Features August 2013 Issue

Can Diet Ease Your Arthritis Pain?

Nutrition is an effective tool, but using a realistic approach is necessary, say Cleveland Clinic experts.

The headlines are everywhere and their claims are bold. With statements such as “Ten foods that make arthritis worse” to “Colorful foods protect against arthritis” in the news, today’s arthritis patient is inundated with dietary information claiming to be the path to easing their pain.
In an effort to seek relief, people with both osteoarthritis (OA) and rheumatoid arthritis (RA) are equally drawn to the latest reports touting the benefits of a particular food or certain types of diets, yet these should be approached cautiously and realistically, according to M. Elaine Husni, MD, vice chairman of the Department of Rheumatic and Immunologic Diseases and director of the Arthritis and Musculoskeletal Treatment Center at Cleveland Clinic.

Understand your diagnosis
“There is very little clinical trial evidence regarding diet to guide arthritis patients,” says Dr. Husni. “Although there are no specific food groups that definitively treat arthritis, we know that diet can still play an important part of one’s overall health. What’s important is that diet be looked at as an adjuvant to managing one’s condition, not as the ‘jackpot’ answer for a cure.”

To help determine if diet may help ease the pain of arthritis, it’s important to first understand the diagnosis. Due to the fact that OA and RA are two very different diseases, treatment—including dietary factors—range widely for the disorders. As a condition that primarily causes joint inflammation, diet would not be the first line of treatment for RA, explains Dr. Husni.

A well-rounded diet and overall healthy lifestyle can positively impact arthritis pain.

"We always first recommend disease modifying drugs approved by the Food and Drug Administration (FDA) for RA due to studies showing their effectiveness as well as benefits from early treatment, then review one’s dietary intake to see if there are specific changes that need to be made. In contrast, OA impacts the cartilage of the joint with reactive changes in the bone and the soft tissue, causing a different approach in medications—including primarily the use of non-steroidal anti-inflammatory drugs.”

Recognize what foods are truly bad (and good) for you
Just as RA and OA affect different areas of the body, different foods and food groups may play various roles in easing inflammation of each condition. For instance, a small study published in Rheumatology (October 2001) looked at 66 RA patients to see whether a vegan diet free of gluten improves the signs and symptoms of their condition. The researchers showed that a vegan diet free of gluten may be of clinical benefit for certain RA patients. This benefit may be related to a reduction in immunoreactivity to food antigens eliminated by the change in diet, according to the study’s authors.

“Studies can help change our way of thinking as to how diet impacts both OA and RA, but often the outcome markers in these small studies are flawed. For instance, we’re not told what type of medications the study participants are taking or how long they’ve been using them,” says Dr. Husni.

Look at the big picture
While there may be speculation as to how food may help an arthritis patient, it’s becoming clearer that eating foods that cause inflammation may make it worse. Often referred to as the “hurting” food group, this primarily includes processed foods such as refined sugar and grain products, including commercial white breads and sugary breakfast cereals.
“Processed foods contain two problematic ingredients: sugar and refined carbohydrates, in addition to being high in saturated and trans-fats,” explains Mira Ilic, a registered dietitian with Cleveland Clinic’s Executive Health program. “Your body’s physiology responds to refined carbs the same way it reacts to sugar. Both quickly create spikes in glucose, which research has shown to be associated with an increase in inflammation.”

Overall, the best dietary approach is one that’s “well balanced” and laden with fresh produce, says Ilic.
“I tell patients to follow the ‘plating method’ of half vegetables, one quarter non-processed carbohydrates like whole grains, beans or lentils, and one-quarter of the plate being protein. Finally, they should include at least two or three fruits and two to three servings of low-fat dairy,” she says.

Including fish in the diet is also important due to the omega-3 fatty acids in fish oil that have shown promising anti-inflammatory properties. A study published in the Journal of the American College of Nutrition (December 2002) reviewed animal experiments and clinical intervention studies that show omega-3 fatty acids have anti-inflammatory properties. The review concluded adding omega-3’s might be useful in the management of inflammatory and autoimmune diseases, the researchers report.
“We wouldn’t recommend one type of food or food group. Rather, patients should try possibly eliminating foods such as excess refined sugar or excess red meat from their diet for a few weeks to see if it helps their symptoms,” says Dr. Husni.

“By keeping a daily food journal and recording what’s eaten, patients can determine what helps them feel better and what causes arthritis flares,” says Ilic.