BY Samuel Mathis, MD, Assistant Professor, UTMB
One of the most frequent recommendations I provide patients is to improve their diet. The evidence is clear that if we fix our diet, we can significantly improve our overall health. One clear example of diet’s effect on our health is through improvement in arthritic symptoms. Both osteoarthritis and rheumatoid arthritis affect a significant portion of the population and prevalence only increases with age. This is why it is so important we work to prevent and treat these conditions in a natural way to reduce the harm of medication side effects from NSAIDS and steroidal agents. While the bulk of research has looked at rheumatoid arthritis, there are also some great studies that indicate dietary changes can affect osteoarthritis too.
One such review in 2018 found that an individual’s diet shows promise in preventing pain and inflammation for arthritis (1). This study looked at the protective effects of foods rich in polyphenolic flavonoids like quercetin. These compounds are typically found in colorful fruits such as blueberries, raspberries, strawberries, and pomegranates. This review found in multiple studies that diets rich in these foods had decreased severity of arthritis symptoms and lower markers of inflammation. The thought process of these foods is that they work through significant antioxidant effects on Interleukin 6, TNF-alpha, and other proinflammatory markers (1).
The benefit to arthritis is not just limited to fruits and vegetables. A recent review found that diet also plays a significant role in rheumatoid arthritis’ progression. This review of over 40 different studies found that certain food choices can worsen or improve symptoms of rheumatoid arthritis. Nutrients such as polyunsaturated fatty acids (like fish oil), antioxidants, high fiber foods, probiotics, and foods with a low glycemic index all worked to improve inflammation and affected the guts microbiome homeostasis (2). It is believed that both factors worked to improve joint health and decrease inflammation. Conversely, foods high in salt, processed sugars, gluten, milk proteins, and trans-fatty acids all had the inverse effect on pain and inflammation. This diet also worsened obesity and gut health, which is also thought to affect the inflammation levels in the body. The authors concluded that diets like the mediterranean diet may be helpful in improving rheumatoid arthritis symptoms (2).
These findings mirrored a study looking at the effect of diet on osteoarthritis symptoms in patients older than 45. This 2023 study looked mostly at dietary patterns and fiber intake on osteoarthritis (OA) progression (3). It found that the Prudent diet and Mediterranean diet reduced OA progression more than the western Standard American Daily (SAD) Diet. This study found that the Prudent diet seemed to be better at preventing OA symptoms than even the Mediterranean diet, though the effects were somewhat inconclusive.
So, what should be our main takeaway from the increasing research on dietary choices? For me, the main point is that we must continue to encourage our patients to eat in a healthy way that will improve their risk of developing health conditions as they age. The Mediterranean diet is one that focuses on whole grains, fruits, vegetables, with occasional fish. The Prudent Diet is one that is high in fruits, vegetables, legumes, whole grains, lean proteins, and low in fat and cholesterol. Both diets also emphasize healthy fats through nuts and seeds rather than oils. The prudent diet has been shown to lower cardiovascular disease risk by 24% compared to a western diet. It has also been shown to lower blood pressure and even improve blood sugar in some patients.
Telling patients to start a new diet can be a challenging conversation. Rather than focus on a specific diet, I often reference back to Michael Pollan’s book “Food Rules.” This book focuses on changing the way we approach food to develop a more wholesome engagement. Some simple rules for eating can be “Only buy food from the outside edge of the grocery store,” or “Only eat things your grandparents would recognize as food.” Another great resource for patients wanting to learn more about the effect their diet has is the book “How Not to Die” by Michael Greger and Gene Stone. These books offer great research and easy to understand concepts of how our diet impacts the entirety of our health and life expectancy. I encourage every physician and patient I council to read these books for a better understanding of their own food choices. These books show that diet is not just foundational for healthy joints. Our diet affects every aspect of our life.
References
- Basu A, Schell J, Scofield RH. Dietary fruits and arthritis. Food Funct. 2018 Jan 24;9(1):70-77. doi: 10.1039/c7fo01435j. PMID: 29227497; PMCID: PMC5788027.
- Shekhar KV, Pathak MM, Pisulkar G. Diet and Lifestyle Impact on Rheumatoid Arthritis: A Comprehensive Review. Cureus. 2023 Nov 10;15(11): e48625. doi: 10.7759/cureus.48625. PMID: 38084187; PMCID: PMC10710847.
- Zeng J, Franklin DK, Das A, Hirani V. The effects of dietary patterns and food groups on symptomatic osteoarthritis: A systematic review. Nutr Diet. 2023 Feb;80(1):21-43. doi: 10.1111/1747-0080.12781. Epub 2022 Oct 24. PMID: 36278278; PMCID: PMC10092134.