Arthritis and Food : Joint pain, arthritis and diet
Sourced and edited from the Royal Prince Alfred Hospital (RPAH), Sydney
Arthritis is rare in cultures that eat traditional diets based on grains and vegetables (1,2) see references below.
- Among American Seventh Day Adventists, vegetarians have a low prevalence of rheumatoid arthritis, semi-vegetarians are higher and non-vegetarians have the highest prevalence of all. (3) In a large UK study, people with the highest red meat intake were found to have an increased risk for inflammatory polyarthritis (4).
- Total fasting has been found to be an effective treatment for rheumatoid arthritis but most patients relapse on the reintroduction of food. This would appear to confirm the food connection. (5,6)
- Arthritis is now the leading cause of disability in the United States - home of the Western diet – with about 30% of adults affected. In 2003, the total cost attributed to arthritis and other rheumatic conditions in the United States was 128 billion dollars. (7)
- Arthritis drugs can work like magic in the short term but can have serious long term consequences and are no longer recommended for long term use. (8)
- An American study followed 24 people with moderate to severe arthritis on a very low-fat vegan diet free of processed foods and modelled on traditional diets. Lead researcher Dr John McDougall said “About 70% of people with rheumatoid arthritis (the most common form of inflammatory arthritis) can expect dramatic benefits, and often a cure, in less than 4 weeks of diet change.” (9)
The RPAH elimination diet (10) that we recommend for food intolerance symptoms has not been scientifically tested for arthritis. However, our database includes 27 reports from arthritics whose sometimes severe and crippling arthritis symptoms – from osteoarthritis to juvenile rheumatoid arthritis – has been helped by diet, e.g.??
"My daughter was diagnosed with juvenile arthritis when she was three. By the time she went to school, at five, she was crippled with it. She's now 25. Three weeks after she started her elimination diet, she told me: "Mum, the pain's gone. For the first time in 23 years, I have no pain".
So which foods cause arthritis? It seems that arthritic joint pain is related to components of the Western diet. But which ones? The trouble is that no one knows - scientifically speaking - because no studies have included a comprehensive set of dietary challenges after improvement. Epidemiologists examine food trends (such as red meat) but some of our readers tell us that additives affect them. So is the observed problem with red meat intake due to the inflammatory effect of red meat, or could it be due to the nitrate and sulphite preservatives often used in red meat products? We don’t know. Reports from our database As with other food intolerance symptoms, people are different, and most people are affected by more than one food chemical: Some Triggers include:
- MSG (glutamates including additives 620-635)
- Wholegrain wheat
- Artificial colour 102 ( tartrazine)
- Amines sulphite preservatives (220-228)
- Soy (other than soy sauce which is high in glutamates)
Most people reported that they improved on the RPAH diet, and were not sure which components affect them, or noticed that they were affected by “processed foods”. Top 3 interesting arthritis reports from our database:
- Bernard’s arthritis-caused-by-salicylates story. A number of people were affected by salicylates. These are natural food chemicals in most fruit and some vegetables. Since the McDougall program is extra high in salicylates, we wonder whether the 30% who didn’t improve on his diet could be salicylate responders.
- A teenager with juvenile rheumatoid arthritis who did the entire RPAH diet with challenges supervised by a dietitian and reacted to only one challenge – MSG(glutamates), one the most widely consumed additives in the world today, though most people aren’t aware they are eating it. The McDougall program can be high in glutamates e.g. in soy sauce which is a mainstay of the McDougall program – soy sauce is considered to be part of the RPAH challenge for MSG.
- A woman whose arthritis is worst affected by salicylates and sulphite preservatives and to a lesser extent, amines and MSG. Sulphite preservatives are probably the most commonly used preservatives in our food supply. There are relatively high levels in foods and drinks, from wine, fruit juice and dried fruit (especially dried apricots) to sausages but there are also low levels in a very wide range of foods. It is possible to remove sulphites in drinks such as wine and cider by using products such as SO2GO or Purewine.
What you can do If you want to do a systematic, scientific investigation of the foods causing your arthritis pain, don’t expect your healthcare provider to help. You will have to decide for yourself. Here are the options: McDougall program If you are prepared to avoid processed foods and stick to a healthy low fat vegan diet – and would rather eat loads of fruit and vegetables than meat and other animal products - consider the McDougall program. You have a strong chance of losing or reducing your arthritis symptoms within 4 weeks. Your risk of heart disease, cancer and dementia will be reduced too. You still won’t know which components of your current diet were causing the problem, but perhaps that won’t bother you, or maybe you will discover the culprits if you break the diet occasionally. More information See the free McDougall program - note that Dr McDougall recommends avoiding wheat for the first week then switching to gluten free: We also recommend Dr McDougall’s book “The Starch Solution”. If you are one of the 30% of arthritics who are not helped by this program, see next option.
RPAH elimination diet
If you want to find out exactly which foods are causing your arthritis symptoms so that you can choose to avoid only those, while still eating many of your favourite foods - or if the McDougall program doesn’t work for you - we recommend a 4 week trial of the RPAH (Royal Prince Alfred Hospital) elimination diet with challenges for 2 reasons:
- Unlike most elimination diets, this one is very comprehensive. Especially when doing the gluten free dairy free option, this diet avoids all foods and food chemicals likely to be a problem; and
- The excellent RPAH challenges are a scientific way to pinpoint exactly what your problems are.
The RPAH diet is a diagnostic tool The RPAH diet consists of 3 stages – elimination, challenges, reintroduction - to find out exactly which food chemicals are causing problems. For 3-4 weeks you have to avoid gluten, dairy foods, natural salicylates, amines and glutamates, and 50 additives. It is best done under the supervision of a knowledgeable dietitian because it can be very complicated, especially challenges. We would love to see a scientific trial of the RPAH diet for arthritis but in the meantime, arthritis is not considered to be one of the conditions for which this elimination diet is used. Unfortunately, this means most dietitians have no idea that this diet works for arthritis so it is probably best to choose an experienced dietitian from our list and request the RPAH diet by name, as Bernard did. Note that it took Bernard 8 days to react to the salicylate challenge, which normally finishes after 1 week – it seems that for arthritis, reaction times may be slower. More information Our dietitians list Free Failsafe Booklet If you would like the gluten free, dairy free version, please ask for Darani’s booklet: email Our shopping list Note that Dr McDougall recommends avoiding wheat for the first week then switching to gluten free. We usually recommend something similar – keep wheat in for the first week then go gluten free unless you’ve seen a huge improvement. This makes the diet changes easier to implement. Q. I want to improve as quickly as possible and I don’t mind eating a very restricted diet for 4 weeks. It seems to me the best chance is to combine both diets – a low salicylate, low glutamate version of the McDougall program. Is this possible? A. Yes, it is. Please request Sue’s low salicylate vegan hints: Some common myths about diet and arthritis Like many myths, they are half right.
- People with arthritis have to avoid high acid foods like tomatoes or oranges. Tomatoes and oranges are very high in salicylates, amines and glutamates. It is true that they can contribute to arthritis in some people but not every arthritic has to avoid them. A systematic trial of the RPAH elimination diet can pinpoint dietary triggers for each individual.
- People with arthritis have to avoid all the foods in the nightshade family (tomato, sweet pepper, eggplant, potato). Tomatoes, capsicums and eggplants are all very high in salicylates, amines and glutamates so can contribute to arthritis in some people . Some varieties of potato (with white flesh and white or brown skin, large, old and thickly peeled) are low in these food chemicals and thus suitable for sensitive arthritics.
People with arthritis should avoid wheat and/or gluten. It is true that wheat and/or gluten may contribute to arthritis in some people but not every arthritic has to avoid them. A systematic trial of the RPAH elimination diet can pinpoint dietary triggers for each individual. Salicylates in medication can also cause problems Paradoxically, many medications used for joint pain contain salicylates that can make arthritis worse in a salicylate-sensitive person. Aspirin and other Non Steroidal Anti-Inflammatory Drugs (NSAIDS) should be avoided on a low salicylate diet. Salicylates are easily absorbed through the skin so over-the-counter topical medications - such as lotions and ointments - can also cause problems. Some NSAIDS such as ibuprofen (Nurofen), naproxen and diclofenac do not contain salicylates but can affect salicylate-sensitive people with cross-reactivity problems.