The inflammation caused by arthritis is a normal defense response which occurs in the body, usually in response to infection or injury. However, with arthritis, the inflammation occurs inappropriately and this can damage the cartilage in the joint. With excessive inflammation and ‘wear and tear’ of the cartilage, this can lead to pain and losing function in the joint. The continuous inflammation also affects the general health and wellbeing of arthritis sufferers. One way in which this inappropriate inflammation can be managed is through diet. Certain foods are thought to promote inflammation in the body and these should be avoided by arthritis sufferers. Other foods may help to reduce inflammation and improve joint health. Optimum nutrition can help to prevent certain types of arthritis, reduce joint pain, prevent disability, and in some cases help to improve the health and wellbeing of those with arthritis. A good diet is an important part of your overall treatment plan and for maintaining general good health. It is not a cure, but it can help to improve the quality of life for those with arthritis. Step one to improving your diet is by reducing or avoiding foods that promote inflammation in the body and consuming more of the anti-inflammatory foods.
Understanding arthritis Arthritis is a condition that affects the joints, leading to pain and inflammation. There are many different types of arthritis, but the most common is osteoarthritis. Other types of arthritis include rheumatoid arthritis, gout, lupus, fibromyalgia, and psoriatic arthritis. Symptoms of arthritis usually appear in adults over the age of 65, but they can also develop in children, teens, and younger adults. Arthritis is more common in women than men and in those who are overweight.
Understanding Arthritis
The term arthritis refers to around 120 different diseases that are characterized by inflammation of the joints. Arthritis is a progressive disease, meaning it tends to get worse as time goes on. It affects many people in varying degrees; 1 in 7 people are affected by arthritis in the UK. It can cause permanent joint changes. These changes may be visible, such as knobbly finger joints, but often the damage can only be seen on x-ray. Some types of arthritis can also affect the muscles, organs and skin. Osteoarthritis is the most common type of arthritis, it is a mechanical problem involving wearing away of the joint. This can happen at any age, but often occurs in people over 40 years old and is more common in women than men. Back pain is often associated with osteoarthritis. Fibromyalgia is a long-term (chronic) condition. Its main symptom is widespread pain, affecting the entire body. The cause of fibromyalgia is not yet known. Non-inflammatory pain is the type of pain that occurs in osteoarthritis and other mechanical type problems, it is usually worse after moving the joint and improves with rest. Inflammatory pain is the type of pain that occurs with inflammation, such as rheumatoid arthritis. It is usually worse in the morning and improves with movement of the joint. Spanish version.
Importance of Diet in Managing Arthritis
It is best to lower the intake of omega-6 fatty acids while keeping a sensible balance of omega-3 to omega-6. Omega-3 is known to have anti-inflammatory effects and is a good nutrient for those with arthritis. It can be found in fish oils, flaxseed oil, and in capsules.
Processed foods often contain an abundance of omega-6 fatty acids. Although omega-6 and omega-3 fatty acids are essential in the diet, an excessive amount of omega-6 can trigger the body to produce chemicals that result in inflammation. Corn, sunflower, safflower, soy, and cottonseed oils are high in omega-6 fatty acids. Fast food is also usually full of unhealthy fats. Saturated fats are known to increase inflammation as well as the risk of heart disease. They may also disrupt the body’s fat balance of omega-3 fatty acids by increasing their oxidation. This, therefore, means an increased amount of omega-6 in relation to omega-3, which is something that needs to be avoided.
It is a well-known fact that diet plays an important role in managing most types of arthritis. A diet based on fruits, vegetables, fish, nuts, soy products, and olive oil (proposed in the Mediterranean diet) helps not only manage a disease like arthritis but also helps reduce heart disease and hypertension. For those who suffer from inflammatory types of arthritis (for example, rheumatoid arthritis), avoiding foods that contribute to inflammation will help to reduce symptoms.
Inflammatory Foods to Avoid
Sugary beverages have a high energy density and little nutritional value. Therefore your body will absorb these drinks quite rapidly. The added sugars can produce substances that are thought to encourage inflammation. High fructose corn syrup is a main source of sugar in the US diet and this is known to be a key contributor to the raise in obesity. This syrup is commonly added to drinks such as sodas and fruit-flavored drinks. But it is not only the high sugar content that is the problem. Sugary drinks also have large amounts of unhealthy additives, such as colorings and preservatives. Sugar can also increase the production of AGEs, harmful molecules that are produced when protein or fat combine with sugar in the bloodstream. AGEs damage other cells in the body and cause further inflammation. High AP levels and inflammatory factors have also been found in the blood of people who gulp down more than three sugary drinks a week. This shows that excessive intake of sugary drinks can indeed promote inflammation. High sugar drinks can also indirectly affect arthritis, by causing weight gain. Your body takes in more sugar than it needs as energy and this is stored as fat. The constant inflow of sugary drinks can be very detrimental to arthritis sufferers, so just imagine the effect that a six-pack a day could have on joint health in the future.
Processed foods have been altered in some way during preparation. Some methods of processing foods can actually lead to an increase in inflammation. There are unprocessed and minimally processed foods. Unprocessed foods include fresh fruits and vegetables. Minimally processed foods are simply pre-processed to make it more convenient for the consumer. For example, fresh-cut or prewashed vegetables, canned fruits in juice, instant rice and oatmeal are all types of minimally processed foods. It is the processed foods that you want to avoid like the plague. Examples of processed foods include frozen pizza, sodas, hot dogs and luncheon meat – just to name a few. These foods have been altered or added to – to an extent that the nutritional value has been greatly depleted, not to mention they are often loaded with unhealthy additives. This can include things such as artificial colorings and flavorings, known to be pro-inflammatory or have a detrimental affect on a person’s health.
Processed Foods
Processed foods are usually very high in trans-fats and saturated fats, both of which have been shown to cause an increase in the inflammation of the body, certainly not a good sign for arthritis, and on top of this they’re usually high in Omega-6 fatty acids which have also been shown to promote inflammation. Research presented at an American Heart Association conference on cardiovascular disease epidemiology and prevention showed that trans fats increase systemic inflammation. The study, on U.S. women, compared with levels of CRP with dietary habits. They found that CRP was higher in the individuals that ate the most trans fats. Similarly, saturated fats increase the production of cytokines, a group of proteins that signal inflammation. 10 healthy men took part in a study at the University of Kuopio in Finland. At the beginning of the study an inflammatory substance was injected into their arms. Blood tests to measure markers of inflammation were then taken. The men were then given meals high in either saturated fats or polyunsaturated fats (like those found in fish and nuts). After two weeks on that diet the injection and tests were repeated using the other arm. This process was then repeated until both arms had been subjected to the inflammatory substance with a diet change in-between. The tests showed that after eating the meal high in saturated fats the levels of inflammation were higher. These are just two such studies of many showing the effects of saturated fats on inflammation. An excess of Omega-6 fatty acids in the diet has many adverse effects, one of which is to promote inflammation. They are an essential fatty acid, we need them, but the typical western diet has an overabundance of them. This is primarily because of the increased use in cooking of vegetable oils, the principle source of Omega-6. Step one to avoiding excess Omega-6 is to check ingredients. Next time you’re at the supermarket pick up the bottle of vegetable oil and look at the ingredients; you’ll find that it’s probably soybean or corn oil, both of which contain a high amount of Omega-6. This is also the case with mayonnaise and many salad dressings. The other principal source of Omega-6 is red meat, the topic of 2.3. Red meat should be limited but who says no to a nice steak? Choose to buy grass-fed beef over grain-fed. Though it is still high in Omega-6 it has been shown to have a more balanced ratio of Omega-6 to Omega-3 and lower levels of trans fats.
Sugary Beverages
Perhaps it is not so much of a surprise to learn that drinking too many sweet drinks may be bad for health, but perhaps the degree of how bad could be shocking for some. The good news is that there is evidence that cutting these drinks out can be beneficial. A study published in the journal Circulation showed that an increased consumption of sweet drinks in 88,520 women (aged 34 to 59 at the start of the study) was linked with an increased risk of coronary heart disease. The risk was elevated regardless of whether or not the women were taking in high levels of caffeine. A similar study in men was also published in Circulation showing that the consumption of sweetened beverages is associated with a higher risk of coronary heart disease. An increase in beverage consumption from one per week to one per day was associated with a 19% higher risk in men.
Sugary beverages: Simple or refined sugars are known to increase inflammation, so anything containing sugar is likely to be something you should avoid. One study published in The American Journal of Clinical Nutrition showed that glucose or sucrose greatly increased levels of inflammatory markers in the blood when compared to complex carbohydrates, and fructose was even worse (Karen M Davison, 2009). Another study found that the fructose from high fructose corn syrup increased the incidence of gout in men (Hyun Choi, MD DrPH, 2008). Additionally, soft drinks usually contain phosphoric acid and caffeine. There is evidence that over-consumption of phosphoric acid (used to give that tangy taste) can lead to a depletion of calcium and cause general bone health to decline. One well-publicized study published in The American Journal of Clinical Nutrition showed that consumption of 330mg of caffeine reduced bone mineral content in elderly women.
Red Meat
Red meat contains chemicals that are known to cause inflammation and damage to the body’s cells. Haem iron is only found in meat and is highly absorbed in the body. High consumption of this can affect joint health and inflammation by increasing free radicals and oxidative stress, damaging joint proteins (Rohrbach, 2004). It can also lead to the development of insulin resistance, which increases the chance of getting type 2 diabetes, leading to less insulin sensitivity and more advanced glycation end products (AGEs).
High consumption of red meat and processed meat can increase inflammation, which can worsen arthritis symptoms. A study done in 2014 showed that patients who have arthritis are more likely to avoid red meat, which can reduce disease activity, physical disability, and improve quality of life. The result also shows the possibility to use red meat as a prognostic marker for remission in inflammatory polyarthritis (Pattison, Al, Pokhrel, 2004).
Foods High in Purines to Avoid
Purine is a common compound found in many foods, and to some degree in all foods. They are the breakdown product of protein, and in the process of their breakdown to uric acid, they can cause problems. High intakes of purine and purine-rich foods are associated with increased levels of uric acid and an increased risk of gout. Gout is a type of arthritis where high levels of uric acid in the blood crystallize and get deposited in joints, leading to painful swollen joints. Attacks of gout can occur out of the blue and are usually linked with severe pain in the big toe or other joints. They can affect people of all ages, however, it is more common in older adults. By avoiding foods high in purines that increase levels of uric acid, it may be possible to help prevent gout occurring in those with an increased risk. Gout is also a common manifestation of uric acid buildup in those with other types of inflammatory arthritis. To understand how all food will affect the gout sufferer, it is possible to measure the uric acid level in the blood and urine. The increase in uric acid level in a day or two of eating a particular food indicates that it is likely to be a contributing factor. By then avoiding that food, the uric acid levels should drop, providing a guide as to whether that food is a significant trigger of gout.
Organ Meats
Although it has been established that the consumption of purine-rich vegetables does not increase the risk of gout attacks, other studies have shown that consumption of cherries and other fruits high in bioflavonoids may decrease the risk of gout attacks.
One study showed that the risk of gout was 2.5 times higher in men who ate 50 grams of liver daily compared to men who did not eat liver. An excessive amount of meat, such as steak, increases the risk of gout in men. For men who ate 5-6 ounces of meat, the risk was 1.5 times higher, and for those who ate 10 ounces of meat per day, the risk was 2.5 times higher. These results were independent of the consumption of seafood and purine-rich vegetables, high alcohol intake, diuretic use, and the presence of chronic kidney disease.
Organ meats, such as liver, have high amounts of purines. People with gout often have difficulty processing the uric acid. Because of this, they should avoid high-purine foods such as organ meats, anchovies, and herring, as well as concentrated meat extracts.
Seafood
Seafood is a high purine food and thus should be avoided when you have arthritis and you are following an arthritis diet. The reason is that purines break down into uric acid and uric acid is the leading cause of gout, which is a type of arthritis. A study found that the risk of gout attacks is significantly higher if a person consumes seafood. Fish is often touted as a healthy thing to eat and it is high in protein and usually low in fat. Canned, fresh or frozen fish and shellfish are also significantly linked to gout. The types of fish that were found to increase the risk of gout attacks were shellfish, tuna, mackerel, herring, sardines, and anchovies. High intakes of seafood are particularly dangerous to people with rheumatoid arthritis and a higher risk of gout. High purine intake also increases the risk of death from hyperuricemia (the buildup of uric acid) and gout in men with high blood pressure. This is particularly bad news for people with arthritis as they are predisposed to heart conditions due to the type of medications that are used to treat arthritis and inflammation in the body. Fish oil has been highly recommended to ease inflammation, pain, and stiffness in joints for people with arthritis. It has been found that there is some benefit in taking fish oil supplements. However, there is evidence that people with arthritis can have severe adverse reactions to fish oils and those with fish allergies can still have allergic reactions to fish oil. Fish oil is found to raise levels of LDL (bad) cholesterol, increase the risk of bleeding, and in some cases has been found to increase the pain and swelling of joint inflammation.
Alcohol
An interesting case study was conducted on a 64-year-old man who had a history of gout and recurring gouty attacks. A possible reason behind the recurring attacks was the fact he had an elevated serum urate concentration and was an excessive consumer of beer. He found that during the week he drank a 6-pack of beer and would increase to several more beers in one day. He was willing to try anything to alleviate his gouty attacks and thus the study conducted total abstinence of beer and any other forms of alcohol. The patient was assessed every two weeks for a period of 8 weeks. They found that after 4 weeks, serum urate lowered to a 1.0 mg/dl and remained that way throughout the total abstinence period. He felt great improvement and had no effects of gout occurring. After 8 weeks, with the permission of the case assessor, the patient decided to use alcohol again on one occasion for the sole purpose of testing the results of alcohol on his serum urate concentrations. The patient drank several cans of beer and they found there was a great increase in serum urate. From this case study, it is clear to see there is a direct correlation between alcohol and increased risk of gout.
Alcoholic beverages containing ethanol have been shown to increase the risk of gout and recurrent attacks, mainly due to the metabolism of ethanol in the body. Beer is particularly bad and the risk is dose dependent. A study was done on over 47,000 men with no history of gout to see if there was an increased risk. They found that after 12 years, 730 of those men developed gout and they found a relative risk of gout to be 1.49 for those who consumed 2 drinks per day. For those who consumed 2 beers per day, the risk was even higher with a relative risk of 2.5. The study found that the main reason for the increased risk was the high content of alcohol in beer and the purine content.
Legumes
Red and white leg beans are of particular concern, as they are among the highest purine-containing foods. In a study using data from the Third National Health and Nutrition Examination Survey, a direct association was observed between the consumption of purine-rich legumes and an increased risk of gout. In comparison to people who might have only one gout attack over the next 5 years, the people consuming the highest purine legumes increased their risk of gout by as much as 3 times. Other legumes pose less of a risk and can be consumed in moderation. The key to these would be the method of preparation. Generally, legumes are ideal sources of protein and complex carbohydrates, which are a healthy alternative to purine-saturated foods such as red meats and fatty processed meals. Soaking and boiling these legumes for long periods has been shown to reduce the purine content anywhere from 10-50%, ultimately making these a viable option for some sufferers.
Legumes are plants that bear fruit in the form of a pod. They also have a unique ability to fix nitrogen from the air into a form of nitrogenous compound, making them an extremely efficient and nutritious food source. The main problem with legumes is that they also contain a high level of purines. Gout and gout arthritis are the result of uric acid crystal formations within the body. These crystals are formed from the high levels of uric acid in the blood and are the cause of the intense pain and discomfort in the joints and the surrounding areas. When our bodies consume foods high in purines, or in the case of legumes, foods that contain a moderate level of purines, they are metabolized into uric acid. Because uric acid is a waste product resulting from the metabolism of purines, it is essential for patients to control intake of foods high in purines or risk increasing their pain and discomfort from gout or increasing the risk or severity of gout attacks.
Foods High in Omega-6 Fatty Acids to Limit
Foods high in omega-6 fatty acids to limit Omega-6 is another essential fatty acid that the body needs, and there is evidence that omega-6 and omega-3 fatty acids compete for the same enzymes in the body. This means that the more of one you consume, the less effective the other will be. Research studies have suggested that an imbalance of omega-6 and omega-3 fatty acids may be a cause of systemic inflammation. The Mediterranean diet, on the other hand, has a healthier balance of omega-3 to omega-6 fatty acids. This can be accomplished by increasing the consumption of alpha-linolenic acid found in flax, hemp, and perilla oils which have a higher ratio of omega-3 to omega-6, and significantly decreasing the intake of oils that are high in omega-6 fatty acids. So although moderate omega-6 fatty acids are needed in the diet, an excessive amount is unhealthy and should be avoided. Listed in descending order: 4.1. Vegetable Oils (sunflower, safflower, corn, cottonseed, soybean, peanut) 4.2. Fried Foods 4.3. Packaged Snacks
Vegetable Oils
Most vegetable oils are very high in omega-6 fatty acids. While these are essential fats and the omega-6s are no exception, they are in far too great a quantity in the standard American diet. Omega-6s are pro-inflammatory and can be converted in the body into even more inflammatory chemicals. High consumption of these vegetable oils also compromises the body’s omega-3s, leading to further imbalance and negative health effects. The only vegetable oil to contain a low amount of omega-6s is olive oil, and it is perfectly acceptable to use in moderation for its known health benefits. However, all other oil consumption should be drastically limited. The oils high in omega-6s include safflower, sunflower, corn, soy, and peanut. Most pre-bought products, whether baked or fried, are made using omega-6 rich oils. Snack foods are also packed full of these unhelpful fats. Therefore, although it takes some effort and is not so convenient, the best thing for anyone who wants to follow a diet that is less pro-inflammatory is to prepare their own cooked food using olive oil and to avoid processed snacks and fast foods.
Fried Foods
The essential issue with fried foods is that the oils are high in omega-6 fatty acids. Therefore, they promote the production of chemicals (prostaglandins series 2) that are pro-inflammatory. This can increase joint inflammation. For every 1% increase in calories from omega-6 fatty acids, there is a 2% increase in the risk of osteoarthritis. Deep fried foods also contain advanced glycation end products. These are molecules that are formed when products are cooked at high temperatures, including when dry heat cooking (frying, oven baking). These molecules will stimulate an inflammatory response and are thought to increase the risk of inflammatory disease, obesity, and diabetes. Deep fried foods are also high in trans fats and saturated fats. Atrial fibrillation sufferers depend on the cause, presence of other cardiac disease, age of the patient, and medical history. Trans fats promote inflammation and are known to cause many other health problems, including increased cardiovascular disease. Saturated fats are not known to directly increase inflammation, but by avoiding the previously mentioned fats and eating more omega-3 fatty acids, the same amount of saturated fats will have less effect on arthritis.
Packaged Snacks
Remember that not all snack type foods are detrimental. Simple changes in what you look for in foods can lead to better long-term health outcomes. For example, rather than chips and dip, try unsalted pretzels or new potatoes roasted in olive oil. Doesn’t garden fresh salsa sound better than the bottled variety? Think about trying rice crackers with low fat cheese, or a handful of unsalted nuts. Use your imagination with fruits and vegetables! With a little effort, it is entirely possible to find better alternatives for your favorite snack type foods. A dietician can provide you with more helpful information and suggestions.
Keep in mind that learning to eat a healthier diet is a process. But for arthritis sufferers, making wise food choices can mean the difference between manageable and unmanageable pain. Note that fatty acids are in general a healthy nutrient. However, for arthritis sufferers increased amounts of omega-3 fatty acids compared to omega-6 fatty acids have led to clinical improvements.
Packaged snacks are a staple in the American diet. Many snacks, however, contain high amounts of omega-6 fatty acids. Avoid snacks that list the following ingredients high in omega-6 fatty acids: partially hydrogenated oils, palm, kernel or coconut oils. Snacks that commonly contain these ingredients include chips, most cheese flavored snacks, and certain types of popcorn.