Arthritis and gout
While heart disease and cancer are the biggest killers in the Western world, arthritis remains a major cause of disability. The term arthritis means inflammation of a joint. Painful, swollen, contorted joints can be a severe handicap, especially when these are the joints of the hand or wrist. Arthritis is not confined to the elderly , there are several types that affect people of all ages , from the juvenile arthritis known as Still’s disease , sometimes found in babies just a few months old , to ankylosing spondylitis , osteoarthritis , psoriatic , rheumatoid and crystal arthritis , also known as gout , which often begins when men are between forty and fifty Correct nutrition can bring tremendous relief to many arthritis sufferers , but it must be undertaken with care , as the different types of arthritis require different nutritional manage mint . It will also take time – anything from a few days to weeks – to calm your body down from any food – related inflammation, and you should allow a couple of months to glean the full benefit from the foods you eat.
You may be used to seeing quicker results from medication, but keep reminding yourself that in the long run your whole body will benefit. Of course, some people cannot cope without medication, but the side effects of some of the powerful drugs used to treat arthritis range from chronic loss of appetite and mild indigestion to more serious gastric or intestinal irritation, even bleeding and subsequent anemia. In this chapter I shall concentrate on rheumatoid arthritis, osteoarthritis and gout, as these are most common in Western society, but will begin with some general advice. The guidelines are much the same as for any healthy person: they play an important role in both the treatment of arthritis and the prevention of complications.
First of all, follow a healthy eating plan. By this I mean that you should eat as wide a variety as possible of fresh foods: vegetables and pulses, fruit, cereal products (bread, rice, pasta etc.) dairy products, eggs, fish, poultry, meat. Vitamin and mineral intakes in arthritis sufferers are often low. This is partly because it can be difficult to shop. cook and care for yourself, and there may be days when you don’t feel like eating much. Medication also has a number of side effects: some drugs take your appetite away or make you crave sweet foods, which don’t tend to be high in vitamins and minerals.
Others interfere with the metabolism of vitamins and minerals, or increase the amount of protein, calcium and zinc the body excretes. Lack of these essential nutrients can cause your body to become more susceptible to colds, infections and other health problems. You should have small meals at least three times a day, rather than skipping meals or having one large, blow – out meal, especially late at night. A regular eating pattern will give your body a steady intake of nutrients.
Water is necessary to keep your body functioning efficiently and enable it to glean nutrients from the food you eat. Aim to drink two and a half liters / four to five pints a day. The following points apply to most arthritis sufferers:
• Keep your caffeine and tannin intakes low. Coffee, tea, hot chocolate and cola – based drinks contain caffeine and tannin, which inhibit the absorption of vitamins and minerals from the gut. Caffeine can also make the gut more sensitive to the irritating effects of anti – inflammatory medication and can increase fluid retention, both of which can cause disability and pain. Ideally keep your intake down to two or three cups a day. Try herb and fruit teas for caffeine – free alternatives.
Watch your weight. Excess weight puts stress on the joints, causing pain and discomfort. Remember it’s much easier to stop weight piling on than to try to lose it later. Unfortunately, it is very easy for arthritis sufferers to put on weight, especially if they are prescribed steroids to reduce the inflammatory process. The balance between calorie intake and expenditure goes against you when it is painful to move around and exercise. You also have to contend with the emotional aspect of being in pain and unable to do anything about it. We would all admit to comfort eating at times, and people with arthritis have more reason than most to turn to food for solace. When you are in pain it is tempting to grab something quick and easy – there are plenty of healthy foods which fit this description.
• Try to keep organized. Most people with arthritis go through good and not so – good periods. Use the periods when you are feeling better to stock up your cupboards and fridge and cook meals which can be frozen in small portions, so that when your joints are extra painful you have plenty of healthy food to. fall back on.
• Any doctor or physiotherapist will agree on the merits of regular exercise. It is important to keep your joints moving, so that in the long run they will be more flexible and less painful and disabling. You need to include stretching and strengthening exercises as well as cardiovascular aerobic exercises. There is a fine balance to achieve, though while you need to exercise the joints, you also need to give them time to recover and rest. If they are particularly inflamed and sore, see if things get better with a day or two’s rest. Once things improve, build up gradually with some exercise.
• Feeling tense, stressed or guilty about resting are arthritis – aggravating emotions. To help you relax, consider aromatherapy oils, such as comfrey. lavender, enroll, votive and benzoin. Comfrey is particularly good at reducing inflammation. These oils can be used in a burner, dropped into your bath, or diluted in a carrier oil (such as grapeseed) and used in massage. It needn’t be a whole-body massage; a foot, hand or back massage can relieve an affected area.
• If you suspect that your arthritis is aggravated by additives and preservatives, I suggest you avoid ready – made, convenience and fast foods for a couple of weeks instead eating simply cooked fresh foods. Replace your chilled or frozen ready to cook dinners with pieces of chicken or fish which are just as easy to pop in the oven or under the grill. Instead of sweets or a bar of chocolate, treat yourself to some grapes, strawberries or other seasonal fruit. Taking this one step further many of my patients feel much better when they eat organic produce and hence reduce their exposure to pesticides and other artificial food additives.
• Take your anti – inflammatory and painkillers with or after food. Many of the anti – inflammatory are particularly fierce on the stomach and intestine, taking them with food helps to minimize gastrointestinal discomfort. However, there are alternative ways of administering pain – relieving drugs, including suppositories, so discuss these options with your doctor.
Rheumatoid arthritis usually starts with swelling, pain or stiffness in the joints, especially the wrists, hands and feet, which is usually worse in the morning. With time the body becomes more and more riddled with pain. In the severest of cases the body can become so disabled that it picks up lung infections easily which can lead to breathing problems and even pneumonia.
The skin. liver and kidneys can also be badly affected. Rheumatoid arthritis plagues many elderly people to the extent that they become physically dependent on others, and this loss of independence, when their mind is still active, puts a strain on their relationships. In this situation food can be very empowering, choosing what to eat and how to manage your meals can have a positive effect on your life. You are making the decisions, instead of relying on doctors and careers.
Diet is very important in the treatment of rheumatoid arthritis. In addition to the good eating habits outlined above there are several modifications which help some people reduce their symptoms:
• People with rheumatoid arthritis frequently find that a diet rich in oily fish significantly reduces inflammation and pain. Oily fish, such as mackerel. salmon, herrings and kippers, tuna, sardines and anchovies, are rich sources of omega 3 fatty acids. These fatty acids have a range of benefits, besides reducing inflammation they have been shown to protect against thrombosis and strengthen the immune system. Some people find oily fish a little heavy on the palate and digestion.
The traditional way to cut the oiliness is to marry the fish with a sharp fresh flavor a wedge of lemon or lime, ginger, horseradish, or a tangy fruit sauce such as gooseberry or rhubarb. Eating some fiber, such as whole meal bread or a portion of spinach, can help your body deal with the fat, my patients seem to experience maximum benefit when they take these fatty acids in food, but if you really dislike oily fish you could take a supplement The optimum dosage would be 600 mg omega 3 fatty acid a day, check that your supplement has this level of omega 3 oil and not just any fish oil.
• If you are a vegetarian and cannot eat fish oils, evening primrose oil has a similar beneficial effect. It contains gamma linoleic acid (GLA), an omega 6 fatty acid which, like the omega 3 fatty acids, seems to reduce the inflammation process. The current recommended dosage of evening primrose oil is 2000-4000 mg a day, usually taken in 500 mg tablets. There does not appear to be any equivalent dietary source of GLA.
• One important point to remember when you are boosting your intake of omega 3 or omega 6 fatty acids is that you need to keep your animal fat intake low as part of a healthy eating plan. If you eat too much animal fat, such as butter, cream cheese and fatty meat, the omega 3 fatty acids and GLA cannot work effectively, and therefore their potential healing power is lost. Many people are swallowing tablets with no chance of success.
• People suffering from rheumatoid arthritis may be the exceptions to my general advice that everyone should eat the equivalent of a daily small pot of yoghurt containing bifid us and acidophilus (bacteria that are beneficial to the digestive system). Sometimes these cultures can cause your symptoms to flare up. I suggest that you keep a food and symptom diary for a few weeks. Take a couple of spoonsful of a yoghurt containing these cultures regularly, then avoid yoghurt for a few days, and note how your body responds. If you can tolerate them, they will help your overall health. Yoghurts containing lactobacillus cultures should not upset you.
Copper, zinc and nicotinamide supplements are sometimes advocated. Without further medical research, I wouldn’t recommend taking any tablets containing these ingredients. A copper wrist band is a traditional arthritis remedy that cannot do any harm, so if you feel it helps, by all means wear one. It may be that a small amount of copper which seeps through the skin in some way reduces the inflammatory response.
When you are in pain, it is tempting to try anything that might help, and you will hear of lots of remedies, many of them involving exclusion diets: no red meat or no citrus fruit for example. Before you cut anything out, take the time to ensure that your diet is well balanced, sometimes it is what you are not eating that can aggravate symptoms. It would be a pity to worry about avoiding foods if all you need to do is eat a healthy diet.
I suggest you keep a food diary to help you explore the relationship between food and your symptoms. Scientists disagree as to whether food intolerances have any role in the cause and hence treatment of rheumatoid arthritis. While not scientifically supported. some specific dietary modifications can make you feel better.
There are those that suggest excluding all meat, eating no cooked foods or grains, no citrus fruits, or drinking whole milk before meals, the respective theories being that meat (or wheat) causes arthritis, raw vegetables cleanse the body, citrus fruits create too much acid, milk helps to lubricate the joints. While these theories are not proven, it may be the case that the altered intake of nutrients beneficially affects the immune system, or the changes cause you to shed some excess weight.
Even if it’s just the placebo effect (. e. if you believe that the diet is helping the power of your mind helps you feel less pain and stiffness), it is always important to feel that you are doing something to help yourself. In order for any food therapy to help rather than hinder your body, it needs to be carefully executed.
A patient of mine was advised by a so – called nutritionist to cut out wheat, dairy products, meat, fish and of all things water from his diet. Without these sources of essential nutrients his body weight dropped dangerously low and he became seriously weak. While the severity of this outcome is extreme, there are thousands of people eating inappropriately in the hope of curing their arthritis symptoms.
If you decide to explore food intolerances you should go about it in a controlled manner, keeping detailed notes of your food and symptoms. Sometimes it is simply a matter of quantity: your body may be able to take a small amount of a specific food, but develops symptoms when you overstep the mark. Try reducing the quantity of a suspected food and see how your body responds. For instance, if you suspect wheat, have just one meal based on wheat (bread, pasta) in a day.
I suggest you allow a couple of weeks before you reach any conclusions, as the body needs a while to show any changes. Some people need to eliminate the food completely to experience any relief. In this case, it is important to replace the food with an alternative source of nutrients. For instance, if you cut out bread, get your carbohydrates from rice or potatoes. If you cut out dairy products you need to find another source of calcium if you cut out red meat you need another source of iron Food can be the most amazing healer, but finding the right foods for your body takes time and care.
Anemia is one of the most common secondary conditions affecting people who suffer from rheumatoid arthritis. This may arise as a result of a poor dietary intake of iron, folic acid or vitamin C. Those following exclusion diets can easily miss out on essential nutrients. Additionally, many of the anti – inflammatory and strong painkilling drugs interfere with the metabolism of vitamins and minerals, in particular the B group of vitamins, folic acid, vitamin C and vitamin E. Anemia can also result from gastrointestinal bleeding, which can occur when you take a lot of non – steroidal painkillers.
You can reduce the likelihood of intestinal bleeding by eating something before taking painkillers. If you are feeling continually tired you should see your GP to ascertain the cause. If it is anemia, there is a lot you can do to help yourself.
Osteoarthritis is a degenerative condition which is more common as you get older – although I have patients as young as ten years old. Osteoarthritis develops as the cartilage around the joints – especially weight – bearing joints such as hips and knees – wears away and new bone material grows beneath the worn cartilage. With the growth of bone tissue, the joint cannot move as smoothly as it is meant to and inflammation occurs. The joints become distorted, which leads to further pain, as muscles are strained and nerves get trapped.
CAN FOOD HELP?
Unlike rheumatoid arthritis, there is no special diet which greatly affects the progression and symptoms of osteoarthritis. However, some of my patients experience relief when they increase their intake of fish oils or evening primrose oil. A copper bracelet also seems to help some people. One unusual ingredient that is currently being investigated is the green – lipped mussel from New Zealand; results are suggesting that it may be able to relieve osteoarthritis.
The issue of weight is particularly relevant with this form of arthritis, since it commonly affects ‘ load – bearing joints such as the knee and hip; if you are carrying excess weight you will place an enormous strain on these joints. Many surgeons advise that patients who need surgery to replace joints should reduce their body weight before undergoing surgery. Losing excess weight increases the success rate of the operation both short and long term. However, as I constantly reiterate, crash diets are not the answer; their effect is only temporary – the weight will soon come back, which will not help your new joint. You can continue to enjoy your food and still lose weight by approaching it sensibly. Read Achieving your ideal weight.
DON’T SUFFER UNNECESSARILY
Your physiotherapist and / or occupational therapist can help make your life easier to manage. Ask for advice about exercises and modified or specially designed household utensils and machines. Some patients don’t like to make a fuss, but if you are suffering pain, don’t be afraid to ask your doctor to review your medication. There are so many different types of painkilling drugs that there should be one that can relieve you of the majority of pain and discomfort.
Some patients find that a change of temperature can reduce the pain. Experiment with heat and cold: hot water bottles, warm baths, ice packs for a bag of frozen peas) on the joints. You can also get special sound wave machines. called TENS machines, which help your body to produce natural painkilling substances. Ask your doctor or physiotherapist about these.
Gout, according to a friend of mine, is excruciatingly painful. ‘ It’s as if someone is ramming a huge hot needle into your toe! ‘ It generally affects men of middle age and older, although this particular friend is in his thirties, and women are not immune Gout has traditionally been labelled as the disease of the heavy drinker and the rich but not all sufferers fall into these categories. The cause is usually genetic, but occasionally gout is a side effect of certain diuretics.
Gout arises when crystals of uric acid deposit in the joints, causing them to become swollen and inflamed. It is most common in the toes, but also affects other joints. Gout is also known as crystal arthritis or hyperuricemia.
Drug therapy using Allopurinol has largely replaced the need for dietary restriction in the treatment of gout, but as a second line of defense many men choose to restrict their intake of purines, the main dietary ingredient that causes the formation of uric acid crystals. Bear in mind that if you suffer an attack of gout it usually takes about five days for the body to rid itself of the dietary sources of uric acid. You should ensure you are drinking enough water to help your body excrete unwanted substances.
Many men think that they need to avoid all types of red meat. This is not totally necessary: the richest sources of purines are game, offal and meat extracts (for example Oxo), and of course products made from them such as pâtés, sausages and pies. If you want to make gravy or soups, I suggest you use fresh stock rather than meat stock cubes. Meat such as beef, lamb and pork, as well as poultry is lower in purines.
Some fish are rather rich in purines: anchovies, herring, mackerel, sardines, sprats and whitebait, as well as fish roes and shellfish such as crab and prawns. This leaves the whole range of white fish open for your enjoyment, from cod and plaice to turbot and Dover sole. Smoked and pickled fish and meat are also high in purines, as are other salty foods, dried fruits, dried beans, peas and asparagus.
While it is good to steer clear of these items, there is no need to avoid them altogether. Instead, I suggest you look out for them, and avoid too many purine sources in one day. For example, by all means enjoy asparagus when it is in season, but follow it with chicken or white fish.
Red wine is traditionally associated with gout, since it can produce uric acid. However, you do not need to exclude all red wine. It is usually a question of quantity, as some men can tolerate more red wine than others. Some people find the lighter Beaujolais – style wines suit them better than port, mature claret and burgundy. The best way of finding the wines you can drink without painful symptoms is to keep a food and drink diary