory omega-3s. Nelson notes that the ratio of omega-6s to omega-3s in the average Western diet is now about 11 to 1, where back before the rise of processed foods it was close to even. Nutrition scientists believe we should at least go back to a ratio of two to one.
Another food to limit, says Baker, is sugar: Sugar intake and inflammation have not been studied directly in arthritis, but higher intakes are clearly linked to more inflammation.
START WITH WATER: As arthritis sufferers plan healthier eating habits to combat joint pain and stiffness, Nelson advises starting with plain old water. You could say that water keeps the rest of a beat-arthritis diet afloat, she says. Water moisturizes and gives structural support to the joints, carries nutrients where theyre needed, and removes metabolic wastes from the body.
Especially as you get older, dont assume youre getting enough fluids just by drinking when you feel thirsty. There is a good deal of evidence that the older we get, the more our capacity to feel thirst when necessary becomes blunted, Nelson warns. Some of the medicines used to treat arthritis can also affect thirst. She recommends drinking at least eight cups of liquids daily, preferably water.
The rest of her recommended eating plan for arthritis patients (both osteoarthritis and rheumatoid arthritis) provides plenty of the individual nutrients that science suggests can help, while also encouraging modest weight loss. Nelson recommends getting 200 milligrams of vitamin C daily, which she says is fairly easy to accomplish from diet alone, without supplements. Many of the fruits and vegetables high in vitamin C, such as sweet potatoes and green leafy vegetables, will also help you get at least 9,000 IU of beta-carotene a day.
Along with whole grains, fruits and vegetables can boost your fiber intake. The Arthritis Foundation says fiber lowers levels of C-reactive protein (CRP), a marker for inflammation.
Heres what Nelson recommends that arthritis sufferers consume daily, on top of at least eight cups of water or other fluids:
– At least three servings of fruits.
– At least three servings of vegetables.
– Four to nine servings of bread, cereal, rice and pasta, at least half from whole grains.
– At least one serving of fish, soy, nuts and legumes.
– Two to three servings of reduced-fat milk, yogurt and cheese.
– No more than two servings of meat, poultry and eggs.
– Oils rich in omega-3s; use other fats and oils sparingly.
– Limit sweets.
This might sound like a lot of food, but she notes that a serving is not the plate-filling portion most of us envision. In general, a serving is a half-cup of fruits or vegetables (one cup for salad greens), three-quarters of a cup of fruit juice, one ounce or a half-cup of grain products, a half-cup of legumes, three ounces of meat or fish, one cup of milk or yogurt, one egg or two tablespoons of peanut butter.
Eating all these healthy foods will leave less room on your plate for processed foods, which are high in calories and unhealthy fats. Serving up less meat can also reduce the risk of chronic diseases linked to inflammation, according to the Arthritis Foundation. When you do have meat, cook it at lower temperatures and in liquid (such as braising) to reduce inflammatory compounds formed in dry, high-heat cooking.
Osteoarthritis sufferers might still need to take a supplement to get enough vitamin D. Rheumatoid arthritis patients should consider supplements of fish oil and calcium, Nelson says. Both types of arthritis may benefit from extra vitamin E if you dont get enough from your diet. A multivitamin can help insure you get enough beta-carotene, but avoid supplements with more than 5,000 IU or containing only beta-carotene.
Combined with an exercise program such as laid out in her book on beating arthritis, such dietary changes can do more than alleviate pain-welcome as that is. Says Nelson, Youre going to end up feeling stronger and more able to tackle the world than you have in years.