Diet and Arthritis
An Information Booklet
Introduction
There is a great deal of advice about diet and nutritional supplements for arthritis and rheumatism in magazines, books, and on the internet. Much of it is confusing. Claims are made for many food supplements and diets, suggesting that they help with arthritis. Some of the advice, particularly on the internet, is given by companies who produce food supplements, and who have an obvious interest in you buying their products! Some people end up taking expensive food supplements or following elaborate and inconvenient diets which do not help, or may even be harmful. Often the same results can be achieved by simpler, cheaper methods. For example, it is generally better to get the vitamins you need from food, rather than take supplements. On balance, altering your diet will not have as great an impact on your arthritis as the more standard drug treatment and in particular you should not stop your medical treatment without discussion with your doctor.
This booklet explains how the food you eat might affect your arthritis. It then gives advice on the most sensible diet to follow and answers the most common questions which people ask about food and arthritis. Terms which are in italics when they are first used are explained in the glossary at the back of the booklet.
Can changing my diet really help my arthritis?
Yes. The right diet can certainly help some people with arthritis and rheumatism. For example, if you are overweight and suffer from arthritis, one of the most important things you can do to help yourself is to change the amount and type of food you eat. Recent research has also discovered several new links between arthritis and diet.
It is also important to consider whether your regular diet is giving you all the important basic nutrients including minerals such as calcium and iron. If it does not, then your general health will suffer and this may have an effect on your arthritis – see the next section.
How can I change my diet (and lifestyle) to help my arthritis?
There are four golden rules you should follow to help your arthritis:
- Eat a balanced and varied diet to maximize your intake of vitamins, minerals, antioxidants and other nutrients you need which will help to keep your weight within the recommended range (see Figures 1, 2 and 3).
- Change the type of fats and oils you eat and include oily fish.
- Eat a more Mediterranean-style diet with plenty of fruit and vegetables.
- Take regular exercise.
Taken together, these measures are likely to be beneficial whatever type of arthritis you have. Current evidence suggests that oily fish is likely to be beneficial if you have an inflammatory type of arthritis (such as rheumatoid arthritis, reactive arthritis, psoriatic arthritis, or ankylosing spondylitis). Oily fish helps protect against heart disease and is good for your health in general, but the strongest evidence that it can help arthritis relates to inflammatory arthritis. Advice relating to specific types of arthritis is given later in the booklet, so it is important to know what type of arthritis you have. All the points above are dealt with in more detail after we have explained why watching your weight is so important.
Why is my weight so important?
The most important single link between your diet and arthritis is certainly your weight. Being overweight puts an extra burden on the weight-bearing joints (back, hips, knees, ankles and feet) when they are already damaged or under strain. Because of the way joints work, the pressure in your knee joints is 5–6 times your body weight when you walk. Even a small weight loss can make a big difference to your joints. If you are overweight and have arthritis in any of your weight-bearing joints losing weight will help you more than any food supplements. Too much body fat may also increase inflammation in the body, making your joints more painful. Some evidence for this can be seen in the fact that achieving a healthier weight can improve the results of blood tests for inflammation such as CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate).
How can I lose weight and eat a healthy diet?
Slimming has become big business. There are many slimming treatments and so-called miracle diets, and this can be confusing. Unfortunately there is no miracle cure for arthritis. Crash and fad diets are usually unbalanced and are not recommended. Most people find they put weight back on when they return to normal eating. The only way to lose weight permanently is to make permanent changes to the way you eat or the amount of exercise you do.
To work normally, your body needs food to supply energy and a variety of vitamins and minerals. If your diet contains more energy than you burn up, your body will convert the extra energy to fat and you will put on weight. On the other hand, if your food contains less energy than you are using, you will lose weight. It may be that you are unable to take as much exercise as before because of your arthritis. This means that you need less energy and should eat less high-calorie foods while maintaining your intake of essential nutrients. The chart in Figure 3 shows whether you are a normal weight for your height. Please note that, in this chart, the 'OK' range is shown in two shades and spans, for example, 8 stones to just under 11 stones for a person who is 5'6" tall. Another method of defining whether you are a healthy weight for your height, overweight or underweight is the Body Mass Index (BMI) (see Table 1 for a description).
Table 1. How to find your Body Mass Index |
| First, multiply your height in metres by itself – this will give you a figure (A). Then divide your weight in kilograms by the figure A. The result is your BMI. An ideal BMI for most people is 20–25. This corresponds to the 'OK' weight range shown in Figure 3. |
The energy in food is measured in kilocalories (kcal), often just called calories. If you eat fewer calories, it is important not to lose out on vitamins and minerals. This is why it is important to eat foods that are high in vitamins and minerals but low in calories, such as fruit and vegetables.
It is healthy to eat starchy foods like bread, potatoes, rice, and pasta. They have no more calories than protein. Wholemeal versions of these starchy foods are better as they are more filling because they are high in fibre, and often supply more vitamins and minerals – for example, wholemeal bread, brown rice, wholegrain breakfast cereals.
Cut down on fat
Fat has twice as many calories as the same weight of starch or protein. Most people eat far more fat than they need for health. Eating 30 g (about 1 oz) less fat each day saves 270 calories. So cutting calories does not require massive sacrifices. Making minor changes to the food you eat can be enough.
The fats in food are of three kinds: saturates, mono-unsaturates, and polyunsaturates. Saturated fats are mostly of animal origin and are found particularly in full-fat dairy products and processed foods including foods like cakes, pastry and biscuits. Chips are sometimes fried in animal fat and therefore can be a source of saturated fat. Lean meat does not contain much saturated fat, and for most people who eat a typical 'traditional' British diet, dairy products (milk, butter, cheese, yogurt etc.) make up the biggest source of saturated fat. Asian food can also be quite high in saturated fats, for example meals cooked using ghee (clarified butter). Some vegetable oils, such as palm oil and coconut oil, contain a lot of saturates. Saturated fats are the most important kind of fat to reduce since they can increase the pain and inflammation in the body. Softer fats and oils from corn or sunflower sources are high in what are called omega-6 polyunsaturates and these can also increase general inflammation in the body. Monounsaturates, as found in olive and rapeseed oil, are 'neutral' fats in this respect and do not worsen inflammation, but remember they contain just as many calories, so limiting them is still important to lose weight.
To eat less fat, follow these guidelines:
- Look out for and avoid 'invisible' fats in foods like biscuits, cakes, chocolate, pastry and savoury snacks – check the labels.
- Trim fat off meat.
- Choose lean cuts of meat.
- Choose fish and poultry more often.
- Use low-fat milk (skimmed or semi-skimmed).
- Use low or reduced fat dairy products (e.g. yogurt, low-fat cheese).
- Use low-fat, olive-oil-based or soya margarines.
- Grill instead of frying.
- If you do have the occasional 'fry-up', use olive oil and use only a very small amount.
- Fill up on wholegrain bread, cereals, fruit and vegetables.
- Look for snacks which are naturally low in fat, such as plain popcorn or fruit, or try roasted beans, such as 'soya nuts'.
Cut down on sugar
Sugar contains only calories and has no other food value (so-called 'empty' calories) so it can be cut down without any loss of nourishment. Eating 30 g (about 1 oz) less sugar each day saves 120 calories.
Try not to add sugar to drinks and cereals. Although artificial sweeteners contain very few calories, it is better to get used to food being less sweet by not adding them to drinks. Dried fruit like raisins can be used to sweeten cereals and puddings; unlike sugar and artificial sweeteners, they also provide vitamins and minerals.
Eat more fruit and vegetables
The World Health Organization recommends that we eat at least five portions of fruit and vegetables every day (see Table 2). This is to make sure that the body receives the important nutrients, particularly vitamins, minerals and antioxidants which it needs to maintain good health and to protect it during the stress of disease. Antioxidants can help protect joints, and help reduce inflammation by 'mopping up' some of the body chemicals which cause inflammation, and may even help prevent arthritis. Recent research has shown that people who eat plenty of fresh fruit and vegetables, particularly those containing vitamin C, seem to have a lower risk of developing inflammatory arthritis. Choose fruit and vegetables of various different colours especially the brightly coloured varieties as these tend to be rich in antioxidants. Examples include apples, oranges, cherries, blueberries, peppers, spinach, tomatoes, avocado, sweet potato, beetroot and broccoli.
You can also get more fibre from eating plenty of fruit and vegetables. Remember that you also get fibre from wholegrain versions of bread, cereals, pasta and rice. In addition, as suggested above, fruit, vegetables and wholegrains are relatively filling and help if you are trying to lose weight.
What counts as one portion of fruit or vegetables?
The table below gives examples.
Table 2. What counts as one portion of fruit or vegetables? |
| ½ grapefruit ½ pepper ½ avocado 1 medium apple 1 medium orange 1 medium banana 1 medium tomato 1 medium onion 2 medium plums 2 small tangerines 2 tinned pineapple rings 2 tinned peach halves 2 2-inch mango slices 2 broccoli florets 3 sticks of celery 3 heaped tablespoons of carrots (raw or cooked) 3 heaped tablespoons of fruit salad 3 heaped tablespoons of frozen peas 5 fresh asparagus spears 6 baby sweetcorn 7 fresh strawberries 8 cauliflower florets 14 button mushrooms 1 heaped tablespoon of sultanas or other dried fruit A handful of grapes 150 ml of fruit juice (counts only once however much you drink) |
You should try to eat at least 5 portions of fruit or vegetables a day
Take regular exercise
Exercise is very important. Not only does it use up calories which would otherwise end up as fat, but it also increases your strength and suppleness. Exercise is good for your general health, especially the heart and circulation. Of course, arthritis can make exercise difficult and painful, and the wrong kind of exercise can make it worse. But exercise does not have to mean running a marathon! A daily walk for half an hour with the dog, for example, or a walk to the local shops or park is exercise and it will help. Many people find particular types of exercise suit them: swimming is a good exercise because being in water takes the weight off the joints. Others prefer keep-fit classes, yoga or cycling. The most important thing is that you enjoy it and so do it regularly. See the arc leaflet 'Keep Moving'.
Should I take extra calcium, vitamin D, or iron?
Calcium and vitamin D
Calcium is an important basic nutrient. Not having enough calcium in the diet can make you more likely to get osteoporosis (brittle bones). Women after the menopause are particularly liable to osteoporosis. Many people with arthritis also have a risk of developing this condition. (See arc booklet 'Osteoporosis'.) Lack of calcium in the diet can also increase your risk of developing osteomalacia (see arc booklet 'Osteomalacia (Soft Bones') '). The richest sources of calcium are milk, cheese and yogurt and, as shown below, certain types of fish which are eaten with the bones. If you are watching your weight it is worth knowing that skimmed or semi-skimmed milk actually contains more calcium than full-fat milk. We recommend a daily intake of calcium of 1000 milligrams (mg) or 1500 mg if you are over 60. A pint of milk a day, together with a reasonable amount of other foods which contain calcium, should be sufficient (see Table 3). Vitamin D is needed for the body to absorb calcium and there is some evidence that arthritis (both osteoarthritis and inflammatory types), progresses faster in people who are low in it. Vitamin D is produced by the body when sunlight falls on the skin, so slight deficiency is quite common in winter, and it can be obtained from the diet (especially from oily fish) or vitamin supplements (see arc booklet 'Osteomalacia (Soft Bones)' for more information on vitamin D and vitamin D deficiency). For people over 60 it may be helpful to take a supplement containing 10–20 micrograms (µg) of vitamin D.
If, for whatever reason, you do not take many dairy products, soya milk is now available in most supermarkets. It can be used in exactly the same way as cow's milk. Some soya milk is fortified with calcium, so try to use this type. Other 'milks', made from rice or oats, are now available; some of these are also fortified with calcium. If you are not taking dairy products or a suitable quantity of other calcium-fortified 'milk' or other calcium-fortified products, you may need a calcium supplement. Discuss this with a dietitian or your doctor.
Table 3. Approximate calcium content of some common foods |
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Iron
Iron is important to prevent anaemia. Many people with arthritis are anaemic. The anaemia can be due to different causes. NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen and diclofenac help the pain and stiffness of arthritis but may cause bleeding and stomach ulcers in some people, leading to anaemia. (See arc leaflet 'Non-Steroidal Anti-Inflammatory Drugs'.) The other main cause of anaemia in arthritis is anaemia of chronic disease, which often occurs with rheumatoid arthritis and similar conditions, and does not improve with iron supplements. If you are anaemic your doctor can tell you if more iron is likely to help.
The best source of iron in food is red meat. However, as many people are now cutting down on red meat for various reasons (and this may also be wise in relation to inflammatory arthritis – see 'Fasting and vegetarian diets for rheumatoid arthritis'), it is important to have iron from other sources. Iron from fish is easily absorbed and oily fish are a good source. For example, sardines contain as much iron as beef. Iron is better absorbed if there is also vitamin C in the meal so have a good portion of vegetables or salad or fresh fruit with your meal. On the other hand, tea reduces the amount of iron which your body can absorb so it is a good idea not to drink tea with your meal. If you are vegetarian, please note that dairy products like milk and cheese are a very poor source of iron, but pulses like haricot beans and lentils and dark green vegetables (such as kale, spinach and watercress) are quite good sources. Good sources of iron like these should be included daily in a vegetarian diet.
Should certain foods be avoided?
- Some foods tend to produce substances in the body which may aggravate arthritis. This is the case, for instance, with gout, although in this case the effects of losing weight and reducing the amount of alcohol you drink are more significant than the effect of cutting out specific foods. See 'Should I alter my diet if I have gout?'.
- Fasting can have a temporary effect on rheumatoid arthritis. However, it is not recommended unless done under specialist supervision. See 'Fasting and vegetarian diets for rheumatoid arthritis'.
- Some people are allergic or intolerant to certain foods. This is highly individual, and varies from person to person. Finding out whether you really are sensitive to a particular food can be quite a difficult process (see 'What about food allergies?').
Should I alter my diet if I have gout?
Gout is a particular type of arthritis caused by a high level of urate in the body (more information is given in the arc booklet 'Gout'). The urate can crystallize in the joints causing severe pain and inflammation. Urate is produced from purines, which are chemicals that result from the natural death of cells. Most purines in the body are produced by this turnover of cells. The build-up (accumulation) of urate is mostly due to the body not metabolising it efficiently enough – often an inherited tendency.
The accumulation of urate is made worse by alcohol and certain medical drugs such as diuretics (water tablets) used to treat heart disease or high blood pressure. Stopping or changing any drugs which may be causing the gout, or treatment with specific drugs designed for gout, tend to be the main approaches used. Certain foods are rich in purines, and reducing these may help if you have gout. The effect of reducing the purine intake may not be particularly great, because the main problem is usually not the amount of purine coming from diet, but the body's metabolism of it. Details of ways in which you can change your diet to help yourself if you have gout are given below.
The most effective dietary treatment for gout is losing weight if you are overweight. This can significantly reduce urate levels in your body, but it must be done gradually because extreme weight loss or starvation diets (fasting) can actually raise urate levels, because they increase cell breakdown in the body.
The second most useful dietary change if you have gout is to cut down on alcohol. Excessive alcohol consumption has been known to be associated with gout for centuries. If you have gout it is advisable to keep your alcohol intake below the safe maximum levels recommended by the government. Currently this is 3–4 units a day for men and 2–3 units a day for women. A unit is 1/2 pint (0.3 litre) of ordinary strength beer, lager or cider (3.5% alcohol by volume or abv), a single pub measure of 25 ml of spirits (40% abv) or a very small glass of wine (12% abv) – no more than 85 ml, which is much smaller than the standard wine glass used!
To reduce the risk of urate crystallizing in the joints it is important to drink plenty of water – if possible as much as 3.5 litres (6 pints) a day. You can include some other fluids in this total, particularly low-fat dairy products. According to recent scientific evidence, drinking a glass of skimmed milk every day may be helpful. But remember that beer or other alcoholic drinks are likely to make gout worse. If you are trying to lose weight bear in mind that many soft drinks contain large amounts of sugar and should be avoided.
As mentioned earlier, cutting down on foods which are high in purines may be helpful if you have gout. This is best done by eating one less portion of meat or fish per day; this could be replaced by other sources of protein, such as beans and pulses, or low-fat dairy products. Note that urate levels are not affected by so-called 'acidic food' like oranges or grapefruit, so you can eat these safely.
Fasting and vegetarian diets for rheumatoid arthritis
Fasting for a week can improve rheumatoid arthritis, but the arthritis quickly returns when you go back to a normal diet. We do not recommend fasting as a treatment for arthritis. If you do want to fast it should be done under specialist supervision.
However, less drastic changes may help. Vegetarian diets have been shown to be helpful in the long term to some people with rheumatoid arthritis. In addition, some studies have shown that people who eat large amounts of red meat seem to have a higher risk of developing inflammatory arthritis. A vegan diet (i.e. no meat, fish, or other animal products such as eggs, milk, cheese or other dairy-based foods) may also be helpful, but it is difficult to get enough of some important nutrients on a vegan diet. A possible explanation of the success of these diets is the change in polyunsaturated fatty acids being eaten. More information about fatty acids is given later in the section 'Omega-3 polyunsaturated fatty acids'.
What about food allergies?
The subject of food allergy or intolerance and arthritis is very controversial. There are many books which recommend all sorts of elimination diets and claim miraculous results in arthritis. Some of these unproven diets would leave your body seriously short of important vitamins and minerals if you followed them for a long time. There are also tests which it is claimed can tell you whether you are allergic to food – but most of them are unreliable. The only way to be sure that you have a food allergy is an elimination diet followed by 'challenge' (see below). Non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly used for arthritis, increase the permeability of the gut, causing it to become 'leaky', allowing larger molecules of food to pass through than would normally be the case, causing food sensitivity. So if you are able to reduce your NSAIDs, you may become less food-sensitive.
How do I know if I have a food allergy?
As mentioned above, there are many tests which it is claimed can detect food allergies. ELISA and RAST are blood tests which identify proteins called immunoglobulins in the blood. These methods have a scientific basis but are not entirely accurate. They only give a guide to foods which might be worth testing in an elimination diet (this type of diet is explained later in this section).
There are many other tests for food allergy, as described in the list below: some of these are quite expensive and all are unreliable. Unreliable methods of testing for food allergy include:
- applied kinesiology (AK), where a drop of the food is put under your tongue, and the strength of your arm tested
- dowsing or psionic medicine, which uses a pendulum and can be done remotely using a 'witness', like a lock of your hair sent by post
- vega testing and similar methods, where you hold an electrode and a sample of the food is put into a machine.
We do not recommend any of these unreliable methods.
Elimination diets
The only reliable method is an elimination diet where you exclude (leave out) a certain food from your diet, for a period of 3–4 weeks, followed by a 'challenge', where you reintroduce the food to see if it causes a reaction. If you think you have an intolerance to a food, try cutting it out of your diet for a month. Then start eating it again and see if it makes a difference. If you really are sensitive you will notice a flare-up of your arthritis within a few days.
However, an elimination diet can be quite difficult to follow. The power of suggestion can be very strong. Also, some foods are used in cooking or food preparation and you may eat them without knowing it. For instance 'modified starch' used in many processed foods may or may not come from wheat; casein and caseinates are milk products, although this is not obvious. They may affect you if you are milk-sensitive. It is important to be systematic, cutting out foods completely, then reintroducing them one at time. Care is needed when excluding foods from your diet as you may be excluding vital nutrients, for example if you cut out milk from your diet you might become deficient in calcium. If you think you have food sensitivities it may well be worth consulting a dietitian who can make sure you are excluding foods correctly and that your diet is providing enough nutrients.
Are there any foods or food supplements which really do help arthritis?
Omega-3 polyunsaturated fatty acids
One of the most exciting recent discoveries is that certain foods and food supplements really can help with arthritis. The effects are fairly specific to the type of arthritis you have, so you need to know which one it is in your case.
Omega-3 polyunsaturated fatty acids, particularly as found in oily fish and the oil produced from them, can be helpful for inflammatory arthritis. (As already stated, inflammatory arthritis includes rheumatoid arthritis, reactive arthritis, psoriatic arthritis and ankylosing spondylitis; it also includes gout but oily fish should generally be avoided if you have gout because of the high purine content.) More detailed information is given below.
What are fatty acids and what types are there?
When the fats and oils we eat are broken down by the digestive system they break down into fatty acids. The nature of the fat or oil depends on the type of fatty acid (or fatty acids) it is made of.
Some fatty acids can be made by the body from other compounds. But some cannot be made and the body must get them from food. These are called essential fatty acids (EFAs). Alpha-linoleic acid (ALA) and linoleic acid (LA) are essential fatty acids.
Polyunsaturated fatty acids are divided into two main groups: omega-3, found in high levels in oily fish and some plant seed oils and nuts, and omega-6, found mostly in plant seed oils such as sunflower oil. The body uses both these types of fatty acids to make chemicals called prostaglandins and leukotrienes; the right balance of these is important to control inflammation in the body.
What should I know about omega-3 (and omega-6) polyunsaturated fatty acids?
Research has shown that omega-3 (also called 'n-3') polyunsaturated fatty acids can help some people with inflammatory arthritis. Omega-6 (also called 'n-6') polyunsaturated fatty acids are not thought to be of benefit in arthritis and in fact they can increase inflammation by competing in the metabolism with omega-3 polyunsaturated fatty acids, causing a 'metabolic traffic jam'. In the UK, most people have diets which already contain more omega-6 than is needed, so it may be helpful to cut down on the amount of omega-6 in your diet (such as sunflower oil, corn oil, and products made from these such as sunflower margarines).
Omega-3 polyunsaturated fatty acids exist in 'long-chain' forms, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and in 'short-chain' forms, such as alpha-linoleic acid (ALA). The long-chain forms are found naturally in oily fish, especially kippers, pilchards, sardines, mackerel and salmon (see Tables 4 and 5). The short-chain forms are found in rapeseed, hemp oil, flaxseed oil and walnuts (see Table 7). The omega-3 polyunsaturated fatty acids which are thought to be of most benefit in inflammatory arthritis are the long-chain forms EPA and DHA. So, if you have an inflammatory type of arthritis (other than gout) it is a good idea to eat oily fish twice a week. Also, most chemists and health food shops sell fish oil capsules which contain high concentrations of EPA and DHA. It is possible that, if you take the short-chain plant seed oil omega-3 essential fatty acids, they may be converted within the body into the long-chain forms which benefit arthritis, but it is not certain that they are as beneficial as the long-chain omega-3 fatty acids found in fish oil. Omega-3s also help protect against heart disease.
For inflammatory arthritis other than gout we recommend 3 grams of fish oil (fish body oil) daily. You can achieve this by eating oily fish, taking fish oil supplements, or a combination of the two.
In relation to osteoarthritis, studies have been carried out (including work funded by arc) to try to find whether fish oils can be helpful for this condition but the results so far have not been conclusive and more research is needed on this subject.
Caution with fish liver oils
It is important not to confuse fish oil with fish liver oil (cod liver oil and halibut liver oil are common examples). Fish liver oils contain omega-3 polyunsaturated fatty acids as well as vitamin D (which helps the body to absorb calcium) and vitamin A. But it is dangerous to take fish liver oils in the large doses recommended for arthritis because of the risk of overdosing with vitamin A. This is particularly important for pregnant women, or women who might become pregnant, because vitamin A can harm the unborn baby.
Pregnant women, or women who might become pregnant, should not take fish liver oils or vitamin A supplements at all. Other adults should not take, in total, more than 3000 micrograms (µg) of vitamin A per day. This is known as the Tolerable Upper Intake Level (UL) for vitamin A, which means that if you repeatedly take more than this you risk doing yourself harm. Be careful if you eat a lot of liver because this usually contains a lot of vitamin A. If you want to take fish liver oil capsules, look on the packaging to check the amount of vitamin A they contain. To summarise, vitamin A can be dangerous especially to women who are, or might become, pregnant. If you take fish liver oil, do not exceed the dose recommended on the label. If you want to increase your intake of omega-3 polyunsaturated fatty acids, you should do so by taking pure fish oil, not fish liver oil.
Table 4. Which are oily fish and which are not? |
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Table 5. Showing the omega-3 fatty acid content of some fish and other seafood |
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Table 6. Showing the omega-3 fatty acid content of some plant seed oils and nuts* |
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Are there any possible side-effects of polyunsaturated fatty acids?
In theory, polyunsaturated fatty acids can cause a problem by generating harmful substances called free radicals in the body. Free radicals can be eliminated by antioxidants. A number of vitamins and minerals are antioxidants. As mentioned earlier, the foods which are richest in antioxidants are fresh fruit and vegetables, especially brightly coloured varieties like cherries, blueberries, apples, oranges, avocado, peppers, spinach, tomatoes, sweet potatoes, beetroot and broccoli. Vitamin E is an effective antioxidant for omega-3 fatty acids, especially those found in fish oil. If you are taking a lot of fish oil (2 grams a day or more), you should eat plenty of fresh fruit and vegetables and include those with good levels of vitamin E. Good sources of vitamin E are: sunflower seeds, nuts (especially almonds), avocado, and spinach. Some breakfast cereals are fortified with vitamin E. Suitable combined preparations of antioxidant vitamins and minerals, which contain vitamin E, selenium and other antioxidants, can be found in chemists and health food shops.
Are there any foods or food supplements which might help arthritis?
Glucosamine sulphate and chondroitin for osteoarthritis
Osteoarthritis is the commonest form of arthritis. It is often regarded as a mechanical or 'wear and tear' form of arthritis and it particularly affects the weight-bearing joints of the legs and back, becoming more common with age (see arc booklet 'Osteoarthritis'). The main problem in osteoarthritis is changes to the cartilage, the smooth tough, elastic 'gristle' which covers the ends of the bones making up the joint. These changes affect the ability of the bones to glide over each other and to absorb shocks.
Many people try glucosamine sulphate and chondroitin tablets that they buy themselves from health food shops and chemists. These products currently are not licensed for use as drugs for osteoarthritis in the UK because there is insufficient research to date to show that they work. The reason behind their use is that joint cartilage normally contains glucosamine and chondroitin compounds and taking supplements of these natural ingredients may help improve the health of damaged osteoarthritic cartilage.
The research findings are conflicting; some recent studies have not shown a beneficial effect. Many people, however, report them to be effective and they appear to be safe, although they should not be taken by people who have an allergy to shellfish. If you want to try them it would be perfectly reasonable to try 1500 mg of glucosamine and 1200 mg of chondroitin (per day) for 3 months and if your joint pain is much improved you may wish to continue with them.
Vitamins and minerals for arthritis in general
Deficiency in some vitamins and minerals seems to be associated with arthritis progressing more quickly. As mentioned earlier, slight vitamin D deficiency is not uncommon, especially in winter. It can be obtained from the diet (especially from oily fish) or vitamin supplements, such as fish liver oil, but, as emphasised previously, it is important not to take too much fish liver oil. Poor vitamin C intake has been linked with arthritis but if you follow the '5 fruit and vegetables per day' advice, you should not have a problem with vitamin C, and we do not recommend supplements.
Mild selenium deficiency is quite common in the UK and may be associated with more rapid progression of arthritis. The richest natural source of selenium is Brazil nuts, but meat and fish also contain some. Selenium is nearly always included in antioxidant vitamin and mineral supplements which you can buy in chemists and health food shops.
Are there any diets or food supplements which are supposed to help but do not?
Some people feel that cutting out 'acidic fruit' such as oranges, lemons and grapefruit helps arthritis. Others believe that vegetables from the so-called nightshade family (solanaceous plants) are bad for arthritis: this is a large plant family which includes several important foods – potatoes, tomatoes, peppers (sweet and hot) and aubergines. There is no scientific evidence that leaving out either of these groups of fruits and vegetables helps arthritis, and such diets may have the undesired effect of reducing the beneficial antioxidants in the diet. Cider vinegar and honey is also sometimes recommended for arthritis. Again there is no scientific evidence that it is helpful.
MSM (methylsulphonylmethane) is a sulphur-containing substance which has been recommended for various health problems, including arthritis. There are no clinical trials in humans which demonstrate that it is effective.
CMO (cetylmyristoleate) is a waxy substance made from beef fat, which it is claimed can help arthritis. Again, there is very little scientific evidence that it does so.
Can diet help if I am taking drugs?
Yes. A good diet still helps even if you are taking strong drugs for your arthritis or rheumatism. In fact, if you are, there is even more reason to eat a good diet as it can help to protect the body against some of the side-effects of drugs. For example steroids, such as prednisolone, can cause osteoporosis, particularly if you stay on them for a long time. Plenty of calcium in your diet will help to reduce the risk.
In addition, some of the changes we recommend in this booklet can help to reduce the amount of drugs you need – losing weight, taking a healthy diet, perhaps excluding some foods, and increasing your omega-3 polyunsaturated fatty acid intake, either though foods or supplements or both.
What are the main points to remember about my diet?
arc and other organizations are continuing to support research into the links between what you eat and your arthritis. From the research evidence so far, we recommend that you should:
- try to lose weight, if you are overweight, by changing your eating habits and increasing exercise if possible – not by crash diets
- eat less sugar and fat, especially saturated fat, and try to use olive oil in your diet
- eat more fruit and vegetables, especially brightly coloured varieties
- take plenty of calcium- and iron-rich foods
- try replacing meat with oily fish twice per week (unless you have gout)
- If you have inflammatory arthritis which is not gout consider further increasing your intake of oily fish and/or fish oil supplements produced from oily fish as described in the text.
If you think you are allergic or intolerant to a food, exclude it from your diet for one month, then reintroduce it, to see if it makes a difference. If this food is a major part of your diet, or if you think you might be sensitive to several foods, it is advisable to seek professional help from a dietitian before starting an elimination diet.
Glossary
Anaemia – a shortage of haemoglobin (oxygen-carrying pigment) in the blood resulting in a decrease in the ability of the blood to carry oxygen.
Antioxidants – substances which can neutralize free radicals (more accurately oxygen free radicals). The body produces its own antioxidants but it is thought that antioxidants in the diet (such as vitamin C) help destroy excess free radicals which may cause tissue damage or disease.
ELISA – enzyme-linked immunosorbent assay.
Free radicals – atoms or molecules which have one or more unpaired electrons. This means that they react very readily with other molecules and can damage cells or tissues. Free radicals are produced naturally in the body as a result of the metabolism, but disease, environmental pollutants, radiation, and stress can create extra free radicals leading to an imbalance. Free radicals are neutralized by antioxidants.
Immunoglobulins – a class of blood proteins which are responsible for immunity to specific infections.
Leukotrienes – have a role in allergic or inflammatory reactions.
Minerals – substances such as calcium, iron, silicon and fluoride. Other minerals are the trace elements such as zinc, selenium, manganese, molybdenum, chromium, cobalt, iodine, vanadium and nickel.
NSAIDs – non-steroidal anti-inflammatory drugs. A large family of drugs, prescribed for different kinds of arthritis which reduce inflammation and control pain, swelling and stiffness.
Prostaglandins – chemicals derived from fatty acids, some of which control inflammation.
Purines – nitrogen-containing compounds, found mostly in nucleic acids – DNA and RNA. The body breaks purines down to uric acid.
RAST – Radioallergosorbent test
Further reading
'Food Allergies and Food Intolerance: The Complete Guide to their Indentification and Treatment' by Professor Jonathan Brostoff and Linda Gamlin, published by Inner Traditions Bear & Company, Vermont USA, 2000. ISBN 9780892818754, price around £12, 480 pages.
'Nutrition and Arthritis' by Dr Margaret Rayman and Alison Callaghan,
published by Blackwell Publishing, 2006. ISBN 9781405124188, price
£39.99, 280 pages.
Please note: this is a textbook intended primarily for dietitians
and medical professionals and, as you will see, this is reflected
in the price. If you wish to consult this book, you may be able
to find a reference copy in your local library.
These books are available from libraries, bookshops and via the internet. (They are not available from arc.)
References
Used as a source of information for Tables 5 and 6:
'McCance and Widdowson's The Composition of Foods, Sixth summary edition.' Published by The Royal Society of Chemistry, Cambridge and The Food Standards Agency, London, 2002. ISBN 9780854044283.
'Fatty Acids: Seventh Supplement to the Fifth Edition of McCance and Widdowson's The Composition of Foods.' Published by the Royal Society of Chemistry, Cambridge and the Ministry of Agriculture, Fisheries and Food, London, 1998. ISBN 9780854048199.
Useful addresses
The Arthritis Research Campaign
PO Box 177
Chesterfield
Derbyshire S41 7TQ
www.arc.org.uk
As well as funding research, we produce a range of free information booklets and leaflets. Please contact the address above for a list of titles or, on this website, see Publications for People with Arthritis.
Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline (freephone): 0808 800 4050
www.arthritiscare.org.uk
Offers self-help support, a helpline service, and a range of leaflets on arthritis.
The British Dietetic Association
5th Floor, Charles House
148/9 Great Charles Street Queensway
Birmingham B3 3HT
www.bda.uk.com
The professional association for dietitians. The BDA’s website has a number of useful links to other diet-related sites.
Food Standards Agency
Aviation House
125 Kingsway
London WC2B 6NH
Phone: 0845 606 0667
Information Centre: 020 7276 8181
Helpline: 020 7276 8829
www.food.gov.uk
www.eatwell.gov.uk
Offers a wide range of information on its websites and publishes a number of free booklets and leaflets, such as 'Healthy Eating Fats', 'Healthy Eating Sugars' and the 'Eat Well Guide'.
NHS Direct Online
www.nhsdirect.nhs.uk
The website has useful information on healthy eating under the section 'Common Health Questions'.
nras (National Rheumatoid Arthritis Society)
Unit B4 Westacott Business Centre
Westacott Way, Littlewick Green
Maidenhead SL6 3RT
Phone: 01628 823524
Helpline: 0845 458 3969
www.rheumatoid.org.uk
A national charity which focuses specifically on rheumatoid arthritis.
The Vegetarian Society
Parkdale, Dunham Road
Altrincham, Cheshire WA14 4QG
Phone: 0161 925 2000
www.vegsoc.org
Information on drugs
Separate arc leaflets are available on many of the drugs used for arthritis and related conditions. We would recommend that you read the relevant leaflets for more detailed information about your medication.
