Anti-Inflammatory Diet for Arthritis

Anti-Inflammatory Diet

1. Anti-Inflammatory Diet While there is no specific “diet” that people with rheumatoid arthritis (RA), should follow, researchers have identified certain foods that can help control inflammation. Many of them are found in the so-called Mediterranean diet, which emphasizes fish, vegetables and olive oil, among other staples.
2. Get Fishy Certain types of fish are rich in inflammation-fighting omega-3 fatty acids, which reduce C-reactive protein (CRP) and interleukin-6, two inflammatory proteins in your body.
   How much: At least 3 to 4 ounces, twice a week
   Best sources: Salmon, tuna, sardines, anchovies and other cold-water fish
3. Eat Your Fruits and Veggies Fruits and vegetables are packed with antioxidants, which support the immune system – the body’s natural defense system – and may help fight inflammation.
   How much: At least 1½ to 2 cups of fruit and 2 to 3 cups of veggies per meal
   Best sources: Colorful foods such as blueberries, blackberries, cherries, strawberries, spinach, kale and broccoli
4. Try a Handful of Nuts or SeedsNuts are full of inflammation-fighting monounsaturated fat, protein and filling fiber, too – a bonus if you’re trying to lose a few pounds.
   How much: Eat 1.5 ounces of nuts daily (about a handful)
   Best sources: Walnuts, pine nuts, pistachios and almonds
5. Break out the BeansBeans have several antioxidant and anti-inflammatory compounds. They’re a low-cost source of fiber, protein, folic acid and minerals such as magnesium, iron, zinc and potassium. See more
6. Pour on the Olive OilOlive oil contains heart-healthy monounsaturated fat, antioxidants and oleocanthal, a compound that can lower inflammation and pain.
   How much: Two to three tablespoons per day for cooking or in salad dressings or other dishes
   Best sources: Extra virgin olive oil is less refined and processed. It retains more nutrients than standard varieties
7. Peel Some OnionsOnions are packed with beneficial antioxidants. They may also reduce inflammation, heart disease risk and LDL, or "bad" cholesterol. Try them sautéed, grilled or raw in salads, stir-fries, whole-wheat pasta dishes or sandwiches.
8. Nightshades or Not?Nightshade vegetables – eggplant, tomatoes, peppers and potatoes – are central to Mediterranean cuisine. Some people believe they trigger arthritis flares, but there’s limited scientific evidence to support this theory. Try cutting nightshades from your diet for two weeks to see if symptoms improve.
9. Fill up on FiberFiber lowers C-reactive protein (CRP), a substance in the blood that indicates inflammation. Getting fiber from foods lowers CRP levels more than taking fiber supplements. Foods that have carotenoids, the antioxidants that give carrots, peppers and some fruits their color, are quite good at lowering CRP.
10. Avoid Processed FoodProcessed foods such as cookies, chips and other snacks can be high in unhealthy fats, which are linked with inflammation. Opt for fresh fruit instead. Canned goods – vegetables and soups – are often high in sodium, which boosts blood pressure. Look for low sodium options, or go with fresh or frozen vegetables.
11. Cut the SaltThere are conflicting reports about just how bad excess salt is for us. We know it causes fluid retention – one of many factors that can lead to high blood pressure. Also, corticosteroids, often used to treat RA, can cause the body to retain more sodium. So play it safe and hold the salt when possible.
12. Drink in ModerationResveratrol, a compound found in red wine, may have anti-inflammatory effects. However, people with RA should limit alcoholic drinks – especially when they are taking medications like methotrexate. Your doctor can let you know what amount of alcohol, if any, is appropriate for you.
13. Fill Your PlateThe Food Pyramid many of us grew up with has been replaced with a colorful plate that emphasizes proper proportions. One important message: Fill half your plate with vegetables. Learn more at www.choosemyplate.gov.

High Cooking Temperature and Inflammation

Learn why you should be wary of advanced glycation end products.
| By Mary Margaret Chappell

If you’ve already given up fried bacon and grilled steak to reduce saturated fat in your diet, there may be another good reason to continue avoiding these foods: Foods typically cooked at high temperatures, like meats, may exacerbate inflammation.

Researchers at the Mount Sinai School of Medicine in New York found that frying, roasting, searing or grilling certain foods at high temperatures produces compounds called advanced glycation end products (AGEs).

Your body produces AGEs, also known as glycotoxins, as part of the metabolic process. AGEs are also present in raw animal products, including meat. Cooking, especially at high temperatures, forms new AGEs in foods.

Although some AGEs are not bad, high levels of the compounds in the tissues and blood can trigger an inflammatory response and have been linked to the recent epidemics of diseases like diabetes and cardiovascular disease.

“We expect that increased levels of AGEs increase inflammation, although a direct link to arthritis is not firmly established,” says Jaime Uribarri, MD, the Mount Sinai physician who has led many studies into the effects of AGEs on the body.

Research shows that restricting the amount of dietary AGEs accelerates wound healing, improves insulin sensitivity and helps prevent diabetes, vascular and kidney dysfunction.

The highest levels of dietary AGEs (dAGEs) are found in beef, pork, fish and eggs; even lean meats like chicken contain high levels of dAGEs when they are cooked with dry heat. Compared to other meats, lamb had the lowest levels of dAGEs. It’s estimated that 10 percent of AGEs we get from eating seared burgers and fried chicken may be absorbed into our tissues and bloodstream.

This news doesn’t mean you have to give up your favorite breakfast meat or get rid of the barbecue forever. “Just diminish your exposure,” advises Dr. Uribarri.

 To achieve a lower AGE diet, try the following:

• Limit the amount of grilled, broiled, fried and microwaved meats in your diet.
• Reduce the cooking temperature of meats and proteins. Steam fish and seafood, simmer chicken in a sauce and braise red meat in a cooking liquid.
• Cut down on processed foods. Many prepared foods have been exposed to a high cooking temperature to lengthen shelf life, so they may have high AGE contents.
• Get more fruits and veggies in your diet. Cooked or raw, they’re naturally low in AGEs, and many contain compounds such as antioxidants that can decrease some of the damage done by AGEs.

Eat Right for Your Type of Arthritis

Learn about the foods that may help ease pain and inflammation and slow disease activity.
| By Michele Andwele

When you have arthritis or a related condition, getting the right nutrients can help to alleviate pain and inflammation and positively affect overall health. Research suggests that what you eat may influence the progression and symptoms of certain types of arthritis and related conditions.

Although there is no magic potion at the supermarket, studies have shown that certain foods have anti-inflammatory properties and specific benefits for rheumatoid arthritis (RA) and other inflammatory forms of arthritis, osteoarthritis, gout and osteoporosis symptoms.

RA and Other Inflammatory Forms of Arthritis

Although there are no specific nutrition guidelines for people with RA, researchers have found a diet rich in omega-3 fatty acids, antioxidants and phytochemicals supplies the body with powerful anti-inflammatory nutrients. These foods are commonly part of a Mediterranean-style diet of fish, olive oil, fruits, vegetables, nuts/seeds and beans. This diet has been analyzed in small studies for its impact on RA symptoms. Results showed improvements in pain, morning stiffness, disease activity and physical function.

Cold-water fish high in omega-3s have shown to be particularly beneficial. Researchers have found that oleocanthal, a key compound in extra virgin olive oil, has a significant impact on inflammation and helps reduce joint cartilage damage. Earlier studies showed that oleocanthal prevents the production of pro-inflammatory COX-1 and COX-2 enzymes – the same way ibuprofen works.

In the 1990s, a combination vegetarian/vegan diet for arthritis was the focus of a small study of 53 RA patients. The participants started with a vegan diet that also excluded several other foods. Milk, dairy and gluten were reintroduced after nine months for participants who didn’t have an intolerance to these foods. After one year, participants sustained improvements in tender, swollen joints, pain, duration of morning stiffness and overall health, leading study investigators to suggest that some people with RA may benefit from a vegetarian diet. Since then, additional small studies have reported symptom improvement among very small groups of patients.

Researchers have also found that green tea significantly reduced the severity of arthritis by causing changes in various immune responses. They showed that an antioxidant in green tea blocks the production of molecules that cause joint damage. In May 2015, researchers reported in the International Journal of Rheumatic Diseases on the superior anti-inflammatory effect of green tea when compared with black tea.

C-reactive protein (CRP) in the blood is a marker of inflammation associated with RA. Several studies have reported that a  high fiber diet helps to reduce CRP  levels. Oatmeal, brown and wild rice, beans, barley and quinoa are excellent sources of whole grains.

Osteoarthritis

Having a balanced, nutritious diet is an important part of achieving and maintaining a healthy weight. That's good news for your joints, not just your wardrobe. A small study published in Arthritis in 2015 reported on a 6-week intervention of 40 individuals with  osteoarthritis  who were placed on a plant-based diet of fruits, vegetables, legumes (beans, peas, lentils) and whole grains. The group experienced significantly reduced pain and improved physical function.

Experts have long known that  milk is good for bones, but its effects on joints were less clear. A study reported in Arthritis Care & Research in 2015 showed that women with knee OA who drank milk regularly had less OA progression than those who didn’t. But high cheese consumption appeared to make OA worse. 

An earlier study published in Arthritis & Rheumatism in 2013, revealed that a compound called sulforaphane, found in Brussels sprouts and cabbage but especially in broccoli, could be key in slowing the progress of OA and the destruction of joint cartilage.

A 2010 study in BMC Musculoskeletal Disorders reported that people who regularly eat foods from the alium family – like garlic, onions and leeks, showed fewer signs of early OA. Researchers think the compound diallyl disulphine found in these foods may limit cartilage-damaging enzymes in human cells – making it a great choice if you have OA.

Gout

Of all the forms of arthritis, gout has the most obvious dietary link. When the body breaks down purine, a substance found in many foods, uric acid forms. People who have gout have trouble eliminating uric acid or they produce too much uric acid cause inflammation and severe pain in the joints.

A study published in the Scandanavian Journal of Rheumatology in 2012 showed that a  Mediterranean diet  decreased uric acid levels and the risk of getting gout. But there have been studies on a few key foods as well.  Researchers suspect the anthocyanins in cherries have an anti-inflammatory effect and may help  reduce the frequency of gout attacks. Anthocyanins are found in other red and purple fruits, including strawberries, raspberries, blueberries and blackberries (some of the best low-sugar fruits). However, tart cherries have higher levels.

Using data from the 14,809 participants in the Third National Health and Nutrition Examination Survey, researchers from Harvard Medical School confirmed that coffee (but not tea) and low-fat dairy product consumption is associated with lower uric acid levels.

Avoiding foods that contain high levels of purines is a critical part of managing gout. These foods include meats (particulary beef, pork and lamb), most seafood (both fish and shellfish) and meat-based broths and gravies. Sugar-sweetened soft drinks and food with fructose also increase uric acid levels. There is a strong association between alcohol intake, especially beer, and an increased risk of gout attacks.

Osteoporosis

Protect bone health with calcium-rich foods, including low-fat dairy products; green, leafy vegetables; shellfish; and calcium-fortified foods. Vitamin D-rich foods, such as salmon, tuna and mackerel, cheese and egg yolks, are equally important since Vitamin D help your body absorb calcium from food. Unfortunately, it’s nearly impossible to get all of the vitamin D your body needs from food sources. On the plus side, the body can make 10,000 international units (IU) of vitamin D in just 15 minutes of unprotected exposure to sunshine. A staple of the Mediterranean diet, virgin olive oil, when combined with vitamin D, may  protect against bone loss  based on the results of an animal study published in the peer-reviewed journal, PLOSOne in 2014.

More Fiber, Less Inflammation?

Eating a high-fiber diet may help reduce inflammation.

Eating a high-fiber diet can yield many rewards. Fruits, vegetables, beans, nuts and whole grains provide a boost of vitamins, minerals, protein and healthy nutrients. They might also help lower markers of inflammation—a key factor in many forms of arthritis. Yet most Americans get far less fiber and fiber-rich foods than government guidelines recommend.

Our bodies need two types of fiber: soluble and insoluble. Soluble fiber mixes with water to form a gel, which slows digestion. It helps the body better absorb nutrients, and may also lower total cholesterol and LDL (“bad”) cholesterol. You’ll find this type of fiber in foods like nuts, seeds, beans, lentils, oat bran and barley. Insoluble fiber helps your digestive system run more efficiently. It adds bulk to stool, which helps prevent constipation. You can get insoluble fiber from sources like vegetables, whole grains, legumes and wheat bran.

Fiber and Inflammation—the Link

A few studies have found that people who eat diets high in fiber have lower C-reactive protein (CRP) levels in their blood. CRP is a marker of inflammation that’s been linked to diseases like rheumatoid arthritis (RA), heart disease and diabetes.

It’s not possible to say that eating more fruits, vegetables and other high-fiber foods will help arthritis specifically, but reducing CRP is another good reason to get more fiber, says Dana E. King, MD, professor and chair of family medicine at West Virginia University in Morgantown. 

In part, a fiber-rich diet may help reduce inflammation by lowering body weight. High-fiber foods also feed beneficial bacteria living in the gut, which then release substances that promote lower levels of inflammation body-wide. Lower inflammation may have to do less with fiber itself, than with healthy plant chemicals called phytonutrients found in fiber-rich fruits, vegetables and whole grains.

A 2009 review published in European Journal of Clinical Nutrition, reported 25 to 54 percent lower CRP levels in people who not only ate a high-fiber diet, but who also lost weight and ate more healthy monounsaturated and polyunsaturated fats. In another study, men who ate a lot more fruits and vegetables – going from two servings to eight per day – lowered their CRP levels by one-third. The researchers say the drop was mainly due to eating foods rich in carotenoids, antioxidants that give carrots and oranges their bright color.

Do Fiber Supplements Work?

Americans who don’t get enough fiber naturally in their diet may wonder if fiber supplements have the same effect on inflammation. To find out, Dr. King led a small 2007 study in which people were randomly assigned to either eat a high-fiber diet (about 30 grams per day) or to supplement their diet with psyllium fiber. Higher fiber—whether it came naturally from the diet or from a supplement—lowered CRP levels. However, it didn’t have the same effect in people who were overweight. “It went down about 40 percent in thinner people, but only 10 percent in people who were overweight,” says Dr. King.

Another larger study Dr. King published the following year also found psyllium supplements didn’t lower CRP levels or other markers of inflammation in overweight or obese people. Why the results were weight-specific isn’t clear. Supplements also don’t provide all the vitamins, minerals, and other nutrients in foods that may contribute to reduced inflammation.

Maximizing Your Daily Fiber Intake

Just how much fiber do you need to get the maximum health benefit? Guidelines recommend 20 to 35 grams per day, including both soluble and insoluble fiber (most Americans get just 14 grams daily). At each meal, fill at least one quarter of your plate with whole grains: foods made with the entire grain kernel, including whole-wheat flour, bulgur, oatmeal, whole cornmeal and brown rice. Another half of your plate should be devoted to fruits and vegetables.

If you’ve been lax about fiber in the past, increase it gradually in your diet. Going straight from 0 to 35 grams a day could lead to uncomfortable symptoms like gas and bloating. You may also have to watch the type of fiber-rich foods you eat. In a small percentage of people, gluten—a protein found in wheat and other grains—may actually set off inflammation. If you’re gluten-sensitive and you think it might be inflaming your joints, talk to your doctor about trying other high-fiber foods instead.

Also don’t forget to drink plenty of water with your fiber. Water helps fiber work more effectively in your body.

Arthritis Food Myths

Get the truth about foods commonly touted to relieve arthritis pain and inflammation.
| By Larry Linder

Lona Sandon, a registered dietitian who has rheumatoid arthritis, or RA, often hears claims that particular foods affect arthritis pain.

“A patient will tell me her arthritis worsens if she eats sugar, or that she has less pain and stiffness if she takes a tablespoon or two of cider vinegar each day,” she says.

Sandon thinks healing food myths are sparked by a search for alternatives to arthritis medications, which have side effects and risks that worry some people. “It is very appealing to find something natural, but there’s no food in the world that can do what medicine can,” says Sandon, assistant professor at the University of Texas Southwestern Medical Center in Dallas.

So why do such myths persist? “The more often you hear it, and the louder and more shrilly you hear it, the more believable it becomes,” says Richard Panush, MD, a professor in the division of rheumatology at the University of Southern California, in Los Angeles.

With that in mind, here is the truth behind the hype about some foods commonly touted as capable of helping or hurting arthritis symptoms.

Myth: A Dozen Gin-soaked Raisins a Day Provide Pain Relief

Science. Raisins are often treated with sulfur dioxide gas to preserve their color, and sulfur has been explored for its role in joint health. Some 25 years ago, Russian researchers reported a sulfur-containing compound helped lessen destructive joint changes in mice, but the results were inconclusive at best. Gin is made from juniper berries, which were used in the Middle Ages for their purported anti-inflammatory properties. That, also, has never been proven.

Bottom Line. No scientific study has shown this folk remedy reduces arthritis pain or inflammation.

Myth: Drinking Cider Vinegar Eases Pain

Science. Some people contend beta-carotene in apple cider vinegar destroys free radicals involved in ravaging the immune system, but the amount of beta-carotene in the vinegar is infinitesimal. Others say acid crystals cause joints to become stiff and vinegar dissolves them. Gout is the only form of arthritis that involves crystals – uric acid crystals, formed from an excess of uric acid in the body – and cider vinegar doesn’t relieve gout pain.

Bottom Line. Apple cider vinegar belongs in your kitchen, not your medicine chest.

Myth: Dairy Products Make Arthritis Worse

Science. In a study Dr. Panush conducted, published in 1983 in Arthritis & Rheumatism, people with rheumatoid arthritis (RA) on a dairy-free diet fared no better than those who didn’t eliminate dairy. In fact, 2014 research published in Arthritis Care & Research found women who drank more milk had less osteoarthritis (OA) progression, and a study in the Annals of Rheumatic Diseases found that milk may help prevent gout.

Bottom Line. Low-fat or nonfat milk and other dairy products are safe for most people with arthritis.

Myth: Nightshade Vegetables Aggravate Arthritis

Science. Tomatoes, potatoes, eggplants and peppers are just some of the nightshade vegetables that contain the chemical solanine, which some have branded a culprit in arthritis pain. But no formal research has ever confirmed the claim, and the vegetables contain essential nutrients. In fact, a study in the Journal of Nutrition in 2011 showed yellow and purple potatoes lowered blood markers for inflammation in healthy men.

Bottom Line. People with arthritis may benefit from nightshades, although some people may have sensitivities to certain vegetables.

Myth: A Raw Food Diet Relieves Symptoms

Science. In the late 1990s, Finnish scientists reporting in the British Journal of Rheumatology put a group of people with RA on a raw vegan diet supplemented with beverages rich in lactobacilli – bacteria considered good for the gut and possibly the immune system. Compared with those not on a raw diet, they reported more symptom relief while on the diet, but researchers found no objective differences in disease activity, duration of morning stiffness or pain. Half of those on the diet quit prematurely because of nausea and diarrhea.

Bottom Line. Eating more fruits and vegetables is beneficial, but if you’re going to increase your intake of raw veggies, do it slowly so the extra fiber won’t upset your stomach. It’s not clear this dietary change brings arthritis relief, though.

Myth: When it Comes to Red Wine, More Is Better

Science. Research has found that resveratrol, a compound in red wine, appears to have anti-inflammatory effects. That includes a study published in 2014 in Nucleic Acids Researchthat found resveratrol stops the formation of inflammatory factors involved with cancer, cardiovascular and chronic inflammatory diseases. Moderate amounts of wine may indeed bring about health benefits, from protecting the heart to reducing food-borne illnesses. However, excessive drinking appears to increase the production of pro-inflammatory cytokines, according to University of North Carolina at Chapel Hill researchers.

Bottom Line. Drink wine in moderation – no more than one drink per day for women and no more than two drinks per day for men, according to the Dietary Guidelines for Americans. And before taking a sip, check with your doctor to make sure alcohol doesn’t interact with your arthritis medications. Excess alcohol intake, including wine, is a known risk for inducing gout attacks.

Myth: Coffee Causes Gout

Science. Researchers found a decreased risk for gout in association with day-to-day coffee drinking after studying tens of thousands of women in the Nurses’ Health Study, according to a study in a 2010 American Journal of Clinical Nutrition. That corroborates a 2007 finding in Arthritis & Rheumatism that long-term coffee intake was associated with a lower incidence of gout in men.

Bottom Line. Coffee does not cause gout, and may lower gout risk.

Myth: Citrus Fruits Cause Inflammation

Science. Websites abound warning people with arthritis away from citrus fruits because they supposedly promote inflammation. On the contrary, citrus is rich in vitamin C, and the long-term Framingham Heart Study in Massachusetts showed OA progression dropped by more than half in people who consumed at least 152 milligrams of vitamin C a day.

Bottom Line. Don’t shy away from citrus fruits. Their vitamin C might protect against OA pain and is critical in the formation of the major components of cartilage. In addition, vitamin C is an antioxidant that can quench cartilage-damaging free radicals.

The Connection Between Gluten And Arthritis

If you have Celiac disease or are sensitive to gluten, changing your diet may ease arthritis symptoms.
| By Linda Rath

Joint pain and inflammation can be common symptoms for the estimated 3 million adults and children in the U.S. who have celiac disease (CD) and possibly for millions more who may be sensitive to gluten. But what if you have arthritis? Will a gluten-free diet help? Doctors are still debating this point, but some experts say it might.

Like many types of arthritis, celiac disease is an autoimmune disease. With these disorders, the immune system mistakenly attacks healthy tissue instead of viruses, bacteria and other pathogens. In people who have CD, gluten – a complex of proteins found in grains such as wheat, barley and rye – triggers a powerful autoimmune response that damages the small intestine and affects its ability to absorb nutrients. This can lead to gastrointestinal symptoms, such as diarrhea, abdominal pain and bloating.  

Alessio Fasano, MD, who directs the Center for Celiac Research at Massachusetts General Hospital in Boston, says people who are sensitive to gluten can have symptoms anywhere in the body when partially digested gluten fragments leak from the intestine into the bloodstream.

"Unlike other proteins, we don't digest gluten completely," he explains. "In some people, the immune system sees gluten as the enemy and will unleash weapons to attack it, causing inflammation in the intestines as well as in other organs and tissues."

This can cause serious problems outside the gut, including weight loss, anemia, osteoporosis, infertility and miscarriage, skin rashes, headache, depression, fibromyalgia and joint pain. This is partly due to inflammation and partly due to poor absorption of vital nutrients.

Getting a CD Diagnosis

Celiac disease is diagnosed with a blood test that looks for antibodies to gluten. Antibodies are protein produced by the body's immune system when it detects harmful substances. If the test is positive, it's followed by an endoscopic biopsy to check for small intestine damage.

"The inside of a healthy small bowel resembles a deep-pile carpet, but in untreated celiac disease, it looks like a tile floor," explains Joseph A. Murray, MD, who directs the Celiac Disease Program at Mayo Clinic's campus in Minnesota. CD damages villi – finger-like protrusions that aid in the absorption of nutrients from the small intestine – and prevents them from doing their job.

Although awareness of CD has never been greater, it remains underdiagnosed. One reason is that CD symptoms are subtle and can look like many other things, from irritable bowel syndrome and migraines to arthritis. Another is that a growing number of people with CD don't experience classic gut problems, and a few with severe intestinal damage have no clinical symptoms at all. These days, it can take five to seven years for some patients with celiac disease to be diagnosed – down from an average of 10 years just a short while ago.

Dr. Murray says rheumatoid arthritis, type 1 diabetes and other autoimmune disorders are red flags that should alert doctors to test for CD because having one autoimmune disease increases the likelihood of having another. A few studies have shown that people with Sjogrens syndrome, psoriatic arthritis and lupus may also have an increased likelihood of having celiac disease. Dr. Murray encourages people with autoimmune conditions to talk to their doctor about being screened for celiac disease or gluten sensitivity.

Gluten Sensitivity: Fact or Fad?

Less is known about gluten sensitivity. According to Rochelle Rosian, MD, a rheumatologist at Cleveland Clinic, people who are gluten sensitive have a different type of immune response to grain proteins. They don't develop antibodies to gluten or have small intestine damage, but they do have CD symptoms, especially outside the gut. There is no test for gluten sensitivity, which has created skepticism among some doctors.

"There is controversy among experts and in the literature as to whether non-celiac gluten sensitivity actually exists," says Maria Vazquez Roque, MD, a gastroenterologist at Mayo Clinic, who is studying the relationship between leaky gut and gluten sensitivity. "But many in the medical community consider patients to have gluten sensitivity when celiac disease and wheat allergy [a reaction to all proteins in wheat, not just gluten] have been ruled out and symptoms improve on a gluten-free diet."

Gluten as Joint Pain Trigger

According to Dr. Rosian, inflammation outside the gut is especially likely to affect the joints. She adds that many of her RA patients who are sensitive to gluten notice less joint pain when they don't eat it.  

"Patients with arthritis are always looking for nondrug ways to manage inflammation," she says. "We know that certain foods are pro-inflammatory and that includes gluten-containing grains and the thousands of foods made from them. When some, but not all, people with celiac disease or gluten sensitivity eliminate these from their diet, they find their arthritis improves."

No Grain. No Pain?

Medical experts caution that it's important not to try a gluten-free diet for arthritis before testing for celiac disease because the test won't be accurate. And sometimes the problem isn't gluten.

"Maybe it's a wheat or lactose allergy or an issue with FODMAPs [small sugar molecules in some fruits and vegetables]. These can be pro-inflammatory and irritate the gut lining," Dr. Rosian says.

For people with celiac disease or gluten sensitivity, however, a gluten-free diet isn't a fad – it's medicine.

Going Gluten-free

The only treatment for diagnosed CD and gluten sensitivity is a gluten-free diet. "For patients with celiac disease, gluten-free isn't a fad, it's a medical necessity," Dr. Fasano says. It is also effective. Many people, including those with gluten-related joint pain, may notice improved symptoms within weeks. For others, it may take longer, and some may never find relief. But experts say it's definitely worth talking to your doctor about being screened for CD if you have RA, type 1 diabetes or any other autoimmune disorder.

Dr. Murray, coauthor of the American College of Gastroenterology’s guidelines on the diagnosis of celiac disease, encourages people with autoimmune conditions to talk to their doctor about being screened for celiac disease and gluten sensitivity. Patients must be heeding Dr. Murray’s advice and physicians must be heeding the advice in the guidelines, because experts at the Celiac Disease Center at Columbia University in New York City say most of their referrals come from rheumatologists and endocrinologists.

The Ultimate Arthritis Diet

Stock your fridge and pantry with Mediterranean staples to fight pain and inflammation.
| By Amy Paturel

One of the most common questions people with any form of arthritis have is, "Is there an arthritis diet?" Or more to the point, “What can I eat to help my joints?”

The answer, fortunately, is that many foods can help. Following a diet low in processed foods and saturated fat and rich in fruits, vegetables, fish, nuts and beans is great for your body. If this advice looks familiar, it’s because these are the principles of the so-called Mediterranean diet, which is frequently touted for its anti-aging, disease-fighting powers.

Studies confirm eating these foods can do the following:

• Lower blood pressure
• Protect against chronic conditions ranging from cancer to stroke
• Help arthritis by curbing inflammation
• Benefit your joints as well as your heart
• Lead to weight loss, which makes a huge difference in managing joint pain.

Whether you call it a Mediterranean diet, an anti-inflammatory diet or simply an arthritis diet, here’s a look at key foods to focus on – and why they’re so good for joint health.

Fish

How much: Health auth­orities like The American Heart Association and the Academy of Nutrition and Dietetics recommend three to four ounces of fish, twice a week. Arthritis experts claim more is better.

Why: Some types of fish are good sources of inflammation-fighting omega-3 fatty acids. A study of 727 postmenopausal women, published in the Journal of Nutrition in 2004, found those who had the highest consumption of omega-3s had lower levels of two inflammatory proteins: C-reactive protein (CRP) and interleukin-6.

More recently, researchers have shown that taking fish oil supplements helps reduce joint swelling and pain, duration of morning stiffness and disease activity among people who have rheumatoid arthritis (RA).

Best sources: Salmon, tuna, sardines, herring, anchovies, scallops and other cold-water fish. Hate fish? Take a supplement. Studies show that taking 600 to 1,000 mg of fish oil daily eases joint stiffness, tenderness, pain and swelling.

Nuts & Seeds

How much: Eat 1.5 ounces of nuts daily (one ounce is about one handful).

Why: “Multiple studies confirm the role of nuts in an anti-inflammatory diet,” explains José M. Ordovás, PhD, director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.

A study published in The American Journal of Clinical Nutrition in 2011 found that over a 15-year period, men and women who consumed the most nuts had a 51 percent lower risk of dying from an inflammatory disease (like RA) compared with those who ate the fewest nuts. Another study, published in the journal Circulation in 2001 found that subjects with lower levels of vitamin B6 – found in most nuts – had higher levels of inflammatory markers.

More good news: Nuts are jam-packed with inflammation-fighting monounsaturated fat. And though they’re relatively high in fat and calories, studies show noshing on nuts promotes weight loss because their protein, fiber and monounsaturated fats are satiating. “Just keep in mind that more is not always better,” says Ordovás.

Best sources: Walnuts, pine nuts, pistachios and almonds.

Fruits & Veggies

How much: Aim for nine or more servings daily (one serving = 1 cup of most veggies or fruit or 2 cups raw leafy greens).

Why: Fruits and vegetables are loaded with antioxidants. These potent chem­icals act as the body’s natural defense system, helping to neutralize unstable molecules called free radicals that can damage cells.

Research has shown that anthocyanins found in cherries and other red and purple fruits like strawberries, raspberries, blueberries and blackberries have an anti-inflammatory effect.

Citrus fruits – like oranges, grapefruits and limes – are rich in vitamin C. Research shows getting the right amount of that vitamin aids in preventing inflammatory arthritis and maintaining healthy joints.

Other research suggests eating vitamin K-rich veggies like broccoli, spinach, lettuce, kale and cabbage dramatically reduces inflammatory markers in the blood.

Best sources: Colorful fruits and veggies – the darker or more brilliant the color, the more antioxidants it has. Good ones include blueberries, cherries, spinach, kale and broccoli.

Olive Oil

How much: Two to three tablespoons daily

Why: Olive oil is loaded with heart-healthy fats, as well as oleocanthal, which has properties similar to nonsteroidal, anti-inflammatory drugs. “This compound inhibits activity of COX enzymes, with a pharmacological action similar to ibuprofen,” says Ordovás. Inhibiting these enzymes dampens the body’s inflammatory processes and reduces pain sensitivity.

Best sources: Extra virgin olive oil goes through less refining and processing, so it retains more nutrients than standard varieties. And it’s not the only oil with health benefits. Avocado and safflower oils have shown cholesterol-lowering properties while walnut oil has 10 times the omega-3s that olive oil has.

Beans

How much: About one cup, twice a week (or more)

Why: Beans are loaded with fiber and phytonutrients, which help lower CRP, an indi­cator of inflammation found in the blood. At high levels, CRP could indicate anything from an infection to RA. In a study published in The Journal of Food Composition and Analysis in 2012, scientists analyzed the nutrient content of 10 common bean varieties and identified a host of antioxidant and anti-inflammatory compounds.

Beans are also an excellent and inexpensive source of protein, with about 15 grams per cup, which is important for muscle health.

Best sources: Small red beans, red kidney beans and pinto beans rank among the U.S. Department of Agriculture’s top four antioxidant-containing foods (wild blueberries being in the number 2 spot).

Whole Grains

How much: Eat a total of 6 ounces of grains per day; at least 3 of which should come from whole grains. One ounce of whole grain would be equal to ½ cup cooked brown rice or 1 slice of whole-wheat bread.

Why: Whole grains contain plenty of filling fiber – which can help you maintain a healthy weight. Some studies have also shown that fiber and fiber-rich foods can lower blood levels of the the inflammatory marker C-reactive protein.

Best sources: Eat foods made with the entire grain kernel, like whole-wheat flour, oatmeal, bulgur, brown rice, quinoa. Some people may need to be careful about which whole grains they eat. Gluten – a protein found in wheat and other grains – has been linked to inflammation for some people.

Should You Avoid Nightshades?

Nightshade vegetables, including eggplant, tomatoes, red bell peppers and potatoes, are disease-fighting power­houses that boast maximum nutrition for minimal calories.

They also contain solanine, a chemical that has been branded the culprit in arthritis pain. There’s no scientific evidence to suggest that nightshades trigger arthritis flares. In fact, some experts believe these vegetables contain a potent nutrient mix that helps inhibit arthritis pain.

However, many people do report significant symptom relief when they avoid nightshade vegetables. So doctors say, if you notice that your arthritis pain flares after eating them, do a test and try eliminating all nightshade vegetables from your diet for a few weeks to see if it makes a difference.

Can Vegan or Vegetarian Diets Help Reduce Arthritis Inflammation?

Small studies show some benefits and potential pitfalls.
| By Amanda Baltazar

Science has long touted the inflammation-fighting benefits of a healthy diet: one low in saturated fats and added sugars, and high in fruits, veggies, lean protein (such as omega-3-rich wild salmon) and whole grains. It’s a long-standing belief among many that avoiding animal products altogether makes for a healthier diet.

As a result, people with inflammatory types of arthritis may be tempted to go vegetarian (no meat) or vegan (no animal products at all, including meat, eggs and dairy) in the hope that doing so will help them avoid painful flares.

There are various studies of the impact of these diets on inflammation. They are mostly small and the results are mixed. In the most recent study, published in Complementary Therapies in Medicine in 2015, 600 participants followed a vegan diet for three weeks which significantly reduced C-reactive protein, a key marker for acute and chronic inflammation. In two small studies published in the Journal of the American Dietetic Association in 2010, researchers observed 79 rheumatoid arthritis patients who did a vegetable fast for seven to 10 days, followed by a vegan diet or lacto-vegetarian diet (includes dairy and egg). In the smaller study (26 participants), the patients followed a lacto-vegetarian diet for nine weeks. Researchers found no significant difference in pain or morning stiffness when compared with the control group. However, in the larger study (53 participants), the patients followed a vegan diet for three and a half months and experienced significant improvement in tender and swollen joints, pain, duration of morning stiffness and grip strength than the people in a control group who consumed an ordinary diet. The vegan group transitioned to a lacto-vegetarian diet for nine months. At the one year follow-up, they continued to have improved symptoms compared with the control group. In another study published in Arthritis Research and Care in 2008, 30 patients with active RA who followed a gluten-free vegan diet for three months experienced reduced inflammation.

Still, there are benefits to going meat-free that are unrelated to inflammation. Vegans and vegetarians are less likely than meat eaters to be overweight or obese, and they tend to have lower blood pressure and cholesterol levels, says Duo Li, PhD, professor of nutrition at Zhejiang University in China and author of a small study published in the Journal of Agriculture and Food Chemistry in 2011. The group in the Arthritis Research and Care study also saw reductions in body mass index and cholesterol.

But there are also potential pitfalls. Vegetarians, and especially vegans, have low blood levels of vitamin B-12 and D, calcium and essential fatty acids, according to Dr. Duo’s study and another study published in the American Journal of Clinical Nutrition in 2014.  These vitamins and minerals play important roles in bone health and low fatty acids levels are associated with a number of cardiovascular risk factors. Vegans may also have higher levels of homocysteine, an amino acid that has been linked to heart disease, and lower levels of HDL, the “good” cholesterol, known to protect the heart.  

If you plan on going vegan or vegetarian, it’s important to talk to your doctor first and also seek guidance from a registered dietician.

With these diets, it’s not just about what you’re not eating (meat, eggs and dairy), but about what you are eating. People who switch to either diet should fill up with more fruits, vegetables, legumes, nuts and seeds, and whole grains such as brown rice and barley instead of empty carbs like white pasta, bread or rice. The healthy alternatives are packed with phytochemicals (plant-based compounds) that include antioxidants, flavonoids and carotenoids, all of which help reduce inflammation and protect the tissues from oxidation, which can damage them.

Any diet, including a vegan or vegetarian one, can reap the anti-inflammatory benefits of adding certain oils.

“Most vegetarians, vegans and meat eaters don’t use enough extra virgin olive oil,” says Kim Larson, RDN, CD, CSSD, national spokesperson for the Academy of Nutrition & Dietetics. Extra virgin olive oil helps reduce inflammation and can have a similar effect of ibuprofen.  However, she advises using it at low temperatures because high heat destroys its beneficial compounds, called polyphenols – so use it in salad dressings or for tossing pasta, for example (not for frying and baking).

Going vegetarian or vegan doesn’t have to be an all-or-nothing proposition. Start with a “meatless Monday”, and gradually build up to more meat-free meals, advises Rene Ficek, RD, lead nutritionist at  Seattle Sutton’s Healthy Eating. You can go vegan overnight, she adds, though doing it gradually often makes it easier both mentally and physically since suddenly cutting out meat can lead to crankiness, headaches and digestive changes.

Also consider that meat doesn’t have to be the central focus of a meal. It can be served in small amounts in a dish such as a stir fry, that’s full of vegetables, or with a salad. You can mix it with a soy product such as tofu or tempeh, or with seitan (wheat gluten).

“It doesn’t have to be a full time commitment; it can be certain days or certain meals,” Ficek says.

If you take the step to go full or part vegetarian or vegan, you may need to take some supplements, says Larson. These include omega-3 fatty acids for your heart and to protect against inflammation, iron to protect against anemia, zinc for the immune system, vitamin D and calcium for strong bones, vitamin B-12 for energy and selenium for a healthy thyroid. But talk to your doctor first before adding supplements to your diet.

If you choose a modified vegetarian diet called the pescetarian diet (includes fish), omega-3s are not necessary provided you eat two or more servings per week of fatty fish such as salmon, mackerel, herring and sardines.

Nutrition Guidelines for People With Rheumatoid Arthritis

While there’s no cure for RA, eating certain foods can help you manage its symptoms.
| By Karen Kennedy

People with  rheumatoid arthritis  ( RA ) are constantly seeking to ease its symptoms with food and dietary supplements. While researchers have turned up no magic elixir to cure RA, several studies show a connection between certain foods and the inflammation that characterizes this autoimmune condition. Before embarking on a special diet or taking supplements, though, consult your doctor. Either approach can interact with traditional RA medications in unintended ways.

The best approach to food for people with RA – or anyone else – is a well-balanced diet which, according to the U.S. Food and Drug Administration, should be centered on plant-based foods. Approximately two-thirds of your diet should come from fruits, vegetables and whole grains. The other third should include low-fat dairy products and lean sources of protein.

Foods That Help Fight Rheumatoid Arthritis

Be sure your diet includes such cold-water fish as herring, mackerel, trout, salmon and tuna. Although there may be no magic elixir, the omega-3 fatty acids in fish oil are the most promising anti-inflammatory in food, says Ruth Frechman, registered dietitian and spokesperson for the American Dietetic Association.

Studies have shown that fish oil can relieve tender joints and ease morning stiffness. It has also allowed some people to reduce the amount of conventional medication they take for RA. Servings of fish provide about one gram of omega-3 fatty acids per 3½ ounces of fish. If you choose to try fish oil supplements, talk to your doctor about a dosage. People with RA can often take a higher level of fish oil than is recommended for the general public, but there can be side effects. Higher doses of fish oil may interact with certain drugs, including those for high blood pressure.

Increasing your intake of fiber from fruits, vegetables and whole grains may also help reduce inflammation. Studies show that   adding fiber to the diet results in lower levels of C-reactive protein (CRP) in the blood; CRP is an indicator of inflammation. 

Extra-virgin olive oil may also help reduce inflammation, in the same way that a  nonsteroidal anti-inflammatory drug (NSAID)  such as ibuprofen or aspirin can – it contains a compound called oleocanthal that blocks the enzymes that cause inflammation.

However, you might not want to empty your medicine cabinet just yet. It would take 3½ tablespoons of olive oil – 400 calories worth – to equal the anti-inflammatory properties of one 200-mg ibuprofen tablet. Instead, use the oil as an alternative to other cooking oils and butter.

Supplements and Inflammation

Research has shown that people with RA have low levels of selenium, a mineral found in whole-grain wheat products and shellfish such as oysters and crab. It contains antioxidants, which are believed to help control inflammation. It may also increase the risk of developing diabetes, so talk with your doctor before taking selenium supplements.

Vitamin D, usually associated with calcium and protection against osteoporosis, may also help lower the risk of RA in older women by helping to regulate the immune system. Good sources of vitamin D include eggs, fortified breads, cereals and low-fat milk.  

Can Food Cause Inflammation?

While some foods seem to ease inflammation, compounds in others have been found to increase it. Eating hamburgers, chicken or other meats that have been grilled or fried at high temperature can raise the amount of  advanced glycation end products (AGEs) in the blood. Although no direct link between AGEs and arthritis has been identified, high levels of AGEs have been detected in people with inflammation.

Another culprit that may boost inflammation is omega-6 fatty acids, which are found in corn, sunflower, safflower and soybean oils, and many snack and fried foods. Consuming more omega-6 fatty acids than omega-3s raises your risk of joint inflammation and obesity. Keep fresh fruits and veggies on hand to help you avoid processed snacks that often contain omega-6 fatty acids.

As a result of menopause or steroid treatment, some people with RA may need more of certain vitamins and minerals. The most common deficiencies are in folic acid, vitamins C, D, B6, B12 and E, calcium, magnesium, selenium and zinc. Nutritionists agree that most nutrients should come from your food, rather than from supplements. Again, talk to your doctor before taking any supplements.

The bottom line when considering nutrition and RA is to maintain a healthy, well-balanced diet. One way to achieve this is to consider adopting a Mediterranean diet, which includes plenty of omega-3 fatty acids, fruits, vegetables and whole grains, the benefits of olive oil – even a glass of red wine if your doctor allows.