Five Top Tips on Arthritis

How much do you know about arthritis?

Musculoskeletal disorders such as Osteoarthritis and Rheumatoid Arthritis are a common cause of long term pain and physical disability around the world. As many as 60% of suffers have tried some form of alternative therapy for symptom relief (1). Many foods and supplements have been touted as relieving symptoms, such as green tea extracts, ginger, New Zealand green-lipped mussels, Noni juice, Shark cartilage, Herbal remedies and so on. But what really works?

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TOP TIP # 1 - Different types of arthritis

The US Arthritis Foundation lists over 60 types of arthritis (2). The most common types are Osteoarthritis and Rheumatoid Arthritis. Osteoarthritis is a degenerative joint disease which often affects the hands, feet and weight bearing joints, causing joint pain, tenderness, and a reduced range of joint motion (1). Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects about 1% of the adult population (3). RA also affects the joints with painful inflammation, which is often more prevalent in the morning, and can impair joint mobility leading to muscle wasting. In RA there are usually signs of systemic inflammation indicated by cytokines (Interleukin-6, IL-6), C-reactive protein (CRP), and rheumatoid factors (3). Other types of arthritis are gout, lupus, fibromyalgia, juvenile arthritis, Kawasaki disease to name a few. Most of the advice is in relation to RA, as there are greater nutritional interventions that apply, whereas with OA the most important nutrition strategy is maintaining a healthy weight.

TOP TIP # 2 - Avoid inflammatory foods

The main foods to avoid due to possible increases in cytokine production and general inflammation in the body are processed foods (such as crisps, cookies, cakes and takeaways), as these typically use vegetables fats or are high in trans fats. Processed foods also have added salt and sugars, which have been shown to increase inflammatory markers. Avoid added salt and sugar with foods and drinks, and reduce the consumption of omega-6 oils (such as sunflower, corn, grapeseed, soy, peanut oils), and alcohol; which are all pro-inflammatory foods.

TOP TIP # 3 - Anti-inflammatory foods

There are many wholesome unprocessed foods that have an anti-inflammatory effect on the body.

Omega-3 fatty acids, (particularly) fish oils have been shown to reduce CRP and IL-6 in the body (3-5). Aim to consume about 100 g of oily fish twice a week. You could also consume walnuts and flaxseeds as these foods are high in Omega-3, but quantities have not been determined.
Increase monounsaturated fatty acids (MUFA) such as olives, olive oil (2 tsp daily) and nuts (small handful of nuts daily).
Increase antioxidants – aim to consume at least 5 servings of fresh fruits and vegetables daily, as these are packed with antioxidants which support the immune system and may help reduce inflammation.
Beans have both anti-oxidant and anti-inflammatory compounds; aim to eat at least 1 cup of beans twice a week.
Increase fibre - especially insoluble fibres, found in oatmeal and wholegrains as these may lower CRP.
Drink more Green tea, as this is packed with polyphenols (antioxidants which may reduce inflammation and slow down cartilage destruction).
Try adding some spices to your cooking, especially turmeric, as this contains the active ingredient Curcumin, which has been found to block inflammatory cytokines. Bear in mind the research is mostly in animal models, so some larger human studies are required to determine exact amounts and dosage (6). What has been suggested is about 2 - 3 g (1/2 teaspoon) of turmeric daily is adequate.

TOP TIP # 4 - Supplements

Top supplements to use if your diet has been determined as inadequate:

Calcium and Vitamin D – Osteoporosis is a risk factor for many sufferers of arthritis, due to the long term use of corticosteroids. If people have osteoporosis or low bone mineral density then a supplement containing both calcium (1200 – 1500 mg daily) and Vitamin D (800 - 1000 IU daily) and in children lower amounts (1000 mg calcium and 400 IU Vitamin D) was shown to significantly improve spinal bone density (7). These supplements are especially useful if your diet is shown to be inadequate in calcium or if you lack exposure to sunlight.
Omega-3s – aim for at least 3 g daily, as mentioned previously this has been shown to reduce inflammation (5).
Folic acid (1 mg/day) may help individuals with RA who are taking methotrexate, and this may reduce liver toxicity and GI toxicity. Folic acid supplements of 5 mg/ week taken 1 day after Methotrexate delivery is recommended (8).
Possibly a general multi vitamin and mineral if fruit and vegetable intakes are poor.

TOP TIP # 5 - Healthy Weight

Aim to maintain a healthy weight for your adult life, as there are links both with obesity and arthritis development, and arthritis and obesity development, due to pain and lack of mobility, reduced energy expenditure or arthritis medications which may increase hunger. In the US from 2013 – 2015, adults 18 years or older who were overweight or obese reported doctor-diagnosed arthritis more often than adults with a lower body mass index (BMI) (9). Around 16% of under or normal weight US adults reported doctor-diagnosed arthritis, compared to almost 23% of overweight and 31% of obese adults (9). Healthy eating and exercise will help you to maintain a healthy weight. Talk to a physiotherapist or a specialist in joint care for advice on specific types of exercises that you can do to relieve symptoms, and possibly delay the progression of arthritis. And consult a Dietitian or nutritionist to review your food intake.

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References

1. Stanner, S. (2007). Nutrition and Arthritis. Nutrition Bulletin, 32(1), 91-93.

2. https://www.arthritis.org/

3. Calder, P. C. (2008). Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ PUFA, inflammatory processes and rheumatoid arthritis: Symposium on ‘The challenge of translating nutrition research into public health nutrition’. Proceedings of the Nutrition Society, 67(4), 409-418.

4. Berbert, A. A., Kondo, C. R. M., Almendra, C. L., Matsuo, T., & Dichi, I. (2005). Supplementation of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition, 21(2), 131-136.

5. Kremer, J. M. (2000). n− 3 Fatty acid supplements in rheumatoid arthritis. The American journal of clinical nutrition, 71(1), 349s-351s

6. Funk, J. L., Oyarzo, J. N., Frye, J. B., Chen, G., Lantz, R. C., Jolad, S. D., ... & Timmermann, B. N. (2006). Turmeric extracts containing curcuminoids prevent experimental rheumatoid arthritis. Journal of natural products, 69(3), 351-355.

7. Warady, B. D., Lindsley, C. B., Robinson, F. G., & Lukert, B. P. (1994). Effects of nutritional supplementation on bone mineral status of children with rheumatic diseases receiving corticosteroid therapy. The Journal of rheumatology, 21(3), 530-535.

8. Ortiz, Z., Shea, B., Suarez-Almazor, M. E., Moher, D., Wells, G. A., & Tugwell, P. (1998). The efficacy of folic acid and folinic acid in reducing methotrexate gastrointestinal toxicity in rheumatoid arthritis. A metaanalysis of randomized controlled trials.

9. Barbour KE, Helmick CG, Boring MA, Brady TJ. Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation — United States, 2013—2015. Morb Mortal Wkly Rep. 2017;66:246–253. DOI: http://dx.doi.org/10.15585/mmwr.mm6609e1.