Arthritis - Both Kinds
From the PCRM website comes this report on this painful condition:
Arthritis is painful for patients and frustrating for doctors. Typical anti-inflammatory treatments help, but they often fail to ease all symptoms and do nothing to stop the progressive joint damage that leads to surgery or loss of function.
Nutrition can help, either with medicines or, in some cases, instead of them. Foods affect the joints in two major ways. First, certain foods trigger the symptoms of rheumatoid arthritis, and eliminating these foods sometimes causes even long-standing symptoms to improve or even remit entirely. Second, certain fatty acids have an anti-inflammatory action that can reduce joint pain, stiffness, and swelling.
The role of nutrition in arthritis was controversial until the early 1990s when research studies established its role beyond any reasonable doubt. Prior to that time, intriguing individual case reports were published in the medical literature showing the dramatic effects of avoiding certain foods, but left unanswered the question of how widespread such sensitivities were.
In 1981, the British Medical Journal reported the case of a woman whose battle with rheumatoid arthritis suddenly ended when doctors discovered that her symptoms were triggered by corn products. Corn was eliminated from her diet and, after 25 years of joint pains, her symptoms were gone. Her doctors reported, however, that six weeks after her remarkable recovery her joint pain returned. They began to suspect that her improvement had been nothing more than a placebo effect until they discovered that the cook preparing her food had started using corn starch as a thickening agent. After eliminating the corn starch, her symptoms again disappeared.1
Such case reports led to open and placebo-controlled food challenge experiments. In 1991, researchers in Oslo, Norway, reported in The Lancet a study in which they eliminated foods believed to be common arthritis triggers in a group of 26 arthritis patients. The average pain score fell from over five, on a scale from zero to ten, to under three. Joint stiffness, swelling, and tenderness diminished, and grip strength also improved. Most importantly, the benefits were sustained on reexamination a year later.2
Numerous studies have shown that, if testing is done with sufficient care, dietary sensitivities can be identified in 20-60 percent of subjects. Pure vegetarian (vegan) diets appear to benefit about half of arthritis patients, including some who have not identified a specific diet trigger.2-6
Clinical Use of Nutrition with Arthritis Patients Patients can be assessed individually for the presence or absence of dietary sensitivities. Normally this is done with both the patient and doctor aware of which foods are being tested, but it can also be done using placebo controls, with the patient’s consent, as will be discussed in more detail below.
The first step is for the patient to base the diet on generous amounts of foods that are known to virtually never cause symptoms (Table 1) and, at the same time, omit those that commonly trigger symptoms (Table 2). It is important to avoid the problem foods completely, as even a small amount can cause symptoms. Foods that are on neither list can be consumed. A four-week period will be enough to gauge the effects.
Such tests are not difficult if the patient and whoever prepares his/her food receive instruction and recipes from a cooking instructor, who should meet with them at least weekly. This is best done in groups, as patients support each other through the dietary transition.
After four weeks, if the patient’s symptoms have diminished or disappeared, the next step is to identify which of the trigger foods has been responsible for the symptoms. This is done by reintroducing the eliminated foods back into the diet one at a time, every two days. The patient should have a generous amount of each newly returned food to see whether joint pains recur. If so, it should again be eliminated for at least two weeks. Many patients have more than one food trigger.
There is no clinical value in returning meats, dairy products, or eggs to the diet, since they tend to have substantial amounts of cholesterol and fat and other disadvantages. Patients who continue a vegetarian diet should be sure to include a source of vitamin B12 in their routine, such as a common multivitamin tablet.
Patients whose symptoms do not improve with the diet change may be sensitive to foods other than the common triggers. An elimination diet allows the doctor and patient to identify these culprits. For one week, the diet consists only of the foods that virtually never trigger joint pains (Table 1). Then, if symptoms have abated, the omitted foods are reintroduced one at a time, as described below.
TABLE 1: FOODS THAT VIRTUALLY NEVER TRIGGER JOINT PAINS1,3,4,7-11
Brown rice Cooked or dried fruits: cherries, cranberries, pears, prunes (but not citrus fruits, bananas, peaches, or tomatoes)
Cooked green, yellow, and orange vegetables: artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, summer or winter squash, sweet potatoes, tapioca, and taro (poi)
Water: plain water or carbonated forms
Condiments: modest amounts of salt, maple syrup, and vanilla extract
TABLE 2: COMMON ARTHRITIS TRIGGERS1,3,4,7-11
Dairy products*
Citrus fruits Corn Potatoes Meats**
Tomatoes Wheat, oats, rye
Nuts
Eggs
Coffee *
All dairy products should be avoided: skim or whole cow’s milk, goat’s milk, cheese, yogurt, cream, etc.
** All meats should be avoided: beef, pork, chicken, turkey, fish, etc.
Additional foods have sparked symptoms in individuals, but are not known to do so in large numbers of people. These include alcoholic beverages, bananas, chocolate, malt, nitrates, onions, soy products, cane sugar, and spices (cardamom, coriander, and mint).
Natural Anti-Inflammatories in Foods Common nonsteroidal anti-inflammatory pain-killers, such as aspirin or ibuprofen, work by blocking the prostaglandins that spark inflammation. Two natural plant fatty acids do much the same thing, albeit less strongly.
The first, called alpha-linolenic acid (ALA), is an omega-3 fatty acid found in many common vegetables, beans, and fruits, and in a more concentrated form in flax, canola, wheat germ, and walnut oils. The second, called gamma-linolenic acid (GLA), is an omega-6 fatty acid found in some unusual seed oils: borage oil, evening primrose oil, blackcurrant oil, and hemp oil.*
At the University of Pennsylvania in 1993, patients with rheumatoid arthritis were given four capsules of borage oil each day, while a control group took placebo capsules made of cottonseed oil. On examination six months later, joint swelling and tenderness were reduced by about 40 percent, morning stiffness was down by 33 percent, and pain was 15 percent less, compared to baseline in the borage oil group, in contrast to the gradual worsening of the placebo group over the same period.12
Similar results have been demonstrated with evening primrose, blackcurrant, and flax oil.13,14 Typical kitchen oils and fats, such olive oil, corn oil, sunflower oil, safflower oil, lard, or butter have no anti-inflammatory action.15
* Fats are named by the location of their first double bond. Omega-3 (or n-3) fatty acids have their first double bond at the third carbon atom from the methyl end of the molecule. Omega-6 (or n-6) fatty acids have their first double bond at the sixth carbon atom.
Arthritis is painful for patients and frustrating for doctors. Typical anti-inflammatory treatments help, but they often fail to ease all symptoms and do nothing to stop the progressive joint damage that leads to surgery or loss of function.
Nutrition can help, either with medicines or, in some cases, instead of them. Foods affect the joints in two major ways. First, certain foods trigger the symptoms of rheumatoid arthritis, and eliminating these foods sometimes causes even long-standing symptoms to improve or even remit entirely. Second, certain fatty acids have an anti-inflammatory action that can reduce joint pain, stiffness, and swelling.
The role of nutrition in arthritis was controversial until the early 1990s when research studies established its role beyond any reasonable doubt. Prior to that time, intriguing individual case reports were published in the medical literature showing the dramatic effects of avoiding certain foods, but left unanswered the question of how widespread such sensitivities were.
In 1981, the British Medical Journal reported the case of a woman whose battle with rheumatoid arthritis suddenly ended when doctors discovered that her symptoms were triggered by corn products. Corn was eliminated from her diet and, after 25 years of joint pains, her symptoms were gone. Her doctors reported, however, that six weeks after her remarkable recovery her joint pain returned. They began to suspect that her improvement had been nothing more than a placebo effect until they discovered that the cook preparing her food had started using corn starch as a thickening agent. After eliminating the corn starch, her symptoms again disappeared.1
Such case reports led to open and placebo-controlled food challenge experiments. In 1991, researchers in Oslo, Norway, reported in The Lancet a study in which they eliminated foods believed to be common arthritis triggers in a group of 26 arthritis patients. The average pain score fell from over five, on a scale from zero to ten, to under three. Joint stiffness, swelling, and tenderness diminished, and grip strength also improved. Most importantly, the benefits were sustained on reexamination a year later.2
Numerous studies have shown that, if testing is done with sufficient care, dietary sensitivities can be identified in 20-60 percent of subjects. Pure vegetarian (vegan) diets appear to benefit about half of arthritis patients, including some who have not identified a specific diet trigger.2-6
Clinical Use of Nutrition with Arthritis Patients Patients can be assessed individually for the presence or absence of dietary sensitivities. Normally this is done with both the patient and doctor aware of which foods are being tested, but it can also be done using placebo controls, with the patient’s consent, as will be discussed in more detail below.
The first step is for the patient to base the diet on generous amounts of foods that are known to virtually never cause symptoms (Table 1) and, at the same time, omit those that commonly trigger symptoms (Table 2). It is important to avoid the problem foods completely, as even a small amount can cause symptoms. Foods that are on neither list can be consumed. A four-week period will be enough to gauge the effects.
Such tests are not difficult if the patient and whoever prepares his/her food receive instruction and recipes from a cooking instructor, who should meet with them at least weekly. This is best done in groups, as patients support each other through the dietary transition.
After four weeks, if the patient’s symptoms have diminished or disappeared, the next step is to identify which of the trigger foods has been responsible for the symptoms. This is done by reintroducing the eliminated foods back into the diet one at a time, every two days. The patient should have a generous amount of each newly returned food to see whether joint pains recur. If so, it should again be eliminated for at least two weeks. Many patients have more than one food trigger.
There is no clinical value in returning meats, dairy products, or eggs to the diet, since they tend to have substantial amounts of cholesterol and fat and other disadvantages. Patients who continue a vegetarian diet should be sure to include a source of vitamin B12 in their routine, such as a common multivitamin tablet.
Patients whose symptoms do not improve with the diet change may be sensitive to foods other than the common triggers. An elimination diet allows the doctor and patient to identify these culprits. For one week, the diet consists only of the foods that virtually never trigger joint pains (Table 1). Then, if symptoms have abated, the omitted foods are reintroduced one at a time, as described below.
TABLE 1: FOODS THAT VIRTUALLY NEVER TRIGGER JOINT PAINS1,3,4,7-11
Brown rice Cooked or dried fruits: cherries, cranberries, pears, prunes (but not citrus fruits, bananas, peaches, or tomatoes)
Cooked green, yellow, and orange vegetables: artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, summer or winter squash, sweet potatoes, tapioca, and taro (poi)
Water: plain water or carbonated forms
Condiments: modest amounts of salt, maple syrup, and vanilla extract
TABLE 2: COMMON ARTHRITIS TRIGGERS1,3,4,7-11
Dairy products*
Citrus fruits Corn Potatoes Meats**
Tomatoes Wheat, oats, rye
Nuts
Eggs
Coffee *
All dairy products should be avoided: skim or whole cow’s milk, goat’s milk, cheese, yogurt, cream, etc.
** All meats should be avoided: beef, pork, chicken, turkey, fish, etc.
Additional foods have sparked symptoms in individuals, but are not known to do so in large numbers of people. These include alcoholic beverages, bananas, chocolate, malt, nitrates, onions, soy products, cane sugar, and spices (cardamom, coriander, and mint).
Natural Anti-Inflammatories in Foods Common nonsteroidal anti-inflammatory pain-killers, such as aspirin or ibuprofen, work by blocking the prostaglandins that spark inflammation. Two natural plant fatty acids do much the same thing, albeit less strongly.
The first, called alpha-linolenic acid (ALA), is an omega-3 fatty acid found in many common vegetables, beans, and fruits, and in a more concentrated form in flax, canola, wheat germ, and walnut oils. The second, called gamma-linolenic acid (GLA), is an omega-6 fatty acid found in some unusual seed oils: borage oil, evening primrose oil, blackcurrant oil, and hemp oil.*
At the University of Pennsylvania in 1993, patients with rheumatoid arthritis were given four capsules of borage oil each day, while a control group took placebo capsules made of cottonseed oil. On examination six months later, joint swelling and tenderness were reduced by about 40 percent, morning stiffness was down by 33 percent, and pain was 15 percent less, compared to baseline in the borage oil group, in contrast to the gradual worsening of the placebo group over the same period.12
Similar results have been demonstrated with evening primrose, blackcurrant, and flax oil.13,14 Typical kitchen oils and fats, such olive oil, corn oil, sunflower oil, safflower oil, lard, or butter have no anti-inflammatory action.15
* Fats are named by the location of their first double bond. Omega-3 (or n-3) fatty acids have their first double bond at the third carbon atom from the methyl end of the molecule. Omega-6 (or n-6) fatty acids have their first double bond at the sixth carbon atom.