How diet affects Osteoarthritis, Rheumatoid Arthritis, and Gout

Posted on: October 7th, 2013 by Dr. Richard R. Olson

“What should I eat more of to help my arthritis?”

Patients suffering from chronic arthritis pain ask this question daily, and it’s a good question to ask.  Often, the hope that at least some relief may be found without taking medication motivates the question.

But the answer is far from simple, despite scores of research studies on diet and arthritis.

On top of that, it’s often not even the right question to ask.

Remember that many types of arthritis exist, and not all dietary study results apply universally to the arthritis umbrella.

Results from a dietary study of the inflammatory disease Rheumatoid Arthritis may not apply to you if you have the more common degenerative condition Osteoarthritis or to the metabolic disease Gout. So if you do your own research (and you should!), make sure to find out to which form of arthritis a study applies.

One hundred years ago, our understanding of arthritis was limited, and we lumped painful joint conditions together.  Now that we have a better understanding of the conditions affecting joints, we know that they may respond quite differently to the same intervention.

Osteoarthritis (OA): Ask the right question

If you have OA, you would do better to ask, “What should I eat less of to help my arthritis?”

This question matters because your weight is the most important factor in OA, which primarily affects weight-bearing joints, including the knees, hips, feet, and lower back.

Cartilage–the low friction gliding surface covering the ends of the bones–deteriorates in OA.

Loss of normal cartilage results in:

  • Pain
  • Stiffness
  • Weakness
  • Loss of function

So you should do everything possible to preserve your cartilage, and while cartilage loss can occur for many reasons, by far the most common reason is a high body mass.

Around age 35-45, however, your cartilage thickness decreases to the point where joint pain develops.  Pain intensifies over time as cartilage decreases to the point where joint pain develops.

Further, you may gain weight because of activity restrictions brought on by pain.  Notice what is happening?  You enter a vicious cycle where decreased cartilage increases pain, forces you to reduce your level of activity, which causes weight gain and more pain.

That cycle is debilitating and reduces your quality of life.

Losing weight is an important preservative measure

Americans dietary choices often lead to obesity.  Almost 36% of American adults are obese according to the CDC.  The data from the Centers for Disease Control demonstrate that arthritis in general affects a large proportion of American adults.

Look at the numbers when you get a chance.

Let’s face it: Americans enjoy calorie dense foods (e.g. fried foods, high fat content foods like ice cream) as well as soft drinks–or pop, soda, cola, coke, depending on where you live.

But the most problematic dietary habit is still excessive portion size and eating frequency.  Snacking is definitely problematic.

Limiting your daily caloric intake will work 100% of the time.  The math is simple: if you burn more calories than you consume, your body loses weight.  With that said, don’t confuse simple math with thinking weight loss is simple.  It takes dedication and self control to make wise eating choices.

Healthy eating lifestyles that reduce overall calories (either fat-restricted or carb-restricted programs) are effective.

You should not participate in a temporary crash diet because it’s not sustainable, which means after you lose the weight, you will likely put it right back on again.

A healthy eating program will include ample portions of fresh fruit and vegetables and will moderate fat consumption.  Consider this: fats have 9 calories/gram compared to 4 calories/gram for proteins and carbs.

Organizations like Weight Watchers can provide you with valuable guidance if you are motivated to make important changes in eating habits.

Rheumatoid Arthritis (RA): diet affects inflammation

Your body uses inflammation as a beneficial response to fight infection.  It works to eliminate a virus or bacteria in order to allow healing.

In RA and other autoimmune forms of arthritis, inflammation is turned against your joints, causing swelling, stiffness, redness, warmth, and pain.

Diets higher in fish oils contain omega-3 fatty acids that modestly limit inflammation.  A shift from red meat to seafood may help.  You could also take fish oil capsules, though the daily dose required (6000 mg) may be higher than you want to take each day.

The precise cause of RA is still unknown, and the clinical course is often unpredictable.

Maybe you attribute flare ups to one of the following factors:

  • The weather
  • Stress
  • Food sensitivities

Food sensitivities are relatively uncommon, and your food sensitivity may differ dramatically from another person with RA, so making broad generalizations about which foods to avoid will not benefit anyone.  It’s better to determine exactly what you need to avoid by talking with your physician.

Gout: directly linked to excessive intake of food and alcohol

Gout occurs because uric acid builds up in the blood, which eventually spills into the joints where it forms crystals that set off inflammation.

More than other forms of arthritis, gout is immediately affected by changes in diet.

Attacks are typically related to alcoholic intake and dehydration (so drink lots of water).  You may also experience an attack if you consume foods with a high purine count (the source of uric acid).  High purine sources include meat–especially organ meat from the liver and kidney–and shellfish.

Beer contains purines, and all forms of alcohol hinder the kidney’s ability to filter uric acid out of the blood.

If you have gout, you should moderate your alcohol, red meat, and shellfish consumption, which will reduce your risk of attack.

Maintaining a healthy weight also lowers blood levels of uric acid, so a proper diet and exercise plan is vital to controlling attacks.

As you can see, diet matters for arthritis patients, but it’s not as simple as saying “eat more broccoli and cherries.”  Numerous reports purport the positive effects of single nutrients or supplements, but they are often flawed because of short study periods, which are unreliable in assessing chronic arthritis symptoms.

Due to the effectiveness of modern marketing, you will be bombarded constantly by the newest “miracle” product, but sadly, the answer to arthritis is not that simple, though everyone wishes it were.

In future posts, I will look at individual nutrient claims in more detail, but for now, remember this overview when reading studies or when someone tells you to “just do [fill in the blank]” and your arthritis will dramatically improve.

Have questions?  Feel free to ask them or share your own experiences with arthritis.

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