Making dietary changes involves planning and willpower. For some it may be easier to start small, making a few changes a little at a time. Others prefer going “cold turkey”. Whichever method is best for you know that making changes is the first step to better health.

Eliminate fried foods:

• Fried foods contain large amounts of unhealthy saturated and trans fats. You can still enjoy your favorite foods by trying new methods of food preparation like baking, grilling and steaming.

Cut out all beverages sweetened with sugar: 

• Eliminate excess calories from sugar sweetened beverages. Excess calories from sweetened beverages will be stored on the body as fat.

Have at least five servings of fruits and vegetables per day.

• 3 servings of vegetables 
• 2 servings of fruit

The benefits of fruits and vegetables are endless. Getting 5 servings per day is not as hard as it sounds:

1. Have fruit at breakfast: use it to top cereal or to have in oatmeal

2-3. Have a salad for lunch. Large salads can be 3-4 servings of vegetables.

4. Have fruit as an afternoon snack

5. Eat a green vegetable at dinner every night.

The Plotkin Technique

• Eat opposite-handed: Slowing your eating will tend to decrease your portion size and calorie intake. A simple trick is to eat with your non-dominant hand.

DIET PLANS

Thousands of diets exist today and below we have outlined the most popular researched diets for treatment of arthritis and joint pain. They include:

• The Mediterranean Diet
• Vegetarian and Vegan Diets
• Elimination Diets
• The Anti-inflammatory Diet

The Cochrane collaboration reviewed 15 studies about diet and arthritis and found that a vegetarian and Mediterranean diet may improve symptoms. The study also proved that some unintentional weight loss occurred when following the special diets (Hagen et al 2009).

I. Mediterranean Diet

The Mediterranean diet is based on dietary traditions of the people of the many regions bordering the Mediterranean Sea. There is a general consensus among health professionals that the Mediterranean Diet is healthier than a western diet because of healthy grains such as pasta and couscous and an emphasis on vegetables, fruits, legumes, nuts and olive oil. Cheese, yogurt, eggs, poultry and fish are the main source of protein but are consumed in small to moderate portions. The main sources of fats in the diet are monounsaturated and polyunsaturated from olive oil, nuts and omega-3 fats. Some studies have shown that omega 3 fatty acids or 'fish oils' found in deep-sea fish may help to reduce the inflammation of rheumatoid and osteoarthritis. Foods rich in Omega 3 include: 

• Oily fish such as salmon, tuna and mackerel
• Linseeds
• Canola oil
• Walnuts
• Fish oil supplements

A Mediterranean-style diet also includes moderate amounts of alcohol, generally red wine.

Staples foods: fruits, vegetables (particularly non starchy), nuts, legumes and whole grains, some dairy products, and small amounts of lean meats and poultry: (white fish, chicken, turkey, lean steaks)

Numerous studies have found patient’s levels of HS-CRP, IL-6 and other inflammatory markers reduced when patients were put on the Mediterranean diet. Of particular interest is a study of Scandinavian patients with rheumatoid arthritis who were placed on the Mediterranean diet and saw levels of HS-CRP decrease along with their pain levels.1

II. Vegetarian Diet

A vegetarian diet is based on the exclusion of animal meats but does allow dairy and egg. Two types of vegetarianism are most common:

• Lacto-Vegetarian diets include milk and dairy products
• Lacto-Ovo-Vegetarian diets include milk, dairy and eggs
• Staple Foods: Grain products, dairy products, soy products, olive and canola oils, beans, lentils and nuts, all fruits and vegetables.

III. Vegan Diet

The Vegan diet is the strictest form of vegetarianism and excludes all forms of animal protein. The vegan diet uses soy products as an alternative to dairy and meats. A vegan diet excludes dairy products, eggs, and any other form of animal protein. The key to a nutritionally sound vegan diet is variety. A healthy and varied vegan diet includes fruits, vegetables, plenty of leafy greens, whole grain products, nuts, seeds, and legumes.

Staple foods: grain products, beans, peas and lentils, soy and soy products, tempeh, nuts, all fruits and vegetables including fresh, frozen, dried and canned vegetables. Oils such as canola, olive, safflower and corn oil.

IV. Elimination Diet

Elimination diets are used when a certain food is suspected to make arthritic pain symptoms worse. Not everyone is affected by food the same way, however, if a food aggravate is suspected an elimination diet is a way to test for symptom alleviation. A simple elimination diet involves removing the suspected food for a set amount of time to see if symptoms improve. Some foods listed below are often viewed as possible triggers to inflammation and arthritic pain:

• Caffeine
• Dairy products
• Nightshade vegetables (potatoes, tomatoes, peppers, eggplant, paprika, cayenne and Tabasco sauce, etc.)
• Sugar
• Additives and preservatives
• Chocolate
• Red meats
• Salt
• Alcohol
• Hydrogenated oils/trans fats

This diet included keeping a food journal, while eliminating one food or food groups at a time to see if symptoms improve or worsen. The average time frame for an elimination diet ranges from weeks to months. The Elimination diet is best utilized when you keep your eating habits the same with the exception of one suspected food or food group.

VI. The Anti-inflammatory Diet

Have you ever thought about how food immediately affects your internal organs and tissues? We often fail to think about the effects of food on our system unless we feel them immediately, like heart burn or indigestion. The truth is that many common foods can increase inflammation in our bodies causing stiff joints and increased pain for arthritis patients. Inflammation plays a large role in cardiovascular disease. Research has well established the fact that inflammation in the arteries is involved with plaque build up over time which leads to blocked arteries in the heart (heart attack).

Inflammation can be defined as a set of symptoms that includes pain, swelling, heat and redness of an affected organ or tissue of the body. Inflammation is the immune system’s response to attacks like infection or injury. The immune system will also respond to an unsatisfactory diet. Recently research has focused on diets and lifestyle plans that look to reduce inflammation and it’s negative effects on the body.

Dietary fats like partially hydrogenated oils or trans fats trigger pro-inflammatory prostaglandins. Pro inflammatory prostaglandins are hormones that activate the inflammation process. We produce pro-inflammatory prostaglandins by ingesting unhealthy dietary fats like partially hydrogenated oils and trans fat found in fast food items and other processed foods. A typical anti-inflammatory diet focuses on creating anti-inflammatory prostaglandins instead of pro-inflammatory prostaglandins by decreasing the amounts of “unhealthy fats” in the diet and increasing “healthy fats”.

The following section describes the key principles the anti-inflammatory diet.

KEY PRINCIPLES TO THE ANTI-INFLAMMATORY DIET:

A. CARBOHYDRATES

Selecting whole grains as your carbohydrate source is a good idea due to the fiber content. Fiber has been found to play a role in decreasing systemic inflammation. Seven out of six studies found that fiber consumption decreased the levels of a biochemical marker of inflammation known as high-sensitivity C-reactive protein or (HS-CRP). The Women’s Health Initiative saw similar results and also found an inverse relationship between fiber intake and another mediator of inflammation known as tumor necrosis factor-alpha.1

Diets high in refined starches and sugars may actually increase levels of free fatty acids. Studies suggest that hyperglycemia may increase levels of free radicals and inflammatory cytokines.2

B. FATS

Along with the quality of your carbohydrates, you should also consider the quality of your fats. Western diets tend to be higher in n-6 PUFA and lower in n-3 PUFA than Eastern diets. The National Health and Nutrition Examination Survey found an inverse relationship between inflammatory mediators HS-CRP and fibrinogen and polyunsaturated fatty acids. They found a positive correlation between saturated fatty acid intake and HS-CRP and fibrinogen levels.

A Harvard Nurses Health Study found that trans-fatty acids were also linked with increasing systemic inflammation. They found a positive correlation between TFA intake and soluable TNF-receptor 1 and 2.

Many studies on humans have found an inverse relationship between intake of omega-3 fatty acids and systemic markers of inflammation. In the Multi-Ethnic Study of Atherosclerosis an inverse relationship was found between eating non-fried fish containing omega-3 PUFA and levels of interleukin-6 as well as matrix metalloproteinase 3. They did not find this relationship with fried fish. An observational study in Australia also found an inverse relationship between HS-CRP in plasma and concentrations of omega-3 fatty acids in the blood.

On the contrary omega-6 PUFA may not be beneficial as it has been found to have both inflammatory as well as pro-inflammatory effects.

A few studies have also found intake of monounsaturated fatty acids (MUFA) to have an inverse relationship with inflammation. In the ATTICA study Oleic acid was found to be inversely associated with HS-CRP and IL-6.1

C. FISH OILS

Long chain n-3 PUFA found in fish oils such as EPA and DHA act to decrease inflammation in rheumatoid arthritis. On the contrary n-6 PUFA found in polyunsaturated cooking oils and margarine actually increase inflammation in RA. A 24 week double blind randomized study of 20 patients with RA tested the ingestion of EPA and DHA at varying doses. Regardless of the dosage, researchers found a decrease in symptoms as well as a decrease in IL-1B production. Similar findings were discovered in a 12 week study comparing intake of n-3 PUFA and placebo in 32 patients with RA.3

D. CAROTENOIDS

A study out of England on polyarthritis found that increasing intake of the carotenoids zeaxanthin and betacryptoxanthin had a negative association with inflammatory arthritis. Increasing your intake of beta-cryptoxanthin is as easy as drinking a glass of orange juice daily.

A Women’s health and aging study also found that women with higher levels of beta-carotene and total carotenoids had lower IL-6 levels than women with low levels of these carotenoids.1

E. MAGNESIUM

There is a strong inverse relationship between magnesium intake and inflammation. The Harvard Nurses Study and the Women’s Health Initiative Observational Study both found evidence to support this. They found that increased intake of Mg caused decreased levels of HS-CRP, IL-6 and TNF-beta-R2. This is most likely attributed to whole grains, green leafy vegetables, nuts, and legumes which all contain magnesium.1

F. ALCOHOL

Alcohol in particular wine is a large part of the Mediterranean diet. It has been suggested that moderate intake of red wine reduces the risk of cardiovascular disease. Studies in both Europe and the U.S. have found that moderate consumption of alcohol may decrease inflammatory markers perhaps due to the ethanol in the wine.2

G. FRUITS AND VEGETABLES

Several studies have found that consuming a diet full of fruits and vegetables has an inverse relationship with inflammation. The MESA study examined different dietary patterns and how they affect inflammatory markers. They found that diets consisting of mainly whole grains, fruit, nuts, and green leafy vegetables; as well as diets consisting of fish, and dark-yellow cruciferous and other veggies both had an inverse relationship with HS-CRP and IL-6 levels.1

Raw fruits and vegetables contain anti-oxidants which have pro-inflammatory effects and may be used as an adjunct treatment of rheumatoid arthritis and other inflammatory diseases. Interestingly enough in France where the typical diet is high in fruits and vegetables and therefore antioxidants, the number of people with RA is significantly lower than in the United States where the typical diet is high in fats and refined carbohydrates.3

Many small studies on treatment of OA have found vitamin E treatment to be helpful especially when combined with vitamin C supplementation. In a 6 week double blind placebo controlled study researchers found that vitamin E treatment for OA increased every efficacy measure. The Framingham Knee OA Cohort Study found that antioxidants do not decrease the incidence of knee OA, however they did find that antioxidants may prevent the condition from progressing in individuals who already have knee OA.3

 

H. INCORPORATE THE PRINCIPLES OF THE MEDITERRANEAN DIET

The “Mediterranean diet” is the traditional diet found in the south of Europe. The diet consists mainly of fruits, veggies, legumes, cereals, fish, olive oil as the fat source, and the consumption of red wine.

Numerous studies have found patient’s levels of HS-CRP, IL-6 and other inflammatory markers reduced when patients were put on the Mediterranean diet. Of particular interest is a study of Scandinavian patients with rheumatoid arthritis who were placed on the Mediterranean diet and saw levels of HS-CRP decrease along with their pain levels.1

VII. Insect, slug and snail diet

The only diet proven to maintain the reader’s interest this far into a monograph!

IN CONCLUSION

Diet therapy and weight loss if overweight is an essential treatment aspect of managing arthritis. While no set diet can cure arthritis adopting better eating habits has unlimited health benefits and my even improve symptoms and overall health. At the Virginia Cartilage Center a Certified Nutrition professional and Registered Dietitian is on staff to assist you with meeting your nutrition goals. Additional information regarding weight loss can also be accessed through this web site

Tips to help you get started with trial DIET THERAPY:

1. Eat a wide a variety of fruit and vegetables everyday, particularly non-starchy vegetables (all those excepting corn, peas, and potatoes).
2. Fill up on soluble fiber; boost your bean and legume intake (lentils, chickpeas, soybeans, kidney beans).
3. Build your diet from a base of grains, rice, pasta and couscous particularly whole grain and rye versions.
4. Have fish more often (2-3 times per week) and lean protein.
5. Use olive or canola oils in cooking and olive or canola based margarines.
6. Minimize fats; no fried foods or snacks
7. Minimize fats; use low fat cheeses and dairy products.
8. Minimize fats; have a handful of unsalted nuts (peanuts, almonds, Brazil and walnuts, etc) on most days of the week in preference to other high fat, sugary snacks.
9. Minimize fats; choose lean cuts of red meat in small amounts, combine with vegetables.
10. Minimize fats; limit high-fat processed meats such as hot dogs, sausages and salami.
11. Consume alcohol and wine in moderation.

REFERENCES

Galland L. Diet and Inflammation. Nutr Clin Prac. 2010; 25(6):634-640.

Giugliano D, Ceriello A, Esposito K. The Effects of Diet on Inflammation: Emphasis on the Metabolic Syndrome. Journal of the American College of Cardiology. 2006; 48(4): 677-685.

Darlington LG, Stone TW. Antioxidants and Fatty Acids in the Amelioration of Rheumatoid Arthritis and Related Disorders. British Journal of Nutrition. 2001; 85, 251-269.

Hagen KB, Byfuglien Jeitung MG, Falzon L, Olsen S,Urke, Smedslund G.(2009) Dietary interventions for rheumatoid arthritis. Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD006400.pub2

Messier SP, Legault, C, Loeser, RF, Van Arsdale SJ, Davis, C, Ettinger WH, Devita, P (2010) Does high weight loss in older adults with knee osteoarthritis affect bone on bone joint loads and muscle forces during walking? Osteoarthritis and Cartilage Epub – ahead of print