Features January 2003 Issue

Diet And Arthritis: More Hype Than Hope?

Although some claim that what you eat can help — or hasten — arthritis pain, the evidence is inconclusive.

Although a connection between diet and arthritis has been suggested for more than 30 years, scientific evidence in support of this theory remains sketchy at best. Rather than focusing on which foods to add or eliminate from your diet, nutritional experts recommend that you consider how osteoarthritis medications can affect your nutritional needs.

According to the American Academy of Rheumatology, more than $1 billion a year is spent in the U.S. on unproven arthritis remedies. Some of these remedies include questionable dietary strategies that argue in favor of eliminating a particular food from your diet, hoping that by removing a food you have a sensitivity toward will also eliminate substances that might irritate your joints.

This food-as-irritant theory has particular resonance for those with rheumatoid arthritis, because such an irritant might affect the immune system—which, in this form of arthritis, is already at fault for attacking joint linings.

In the 1980s, Dr. Richard Panush, an immunologist at Saint Barnabas Medical Center in New Jersey, examined the possible link between food sensitivities and rheumatoid arthritis and concluded that it might play a role in perhaps 5 percent of those with the disease.

More recently, a study published in the Journal of Rheumatology examined gluten (a protein found in various grains) and its possible connection to rheumatoid arthritis. Of 22 participants with rheumatoid arthritis who ate a gluten-free vegan diet (devoid not only of meat but also dairy or any foods derived from an animal), 40 percent reported improvement in symptoms after nine months, while only 4 percent of those who followed a balanced vegetarian diet had similar claims.

“Food sensitivities shouldn’t be dismissed as a possible irritant to your arthritis,” says Andrea Dunn, a registered dietitian at The Cleveland Clinic, “it’s just that there’s not enough convincing evidence yet.” What makes this proof of cause-and-effect difficult is that any particular food you may be sensitive to contains numerous substances, any of which could be the offending irritant.

Elimination Diet: Steps To Take
With this in mind, Dunn suggests that if you’re going to try an elimination diet, follow these steps: 1) eliminate only one food at a time, 2) keep it out of your diet for at least two to three weeks, 3) keep a daily journal of your arthritis symptoms, 4) don’t stop taking your regular medications, and 5) let your doctor know what you’re doing.

However, even if your dietary experiment seems to ease your symptoms, interpreting the results can be tricky. This is because arthritis naturally goes through periods of remission and flare-up, independent of anything you might eat. And remissions can last for a few days, weeks or months. So if you begin your diet at the same time your arthritis goes into remission, it’s easy to attribute any improvement to the dietary change, instead of to chance.

Will Adding Foods Or Supplements Help?
Other unproven strategies for managing your arthritis argue for adding various foods or supplements to your diet. Although some with rheumatoid arthritis claim that the omega-3 fatty acids found in fish can ease their inflammation, there is still no scientific evidence to support this.

Osteoarthritis sufferers often supplement their diets with Vitamin C, Vitamin E and beta carotene in hopes that these anti-oxidants might slow the course of their disease. But results of an osteoarthritis study conducted by the Framingham Study group in Framingham, Mass., showed that taking these antioxidants neither reduced the risk of osteoarthritis nor had any effect on the ongoing course of the disease.

“Taking a multiple vitamin to get the recommended daily amount of a variety of vitamins and minerals makes sense, because a shortage can slow your ability to make collagen and repair joint tissue,” says Dunn. “But there is no support for taking these in mega-doses.”

However, Dunn does support the idea that women with arthritis should have an extra dose of calcium to bring them to 1500mg a day (a normal dose is 1000-1200mg a day). This is because women with arthritis tend to be less active, and inactivity leads to calcium loss from bones, increasing the risk of osteoporosis.

A dietary issue often overlooked is the effect osteoarthritis medications might have on your nutritional needs or your hunger.

“Some of the drugs you take to manage your arthritis can throw off your electrolyte balance,” says Dunn, “and you may need to adjust your diet to restore it.”

Those who take prednisone (or other corticosteroids) to treat rheumatoid arthritis or gout tend to lose potassium and retain excess sodium. To offset this, Dunn suggests eating more vegetables and fruits (e.g., potatoes, bananas, raisins) to add potassium, and cut back on salt to lower sodium levels.

Methotrexate, a B-vitamin drug taken to manage rheumatoid and psoriatic arthritis, also has a nutritional impact. “It lowers your level of folic acid,” says Dunn. To compensate, she suggests either a multiple-vitamin (minimum 0.4mg of folic acid) or foods rich in folate, such as fresh greens, dried beans, peas, fortified grains (cereals and breads), oranges, broccoli and asparagus.

Appetite Reducers
Adjusting what and how often you eat can also offset another unwelcome side effect of some arthritis medications—weight gain.

According to Dunn, corticosteroids, which are often used to treat rheumatoid arthritis, can increase your appetite and tendency to put on weight. One strategy to counteract this is to maintain a more ongoing sense of fullness by eating smaller meals more often, perhaps five or six a day. Eating more fiber through whole grains, vegetables and fruit is another low-calorie way to feel full.

“Anti-inflammatory medications can also trigger overeating if you mistake stomach irritation as hunger pains,” says Dunn. “To avoid this sense of false hunger, make sure to take these medications as directed.”

Until further research demonstrates a more conclusive link between the foods you eat and your arthritis symptoms, the best advice remains the same: Eat a well-balanced diet and maintain a healthy body weight to reduce the stress on your bones and joints.