Your joints thrive on the same healthy diet as your heart and brain, with plenty of fresh fruit, vegetables, nuts, seeds, and oily fish (eg salmon, fresh tuna, mackerel, herrings, sardines, pilchards).
Eat more fruit and vegetables
My first Golden Rule for arthritis is to eat at least five (and preferably more) servings of fruit and vegetables per day. These provide an array of vitamins, minerals and antioxidants that are beneficial for all types of joint pain and swelling, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and gout.
Fruit and vegetables are the main dietary source of vitamin C, for example, which is needed for collagen synthesis in cartilage, as well as for it’s anti-inflammatory antioxidant effects. Vitamin C reduces the rate at which cartilage breaks down, and people with moderate to high intakes (two or more times the recommended daily amount from dietary sources) are three times less likely to develop knee pain or see their knee osteoarthritis progress than those with low intakes of vitamin C (up to about twice the recommended daily amount).
Eat an apple a day for their anti-inflammatory polyphenols. One large apple (100g) provides the same benefits against inflamed joints as 1,500 milligrams of vitamin C. Wash but don’t peel your apples – the polyphenols are five times more concentrated in the skin than the flesh.
Avocado supplies unique anti-inflammatory substances that suppress joint inflammation by reducing production of inflammatory cytokines. These have been found to promote the repair of cartilage in osteoarthritis by stimulating the activity of osteoblasts (bone-building cells) and chondrocytes (cartilage cells).
Olive oil is best for cooking as it is a rich source of anti-inflammatory substances such as oleic acid, oleuropein, tyrosol, hydroxytyrosol and vitamin E. Greek studies suggest that those with greater olive oil consumption are over a third less likely to develop RA. Olive oil may also protect against osteoarthritis.
Brazil nuts are the richest dietary source of selenium – a single brazil nut typically contains at least 50mcg. Selenium improves the quality of cartilage proteins.
Curry spices such as anise, chilli, cloves, cumin, fennel, ginger, mustard and turmeric, whose anti-inflammatory, pain-killing action can reduce inflammation and improve arthritis pain in a similar way to aspirin. Curry spices can modulate the activation of immune cells and reduce expression of inflammatory cytokines such as TNF-alpha, NF-kappaB and interleukins. Turmeric contains curcumin, which reduces cartilage destruction in osteoarthritis, and is as effective as ibuprofen for reducing joint pain. Some people are sensitive to chilli peppers however which are a member of the nightshade family (see below – Foods to avoid).
Dark green leafy vegetables such as kale, broccoli, spinach, spring greens, dark green cabbage and parsley supply antioxidant polyphenols, vitamins and minerals with anti-inflammatory actions. A high intake of these vegetables seems to protect against arthritis, as they contain polyphenols, such as sulforaphane, which protects cartilage from breaking down.
Dark, blue-red pigmented fruits (eg cherries, grapes, blueberries, bilberries, blackberries, dark raspberries, elderberries) supply anthocyanin polyphenols that lower levels of inflammatory cytokines such as TNF-alpha. Regular intakes also lower uric acid levels to prevent gout.
Yellow/orange fruit & vegetables such as carrots, sweet potatoes, guava, mango and pumpkin are rich sources of vitamin C and antioxidant carotenoids that reduce inflammation. Fruit and vegetables with a high antioxidant content can reduce pain and inflammation in all types of arthritis.
Onions are rich source of polyphenols and thiosulfinates that suppress the production of inflammatory cytokines to reduce inflammation. Red onions have the highest content of antioxidants.
Pomegranate is a rich source of antioxidant polyphenols, vitamin C, vitamin E and carotenoids. Its anti-oxidant potential is two or three times higher than that of red wine and green tea. Ellagic acid in pomegranate juice reduces inflammation by blocking activation of inflammatory cytokines such as NF-kappaB and IL-1b which play a key role in cartilage degradation in osteoarthritis.
Soy beans contain antioxidant isoflavones (genistein, daidzein, formononetin, biochanin A and glycitein) that have a beneficial oestrogen-like action to strengthen bones. Soy suppresses joint inflammation and pain. It blocks production of inflammatory cytokines in joints and promotes repair of cartilage in osteoarthritis by stimulating the activity of osteoblasts (bone-building cells) and chondrocytes (cartilage cells).
Walnuts are a rich source of omega-3 fatty acids with an anti-inflammatory action and eating walnuts daily may provide additional benefits for people with rheumatoid arthritis.
Eat More Oily Fish
My second Golden Rule for arthritis is to eat oily fish (eg salmon, sardines, herrings, mackerel) two to four times a week or take omega-3 fish oil supplements.
Fish oils provide two long-chain, omega-3 fatty acids, EPA and DHA, which are converted in the body into substances (series 3 prostaglandins and series 5 leukotrienes) that balance the inflammatory action of omega-6 fatty acids (mostly derived from vegetables oils such as sunflower, safflower and corn oils) to reduce inflammation, joint pain and swelling. A number of studies show that fish oil supplements can reduce the need for prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) in people with osteoarthritis or rheumatoid arthritis. Fish oils are also a source of vitamin D, which has protective effects against joint degeneration and autoimmune conditions.
A large analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in rheumatoid and other autoimmune forms of arthritis showed they significantly reduce joint pain intensity, duration of morning stiffness, number of painful joints and need to take NSAID painkillers – all within 3 to 4 months.
More than two servings of grilled or baked fish per week halves the risk of developing RA compared to those eating less than one serving.
If you eat fish regularly, a dose of 500mg to 1g per day is ideal. If you rarely eat fish, higher doses of 2.7g per day or more may be needed for a good, anti-inflammatory effect.
These fish oils will also help to offset the increased risk of heart disease associated with inflammatoryconditions such as rheumatoid arthritis. Click here to read my review of the best fish oil supplements for heart/joint health.
Drink sufficient fluids
My third Golden Rule is to drink 2 to 3 litres of fluids per day (including water, soups, tea, juices) to maintain good hydration and flow of nutrients to your joints.
White, green, oolong and black teas contain high levels of antioxidant catechins such as epigallocatechin-3-gallate (EGCG) which inhibit the production of inflammatory mediators in arthritic joints and helps to protect joint cartilage from breaking down.
Lose at least some excess weight
For every kilogram of excess weight you lose, the overall force across your knees, when walking or standing, will reduce by two to three kilograms. As a result, overweight people who successfully lose 5 kg in weight can halve their risk of developing knee osteoarthritis over the next 10 years. This is especially important if you store fat around your waist and internal organs. This visceral fat produces inflammatory substances which can make symptoms of pain and stiffness worse.
What about foods to avoid?
A number of foods have the potential to trigger pain in some people with arthritis. Some reactions are due to an idiosyncratic food intolerance, while others upset a significant number of people.
If you can identify and eliminate the particular foods that bring on your symptoms, your arthritis may improve. The foods most commonly found to worsen arthritis symptoms are: wheat, corn, rye, sugar, caffeine, yeast, malt, dairy products, oranges, grapefruit, lemons and tomatoes.
Keeping a food and symptom diary can help to pinpoint foods that provoke your symptoms. This is not always easy, however, as a flare-up in symptoms can occur 24 to 36 hours after eating the culprit food. Following an ‘elimination and challenge’ diet under the supervision of a nutritionist is the best approach.
An elimination and challenge diet involves following a bland, hypoallergenic diet that includes only a few, limited foods that are least associated with joint inflammation, such as:
- Grains: White rice, tapioca
- Fruits: Pears, pear juice, cranberries
- Vegetables: Squash, carrots, parsnips, lettuce, lentils, split peas
- Meat: wild game, turkey
Once symptoms have improved, you start re-introducing eliminated foods one by one, usually at three-day intervals, while keeping a careful food and symptom diary to help identify problem foods. If symptoms flare up, you continue to avoid that food and wait until your symptoms have improved before testing another food. If the test food does not trigger joint pain, you can add it to the list of foods you can eat, and test another food.
Eliminating nightshade plants
Some people with arthritis believe they are sensitive to the small amounts of glycoalkaloids present in plants of the nightshade family, such as potatoes, tomatoes, bell peppers, chilli, physalis and eggplant/aubergines. Why these cause joint pain and stiffness to worsen is not fully understood, but suggestions include cell-mediated immune reactions, alterations in calcium metabolism and adverse effects on intestinal permeability that allow other food components to trigger inflammatory reactions.
It takes more than 24 hours to clear ingested glycoalkaloids from the body, and if you eat these foods regularly, it is possible for these to accumulate to cause symptoms. Unlike many other plant toxins, steroidal glycoalkaloids are not broken down or detoxified by cooking, baking, or frying which does, in fact, concentrate them. This may explain why eating small amounts of nightshade foods infrequently does not trigger a flare-up, but eating a large amount, or regular consumption, does.
Research dating back to 1979 suggests that eliminating these foods can improve arthritis symptoms in over 70% of people osteoarthritis, rheumatoid arthritis, and other joint problems such as gout. There are no modern studies to confirm this, however, and it remains controversial. If you have persistent joint pain you may want to eliminate ‘nightshade’ foods from your diet for two or three weeks to see if you notice a benefit.
Population-based studies have found associations between national consumption of meat products and an increased risk of developing osteoarthritis or rheumatoid arthritis. If you decide to follow a vegetarian or vegan diet, don’t just cut out meat, but substitute it with other good sources of protein, and consider taking a supplement supplying vitamins B12 and D, iron and zinc which can be difficult to obtain on a plant-based diet. Seek advice from the national Vegetarian Society in your home country.
Eliminating purine-rich foods
Gout is an inflammatory arthritis caused by high levels of uric acid. These precipitate out into joints and tissues as needle-like crystals that produce severe inflammation and pain.
Most uric acid is produced in the body during the breakdown of purines released when the genetic material (DNA) of worn out cells is recycled. Dietary changes can lower uric acid levels by up to 20%, however, and usual advice is to reduce your intake of purine-rich foods: offal, shellfish, oily fish, game, meats, yeast-extracts, asparagus, and spinach. I also suggest that you avoid alcohol which both increases uric acid production and reduces its excretion – especially beer which is also rich in purines.
Eat a high-fibre, mainly vegetarian diet, with plenty of fruit and vegetables.
Dark blue-red pigmented fruits (eg cherries, grapes, blueberries, bilberries) contain antioxidants such as anthocyanidins that can lower uric acid levels contain anthocyanidins that can prevent gout when around 250g are eaten daily.
Drinking at least 2 litres of water a day helps to keep uric acid dissolved (so it cannot crystallise out into joints and tissues) and also reduces the formation of urate kidney stones.
Use pain relieving creams and gels
Topical treatments applied over a painful joint can sink into the skin to reduce pain perception. These are at least as effective as oral painkillers, and have less risk of producing side effects. Click here to read my review of pain-relieving creams and gels for arthritis.
|My book, Overcoming Arthritis, covers all the above nutritional approaches in three, easy-to follow programs. It also includes information on complementary treatments from osteopathy, yoga and hydrotherapy, to copper bracelets, magnetic therapy and meditation.
My daily nutritional plans, exercise routines, therapeutic techniques and lifestyle changes can make a real difference to your joint symptoms.
Image credits: daxiao productions/Shutterstock;