Arthritis

The most common form of arthritis is called osteoarthritis, a degenerative disease where articular cartilage gradually becomes thinner as its renewal does not keep pace with its breakdown. Eventually the bony articular surfaces come into contact and the bones begin to degenerate. This condition tends to occur in older people; around 12 per cent of people over 65 in the UK are affected (NHS Direct, 2005). Osteoarthritis can develop after an injury to a joint; this can happen months or even years after the injury. The most frequently affected joints are in the hands, knees, feet, hips and spine.

The next most common type of arthritis is rheumatoid arthritis, a chronic inflammatory disease of the joints. This type of arthritis affects up to three per cent of the UK population, and tends to occur in people between the ages of 30 and 50. Women are three times as likely to develop this condition as men (NHS Direct, 2005). Rheumatoid arthritis is a chronic condition characterised by hot painful swelling in the joints. In many diseases inflammation can help towards healing but in rheumatoid arthritis it tends to cause damage. For some people the pain and discomfort caused by this condition has a serious impact on their lives. Rheumatoid arthritis is thought to be an autoimmune disease, caused by a fault in the immune system that causes the body to attack its own tissues. This condition usually starts in the wrists, hands and feet but can spread to other joints in the body.

Other forms of arthritis include ankylosing spondylitis, cervical spondylitis, fibromyalgia, lupus, gout, psoriatic arthritis and Reiter’s syndrome (NHS Direct, 2005). Arthritis can also affect children but the causes of juvenile arthritis are poorly understood. It has been suggested that genetic factors or viral infections may be responsible (NHS Direct, 2005). 

Until recently there has been little scientific research into the links between diet and arthritis but recent research suggests that diet may be involved in its development. It is important for people with arthritis to maintain a healthy well-balanced diet. Arthritis Care (the UK’s largest voluntary organisation working with and for people with arthritis) suggest a diet high in fruit, vegetables, pasta, fish and white meat and low in fatty foods such as red meat, cream and cheese can help (Arthritis Care, 2004). Indeed most people could benefit from eating less sugar and saturated fat and eating more complex carbohydrates, fibre, vitamins and minerals.

If you suffer from arthritis it is important to keep as healthy as possible by ensuring that the diet provides all the important nutrients including minerals such as calcium and iron. Some people are concerned that their calcium intake may drop if they cut out dairy foods. Arthritis Care suggests that if you don’t like or are unable to eat dairy products, you should obtain enough calcium from non-dairy sources (Arthritis Care, 2004a). They list several non-dairy sources of calcium including bread, green leafy vegetables and baked beans (also see here). They also warn people with arthritis to be careful not to have too much animal protein, salt or caffeine as excessive quantities of these can reduce the body’s ability to absorb or retain calcium (Arthritis Care, 2004a). Others are worried about iron, particularly people who have recently stopped eating red meat. This should not be a concern as vegetarians and vegans are no more likely to become iron deficient than meat-eaters. Indeed one of the largest studies of vegetarians and vegans in the world (the EPIC Oxford cohort study) looked at over 33,883 meat-eaters, 18,840 vegetarians and 2,596 vegans and found that the vegans had the highest intake of iron, followed by the vegetarians then the meat eaters (Davey et al., 2003). It should be stressed that milk and milk products are an extremely poor source of iron, whereas pulses, dried fruits and dark leafy vegetables are good sources.

The Arthritis Research Campaign (ARC) founded in 1936, raises funds to promote medical research into the cause, treatment and cure of arthritic conditions. ARC has produced dietary guidelines for people with arthritis and they suggest that one of the most important links between diet and arthritis is being overweight. The extra burden on the joints can make symptoms considerably worse. Losing weight can have a dramatic effect in improving the condition. In order to lose weight, you need to use more energy than you consume in the diet. Research shows that vegetarians and vegans weigh less than meat-eaters and ARC suggests that a lacto-vegetarian diet might help some people with rheumatoid arthritis. They also go further to state that a vegan diet may also help (ARC, 2002). Cutting down on sugar and taking regular (even gentle) exercise will help control weight as well. 

Saturated fats are the most important kind of fat to cut down on. The body does not require saturated fats and they may aggravate arthritis whereas essential fatty acids (EFAs) have been shown to help some people with arthritis as the body uses EFAs to make substances that help control inflammation (ARC, 2002). When trying to lose weight, it is important to maintain a good intake of vitamins and minerals. This means consuming plenty of fruit and vegetables. A healthy balanced diet containing plenty of fruit and vegetables, pulses and whole grain carbohydrate foods (such as wholemeal bread, brown rice and whole wheat pasta) provides a good supply of vitamins and minerals (and fibre). A diet lacking in fruit and vegetables, and containing processed carbohydrates (such as white bread, white rice and white pasta) does not provide such a good source of these essential nutrients. This can have a deleterious effect on health as the ARC states that a good diet can still help even if strong drugs are being taken to treat arthritis (ARC, 2002).

The subject of food allergy and arthritis is quite controversial. However, research has shown that, in some people, rheumatoid arthritis can be made worse by certain foods including milk products and food colouring (ARC, 2002). If you think you are allergic to a particular food ARC recommend cutting it out of your diet for one month then reintroducing it to see if it makes a difference. In 2001, Swedish researchers reported that nine out of 22 patients with rheumatoid arthritis showed significant improvements in their condition compared to one patient out of 25 after following a gluten-free, vegan diet (Hafstrom et al., 2001). Of course it is difficult to say whether eliminating milk was the reason these patients improved as they eliminated all animal foods and gluten from the diet. However, this work does provide evidence that dietary modification can benefit arthritis patients.