The Food Link

The Food Link

Jeanne was overweight and knew that losing weight was the best way to address her continuing knee problems. Her struggle with the scale, however, had been lifelong. Meanwhile, her knees ached each morning and limited her mobility all day long. Her doctor told her that her last set of x-rays showed that the right knee was progressively on its way to an arthritis that eventually would require surgery to repair. The medications she now took, nonsteroidal anti-inflammatories, or NSAIDs, bothered her stomach. She decided to see a doctor who would treat her with more natural substances, a naturopath—a doctor who specializes in herbs and other natural treatments.

The naturopath examined her, took her medical history, then spoke to Jeanne about a diet that would allow her to take better control over her weight. Then, the doctor gave her a list of supplements and herbs to take. Some called antioxidants, like vitamin C, beta-carotene, and vitamin E, are helpful in combatting joint damage. Other supplements were less familiar to her, including glucosamine and chondroitin sulfate, substances that the doctor said are essential ingredients in cartilage formation. Jeanne took these in capsule form, along with some vitamins and minerals. The doctor also gave Jeanne a form of vitamin B₃ called niacinamide, telling her how a physician in North Carolina, William Kaufmann, M.D., had shown niacinamide to be effective in osteoarthritis, especially of the knee.

Within months, Jeanne felt the difference. There was less pain, less stiffness, and she had less difficulty getting up in the morning. Under her doctor's guidance, Jeanne began a walking and swimming program and began to shift her diet away from carbohydrates and starches—food that's good for many people but had been her particular downfall. As her weight dropped away, she became more motivated and energetic, even taking up an old hobby of hers, ballroom dancing.

Arthritis and food—the connection between the two has long been the subject of intense debate and research. Could what someone eats affect the health of their muscles, bones, and joints? Is there such a thing as an "antiarthritis diet"? Are there nutrients that are more helpful than others in suppressing the disease process and reducing pain? As this chapter explains, there does indeed appear to be a distinct link between food and inflammatory conditions, one that could mean a great deal to you in your struggle to find comfort and relief for your arthritis.

As you read this chapter, you'll probably be looking most closely at the specific suggestions we make about food and its relationship to arthritis. However, keep in mind that changing or supplementing your diet in order to improve the health of your joints will probably provide you with many other benefits, not the least of which will be a new sense of empowerment and self-esteem that comes with establishing any new positive habit. With every success, your spirit and energy—perhaps already a bit dampened and damaged by this chronic illness—will experience a renewal.

In this chapter, we'll explore three different ways that your diet may be affecting both your arthritis in particular and your general health. First, we'll look at the importance of maintaining a healthy weight in order to decrease stress and strain on the joints and muscles while providing you with a sensible, healthful eating plan. Then we'll outline the way allergies to certain foods may be triggering or exacerbating your disease process. Finally, we'll suggest a number of different vitamins and minerals that may help to relieve your pain, heal your joints, and prevent your arthritis from progressing.

Eating for Fitness and Health

Are you at a healthy weight, or are you like more than 30 percent of your fellow Americans: more than 10 percent over your ideal weight? If you are carrying extra pounds, they may be doing you more harm than simply bulking up your clothes or making you feel flabby. The extra weight could be contributing to the damage done to your joints by the arthritic process by forcing your joints to perform extra work to move this excess poundage. In fact, many researchers point to the increase in obesity as an important factor in the increase we've seen in cases of arthritis.

Why is obesity such a widespread problem in America today? Although most of us tend to blame our own lack of willpower, we can look to a number of outside influences that conspire to turn us into a nation of unhealthy eaters. Perhaps the most obvious and pervasive one is the television set. Not only does it compel us to spend too many hours sitting in a heap in front of it, but it constantly sells us apparently delicious, time-saving delectables—most of which are laden with fat and empty calories. The fact that our lives tend to be hectic and disjointed, leaving us with little time to plan our meals and enjoy them together with friends and family, also contributes to our increasingly poor eating habits and large waistlines.

At the same time, we read headlines every day about the dangers of food—sugar is bad, fat is worse, margarine is better than butter one day then a health risk the next. The mixed messages we receive tend to either confuse us to the point that we no longer even try to learn about nutrition or turn us into hypervigilant, slightly paranoid "food avoiders." In all this, we forget that food is good for us. It's meant to be enjoyed and savored at every meal.

Food is nourishment. The nutrients in the food you eat are the catalysts for millions of major and minor miracles—the beating of your heart, the birth of an idea, the appreciation of taste and smell—that take place within the chemistry lab that is your body. Food is also a source of pleasure. We do not eat merely to ingest the various vitamins, minerals, and other substances we need to survive. Instead, eating is a supremely sensual activity: We smell food's aromas, taste its flavors, admire its colors and textures, and feel its consistency inside our mouths. Depending on the circumstances, our sense of hearing is also stimulated by the conversation of our tablemates or the sounds of soothing dinner music.

As you consider your dietary habits, ask yourself these questions: Do you take the time to enjoy the sensual aspects of eating or do you think of food as simply fuel for the body? Or do you eat only those things that taste good without considering their nutritional value? Are there foods that you enjoy eating but which seem to exacerbate your arthritis symptoms or otherwise upset your system? Depending on how you answer these questions, you may discover that your approach to eating could use a little readjustment, especially if those habits have left you eating too much of the wrong kinds of food.

If you need to lose weight, or if you otherwise feel that you're not getting enough nutrition, take a look at the new Pyramid Plan devised by the United States Department of Agriculture. This plan organizes the food we eat into six different categories and shows us how much of each type of food we should, in general, eat every day. Please note, however, that your particular body chemistry may require more or less of certain foods in order to keep you healthy and arthritis-free.

Complex carbohydrates (6 to 11 servings a day): Carbohydrates are substances that provide the body with energy, fiber, and the feeling of "fullness" we've come to expect from food. Whole-grain bread, pasta, and rice are the primary forms of complex carbohydrates; most experts say they should compose the bulk of our daily caloric intake.

Protein (2 to 4 servings a day): Protein is the major component of our muscles and bones. In order for the health of our joints to be maintained, we need to consume some protein every day—about 55 grams, or the amount supplied in about 4 ounces of some lean meat, chicken, or fish. Among the most healthful sources of protein are cold-water fish such as mackerel, herring, and salmon, which contain certain substances called omega-3 fatty acids, which make anti-inflammatory substances in the body. Dr. Barry Sears, a researcher in metabolism, has recently pointed out that protein of any kind encourages the production of these anti-inflammatory substances in the body, while carbohydrates block their production. In his book, Enter the Zone, he suggests that a diet with 30 percent protein and 40 percent carbohydrate might be a better choice for a person coping with an inflammatory disease like arthritis. Research shows that several vegetable sources of protein, including some beans and legumes, provide other nutrients as well and may be better choices for those also attempting to lose weight.

Fruit (2 to 4 servings a day): The luscious sweetness of a peach, the exotic tang of a mango, the mellow tartness of fresh cherries. In addition to the pleasure we get from the flavor and texture of fruit, our bodies receive some essential nutrients from these foodstuffs, including antioxidants and flavonoids, two substances that work to keep body cells healthy and reduce inflammation.

Vegetables (3 to 5 servings, or more): "Eat your vegetables," our mothers told us, and like perhaps much of her other advice, this suggestion holds a great deal of merit. Vegetables provide the body with a wide variety of vitamins and minerals essential for its proper functioning, as well as fiber to help keep the digestive tract in good working order. We should all strive to eat more fresh vegetables every day.

Dairy products (2 to 3 servings): Milk, cheese, and yogurt are important to include in our daily diets because they contain calcium, magnesium, and vitamin D—all essential for the building and maintenance of our bones and muscles. For those of us who have difficulty digesting dairy products, there are other equally nutritious sources of these nutrients. Leafy green vegetables contain lots of calcium and magnesium, for instance, while fish and the rays of the sun provide us with vitamin D. Because fat inundates many dairy products, it's important to find some nondairy sources of these nutrients as well.

Fat and sugar (sparingly): From the foods listed above, we receive all the fat and sugar our bodies need to survive and thrive. However, as most of us can attest, fat and sugar, especially in combination, taste good. There are few among us who don't enjoy the sensual richness of chocolate or the mellow tartness of a lemon custard. As long as you limit the amount of these substances you eat on a regular basis, you should feel free—and guilt-free!—to enjoy an occasional treat (unless, of course, you have a medical condition like diabetes that involves specific dietary requirements). If you eat too much of these substances, however, it can have a definite impact on the arthritic process and the amount of pain and stiffness you feel for two reasons. First, you'll be more likely to gain weight—and thus place more stress and strain on your joints—if you overload on fat- and sugar-laden products. Second, as we'll see later in this chapter, sugar has a specific, and often quite negative, effect on the inflammatory process.

If you follow this rough outline—cutting way back on fat and sugar, eating more fresh fruit and vegetables, lean protein, and complex carbohydrates—it's likely you'll be able to maintain a healthy weight, even lose weight, even without counting calories. Nevertheless, knowing this simple fact may help you put weight loss into some perspective: To lose weight, you must expend more calories than you consume. Since 3,500 calories equal one pound of fat, you must either eat 3,500 fewer calories than your body needs to maintain its weight or burn 3,500 more calories through exercise to lose one pound. Indeed, another important fact to keep in mind is that exercise may very well be the key to staying healthy, fit, and able to eat the foods you love. Studies have shown that active thin people generally take in an average of 600 calories a day more than their overweight peers, proving the point that the amount of food you eat is not the only factor in losing weight. However, the key word is active: These people are working off more calories every day through exercise and the increase in metabolism that regular exercise induces. In Chapter 5, we discuss how to fit exercise into your life, even if arthritis besets your joints.

In the meantime, the simplest way to go about changing your diet in order to lose weight sensibly is to concentrate first on adding lots of good food. That's right. Losing weight does not always mean eating less and less food. You may be able to eat as much food as you ever have and still lose weight—if you eat the right kind of food. Our bodies use complex carbohydrates, for instance, much more efficiently than fat. A gram of fat provides more than twice the calories of a gram of carbohydrates (9 calories compared with 4). That's why one ounce of potato chips—processed in fat and totaling more than 160 calories—is more fattening than one ounce of baked potato, which contains about 30 calories and no fat at all.

In the end, then, the best way to diet is to concentrate on eating more vegetables, fruit, lean protein, and complex carbohydrates while cutting back on fat and sugar. If you eat relatively small portions of a wide variety of foods, and expect to lose just 1 to 2 pounds a week, you should be quickly on your way to improving your overall health and the health of your joints. Fad diets that promise rapid weight loss and focus on eating just a few select foods, on the other hand, are dangerous for many reasons. By concentrating solely on losing pounds and not on learning proper nutrition, you'll most likely fall back into the same kinds of bad eating habits that made you heavy in the first place. By adapting sensible portion control, you should be able to devise a healthy eating plan that will help you to lose or maintain weight without starving or depriving yourself of satisfying, filling foods. There are many such diet plans available, including those developed by Weight Watchers and the American Heart Association, if you need further guidance and support (see Natural Resources, page 168).

FINE-TUNING YOUR BODY CHEMISTRY

In addition to general dietary prescriptions for healthy eating, however, those with arthritis may need to look more closely at the amount of certain substances they ingest:

Antioxidants. Found in rich supply in fruits and vegetables, certain vitamins and minerals known as antioxidants appear to reduce the harmful effects of the inflammatory process by protecting muscle, tendon, and ligament cells from being damaged by chemicals called free radicals. Free radicals are unstable molecules created by normal chemical processes in the body (like the immune response to injury) or environmental influences like radiation and cigarette smoke. These unstable molecules, in an attempt to stabilize themselves, try to combine with other cells in the body. By doing so, they often damage the membranes and internal structures of healthy cells—including healthy muscle, tissue, and synovial cells—leaving them weak and unstable themselves.

In the body, the most damaging free radicals are derived from the chemical process by which oxygen is utilized inside the cells. Antioxidants, such as vitamins C and E, beta-carotene (which the body converts to vitamin A), and the mineral selenium, render these free radicals harmless. The more fresh fruits and vegetables containing these substances you consume, the better off your general health, and specifically the health of your joints, is likely to be. Later in the chapter, we'll discuss how you can boost your antioxidant levels by using vitamin and mineral supplements.

Flavonoids. The flavonoids are a group of plant pigments largely responsible for the colors of fruits and flowers. In addition, they serve to protect plants against environmental stress. In the human body, they modify the reaction to allergens and infectious agents. Flavonoids also have anti-inflammatory properties. Among the most important flavonoids for people with arthritis are those responsible for the colors of blueberries, blackberries, cherries, grapes, and other plants. Among their properties is the ability to increase vitamin C levels within cells, decrease the leakiness and breakage of small blood vessels, and protect against free radical damage. In addition, they appear to inhibit enzymes secreted by white blood cells that would otherwise destroy collagen structures during inflammation. Consuming the equivalent of a half pound of fresh cherries per day has been shown to be effective in lowering uric acid levels and preventing attacks of gout, as well as serving as a protection against the cell destruction involved in other types of arthritis.

Purines. Purines are natural substances found in certain foods, including organ meats, sardines, and anchovies. Research has shown that excess purine in the blood can raise uric acid levels. Uric acid, as you may remember from Chapter 2, has been directly linked to gout, a particularly painful form of arthritis. Excess uric acid may form crystals that settle in the joints, causing them to swell and, eventually, begin to erode. If you suffer from gout or another form of arthritis, most doctors would recommend that you limit the amount of purine-rich foods you eat.

Alcohol. To drink or not to drink? From its effects on atherosclerosis to cancer to arthritis, the impact of alcohol on disease remains the subject of a great deal of scrutiny among health professionals. Generally speaking, drinking a moderate amount of alcohol—about 2 to 4 ounces—every day appears to be good for most people (at least those who do not have an addictive problem related to alcohol). At least, drinking a small amount of alcohol appears to do no harm. As far as arthritis goes, however, there are a few exceptions. Alcohol may both increase uric acid production and reduce its excretion, which explains why alcohol consumption is often a precipitating factor in acute attacks of gout. Furthermore, heavy drinking—more than 4 to 8 ounces of alcohol a day—will deplete the body of a number of vitamins and minerals. However, if you currently enjoy an evening cocktail or a glass or two of wine with dinner and this habit appears not to cause a flare-up of your arthritis, you should feel free to continue to do so.

Sugar. When we eat simple sugars, such as refined table sugar or the sugar found in cookies and candy, the level of sugar in our blood (called glucose) rises rapidly. In response, the body releases a hormone, called insulin, which helps the cells absorb and use glucose as energy. If glucose and insulin levels rise and drop quickly, over and over again, muscle, tendon, and joint cells will become exhausted from these shifts. In addition, a chemical bonding occurs between muscle tissue, joint linings, and the sugar in the fluid that bathes them. This reaction, called glycosylation, goes on continually and irreversibly in direct proportion to the level of sugar in the blood. Hence, the more bonding that takes place, the more work your body tissues must perform. Therefore, the more sugar you consume, the more quickly your tissues will become damaged by this process. Finally, excess sugar in your diet and bloodstream may interfere with the proper functioning of your immune system. Should your immune system fail for this reason, infection may occur, further exhausting your body and leaving you open to aches and pain.

There is no need to deny yourself an occasional sugary indulgence if you have a sweet tooth. However, for many reasons, including those directly related to the pain, strain, and inflammation associated with arthritis, you should try to limit the amount of sugar you eat on a daily basis.

Now that you've read about some general guidelines related to diet and arthritis, it's time to look at the way food may be negatively affecting your individual body chemistry and disrupting the health of your joints and connective tissues.

Understanding the Food Allergy Connection

One man's nectar is another's poison—at least when it comes to the food we eat and the way it affects us. Some people are highly sensitive to certain foods, or substances in food, that may either trigger arthritis flare-ups or exacerbate the pain and inflammation involved. There is much evidence to show that an allergic hypersensitivity to certain foods or food-related substances can trigger arthritis in some individuals.

An allergy is an immune system reaction to a substance that most people find harmless. Your immune system is designed to defend your body against harmful organisms and substances, such as bacteria, viruses, and other invaders that cause infection. When the immune system recognizes a substance as being harmful, it mounts a response by producing white blood cells (called antibodies) and other chemicals that attack the offending substance.

If your immune system reacts to generally benign foreign substances, such as pollen, dust mites, or certain foods, you are said to be allergic to that material. When you come into contact with a food or environmental factor (such as pollen or molds) to which you are allergic, your immune system attacks it just as if it were a virus or bacterium. It releases a substance called histamine—a body chemical that can act as an irritating stimulant. When your cells release histamine into the lungs, it causes the lining of the airways to narrow, swell, and serete mucus. This leads to wheezing and coughing.

In some cases, histamine may be released into one or more joints, which causes an inflammatory response. This leads to arthritis-related swelling, tenderness, and stiffness that can become chronic and entrenched over time. Many scientists believe that a primary cause of rheumatoid arthritis may be food allergies, which trigger an autoimmune disturbance that results in the immune system attacking joint tissue.

Although you may be allergic or sensitive to any food, the most common culprits when it comes to back pain, especially back pain related to arthritis, are plants of the nightshade family—also called solanines—including tomatoes, potatoes, eggplant, and peppers. As discussed in Chapter 2, these foods tend to trigger the inflammatory response. Another plant of the nightshade family is tobacco. Not only might tobacco cause an allergic reaction, but nicotine reduces blood flow to the muscles and joints, further complicating matters for people with arthritis. Other common food allergies implicated in rheumatoid arthritis symptoms involve yeast and fermented products, wheat, and sugar.

If you are concerned that your symptoms are affected by food or other substances that you consume, talk to your doctor. She may suggest that you keep track of your diet and symptoms, writing down the foods you eat, when you eat them, and the symptoms that arise over the course of a day. After a few weeks, a pattern may appear. If a certain food appears to trigger an arthritis flare-up, it would, of course, make sense for you to avoid that food in the future.

In the end, the rule of thumb should be: "If it makes you feel bad, don't eat it!" Instead, eat the foods that contribute to your general health and sense of well-being, and avoid those that appear to intensify your symptoms or otherwise upset your system.

And if you smoke, stop as soon as you can. Talk to your health practitioner about natural herbs like chlorophyll and the amino acid l-glutamine, which may help you in your effort to beat the habit. Acupuncture, hypnosis, and biofeedback have all been used successfully in "stop-smoking" programs, but the first step is to sit down and really convince yourself that you want to stop. If you are trying to quit just because someone tells you it's bad for you, you probably won't be successful.

The ABCs of Nutritional Supplements

Although in the best of all possible worlds we would receive all the nutrients we need from the food we eat, many researchers believe that supplementing our diets with certain vitamins and minerals is an important component in any successful treatment of arthritis. The following nutrients are those most often mentioned in this connection.

Boron. Boron, a mineral deficient in most of our diets, may help prevent bone destruction such as occurs in osteopororsis. The usual supplemental dose is 3 to 6 milligrams a day.

Calcium and Magnesium. The mineral calcium is essential for bone, joint, muscle, and ligament health. Although it is only one factor in bone and joint maintenance, it is an important one. Your body does not produce any of its own calcium, so to meet your daily needs you must eat food rich in calcium or take calcium supplements. At the same time, however, you must also consume enough of the mineral magnesium, which allows bone tissue to absorb and use calcium. Without enough magnesium, any extra calcium in your blood ends up in soft tissues and joints, causing pain and swelling.

To bolster the supply you receive from fresh foods and to compensate for any deficiency, you should feel free to take up to 600 to 800 milligrams of magnesium a day. (Magnesium is found in high quantities in green leafy vegetables, nuts, and legumes.) As for calcium, you should consume at least 1,000 to 1,500 milligrams a day of this mineral or take a supplement to make up the difference.

Glucosamine Sulfate. Glucosamine is a naturally occurring substance found in high concentrations in joint structures. It appears that this chemical plays an integral part in stimulating the production of connective tissue and new cartilage growth essential to repair the damage done to these structures by arthritis. Research shows that as we age, we may lose the ability to manufacture enough glucosamine, resulting in damaged and weak cartilage that is then unable to hold water and act as a shock absorber.

When taken as a nutritional supplement, glucosamine sulfate appears to help the body to stimulate joint repair, thus reversing the arthritic process while reducing pain and inflammation. The standard dose for glucosamine sulfate is about 500 milligrams, three times a day. The body tolerates this supplement very well, much better than it does NSAIDs and other pain relievers, and thus may provide a welcome option for long-term osteoarthritis sufferers.

Omega-3 Fatty Acids. These fatty acids, derived mainly from cold-water fish such as mackerel and salmon, inhibit the inflammatory response. (In addition, omega-3 also helps to reduce cholesterol levels in the body.) If you wish to supplement your diet, you can take up to 10,000 millligrams per day. Make sure you purchase supplements that contain 150 to 1,000 milligrams of EPA, the active fatty acid in omega-3.

Pantothenic Acid. A member of the B-vitamin family, this micronutrient plays a key role in energy metabolism pathways in the body. It is also a component in the manufacture of cartilage. In addition, it is essential in the production of natural steroid hormones, necessary to keep our immune system up and running during times of physical and/or emotional stress. Egg yolks, kidney, liver, and fortified wheat flour are rich sources of pantothenic acid.

Selenium. This trace mineral is a component of an enzyme that is responsible for preventing the buildup of free radicals. By taking just 200 micrograms of this nutrient every day, you can help protect your muscles and bones from becoming damaged. Please note that selenium does not work alone: It requires sufficient amounts of vitamin E to function efficiently as an antioxidant. Selenium can be found in seafood and meats.

Vitamin B Complex. All of the B vitamins, including vitamins B₁, B₂, B₃, B₆, B₁₂, and folic acid, are considered important to the development and maintenance of bones and muscle, and thus essential to the health of one's joints. In addition, vitamins B₁, B₃, and B₆ are particularly helpful in reducing anxiety, which can help alleviate the cycle of pain that many people with arthritis must endure. Vitamin B₆ has also been shown to help reduce the pain of carpal tunnel syndrome, an impingement on the median nerve of the wrist and strain of the tendons of the hand and shoulder. Hence, it is quite possible that vitamin B₆ would also help to alleviate pain caused by similar functional problems in other joints afflicted by arthritis. A form of vitamin B₃, known as niacinamide, seems to have a positive effect on arthritis, especially of the knees. The usual dosage is 250 milligrams taken every few hours. Since niaicinamide may affect the liver, you should be under a doctor's car