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
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
·
gout
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. For more information see the Introduction
to Food Intolerance
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
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
'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. -
[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
[877]
621: Juvenile Rheumatoid Arthritis – pain free when avoiding MSG (November
2009)
SUCCESS!!!
Our 12 year old daughter with Juvenile Rheumatoid Arthritis is pain
free!!
We have finished all challenges on the
elimination diet and have discovered glutamates - MSG and all 600 numbers to be
extremely bad for our daughter with arthritis. Within 8 to 12 hours of having
MSG our daughter went from no pain to all the symptoms of arthritis, swollen
joints, very sore, trouble walking, and lots of pain. We continued the
challenge for 48 hours and by then she had problems with all her joints,
soreness, swelling and was absolutely miserable! Within 12 hours of stopping MSG her symptoms
settled and she was back to "normal" – no pain! We now totally avoid
MSG, all 600 numbers and unspecified 'flavour' listed
on any product!
It has been 7 months now since we began
the elimination diet and took our daughter off all arthritis medication. She is
fantastic! We had a check up with the
rheumatologist recently and she was amazed.
We don't need to see her for another 6 months and she has classed our
daughter as "in remission"!!!!
No pain, No symptoms and No medication!
I hope this is of assistance to other
sufferers of arthritis! It has made a
huge difference to our daughter's life. Thank you for your wonderful
information, without this we would be further down the track of a life of pain,
misery and medications with nasty side effects for our daughter. To look at our
daughter now, you would never know that she suffers from a chronic,
debilitating condition, she is full of energy and her love for life is back
again!
We completed all food challenges in this
order: milk, wheat, bread, salicylates,
amines, MSG, propionates, sorbates, antioxidants, colours, benzoates, nitrites and sulphites (all food not
capsules). The only challenge our daughter reacted to was MSG, 600 numbers and
naturally occurring glutamates. She had no reaction to any other challenge.
Once we had completed all the challenges we challenged tomatoes, broccoli and
those foods high in natural glutamates separately. She came out in an itchy
rash if she ate too many tomatoes or broccoli (at least
We saw the dietitian you recommended. She
was very helpful, knowledgeable and thorough in what quantities etc to
challenge. She was very interested in the results. She suspected MSG from early
on because we had commented on how over the Christmas holidays (before
elimination diet), our daughter had eaten CC's and was so sore the next day she
could hardly walk. We kept a daily food diary and I also kept a dated scrap
book with labels of products we had eaten so I could check back as a reference
if needed.
For the MSG challenges we used "Coles
Farmland" packet chicken noodle soup, about 500 mls
to a litre a day (contains 621, 627 and 631) and soy
sauce about 4+ tablespoons a day. (Need to check labels for soy sauce because
not all list MSG or 600 numbers).
We are amazed at how many foods with
unspecified 'flavour' (but no MSG or 600 numbers
listed) affect her. We have found this with tomato soups, tomato pastes etc
where they list 'flavour' and our daughter has been
sore after having this. We have completed our own challenge with some of these
products and her reaction varies. We avoid any savoury
type products that have 'flavour' listed with no
specific ingredient numbers on labels. The unknown is not worth the soreness
for our daughter.
Foods previously eaten which we avoid
completely now include: All packet
soups, cup of soups, packet stocks, stock cubes, any chips or corn chips that
have a flavour, BBQ shapes and all shape/savoury biscuits with flavour,
tomato and BBQ sauce, some mayonnaise and dressings, packet pasta mixes (ie continental pasta packs), sausage rolls, pies, breads with
savoury toppings, pizza, concentrated tomato paste,
tomato soup - most have unspecified 'flavour' - and
lots of other savoury foods. We never used to eat a
lot of these foods, but even having things once to twice a week was enough to
have our daughter in continuous pain.
She now is totally pain free, medication
free and living a very active, sporting life. She plays
netball weekly, has participated in the school athletics and cross country team
this year and is currently in weekly training with the school volley ball team
to go to Nationals in December. All of
these activities were completely impossible 12 months ago! The difference is
amazing! We are so thankful that your
website and information has led us to finding an alternative to medication, and
a way to manage our daughter's condition and allow her to live a very active
life. I hope that there will be others out there that will try the elimination
diet and find an alternative to medications and a life of chronic pain. - Sandra, Vic
[846]
Pain like gout from milk (August 2009)
I have written before about my husband
drinking milk and getting a pain like Gout in his foot. Now we just have A2
milk but he had a coffee one morning with Woolies Lite Milk (that’s all he
could get and left the A2 for the kids) still got a pain in his foot, next time
tried with A2 and didn’t have any pain. Tracey, by email (The medical
recommendation for gout used to be avoidance of purine-containing foods -
essentially failsafe foods with a few exceptions - but this has been disproved.
I wonder whether gout is just another symptom of food intolerance because
failsafe families often report the father’s gout improved when they changed
their diet. I’d love some more reports: suedengate@ozemail.com.au)
[966]
Gout, red meat and the elimination diet (October 2010)
My husband and I have been doing the
elimination diet for two weeks now. We are both feeling great, our tummies are
not bloated, we are not sour in the stomach in the morning.
Another thing that we are so pleased about! My husband can suffer with gout, if
he has any red meat. There are also other triggers for him, but the red meat is
really the big one. Over the past weekend, we were at friends, and enjoyed some
beef and lamb (only seasoned with salt). I knew that we were pushing the
boundaries, but I checked with my husband this morning, and there has been no
sign of gout at all! Thank you. Things are really going well. - Carla, NT
FROM
[964]
My husband is an amine responder and
reacts to chocolate with gout like symptoms - Rose, WA
[965]
Gout and salicylates (October 2010)
My partner's uncle tells me he used to be
addicted to tomato sauce and had to give up because it was causing his bouts of
gout.Now he longer gets it unless he goes to Fiji,
which he does quite regularly, where he eats a lot of curry (so obviously salicylate
related).He had no idea about the connection. Cherie (gout has been associated
with low dose salicylates in medication http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174925/?tool=pubmed)
·
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. From our point of view, this is because fruits (salicylates) are
considered to be very safe and are usually some of the first foods
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. From our point of view, as with total
fasting above, this is because fruits (salicylates) are considered to be very
safe and are usually one of the first foods 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.
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.
7. Jacobs
CL, Stern PJ. An unusual case of gout in the wrist: the importance of
monitoring medication dosage and interaction. A case report.
Chiropr Osteopat. 2007 Oct
9;15:16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174925/?tool=pubmed
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.
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 write for our list of supportive dietitians (confoodnet@ozemail.com.au)
© Sue Dengate update October 2010
