Nutrition & Arthritis
DIET AND ARTHRITIS
ARTHRITIS ACTION FACTSHEETS
L A S T R E V I E W : J U N E 2 0 1 8 C O P Y R I G H T O F A R T H R I T I S A C T I O N
The most important thing you can do if you have arthritis is to eat a wellbalanced diet and keep to a healthy weight. Contrary to popular belief, there are no particular diets or types of food that will make arthritis better or worse.
Several different diets have been tested clinically for rheumatoid arthritis (RA), including the vegan or vegetarian diet, the elemental diet, the exclusion diet and the Mediterranean diet. No particular diet has been shown to help with RA, though the National Institute of Health and Care Excellence (NICE) guideline for rheumatoid arthritis stated that the Mediterranean diet could be an option. Evidence suggests that the Mediterranean diet can reduce the risks of cardiovascular diseases, such as strokes and heart attacks, which can affect people with RA.
A number of studies have shown that people with osteoarthritis (OA) may experience less cartilage damage when following a Mediterranean diet. In terms of nutrients, studies have found people with OA who had a diet high in total and saturated fats experienced damage in the cartilage, compared to those with a moderate or lower-fat diet. As there is no definite evidence that any particular diet can affect arthritis, eating a healthy and well-balanced diet is the most sensible approach. The latest guidance from Public Health England, called Eatwell Guide, provides information about healthy eating in general.
Weight Management & Arthritis
The most important link between diet and OA is body weight. Being overweight increases the risk of OA and worsens the pain in many joints, especially in the knees, hips and feet. Every 5kg of weight gain confers to a 36% increased risk of knee OA. Being overweight can also increase the risk of developing gout. A 10% of weight loss can reduce pain significantly, especially in the knees, and is one of the most important things you can do to help yourself. For instance, if you weigh 100kg (15 stone 10 pounds), losing just 10kg (22 pounds) can make a big difference to your pain and improve physical function. If you have rheumatoid and psoriatic arthritis, being overweight means that your arthritis is much less likely to respond to medicines and go into remission. People with rheumatoid and psoriatic arthritis also have a higher risk of cardiovascular disease, so keeping to a healthy weight is even more important for them.
Some people believe that eating so-called acidic foods, such as oranges, can make their arthritis worse. In fact, no foods can change the acidity in our bodies and there is no evidence suggesting that eating acidic foods makes arthritis any worse, or that avoiding these foods can help treat arthritis.
Nightshade Family of Vegetables
Another popular belief is that foods from the nightshade family, such as tomatoes, potatoes and peppers, can make arthritis worse. There is no evidence that this is the case or that avoiding these foods can help treat arthritis. If anything, these foods have high levels of antioxidants which may help reduce the risk of arthritis progression,
Food Allergies & Intolerance
The connection between food allergy or intolerance and arthritis is controversial. Research has shown that less than 5% of people with RA have definite sensitivity to certain foods, a percentage no different to the general population. Interestingly, nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol can increase the permeability of the gut which might affect food sensitivity. Provided you have a balanced diet, there is no harm in avoiding certain foods to see if this makes a difference to your arthritis, but make sure that you speak to your GP before trying this.
Gout & Diet
Gout is caused by too much uric acid in the blood. Only a small amount of uric acid comes from our diet. High uric acid is sometimes caused by genetic factors but more often by certain drugs, drinking too much alcohol, and being overweight. If you have gout, the most important thing you can do to help yourself is to keep to a healthy weight, reduce your alcohol intake – especially beer – and stay well-hydrated. Do not try to lose weight too quickly by fasting, using fad diets or completely cutting out carbohydrates. Doing this can actually increase uric acid levels in the body and make gout worse. Drinking cherry extract and increasing your intake of low-fat dairy products such as skimmed milk may also help reduce uric acid levels and the risk of acute gout attacks respectively.
Many people with arthritis use dietary supplements albeit there is not much evidence that they work. Omega-3 polyunsaturated fatty acids may help people with inflammatory arthritis such as RA and psoriatic arthritis, but not in OA. There is no evidence that cod liver oil can reduce the symptoms of arthritis. Caution must be taken to not take cod liver oil in excess, especially in women who are pregnant or breastfeeding. People with OA often take glucosamine sulphate or chondroitin tablets, which are made from shellfish. Studies have not shown convincing evidence that they help, and they are not recommended in current guidelines. Many people with arthritis have also tried rosehip and turmeric (curcumin). Trials of these supplements have often shown conflicting results, however, some people with arthritis may find a small benefit.
People with arthritis may be at risk of Vitamin D deficiency. Vitamin D is essential for bone and muscle health and the main source of Vitamin D is sunlight. Current Department of Health guidelines recommend that all adults should consider a Vitamin D supplement of 10 micrograms (400 IU) daily between October and the end of
March, when there is not enough sunshine. People at risk of Vitamin D deficiency (those with dark skin or in care homes) should consider a supplement all year round.
Dyer J, Davison G, Marcora S & Mauger A (2016) Effect of a Mediterranean type diet
on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. J.
Nutr Health Ageing. Available at: http://link.springer.com/article/10.1007/s12603-016-
0806-y). Accessed on 3/10/16
Estruch R, Ros E et al. (2013) Primary Prevention of Cardiovascular Disease with a
Mediterranean Diet. N Engl J Med 368:1279-1290
Goff L. and Barasi M (1999) An assessment of the diets of people with rheumatoid
arthritis. Journal of Human Nutrition and Dietetics 12: 93–101
Hliddal B, Leeds A & Christensen R (2014) Osteoarthritis, obesity and weight loss:
evidence, hypotheses and horizons – a scoping review. Obes Rev 15(7): 578–586
Rosato, V., Temple, N.J., La Vecchia, C. et al. Eur J Nutr (2017) Mediterranean diet
and cardiovascular disease: a systematic review and meta-analysis of observational
studies. Eur J Clin Nutr DOI: 10.1007/s00394-017-1582-0
Veronese N, Stubbs B, Noale M, Solmi M, Luchini C, Maggi S. (2016) Adherence to a
Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the
osteoarthritis initiative. Clin Nutr 36(6):1609-1614
Veronese N, La Tegola L, Crepaldi G, Maggi S, Rogoli D, Guglielmi G. (2018) The
association between the Mediterranean diet and magnetic resonance parameters for
knee osteoarthritis: data from the Osteoarthritis Initiative. Clin Rheumatol DOI:
DIET AND ARTHRITIS
Arthritis is a condition that causes joint pain. This Food Fact Sheet is about the role diet has in managing symptoms of the most common arthritic condition, osteoarthritis (OA).
What is osteoarthritis?
OA commonly affects the large joints such as the knees and hips but frequently occurs in the hands, the base of the big toe and the spine. It is a condition that affects the whole joint, where cartilage breakdown and inflammation can lead to pain, discomfort and a reduced quality of life. In the UK, it is the fastest growing cause of disability. OA may run in families or can develop as a result of injury. It largely affects people later in life and obesity is a major risk factor.
There is currently no cure for OA, so treatment options are generally limited to the management of pain and symptoms. Though there is no evidence that elimination diets are effective in OA, there are a number of dietary strategies that may help you to ease its symptoms, as explained below.
Maintaining a healthy weight
The most important relationship between diet and OA is weight. Not only does being obese or overweight increase the strain on joints, but excess fat causes inflammation which can exacerbate symptoms. There is strong evidence that losing weight can reduce pain and improve physical function and mobility. If you are overweight or obese, losing 10% of your body weight will give optimum benefit, not only for symptoms but for overall health. This can be achieved by eating a healthy diet with plenty of fruits and vegetables. Incorporating exercise helps to maintain muscle while losing weight. OA has been linked to type 2 diabetes and cardiovascular disease; losing excess weight will also help to prevent or manage these conditions.What fats should I be consuming?
The long-chain omega-3 polyunsaturated fatty acids found in oily fish have anti-inflammatory properties that may well be of benefit in OA. Aim to consume at least one portion of oily fish a week, preferably two, e.g. sardines, mackerel, salmon and tuna (though not tinned tuna). If this is not possible, consider a trial of fish-oil capsules; 1-2 capsules should supply 450 mg EPA+DHA per day. Although, strictly speaking, this is not enough to produce anti-inflammatory effects, it is the dose that improved pain and function in a trial on knee OA patients and the dose recommended for reducing cardiac death. Omega-6 polyunsaturated fats (found in sunflower safflower, corn and grapeseed oils) are somewhat pro-inflammatory so may make symptoms worse, as may saturated fats. Replace them by oils and spreads rich in mono-unsaturated fats such as rapeseed oil and olive oil.
OA patients are more likely to have raised blood cholesterol than those without OA. There is some suggestion that lowering blood cholesterol will improve OA. In any case, if blood cholesterol is raised, it is important to make dietary changes to lower it – this will also benefit cardiovascular health. Collective dietary measures include:
2g/day of plant stanols/sterols – these can be found in proprietary fortified drinks, spreads, and yogurts;
reducing the intake of foods high in saturated fat;
increasing the intake of oats and other soluble fibres;
eating nuts (30g /day);
consuming soy protein (25g /day) e.g. tofu, soy milk, soy beans /edamame beans.
For more information on dietary changes to help lower blood cholesterol, please see the BDA Food Fact Sheet on Cholesterol.
Antioxidants, found in certain animal and plant products, protect the body from damaging oxidation, so-called ‘oxidative stress’ which may be involved in the development and progression of OA. Antioxidants that may be relevant include vitamins A, C and E. Though evidence for the effect of these vitamins in OA is weak, it would be wise to ensure an adequate daily intake as part of a healthy balanced diet (Table 1 gives rich sources). Getting these nutrients from food as opposed to supplements is always preferable because they come with other nutrients.
The importance of vitamin D
Vitamin D is essential for bone and cartilage health. Between the months of April and October in the UK, sunlight is the primary source of vitamin D although it can also be obtained from dietary sources (Table 1).
Studies have shown that it may have a positive effect on muscular strength and balance. However, most people consume only small amounts in their diet. Taking a daily vitamin D supplement (e.g. 10-25 μg/day), especially during the winter months, will help to ensure sufficient status throughout the year. Maintaining a healthy weight may also improve the ability of your body to access vitamin D as it is sequestered in fat.
Should I be having more vitamin K?
Vitamin K may influence OA through its role in making bone and cartilage. Although evidence of benefit in OA is suggestive but currently limited, there is some suggestion that increasing vitamin K may be of benefit to those who are deficient, hence it is important to obtain it as part of a healthy balanced diet. Certain fats and oils (e.g. olive oil, margarine) contain small amounts of vitamin K and may also help its absorption from foods.
Several popular diet books on arthritis advocate avoiding foods such as dairy products or the nightshade vegetables (tomatoes, potatoes, bell peppers and aubergines). Though there is some evidence that food avoidance may help rheumatoid arthritis patients, there is no evidence of benefit in OA patients.
There is no good trial evidence to show that glucosamine, chondroitin, rose hip or turmeric help OA symptoms; studies claiming beneficial effects are more likely to be published than those that don’t. Recent analysis of patient data has failed to find any support for glucosamine. However, if your diet is restricted or your appetite is poor, you should consider taking a multivitamin/mineral supplement containing the recommended intake amounts (RNI or RDA) of the nutrients listed in Table 1.
- Key nutritional and lifestyle recommendations for OA
Aim for a healthy BMI, i.e. between 18.5 and 25 kg/m2.
If you are overweight or obese, take action to reduce your body weight by 10%.
Regular exercise is likely to help symptoms by preserving muscle strength.
Consume 1-2 portions of oily fish a week. If you cannot do that, consider trialling a fish-oil supplement (≥ 1.5 g fish-oil/day).
Use oils rich in mono-unsaturates (e.g. rapeseed oil and olive oil).
Take dietary action to reduce your blood cholesterol, if elevated.
During the summer months, aim for daily sunlight exposure (10-15 minutes without sunscreen) to increase vitamin D.
Take a vitamin D supplement of 10-25 μg /day, when there is no sun exposure.
Consume rich sources of vitamin K and the antioxidants, A, C, and E as part of a healthy balanced diet.
If you are overweight or obese, combining regular exercise with healthy eating to achieve weight loss is the most effective strategy to reduce joint pain. Increasing intake of long-chain omega-3 fatty acids and reducing blood cholesterol may be of some benefit and will improve cardiovascular health. To optimise intake of relevant micronutrients, eat food sources shown in Table 1. Discuss any change in diet or nutritional supplements with your rheumatologist, GP or dietitian.
Useful links: NHS: www.nhs.uk/Livewell/healthy-eating
Arthritis Action: www.arthritisaction.org.uk
Further information: Food Fact Sheets on other topics including Weight loss, Omega-3, Cholesterol, Vitamin D and Healthy eating are available at