Doctors explained the effect of nutrition on the treatment of arthritis

An anti-inflammatory diet for arthritis is often presented as a long list of prohibitions, but scientific evidence does not confirm this. Olga Chistik, internist, gastroenterologist at the Scandinavian Health Center, and Nadezhda Shulpina, Candidate of Medical Sciences, Deputy chief physician, rheumatologist at Olympus Clinic MARS, told Izvestia on October 12 about which changes in the diet really support joints, whether it is worth giving up sweets, and why a proper diet does not help everyone.

How nutrition affects joint inflammation

According to Chistik, the word "arthritis" refers to several different diseases. In rheumatoid arthritis, the joints are attacked by their own immune system, in gout, uric acid crystals cause inflammation, and in osteoarthritis, cartilage gradually wears out.

The main factor here is weight. Adipose tissue, especially on the abdomen, itself secretes substances that support inflammation. In addition, every extra kilogram adds strain to the knees and hip joints. A diet high in sweets, sausages, and fast food contributes to both weight gain and inflammation. Therefore, to begin with, it is enough to eat more vegetables, fish, legumes and vegetable oils and less sugar and processed foods.

Shulpina agrees: nutrition affects inflammation, but the degree depends on the type of arthritis. In rheumatoid, psoriatic, and other seronegative arthritis, food affects systemic inflammation, the composition of the gut microbiota, and metabolic health.

In osteoarthritis, weight is a key factor: extra pounds increase the mechanical load on the joints. In gout, the relationship with nutrition is most direct — uric acid depends on the intake of purines, alcohol and fructose. A healthy Mediterranean-type diet is associated with a decrease in inflammatory markers and a milder course of arthritis.

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Sugar and inflammation: where is the connection

Chistik noted that there is a connection between sugar and inflammation, although not as direct as they say in social networks. Sugary drinks, pastries and desserts provide a lot of calories and little satiety, and a person imperceptibly gains weight, primarily on his stomach. The fat in this area supports inflammation, and the circle closes.

Many patients with rheumatoid arthritis themselves notice that after soda and sweets, the joints worry more. Sugary drinks and packaged juices are especially harmful for gout, because the fructose in their composition increases uric acid levels.

Which products help and which don't

Chistik noted that the basis of the diet should be vegetables, fruits and berries of different colors: green, red, orange, blue. Each has its own set of antioxidants, so the more colorful the plate, the better. Next come fatty fish, legumes, whole grains, nuts and seeds.

The main fat for salads is better to make extra virgin olive oil. Some substances are better absorbed in combination with other foods: carotenoids from carrots, pumpkins and tomatoes dissolve in fats, so it is more useful to eat such vegetables with a spoonful of oil or together with fish.

Shulpina added that in gout, alcohol, especially beer, excess offal, red meat, some seafood and fructose-containing beverages increase uric acid levels and the risk of seizures. Vegetable purines practically do not give such an effect. In inflammatory arthritis, ultra-processed foods, excess sugar, and large amounts of red meat are associated with higher levels of inflammation.

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Supplements and myths about prohibitions

Shulpina explained which supplements have an evidence base. Omega-3 fatty acids are the most convincing evidence for inflammatory arthritis: a moderate reduction in pain and the need for painkillers. Vitamin D is useful in cases of proven deficiency. Turmeric shows evidence for osteoarthritis of the knee. Collagen is limited data, mainly in osteoarthritis. Most other "joint" supplements are marketing with a weak evidence base. The rheumatologist also dispelled myths about prohibitions.

So, dairy products do not need to be excluded by everyone: in gout, low-fat dairy products are associated with a decrease in uric acid, and in inflammatory arthritis, sufficient protein and calcium are important. Nightshades — tomatoes, eggplants, peppers, potatoes — also do not need to be excluded, there is no scientific evidence of their harm.

The gastroenterologist also listed the typical mistakes of patients. First, they exclude the "forbidden", but do not add anything in return. Secondly, they remove products for no reason, such as tomatoes or gluten, although there is no evidence of their harm. Third— they don't keep track of their weight: even from the "right" foods, it's easy to gain excess weight if the portions are large. Fourth, they expect a quick result, although the effect accumulates over several months.

Fifth, they are trying to replace treatment with a diet: food supports therapy, but you cannot cancel or skip medications prescribed by a rheumatologist. Sixth— they forget about alcohol, which is associated with exacerbations of rheumatoid arthritis and gout, and when taking methotrexate, alcohol additionally loads the liver.

If you don't feel well in a few months, you should see a rheumatologist to evaluate the treatment and review the nutrition diary separately.