Can eating particular foods cause your arthritis to flare up?

Eat this. Don’t eat that. Cut out this. Take that supplement. Try this diet... With all the arthritis/diet information coming at us from all quarters, we couldn’t be blamed for being confused. What actions, then, are correct when it comes to alleviating the pain and inflammation associated with arthritis? Is there, for instance, a specific anti-inflammatory diet?

“There are lots of myths surrounding diet and arthritis,” says Richelle Flanagan, a member and former president of the INDI (Irish National Dietetic Institute), “like the common belief that nightshade vegetables (including potatoes, tomatoes and aubergine) will lead to an increase in symptoms, but there is no evidence to support this.

Likewise with alkaline and ketogenic diets, which a lot is heard of these days where many foods and carbs are cut out. There is either no or limited evidence that these are good – and they may also be potentially harmful.

The bottom line is that, while there is no specific ‘anti-inflammatory diet’, eating a Mediterranean-style diet that emphasises fish and vegetables, losing weight if you need to and taking regular exercise will best help you to manage your arthritis,” says Richelle.

AVOIDING WHAT WE SHOULD BE DOING

Getting caught up in the latest “don’t eat this or that for arthritis” story can sometimes be a way of avoiding what we should really be doing, she believes.

“Usually people are just avoiding what they need to face, which is putting the work into their diet and looking after themselves properly. The problem is that a lot of people are too stressed or too busy to take time out to really look at what they’re eating.”

Even a relatively small loss of weight can help, she says. “Obesity has a huge impact on joints. Even being 10 pounds overweight will put 40 pounds extra pressure on your knees.

Managing to lose even five to 10% of your body weight, then, will reduce the stress on your joints, increase strength, flexibility and mobility and reduce pain sensitivity too.

Exercise is important also.

“Contrary to belief years ago, exercise is now considered essential for those with arthritis, helping with weight loss and mobility,” she says.

ALL ABOUT MANAGEMENT

Managing your arthritis well also means having regular blood pressure, cholesterol and blood-sugar tests. “Getting your vitamin D, vitamin B12 and iron levels checked by way of a blood test is important as well, before you go taking a lot of supplements. That way you’ll know if you need them or not.

“And sometimes being screened for coeliac disease is a good idea too, depending on your symptoms. If you ask your GP to refer you to a dietitian, she or he will do an assessment and advise you about making safe and sensible dietary changes that will not damage your health.”

Recommended ARTHRITIS DIET

A FOOD DIARY IS KEY

Richelle advises keeping a food diary for a few weeks. “The food diary is a really powerful tool. It’s like a bank balance: you can’t balance the books if you don’t look at what’s going in and out.”

Richelle finds that her patients often speak of how the food diary informs them. “They always come back saying: ‘I didn’t realise I did X, Y or Z.’ Having that information empowers the patient.

Giving out to people doesn’t work, but if they see for themselves where they have been going wrong they are then able to make changes for the better.

While she accepts that losing weight can be difficult if exercise is painful, every bit of movement helps, she says. The key to losing weight to help reduce your symptoms of arthritis is your diet, however, and portion control plays a big part in achieving successful weight loss.

SUPPLEMENTS – HOW TO APPROACH

Taking supplements unadvisedly and in high doses is not a good idea, she states. “When someone in my clinic lists off a lot of supplements they’re taking, I say: ‘What you’re trying to do here is stop the gaps.’ Taking supplements never makes up for a poor diet. Vitamins taken in food are always better.”

People could be taking a supplement that has a negative impact on their health too or taking them in too high doses; for instance, omega 3 oils.

Some research shows there is benefit in terms of fish oils for arthritis, but other research done four of five years ago in the US showed that men who had high levels of omega 3 in their blood were at a higher risk of prostate cancer.

Omega 3 supplements are beneficial if someone doesn’t like eating oily fish, but not in high doses. Be guided by your GP on what strength to take.”

What about glucosamine and chondroitin, the supplements long believed to help joints? “The evidence isn’t strong enough to take this combination supplement,” she says, “but I don’t think they’re going to cause anyone any harm if individuals feel they do help.”

As a general rule of thumb, if no improvement is notable after two months of taking either/both of these supplements, they will probably not help, and should be discontinued, she adds.

TOMATOES, PEPPERS – BADDIES?

Contrary to rumours, peppers and tomatoes do not exacerbate arthritis symptoms, she says. “It hasn’t been proved scientifically – and if you start cutting out these foods you could be cutting out good sources of antioxidants and vitamin C.

“Some people say: ‘if I eat tomatoes, I’m worse’ – and as a dietitian you have to listen to that person. It’s not going to be the end of the world if they cut out tomatoes, but they do have to eat vitamin C-rich foods to replace them.”

She suggests keeping a diary, logging how you are when you eat tomatoes and when you don’t, for a few weeks. “If you cut these out and notice an improvement, make sure you then eat other vitamin C-rich foods, but if there is no improvement don’t cut the food (for instance, tomatoes) out.”

VITAMIN D FOODS ARE IMPORTANT

There is some evidence to show that low vitamin D levels often present in people with some types of arthritis, for instance rheumatoid, she says.

“In one study, up to 60% with this form of arthritis were low in vitamin D. Many people in Ireland are low in vitamin D because of lack of sunshine, so they should ensure they are getting an adequate amount. Get your levels checked by your GP and discuss taking a supplement if that’s necessary.”

FAD DIETS

The INDI spokesperson doesn’t have much good to say about fad diets. These include the alkaline diet and the ketogenic diet, endorsed by celebrities. “These diets don’t show any benefit for people with arthritis, and while getting more fruit and veg in may be one of the positive things about them you don’t need to cut out red meat and fish.

We would say if a person is seriously considering one of these diets then do it only under the careful supervision of a dietitian, so that all food bases are covered.

The same applies with a vegan diet.

“A lot of people think being vegan is easy, but you have to be really careful about making sure that you get enough protein. You’re at risk of being low in iron and vitamin B12 too, so it’s not something to be taken light-heartedly.” CL

GOUT

Gout is a type of arthritis that causes inflammation of one joint; for example, the joint at the base of the big toe. It occurs because of a build-up of uric acid crystals and can be very painful.

“You need to be careful (diet-wise) if you’ve got gout,” according to the INDI.

“Oily fish, for example, tends to be a bit higher in purines. Gout is affected by purines – chemical compounds in foods – so foods like liver, heart, and kidney and sweetbread should be avoided, as they are high in fat and purines.

Swapping from eating animal meat always as your source to more plant-based proteins like pulses, nuts and tofu may help.

Reducing alcohol intake is important too if you’re prone to this form of arthritis.”

DIETITIANS AND NUTRITIONIST: WHAT’S THE DIFFERENCE?

Dietitians are regulated professionals, she points out, and have to be guided by the research available.

“We don’t sell any supplements, and we don’t advise people to take very high doses of anything. If people take supplements, it’s on the basis of what’s missing in their diet. It’s evidence-based (on a blood test) rather than: ‘You have to follow this diet – and by the way you have to buy X, Y and Z supplement here.’ If you are eating properly you will be getting all the nutrients you need.”

Dietitians also have to be mindful of other medical problems patients might have. “Many people have co-morbidities with their arthritis, like high blood pressure, heart disease, high cholesterol. These have to be taken into account. We work on a one-to-one basis and have been trained to look at the whole picture.”

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