Last updated: Thursday, July 06, 2006
Seven guidelines for a healthy diet
A good diet is important for everyone but it is especially helpful for people with arthritis. Experts in diet recommend seven basic guidelines for a balanced healthy diet.
You can use these guidelines in planning meals every day. A doctor nutritionist or other health care professional can help you tailor these guidelines for yourself for instance by determining your ideal weight or teaching you how you can eat more fiber.
A good diet includes some choices from each of five different groups of foods:
Eating a variety of foods gives you the nutrients your body needs. Nutrients are substances in food that help the body grow and function.
Arthritis can make it harder to get variety in your diet. Fatigue and pain can lower your appetite. Swollen joints and loss of movement may lead you to avoid foods such as vegetables that need more time or effort to prepare and cook. Certain kinds of arthritis and some medications can also affect how well your body uses what you eat.
There are many ways to make preparing foods and cooking easier. Rest while you are preparing meals by planning breaks in between preparations of different foods. On days that are especially painful use convenience foods to reduce the strain of cooking meals. Some chores such as peeling or dicing vegetables are hard on joints that are painful and have lost some movement. Many new appliances help do the work for you and protect your joints.
There are health professionals in your community who can help you learn easier cooking methods. Your doctor can refer you to an occupational therapist for advice on making cooking easier. Some local chapters of the Arthritis Foundation also sponsor cooking classes or demonstrations with helpful hints.
Nutrients and medications
Some medications for arthritis can affect the amount of certain nutrients in your diet. For example corticosteroids cause your body to lose potassium and retain sodium. Antacids sometimes taken to reduce stomach irritation also contain high levels of sodium as well as magnesium. It is important to know this if you have kidney problems. Colchicine used for gout can affect how well vitamin B-12 is absorbed. Penicillamine used for rheumatoid arthritis lowers levels of copper. For most people eating a variety of foods will help keep up the levels of these nutrients.
Can food aggravate arthritis?
No foods have been definitively shown to cause or exacerbate arthritis in most individuals. A variety of diets and "hand-me-down" information exists about certain foods and arthritis in particular the night shade plants but none of it has been proven.
However there is a rare form of arthritis caused by allergies to wheat products called "Sprue." Avoiding wheat products will eliminate the arthritis. Associated features include weight loss diarrhea and osteoporosis. Consult your health care provider if this is a concern.
In addition gout can be affected by diet or by excessive amounts of alcohol. In particular foods such as brains kidney broths gravies sardines anchovies liver and sweetbreads may raise uric levels which may aggravate gout. Read our Gout article for more information on diet and gout.
In general if a person feels strongly that certain foods make them feel worse it is not unreasonable to avoid them. For those who want an in-depth review of this topic an article by Dr. Henderson and Dr. Panush in the Rheumatic Clinics of North America in 1999 volume 25 number 4 pages 937-968 can provide information.
Body weight and arthritis
Keeping body weight down helps with arthritis in the knees or hips since these joints bear the weight of the body.
Being overweights puts stress on joints. Many older adults with arthritis also have high blood pressure or heart disease. It is important for both diseases to keep trim by reducing fats cholesterol and sugar in your diet.
Ask your doctor to check your weight against recommended weights for people your sex height and age.
Tips for weight control
To lose weight eat less and exercise more. A good way to eat fewer calories is to cut down on foods high in fats cholesterol and sugar. A daily walk or swim may help without placing too much stress on joints. If you are overweight work with a nutritionist and your doctor to find a lifelong weight control plan that is right for you. A nutritionist is a health professional trained to help you plan changes in your diet.
Connections between arthritis and diet
Starch and fiber
Foods high in starch and fiber help give you energy and keep your bowels regular. Most of these foods are also low in fat. They help keep your weight down while giving you the vitamins and minerals your body needs. And they taste good so they can tempt your appetite. They also are helpful if you are having problems with diarrhea or constipation. Some drugs for arthritis can cause these problems.
Starchy foods are high in carbohydrates which help supply your body's energy needs. If you cut down on fats and sugars in your diet you need to increase the amount of starchy foods you eat to give your body another source of fuel for energy. Starchy foods can also supply bulk which can help if you sometimes have diarrhea. You may have some diarrhea when you first start taking some arthritis drugs such as oral, gold or some nonsteroidal antiinflammatory drugs. If diarrhea continues while you are on a drug it is important to tell your doctor. You may be able to switch to another medication.
Fiber helps avoid constipation and keeps you regular. It comes from the parts of plants which your body cannot digest. Some types of fiber result in softer stools and more rapid elimination of waste. These foods can help you avoid constipation. Fruits and vegetables are foods high in fiber.
Many older adults with arthritis also have to watch how much sodium (salt) they eat because they have high blood pressure. While some frozen and fast foods are convenient they may also be high in sodium. Some arthritis drugs such as corticosteroids also may cause the body to keep too much sodium. Sodium causes your body to retain water which can affect your blood pressure. Your doctor may recommend a low sodium diet to help with this problem. Some foods now come with low or no salt choices.
Alcohol can affect how well arthritis drugs work. It can weaken your bones. And it also adds pounds since alcohol puts extra sugar in your diet.
Drinking alcohol does not mix with certain drugs for arthritis. Stomach problems are more likely if you drink alcohol and take nonsteroidal anti-inflammatory drugs or aspirin. Large amounts of alcohol combined with acetaminophen can damage the liver. Drinking too much alcohol with anti-gout medications may make stomach problems more likely. It may also increase uric acid in the blood thus lessening the effects of the medication. If you are taking any medications for arthritis check with your doctor about using alcohol.
Research has shown several connections between food and some forms of arthritis; these include links with gout osteoporosis and Reiter's Syndrome.
Purines and gout
Gout is the most familiar example of a known link between diet and arthritis. People with gout may have a painful attack if they eat foods with high levels of chemicals called purines.
When you have gout your body has trouble with the way it uses or gets rid of purines. A build-up of purines in the body can worsen the symptoms of gout. Fortunately medications to control gout are very effective. If you are on gout medication you probably will not even have to change your diet. But your doctor may suggest that you drink more fluids to help your body get rid of purines.
Calcium alcohol and osteoporosis
Diets low in calcium or high in alcohol may increase your chances for getting osteoporosis. In osteoporosis bones lose enough strength so that they break easily. Both calcium and alcohol affect the strength of your bones.
You may need to increase the amount of calcium in your diet to 1000-1500 milligrams (mg) especially if you are a woman under 35. Calcium is one of the main building blocks of bone. During the first 20-25 years of life your bones are building up peak strength. Studies show most women only get about 500 mg of calcium a day in their diet. But calcium appears to be only one of several factors in building and maintaining strong bones. Studies show that calcium alone will not slow down osteoporosis once you have it.
Heavy drinking on the other hand weakens bones. Drinking more than two drinks per day increases your chances for weaker bones.
Food poisoning and Reiter's syndrome
Food or water spoiled by salmonella or certain other bacteria can lead to a form of arthritis called Reiter's syndrome. People who develop this rare kind arthritis seem to have a defect in their body's defense system. This makes them more likely to develop arthritis in response to certain infections.
Research into diet and arthritis
There are some scientific reasons to think that diet affects arthritis.
Diet may serve as a risk factor by increasing your chances for developing certain kinds of arthritis. Diet may also change the way the body's defenses--the immune system react in certain kinds of arthritis that involve inflammation. Inflammation is a part of the body's defense system. It can cause the swelling redness warmth and tenderness that come with some kinds of arthritis.
How diet affects the response of the immune system is a central question in several research studies. These studies are looking at the role of diet in worsening or lessening symptoms in certain types of arthritis.
Some very early studies in animals or in small numbers of people with certain types of arthritis suggest but do not prove that changes in diet may help. The results of these studies are experimental. They need to be studied further in large numbers of people. So there is not enough scientific evidence to recommend to people with arthritis any of the dietary changes described below except for weight control.
Weight and osteoarthritis
Being very overweight or obese increases your risk for developing osteoarthritis in the knees. People who are very overweight tend to develop osteoarthritis in the knees at an earlier age than people with ideal weights for their heights. Weight is only one of several factors that increase your chances for osteoarthritis in the knees.
Food allergies and/or reactions
Reactions to certain foods by the immune system may lead to or worsen symptoms in certain kinds of arthritis. Researchers think it is possible that a small number of otherwise healthy people develop temporary symptoms of arthritis from an allergic reaction to food. In a few people who already have arthritis reactions to certain foods may worsen symptoms. However available observations suggest that for most people who thought their arthritis symptoms were related to food a connection between food and the arthritis symptoms could not be confirmed.
Fasting low calorie or low fat diets
The immune system may work to lessen symptoms in response to other factors in our diet. For example several researchers have observed that fasting and low calorie/low fat/low protein diets slightly reduce some symptoms of rheumatoid arthritis in humans or lupus in animals. Scientists do not yet understand why this happens or if certain changes in diet such as short-term fasts help.
Fatty acids and/or fish oils
Another example of the possible effect of diet on arthritis is the role of certain fatty acids in the chemical chain reaction that causes inflammation. For instance oils from some cold water fish and plants block the body from making certain chemicals. These chemicals cause painful inflammation in rheumatoid arthritis. More studies are needed to see if these oils are an effective and safe way to block inflammation.
How is diet researched?
Researchers test the role of diet in arthritis in certain ways. They accept that there is a connection between diet and arthritis only after a number of studies show the same results.
To test what effect a diet may have on arthritis researchers will have one group of people with arthritis try a test diet. The foods in this diet are those thought to make arthritis better or worse. A second group of people stays on a diet that does not contain the foods being tested. Neither the researchers nor the people in the study are told who is in which group.
Both groups are alike. There are an equal number of men and women. The people are similar in their ages as well as in the kind of arthritis they have. People in both groups continue to follow their diets for a number of weeks. In addition the people in both groups usually stay on their regular medical treatment programs during the study.
Researchers measure the amount of improvement--such as the amount of swelling in each joint--in each person by several different ways. Then they compare the total improvement between the two groups to see if the test diet made a difference. Other researchers repeat the study at least three or four times in other groups of people with arthritis to see if they get the same results. Only then do researchers accept the treatment as effective.
Health frauds or diets under study?
Some people claim that special diets foods or supplements cause or cure arthritis.
These claims usually appear in magazine articles books and on talk shows. Most claims for such diets have not been scientifically tested to prove that they work and are safe.
Some claims for special diets for arthritis are health frauds. There is no scientific basis for the claims. Other findings like those described earlier in the section on research are still under study. Still other claims have never been studied. All diets are considered unproven until repeated studies show they work and are safe.
When you hear about diet claims in the treatment of arthritis ask the following questions:
If you can answer yes to either question you are probably looking at an unproven diet.
Trying a change in diet
Most claims for special diets that help arthritis are unproven. But surveys show that many people believe that diet is linked to arthritis and try changes in their diets anyway. If you think something in your diet makes your arthritis either better or worse talk with your doctor. And continue your regular medical care for arthritis even if you decide to try a diet change.
Healthy diets are important
Researchers are looking with increased interest at several roles diet may play in arthritis.
There is not yet enough scientific evidence to tell if and how people with certain kinds of arthritis should change their diet. For this reason any claims for a special diet for arthritis are unproven. However researchers stress the importance of a healthy diet for people with arthritis.
There are three major ways to change to a healthier diet including:
There are many sources for answers to your questions about diet. A place to start is with your doctor. Your doctor can refer you to experts in diet and nutrition for help.
Cooperative Extension Services can help answer your questions about meal planning. Look in the "Government Offices" section of your phone book under "Cooperative Extension Service."
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
Adapted from a pamphlet originally prepared for the Arthritis Foundation. This material is protected by copyright.