Millions of people in the UK experience some form of musculoskeletal problem each year. Around nine million people seek help from their GP each year, of these, more than two million have osteoarthritis and more than 350,000 have rheumatoid arthritis. About 15,000 children and adolescents suffer from juvenile forms of arthritis (Arthritis Research UK, 2013).
Osteoarthritis, the most common form of arthritis in the UK, affects an estimated 8.5 million people and often develops in people who are over 50 years of age (NHS Choices, 2012d). Osteoarthritis is a degenerative disease where articular cartilage gradually becomes thinner as its renewal does not keep pace with its breakdown. Eventually the bony articular surfaces come into contact and the bones begin to degenerate. Osteoarthritis can develop after an injury to a joint; this can happen months or even years after the injury. The most frequently affected joints are in the hands, knees, feet, hips and spine.
The next most common type of arthritis is rheumatoid arthritis, a chronic inflammatory disease of the joints. In the UK, rheumatoid arthritis affects around 400,000 people and often starts in people between the ages of 40 and 50 years old. Women are three times more likely to be affected by the condition than men. (NHS Choices, 2012d). Rheumatoid arthritis is a chronic condition characterised by hot painful swelling in the joints. In many diseases inflammation can help towards healing but in rheumatoid arthritis it tends to cause damage. For some people the pain and discomfort caused by this condition has a serious impact on their lives. Rheumatoid arthritis is thought to be an autoimmune disease, caused by a fault in the immune system that causes the body to attack its own tissues. This condition usually starts in the wrists, hands and feet but can spread to other joints in the body.
Other forms of arthritis include: ankylosing spondylitis, cervical spondylitis, fibromyalgia, lupus, gout, psoriatic arthritis, reactive arthritis, secondary arthritis and polymyalgia rheumatica (NHS Choices, 2012d). In the UK, about 12,000 children under 16 years of age have arthritis. Most types of childhood arthritis are referred to as juvenile idiopathic arthritis and although the exact causes are unknown, the symptoms often improve as a child gets older, allowing them to lead a normal life (NHS Choices, 2012d).
There has been a general reluctance to acknowledge the links between diet and arthritis with a tendency to dismiss anecdotal evidence. However, studies show that people who eat a lot of red meat may have a higher risk of developing inflammatory types of arthritis. It has also been suggested that dairy may trigger an inappropriate autoimmune response in some people who may then go on to develop rheumatoid arthritis via a mechanism called molecular mimicry. This may occur when antibodies react to a protein in cow’s milk called bovine serum albumin, mistaking it for an antigen or foreign protein.
Some studies have looked at the effects of a vegan diet on the symptoms of arthritis. A single-blind dietary intervention study investigated the effects of a very low-fat, vegan diet on patients with rheumatoid arthritis (McDougall et al., 2002). This study evaluated the influence of a four-week, low-fat, vegan diet on 24 people with rheumatoid arthritis. The results showed a significant decrease in symptoms. The degree of pain dramatically reduced; limitation in ability to function improved, joint tenderness and joint swelling significantly decreased. The severity of morning stiffness improved, the only thing not to improve was the duration of the morning stiffness. The researchers concluded that patients with moderate-to-severe rheumatoid arthritis, who switch to a very low-fat, vegan diet can experience significant reductions in their symptoms.
It is now accepted that the Mediterranean diet can help people with arthritis as well as a number of other conditions. This diet includes plenty of fruit and vegetables, fish, grains and pulses and a moderate amount of red meat. Foods rich in omega-3 are believed to have an anti-inflammatory effect, which may reduce the pain associated with inflamed joints. Omega-3 is found in nuts and seeds (particularly linseed or flax seed) and is regularly used to fortify margarines. (It is also found in oily fish but oily fish also contains PCBs, dioxins and other toxins that are best avoided by opting for plant-based sources of omega-3s.) It is important for people with arthritis to maintain a healthy well-balanced diet. Arthritis Care (the UK’s largest voluntary organisation working with and for people with arthritis) suggest a diet high in fruit, vegetables, starch and fibre and low in fatty foods, salt and added sugars can help (Arthritis Care, 2011).
Some research suggests a high intake of fruit and vegetables may prevent or slow down osteoarthritis. Sulforaphane, a chemical found in vegetables such as broccoli, has been reported to have antiinflammatory properties, may protect against a form of inflammatory arthritis and reduce the production of enzymes that contribute to the breakdown of cartilage. Indeed a recent study from the University of East Anglia looked at human cartilage cells treated with cytokines and found that sulforaphane reduced the production of enzymes involved in cartilage damage (Davidson et al., 2013). This suggests that sulforaphane could help reduce cartilage damage and prevent or slow the progression of arthritis. Most people could benefit from eating more fruit and vegetables, complex carbohydrates, fibre, vitamins and minerals and less sugar and saturated fat.
If you suffer from arthritis it is important to keep as healthy as possible by ensuring that the diet provides all the important nutrients including minerals such as calcium and iron. Some people are concerned that their calcium intake may drop if they cut out dairy foods. Arthritis Care state that dairy products are not the only sources of calcium and that you can reach the recommended daily amount by eating a variety of calcium-rich foods (Arthritis Care, 2010). They list several non-dairy sources of calcium including watercress, tofu, figs, Brazil nuts, bread and baked beans. Be careful not to have too much salt or caffeine as excessive quantities of these can reduce the body’s ability to absorb or retain calcium.
Others are worried about iron, particularly people who have recently stopped eating red meat. This should not be a concern as vegetarians and vegans are no more likely to become iron deficient than meat-eaters. Indeed one of the largest studies of vegetarians and vegans in the world (the EPIC Oxford cohort study) looked at over 33,883 meat-eaters, 18,840 vegetarians and 2,596 vegans and found that the vegans had the highest intake of iron, followed by the vegetarians then the meat-eaters (Davey et al., 2003). It should be stressed that milk and milk products are an extremely poor source of iron, whereas pulses, dried fruits and dark leafy vegetables are good sources.
The Arthritis Research Campaign (now Arthritis Research UK) founded in 1936, raises funds to promote medical research into the cause, treatment and cure of arthritic conditions. They have produced dietary guidelines for people with arthritis and they suggest that one of the most important links between diet and arthritis is being overweight. The extra burden on the joints can make symptoms considerably worse. Losing weight can have a dramatic effect in improving the condition. In order to lose weight, you need to use more energy than you consume in the diet. Research shows that vegetarians and vegans weigh less than meat-eaters and Arthritis Research UK suggests that vegetarian diets have been shown to be helpful in the long term for some people with rheumatoid arthritis. A vegan diet, which doesn’t include any meat, fish or other animal products, may also be helpful, possibly because of the types of polyunsaturated fatty acids included in the diet (Arthritis Research UK, 2013a). Cutting down on sugar and taking regular (even gentle) exercise will help control weight as well.
Saturated fats are the most important kind of fat to cut down on. The body does not require saturated fats and they may aggravate arthritis whereas essential fatty acids (EFAs) have been shown to help some people with arthritis. These polyunsaturated fatty acids are divided into two main groups: omega-3 and omega-6. Omega-3 fatty acids are thought to be of most benefit in inflammatory arthritis (Arthritis Research UK, 2013a).
When trying to lose weight, it is important to maintain a good intake of vitamins and minerals. This means consuming plenty of fruit and vegetables. A healthy balanced diet containing plenty of fruit and vegetables, pulses and whole grain carbohydrate foods (such as wholemeal bread, brown rice and whole wheat pasta) provides a good supply of vitamins, minerals and fibre. A diet lacking in fruit and vegetables, and containing processed carbohydrates (such as white bread, white rice and white pasta) does not provide such a good source of these essential nutrients and can have a deleterious effect on health. Whereas a good diet may help even if strong drugs are being taken to treat arthritis.
The subject of food allergy and arthritis is quite controversial. However, research has shown that, in some people, rheumatoid arthritis can be made worse by certain foods including milk products and food colouring (Laar and Korst, 1992). In 2001, Swedish researchers reported that nine out of 22 patients with rheumatoid arthritis showed significant improvements in their condition compared to one patient out of 25 after following a gluten-free, vegan diet (Hafstrom et al., 2001). Of course it is difficult to say whether eliminating milk was the reason these patients improved as they eliminated all animal foods and gluten from the diet. However, this work provides evidence that dietary modification can benefit arthritis patients. Diet is not the only factor to cause and aggravate rheumatoid arthritis, nor is a vegan diet the only way to reduce or eliminate the pain and damage caused by this disease. However, research shows that a low fat vegan diet can be a powerful and positive, drug free way of limiting the painful symptoms caused by this disease.