Diet and Your Arthritis...
Many people ask if diet affects arthritis. They wonder if what they eat can cause, cure or affect arthritis. Since symptoms of arthritis can vary from day to day, it is natural to think that what you ate yesterday caused or reduced the pain you feel today.
Researchers are looking with increased interest at the roles diet may play in arthritis. There are some scientific reasons to think that the foods you eat might affect certain kinds of arthritis. But there is not yet enough evidence to clearly understand how diet might hurt or help specific types of arthritis, or to recommend that people with certain kinds of arthritis adopt special diets.
What Do We Already Know?
Research has shown several connections between food and some forms of arthritis. These include the links with gout, osteoporosis and Reiter's syndrome.
Purines and Gout
Gout is the most familiar example of a known link between diet and arthritis. People with gout may have a painful attack if they eat foods with high levels of chemicals called purines. These chemicals come from the breakdown of protein in the body. Foods rich in protein (such as meat and dairy products) produce high levels of purines.
When you have gout, your body has trouble with the way it uses or gets rid of purines. A build-up of purines (uric acid) in the body can worsen the symptoms of gout. Fortunately, medications to control gout are very effective. If you are taking gout medication, you
may not even have to change your diet. However, your doctor may suggest that you drink more fluids or monitor the intake of certain foods to lower uric acid levels.
Calcium, Alcohol and Osteoporosis
Diets low in calcium or high in alcohol may increase your chances for developing osteoporosis. In osteoporosis, bones become thin so that they break easily. Both calcium and alcohol affect the strength of your bones.
Calcium is one of the main building blocks of bone. During the first 20 to 25 years of life, your bones are building up peak strength. lo help prevent osteoporosis, you may need to get 1000 to 1500 mg of calcium a day, especially if you are a woman under 35.
But calcium appears to be only one of several factors in building and maintaining strong bones. Getting enough vitamin D in your diet also is important to help absorb calcium from food. Vitamin D can come from food such as fortified dairy products or sunIight. Older women are especially prone to low vitamin D levels because they may not get out in the sun enough to meet their needs. Studies show that calcium alone will not slow down osteoporosis once you have it.
Alcohol intake, on the other hand, weakens bones. Drinking more than two alcoholic drinks a day increases your chances for thin bones and may lead to osteoporosis.
Food Poisoning and Reiter's Syndrome
Food or water spoiled by Salmonella or certain other bacteria can lead to a form of arthritis called Reiter's syndrome. People who develop this rare form of arthritis seem to have an abnormal response to certain infections. Instead of fighting the infection, their immune system attacks their joints. This makes them more likely to develop arthritis in response to certain infections.
What's New in Research?
In addition to these specific examples, there are some scientific reasons to think that diet affects arthritis in a more global sense. Diet may serve as a risk factor by increasing your chances for developing certain kinds of arthritis. Diet may also change the way the body's defenses (the immune system) react in certain kinds of arthritis that involve inflammation. Inflammation is a part of the body's defense system that can cause the swelling, redness, warmth and tenderness that come With some kinds of arthritis. However, inflammation is sometimes helpful in the body's normal defense against infection and other disease causing agents.
How diet affects the response of the immune system is a central question in several research studies.These studies are looking at the role of diet in worsening or lessening symptoms in certain types of arthritis.
Some studies in animals and in small numbers of people suggest that changes in diet may help arthritis. Other studies of dietary supplementation have shown positive results in some cases. Four types of diet changes are explained on the following pages. Talk to your doctor before making any changes in your diet to treat your arthritis.
Weight and Osteoarthritis
People who are overweight have a higher frequency of arthritis. Being overweight or obese increases your risk for developing osteoarthritis in the weight-bearing joints, and possibly in the hips and hands. People who are overweight tend to develop osteoarthritis in the knees at an earlier age than people with ideal weights for their heights. It's important to maintain your recommended weight, especially as you get older.
What if you're already overweight? Research shows that middle-age and older women of average height who lose 11 pounds or more over 10 years cut their risk for developing knec osteoarthritis in half.
Food Allergies/Reactions
Reactions to certain foods by the immune system may lead to or worsen symptoms in certain kinds of arthritis. Researchers think it is possible that a very small number of otherwise healthy people develop temporary symptoms of arthritis from an allergic reaction to food. In a few people who already have arthri tis, reactions to certain foods may worsen symptoms. However, available observations suggest that for most people who thought their arthritis symptoms were related to food, a connection between food and the arthritis symptoms could not be confirmed.
Fasting/Low-Calorie/Low-Fat Diets
The immune system may work to lessen symptoms in response to other factors in the diet. For example, several researchers have observed that fasting and low-calorie/low-fat/ low-protein diets slightly reduce some symptoms of rheumatoid arthritis in humans or lupus in animals. This is because the active immune response in diseases such as rheumatoid arthritis is inhibited during tasting. However, since tasting can cause you to lose muscle, it is not recommend as a treatment for arthritis except in scientitic studies. because people with inflammatory diseases such as rheumatoid arthritis have been shown to havc low muscle mass, fasting may be especially dangerous to them.
Studies using a vegetarian diet pattern are also encouraging. Following a vegetarian diet will allow you to get all the nutrients you need while eating foods from the lower levels of the Food Guide Pyramid that are the basis of a healthy diet for anyone . Your physician and dietitian are the best people to guide you in these therapies.
Fatty Acids/Fish Oils
Another example of the possible ettect of diet on arthritis is the role of certain fatty acids in the chemical chain that causes inflammation. For instance, oils from some cold-water fish (such as salmon, mackeral and herring) block the body from making certain substances that cause painful inflammation in rheumatoid arthritis. Studies show that patients with rheumatoid arthritis may have modest improvement in tender joints after taking large amounts of fatty acids (called omega-3 fatty acids) from fish and plant oils over a period of time. However, since these fatty acids may have unwanted side ettects, it is generally recommended that two meals including cold-water fish are eaten per week. Supplementation with omega-3 fatty acids should be done with a doctor's supervision.
How Do Researchers Test Diets?
To test what ettect a diet may have on arthritis, researchers have one group of people with arthritis try a test diet toods thought to make arthritis better or worse. A second group of people stays on a diet that does not contain the foods being tested. Neither the researchers nor the people in the study are told who is in which group.
Both groups of people are alike. There is an equal number of men and women. The people are similar in their ages as well as in the type of arthritis they have. People in both groups follow their diets for a number of weeks. They usually stay on their regular medical treatment programs during the study.
Researchers measure the amount of improvement over time (such as less swelling in each joint) in each person by several different ways. Then they compare the total improvement between the two groups to see if the test diet made a difference. Other researchers complete the study at least three or four times in other groups of people with arthritis to see if they get thc same results. Only then do researchers accept the treatment as being proven effective.
What Diet Claims Are Unproven?
Some people claim that special diets, foods or supplements cause or cure arthritis. These claims usually appear in magazine articles, advertisements, books and on talk shows. Most claims for such diets have not been scientifically tested to prove that they work and are safe.
Some claims for special diets for arthritis are health frauds. There is no scientific basis for the claims. Other findings, like those described earlier in this booklet, are still under study. Still other claims have never been studied. All diets are considered unproven until repeated scientific studies show they work and are safe.
This chart lists some common diets, foods or supplements for which unproven claims have been made. For some, there are studies or case reports about the claim. These are descriptions in a medical journal of an unusual symptom, reaction or disease in one or more persons. A circle marks those diets or foods with reports suggesting a negative or harmful effect on health. The effects or safety of many other items on the list are unknown.
Diet/Supplement Possible Hormful Effects
Alfalfa
Black walnuts
Copper
Copper salts
Dairy products
Fish oils
Immune power diet
Low calorie/fat/protein diet
No meats/preservatives diet
No nightshades diet
Plant oils
Sodium nitrate
Vinegar and honey
Vitamin C
Zinc
Questions About Diet Claims
When you hear about diet claims in the treatment of arthritis, ask the following questions:
Does the diet eliminate any complete group of foods from the Food Guide Pyramid ?
Does it stress only a few foods or eliminate others?
lf you can answer yes to either question, you are probably looking at an unproven diet
TRYING A CHANGE IN DIET
It is important to determine if a treatment ,you'd like to try has been proven effective in a scientific study. Most claims for special diets that help arthritis are unproven. But surveys show that many people believe that diet is linked to arthritis, and they try changes in their diets anyway. If you think something in your diet makes your arthritis better or worse, talk with your doctor and dietitian. Continue your regular medical care for arthritis even if you decide to try a diet change.
GUIDE TO A HEALTHY DIET
Because there are over 100 types of arthritis, no one diet will help everyone with arthritis. However, researchers do recommend that people with arthritis eat a good diet based on variety, balance and moderation. Following a balanced diet can help you feel better and stay healthy, prevent chronic diseases such as cancer and cardiovascular disease, and be a positive step toward managing your arthritis.
People with arthritis may have difficulty preparing foods because of joint pain and swelling or limited mobility. Some arthritis medications may lessen appetite and cause gastrointestinal (G.I.) upset, as can pain and depression. Because of these and other factors, maintaining good nutrition is often a challenge for people with arthritis.
What Is a Good Diet?
Experts in diet recommend seven basic guidelines for a balanced, healthy diet.You can use these guidelines in planning meals every day. The following sections explain how each of the seven guidelines is helpful to people with arthritis.
Seven Guidelines for a Healthy Diet
* Eat a variety of foods.
* Maintain a healthy weight.
* Use fat and cholesterol in moderation.
* Eat plenty of vegetables, fruits and grain products.
* Use sugar in moderation.
* Use salt and sodium in moderation.
* If you drink alcohol, do so in moderation.
*Eat a Variety of Foods
Variety, balance and moderation are keys to a healthy diet.Variety usually means eating more grains, fruits and vegetables than most Americans do. A good diet includes some choices from each of five different groups of foods: breads and cereals, fruits, vegetables, dairy products and meats. Eating a variety of foods gives you the 40 or more nutrients your body needs. Nutrients are substances in foods that help the body grow and function.
Arthritis can make it difficult to eat a variety of foods. Pain, fatigue and depression can lower your appetite. Swollen and painful joints and loss of movement may cause you to avoid foods that require more time or effort to prepare. Follow these tips in the following box to make food preparation easier:
* Plan rest breaks during meal preparation time.
* Use good posture while cooking.
* Keep the things you use most otten out on the counter.
* Occasionally use convenient foods to reduce the strain of cooking meals.
* Add fresh fruit and bread to a frozen dinner to make a complete satisfying meal.
* Purchase presliced and chopped vegetables from the produce or frozen food sections of grocery stores.
* Use kitchen gadgets and appliances such as electric can openers and microwave ovens to make cooking tasks easier.
Health professionals in your community can help you learn more efficient cooking methods. Your doctor can refer you to an occupational therapist for advice on making cooking easier. Some local chapters of the Arthritis Foundation and the Cooperative Extension Services of some state universities may also sponsor cooking classes or demonstrations with helpful hints for making cooking easier.
Certain kinds of arthritis and some medications can also affect how well your body uses what vou eat. For example, corticosteroids cause your body to lose potassium and retain sodium. Some antacids, which may be taken to reduce stomach irritation, also contain high levels of sodium, calcium and magnesium. It is important to know this if you have kidney problems, which can make it harder for your body to regulate these important minerals. Colchicine used for gout can affect how well vitamin B12 is absorbed. Penicillamine used for rheumatoid arthritis lowers levels of copper. Methotrexate can lower levels of folic acid. Having a folic acid deficiency may predispose you to methotrexate toxicity. For most people, eating a variety of foods will help keep up the levels of these nutrients. Talk to your physician about how the medications you take affect your nutritional status and whether a vitamin supplement may be useful for you.
Maintain a Healthy Weight
People who are overweight have greater ditficulty with osteoarthritis, especially in the knees or hips, since these joints bear the weight of your body. Extra pounds stress your joints, which increases your risk for developing osteoarthritis in the knees, and possibly in the hips and hands. It's also important to control your weight if you already have knee osteoarthritis. Being overweight puts you at risk for more severe disease, and for getting osteoarthritis in your other knee if onlv one is affected now.
Ask your doctor to check your weight against the recommended weights tor people your sex, height and age. If you are overweight, work with a registered dietitian and your doctor to find a lifelong weight management plan that is right for you. A good plan will include balance, variety and moderation in your diet as well as regular exercise. It is important to cut down on foods high in fats and sugar. A daily walk or swim may allow you to get the exercise you need without placing too much stress on your joints.
Use Fat and Cholesterol in Moderation
Many adults with arthritis also have high blood pressure or heart disease. Reducing fats and cholesterol in your diet will help control or prevent these diseases.
Because fat is a source of concentrated calories, eating less fat also helps to maintain or lose weight. To follow a diet low in saturated fat and cholesterol, choose low-fat cuts of meat, use low-fat dairy products and limit the use of add-ed fats, oils, salad dressings, nuts and nutbutters. A daily serving of meat or fish the size of two decks of playing cards is adequate for most adults. Egg yolks should be limited to three per week.
Eat Plenty of Vegetables, Fruits and Grain Products
Fruits, vegetables and whole-grain products help give you energy and keep your bowels regular. Most of these foods are also low in fat and high in fiber, and are important sources of vitamins and nutrients. Starchy foods are high in complex carbohydrates, which help meet your body'.s energy needs. Foods high in carbohydrates are useful in weight control since thev pratluce a feeling of fullness.
Fruits, vegetables and whole-grain prod ucts are also excellent sources of fiber. Fiber comes from the parts of plants your body cannot digest. Some types of fibers result in softer stools and more rapid elimination of wastes. Foods with fiber can help you avoid constipation.
Examples of high-fiber foods
Some fibers such as oat bran help lower cholesterol levels. It is generally better to get fiber naturally from foods instead of from fiber supplements.
Use Sugar in Moderation Sugars provide sweetness to your food. However, they also add calories and promote weight gain and tooth decay. This is why sugars should be added to the diet only in moderation. When checking the sugar content of foods, look for the words dextrose, sucrose, fructose, honey, dextrin and maltadextrine to detennine whether there is added sugar.
Use Salt and Sodium in Moderation
Many adults with arthritis have to watch how much sodium or salt they eat because they have high blood pressure. While some processed and fast foods are convenient, they may also be high in sodium. Some arthritis drugs, such as corticosteroids (Prednisone), also may cause the body to keep too much sodium. Sodium causes your body to retain water, which can affect your blood pressure. Your doctor may recommend a low-sodium diet to help with this problem. Many foods now come with lowor no-salt-added choices. This makes it easier to maintain a low-sodium diet.
Another way to cut down on sodium is to remove the salt shaker from your table. You may also want to talk with your doctor or dietitian about whether a salt substitute would be useful for you.
If You Drink Alcohol, Do So in Moderation
Alcohol can havc many adverse effects on your health. Excessive alcohol use can weaken your bones, which can lead to osteoporosis. Alcohol also adds unwanted pounds, since it adds extra calories to your diet.
Drinking alcohol does not mix with certain arthritis medications. Stomach problems are more likely if you drink alcohol and take aspirin or other nonsteroidal anti-inflammatory drugs. Large amounts of alcohol combined with acetaminophen can damage the liver. Drinking too much alcohol when taking anti-gout medications may make stomach problems more likely It may also increase uric acid in the blood, thus lessening the effects of the drugs. If you are taking methotrexate, combining it with alcohol can cause liver damage. If you are taking any other medications for arthritis, check with your doctor about using alcollol, even in moderation.
The Food Guide Pyramid
The Food Guide Pyramid developed by the U.S. Department of Agriculture and Health and Human Services shows how to follow these dietary guidelines and make wise food choices. Select most foods from the bottom two layers of the pyramid and fewer foods from the top, based on the recommended number of servings. A variety of foods from the five major food groups should be eaten to help provide all the nutrients your body needs each day. Following the Food Guide Pyramid will help you eat a balanced diet with moderate amounts of sugar, sodium and saturated fat. It will also help you get the right amount of calories to maintain a healthy weight.
The Food Labeling Act
Beginning in 1994, a new nutritiorl label was required to be on most foods. Many packages already listed ingredients, but there were no standards for comparing one food with another. The new label allows you to read the nutritional content of the food so you can make smart choices for a healthier diet.
The Food Labeling Act also set new guidelines for health claims a food manufacturer can make. Claims such as "fat free,"cholesterol free,"low sodium" and others are now defined by government standards. Certain requirements must be met before these types of claims can he made. Instead of learning what each claim means, remember these key words to help you judge nutritional content:
€ "Free" has the least amount;
€ "Very low" and "Low" have a little more; and €"Reduced"or"less" always means that the food has 25 percent less of that nutrient than the reference (or standard) version of the food.
IN SUMMARY
Researchers are looking with increasecl interest at several roles diet may play in arthritis. There is not yet enough scientific evidence to tel1 if and how people with certain kinds of arthritis should change their diet. For this reason, any claims for a special diet for arthritis are unproven. However, researchers stress the importance of a healthy diet for people with arthritis. I here are two major ways to change to a healthier diet: Add variety to your diet and eat more foods with fiber and starch; and reduce your intake of salt, fat, cholesterol, sugar and alcohol.
These changes will help you maintain or achieve a healthy weight - the foundation for improved quality of life for many people with arthritis.
FOR MORE INFORMATION
There are many sources for answers to your questions about diet. One place to start is with your doctor: He or she can refer you to experts in diet and nutrition for help with applying diet guidelines, planning a weight-loss program or answering any of your questions.
To learn more about treatments and different kinds of arthritis, contact your local Arthritis Foundation chapter for a list of free brochures and detailed intormation. Their programs and services may help you.
Information provided by The Arthritis Foundation.
The Arthritis Foundation gratefully acknowledges the ,Assistance of the following, people in the preparation of this information: Joel M. Kremer, Ml), Albany Medical College; Sarah L. Morgat7, Ml), Rl), University of Alabama at Rirmin,qlnu//; Richanl <5. I~nush, M1), St. Baru``bas Medir`71 Ceuter; Roueun RoubenoJ}; Ml), MHS, 7uJts University; Richa/f7'1. .Sperling, 1\ IL), Brig/7a7r7 and Women5 Hospital; and Nedra Wilson, M<5, Rl), Unircrsit: of Alabam`7 at Birt7?ingham.
Food Guide Pyramid: U..S Department of Agriculture/U.S Department ot Htalt// an`l Human Services. Food Label: American Heart Association.
Information about Antioxidants provided by Nature's Blend Vitamins.
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