Arthritis diet

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

One of the most intriguing questions that remains unanswered is “What is the role of diet in arthritis?”

For some types of arthritis conditions, the relationship is concrete. For instance, in patients who have osteoarthritis involving weight-bearing joints such as the low back, hips, and knees, it does not take a rocket scientist to know that if the patient is overweight, they need to lose it.

Gout is a type of arthritic condition that is clearly diet related. Restriction of dietary purines is a mainstay in treatment.

For other types of arthritis though, diet is now beginning to be scrutinized more.

Mainstream groups like the Arthritis Foundation and the American College of Rheumatology have long held the position that dietary cures for arthritis were quackery. But they have recently been forced to alter their position in light of evidence that dietary approaches may make a difference.

Dietary "cures" for RA, and even osteoarthritis, have long been advocated by alternative therapy groups. Researchers have compiled scientific data from as far back as 1911, with studies showing that restricted diet programs could produce remission of arthritis. The subject is a difficult one to examine in non-controlled fashion because of the natural variability of the disease. Since arthritis symptoms are subject to so many variables, this variability itself may explain why not all patients respond to dietary intervention alone.

Patients who are obese must make dietary changes. Experimental trials have shown that if arthritis patients go on a hypoallergenic diet in which common food allergens are eliminated and substituted by a neutral synthetic food supplements (e.g., Vivonex), their symptom scores improve markedly. Some studies have demonstrated the value of specific allergy testing of the skin or the blood to predict which food should be eliminated. Other studies have underscored the value of a low-fat diet based largely on fresh fruits, vegetables, cereal grains, and legumes. Some trials have produced benefits when patients eliminate cereal grains altogether and emphasize proteins rich in polyunsaturated fat, such as fish and nuts. These low-carbohydrate diets may help because they suppress growth of harmful or immune-active intestinal bacteria.

The theory is that foods contain allergens that the body is constantly trying to fight or adapt to. Some of these allergens are natural; others come from additives. In any event, finding the foods that stimulate symptoms is one of the first steps patients with arthritis should take.

There are many food allergies that can possibly aggravate RA symptoms. Among the most common foods are wheat, corn, milk and other dairy products, and beef. If a patient has had allergies as a child, if there is a family history of allergies, if the patient developed sensitivities in recent years, food allergies could be causing RA symptoms. In order to discover exactly what foods are the culprit, the best approach is an allergy-elimination diet.

Much has been written regarding the role of the nightshade family of foods. The connection between rheumatoid arthritis and these foods was originally made by Childers, a horticulturist, who found that eliminating foods of the nightshade family cured his arthritis. While his theory--that long-term consumption of the alkaloids in potatoes, tomatoes, eggplant, peppers, paprika, cayenne, and tobacco inhibit collagen and cartilage repair--has never been proven, it is true that some patients find relief from their symptoms when they eliminate these foods. There is an animal model for arthritis: if cows are mistakenly given fodder that is heavily laced with wild-growing nightshade family plants, they actually develop a type of osteoarthritis. Anyone who suffers from arthritis could try avoiding these foods for a month and then gradually reintroducing them to see whether they affect the symptoms.

It's interesting to note that people who eat a more "primitive" diet--one containing fewer refined foods and foods with additives--than the standard American diet have a lower incidence of rheumatoid arthritis. This indicates that perhaps dietary changes may make sense. Modify your diet to reduce sugar, saturated fat, meats, and refined carbohydrates. Increase the amounts of fresh fruits and vegetables, whole grains, and unrefined carbohydrates. Some patients have found that becoming a vegetarian significantly reduces their symptoms. One study tested a one-week fast followed by a year of a lactovegetarian diet in a controll test group. The group on the vegetarian diet found significant improvement in joint tenderness, swollen joints, pain, duration of morning stiffness, grip strength, and white blood count, among others. The control group found that only their pain improved significantly. The benefits for the vegetarian group were still present after a year.

Some patients report a good result when they significantly lower the fat in their diet. This reaction was discovered accidently by researchers at Wayne State University in Detroit who were working with obese women, two of whom suffered from rheumatoid arthritis. While on the low-fat diet, both women experienced a complete remission of their symptoms. They stayed on the diet for up to fourteen months without symptoms, but when they ate any fatty foods, their pain and stiffness returned within a day or two. Elimination of animal and vegetable fats may be helpful. Dietary fish oils though are OK.

Some patients find relief with an occasional fast of no more than four days. No one knows exactly why fasting helps. Fasting has been shown to be therapeutic in some cases for both osteoarthritis and RA. One theory is that fasting allows the body to detoxify and offers a break from the onslaught of food antigens that may trigger joint inflammation. This traditional therapy seems to work in many cases – a patient goes on a fast and their arthritis gets better. It may help because of food intolerances, or it may allow the gut to stop supporting the growth of certain harmful bacteria or fungi that produce toxic byproducts that somehow trigger the arthritis.

In the "leaky gut syndrome," a stressed intestinal tract may become permeable to microscopic food protein particles, allowing them to enter the bloodstream and set up an immune reaction in the tissue. An overgrowth of harmful intestinal bacteria or yeast, otherwise known as dysbiosis, may compound the problem. Detoxification regimens sometimes use fibers like psyllium or absorbent clays like bentonite, with or without the assistance of colonic irrigations or enemas. It may also help to replace harmful intestinal flora with cultures of benign bacteria like Lactobacillus acidophilus from yogurt or supplements So, fasting eliminates the source of any food allergies, but there also seems to be some connection with fasting and the suppression of the immune system that fights rheumatoid arthritis symptoms. One method is to go on a vegetable juice fast for three or four days if symptoms are severe, making sure that the vegetable juices contain no nightshade. (Check with your doctor to determine whether fasting would be appropriate for you).

Several nutrients affect arthritic symptoms, some by reducing inflammation and others by retarding the degeneration of cartilage or normalizing immune reactions.

The omega-3 oils, present in flaxseed oil and in cold-water fish, such as tuna, salmon, herring, trout, mackerel, sardines, and cod liver, are especially helpful in relieving morning stiffness and tender joints. GLA (gamma-linolenic acid), an omega-6 oil that is present in primrose oil, borage oil, and black currant seed oil, has been shown to augment the anti-inflammatory effect of the omega-3 oils.

Researchers at the Department of Epidemiology, University of Athens Medical School, Greece examined the relation between diet and the risk of rheumatoid arthritis (RA) in persons from southern Greece. The results of their study suggest that eating hearty amounts of cooked vegetables and olive oil may significantly reduce the risk of developing RA, a chronic inflammatory disease of the joints. The cause of RA is unknown, but genes, infectious agents, hormones, and diet have all been suggested as possible causes.

Researchers studied 145 RA patients and 188 control subjects who responded to an interviewer-administered food-frequency questionnaire that assessed their consumption of a wide variety of foods. In this study, consumption of both cooked vegetables and olive oil was found to be inversely associated with risk of rheumatoid arthritis, meaning that individuals whose diets included higher amounts of cooked vegetables and olive oil had a lower risk of developing RA. Those individuals who regularly consumed both cooked vegetables and olive oil had the lowest risk for RA.

Investigators found that people who consumed the least olive oil were 2.5 times more likely to develop rheumatoid arthritis compared to those who consumed the most of this healthful oil. Additionally, those who consumed the most cooked vegetables had a 75% lower risk of developing rheumatoid arthritis.

Although the underlying mechanisms by which cooked vegetables and virgin olive oil lower RA risk remains unclear, the authors theorize that when vegetables are cooked, the heat destroys the vegetables’ cell walls, making it easier for the body to absorb their beneficial substances. They also suggest that both the antioxidant properties and high monounsaturated fatty acid content of olive oil might play a protective role.

Most people are aware of the many antioxidants in vegetables, but it is less well known that olive oil is rich in vitamin E, one of the body’s most important free radical quenchers. Free radicals are destructive molecules that are involved not only in RA, but also in many chronic diseases as well as aging. Additionally, both saturated fats and vegetable oils high in omega-6 fats are used by the body to produce hormone-like substances called Series 2 prostaglandins that promote inflammation. In contrast, the monounsaturated fats in virgin olive oil are not used to create these inflammatory prostaglandins. Plus in addition to vitamin E, virgin olive oil contains polyphenolic compounds that have been shown to have both anti-inflammatory and antioxidative effects. So, when olive oil is consumed instead of these other pro-inflammatory fats, the result is a significant lessening in inflammatory processes.

Western herbs may be beneficial in the treatment of arthritis. It's worth remembering that the discovery of aspirin was predicated on the traditional folk wisdom that the bark of the white willow could reduce aches and pains. White willow bark is high in salicylate acid, the active ingredient of aspirin. Herbs that can play an important role in treating arthritis include curcumin (extracted from the spice turmeric), Jamaican dogwood, feverfew, devil's claw, licorice, ginger, and yucca. Many are available in easy-to-use alcohol or glycerine tinctures or in an encapsulated freeze-dried form. Capsaicin, an extract of cayenne pepper, is a topical counterirritant cream that provides relief from joint pain. It's an alternative to the traditional menthol-containing ointments and may be slightly more effective for some.

Natural therapies like antioxidants, the omega-3 and omega-6 oils, and others do not provide instantaneous pain relief, but they do gradually alter the underlying physiology of inflammation and may be safer than conventional arthritis medicines in the long run. This highlights the divergence between the conventional medical approach and the alternative approach. Since alternative therapies don't relieve pain so quickly, patients may have to be willing to tough it. If they do get good results, then the outcome may be more gratifying.

A particularly useful test is the food allergy panel run by Immunolabs of Fort Lauderdale, Florida. This is an excellent test that identifies the presence of food allergies. It is accompanied by a suggested four day rotation elimination diet.


References:

Linos A, Kaklamani VG, Kaklamani E, Koumantaki Y, Giziaki E, Papazoglou S, Mantzoros CS. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am J Clin Nutr1999 Dec;70(6):1077-82.

Patrick L, Uzick M. Cardiovascular disease: C-reactive protein and the inflammatory disease paradigm: HMG-CoA reductase inhibitors, alpha-tocopherol, red yeast rice, and olive oil polyphenols. A review of the literature. Altern Med Rev 2001 Jun;6(3):248-71

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