Get Enough
The basic goal of good nutrition is to get enough of everything -- which is easy if you eat a balanced diet that includes lots of different foods. But these six nutrients appear to have special benefits for people with arthritis. None of these nutrients offer miracle cures, and some appear to have more of an impact on arthritis than others. Bottom line: It's likely these nutrients help, getting more of them certainly won't hurt you, and it's easy to work them into your daily eating without overhauling your diet.1. Omega-3 fatty acids. They may sound technical and unappetizing, but it's worth savoring what omega-3s do for the body -- especially the joints. Fatty acids are a family of special fats that the body needs but can't make for itself, so you have to get them from food. Once in the body, they collect in cells, where they help form hormone-like substances, called leukotrienes, that put the brakes on inflammation -- a root cause of rheumatoid and, to a lesser extent, osteoarthritis. More than a dozen reliable studies suggest that increasing your intake of omega-3 fatty acids can help quell symptoms of rheumatoid arthritis, even if the fats don't slow progression of the disease.
The most important food source of omega-3s is cold-water fish such as salmon, tuna, mackerel, and trout. But you'll also find types of omega-3s in nuts and seeds, beans, soy products, green leafy vegetables, and cooking oils such as canola oil. Fish oil is not entirely benign: Taking large amounts in supplements can have side effects, and even eating too much fish raises health concerns. Nor is cod liver oil the answer. It is high in calories, has high amounts of vitamin A, and may contain high amounts of cholesterol. Here's how to safely add omega-3s to your diet.
- Switch from corn oil to canola oil. Close relatives of the omega-3s are the omega-6s, fatty acids found in corn and other vegetable oils. While omega-3s (found in abundance in canola oil) are beneficial for your joints, omega-6s aren't: they make arthritis pain worse by promoting inflammation. They also compete with omega-3s in the body. So by switching your cooking oil, you boost your cells' usage of omega-3s and bring your body's fatty acids into better balance.
- Consider omega-3 supplements. To get omega-3s in the amounts used for many studies, you'd need to eat more fish than you can probably stomach -- at least three servings every day. That makes taking fish oil supplements a viable alternative. But first, check with your doctor. On the whole, fish oil is safe, with mild side effects such as fishy burps. But omega-3 fatty acids also thin the blood, so you should be cautious if you're taking blood-thinning medications, including aspirin.
- Emphasize salmon and canned tuna. It's not that these fish are richer in omega-3s than their cold-water companions; it's that they are generally safer to eat. The Food and Drug Administration warns that many cold-water fish, such as king mackerel, swordfish, tilefish, and shark, contain toxic levels of mercury that make eating too much of them potentially dangerous. A safe limit: no more than 14 ounces a week of fish on the FDA caution list cited above. As for salmon, they are usually farmed or caught in the cleaner waters of Alaska. And cans of tuna tend to be packed with younger fish that haven't had as much time to accumulate toxins.
- Say "no" if you have gout. People with gout, a specific type of arthritis caused by excess uric acid, should avoid fish altogether because many types -- including mackerel -- contain purines, a building block for uric acid.
2. Vitamin C. It's one of the most familiar of all nutrients, but vitamin C's role in joint health tends to be underappreciated. Vitamin C not only helps produce collagen, a major component of joints, but sweeps the body of destructive molecular byproducts known as free radicals, which are destructive to joints. Without vitamin C and other so-called antioxidant nutrients, free-radical damage to joints would be much worse. One of the best-known studies looking into vitamin C and arthritis, the Framingham osteoarthritis study, found that people whose diets routinely included high amounts of vitamin C had significantly less risk of their arthritis progressing. Points to bear in mind:
- Drink OJ from frozen concentrate. A prime source of vitamin C, orange juice is a favorite breakfast eye opener. While orange juice bought in the carton is wonderfully healthy, OJ made from frozen concentrate is even better. According to recent research published by the American Dietetic Association, juice reconstituted from frozen concentrate has more vitamin C than fresh-squeezed juice after four weeks of storage. If you prefer no-fuss pourable products, buy juice three to four weeks before the expiration date and drink it within a week of opening.
- Spread out intake. Your body doesn't store vitamin C; rather, it takes what it needs from the bloodstream at any given time and flushes out the rest. So a megadose in the morning doesn't really do as much good as you would think. Rather, replenish your vitamin C stores throughout the day by sipping citrus drinks or eating C-rich fruits and vegetables such as strawberries or melon, broccoli or sweet peppers at meals.
- Beware of megadoses. Your body needs about 60 milligrams of vitamin C each day for basic bodily functions. For healing and antioxidant purposes, many people take much higher doses. Most people aren't affected by a few hundred milligrams of vitamin C, but once you get past 500 milligrams or so, you should check with your doctor. Some people develop digestive unrest when they megadose on the vitamin. In addition, high doses of vitamin C can raise blood levels of salicylate medications such as aspirin, and can also interfere with absorption of other nutrients.
Choose Multiple Sources
3. Vitamin D. You can get vitamin D just from standing in the sun. That's because ultraviolet light converts precursors of the vitamin in the body into a usable form. Many people with arthritis are D-deficient. Studies find that getting more vitamin D protects joints from osteoarthritis damage, probably because this nutrient is vital to the health of bones that support and underlie joints. Vitamin D also appears to play a role in production of collagen in joints themselves. Some suggestions:- Get into the sunlight. You don't need to bake on the beach to get sun-stimulated vitamin D: The skin only needs 10 to 15 minutes of exposure two to three times a week to synthesize what it needs. Your usual outdoor walks, games, or yard work should fill your vitamin D needs.
- Read your dairy labels. Milk, from skim to homogenized, is a prime source of vitamin D because it is D-fortified. Check labels on other dairy products. Though domestic cheese, cream, ice cream, butter, and yogurt often contain vitamin D, they're sometimes made with unfortified milk.
- Beware of oversupplementing. Vitamin D is a fat-soluble vitamin, which means excess amounts are stored in the body rather than immediately excreted. Large doses from high-potency supplements or multivitamins can build up and become toxic to soft tissues such as the kidneys and heart. Getting your D from foods and sunlight poses no such problems.
4. Vitamin E. Like vitamin C, this is an antioxidant vitamin that protects the body -- including the joints -- from the ravages of free radicals. Some of the same research showing that other nutrients protect against arthritis also indicates that vitamin E can help prevent joints from becoming worse, though E's effects appear more limited than those of vitamins C and D. Some suggestions for getting vitamin E into your body:
- Try soybean oil. Up in the omega-3 section, we suggested switching to canola oil, which is widely available and no more expensive than corn oil. To go one better, though, try finding and then cooking with soybean oil. Though vitamin E can be tough to get from eating prime sources such as wheat germ and avocados, it's easy to pick up in other foods when cooked in this E-rich oil. Bonus: Soybean oil is also a good source of omega-3 fatty acids.
- Combine with fish oil. Taking vitamin E together with fish oil seems to boost the body's ability to fight inflammation beyond what either nutrient would do on its own, according to two recent studies in animals, at Loyola University, in Illinois, and the University of Buffalo. Be wary of heavy-duty supplements, however: Like fish oil, vitamin E thins the blood.
- Compensate for cooking. Whenever possible, eat E-rich foods raw -- cabbage in coleslaw, for example. While a number of vegetables (including asparagus, brussels sprouts, and cabbage) contain small amounts of vitamin E, boiling can deplete food of as much as a third of its E content. Another option: Save cooking water, which retains leached nutrients, and use it to moisten mashed potatoes or make soup or sauce.
- Add nuts to your cereal, salads, and snacks. Sprinkling a quarter cup of almonds on your breakfast cereal or lunchtime salad will give you your daily requirement of vitamin E. Pumpkin and sunflower seeds, eaten as a snack or added to muffins, are another good source of vitamin E. Of course, dieters should be careful. Nuts are as high in calories as they are rich in nutrients, so weigh the benefits and drawbacks.
5. B vitamins. As cousin chemicals in the B-vitamin family of nutrients, vitamin B6 and folate are also among the nutrients most likely to be lacking in people with arthritis. Part of this is due to deficiencies common population-wide -- for example, one study found 90 percent of women don't get enough B6 in their diet. But there's also evidence that the inflammation process eats up these B vitamins especially fast in people with rheumatoid arthritis -- bad news for a variety of bodily functions, including the manufacturing of protein, the building block for tissues such as cartilage.
- Double up. When possible, eat foods that contain both vitamin B6 and folate, such as spinach and fortified cereal. Otherwise, look to B vitamin sources for other arthritis-fighting nutrients. For example, in addition to being a rich source of B6, tuna and sardines contain omega-3 fatty acids, and fortified cottage cheese contains vitamin D. Bonus foods for folate include asparagus (vitamin E) and broccoli (vitamin C).
- Take a multivitamin. To ensure you get enough of these nutrients, consider taking a multivitamin that provides 100 percent of the recommended Daily Value of 2 milligrams for B6 and 0.4 milligrams for folate. (Look also for vitamin B12, which works in tandem with folate.) But steer clear of high-dosage, single-nutrient supplements, which may pose risks of nerve damage.
6. Calcium. The issue with calcium, as with vitamin D, is bone health. Calcium has obvious importance to bones -- more than 90 percent of the body's stores are contained in the skeleton and teeth. Getting too little calcium raises the risk of osteoporosis, a brittle-bone condition that accelerates if you have rheumatoid arthritis. All women (who are especially at risk) should get about 1,200 milligrams a day after age 50 -- about twice what's typical.
- Drink milk; cook with milk. You probably know that milk is a prime calcium source -- but the same is true even for cooked foods made with milk. So consider having pancakes or waffles (one large waffle may contain as much as 12 percent of your daily calcium requirement) at breakfast or lunch. For other meals, balance your diet with low-fat cheese as a topping for savory fare such as chili or spaghetti.
- Down it with D. One reason vitamin D is so important to bone health is that it boosts the body's absorption of calcium -- another reason to consume more D-fortified dairy, which contains both nutrients.
- Go beyond the dairy case. Milk and milk products aren't the only sources of calcium: It's also found in vegetables such as cauliflower, cabbage, brussels sprouts, kale, kohlrabi, broccoli, and turnip greens. These foods have less calcium than dairy products, but contain a form that's easier for the body to absorb. Other non-dairy calcium sources include omega-3-rich fish that have edible bones, such as salmon and sardines.