Anti-Inflammatory Eating for Arthritis

More than 50 million adults in the U.S. have arthritis, which is a general term describing joint pain or disease. Osteoarthritis (OA) is the most common type, affecting 31 million Americans, while another 1.5 million suffer from rheumatoid arthritis (RA). Adopting an anti-inflammatory diet can help in the pain management of OA and RA, as inflammation plays a role in both forms.

OA vs. RA. “OA is a wear-and-tear condition in which cartilage gets broken down and bone starts rubbing on bone, causing pain,” says Lona Sandon, PhD, RDN, assistant professor at University of Texas Southwestern Medical Center. Sonya Angelone, MS, RDN, a spokesperson for the Academy of Nutrition and Dietetics, adds, “OA tends to occur more in those who are overweight, whose joints become damaged from carrying extra weight, especially in the knees and hips.” While inflammation is not the root cause of OA, cartilage damage can trigger inflammatory processes, and excess weight is associated with inflammation, which can damage joints further.

Unlike OA, RA is an autoimmune disease in which the immune system attacks the joints, resulting in a condition where the synovial fluid around the joint is inflamed, and that inflammation is what results in pain and morning stiffness, says Sandon, who suffers from RA.

Diet and Inflammation. Many diet patterns, foods, and nutrients impact inflammation.

• Fatty Acids. “Omega-3 fatty acids probably have the most solid research that supports their impact in decreasing inflammation,” says Sandon of the fats found in coldwater fish and fish oil. She suggests consumption of three grams a day of the omega-3s EPA and DHA combined to relieve symptoms associated with inflammation in RA. That’s the amount found in approximately six ounces of salmon. Consuming that much daily EPA and DHA may be difficult through diet alone, thus supplementation may be in order, with approval of your health provider. Plant sources of omega-3s (ALA) include walnuts, chia, and flax seeds. Sandon adds, “It’s not just adding omega-3 fatty acids to your diet; you have to remove other foods with the not-so-good fats; particularly red meat high in arachidonic acid which is pro-inflammatory.” An overconsumption of omega-6s found in vegetable oils coupled with low intake of omega-3s may result in increased inflammation, though more research is needed to confirm this. Saturated and trans fatty acids seem to promote inflammation.
• Olive Oil. Oleocanthal, a compound found in extra-virgin olive oil, has been shown to inhibit pro-inflammatory enzymes.
• Probiotics. “There’s some support for encouraging probiotics, as they can produce butyric acid in the colon. Butyric acid helps keep the colon cells and gut mucosa healthy while not allowing compounds to cross over that could potentially trigger inflammation,” Sandon explains. Fermented foods like yogurt and kefir contain active cultures that act as probiotics.
• Dietary Fiber. Fiber has been shown to lower C-reactive protein levels, a marker of inflammation in the body. Sandon says, “Fiber is also important for those probiotics to have something to chew on to produce the butyric acid needed.”
• Fruits and Vegetables. In addition to providing fiber, produce in general is linked with lower inflammation in the body due to the presence of phytochemicals, which possess antioxidant and antioxidant activity.
• Vitamin D. “Inflammation is associated with low vitamin D levels,” says Angelone. Vitamin D is also important for bone health. According to Sandon, “It is well known that those with RA develop reduced bone mass or softening of the bones earlier in life than those without RA.” Vitamin D is synthesized in the skin when exposed to ultraviolet light, and occurs naturally in only a few foods (fish, and small amounts in egg yolks). It can also be obtained from foods (like some cereals) and beverages (milk) fortified with the vitamin. It is important to check the nutrition facts panel of packaged products for vitamin D content.
• Sugar and Refined Carbs. High intakes of added sugars and refined carbohydrates have been linked to increased inflammation in the body.

What to Do. Weight loss is typically the first line of defense to help reduce pressure on the joints and reduce inflammation, particularly with OA. Angelone stresses that each person may react differently to food and food components, so you may benefit from working with a registered dietitian who can help identify specific triggers. In the end, eating a balanced diet rich in whole foods—fish, beans, nuts, whole grains, fruits, and vegetables—may be your best bet to help reduce inflammation through diet.

—Andrea N. Giancoli, MPH, RD

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