Osteoarthritis (+ dietary recommendations)
More than half a million New Zealanders will be affected by arthritis at some point in their lifetime.
Arthritis affects the joints and the musculoskeletal tissues that surround them. The most common physical symptoms of arthritis are inflammation around the joint, swelling, stiffness and joint pain, and arthritis itself can be the primary condition or a result of other health conditions affecting other organs. Though it’s more common for someone 65 and over to experience arthritis, more and more young people are also affected.
Osteoarthritis is the most common type of arthritis, but there are more than 100 different types, and rheumatoid arthritis, fibromyalgia, psoriasis arthritis and gout are other common forms. Though I only have space to focus on osteoarthritis in today’s article and will focus on other forms in future articles, many of the recommendations here may aid pain management in other types of arthritis.
Osteoarthritis (OA) is a chronic degenerative joint disorder with the characteristics of articular cartilage destruction, alteration of the bones that sit beneath the cartilage and inflammation of the synovial membrane. Clinical signs and symptoms of osteoarthritis include pain, stiffness, restricted motion and grating or popping sounds under the joint (otherwise known as crepitus). It is a condition that affects major weight-bearing joints such as the hips and the knees, but is also found in other joints such as our hands and in the spine. It is a particularly debilitating condition that affects quality of life.
Though it is related to the wear and tear in a joint, and it is more common in older people, sports injuries and other trauma to joints increase the risk of developing osteoarthritis in younger people, and there are certain genes that may place an individual at greater risk of developing osteoarthritis.
Reduce excess body fat
One of the first recommendations is to reduce excess body fat (if any) to reduce the load on a joint that can’t support it. Crash dieting or a very low-calorie or low-fat diet isn’t recommended, however, given that the provision of nutrients is essential to help with pain management and protection of the bone. Therefore (as with any health goal), the focus should instead be on a nutrient-dense diet that supports joint health rather than weight loss per se.
A dietary pattern that helps reduce inflammation will likely result in a changes to body composition if that is also required. Though triggers for inflammation in the body depend on the individual, the removal of grain-based products, dairy and industrial seed oils that provoke inflammatory pathways in the body (such as soy or canola oil) for a period of time is a good starting point. This generally means removing most (if not all) packaged items from the diet.
Caffeine and alcohol can also cause inflammation, depending on an individual’s ability to metabolise them, therefore a period of time without either is often warranted. Though this may seem unnecessarily restrictive, these broad recommendations have been found to reduce inflammation and will help decipher which of the food groups may be particularly aggravating for an individual when it comes to reintroducing them. Many people with OA are in such pain that the hardship of eliminating these foods pales in comparison to the reduction in symptoms.
Working with a practitioner to ensure nutrient adequacy of the diet is important, and there are plenty of amazing, flavourful foods that provide the nutrients required to help dampen down inflammation. An abundance of green leafy vegetables for the antioxidants they provide (to help reduce oxidative stress, a contributor to inflammation in the body), cruciferous vegetables (broccoli, cauliflower and brussels sprouts, for example) and fish high in omega 3 fatty acids (salmon, mackerel and sardines) should be mainstays.
The inclusion of olive oil, eggs and nuts are all part of a dietary pattern that reduces inflammation, as is non-processed red meat, which is associated with decreased likelihood of a hip replacement due to OA and is an often overlooked part of an anti-inflammatory diet. It is speculated that intake of the minerals present in meat, especially iron, zinc, selenium and magnesium, is positively associated with bone mass and strength. Higher animal protein consumption has been shown to be associated with increased bone mineral density and decreased bone loss.
Another potential dietary superstar is broccoli sprouts. These contain fewer antioxidants then other members of the brassica family but are garnering interest among researchers for their anti-inflammatory properties. Their membrane contains an enzyme (myrosine) which, when cut into or chewed, allows it to interact with another substance called glucoraphanin — the chemical reaction that takes place when this happens forms a phytochemical called sulfurophane, which has been found to delay the progression of OA in rodents in laboratory trials.
Spices also play an important role in an anti-inflammatory diet: Curcumin, an active compound in the spice turmeric — in amounts of around 500mg per day across a two-month period — has been found to be as effective as ibuprofen at reducing pain for osteoarthritis, and I have had many clients say a turmeric supplement has helped them tremendously with their arthritic pain where they previously took anti-inflammatory medication. Liberal inclusion in the diet is a good idea (try this turmeric latte, pictured below), however therapeutic doses are likely higher than what we can easily include every day, so a supplement makes for a good option.
When looking for a turmeric supplement you want to find a form that is bioavailable; inclusion of piperine, or black pepper extract, a liposomal curcumin compound, or one that has been encapsulated or formulated into nanoparticles are four such supplements. As some formulations of curcumin may interfere with certain drugs, you should to talk to your doctor if you are considering taking it. However it is certainly a promising therapeutic intervention.
Though less evidence is available for spices in relation to arthritis, ginger, cinnamon and cloves have long been held to have anti-inflammatory properties, as have garlic, cayenne and black pepper.
When people with osteoarthritis were provided with 10g of collagen peptides from a pork and bovine source over a six-month period in a randomised control trial, quality of life measures improved and swelling and subjective pain was reduced. The benefits were most pronounced in the groups reporting the most discomfort initially.
Cuts of meat that include the joint and are slow-cooked can be a great source of these peptides and broth from slow-cooked meat is another source, as the tissue breaks down during the cooking. Gelatin powder can also be added to smoothies, soups and mince-based dishes if you don’t have a bone broth on the go. It is thought to work by reducing inflammatory markers related to joint pain, but also by coating the cells of the gut lining and making these more robust against inflammatory processes.
Through her subscription service of meal plans and nutritional support, nutritionist Mikki Williden helps people manage their diets in an interesting way, at a low cost. Find out more at mikkiwilliden.com