Arthritis which means "joint inflammation" in Greek, is probably one of the most universal conditions to afflict populations throughout the world.
It is important to remember that there are two very different types of arthritis, namely systemic, autoimmune rheumatic diseases or rheumatoid arthritis, and non-systemic osteoarthritis (Mahan et al, 2012).
In response to questions I have received from the public, we shall first consider osteoarthritis and explore if dietary factors can be used to treat this often crippling condition.
It has been estimated that more than 27 million Americans suffer from osteoarthritis which costs the USA 128 Billion US dollars per year in terms of medical expenditure and lost productivity. Osteoarthritis is more prevalent in older individuals who are female, white and overweight.
Osteoarthritis is characterised by destruction of the cartilage in joints of the knees, hips, ankles, hands, the neck, the spine and other articulated weight-bearing points in the body due to over-use and it is logical therefore that heavier people will tend to exert greater stress on such joints.
We heard from the first SA National Health & Nutrition Survey (2013), that up to 70% of South African women are overweight or obese, thus paving the way for an upsurge in joint disease unless the obesity epidemic and the lack of fitness in our population are addressed immediately.
Osteoarthritis is characterised by pain and swelling in the affected joint that may be mild to severe. Stiffness particularly after periods of inactivity such as sleeping or travelling, also hampers mobility.
Treatment of osteoarthritis
In general treatment involves taking anti-inflammatory and analgesic medications, weightloss for patients who are obese or overweight, surgery in severe cases, gentle supervised exercise (all high impact exercises should be avoided) and an anti-inflammatory diet.
The Anti-inflammatory Diet
In contrast to patients with rheumatoid arthritis or gout, patients suffering from osteoarthritis were until relatively recently not actively treated with a specific anti-arthritis diet. Weight-loss diets to alleviate stress on affected joints has always been part of the anti-arthritis treatment, but the use of the so-called "Anti-inflammatory Diet" is a more recent development.
Mahan et al (2012) suggest the following dietary changes as part of the Anti-inflammatory Diet:
Use a varied diet that consists mainly of fresh foods that are processed as little as possible. "Fast foods" should be avoided and replaced with fresh fruits and vegetables. All fresh fruits and vegetables, except onions and potatoes which contain an alkaloid called solanine, should be used abundantly to boost the patient’s intake of phytonutrients:
- Berries (strawberries, gooseberries, blueberries, raspberries)
- Dark orange and dark green fruits and vegetables which are rich sources of beta-carotene such as apricots, pawpaw, spanspek, carrots, pumpkin, butternut, spinach, dark green lettuce leaves, broccoli
- The cabbage family or cruciferous vegetables which include cabbage of all types, broccoli, Brussels sprouts
- Soy foods such as soy beans, tofu
- Tea including green, black, and rooibos
- Dark plain chocolate in moderation so as not to increase energy intake excessively
Avoid foods that are high in saturated and trans fats (all commercially produced cakes, pies, pastries, confectionary, take-away meals, foods fried over and over again in the same oil)
Decrease the intake of foods rich in omega-6 fatty acids, for example vegetables oils like sunflower oil and animal fats and all foods made with these fats. Keep in mind that Evening Primrose Oil supplements are rich in omega-6.
Increase the intake of omega-3 fatty acids (EPA and DHA intake should be at least 1 gram per day) by using olive, grapeseed, flax and canola oils, walnuts and walnut oil, pumpkin seeds and fatty cold water fish including mackerel, salmon, sardines, herring and snoek. Salmon oil and krill oil capsules are rich sources of omega-3 fatty acids.
Avoid highly refined carbohydrates (sugars and starches) such as table sugar, fructose, pasta, white bread and white rice. Rather use unrefined or unsifted grains and flours like unsifted maize meal, brown rice and bulgur wheat. Protein foods such as low-fat or fat-free milk, cottage cheese and yoghurt, lean chicken and fish are preferred to eggs, red meat, butter and full-fat dairy products and cheeses.
Use spices including ginger, curry, turmeric and rosemary which are believed to produce an anti-inflammatory effect.
This diet should be combined with moderate, supervised exercise (consult a physiotherapist). If you need to lose weight, consult a dietitian for an individually tailored slimming diet. Weightloss not only reduces the stress on damaged joints and disintegrating cartilage, but also has an anti-inflammatory effect because it has been found that when we reduce the quantity of fat in the body the number of so-called ‘inflammatory mediators’ in the fatty tissue are also reduced (Mahan et al, 2012).
Deficiencies and supplement use
Consulting a registered dietitian for an anti-inflammatory and/or slimming diet may also help patients with osteoarthritis avoid deficiencies linked to this condition. Common nutritional deficiencies that have been linked to osteoarthritis are as follows:
Calcium and vitamin D - in view of the recent research linking the intake of some calcium supplements to an increase in cardiovascular events, it may be prudent to use MenaCal.7 if a supplemental intake of these two nutrients is required. In addition to calcium and vitamin D, MenaCal.7 contains vitamin K which helps the body deposit the calcium in the bones and not in the arteries. Vitamin D is a hormone-like nutrient that we are capable of synthesising in our own bodies if we expose the skin to sunlight for periods of about 20 minutes a day. People who spend most of their time indoors or wear clothing that prevents the skin from being exposed to sunlight, or live in cooler, cloudy climates may develop a vitamin D deficiency.
Vitamin K - found in the above mentioned supplement and all green leafy vegetables like spinach, broccoli, asparagus, cabbage, lettuce (dark green leaves) Vitamin B6 or pyridoxine is found in lean meat, whole-grains, vegetables and nuts
Magnesium - good sources are unrefined, minimally processed cereals and grains, tofu and legumes such as dry beans, peas, lentils and soy, lean meat, low-fat milk, green vegetables
Despite the mention of using supplements such as MenaCal7 (calcium and vitamins D and K) and salmon or krill oil capsules for omega-3, the indiscriminate use of large doses of antioxidants which include vitamin C, vitamin E, beta-carotene and selenium have not been shown to have any benefit in alleviating the symptoms or progression of osteoarthritis (Mahan et al, 2012).
If you suffer from the pain and disability of osteoarthritis, do consider losing weight if this should be necessary and apply the principles of the Anti-inflammatory Diet.
References: (Mahan LK et al (2012).Krause’s Food and the Nutrition Care Process,13th Edition. Elsevier, USA; SANHANES-1 Report, (2013). South African National Health & Nutrition Examination Survey, ADSA Communication. )
Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Health24.com. Read more of her articles.