Will a special diet help my arthritis?

Many people with arthritis ask whether special diets will help them or whether they should avoid certain foods. Research has not found any convincing evidence that arthritis can be cured or relieved by avoiding or eating particular foods (other than for gout - see below).

A balanced diet, which includes a variety of foods from the four major food groups each day, helps to promote overall good health. The four food groups are:

• vegetables and fruits
• bread and cereals
• milk and dairy products
• lean meats, poultry and fish.

Try to restrict the amount of fat, salt and sugar you eat and eat more fruit, vegetables, breads and cereals. Adequate calcium for people of all ages is important to help protect against osteoporosis, which causes many fractures in older age (particularly in women). This is especially important for people taking corticosteroid medication over a long period of time.  Low fat milk and dairy products are preferable to full fat types and are widely available.

Gout is the only form of arthritis in which a change of diet may be beneficial. Gout is very common in New Zealand and particularly common in Maori and Pacific Islanders. Some surveys have shown it to be present in up to ten percent of all adult New Zealand men. However it is also common in older women.

Some foods to be avoided or restricted in gout are offal foods (such as liver, kidney, tripe etc), alcohol, shellfish and peas, beans and lentils.

Miracle diets

Friends may suggest a range of dietary cures, perhaps eliminating acid food, or foods in the nightshade family, that is, tomatoes, potatoes, capsicum etc.

Most people with arthritis, particularly inflammatory arthritis, tend to have good and bad patches, with symptoms sometimes disappearing for varying lengths of time. If you remember that it is common to experience these remissions you will see how it is sometimes thought that avoiding or eating a particular food has caused an improvement. This may be just a coincidence and may have occurred anyway.

If you really believe a special product or diet will help your arthritis, it may well do so for a short time, but if the improvement is due only to this belief it will soon tend to disappear.

Vitamin and mineral supplements

Eliminating important foods (as in some 'fad' diets) can lead to deficiencies and vitamin and mineral supplements cannot compensate for a poor diet.

It is advisable to seek dietary counselling from a dietician if foods from a specific food group are not tolerated, eg. milk and milk products. Many people take the vitamins they least need, through lack of knowledge.

Fasting and 'Cleansing Diets' are sometimes promoted as methods of treating arthritis. There is no evidence that these have any long term benefits. In contrast, they could lead to malnutrition and serious health problems.

Other diets promote the use of herbs, honey, vinegar etc. but there is no evidence that these have any long term benefit for people with arthritis.

Over the years scientists have investigated vitamins and minerals to see if they have any real effect on patients with arthritis, but there has been no real evidence that they alter the course of arthritis.

Many people with arthritis try wearing copper bracelets, presumably because they think copper may be absorbed through the skin and have some good effect on their arthritis. However, there is no evidence that wearing these bracelets helps, but neither do they do any harm!

Omega-3 fatty acids/ GLA

Initial studies have shown that diets low in saturated fats, or that include certain fish oils in the Omega-3 fatty acids group (usually found in cold-water fish such as salmon, tuna, halibut), seem to have a mild anti-inflammatory effect in arthritis, but further studies are needed. Cod liver oil is NOT the source of these particular oils and should not be taken in large quantities as it may lead to vitamin A and D toxicity. 

GLA (gamma-linolenic acid) is a type of Omega-6 fatty acid found in evening primrose oil, black currant oil and borage oil. These oils have shown promise in relieving symptoms in arthritis.

Supplements can cause side effects and in some cases may interact with traditional medicines. It is a good idea to discuss your intentions to take any supplements with your doctor first.

Glucosamine and chondroitin sulphate

Glucosamine is a major component of joint cartilage. Supplements are derived from shrimp, lobster and crab shells.

Chondroitin sulphate is a component of human cartilage, bone and tendon. Supplements usually come from bovine trachea (cows' windpipes) or pork byproducts.

The Cochrane Collaboration is an international non-profit and independent organisation, producing evidence-based reviews on health interventions. According to Cochrane reviews, both glucosamine and chondroitin sulphate are useful in arthritis and seem to be safe. They appear to protect cartilage from damage and help with pain relief and mobility. However, more information is needed about the long term effects.

Large, independent clinical trials are currently under way and will hopefully provide more definitive evidence about the use of these agents in arthritis.

Weight watching

Research has proved that people who are overweight are more likely to develop osteoarthritis. Being overweight leads to increased stress on weight-bearing joints, such as the knees and lower spine, and people who are overweight are also more likely to develop osteoarthritis in their fingers and hands.

Losing weight will not only reduce the load on painful joints but will also improve your ability to get about and exercise more. You will find your general health improves as well.

Losing weight will also improve the long term success of joint replacement surgery if this becomes necessary.

Many people eat too much sugar and fat, and losing even a few kilograms will help.

Ask your GP to send you to a dietician who will help you lose weight and the Arthritis New Zealand's Field Officers who can be contacted through the Divisions list will be able to help you obtain good advice.

Exercise is an important factor in losing weight, and although physical activity may be difficult and painful for a person with arthritis, low impact activities such as exercising in water involves less strain on painful joints. The Foundation's divisions organise these hydrotherapy classes in most areas. Exercise combined with a suitable diet has been shown to lead to the most effective weight loss.

The best advice is to adopt a healthy lifestyle and eat a balanced diet choosing foods low in sugar and fat. People affected by arthritis, facing a long-term condition with unpredictable symptoms may be tempted to change their diet to try to improve their arthritis themselves.

If, in spite of the lack of evidence of any real benefit, you decide to experiment with your diet, you should not make any major changes without talking about it with your doctor to make sure you are getting the balance necessary for good health.

Unproven remedies

The promises of quick 'cures' and 'miraculous relief' sound wonderful to a person with a chronic illness. Most of the products advertised in this way, whether drugs, dietary supplements or mechanical devices are not harmful, but worthless and expensive. To avoid falling into these traps people should discuss with their doctor any other forms of treatment they are considering.

Food and nutrition guidelines

Eat a variety of food from each of the following four major food groups every day.

• vegetables and fruits - at least two servings of fruits, and three servings of vegetables i.e. one serving is half a cup of cooked vegetables, or one medium potato or one medium apple
• breads and cereal foods - at least six servings i.e. one serving is one roll or one slice bread or one cup cooked rice
• milk and dairy products, especially the low fat varieties - at least two servings i.e. one serving is one cup of milk or 40g cheese
• lean meats, poultry, fish, eggs, nuts or pulses - one serving i.e. one serving is two slices of cooked meat or one fillet of fish (100g)
• prepare meals with a minimal added fat (especially saturated fat) and salt
• choose pre-prepared foods, drinks and snacks that area low in fat (especially saturated fat), salt and sugar
• help to maintain a healthy body weight by regular physical activity and eating sensibly
• drink plenty of liquids each day
• if drinking alcohol, do so in moderation.

Original material supplied by Arthritis New Zealand. Edited by everybody, July 2005.