Arthritis
Preventive Medicine and Nutrition
Physicians For Responsible Medicine
Foods and Arthritis
Millions of people suffer from painful and swollen joints associated with arthritis. In the past, many doctors told arthritis patients that dietary changes would not help them. However, this conclusion was based on older research with diets that included dairy products, oil, poultry, or meat.1,2 New research shows that foods may be a more frequent contributor to arthritis than is commonly recognized. It is clear that, at least for some people, a healthier menu is the answer.
Different Types of Arthritis
Arthritis is actually a group of different diseases. Osteoarthritis is a gradual loss of cartilage and overgrowth of bone in the joints, especially the knees, hips, spine, and fingertips. At least 85 percent of the population above the age of 70 has osteoarthritis, which seems to be the result of accumulated wear and tear. Although it can cause painful episodes, it is characterized by only transient stiffness and does not cause major interference with the use of the hands.
Rheumatoid arthritis, which affects over 2 million people, is a more aggressive form of the disease. It causes painful, inflamed joints, which sometimes become damaged.
Rheumatoid arthritis is one of medicine's mysteries. There were no medical reports of the disease until the early 1800s. Some have suspected that a virus or bacterium may play a role, perhaps by setting off an autoimmune reaction. Genetics may also be a factor, in that it may influence susceptibility to the disease.
The Role of Diet
For years people have suspected that foods are an important factor in the development of rheumatoid arthritis. Many notice an improvement in their condition when they avoid dairy products, citrus fruits, tomatoes, eggplant and certain other foods.
Initially, the evidence was anecdotal. A woman from the Midwest once suffered from painful arthritis. Today she is a picture of health, thin and athletic, and her arthritis is totally gone. It seemed that dairy products were to blame for her arthritis, for when she eliminated them from her diet, the arthritis disappeared completely.
Another woman, from Wisconsin, also found that her arthritis was clearly linked to dairy products. Although she had been raised on a dairy farm, she learned that staying away from dairy products was the key to relieving her symptoms.
A 1989 survey of over one thousand arthritis patients revealed that the foods most commonly believed to worsen the condition were red meat, sugar, fats, salt, caffeine, and nightshade plants (e.g., tomatoes, eggplant).3 Once the offending food is eliminated completely, improvement usually comes within a few weeks. Dairy foods are probably the principle offender, and the problem is the dairy protein, rather than the fat, so skim products are as much a problem as whole milk.4
An increasing volume of research shows that certain dietary changes do in fact help. For example, polyunsaturated oils and omega-3 supplements have a mild beneficial effect, and researchers have found that vegan diets are beneficial.5 Several studies have also shown that supervised fasting can be helpful.6
Vegan diets dramatically reduce the overall amount of fat in the diet, and alter the composition of fats. This in turn can affect the immune processes that influence arthritis. The omega-3 fatty acids in vegetables may be a key factor, along with the near absence of saturated fat. The fact that patients also lose weight on a vegan diet contributes to the improvement.
In addition, vegetables are rich in antioxidants, which can neutralize free radicals. Oxygen free radicals attack many parts of the body and contribute to heart disease and cancer, and intensify the aging processes generally, including of the joints.
Iron acts as a catalyst, encouraging the production of these dangerous molecules. Vitamins C and E, which are plentiful in a diet made of vegetables and grains, help neutralize free radicals. Meats supply an overload of iron, no vitamin C, and very little vitamin E, whereas vegetables contain more controlled amounts of iron, and generous quantities of antioxidant vitamins.
As well as being helpful in preventing arthritis, antioxidants may also have a role in reducing its symptoms. Some arthritis treatments, including non-steroidal anti-inflammatory drugs, work at least in part by neutralizing free radicals. For the most part, however, vitamins and other antioxidants will be of more use in preventing damage before it occurs, rather than in treating an inflamed joint.7
A diet drawn from fruits, vegetables, grains, and beans therefore appears to be helpful in preventing and, in come cases, ameliorating arthritis.
A Case Study
A team of Scandinavian researchers hit upon a regimen that produced significant improvements in rheumatoid arthritis.6 The number of tender or swollen joints diminished, morning stiffness decreased, and grip strength improved, as did blood tests used in the assessment of arthritis, although X-rays of the joints did not. The program was carefully tested in comparison with standard medical treatment. The Lancet, a prominent British medical journal, published the report as its lead article on October 12, 1991. The research team used the following treatment program:
The patients first began a modified fast for seven to ten days. During this period, they consumed herbal teas, garlic, vegetable broths, and juice extracts from carrots, beets, and celery. No fruit juices were allowed.
After the fast, the patients reintroduced a “new” food item to their diet every other day. If they had any worsening of symptoms during the following two days, this item was eliminated for at least seven days. If the item was introduced again, and caused worsening of symptoms, it was omitted permanently.
For the first three to five months, they eliminated meat, fish, eggs, dairy products, gluten (a wheat product), refined sugar, and citrus fruits. In addition, salt, strong spices, preservatives, alcoholic beverages, tea, and coffee were to be avoided, but would be re-eliminated if they produced symptoms.
Other Approaches
For some arthritis patients, supplements of certain essential fatty acids have been helpful. They should be thought of as a medicine, rather than a food. A typical regimen would include a tablespoon of flaxseed oil with 500 mg of blackcurrant oil (or three capsules of evening primrose oil) twice each day. If it is helpful, it should be reduced to the lowest effective dose. Some people also benefit from an herb called feverfew, taken two to three times per day. (Caution: Do not take feverfew if you are pregnant.)
These supplements are available in health food stores.
References
1. Panush RS, Carter RL, Katz P, Kowsari B, Longley S, Finnie S. Diet therapy for rheumatoid arthritis. Arthritis and Rheumatism 1983;26:462-71.
2. Lithell H, Bruce A, Gustafsson IB, et al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol 1983;63:397-403.
3. Sobel D. Arthritis: What Works. New York, St. Martin's Press, 1989.
4. Skoldstam L, Larsson L, Lindstrom FD. Effects of fasting and lactovegetarian diet on rheumatoid arthritis. Scand J Rheumatol 1979;8:249-55.
5. Skoldstam L. Fasting and vegan diet in rheumatoid arthritis. Scand J Rheumatol 1986;15:219-23.
6. Kjeldson-Kragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:889-902.
7. Merry P, Grootveld M, Lunec J, Blake DR. Oxidative damage to lipids within the inflamed human joint provides evidence of radical-mediated hypoxic-reperfusion injury. Am J Clin Nutr 1991;53:362S-9S.