(2) Arthritis
There are two main types of arthritis: osteoarthritis (caused by degeneration
and wear and tear on joints) and rheumatoid arthritis (an inflammatory
condition, thought to be an auto-immune disorder). Diet is an important
aspect in the management of both types, but so-called "dietary cures"
are controversial.
Patients with arthritis often have difficulties with cooking, shopping
and preparing food, and pain may lead to poor appetite. This can result
in a restricted diet (eg, limited vegetables and fruit) with a poor vitamin
and mineral content. Many of the drugs used to treat arthritis (eg, non-steroidal
anti-inflammatory drugs) have nutritional implications, such as gastrointestinal
irritation and bleeding).
Osteoarthritis
Body weight — Correct or prevent obesity or overweight.
Excessive weight increases the strain on load-bearing joints, such as
hips and knees. Weight reduction can reduce pain and improve mobility
and may also reduce the risk of developing osteoarthritis.
Balanced diet — Eat a healthy, balanced diet with
plenty of fruit, vegetables and grains. Use fatty and sugary foods in
moderation.
Glucosamine — Several trials have shown that glucosamine
(a synthetic glucose polymer based on a natural substance found mainly
in joints) can improve symptoms of osteoarthritis, but all have contained
study design flaws and problems with data analysis. Adverse effects are
few and limited mainly to gastrointestinal disturbances, although studies
have shown that glucosamine can impair insulin secretion and metabolism.
Care should therefore be taken in patients with diabetes.
Antioxidants and vitamin D — There is some evidence
that patients with an increased intake of dietary antioxidants (eg, vitamins
C and E, selenium) and vitamin D reduce the risk of osteoarthritis progression.
Fish oils — There is anecdotal evidence that fish
oils are useful in the management of osteoarthritis but clinical trials
show more evidence of benefit in rheumatoid arthritis.
Rheumatoid arthritis
Body weight — Correct or prevent obesity and overweight
and eat a healthy, balanced diet.
Food allergy — Food allergy has been suggested to
be a cause of rheumatoid arthritis, and many popular books advocate exclusion
diets to help identify possible dietary causes. An exclusion diet involves
avoidance of potential allergens for two to three weeks and re-introduction
of foods in a pre-determined sequence to see which cause symptoms. Common
culprits are milk and dairy products, wheat, peanuts, beef, citrus fruits,
tomatoes and coffee. Such action may help individuals to gain control
of their condition, but may also cause nutritional deficiencies.
Fish oils — Fish oils contain omega-3 fatty acids
(eicosapentaenoic acid [EPA] and docosahexanoic acid [DHA]), which may
help to reduce symptoms of pain, morning stiffness and swollen joints.
They appear to act by reducing production of pro-inflammatory prostaglandins
and leukotrienes. Fish oils can be obtained from oily fish (eg, mackerel,
herring, sardines) but, to obtain beneficial amounts of fatty acids, it
is necessary to eat 8oz of oily fish each day. Fish oil supplements are
a more manageable alternative and a supplement providing 1,000-1,500mg/day
of omega-3 fatty acids is an appropriate choice.
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