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Doctor Wei... Tell Me About Foods And Diets For Arthritis.

Oct 21, 2007
Arthritis is the disease process most often associated with disability and affects between 50 and 70 million Americans (depending on the estimates used). There are more than 100 different kinds of arthritis and each is treated differently.

While effective medical remedies are available for most forms of arthritis, many people are curious as to the role of food in either helping or making arthritis worse.

When it comes to food there are two major issues. The first is the mechanical effect and the second is the inflammatory effect.

The mechanical effect refers to the problems that can occur with excess stress on the musculoskeletal system. This happens when people weigh too much. Every extra pound translates to five extra pounds the weight-bearing joints transmit. So if you're 30 pounds overweight, that's about 150 extra pounds of stress on your low back or hips or knees.

Obviously, the less weight you have to lug around, the better. In addition, having extra body fat also contributes to the second major issue... that of inflammation. Substantial evidence links abnormal metabolic processes in fat with increased inflammation. So extra weight is a double whammy.

Inflammation can also occur via another food avenue. Some types of arthritis such as gout are directly linked to food. Foods that are high in purines are converted by the body into uric acid which causes inflammation and damage to the joints and kidneys. By reducing the intake of high purine foods and taking appropriate medication, People with gout can lead a relatively normal, pain-free life.

So what else can be done to reduce inflammation through a better diet. The key task is to eliminate foods that can potentially make inflammation worse, such as saturated fats and trans fats... and at the same time increasing the amount of foods that might suppress inflammation.

Not all fats are bad. For example, foods that contain omega-3 fatty acids decrease inflammation by suppressing the production of cytokines (chemical messengers) and enzymes that promote inflammation within the synovium (lining of the joint) and cause damage to cartilage. A number of well-controlled studies have shown that omega-3 fatty acids have a modest but definite anti-inflammatory effect in rheumatoid arthritis.

Some data also supports the use of omega-3 fatty acids in suppressing the inflammation that can occur with osteoarthritis as well. What foods are high in omega-3? They are cold water fish (salmon, herring, sardines, anchovies, rainbow trout, and oysters), flaxseed, and walnuts.

Another "food" to consider is olive oil. This oil which can be used for sautéing vegetables and also as a component of salad dressing, contains an anti-inflammatory monounsaturated fat called a polyphenol. Polyphenols act as anti-oxidants. Both fish oil and olive oil have been shown in animal models to reduce inflammation in arthritis.

Foods containing alpha-linoleic acid and gamma lenolenic acid are anti-inflammatory. Foods that have these are flaxseed, corn, sunflower, safflower, soy, and peanuts.

Mediterranean diets which have some data to support their effectiveness in arthritis are high in alpha-linoleic acid.

One of the major pathways by which inflammation causes damage is through the process of free radical production. Free radicals cause inflammation and damage through the process of oxidation.

Antioxidants protect against the effects of free radicals, and are a critical part of a diet that is designed to reduce inflammation.

Studies have demonstrated that some antioxidants may help not only prevent arthritis, but also retard its progression and relieve stiffness and pain.

Quercetin, proanthocyanidins, and anthocyanidins are bioflavenoids. These are powerful antioxidants known to reduce inflammation. They block the production of substances such as pro-inflammatory cytokines and prostaglandins. They also help with the production of normal joint tissue. They have anti-inflammatory effects similar to those of non-steroidal anti-inflammatory drugs (NSAIDS). I

In fact, there is an anti-inflammatory drug, Limbrel, which is FDA-approved for arthritis which has anti-inflammatory effects based on food properties.

Foods containing high levels of quercetin include vegetables like onions, kale, leeks, cherry tomatoes, broccoli, and fruits such as blueberries, black currants, elderberries, apricots and apples. In addition, cocoa powder, interestingly enough, also has significant amounts of quercetin. The best foods for anthocyanidins are fruits such as blackberries, black currants, blueberries, elderberries, raspberries, cherries, boysenberries, red/black grapes, strawberries and plums. In addition, vegetables like eggplant also contain large amounts of anthocyanidins.

Vitamins like vitamin C have antioxidant effects. Also vitamin C has a major role in the production of collagen, a major component of cartilage. Vitamin C deficiency can lead to scurvy which causes symptoms such as joint pain and excessive bleeding because of the lack of normal collagen production. A diet low in vitamin C has also been demonstrated to be a risk factor for some forms of arthritis.

Vitamin C is found in many fruits such as oranges, grapefruit, strawberries, pineapple, papayas, lemons, kiwi, cantaloupe, mangos, guava, and vegetables like kohlrabi, broccoli, kale, brussel sprouts, kidney beans, cauliflower, red cabbage, sweet peppers, white potatoes, and mustard greens.

Selenium deficiency can contribute to the development or the worsening of both osteoarthritis as well as rheumatoid arthritis.

Selenium rich foods are: brazil nuts, tuna, crab, oysters, tilapia, pasta, lean beef, cod, shrimp, whole grains, turkey and wheat germ.

Bromolein, an ingredient in pineapple, has also been shown to have unique anti-inflammatory properties.

Carotenoids are powerful antioxidant nutrients found in many fruits and vegetables. A specific types of carotenoid called beta-cryptoxanthin may reduce the risk of developing conditions such as rheumatoid arthritis.

Foods high in caretenoids are vegetables like sweet potatoes, carrots, kale, most types of squash, turnip greens, pumpkin, mustard greens, cantaloupe, sweet red pepper, and spinach, and fruits like apricots, persimmons, tangerines, and oranges.

Some spices have anti-inflammatory effects. Ginger has properties similar to that of some NSAIDS. However, because ginger can also act as an anticoagulant (blood thinner), a patient already taking a blood-thinner should consult with their physician before using it. Turmeric (curcumin), is a spice used in south Asian cooking. It is the main ingredient in curry.

Scientific studies have shown that turmeric may help arthritis by suppressing pro-inflammatory prostaglandins and cytokines.

Capsaicin, the active ingredient in hot red peppers, also appears to have anti-inflammatory effects. Also, it has a direct pain-relieving action on peripheral nerve fibers and is often used in topical agents (rubs) for arthritis.

Another area of both promise as well as controversy is the role of food allergies in arthritis. While there is powerful evidence that individuals may be susceptible to certain foods... that these foods may induce a worsening of arthritis and that changing the diet can improve arthritis, there is still abundant criticism.

At our center we do recommend food allergy testing for patients in whom there is more disease going on than there should be, given the medication program they are on. We have found that food allergy testing is valuable in allowing us to identify potential reasons why arthritis is not improving.

So, the upshot is that you can give yourself the edge when it comes to arthritis by using your diet as the secret weapon.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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