Nutrition and Arthritis

In every public forum conducted by AFM, the most common question asked by participants is what they should or should not eat. Joint Efforts brings you the answer here:

Good nutrition and a healthy lifestyle are important for everyone. Yet, many arthritis patients face multitude problems getting enough nutrition due to limited mobility resulting from joint pain, swelling and fatigue. Appetite may also be reduced because of medications, pain and depression.

Not only that, there is so much conflicting information on what you can or cannot eat that you don’t know who to believe any more! Remember, every arthritis patient is different so different foods may react differently in different people. For example, eating less protein is appropriate if you have Systemic Lupus Erythematosus (SLE) that has affected your kidney function.

Unless you have gout, most foods can be eaten. Basically, the most important factors for arthritis patients where food is concerned are:

• Variety- eat a wide choice of food for the necessary nutrients
• Balance- less fat, less sugar, more fruit and vegetables, more oily fish and plenty of calcium and iron-rich foods.
• Moderation- eat smaller amounts but more frequently to keep weight down.

Omega-3 fats

There is growing evidence that omega-3 polyunsaturated fatty acids can help people with inflammatory arthritis. Omega-3 fats are found in:

• oily fish such as salmon, sardines, herring, mackerel and trout, or fresh tuna.
• avocados
• nuts and seeds
• vegetable (rapeseed or flaxseed) oil.

Omega-3 fats can lead to the production of harmful substances called free radicals. To combat this, combine them with plenty of antioxidants (in brightly coloured fruits and vegetables) and vitamin E (in nuts, seeds, sweet potatoes and avocados).

Calcium

People with rheumatoid arthritis are at increased risk of developing osteoporosis, so ensuring an adequate calcium intake is very important. Foods rich in calcium include:

• sardines (including their bones)
• milk, yoghurt and cheese
• white, brown or wholemeal bread
• green leafy vegetables, such as kale, cabbage and okra (but not spinach)
• calcium-enriched soya products
• sesame seeds.
  

Vitamin D is also needed for the body to absorb calcium. The main source of vitamin D is from sunlight, but it is also found in oily fish.

Iron

Fatigue is a very common symptom of rheumatoid arthritis. This can be made worse by anaemia (red blood cells deficiency), which is the result of inflammation or because of the long-term use of NSAIDs. Iron-rich foods include:

• red meat
• darker coloured fish
• eggs
• green leafy vegetables
• pulses
• fortified breakfast cereals.
  

Iron is more easily absorbed if consumed with vitamin C, so have

a portion of fruit or vegetables with your meal. Avoid tea and coffee as it inhibits the absorption of iron.

Nuts

• Contains omega-3 fats, which help ease stiffness and reduce inflammation.
• Pecans, walnuts and hazelnuts are high in antioxidants. Brazil nuts are also high in selenium, which may limit the damage that occurs in arthritis and is an immune system booster
• High in fat, so eat them in moderation
  

Cruciferous vegetables (broccoli, cauliflower, cabbage and Brussels sprouts)

• People with rheumatoid arthritis are at increased risk of developing heart disease, so increase intake of vegetables that are heart-healthy
• Contains fibre, folic acid, and vitamins A, C and K
• Fibre is important to prevent constipation, which is often caused by arthritis medications, such as NSAIDs and painkillers
  

Apples

• Contain magnesium, which is thought to decrease the pain of fibromyalgia.
  

Berries (blueberries, blackberries, blackcurrants, cranberries, raspberries and strawberries)

• Contain antioxidants that can reduce inflammation
• Contain fibre, folic acid, magnesium, potassium and vitamin C
• Natural folic acid helps patients on methotrexate for cell regeneration
  

Cherries

• Helps decrease inflammation and pain
• Contain fibre, vitamins A and C.
  

Citrus fruits (oranges, lemons, limes, kiwis, grapefruit)

• Rich in vitamin C, which might help protect against developing inflammatory arthritis
• Contain fibre, folic acid, magnesium and potassium.
• Grapefruit (or grapefruit juice) may interfere with the action of some disease-modifying antirheumatic drugs (such as ciclosporin) and some other, so choose orange
  

Leafy green vegetables (kale, mustard greens, Swiss chard and brinjal)

• Rich in calcium and iron
• Good for the heart
• Nutrient rich and low in calories.
  

Dairy products (Milk, cheese and yoghurt)

• High in calcium, which is important for healthy bones.
• Also high in folic acid, magnesium, and vitamins
• Choose skimmed or low-fat versions to avoid eating too many saturated fats, which could increase inflammation.
  

Oily fish

• Contains oils that help fight inflammation, joint pain and stiffness
  

Peas, beans and lentils

• Good source of iron to prevent anaemia
• Also contain fibre, folic acid and other minerals
  

Whole grains (wholewheat and brown rice)

• Contain magnesium, which is important for healthy bones
• Also high in fibre

Food For Thought

1.)    DO remember that everyone will react differently to various foods.

2.)    DO replace or supplement your diet with the necessary nutrients if you decide to stop taking certain foods

3.)    DO keep a food diary and conduct a food elimination test if you suspect certain foods to trigger your arthritis attacks.

4.)    DO remember that some of the foods that you are adverse to such as wheat and dairy products can be hidden in common foods

1.)    DO NOT exclude any foods completely without consulting your doctor first as you may be missing out on essential nutrients.

2.)    DO NOT adopt a vegan diet or practise prolonged fasting without the advice of your doctor or dietician.

3.)    DO NOT skip your medicine if you are taking traditional food supplements such as bird's nest, tree fungus, lingzhi and essence of chicken

4.)    DO NOT eat excessively as the extra weight will bear additional pressure on your knee joints.

Arthritis medicines and food

Some medicines must be taken at the right time in relation to meals.

Ponstan, Aspirin and Indocid- these painkillers are best taken after food.

Residronate and Alendronate- these bone-strengthening medicines must be taken with an empty stomach because they are not well absorbed in the presence of food.

Prednisolone- commonly used to treat SLE and rheumatoid arthritis, can give you a voracious appetite. Many patients put on a lot of weight because of this. A good way to handle this is to keep non-fattening food, like carrot or celery sticks, in your refrigerator and chew on them when you feel that you have to eat something outside of your mealtime.

Cyclophosphamide- sometimes prescribed to SLE patients, can cause appetite loss or even nausea and vomiting. If this happens, let your doctor know and he or she can order another medicine for you to remove this unpleasant sensation.

Methotrexate-  used for Rheumatoid Arthritis, myositis and psoriatic arthritis, can lower levels of folic acid. Having a folic acid deficiency may predispose you to methotrexate toxicity.

Talk to your physician about how the medications you take affect your nutritional status and whether a vitamin supplement may be useful for you.

References: Singapore Arthritis Foundation, www.arthritiscare.org.uk