Diet and arthritis: the facts
Reproduced from Issue 101 of Arthritis Today
The effect of diet – or lack of it – on arthritis is always guaranteed
to raise hackles among rheumatologists probably more than any other topic.
But while many doctors dismiss its effects as negligible, many patients
swear that cutting out this or that particular food has helped their arthritic
symptoms.
There's so much conflicting evidence, and the fact that a great deal of nonsense is written about how to "cure" arthritis through diet doesn't help. Dozens of books vie with each other to suggest yet another method of ridding sufferers of pain and inflammation – often contradicting each other.
Most rheumatologists – trained to believe in conventional drug therapies above all else – are particularly unreceptive to the idea that diet can help with arthritic conditions, pointing out to the lack of scientific evidence that it actually works.
And yet. The public's thirst for knowledge, and to find something other than drugs and medication that might just work for them, seems boundless. Admittedly, some of the claims of people to excitedly contact arc with news about what "cured" them veer towards to wacky and weird – (two prunes and a capful of gin is one of the more memorable) but others are serious and sincerely believe that cutting out acid, or other types of food, have genuinely been of help.
Bombarded with contradictory information in the media – one week it's food supplement glucosamine sulphate, the next green-lipped mussel extract – confusion is rife in the public mind, and no wonder.
"Rheumatologists take one view, and patients take another, and there is this effective stalemate," said Dr Gail Darlington, consultant rheumatologist at Epsom General Hospital, and co-author of Diet and Arthritis, A Comprehensive Guide to Controlling Arthritis Through Diet.
"One of the reasons I have studied this subject is that if the establishment pretends that this stalemate does not exist as a problem, then patients are driven into the arms of quacks, and they are extremely vulnerable as a result."
'As a rule, rheumatologists are not very open-minded about diet – there is the opposite risk of quacks who do weird and wonderful tests for allergies, and encourage multiple food supplements. There should be a middle way.' |
Dr Peter Fisher, consultant rheumatologist at King's College Hospital and the Royal London Homeopathic Hospital, who has written arc's new booklet on Diet, concurs.
"As a rule, rheumatologists are not very open-minded about diet – there is the opposite risk of quacks who do weird and wonderful tests for allergies, and encourage multiple food supplements. There should be a middle way."
Both doctors advocate the middle way in their respective publications, which offer a carefully charted path through claim and counter claim, suggesting a common sense approach to diet and arthritis.
Both Dr Darlington and Dr Fisher are enthusiastic about elimination diets and their effects on food allergies, particularly for patients with rheumatoid arthritis. Patients exclude a certain food from their diet to try to discover if they have a food allergy. They advise people to cut out a particular product for 3–4 weeks, then start eating it again and see if it makes a difference.
For Dr Darlington, it was her discovery of dietary treatment, and its spectacular effect on a young rheumatoid patient, that led her to investigate the subject in more detail.
In her book she describes how a 14-year-old girl, referred to her in 1980, had to give up the ballet she loved because of her increasingly painful condition. The girl was becoming steadily more disabled when her mother asked Dr Darlington if she minded if her daughter were treated for arthritis with a diet, by another doctor.
Dr Darlington said that she had no objection, although she didn't think it would do much good. "Three months later," she recalls, " to my great surprise, the girl returned – not entering my consulting room slowly and painfully as before, but breezing in, wearing jodhpurs and having just returned from a riding holiday. The contrast between her state of health then and three months earlier was astounding."
Dr Darlington claims that about 36% of her patients using dietary treatment have done so well, that they were able to stop taking drugs for several years; and her claims are backed up by controlled clinical studies.
'eat a balanced diet which gives you all the vitamins and mineral you need, and which also keeps your weight down; eat more fruit and vegetables; and take regular exercise.' |
Despite her interest in diets, however, she doesn't necessarily think they the be all and end all, and doesn't advocate patients giving up their drugs. "I'm not a promoter of diets, more an adviser on diets."
The effects of food and dietary substances were now much better understood than ever before, and there were serious scientific reasons why dietary changes may be beneficial.
"I am very much on the establishment side, but I feel that the effects of diet should be investigated. When the cure for arthritis comes, then everything else becomes irrelevant, but until that day if you can use something as safe as dietary change to help people, then I am not wasting my time. And if dietary doesn't work for a patient at least they have tried it, and are then often more willing will to go back to their drugs."
Dr Fisher agrees that patient empowerment is very important. "Diet is one of the most important things you can do for yourself, and there is strong evidence that diet does make a difference, especially in the long-term – over five to ten years."
Most medics would support Dr Fisher's three golden rules of how changing your diet can help arthritis: eat a balanced diet which gives you all the vitamins and mineral you need, and which also keeps your weight down; eat more fruit and vegetables; and take regular exercise. The Diet and Arthritis booklet also contains uncontroversial advice on cutting down on fat and sugar.
Research work – including studies carried out by Professor Jill Belch at Ninewells Hospital in Dundee on an arc grant – has now shown that consuming essential fatty acids (EFAs) contained in things like fish oil and plant seed oil can reduce inflammation in patients with rheumatoid arthritis.
arc's Diet and Arthritis booklet duly recommends that patients should eat oily fish such as mackerel, pilchards, salmon and sardines, three times a week, and to take oil of evening primrose which can be found in chemists and health food shops.
What is doesn't do is give credence to unproven "miracle cures" such as coral calcium, green-lipped mussel extract and other food supplements. Nor does it claim anywhere that diet will cure arthritis. But then people can read that sort of stuff elsewhere.
What is clear is that opinion on the links between arthritis and diet are changing, and there is increasing worldwide interest in the subject. Rheumatologists might be sceptical, but as one patient remarked:" Something that you put into your body three times a day might just have an effect on it."
- Diet and Arthritis is available free of charge from arc.
- Diet and Arthritis by Dr Gail Darlington is published by Vermilion, priced £9.99, available from bookshops.
