- 1 NSAIDs and painkillers
- 2 How important is diet for osteoarthritis?
- 3 Strengthening Bones and Joints
- 4 Sourcing the nutrients
- 5 Natural remedies
- 6 Product guide: joint food supplements
- 7 Conclusion
- 8 Bibliography
There are approximately 10 million people in the UK alone suffering from some form of arthritis. 80% of them suffer from osteoarthritis, marked by pain in the weight-bearing joints (knees, hips, back) due to excessive wear and tear.
NSAIDs and painkillers
Long-term sufferers of osteoarthritis are often dependent on pain relief medication. During the early stages of the disease, less potent drugs such as aspirin are often sufficient to manage the pain. As the disease progresses and the pain intensity increases, anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are frequently used.
However, these have very severe side effects if used long-term. They can damage the gastro-intestinal tract, as well as the kidneys. Also, many of these medications are unsuitable for patients with other underlying health issues, such as cardiovascular diseases for example.
How important is diet for osteoarthritis?
Good nutrition is very important for joint health. Maintaining a balanced diet and exercising regularly can help prevent or delay the development of osteoarthritis. Unfortunately many people don’t give much thought to joint health until they start experiencing pain. By this stage it’s very difficult to stop the progression of the disease by good food and exercise alone.
There are several key dietary recommendations for people with arthritis:
This is the most common type of non-inflammatory arthritis and is the most common form of arthritis in the UK1. Statistics from Arthritis Research reveal that 8.75 million people have sought treatment for osteoarthritis in the UK.
While this disease usually develops in people over the age of 50, it can develop at any age in response to anther joint-related problem or an injury. More than 30 percent of women have some degree of osteoarthritis by age 65.
Osteoarthritis make movement very difficult. In the early stages the disease affects the cartilage lining of the joints, leading to stiffness and pain. As the cartilage thins the joint bones start to rub together, increasing deformation and discomfort.
Initially, osteoarthritis starts with minor pain during activities, but soon the pain can become continuous and even occur while in a state of rest. The joints most commonly affected by osteoarthritis include the hips, knees, hands, and spine.
People with prior joint trauma, obesity, and a sedentary lifestyle are at the highest risk of developing osteoarthritis.
The principal aims of treating osteoarthritis are to adequately control pain, enhance function, and minimise disability. All treatment plans should include a combination of therapies focusing on the best strategy for individual circumstances.
The primary treatment for osteoarthritis has been paracetamol for pain relief, although NSAIDs (nonsteroidal anti-inflammatory drugs) are also recommended in the case of moderate or severe pain 2. The types of medications prescribed to help manage osteoarthritis will depend on other underlying health factors. For example, people suffering from osteoarthritis and hypertension should avoid NSAIDs and cyclooxygenase-2 (COX-2) inhibitors because they can increase blood pressure3. Corticosteroids and hyaluronic acid injections may also be a viable short-term treatment option for some patients.
Occupational therapy combined with a healthy diet and nutritional supplements can help to lessen the burden on the joints and improve overall joint health.
Strengthening Bones and Joints
Many people that suffer from arthritis are also at risk of developing osteoporosis.
Therefore, any arthritis diet foods should contain nutrients that support the strengthening of the joints and bones.
Calcium, vitamin K2 (menaquinone), vitamin D, phosphorus, magnesium, and manganese are all important nutrients that support healthy bones and joints.
Calcium is essential for maintaining bone mass.
However, for the body to effectively utilise calcium it needs the support of other nutrients.
Foods that promote strong bones & joints
While most people associated dairy foods with calcium, many leafy greens, legumes, fruit, and seafood also contain this important mineral.
- Collard greens
- Soy beans
- Bok Choy
- Cheddar cheese
- Feta cheese
- Cottage cheese
- Parmesan cheese
Key nutrients that support calcium absorption
This vitamin plays a key role in calcium metabolism, with several studies confirming that menaquinone is important for protecting bone health8,9,10. Menaquinone is found in certain animal foods and fermented foods. Unfortunately, K2-rich foods are typically high in fat. So while it is important to included foods containing K2 in an arthritis diet, they should be consumed in moderation.
This pseudo-vitamin is needed to help increase the absorption rate of calcium within the gastrointestinal tract. Without vitamin D, calcitriol cannot be formed, preventing the insufficient calcium availability and weakening of the bones.
The second most abundant mineral in the body after calcium, phosphorus also plays an important role in building strong bones and teeth. Most people get sufficient phosphorus in their diet.
Magnesium and Manganese
The primary sources of this vitamin are meat derived, especially organ meat. This is because animals have the ability to synthesise this vitamin from vitamin K1 they aquire from eating grass. Consequently, meats, dairy and eggs derived from grass-fed animals have a richer concentration of vitamin K2 compared with animals that are grain fed13.
Natto is the only vegetarian source of vitamin K2. The only reason natto contains vitamin K2 is due the bacterial strain used during the fermentation process. Vegetarians and vegans may need to take a dietary supplement to ensure that they are gaining enough vitamin K2 in their diet.
Since the richest sources of vitamin K2 also have a high concentration of saturated fat it’s important not to eat excessive amounts of these foods. This is another reason why a dietary supplement may be a better alternative.
Vitamin K2-Rich Foods
- Natto (fermented soybeans)
- Hard cheese
- Soft cheese
- Egg yolk
- Chicken liver
- Chicken breast
- Ground beef
The body produces vitamin D when exposed to sufficient sunlight. There are also some food sources of vitamin D, but this is largely restricted to fish.
Vitamin D-Rich Foods
- Fish liver oil
- Beef liver
- Egg yolks
Fortunately phosphorus is found in just about all foods, so rarely are any changes needed in an arthritis diet to account for a deficiency.
- Pumpkin Seeds
- Brazil Nuts
- Soya Beans
Seafood and plant-based foods tend to be the best sources of the trace elements magnesium and manganese.
Manganese & Magnesium-Rich Foods
- Whole Grains
These nutrients can all be sourced from high quality whole foods. However, foods supplements are more time-efficient and cost-effective at supplying the nutrients. Of course, patients should do their utmost to follow a healthy arthritis-friendly diet in any case.
Sourcing the nutrients
There are essentially two ways to source the above nutrients: from high quality, whole foods or from food supplements.
On the one hand, sourcing the nutrients from whole food will guarantee that you will eat a more balanced and complete diet on the whole. On the other hand, however, it is both cost and time-intensive to ensure that all nutrients are supplied every day in sufficient dosages.
Fresh, unprocessed high quality foods need to be purchased from markets to minimise occurrence of preservatives and toxins. Of course, these pollutants in cheap food can themselves aggravate inflammation.
Food supplements are more efficient and effective at supplying the nutrients. Of course, patients should do their utmost to follow a healthy arthritis-friendly diet in any case.
There has been a lot of research into alternative natural remedies for osteoarthritis. Exploring these options can help to reduce the reliance on NSAIDs. This will help to avoid the risks associated with long-term use of anti-inflammatory drugs.
Omega 3 : DHA and EPA
Omega-3 fatty acids DHA and EPA help to suppress the activity of arachidonic acid (one of the omega-6 fatty acids) and are unable to be converted into inflammatory prostaglandins. A diet rich in omega-3 fatty acids DHA and EPA can help to reduce inflammation of the joints and help with pain relief.
A recent meta-analysis has confirmed that omega-3 fatty acids can assist to minimise the symptoms of pain in sufferers of rheumatoid arthritis14. The patients that participated in this study significantly reduced their NSAID consumption. They took 2.7g of omega-3 fatty acids every day for a period of three months to achieve these results.
Glucosamine and chondroitin
Currently, the most promising approach to natural pain management is the combination of omega-3 fatty acids with glucosamine sulfate. In one study, researchers used 1,500 mg glucosamine sulfate per day in combination with omega-3 fatty acids15. Over a period of 26 weeks, the study participants were interviewed about the degree of pain relief they were experiencing.
Patients with combined therapy had significantly less pain. Their degree of morning joint stiffness and loss of motion was much less when compared with the group only taking glucosamine sulfate. Neither combination showed long-term side effects. Researchers believe that this approach could be developed into a safe treatment method. They are confident that a combination of glucosamine and omega-3 fatty acids slowed the progression of osteoarthritis.
Pine bark extract
Tree bark extracts have been used for thousands of years for medicinal purposes. The extract from the French maritime pine contains many proanthocyanidins. These compounds have anti-inflammatory and circulation-enhancing effects, helping to reduce pain without negative side effects.
Vitamins, amino acids and trace elements
The body must have sufficient vitamins, sulfur-containing amino acids and trace elements available to regenerate the cartilage matrix. Unfortunately, rarely do individuals receive enough of these vital nutrients from their diet.
According to studies by the German Federal Ministry of Food, Agriculture and Consumer Protection16
- about 90% of older people were deficient in vitamin D,
- about 50% of older people were deficient in vitamin E
- about 30% of older people were deficient in vitamin C
- about 25% of older people were deficient in zinc and/or selenium.
These are just a few examples. Nutritional deficiencies are known to contribute to increased susceptibility to joint diseases, such as osteoarthritis and arthritis.
Product guide: joint food supplements
Several good combination preparations for joints also contain multiple of the above nutrients. As the health of the joint cartilage depends on many factors, combination preparations are usually superior to individual active ingredients.
A large number of arthritis-friendly foods have been identified and these should be preferably consumed. At the same time it is advisable to consume so-called combination joint supplements to ensure that the micro nutrients are available to the body in effective dosages.
- “VanItallie TB (October 2010). “Gout: epitome of painful arthritis”. Metab. Clin. Exp. 59(Suppl 1): S32–6. doi:10.1016/j.metabol.2010.07.009. PMID 20837191″
- “Puttini, P. et.al. (2005). Osteoarthritis: an overview of the disease and its treatment strategies. Seminars in Arthritis and Rheumatiodism, Volume 35, Issue 1, (pp. 1-10).
- “Verdecchia, P. et.al. (2010). Treatment strategies for osteoarthritis patients with pain and hypertension.” Therapeutic Advances in Musculoskeletal Disease, Volume 2, Issue 4, (pp. 229-40).
- “Itoh, K. et.al. (2008). A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA). Chinese Medicine, Volume 3, Issue 2.
- “Zhang, W. et.al. (2010). OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and Cartilage, Volume 18, Issue 4, (pp. 476-99).
- “Denegar, C. et.al. (2010). Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clinical Interventions in Aging, Volume 5, (pp.199-206).
- “Turley, M. et.al. (2006) Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults. Australian and New Zealand Journal of Public Health, Volume 30, Issue 3, (pp. 231-237).
- “Kanpen, M. et.al. (2013).Three-year-low-dose menaquinone-7 supplementation helps decrease bone lose in healthy postmenopausal women. Osteoporosis International. Volume 24, Issue 9, (pp. 2499-507).
- “Cockayne, S. et.al. (2006). Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Achieves of Internal Medicine, Volume 166, Issue 12, (pp. 1256-61).
- “Ishida, Y. (2008). Vitamin K2. Clinical Calcium, Volume 18, Issue 10, (pp. 1476-82).
- “Strause, L. and Saltman, P.(1987). “Role of Manganese in Bone Metabolism.” In: Nutritional Bioavailability of Manganese. American Chemical Society, (pp. 46-55).
- “Castiglioni, S. et.al. (2013). Magnesium and Osteoporosis: Current State of Knowledge and Future Research Directions. Nutrients. Volume 5, (pp. 3022-33).
- “.Rheaume-Bleue K. (2011). Vitamin K2 and the Calcium Paradox: How a Little-Known Vitamin Could Save Your Life. 1st ed. Ontario, Canada; Wiley.”
- Lee, YH. et al. 2012. “Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis.” Arch Med Res. 43(5):356-362.
- Gruenwald, J. et al. 2009. “Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis.” Advances in Therapy. 26(9):858-871