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
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
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 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!
* 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.
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
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,
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
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 find a supportive
dietitian through the Dietitians Association of
© Sue Dengate update February
2008
