Arthritis is a painful condition of the joints and bones. There are many different forms of arthritus; the two main types are osteoarthritis and rheumatoid arthritis. Other forms include ankylosing spondylitis, cervical spondylitis, fibromyalgia, lupus, gout, psoriatic arthritis and Reiter's syndrome.
Osteoarthritis is the most common type of arthritis in the UK, affecting 8.5 million people. Sometimes called ‘wear and tear’ arthritis, it occurs when cartilage (the strong, smooth lining covering our bones) breaks down faster than it can be repaired.
Eventually the surface of the bones rub together, causing damage. This can lead to bony growths developing around the edge of the joints and inflammation of the tissues. Osteoarthritis mostly occurs in the knees, hips and hands but can affect any joint.
It generally occurs in the over 50s, and is more common in women than men. However, it is not an inevitable part of aging. It can develop after an injury to a joint; this can happen months or even years after the injury.
There is much less research on omega-3s and osteoarthritis compared to rheumatoid arthritis (see below). However, some work indicates that omega-3s are involved. One study found that cartilage from osteoarthritis patients had higher levels of omega-6s and lower levels of omega-3s than muscle tissue from the same people. Another study showed that long chain omega-3s can reduce the level of cartilage-degrading enzymes. This raises the possibility that omega-3s can help prevent the loss of cartilage and ultimately prevent osteoarthritis.
More research on omega-3 fats and osteoarthritis is needed. Eating a healthy plant-based diet, containing a good supply of omega-3 fats (including an algal supplement if necessary), would however be a good insurance policy, rather than just waiting for the research.
Rheumatoid (inflammatory) arthritis is a more aggressive, but less common condition than osteoarthritis. It is known as an ‘autoimmune’ disease, whereby the body’s own immune system attacks the joints, causing pain and swelling and the destruction of cartilage and bone.
Rheumatoid arthritis affects around 350,000 people in the UK and like osteoarthritis, is also more common in women than men. It is most common after the age of 40, but can affect people of any age.
It is characterised by hot painful swelling in the joints. It usually starts in the wrists, hands and feet but can spread to other joints. In many diseases inflammation can help healing, but in rheumatoid arthritis, it damages. For some people the discomfort, pain and loss of mobility can have a serious impact on their lives.
Diet and arthritis
In the past, people with arthritis were told that changing their diet would not help them. Despite this, over the years, many arthritis patients have found that certain foods can help, while others can harm.
Arthritis Care, the UK’s largest voluntary organisation working with and for people with arthritis, suggest a diet high in fruit, vegetables, pasta, fish and white meat and low in fatty foods such as red meat, cream and cheese can help. Most people would benefit from eating less saturated fat and sugar and eating more complex carbohydrates, fibre, vitamins and minerals. It is clear that for many people with arthritis, a healthier diet can help considerably.
The research shows that people who eat the most red meat, white meat and meat products have the highest risk for inflammatory arthritis, while vegetarian and vegan diets can prevent and treat this and many other diseases.
Studies show that low-fat, gluten-free, vegan diets can help reduce symptoms of arthritis. Other work, looking at an uncooked vegan diet, rich in antioxidants and fibre, reduced joint stiffness and pain. Further studies show that fasting, followed by a vegetarian or vegan diet can help people with arthritis. These studies provide strong evidence that dietary modification can benefit arthritis patients and that some foods do help while others harm.
It is very important for people with arthritis to maintain a healthy weight. The extra burden on the joints, in overweight or obese arthritis patients, can make symptoms much worse. Losing weight can have a dramatic effect in improving the condition.
Vegetarian and vegan diets can help people lose weight and maintain a healthy body weight. Many studies show that vegetarians and vegans weigh less than meat-eaters; on average between six pounds and two stones less.
When losing weight, it is important to ensure a good intake of nutrients. A healthy balanced diet containing plenty of fruit and vegetables, pulses and wholegrain foods (wholemeal bread, brown rice and wholemeal pasta) provides a good supply of vitamins, minerals and fibre. A diet lacking in these foods and rich in meat,
dairy and processed foods (such as white bread, white rice and white pasta), does not provide a good source of nutrients. Find out how to achieve and maintain a healthy weight while protecting your health too in Viva!Health’s V-Plan Diet guide.
Getting the fats right
While vegetarian and vegan diets have been shown to help some people with arthritis, people who eat large amounts of red meat, dairy and processed foods may suffer more. The key point here is that plant-based diets (rich in antioxidants and omega-3 fats) are helpful, whereas Western diets (rich in meat, dairy and processed foods) contain harmful saturated fat which can increase the pain and inflammation of arthritis. The fact that people also lose weight on a plant-based diet is an added bonus.
Omega-6 fats don’t appear to help people with arthritis. In fact, they may increase inflammation by competing with omega-3 fats. Most people have diets which already contain more omega-6 than they need. If you have arthritis, it may be helpful to replace some of the omega-6 fats (found in sunflower oil, corn oil and products made from them such as margarine) with omega-3 fats from flaxseed, hempseed and rapeseed oils and walnuts. Omega-3s from these sources will ensure you get this healthy fat without exposing your body to the harmful toxins found in oily fish. For an extra boost, you can take omega-3 algal supplements.
People with gout are advised not to eat oily fish. Gout is a type of arthritis caused by a high level of uric acid in the body which can crystallise in the joints and cause severe pain and inflammation. Uric acid is produced from the breakdown of foods high in substances called purines. Such foods include certain meats (kidney, liver, veal, turkey and venison) and fish (anchovies, herring, mackerel, sardines, fish roes, mussels and scallops).
To avoid foods high in purines, replace animal-based foods with other sources of protein such as pulses, nuts and seeds. Other dietary measures for gout include losing weight (if you are overweight) and avoiding excessive alcohol consumption.
A well-balanced healthy diet can help if you are taking strong drugs for arthritis. In fact, it could help protect against some of the side-effects. For example steroids (such as prednisolone), can cause osteoporosis, particularly if you stay on them for a long time. Plenty of calcium in your diet will help reduce the risk.
Arthritis Care warns that some people with arthritis have an increased risk of osteoporosis and say that ensuring a good calcium intake is very important. While cow’s milk and dairy products are indeed a source of calcium, they are not the best. This is because they contain animal protein. Excessive amounts of animal protein can upset the acid balance within the body, which then takes calcium from the bones to neutralise the acid. Even the usually pro-dairy National Osteoporosis Society says that it is a good idea to avoid too much protein, particularly animal protein such as meat and cheese. It is also a good idea to avoid too much salt, fizzy drinks and caffeine for the same reason.
Healthy sources of calcium include green leafy vegetables (broccoli, kale, spring greens, cabbage, parsley and watercress – but not spinach), dried fruits (figs and dates), nuts (almonds and Brazil nuts), seeds (sesame seeds and tahini – sesame seed paste) and pulses (peas, beans, lentils and soya products such as calcium-set tofu and calcium-enriched soya milk). For more information on calcium see Viva!Health’s fact sheet Boning up on Calcium.
Some people with arthritis may be concerned about their iron intake, particularly (they may be told) if they have decided not to eat red meat. This should not be a concern as the British Medical Association and the American Dietetic Association agree that vegetarians are no more likely to suffer from iron deficiency than meat-eaters. Indeed one of the largest studies of vegetarians and vegans in the world found that the vegans had the highest intake of iron, followed by the vegetarians and then the meat-eaters.
Good sources of iron include pulses, dried fruits and green leafy vegetables.
Unlike iron from plant foods, the iron in meat is absorbed into the body whether it is needed or not. Thus meat can supply an overload of iron (but no vitamin C and very little vitamin E). Excessive iron in the diet can increase production of harmful molecules called free radicals (see Antioxidant action, page 20) linked to heart disease, cancer and other diseases. Conversely, vegetables and wholegrain foods can supply as much, or as little iron as is required, as well as an abundance of antioxidant vitamins and other nutrients.
For more information on iron see the Viva!Health’s fact sheet Ironing out the Facts.
The antioxidant vitamins A, C and E protect against disease (and aging) by ‘mopping up’ harmful free radicals, produced as your body breaks down food or when it is exposed to harmful chemicals (including cigarette smoke). Free radicals play a role in the development of many diseases. They do this by causing a sequence of events (rather like a line of dominos falling down) which can ultimately result in cancer, heart disease or arthritis.
Anti-rheumatic drugs may work by acting as antioxidants. For example, non-steroidal anti-inflammatory drugs act as free radical ‘scavengers’ mopping up free radicals. However, antioxidants may be more useful in preventing damage before it occurs, rather than treating an already inflamed joint. A plant-based diet, rich in a wide range of brightly coloured fruit and vegetables (such as sweet potato, red cabbage, carrots, blueberries and so on) will provide an abundance of disease-busting antioxidants that will fight off many diseases, not just arthritis.
For some people with arthritis, omega-3 supplements may be helpful, for example a tablespoon of flaxseed oil twice a day (this exceeds the 1-2 teaspoon-a-day recommendation for normal consumption). If it is helpful, it is a good idea to try to reduce your intake to the lowest effective dose.
Some arthritis patients have benefited from taking a herbal remedy isolated from rose-hips. In one study, the rosehip remedy reduced pain so much after just three weeks that patients were able to reduce their intake of painkillers and non-steroidal anti-inflammatory drugs. This result compares favourably with glucosamine, currently the most popular supplement for joint health.
Losing weight and eating a healthy plantbased diet that includes a good supply of omega-3 fatty acids (either through foods or algal supplements) and antioxidants can
help reduce the symptoms of arthritis and may help some people reduce the amount of medication they are taking.