April 2012 Issue

Alleviate Achy Joints — Healthful Fats and Whole Foods May Relieve Symptoms
By Carol Meerschaert, MBA, RD
Today’s Dietitian
Vol. 14 No. 4 P. 12

At the age of 51, Angela began experiencing joint pain and stiffness in her hands and fingers each morning. As the pain gradually worsened, she began soaking her hands in warm water to alleviate the pain before starting her day. Soon simple tasks such as washing dishes, typing on her computer, and carrying groceries became unbearable. She noticed redness, inflammation, and swelling of the joints in her fingers and finally made an appointment with her physician. After her doctor examined her and ordered some blood tests, she diagnosed Angela with rheumatoid arthritis (RA).

RA is a chronic form of inflammatory arthritis, an autoimmune disease. When someone has RA, the immune system attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints, causing inflammation, fluid buildup, and pain.

RA is the most common inflammatory arthritis, affecting 0.8% of the adult population worldwide. Most people begin to develop symptoms of this disease between the ages of 30 and 50.1 An estimated 1.3 million people in the United States have RA, and 70% of them are women.2 The experience of living with this disease varies. In some people, RA remains continuously active, while others will encounter long periods of remission peppered with flare-ups.

Over time, RA can affect numerous organs and internal systems, causing an estimated 250,000 hospitalizations and 9 million physician visits each year.3 Beyond the healthcare ramifications, the economic impact is also significant: When left untreated, 20% to 30% of people with RA become permanently disabled and unable to work within three years of their diagnosis.4

RA Treatment
RA is a lifelong illness. In the past, first-line pharmacologic treatment for RA was used to simply alleviate symptoms. Only when symptoms progressed were medications added or dosages changed. Taking the medication methotrexate combined with the new biologic agents could lead to remission in 30% to 40% of patients, but for most people, significant symptoms persisted despite treatment.

Now RA is treated with medications that interrupt its pathway, as disease-modifying antirheumatic drugs (DMARDs) are initiated on diagnosis to slow disease progression.5 People with RA also take nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, or cyclo-oxygenase-2 (COX-2) inhibitors to reduce joint pain and swelling. However, these drugs don’t alter the disease course.

Healthful Fats
Interestingly, foods and the types of fats people consume have an impact on the severity of the disease. For example, COX-2 enzymes become more active and cause more joint inflammation in people who consume large amounts of omega-6 fatty acids. Most people get far too much omega-6 fat, as this type of fat is abundant in cooking oil, processed foods, fried foods, peanuts, and soy. Most guidelines suggest dietitians instruct clients to limit their omega-6 fat intake to no more than 3% to 5% of total calories. That means reducing or eliminating fried foods and vegetable oil-laden fare.

Research shows that increasing omega-3 fats can modulate the activity of inflammatory factors that cause cartilage destruction in arthritis. A study published in 2000 in the Journal of Biological Chemistry showed that omega-3 fatty acids offered a dose-dependent reduction in the expression of COX-2.6

Another type of fat that’s useful in reducing inflammation is olive oil. Gary Beauchamp, PhD, director of the Monell Chemical Senses Center in Philadelphia, noticed that olive oil led to a ticklish, peppery sensation in the back of his throat nearly identical to the sting he’d felt when swallowing a liquid form of NSAIDs such as ibuprofen and aspirin during previous sensory studies. Beauchamp’s research revealed that oleocanthal, a compound found in olive oil, prevents the production of proinflammatory COX-1 and COX-2 enzymes the same way NSAIDs work. By comparison, 50 mL of olive oil, or about 31/2 tablespoons, is equal to a 200-mg tablet of ibuprofen.7

Whole Foods, Spices, and Supplements
In addition, apples, berries, onions, ginger, cherries, and turmeric contain compounds that decrease the activity of the COX-2 enzyme, reducing joint inflammation.8 Apples and cherries contain the red pigment anthocyanin, a phenolic compound that has powerful anti-inflammatory properties. A preliminary study showed that consuming cherries relieved symptoms of arthritis due to these properties.9 And a diet high in whole grains and fiber has been shown to lower blood levels of C-reactive protein (CRP), an indicator of inflammation.10

The Iowa Women’s Health Study (IWHS), a population-based prospective cohort of more than 41,000 women aged 55 to 69, found an inverse association between a greater intake of vitamin D and RA risk. The association persisted even after potentially confounding variables were included in the analyses. Vitamin D from supplements showed a stronger inverse association with RA development than did dietary vitamin D. (Vitamin D, well known for its important role in bone metabolism, also may have immunomodulatory effects. It’s been shown to suppress the development of autoimmunity in some experimental animal models.) There wasn’t one food in particular that was high in calcium or vitamin D that lowered RA risk, just the overall vitamin D intake. Because of this, it’s important for RDs to determine the variety of foods from which their clients get their vitamin D and not just focus on their intake of dairy products, which contain both vitamin D and calcium.11

The Institute of Medicine’s Recommended Dietary Allowance of vitamin D is 600 IU/day for adults younger than the age of 70 and 800 IU/day for those aged 71 and older.12 As new studies continue to demonstrate the potential benefits of vitamin D, more scientists are calling for increased recommendations. Some suggest as much as 10,000 IUs, which is the daily tolerable upper intake.13

Food Allergies’ Role
Published reports14 have linked food allergies, including dairy allergy, to the development of RA, and others have shown that vegan diets can alleviate RA symptoms.15 In some people, specific foods, such as milk and cheeses, have been shown to exacerbate the symptoms of RA.16 Yet avoiding these foods or food groups have been shown to have limited, short-term benefits and no long-term advantages. Eliminating certain foods to which clients may be allergic reportedly has improved symptoms in some patients, but this may be a result of a spontaneous, temporary remission.

If food allergies are suspected or if a client wishes to follow a vegan diet, RDs can assist these people with developing a healthful eating plan to ensure they get the nutrients they need from alternative food sources.

These five easy tips can help clients boost their intake of nutrients that may help reduce RA symptoms:

1. Choose whole grain foods such as oats, whole wheat breads, quinoa, tabbouleh, brown rice, and barley. The Whole Grains Council has started a labeling program to help consumers find 100% whole grain foods by just looking for the label. Their website (www.wholegrainscouncil.org) also offers recipes and cooking tips.

2. Eat a diet rich in fruits and vegetables, including cherries, apples, blueberries, and raspberries.

3. Season foods with onions, ginger, and turmeric.

4. Use extra-virgin olive oil in cooking, and avoid fried foods.

5. Get adequate vitamin D from fortified foods and supplements. Seafood, including cod liver oil, salmon, mackerel, and tuna, are good sources of vitamin D, and they contain omega-3 fatty acids. Foods fortified with vitamin D include soy and dairy milks, some yogurts and cheeses, breakfast cereals, and juices; suggest clients read Nutrition Facts labels before buying a brand with added vitamin D. After accounting for the amount of vitamin D they get from foods, clients can consider taking a supplement to reach a total intake up to, but no more than, the upper limit of 10,000 IUs.

— Carol Meerschaert, MBA, RD, is a marketing professional and writer in Paoli, Pennsylvania.


1. Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005;72(6):1037-1047.

2. Who gets rheumatoid arthritis? Arthritis Foundation website. http://www.arthritis.org/who-gets-rheumatoid-arthritis.php. Accessed February 2012.

3. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46(2):328-346.

4. Sokka T. Work disability in early rheumatoid arthritis. Clin Exp Rheumatol. 2003;21(5 Suppl 31):S71-S74.

5. Pincus T, O’Dell JR, Kremer JM. Combination therapy with multiple disease-modifying antirheumatic drugs in rheumatoid arthritis: a preventive strategy. Ann Intern Med. 1999;131(10):768-774.

6. Curtis CL, Hughes CE, Flannery CR, Little CB, Harwood JL, Caterson B. n-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem. 2000;275(2):721-724.

7. Beauchamp GK, Keast RSJ, Morel D, et al. Phytochemistry: ibuprofen-like activity in extra-virgin olive oil. Nature. 2005;437:45-46.

8. Kelley DS, Rasooly R, Jacob RA, Kader AA, Mackey BE. Consumption of bing sweet cherries lowers circulating concentrations of inflammation markers in healthy men and women. J Nutr. 2006;136:981-986.

9. Blau LW. Cherry diet control for gout and arthritis. Tex Rep Biol Med. 1950;8(3):309-311.

10. Qi L, van Dam RM, Liu S, Franz M, Mantzoros C, Hu FB. Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care. 2006;29(2):207-211.

11. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum. 2004;50(1):72-77.

12. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2011.

13. Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. J Bone Miner Res. 2001;26(3):455-457.

14. Parke AL, Hughes GR. Rheumatoid arthritis and food: a case study. Br Med J (Clin Res Ed). 1981;282(6281):2027-2029.

15. Beri D, Malaviya AN, Shandilya R, Singh RR. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis. 1988;47(1):69-72.

16. Panush RS. Does food cause or cure arthritis? Rheum Dis Clin North Am. 1991;17(2):259-272.