Healthy Eating with Arthritis

Organic Food and Your Health

Does going organic make you healthier? Get experts’ insights.

With reports that antioxidants, omega-3s and other critical nutrients can help stave off disease, many people with arthritis turn to the grocery aisles to save their joints. So we asked the experts to weigh in on one of the most hotly debated food topics: Is organic necessary for good health?

Q: What does "organic" really mean?

A: To earn the United States Department of Agriculture’s, or USDA, organic certification, crops must be grown on land that has been free of prohibited substances – including conventional pesticides, petroleum-based fertilizers and sewage sludge-based fertilizers – for at least three years, and animal products must be raised on organic feed without the use of added hormones or antibiotics.

Q: If organic food has fewer pesticides, and we know pesticides may play a role in the development of rheumatoid arthritis, shouldn't we always eat organic?

A: Not necessarily. According to Jo Ann Hattner, a dietitian and nutrition consultant for Stanford University Medical Center and author of Gut Insight, the most important message for people with arthritis is to eat a healthy diet including at least five servings of fruits and vegetables a day. "But if people are concerned about the risk of pesticides, hormones and antibiotics, they're better off buying organic."

Q: Is there any scientifically proven link between food chemicals and autoimmune diseases like arthritis?

A:  In the area of autoimmunity, including rheumatoid arthritis, there's not much evidence that eating organic makes a difference, says Emilio Gonzalez, MD, director and chief of the Division of Rheumatology at the University of Texas Medical Branch in Galveston, Texas. Still, it makes sense to minimize your exposure to undesirable chemicals, hormones and antibiotics – and eating organic is one way to do that. In fact, he says, the best time to go organic is before arthritis sets in. Since organic foods contain fewer pesticides, theoretically, they wouldn't stimulate the immune system, which may lead to inflammation and ultimately arthritis.

Q: Are there nutritional differences between organic and conventional foods?

A: Government agencies like the USDA and American Dietetic Association, or ADA, stand behind their claim that organic foods are not nutritionally superior or safer than conventionally produced food. But there are a few studies suggesting that organically grown produce may be more nutrient-rich than their conventionally grown counterparts. A study from the University of California Davis, for example, found that organically grown berries and corn contained nearly 60 percent more polyphenols – natural antioxidants that may be good for health. And in a second study published in the journal Food Chemistry, Spanish researchers found that organically produced tomato juice contained more polyphenols than conventionally grown crops. Why the nutrient boost in organic foods? Scientists theorize that when plants aren’t coated in chemicals to help fight off pests and insects, they develop stronger compounds to protect themselves – not unlike the way we build antibodies when confronted with bacterial ‘bugs.’ If you eat that produce, you get those disease-fighting compounds, too!

Organic animal products may also have added benefits. English researchers found that organic milk has higher levels of Omega 3 fatty acids, which may help alleviate arthritis symptoms and enhance health, than non-organic milk. That may be one reason why organic milk is often richer and creamier than conventional. Other studies have shown that organic milk has higher levels of vitamin E and other antioxidants as well as minerals like calcium, iron, magnesium and chromium.

Q: How do the hormones and antibiotics in conventional animal products affect people with arthritis?

A: If you’re immune-compromised organic livestock products may be safer than conventional varieties. "When you eat meats, eggs or cheeses that contain antibiotics, you get a dose, too," says Dr. Gonzalez. "So, the next time you have a bacterial infection, there may be a greater chance that your antibiotics won’t work." Beyond that, he says, there's no evidence that conventional foods are bad for people with arthritis.

Q: Does eating organic guarantee a food that's free from pesticides?

A: Unfortunately, no. In fact, according to the USDA, 23 percent of organically grown produce contains pesticide residues. These residual chemicals can come from substances already in the soil, some of which have been banned for decades but remain in the ground, or from pesticides that drift onto organic crops from nearby non-organic fields. Still, says Hattner, the growers do their best to produce crops that are pesticide-free.

Q: Does eating organic protect against food borne illness?

A: Not necessarily. A small outbreak of salmonella in organic eggs from Minnesota in 2011 shows that no food is immune to contamination. In fact, the Food and Drug Administration, or FDA, which oversees the safety of most of the U.S. food supply, reported at least 20 recalls due to pathogens in organic food in the last two years, while the Agriculture Department, which oversees meat safety, issued a recall of more than 34,000 pounds of organic beef last year due to possible contamination with E. coli. These regulatory bodies often focus on companies that reach the most people; so small local farms aren't always subject to the same safety standards.

Q: If I'm not buying organic, what can I do to reduce pesticide exposure from eating conventional foods?

A: First, don't stop eating fruits and vegetables. Even with potentially harmful chemicals, fruits and vegetables offer critical vitamins, minerals and antioxidants that help protect against a whole host of health conditions – not just arthritis. Washing produce with water or a water/vinegar rinse and choosing fruits and vegetables with hard exteriors or peels can help limit your exposure to pesticide residues, says Hattner. So if you can afford to buy some organic products, consider produce with soft exteriors like peaches, berries, spinach and bell peppers over foods like oranges, bananas and potatoes. And remember, variety is key. “The most important thing,” says Hattner, “is not to eat the same type of fruit everyday. There are toxins in fruit that are a natural part of the food.” So, if you eat 10 apples a day – organic or not – you’ll be getting a high amount of natural apple toxins.

How to “Seal” the Deal

Before a product can be labeled organic, a government-approved certifier inspects the farm where the food is grown to ensure compliance with USDA’s organic standards. But not all organics are created equal. Here’s what the different certifications mean:

• “100 percent organic” products must be made with only all organic ingredients.
• “Organic” labeled foods must consist of at least 95 percent organically produced ingredients, and may bear the USDA organic seal.
• “Made with organic ingredients” may use this phrase if a product contains at least 70 percent organic ingredients, and it may contain up to three of the organic ingredients on the display panel. For example, soup made with 70 percent organic ingredients may be labeled “soup made with organic tomatoes, corn and potatoes” or “soup made with organic ingredients.”
• Processed products that contain less than 70 percent organic ingredients cannot use the term organic on the main display panel, but may list organic ingredients in the ingredients list.
• Non-organic foods may display truthful claims such as “natural”, “free-range,” “hormone-free” or “sustainably harvested,” but only foods labeled organic meet USDA’s organic certification standards.

Healthy Freezer Meals

Save time with nutritious make-ahead meals. | By Alexandra Kummernes

A hot, home-cooked meal after a hectic day may be just what you need – but preparing it can create even more stress and exhaustion.

Instead of whipping up a meal from scratch every night, registered dietitian Sara Haas, a spokesperson for the Academy of Nutrition and Dietetics, recommends making meals in bulk and freezing them; at the end of a long day, all you have to do is reheat and serve.

Freezing meals, Haas says, “Is a great to get balanced, more healthful meals in the comfort of your home.”

Unlike frozen meals available in the grocery store, made-from-scratch foods can be prepared and stored without preservatives or added sodium, making them a healthy addition to your diet, Haas says.

“If pre-made meals are prepared in a nutritious way, they are an amazing asset to your freezer,” she says.

Before you start prepping meals for the freezer, here are a few things to keep in mind.

Select freezer-friendly foods. “Some foods don't hold up well to freezing,” Haas says. For example, eggs and foods that contain a lot of water, such as celery, cabbage, tomatoes or salad greens can get soggy after being frozen and thawed and are best prepared fresh.

There are plenty of foods that retain their taste and texture after cooking and freezing, including whole grains like quinoa and bulgur, beans, pureed soups, meat and stews, making them great freezer meals.

“I recommend pre-portioning them before freezing so that you can cook what you need,” Haas says.

Shop smart. Buy ground beef in bulk when it goes on sale, brown it and freeze it in two-cup portions. It can be used in anything from tacos and sloppy Joes to baked ziti and chili.

Other proteins, including chicken and seafood, can also be frozen either raw or cooked. Susie Theodorou, author of Can I Freeze it? (Morrow Press, 2009), notes that cooked, frozen ingredients can be stir-fried, grilled or roasted for a no-fuss, great-tasting main course.

Buy enough ingredients to make two batches of your favorite soups and stews. Prepare twice the amount you need for dinner and put the other half in the freezer for a quick and nutritious meal.

Don’t be afraid to experiment. If you aren't sure if a food freezes well, just try it. Next time you make a meal and have extra, cool it, package it, label and date it and stick it in the freezer. Pull it out in a few days and see how it tastes. “Experimentation is a good way to find out if freezing works,” Haas says.

Keep your freezer “pantry” stocked. You don’t have to freeze entire meals.

Make an extra batch of spaghetti sauce for the freezer; it can be thawed, reheated and added to fresh pasta, cutting down prep and cooking time for a favorite weeknight meal.

Other freezer staples include broth and stock, which you can freeze in ice-cube trays and then transfer the cubes to a plastic freezer bag; one cube yields approximately two tablespoons. Gravy and other sauces are also good options, but note that a sauce with fat may separate during freezing. If this happens, toss it in a blender after thawing to recombine the ingredients. Fresh meat, butter or margarine, cheese, nuts and spices also tend to freeze well.

Choose the right container. Select glass containers that are designed for freezing and can withstand heat, advises Theodorou. It’ll save a step if you can freeze and reheat meals in the same container.

Plastic containers with a snowflake symbol close securely and will not become brittle in the freezer. Vacuum-sealed bags can also be an excellent tool to help prevent freezer burn and maintain flavor. If in doubt, look for “freezer safe” on the container or package label.

Safety first. To help prevent bacterial growth, Theodorou recommends thawing foods in the refrigerator. Allow approximately eight hours per pound of meat, six hours per pound of fruit or vegetables and 12 to 24 hours for stews and casseroles to defrost.

Fresh, Canned or Frozen Produce?

Unless you're picking fruits and veggies yourself, there might not be much difference nutritionally.
| By Sean Kelley and Jodi Helmer

There's nothing quite like eating a handful of freshly picked blueberries on a warm summer day, each bite bursting with flavor and inflammation-fighting polyphenols, bone-building minerals and must-have vitamins. Surprisingly, you can get nearly the same nutrition from a bag of frozen blueberries.

Despite what you might have heard, fresh produce may not be more nutritious than frozen produce. Even canned fruits and veggies are a good source of many of the nutrients found in the produce section of your grocery store.

“Nutrition is not always as straightforward as you'd like it to be,” says Gene Lester, a U.S. Department of Agricultural plant physiologist who specializes in the nutritional content of plants and fruits.

Many things factor into produce's nutritional makeup – the soil it’s grown in, when it's picked, how it’s preserved and even the way a vegetable or fruit is prepared. One thing is very clear: The nutritional value of fruits and vegetables is unparalleled.

Fruits and vegetables are rich in important vitamins and minerals and a good source of dietary fiber, which increases satiety and helps put the brakes on overeating, helping control excess weight that adds to pressure on painful joints. And many contain nutrients that may help fight inflammation associated with inflammatory forms of arthritis, such as rheumatoid arthritis (RA). 

For example, butternut squash and pumpkin contain beta-cryptoxanthin, which a study in the August 2005 issue of American Journal of Clinical Nutrition linked with reduced RA-related inflammation. Antioxidants in the squash, including vitamin C, also help fend off inflammation.

“One of the key nutrients that play a vital role in risk reduction [of RA inflammation] is vitamin C in foods like broccoli, strawberries, citrus fruit, peppers, cabbage, collard greens, melons, potatoes and tomatoes,” says registered dietitian Angela Ginn, senior education coordinator at the University of Maryland and a spokesperson for the Academy of Nutrition and Dietetics.

Are nutrients in frozen and canned fruits and vegetables on par with fresh produce? It depends.

Diane M. Barrett, PhD, a fruit and vegetable products specialist in the University of California, Davis’s Food Science and Technology department, notes that frozen produce could actually have a leg up on imported offerings, which may lose some nutritional value through transport and storage.

“When fruits and vegetables are allowed to ripen to their peak eating quality before being harvested and then quickly frozen to lock in their nutrients, flavor and color, they may be superior,” Barrett says.

Commercial fruits and veggies are often picked before they reach their nutritional peak, so that they can ripen while in transit. In contrast, frozen fruits and vegetables are often picked at a more mature state and then flash frozen. Canned vegetables go through a similar process, sealing in many nutrients. Here are a few frozen and canned selections that might surprise you:

• Raspberries. Scientists discovered that levels of antioxidants, including vitamin C, polyphenols and anthocyanins, are about the same in frozen raspberries as fresh.
• Green peas. Research found that freezing peas helps preserve vitamin C levels that fresh peas quickly lose after being harvested.
• Peaches. Canned peaches in light syrup have more vitamin C than their fresh counterparts.
• Spinach. Cup for cup, frozen, chopped spinach actually contains higher concentrations than fresh spinach of a range of nutrients, including folate, vitamin E, vitamin A, vitamin K and calcium. These nutrients build stronger bones and lower the risk of hypertension. (Hypertension raises the risk of cardiovascular disease, which is already higher in people with RA than other people.)

Still, the preservation methods are not without their drawbacks.

Some important nutrients like B vitamins and vitamin C are water-soluble; in canned goods, those vitamins leach into the packing water. Exposure to air and light – either in your fridge or in a fruit bowl on your kitchen counter – can also limit the shelf life of some vitamins. But other nutrients – including vitamins A, D, E and K, and fiber – survive this process.

The important thing is to eat more vegetables and fruit, whether they’re canned, frozen or fresh. Not only do they deliver in nutritional value, they can replace less healthy choices that people make, says Lester. “The more mouthfuls of vegetables you eat, the [fewer] mouthfuls of fattier foods you’ll eat.”

The Promise of Probiotics for Arthritis

Foods and supplements with these “good bacteria” may prove to help arthritis and overall health.
| By Jodi Helmer

It’s almost impossible to turn on the television or read a magazine without seeing ads for products with probiotics – so-called “good bacteria,” yeast or other living microorganisms in foods or supplements that are touted to have health benefits, including for arthritis. And demand for these products is only growing; the global market for probiotics is expected to top $28 billion in 2015, according to industry reports.

Probiotics are present in or added to such foods as certain yogurts, kefir, sauerkraut, tempeh, kimchi and kombucha, and probiotic dietary supplements are available in capsule, powder, tablet and other forms.

Probiotics are thought to promote health by giving a boost to the good bacteria that live in the gut (the so-called gut microbiota). In fact, some of the bacteria that are present in our bodies are also available as probiotics, including certain strains of Lactobacillus and Bifidobacterium.

Everybody has a unique collection of microbes that inhabits their body (in the gut, on the skin and in the mouth, for instance). These communities are altered over time by diet, environment, medications and experiences. And scientists are learning that they affect many aspects of our functioning.

Probiotics and Your Health

“There is more recognition that gut microbes play a bigger role in our health than we once thought,” explains Katherine Zeratsky, a registered dietician at Mayo Clinic. “All of the beneficial bacteria help keep the bad bacteria in check, and that’s good for your overall health.”

Researchers are discovering that the gut microbiota is crucial to our very survival – for example, by helping our immune system decide if something is friend or foe, and by helping our digestive system extract important nutrients. Some of these microorganisms are good, some bad, others appear to be neutral, and some are both good and bad, depending on the context.

“There is an intimate relationship between [the gut microbiota] and disease,” explains Jeremy P. Burton, PhD, assistant professor at the Canadian Centre for Human Microbiome and Probiotics. “Whenever there is a chronic disease that impacts the intestinal tract, including [autoimmune types of] arthritis, there is the potential to treat it with probiotics.”

Probiotics seem to work in three ways:

• Maintaining a balance between “good” and “bad” bacteria in your body
• Reducing bad bacteria that cause infections and illnesses
• Replenishing good bacteria that are lost (after illness or a course of antibiotics)

There is evidence that Lactobacillus and Bifidobacterium, two of the most popular probiotics, might help the body by speeding up treatment of certain intestinal infections; helping reduce gas, bloating; preventing or reducing the severity of colds and flu; improving blood pressure; and alleviating symptoms of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis.

Probiotics and Your Arthritis

If you have an inflammatory type of arthritis, probiotics may be especially important. The beneficial bacteria appear to have an impact on inflammation, reducing common biomarkers of inflammation, including C-reactive protein.

“People with inflammatory arthritis have been shown to have inflammation of the intestinal tract, which results in increased intestinal permeability,” says registered dietitian nutritionist Sonya Angelone, nutrition consultant and spokesperson for the Academy of Nutrition and Dietetics. This enables certain bacteria to cross the intestinal barrier, get into the bloodstream and trigger an inflammatory response. “Probiotics may be able to help decrease the inflammation associated with increased intestinal permeability,” she says.

“A healthy diet helps keep the intestinal barrier strong and the immune system in a top fighting condition,” Angelone adds. “Healthy foods and probiotic supplements can work together to keep joints healthy and also keep the rest of the body strong.”

In a 2014 study published in the journal Nutrition, 46 patients with rheumatoid arthritis (RA) were divided into two groups. One group received daily supplements containing Lactobacillus casei and the other group received a placebo. After an eight-week period, several markers of inflammation were significantly lower in the probiotic group, leading researchers to state that, although further studies are needed to confirm the results, these conclusions may lead to the use of probiotics as an adjunct therapy for patients with RA.

Another study, published in the peer-reviewed journal PLOS One in 2012, found that gut bacteria in mice could be studied to determine which animals were more susceptible to developing RA and collagen-induced arthritis (CIA) – the mouse equivalent of osteoarthritis. This led researchers to assert that the gut microbiome could be a potential indicator of susceptibility to arthritis.

Selecting Probiotics

Probiotics and their potential effects on certain health conditions still are not well understood. What’s more, Burton warns that supplements are not regulated, which means there is no guarantee that they contain the same strains of probiotics that have been proven clinically effective. A recent report from ConsumerLab found that 30 percent of probiotic supplements did not contain the amounts of helpful organisms touted on their labels.

“There is no real guide for consumers with regards to probiotic supplements,” Burton says. “You should research the strain and dose and compare it to the clinical research to know if it will work – but most consumers won’t take the time to do that, so there is a lot of trial and error.”

Look for supplements with a USP label, which indicates that an independent third party has verified the ingredients – and ask your doctor before starting any supplements; they may interact with your medications or produce other unintended effects. Your doctor also may be able to give you some guidance on the best way to take them.

How to Read a Nutrition Label

Learn which information on a nutrition label is most important for your nutritional needs (and how to avoid falling for false claims).
| By Lisa Milbrand

Detailed nutrition labels are supposed to make it easier for you to select healthy foods. But sometimes they cause information overload – and confusion. Is it more important that something has fewer overall grams (g) of fat or fewer trans fats? Are you better off getting fewer calories even if it means getting fewer nutrients?

Here are some tips for deciphering nutrition label information.

Focus on the Fats

Look for products with less than 1 g of saturated fat and no trans fat, says registered dietitian Jennifer Vimbor of Nutrition Counseling Services in New York.

“If you’re looking to lose weight, look for foods that are low in fat overall,” she says.

Foods with the “low fat” label, for example, contain fewer than 3 grams of fat per serving.

Research shows that having some fat in your diet is good. Scan the labels for polyunsaturated fats and monounsaturated fats, which are healthier than saturated fats.

Fill up on Fiber

Preliminary research indicates that a high-fiber diet (more than 25 g per day) lowers cholesterol and helps prevent diabetes. A “high-fiber” food has at least 5 g of fiber per serving.

Manufacturers sometimes process dietary fiber out of a product and then add processed fiber, so foods labeled “high fiber” might not be as healthy as they seem. (Ingredients including inulin, polydextrose or maltodextrin suggest fiber is added.) Look for products made with bran, oats or other whole grains, which are nutritious sources of fiber.

Remember, even nutritious products like yogurt with supplemental fiber may have a lot of added sugar, says Alicia Romano, clinical registered dietitian at Tufts Medical Center.

Skimp on Sodium

A high-sodium diet, like a high-fat diet, puts you at risk for high blood pressure. Experts recommend keeping your total sodium intake at less than 2,400 milligrams (mg) per day.

The American Heart Association requires foods with a “heart healthy” label to contain fewer than 480 mg of sodium and fewer than 20 mg of cholesterol. Remember, even foods with the heart healthy label can be highly processed, sugar-laden and lacking in important vitamins and minerals, so be sure to read the ingredient listings carefully.

Skim the Ingredients

The main ingredients are listed first on a nutrition label, so check out the top three or four. And remember that some ingredients can sneak in under different names. If sugar, molasses, honey, turbinado, maple syrup or high-fructose corn syrup are near the top, you’re getting a lot of sugar, says Vimbor.

Look for Must-Have Nutrients

Tanya Horacek, a registered dietician and associate professor at Syracuse University in New York specifically recommends calcium, vitamin D and omega-3 fatty acids, which are found in fish and flaxseed oil. Consider foods high in antioxidants, such as vitamins C and A, which are believed to have anti-inflammatory properties.

Instead of processed foods, eat a variety of antioxidant-rich whole foods, including a rainbow of deeply hued fruits and vegetables like blueberries, prunes, kidney beans and cherries.

Need Nutrition Help?

Meeting with a registered dietitian can help you better manage arthritis pain.
| By Amy Paturel

While you may not view arthritis as a diet-related condition, the reality is, what you eat impacts your joints more than you think. Studies suggest certain foods could help alleviate arthritis pain and stiffness.

“Antioxidant-rich foods like fruits and vegetables, particularly those that are rich in vitamins C and E, may help reduce inflammation that is at the crux of many forms of arthritis,” says Karen Ansel, MS, RDN the co-author of The Calendar Diet: A Month by Month Guide to Losing Weight While Living Your Life. “On the flip side, it may also be beneficial to avoid inflammatory foods, such as red meat and full-fat dairy.”

Whether you’re trying to  lose weight to reduce pressure on your joints or wondering which supplements and nutrient-rich foods can help mitigate arthritis pain, a registered dietitian (RD) can offer personalized guidance that also appeals to your taste buds.

What Can a Dietitian Do for Me?

Help You Lose Weight

Excess body weight can increase arthritis-related pain. “In many cases, the most helpful dietary change for people suffering from osteoarthritis is a calorie-controlled diet, which can help them lose weight and relieve pressure on joints,” says Ansel. Unfortunately, with the preponderance of nutrition misinformation available, following such a diet isn’t always easy.

Even for the savviest health nut, navigating the murky seas of nutrition advice can be overwhelming. Fad diets may offer a quick fix, but they won’t sustain you for the long haul. What’s worse, you’re likely to gain back any lost weight – plus more, explains Ruth Frechman, RD and spokesperson for the Academy of Nutrition and Dietetics and author of The Food is My Friend Diet (Gales Publishing, 2012).

Using creative, out-of-the-box strategies, RDs can help you develop a safe and effective weight loss plan. They also will show you how to plan meals, shop for the most nutrient-rich foods and develop mindful eating practices, so nutrition becomes a source of pleasure, rather than confusion and anxiety.

Help You Pick Arthritis-friendly Foods

Some medications prescribed for arthritis interfere with the absorption of important nutrients. Dietitians can help ensure you’re getting the most out of your food. They also can help you limit potentially harmful food components like saturated fat and sodium.

For people with rheumatoid arthritis (RA) or gout, consulting a dietitian can be especially beneficial, as certain foods have been shown to exacerbate (or alleviate) these conditions, explains Ansel. “Fish, which can be beneficial for people with RA, can actually lead to gout flare ups, while milk can reduce the risk of gout, but if it’s full-fat, it can increase inflammation for people who have RA.”

Figure Out If Supplements Are Helpful or Hurtful

In some instances, vitamin complexes and nutrient supplements may help alleviate arthritis pain, but it can be tough to weed through the health claims and recognize the facts. “People with arthritis may be spending a lot of money on needless supplements that promise results,” says Frechman. An RD can evaluate and determine which supplements are beneficial and which are better left on the shelf.

Formulate an Exercise Plan Tailored to You

People with arthritis need to keep moving, says Frechman. A dietitian can help people with arthritis make the most of their diets so they feel better, which in turn can help them move more.

How to Find a Nutritionist

When searching for nutrition professional, it’s important to realize that not all nutritionists are created equal, and some aren’t even trained to deliver diet advice. 

“The term ‘nutritionist’ isn’t regulated,” says Frechman. “So while all RDs are nutritionists, not all nutritionists are RDs.” In fact, anyone can claim to be a nutritionist, regardless of whether they’ve completed the appropriate education.

An RD, on the other hand, must complete multiple layers of training. According to the Academy of Nutrition and Dietetics, RDs must obtain a bachelor’s degree, fulfill an accredited nutrition curriculum, pass a rigorous registration exam, and complete extensive supervised training.

What’s more, about half of all RDs hold advanced graduate degrees and many have earned certifications in specialized fields, including arthritis, diabetes and geriatric nutrition. Iin many cases, insurance covers at least some portion of the cost for visits with a qualified RD; that’s not usually the case with a “nutritionist.” 

“Most insurance companies cover a dietitian for a certain number of visits,” says Frechman. But every policy is different, so check with your provider.

In the meantime, the best eating advice is to follow a balanced diet that includes lots of fruits, vegetables and whole grains, which can help you maintain a healthy body weight – one of the most important goals for improving arthritis pain.

Tips for Choosing the Freshest Fruit

How to know if fruits are ready to eat – or past their prime.
| By Lisa Milbrand

Fruit is low in fat, sodium and calories, which can help you maintain a healthy weight, and it is rich in nutrients that help fight inflammation. Plus, it tastes great.

If you’re skipping the produce aisle because you don’t know how to choose the freshest fruit (will a rock hard pear really ripen at home? How do I know if a melon is ripe?) or you’re worried about wasting money if fruit spoils before you eat it, we’re here to help.

Here are tips for finding the freshest fruit and storage tips to increase its shelf life.

Berries. 
Go for plump berries with deep color. They stop ripening once off the vine and tread a thin line between ripe and rotting. Staining at the bottom of the container indicates over-ripeness. Stored in a glass bowl lined with paper towels and left in the fridge, berries will last up to four days.

Oranges. 
The sweetest ones give slightly when squeezed and have shiny, thin skin. It’s OK if Valencias aren’t orange; they can have a green tinge even after they ripen. Oranges and other citrus fruits will lasts up to 2 weeks if you store them in the fridge.

Melons. 
Expect melons to ripen after a few days at room temperature (the bottom of a watermelon will go from white to creamy yellow). Cantaloupes are ready when they’re fragrant. Once ripe, keep melons in the fridge (away from the vegetables) and they’ll last up to four days.

Kiwis. Set these small fruits on the counter to ripen. A kiwi is ready when it yields to a soft squeeze. It’s best to store kiwis at room temperature until they’re ripe; once the fruit is at its peak, move it to the fridge where it’ll last up to three weeks.

Mangoes. Ripen mangoes at room temperature; they’re ready to eat when they’re slightly soft and very fragrant. A little speckling or bruising won’t affect the flavor. Once ripe, put them in the crisper; they’ll last up to four days.

Pears. Pears are picked mature, but not ripe. They will ripen when left at room temperature. When the stem end of the fruit yields to gentle pressure, it’s ready to eat. Ripened fruit can be stored in the refrigerator for about 5 days.

Pomegranates. 
The fruit is shipped ripe. For the best flavor, choose a large, brightly colored pomegranate with its skin intact. The flavorful fruits will last up to two months in the refrigerator.

Pineapples. 
Pick one that’s fully ripe – yellow hue, deep green leaves and slightly firm with a sweet smell. Pineapple can be stored in the fridge whole (with the top still on) or peeled, sliced and stored in a covered container; it’ll last for up to one week in the refrigerator.

Apples. The fruit is fully ripe when it’s picked. Look for firm, smooth skin without soft spots. Apples will remain fresh for up to six weeks if you store them in a plastic bag in the refrigerator.

Bananas. 
Buy bananas when they are green and less fragile. Ripen them at home (hanging a bunch on a banana hammock in a cool area of the kitchen will keep them fresh for up to a week). Bananas are ripe when the peels turn yellow with hints of brown.

Peaches, nectarines. These stone fruits are usually sold “ripe when picked” but the fruit can still be fairly firm. Avoid rock hard fruits (peaches and nectarines will get soft and juicy if they’re left on the counter for a few days). Store them in a paper bag at room temperature until ripe, then put them in fridge where they’ll last up to one week.

Cherries. The fruit stops ripening after it’s picked. Buy only plump and firm cherries with their stems attached. cherries  will last up to two weeks if they’re stored in a covered container in the fridge.

Healthy Side Dishes

Skip the box of seasoned rice or pasta and try these healthier side dishes.

You’re aiming to cook healthy meals, but you’re in need of some healthy side dishes. Before you reach into the cabinet for a convenient box of seasoned pasta or even a rice mix, beware. What you gain in convenience you may lose in nutrition. One serving of Rice-A-Roni, for example, contains nearly half the daily recommended amount of sodium. And cream-sauce pasta dishes can top 25 g of total fat per serving.

Heather Bainbridge, a registered dietitian at the Comprehensive Weight Control Program at Weill Cornell Medical Center in New York City, says it’s almost as quick – and a lot healthier – to make easy side dishes yourself.

Consider these easy side dishes:

• Add sautéed veggies, a bit of pesto and a small can of fire-roasted diced tomatoes to cooked whole-grain pasta.
• Toss pasta with store-bought pesto sauce or a bit of olive oil and sundried tomatoes, and top with fresh Parmesan or Romano cheese. Or keep flavors simple with a homemade “sauce” of balsamic vinegar, basil, pepper, lemon and a few sprinkles of cheese.
• Go for cooked grains instead of pasta. Toss a bag of shredded carrots or broccoli-slaw mix with any cooked grain (in addition to rice or pasta, try barley or couscous, wheat berries or quinoa).
• Turn your salad into a heartier side dish. Cook barley or wheat berries ahead of time, chill and toss an ample amount into your favorite green salad.
• If you do use a ready-made mix:
• Discard half the packaged seasoning. Try lower-sodium brands (less than 300 milligrams), and mix in your own seasonings, such as Mrs. Dash, garlic or hot pepper flakes.
• If the directions say to add butter, use olive or canola oil instead. The same goes for milk: Use skim or 1 percent instead of whole.
• Add a handful of fresh or frozen vegetables a few minutes before the dish is done to get more fiber, vitamins and antioxidants. You’ll fill up faster and save calories by eating less of the pasta or rice in veggie-filled healthy side dishes.

Misleading Food Labels

Foods may not be as healthy as they seem. Here’s what food labels don’t say.
By Amy Paturel

Sticking to the perimeter of the store, where healthier whole foods are displayed, is your best bet when grocery shopping, but it’s hard to avoid packaged foods altogether ­– especially when many labels promise everything from a slimmer figure to better health. Here are some common health claims you’ll see on labels, and the truth behind them.

The claim: High fiber
The truth: Products carrying the “high fiber” claim contain at least 5 grams of fiber per serving. But maufacturers sometimes process dietary fiber out of a product and then add processed fiber, so it’s not as healthful as it seems. What’s more, even seemingly nutritious products like yogurt with supplemental fiber may have a lot of added sugar, says Alicia Romano, clinical registered dietitian at Tufts Medical Center.
What you can do: Choose products with bran, oats or other whole grains, and check the sugar content. Ingredients including inulin, polydextrose or maltodextrin suggest fiber is added.

The claim: Low-fat
The truth: Items labeled “low-fat” must contain fewer than 3 grams of fat per serving. But if you’re trying to lose weight, fat is only one part of the equation. If the ingredients include refined grains, added sugar or high-calorie fillers, the product may be less nutritious and no better at helping with weight-loss than the full-fat version.
What you can do: Research shows that having some fat in your diet is good, but when you’re scanning labels, look for “unfats,” suggests Romano, including polyunsaturated fats and monounsaturated fats, which are healthier than saturated fats. Avoid trans fats.

The claim: No added sugar
The truth: Whether sugar is added or not, a food may sport a hefty dose of the sweet stuff, which adds calories and can lead to inflammation. Manufacturers often replace sugar with substitutes that have the same effects, such as honey, molasses or corn syrup, says Bonnie registered dietitian Taub-Dix, author of Read It Before You Eat It (Plume, 2010). Even “all natural” fruit juice is full of naturally-occurring sugars that can send blood sugar levels soaring.
What you can do: Look at total grams of sugar in the nutrition facts label. Anything above 15 grams is best left on the shelf.

The claim: Antioxidant-rich
The truth: Although scientists are increasingly recognizing that certain foods have powerful anti-inflammatory properties, they don’t know what levels of antioxidants are beneficial. Plus, isolating a particular antioxidant, like vitamin C, rules out the synergistic effects of foods’ other nutrients, says Romano.
What you can do: Eat a variety of antioxidant-rich whole foods, including a rainbow of deeply hued fruits and vegetables.

The claim: Heart healthy
The truth: The American Heart Association requires foods with this claim to be low in total fat, have no more than 20 mg of cholesterol and no more than 480 mg of sodium. But even these can be highly processed, sugar-laden and lacking in important vitamins and minerals.
What you can do: Avoid products containing more than a handful of ingredients.