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The Role of Good Nutrition to Help the Symptoms of Osteoarthritis29th October 2020
By Tanya Clarke, Nutritional Therapist and Naturopath
With a diagnosis of Osteoarthritis (OA), you are most likely to be presenting with symptoms such as joint swelling, synovitis and inflammatory pain¹.
A balanced, nutritious diet may:
- Help to reduce inflammation help to prevent further damage to the joint
- Help to reduce pain and joint swelling
- Help you to maintain a healthy weight
You may have been advised to watch your weight - this is important because being overweight can increase the pressure on the knee and worsen OA symptoms². Adipose (fat) tissue is active and secretes a number of chemical factors, some of which have inflammatory effects³. Keeping moving helps maintain a healthy body weight and protects joints by strengthening muscles, reducing joint loading and reducing stiffness 4.
The Mediterranean Diet
Following a whole food plant-based (WFPB) diet is a recommended adjunct to standard medical management of OA5. A higher adherence to a WFPB diet, such as the Mediterranean diet, is associated with a better quality of life and decreased pain, disability, and depressive symptoms6 The Mediterranean diet is rich in long-chain omega-3 polyunsaturated fatty acids and oleic acid (omega-9 monounsaturated), antioxidant nutrients and unrefined carbohydrates. This all helps to reduce inflammation and the pain associated with inflammation.
The Mediterranean diet involves eating primarily:
- Plant-based foods including fruits, vegetables, wholegrain cereals, legumes, nuts and seeds
- Minimally processed foods, seasonally fresh and locally grown
- Healthy fats like olive oil
- Herbs (especially parsley and coriander) and spices (especially ginger and turmeric) to flavour foods as this reduces the use of salt
- Fish and poultry at least twice a week - red meat is limited (1-4 per month)
Drinking red wine in moderation is optional although you may be advised to cut out alcohol completely with OA.
Staying hydrated with filtered water helps to protect tissues, spine and joints by keeping them lubricated and promotes the excretion of uric acid. It is important to remember that cartilage is about 85% water!
Foods to embrace:
- For increasing intake of essential fatty acids that can help to reduce inflammation:
- Oily fish (wild salmon, mackerel, anchovies, sardines, herring)
- Flax seeds, hemp seeds and chia seeds
- For their anti-inflammatory and anti-oxidant properties due to the high phytonutrient content (especially quercetin and the carotenoids) and micro-nutrient content (especially vitamins A, C, E and manganese):
- Dark leafy green vegetables (spinach, bok choy , broccoli, collard greens, kale, Swiss chard, etc.)
- To help mobilise uric acid out of joints, increase collagen metabolism and prevent/reduce inflammation:
- Dark red, blue and purple fruits (plums, blackberries, cherries, etc.)
- To help regulate your immune system and reduce chronic inflammation:
- Foods high in vitamin D – oily fish (wild salmon, mackerel, anchovies, sardines, herring), eggs, mushrooms, fortified cereals and yoghurts
- To combat the free radicals caused by the immune response in chronic inflammation:
- Eat a rainbow of fruit and vegetables to ensure that you are getting a variety of antioxidants - aim for 10 fist-sized portions per day (eight vegetables and two fruit)
Foods to avoid:
- To help reduce inflammation and symptoms of OA:
- Sugar, white flour, tea and coffee, malt and white vinegar, chocolate, soft drinks, wheat and all processed food
- To help prevent the inhibition of normal collagen repair or promotion of inflammatory degeneration of the joints:
- The Solanacea or nightshade family – white potatoes, tomatoes, aubergine and peppers (for some people the elimination of this family is beneficial as the consumption of Solanum alkaloids may aggravate inflammation)
- To reduce uric acid levels in the joint:
- Foods high in purines - organ meats, red meats, alcohol, shellfish, sardines, etc. (for some people who are prone to increased uric acid levels, the elimination of purines altogether may be beneficial)
The Mediterranean diet is not just about food, it includes the process of eating - sitting down to eat a meal with friends and family, chewing well, taking time to digest (to assist with the absorption of beneficial nutrients) and not eating on the run. It also encourages exercise, being outdoors and in the sunshine - the easiest source of Vitamin D.
Further information about the Mediterranean diet can be found here.
Keeping a food diary can help to highlight foods that may trigger or exacerbate symptoms and allow you to eliminate those foods to see if there is a beneficial effect for you. Keep a note of all your food and drink intake. Score both symptoms and mood (0-10) where 10 is as bad as it can be. Look for patterns and discuss this with your GP/healthcare provider or a registered nutritional therapist.
Epsom Salt Baths
The magnesium in Epsom salt baths may help with inflammation and pain and can soothe stiff joints7. Use two cups of Epsom salts in a bath of warm water at a temperature of about 38°C and soak for 30 minutes. When you get out of the bath, make sure that you lie down for 20 minutes.
Practising mindfulness-based meditation may help reduce inflammation, pain, dysfunction and improve mood8. Sit for 15-20 minutes twice a day with eyes closed and repeat a chosen mantra. Look for a Transcendental Meditation class near you.
Pain, stiffness and fatigue may be decreased with the use of an Infrared sauna9. The increase in circulation and oxygenation has a therapeutic effect on the body. Portable ones are available for home use.
1. Sellam, J. & Berenbaum, F. (2010). ‘The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis’, Nature Reviews Rheumatology, 6, 625–635
2. Vina, E. & Kwoh, C. (2018). ‘Epidemiology of Osteoarthritis: Literature Update’, Current Opinion in Rheumatology, 30(2): 160–167
3. Berenbaum, F. Eymard, F. et al. (2013). ‘Osteoarthritis, inflammation and obesity’, Current Opinion in Rheumatology, 25(1):114-118
4. Wellsandt, E. & Golightly, Y. (2018). ‘Exercise in the management of knee and hip osteoarthritis’, Current Opinion in Rheumatology, 30(2):151-159
5. Clinton, CM. O'Brien, S. et al. (2015). ‘Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis’, Arthritis, 708152. doi:10.1155/2015/708152
6 Veronese, N., Stubbs, B. et al. (2016). ‘Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative’, The American Journal of Clinical Nutrition, 104(5), 1403–1409
7. Yoshioka,A. Bando, H. et al. (2019). ‘Recent status of hydrotherapy and balneotherapy with clinical beneficial effects’, International Journal of Complementary & Alternative Medicine, 12(6), 217-219
8. Selfe, T. & Innes, K. (2013). ‘Effects of Meditation on Symptoms of Knee Osteoarthritis’, Alternative & Complementary Therapies, 19(3),139-146
9. Oosterveld, F. Rasker, J. et al. (2008). ‘Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis’, Clinical Rheumatology, 28(1),29-34