Most of my patients in my integrative medicine clinic in San Jose, California know that one of my personal passions is the treatment of rheumatological diseases. It definitely helps that these diseases respond very well to diet and lifestyle changes (3,4), but more importantly, the honor of being able to witness significant improvement in quality of life for these patients after they make these changes is very rewarding to say the least.
Due the strong impact of diet and nutritional intake and many various diseases (3,4), I would like to spend the next couple of months discussing various dietary changes that have been seen to be helpful with various types of rheumatological conditions.
This month, I would like to kick off this series with a focus on gout and osteoarthritis.
Gout is a defect in intermediate breakdown that leads to uric acid build up (3,4). Foods rich in purines help with uric acid production and thus should be avoided in patients with gout (3,4). These foods include but are not limited to beer, organ meats, yeast, shellfish, sardines, herring, and bacon (3). Alcohol helps to increase purine production and lowers our kidney's ability to clear out uric acid (3,4) therefore high purine foods and alcohol consumption for those with gout is not recommended.
Being overweight is associated with increased uric acid levels and gout flares (3). It seems that early studies suggest a diet that is low in carbohydrates and is restricted in calories with a large amount of monounsaturated fats and higher in total daily protein than previously recommended may be beneficial to patients with gout (3,4). When you look at all of this information together, a diet low in carbohydrate or sugar load and an emphasis on weight loss is indicative of gout status improvement (3).
Osteoarthritis (OA) is a degenerative arthritis or, as my patients like to say, an arthritis from wear and tear of aging. This state can be accelerated by obesity and so weight management is important especially for osteoarthritis of the knee and hips (3,4). Therefore, it makes sense that weight loss is important in helping symptoms of osteoarthritis (3,4).
Although many people may think that with joint pains, they should not exercise or work out, that is not true. Physical activity is beneficial for osteoarthritis simply because it helps to maintain mobility and helps with our weight management which directly helps to stem the negative impact of OA (3,4). If joint degeneration is severe and you are not able to easily exercise, some other options that are gentler on joints are swimming and qi gong (3,4).
In terms of supplements, are there any that are beneficial to OA?
Some studies suggest that antioxidants are helpful for OA and that having adequate vitamin D levels are known to help limit progression of OA (4). There are also some early observational evidence that certain vitamin deficiencies like vitamin D and K can negatively impact osteoarthritis joint status (3,4).
Many people ask me about glucosamine sulfate as therapy for OA. The answer to that is that there is some evidence that it can help with mild to moderate OA so as to help limit disease progression but it is not great at giving immediate pain relief (5).
So in regards to pain relief, if you don't want to use the typical prescription or over the counter pain medications, what should you use?
Omega-3 fatty acids are a great choice for inflammatory joint symptoms. So I would recommend this for not just OA but also for gout (2). Our current modern diet has a higher preponderance of omega-6 to omega-3 ratio but our ancestors had diets that were more balanced between omega-6 and omega-3 fatty acids (2). The reason why we want a diet higher in omega-3 is that they lead to generation of anti-inflammatory chemicals called cytokines (2). Despite my noting of the fact that we need more omega-3, that doesn't mean we don't need omega-6, it's just that there should be a closer balance of the two rather than a large predominance of omega-6 over omega-3 (2). Other options for joint pain relief include the potential usage of capsaicin, ginger, and SAMe (1,6,7).
Although I am a big proponent of herbal and vitamin therapy, I want to caution readers to always check with your physician before using any supplements. You should not think that just because it's not a prescription medication, everything over the counter is safe for everyone. So, my recommendation is to play it safe and always check with your physician before using any supplements and to let them know what you are taking so they can keep their list of your therapeutic regimen updated.
So, in summary for the information we addressed this month for osteoarthritis and gout, the main takeaway points are that a diet that is more vegetable-based and healthy lean protein-based with lower carbohydrates can help with diseases like gout. But most importantly, a diet such as this were we are trying to prevent insulin resistance can help with inflammation as well as weight management. Obesity and being overweight are linked to higher disease state complications and progression of both gout and osteoarthritis. So getting yourself into target weight is important for joint health. (3.4)
Finally, if you would prefer not to use over the counter or prescription medications, some supplement options were discussed but I would like to again make sure I am clear that I am a big proponent of you checking with your doctors first before starting any supplements. Just because something is a supplement, doesn't mean it is always safe... but similarly, just because it's a supplement, doesn't mean it won't work or it's just placebo effect because some studies suggest that various options we discussed can be therapeutic and helpful in gout and osteoarthritis. (1-7)
References:
1.Altman RD, et al. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001;44:2531-2538.
2.Calder PC. N-3 polyunsaturated fatty acids and cytokine production in health and disease. Ann Nutr Metab 1997;41:203.
3.Cleland LG, et al. Diet and arthritis. Bailleres Clin Rheumatol 1995;9:771.
4.Katz, DL. Nutrition in Clinical Practice 2nd Edition. 2008.Lippincott Williams and Wilkins. Philadelphia, PA.
5.Pavelka K et al. Glucosamine sulfate use and delay of pregression of knee osteoarthritis: a 3-year randomized placebo-controlled dougle blind study. Arch Intern Med. 2002;162:2113-2123.
6.Soeken KL, et al. Safety and efficacy of SAMe for osteoarthritis: a meta-analysis. J Fam Practice 2002;51:425-426.
7.Zhang WY, et al. The effectiveness of topically applied capsaicin. A meta-analysis. Eur J Clin Pharmacol 1994;46:517-522.