by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known 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. This is because of both mechanical factors as well as recent research indicating that fat cells produce leptins, substances that aggravate inflammation.
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 arthritis symptoms. This variability may explain why not all patients respond to dietary intervention alone.
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, their symptom scores improve. 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. Gut bacteria have been implicated as a cause of arthritis.
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 provoke symptoms is an important first step.
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. Anyone who suffers from arthritis could try avoiding these foods for a month and then gradually reintroduce them to see whether they affect the symptoms.
Some people who eat a "primitive" diet--one containing fewer refined foods and foods with additives--than the standard American diet have a lower incidence of rheumatoid arthritis. To do this, you can 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.
Vegan diets have been shown to reduce the risk of atherosclerotic cardiovascular disease and also may have beneficial effects on inflammatory arthritis.
Some patients report a good result when they significantly lower the fat in their diet. 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. 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," the intestinal tract is permeable to microscopic food protein particles, letting them enter the bloodstream and set up an immune reaction in the tissue. While this is a controversial topic, it may explain the connection between gut bacteria and inflammatory arthritis. There also seems to be a tenuous connection with fasting and the suppression of the autoimmune reaction that leads to rheumatoid arthritis symptoms.
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.
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. 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.
Herbs may be beneficial in the treatment of arthritis. It's worth remembering that the discovery of aspirin was discovered because 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 may play an important role in treating arthritis include curcumin (extracted from the spice turmeric), Jamaican dogwood, feverfew, devil's claw, licorice, ginger, and yucca. 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.
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.
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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