FOOD INTOLERANCE NETWORK FACTSHEET

Joint pain, arthritis and diet

Introduction: joint pain and arthritis

Diet for joint pain and arthritis: summary

Some common myths you will hear about diet and arthritis - like many myths, they are half right.

Salicylates in medication can also cause problems

READER REPORTS

The science

References

More information

Introduction: joint pain and arthritis

Arthritis is inflammation of a joint. It can be associated with pain, swelling, reduction of mobility and possible structural damage to the joint. There are various forms of arthritis including:

* osteoarthritis - associated with ageing

* psoriatic arthritis - associated with the skin condition psoriasis

* rheumatoid arthritis - an autoimmune disease

* juvenile arthritis - diagnosed in children under 16, most likely to be rheumatoid arthritis

Diet for joint pain and arthritis: summary

While doctors don't usually recommend diet for arthritis, we have received many reports from readers of all ages with various forms of arthritis who have improved on failsafe eating, see reader reports below. Salicylates are the food chemical most commonly implicated, but any of the usual culprits can be involved (about 50 additives, other natural chemicals called amines and glutamates, dairy foods and wheat or gluten). We recommend a trial of the RPAH elimination diet - free of additives and low in salicylates, amines and natural flavour enhancers, with optional avoidance of dairy foods and wheat or gluten, depending on severity of symptoms - to pinpoint exactly which food chemicals trigger your arthritis.

Some common myths you will hear about diet and arthritis - like many myths, they are half right.

* People with arthritis have to avoid high acid foods like tomatoes or oranges. WRONG. It is true that tomatoes and oranges can contribute to arthritis, but this seems to be because they contain salicylates, not because they are "acid foods".

* People with arthritis have to avoid all the foods in the nightshade family (tomato, sweet pepper, eggplant, potato). WRONG. It is true that tomatoes, capsicums and eggplants can contribute to arthritis but this seems to be because they contain salicylates. Some varieties of potatoes (such as Sebago with white flesh, brown skin) are low in salicylates and suitable for arthritics when large, old and thickly peeled.

* People with arthritis should avoid wheat and/or gluten. WRONG. It is true that wheat and/or gluten may contribute to arthritis in some people but not every arthritic has to avoid them. A 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. See reader report below.

[474] Stiffness, aching joints and eczema aggravated by salicylates in heat rubs for join pain (November 2006)

We solved my father in law's severe eczema after visiting your website. Dermatologist couldn't cure his problem at all, and he was using Wintergreen and Deep Heat to relieve the joint pain symptoms. Since following the low salicylate diet, he is 100%. He cannot believe that the stiffness and aching joints, and the bad eczema have disappeared. - Annelize, NSW

READER REPORTS

One-liners

My husband has severe and crippling arthritis - failsafe foods have given him relief and mobility. – by email, NZ [368] March 2005

I have osteo-arthritis which is much less painful if I adhere to the diet – if I inadvertently eat something that upsets me, I become overwhelmingly weary, my arthritis flares up and I can get bloating and irritable bowel symptoms. l often say in jest, " I cheat! I pay!" – by email, ACT [368] March 2005

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". - by email, NT [600] February 2008

My mother, grandmother and aunt all have arthritis. I've been failsafe for six years and I'm pretty sure if I wasn't failsafe I would have arthitis too, because I can notice my hands get stiff if I break my diet and eat too many salicylates. - by email, NT[600] February 2008

My 8 year old daughter has rheumatoid arthritis. It's hard to believe, after three weeks on failsafe foods, she is free of pain for the first time in years. - by email, NT [600] February 2008

 [601] Bernard's arthritis story (February 2008)

The most remarkable story comes from Bernard in Wollongong. Now active and virtually arthritis-free, Bernard suffered from painful and crippling arthritis for nearly 30 years. In 1994, he was told that if his arthritis was not controlled by daily use of medication, he had 'only four or five years of active life left'. After extensive reading, Bernard opted to try an elimination diet against the recommendation of his specialist, and achieved remarkable results. He warns that arthritis sufferers may need extra time. Bernard wrote:

'If you think that the time span of the food effects on children and their behaviour is long you should try solving the rheumatic and inflammatory disease problem. You are looking at an abstinence time of up to 12 weeks before challenges, symptoms that could take more than a week to identify, and challenges that could take four months or more to complete. I am still improving after eight and a half years on low chemical foods. NOTHING will make me eat the foods I once loved so much.' ...

When Bernard challenged salicylates, on the morning of the eighth day he found his arthritis had returned with such a vengeance that it took him an hour to get out of bed. Artificial food colouring took two days to aggravate his arthritis.

After so many years of needless pain and suffering it is not surprising that Bernard and others like him feel angry about misinformation from experts. When a well-known Australian nutritionist wrote that there is no truth in the rumour that people with arthritis should not eat tomatoes, Bernard added his own comment: 'like hell there isn't!'

You can read about the effects of additives and natural chemicals in fruit and vegetables in Bernard's "My life with arthritis" story: "I have suffered with the pain and swelling of arthritis in my arms, hands, neck, back, legs and feet for almost half of my adult life. At times my condition was so bad that I was only able to walk about 50 metres without a rest. The constant pain I suffered was unbearable ... " on the website: http://members.ozemail.com.au/~btrudget/.

[602] Aching joints began during pregnancy (February 2008)

I began the elimination diet after reading Fed Up with Asthma [now out of print, the asthma information from this book has been incorporated into the 2008 edition of Fed Up]. I was pregnant with our second child. My first pregnancy was fraught with pain from aching joints, hips especially, from which I d never suffered before. The pain was very great and continued after childbirth, though not troubling me much, just now and then. My joint movement continued to be impaired. In this pregnancy the pain began in the first trimester, whereas it had begun late in the previous pregnancy. I suffered much sleeplessness and worried how I would last 9 months like this. After 2-3 weeks on the diet (dairy and gluten-free as well) I no longer needed ventolin at all, just one puff daily of my preventer (I'd been using ventolin up to 8 times daily with little effect and 4 puffs of the preventer). Also, no joint pain at all, and the return of a normal range of joint motion. - Elizabeth, by email

[603] Arthritis started after a car accident (February 2008)

My arthritis started after a car accident at the age of 19, also ringing in the ears. The arthritis was to the point where I would soak my hands in hot water each morning to get them ok to work. Both my arthritis and ringing in the ears disappeared totally on failsafe, it was incredible. Four years on, it remains largely stable, is clearly affected by mainly salicylates and sulphites and to a lesser extent amines and MSG. Medication was generally ineffective. - by email, Qld

[605] Joint pain from intolerance to soy (February 2008)

I am soy intolerant. More specifically I suffer from a legume intolerance which is only now apparent after 13 years of suffering and frustration. My intolerance manifests itself in the form of hives, large red itchy welts that, in a severe attack can cover almost all of the body, be unbelievably itchy and uncomfortable to say the least. In my situation, my symptoms got worst and extended to lethargy, aching and swollen joints, sleepless nights and eventually an emotional feeling of hopelessness of ever being able to stop the relentless onslaught.  See the rest of this story on the website - story [314]: "13 years of intolerance to soy"

[604] 'Awful joint pains' from salicylates in 'loads of fruit and veg' (February 2008)

From the age of 15 I slowly became more and more tired and foggy headed. Gradually I found it impossible to walk to school anymore, and regularly got 12 hours of sleep or more a night. I found out a few years ago that gluten does awful things to my energy levels and brain function, I wish I had known that when I was at school as I'm sure it held me back. In the last two months I was put on a rotation diet where I had to eat a huge variety of fruit and vegetables but could only have each every fifth day. I have NEVER felt so foggy headed, had such blurry vision or had such awful joint pains. All from eating loads of fruit and veg. Consequently, I have high hopes for Failsafe!

The science

* Scientists have been researching diet and arthritis for over 50 years using a wide range of diets. However, as with the diet-behaviour connection, most studies didn't eliminate enough foods, produced confusing and conflicting results, and seemed to suggest that only a few arthritis patients may benefit from diet.

* Total fasting for 7-10 days has been found by many researchers to be an effective treatment for rheumatoid arthritis [2]. This would appear to confirm the food connection. However, the beneficial effects wear off when foods are reintroduced.

* An elemental diet is a simple liquid diet consisting of nutrients including amino acids, carbohydrates, vitamins, minerals, and fat (such as Neocate). This means that elemental diets may be free of additives and low in salicylates, dairy and gluten. Elemental diets have been found to effective at reducing a number of symptoms of arthritis. [3-6]. Most recently, researchers compared the effectiveness of an elemental diet to medication during a short trial (two weeks). Researchers concluded that the elemental diet was as effective as oral prednisolone [3]. However, as with fasting, problems arise when normal foods are reintroduced.

* Other than the use of elemental diets, I couldn't find any trials of a low-salicylate diet comparable to that which we recommend for arthritis.

References

1. Jenkins C and others, Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ. 2004 ;328(7437):434.  6-7. Researchers found that aspirin sensitivity in asthmatic adults was more prevalent than previously thought and that the majority of salicylate sensitive asthmatics demonstrated cross sensitivity to ibuprofen, 98%; naproxen, 100%; and diclofenac, 93%, whereas the incidence of cross sensitivity to paracetamol was only 7%. Although this study is about asthmatics, our experience suggests that the figures seem to apply to anyone who is sensitive to salicylates.

2. Sköldstam L, Magnusson KE. Fasting, intestinal permeability, and rheumatoid arthritis. Rheum Dis Clin North Am. 1991;17(2):363-71. A review of 7-10 day fasting for otherwise healthy and well-nourished patients with rheumatoid arthritis concluded that fasting results in significant clinical improvement that are lost eating is taken up again.

3. Podas T and others, Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone. Postgrad Med J. 2007;83(976):128-31. This study from Leicester General Hospital UK found that an elemental diet for 2 weeks resulted in a clinical improvement in patients with active rheumatoid arthritis that was as effective as a course of oral prednisolone 15 mg daily in improving subjective clinical parameters. Researchers concluded that "this study supports the concept that rheumatoid arthritis may be a reaction to a foods".

4. Holst-Jensen SE and others Treatment of rheumatoid arthritis with a peptide diet: a randomized, controlled trial. Scand J Rheumatol. 1998;27(5):329-36. Thirty Danish patients with rheumatoid arthritis followed an elemental diet for four weeks compared to a control group on normal foods. One patient experienced longterm clear remission and two patients dropped out. For the others there were significant improvements in some symptoms for the duration of the elemental diet that did not continue with introduction of normal foods.

5. Kavanaghi R and others.The effects of elemental diet and subsequent food reintroduction on rheumatoid arthritis. Br J Rheumatol. 1995;34(3):270-3. In this study with 24 patients at Addenbrooke's Hospital, Cambridge, UK, an elemental diet was supplemented with a small number of foods. There was a high drop out rate and initial improvements were not maintained after introduction of foods,   

6. Haugen MA and others. A pilot study of the effect of an elemental diet in the management of rheumatoid arthritis. Clin Exp Rheumatol. 1994;12(3):275-9. In Norway, this controlled study compared an elemental diet with ten patients with a prepared soup from fresh additive free foods for seven controls for three weeks. In the 4th week, patients resumed their normal diet. There were some improvements in both groups. Researchers concluded that that some rheumatoid arthritis patients may respond to the elimination of offending food items.

More information

We recommend a trial of the RPAH elimination diet - free of additives, low in salicylates, amines and flavour enhancers, and with optional removal of dairy foods and wheat or gluten, depending on severity of symptoms - preferably supervised by a dietitian. Write to confoodnet@ozemail.com.au for our list of supportive dietitians, and see Failsafe Eating.

www.fedup.com.au

The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can find a supportive dietitian through the Dietitians Association of Australia (http://www.daa.asn.au/find_a_dietitian/index.asp?pageID=2145835649) or write for our list of supportive dietitians (confoodnet@ozemail.com.au)

 © Sue Dengate update February 2008