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BIOACTIVE FOOD
AS DIETARY
INTERVENTIONS
FOR ARTHRITIS
AND RELATED
INFLAMMATORY
DISEASES
BIOACTIVE FOOD
AS DIETARY
INTERVENTIONS
FOR ARTHRITIS
AND RELATED
INFLAMMATORY
DISEASES
Second Edition
Edited by
RONALD ROSS WATSON
VICTOR R. PREEDY
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CONTENTS
Contributors xv
Acknowledgments xxiii
Section A Overview and Background on Diet and
Arthritis/Inflammation Modifications 1
1. Foods and Arthritis: An Overview 3
G.M. Masud Parvez, Khokon Miah Akanda
1. Arthritis 3
2. Prevalence of Arthritis 4
3. Foods and Arthritis 4
4. The Role of Diet in Arthritis 4
5. Foods That Avoid in Arthritis 5
6. Food Ingredients That Can Cause Inflammation and Arthritis 7
7. Best Foods for Arthritis 9
References 19
2. Probiotics for the Management of Rheumatoid Arthritis 23
Harman Dhanoa
1. Introduction 23
2. Rheumatoid Arthritis 23
3. Probiotics 24
4. RA and Gut Bacteria 25
5. RA and Oral Bacteria 26
6. Probiotics as RA Therapy 26
7. Limitations of Current Research 33
8. Conclusion 33
References 34
3. Integrative and Complementary Medicine Use in Adults With Chronic
Lower Back Pain, Neck Pain, and Arthritis/Musculoskeletal Diseases 37
Justice Mbizo, Anthony Okafor, Melanie A. Sutton, Leauna M. Stone
1. Introduction 37
2. Costs, Quality of Life, and Patient Satisfaction With CAM 38
v
CHAPTER 1
Foods and Arthritis: An Overview
G.M. Masud Parvez, Khokon Miah Akanda
Department of Pharmacy, Varendra University, Rajshahi, Bangladesh
ABBREVIATIONS
AGE advanced glycation end
AGEs advanced glycation end-products
ALA alpha linoleic acid
CRP C-reactive protein
DHA docosahexaenoic acid
EGCG epigallocatechin-3-gallate
EPA eicosapentaenoic acid
ESR erythrocyte sedimentation rate
FDA Food and Drug Administration
IL interleukin
LDL low-density lipoprotein
MMP matrix metalloproteinase
MSG monosodium glutamate
NSAIDs nonsteroidal antiinflammatory drugs
PCBs polychlorinated biphenyls
PG prostaglandin
PUFA polyunsaturated fatty acid
RA rheumatoid arthritis
TNF tumor necrosis factor
1. ARTHRITIS
The word arthritis is derived from the Greek words arthron for “joint” and itis for
“inflammation.” Today, the term is used for hundreds of different varieties of joint prob-
lems that have specific symptoms, such as pain, swelling, and stiffness. Arthritis refers to a
range of musculoskeletal conditions where a person’s joints become inflamed, which may
result in pain, stiffness, disability, and deformity. These symptoms can often have a sig-
nificant impact on a person’s everyday functioning life.
1
There are more than 100 types of
arthritis.
2
3
Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases ©2019 Elsevier Inc.
https://doi.org/10.1016/B978-0-12-813820-5.00001-5 All rights reserved.
2. PREVALENCE OF ARTHRITIS
In developed nations, osteoarthritis is considered to be one of the 10 most common
disabilities in older individuals, especially those who remain active in the workforce.
3
From 2013 to 2015, an estimated 54.4 million US adults (22.7%) had doctor-diagnosed
arthritis, with significantly higher age-adjusted prevalence in women (23.5%) than in
men (18.1%). Today, an estimated 30.8 million adults have osteoarthritis.
4
Osteoarthritis
ranks fifth among all forms of disability worldwide.
5
In US adults, osteoarthritis is
considered to be the most common form of arthritis and the most common cause of dis-
ability. Arthritis prevalence increases with age.
6
By 2040, an estimated 78 million (26%)
US adults aged 18 or older are projected to have doctor-diagnosed arthritis.
7
In 2014–15,
15.3% of Australians (3.5 million people) had arthritis, with prevalence higher among
women than men (18.3% compared with 12.3%). Of persons with arthritis, more than
half (58.9%) had osteoarthritis (deterioration of cartilage inside a joint), 11.5% had
rheumatoid arthritis (an autoimmune disease in which the body is attacked by bacteria
or viruses), and 34.8% had an unspecified type of arthritis.
1
Men are nearly three times
more likely to develop gout compared with women, and black males are most commonly
affected.
8
3. FOODS AND ARTHRITIS
Millions of people suffer from painful and swollen joints associated with arthritis. In the
past, many doctors told arthritis patients that dietary changes would not help them. How-
ever, this conclusion was based on older research with diets that included dairy products,
oil, poultry, or meat.
9,10
New research shows that foods may be a more frequent con-
tributor to arthritis than is commonly recognized.
4. THE ROLE OF DIET IN ARTHRITIS
For years, people have suspected that foods are an important factor in the development of
rheumatoid arthritis. Many notice an improvement in their condition when they avoid
dairy products, tomatoes, eggplant, and certain other foods. At present, 69% of patients
with OA take some form of dietary supplements for their condition.
11
The spinaciaoler-
acea vegetable can mitigate OA effects by increasing bone volume to tissue volume,
which results in a decrease of the trabecular pattern factor by more than 200%.
12
After a survey of more than 1000 arthritis patients, it was concluded that foods most
commonly believed to worsen the condition were red meat, sugar, fats, salt, caffeine, and
nightshade plants (e.g., tomatoes, eggplant).
13
Once the offending food is eliminated
4Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
completely, improvement usually comes within a few weeks. Dairy foods are one of the
principle offenders, and the problem is the dairy protein, rather than the fat, so skin prod-
ucts are as much a problem as whole milk.
14
An increasing volume of research shows that certain dietary changes do, in fact, help.
For example, polyunsaturated oils and omega-3 supplements have a mild beneficial
effect, and researchers have found that vegan diets are beneficial.
15
One study in 2002
looked at the influence of a very low-fat vegan diet on subjects with moderate to severe
RA. After only 4 weeks on the diet, almost all measures of RA symptoms decreased sig-
nificantly.
16
The journal Rheumatology published a study that found that a gluten-free
vegan diet improved the signs and symptoms of RA.
17
An uncooked vegan diet rich
in antioxidants and fiber was shown in another study to decrease joint stiffness and pain
in patients with RA.
18
Some research studies have looked at fasting followed by a veg-
etarian or vegan diet. A review of multiple research studies concluded that this dietary
treatment might be useful in the treatment of RA.
19
Vegan diets dramatically reduce the overall amount of fat in the diet and alter the
composition of fats. This, in turn, can affect the immune processes that influence arthritis.
The omega-3 fatty acids in vegetables may be a key factor as well as the presence of sat-
urated fat in negligible amounts.
In addition, vegetables are rich in antioxidants, which can neutralize free radicals.
Oxygen free radicals attack many parts of the body and contribute to heart disease
and cancer; they also generally intensify the aging processes, including the joints. Iron
acts as a catalyst, encouraging the production of these dangerous molecules. Vitamins
C and E, which are plentiful in a diet made of vegetables and grains, help neutralize free
radicals. Meats supply an overload of iron, no vitamin C, and very little vitamin E,
whereas vegetables contain more controlled amounts of iron and generous quantities
of antioxidant vitamins.
As well as being helpful in preventing arthritis, antioxidants may also have a role in
reducing its symptoms. Some arthritis treatments, including nonsteroidal antiinflamma-
tory drugs, work at least in part by neutralizing free radicals. For the most part, however,
vitamins and other antioxidants will be of more use in preventing damage before it
occurs, rather than in treating an inflamed joint.
20
A diet drawn from fruits, vegetables, grains, and beans therefore appears to be helpful
in preventing and, in some cases, ameliorating arthritis.
5. FOODS THAT AVOID IN ARTHRITIS
Common forms of arthritis include osteoarthritis, caused by wear and tear on the joints;
rheumatoid arthritis, an autoimmune disease in which the body attacks its own joints; and
gout, caused by a buildup of uric acid in the body. Regardless of the type of arthritis you
5Foods and Arthritis: An Overview
have, cutting back or eliminating foods that can aggravate inflammation may help alle-
viate the pain and swelling.
5.1 High-Calorie Foods
Obesity is directly related to osteoarthritis, especially of the knees. Each pound of extra
weight puts four pounds of extra stress on knees. Fat itself generates chemicals that can
exacerbate inflammation, which describes why overweight people are also at greater risk
of arthritis in the hands. It is clear that obesity is connected to rheumatoid arthritis and
gout as well. Cutting back on foods that are full with fats and sugars, especially empty
calories such as soda or foods that trigger overeating, can help peel off pounds.
5.2 Foods Cooked at High Temperature
Advanced glycation end products, or AGEs, are substances present in high-fat foods, pro-
cessed foods, and foods that are fried, grilled, microwaved, or baked. Although foods
overburdened with AGEs have not been linked directly to arthritis, avoiding them
can help to mitigate inflammation. By eating more fish, vegetables, fruits, grains, and
low-fat dairy products and fewer meats and high-fat dairy foods, AGE can be uptaken
to a lesser extent. Foods should be cooked at lower temperatures or by moist-heat
methods or meats should be steeped in an acid-based marinade before grilling, baking,
or frying.
5.3 Food Sensitivities
The sensitivity of a person in regard to gluten can cause a variety of symptoms, including
joint pain. People with rheumatoid arthritis have reported that dairy foods, citrus fruits,
or plants in the nightshade family such as potatoes or chili peppers aggravated arthritis
symptoms. It is thought that food sensitivities might aggravate the autoimmune responses
in rheumatoid arthritis.
5.4 High-Purine Foods and Alcohol
Purine-rich foods cause an increase in uric acid, so they should be used in lesser amounts.
These types of foods include anchovies, asparagus, organ meats, herring, mackerel, sar-
dines, scallops, and dried beans and peas. Alcohol can also increase uric acid.
5.5 Butter
Many people grew up with the habit of taking butter with biscuits or potatoes, but people
with arthritis may benefit by limiting butter intake. Obesity worsens arthritis because the
extra weight puts pressure on the joints. Foods that are rich in fat are often high in calories
and can lead to weight gain if eaten excessively. Butter not only contains high fat, but also
6Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
saturated fat, which can increase swelling and pain in the body. Therefore, it is better that
butter should be avoided by people with arthritis.
5.6 Beef
Meats such as beef, and mutton have been linked to increased inflammation and joint pain
from arthritis. People with arthritis generally experience less pain when they go on a veg-
etarian diet. Beef also contains saturated fat, which can increase pain. Ecological studies
have shown that the prevalence of RA is also higher in countries with higher consump-
tion of red meat..
21
5.7 Candy
Sugary foods such as candy and chocolate should be eaten sparingly by arthritis patients.
Because candy contains calories but no fiber or nutrients, it can lead to weight gain. Gain-
ing too much weight can worsen the pain for an arthritic person.
5.8 Nightshade Vegetables
Eggplants, peppers, tomatoes, and potatoes are all members of the nightshade family.
These vegetables contain the chemical solanine, which aggravates arthritis pain and
inflammation.
6. FOOD INGREDIENTS THAT CAN CAUSE INFLAMMATION
AND ARTHRITIS
When someone has arthritis, their body is in an inflammatory state. What they eat may
not only increase inflammation, but it may also set you up for other chronic conditions
such as obesity, heart disease, and diabetes. Activated white adipose tissue increases the
synthesis of proinflammatory cytokines such as IL-6, IL-1, IL-8, TNFα, and IL-18 while
regulatory cytokines such as IL-10 are decreased to increase body fat. In addition, exercise
disrupts the clustering of cytokine expression and improves glucose tolerance without
reducing body fat or cytokine levels.
22–25
A few recent studies show enhanced
pain responses in peripheral inflammation models in rodents with diet-induced
obesity.
26–29
The following are some food ingredients that may trigger more inflamma-
tion in the body.
6.1 Sugar
It may be hard to resist desserts, pastries, chocolate bars, sodas, and even fruit juices. How-
ever, processed sugars trigger the release of inflammatory messengers called cytokines.
Sugar goes by many names so look out for any word ending in “ose,” for example, fruc-
tose or sucrose on ingredient labels.
7Foods and Arthritis: An Overview
6.2 Saturated Fats
Several studies have shown that saturated fats trigger adipose (fat tissue) inflammation,
which is not only an indicator for heart disease but also worsens arthritis inflammation.
Pizza and cheese are the biggest sources of saturated fats in the average American diet.
Other culprits include meat products (especially red meat), full-fat dairy products, pasta
dishes, and grain-based desserts.
6.3 Transfats
Known to trigger systemic inflammation, transfat can be found in fast foods and other
fried products, processed snack foods, frozen breakfast products, cookies, donuts, crack-
ers, and most stick margarines. Avoid foods with partially hydrogenated oils in the ingre-
dient labels.
16
6.4 Omega 6 Fatty Acids
Omega 6 fatty acids are an essential fatty acid that the body needs for normal growth and
development. The body needs a healthy balance of omega-6 and omega-3 fatty acids.
Excess consumption of omega-6 s can trigger the body to produce proinflammatory che-
micals. These fatty acids are found in oils such as corn, safflower, sunflower, grapeseed,
soy, peanut, and vegetable as well as mayonnaise and many salad dressings.
30,31
6.5 Refined Carbohydrates
White flour products (breads, rolls, crackers), white rice, white potatoes (instant mashed
potatoes or french fries) and many cereals are refined carbohydrates. Processed carbohy-
drates may trump fats as the main driver of escalating rates of obesity and other chronic
conditions. These high-glycemic index foods fuel the production of advanced glycation
end (AGE) products that stimulate inflammation.
6.6 Monosodium Glutamate
Monosodium glutamate (MSG) is a flavor-enhancing food additive most commonly
found in prepared Asian food and soy sauce, but it can also be added to fast foods,
prepared soups and soup mixes, salad dressings and daily meats. This chemical can trigger
pathways of chronic inflammation and affect liver health.
6.7 Gluten and Casein
People who have joint pain and are sensitive to gluten, found in wheat, barley, and rye, or
casein, found in dairy products, may find relief by avoiding them. And those diagnosed
with celiac disease, in which gluten sets off an autoimmune response that damages the
small intestine and sometimes causes joint pain, may find relief when they adopt a
8Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
gluten-free diet. There may be an overlap in which some people with arthritis also have
gluten sensitivity or celiac disease.
6.8 Aspartame
Trying to go sugar-free? Aspartame is a nonnutritive, intense artificial sweetener found in
more than 4000 products worldwide. While aspartame is approved by the FDA, studies
on its effects are mixed, and the impact on people with autoimmune disease is unknown.
If someone is sensitive to this chemical, their immune system may react to the “foreign
substance” by attacking the chemical, which, in turn, will trigger an inflammatory
response.
6.9 Alcohol
Alcohol is a burden to the liver. Excessive use weakens liver function, disrupts other mul-
tiorgan interactions, and can cause inflammation. It is best eliminated or used in moder-
ation. Long-term consumption of alcohol in moderate amounts may affect immune
function and could downregulate production of proinflammatory molecules involved
in the development of RA.
32–36
Cutting back on foods that promote inflammation, increasing the proportion of fruits
and vegetables in the diet, making fish the main protein, and getting more omega-3 s can
make a big difference in arthritis symptoms.
7. BEST FOODS FOR ARTHRITIS
Although there is no diet cure for arthritis, certain foods have been shown to fight inflam-
mation, strengthen bones, and boost the immune system. Adding these foods to your
balanced diet may help ease the symptoms of your arthritis.
7.1 Fruits
Fruits are naturally sweet and many offer a substantial dose of antioxidants, fiber, vitamins,
minerals, and other nutrients. Some have components that may help lower the inflam-
mation that often affects people with arthritis and is linked to other serious conditions,
such as heart disease and stroke. The plasma levels of vitamin C, retinol, and uric acid are
inversely correlated to variables related to rheumatoid arthritis disease activity.
37
The vast variety of fruits means that there are lots of great options for a healthful boost.
Many berries, for example, are loaded with antioxidants, such ascorbic acid (a form of
vitamin C) and anthocyanins and carotenoids, which give soft berries their deep colors.
These compounds help rid the body of free radicals that promote inflammation as well as
help prevent heart disease and certain cancers.
9Foods and Arthritis: An Overview
Whatever your favorite fruit, we should try to choose seasonal, locally grown fruits as
they are fresh, readily available, and cheap. Although frozen fruits retain some of their
nutrients, buy fresh for the best taste and highest concentration of beneficial compounds.
7.1.1 Mango
Mangoes are cultivated throughout the tropical and subtropical world for commercial
fruit production. Their main constituents are polyphenols, flavonoids, triterpenoids,
mangiferin, isomangiferin, tannin, and gallic acid derivatives. The possible health benefits
of mangoes are being antidiabetic, antioxidant, antifungal, antimicrobal, antiinflamatory,
antiviral, hepatoprotective, hypoglycemic, antiallergic, and anticancer.
38–41
7.1.2 Tart Cherries
Tart cherries get their rich red color and many of their powerful antiinflammatory and
antioxidant benefits from the flavonoid anthocyanin. These properties make tart cherries
a popular research subject, and some investigators compare the effects to nonsteroidal
antiinflammatory drugs (NSAIDs). Studies that often use the concentrated juice of Mont-
morency cherries have found that tart cherries may relieve joint pain in people with oste-
oarthritis and lower the risk of flares in those with gout.
42
7.1.3 Strawberries
Dietary strawberries may significantly decrease inflammation and cartilage degradation,
interleukin (IL)-6, IL-1β, and matrix metalloproteinase (MMP)-3 in obese adults with
established knee OA.
43
Strawberries are naturally low in sugar and have more vitamin
C per serving than an orange. Vitamin C can lower the risk for gout, high blood pressure,
and cholesterol problems. Research has also shown that women who ate 16 or more
strawberries a week had lower C-reactive protein (CRP), a measure of body-wide
inflammation linked to arthritis flares and heart disease.
Scientists suspect that anthocyanin, along with other phytochemicals, gives straw-
berries their antiinflammatory and antioxidant health benefits, as with cherries. These
berries are also a good source of folic acid, which the arthritis medication methotrexate
can deplete. People taking the drug often need folic acid supplements to help prevent side
effects.
7.1.4 Red Raspberries
Like strawberries, these berries are among the highest in vitamin C and anthocyanin.
Animal studies have shown that extracts from the fruit reduce inflammation and osteo-
arthritis symptoms. Other research shows that the fruit’s bioactive compounds lower sys-
temwide inflammation and, when a regular part of the diet, help prevent a number of
chronic conditions, such as heart disease, stroke, and type-2 diabetes.
10 Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
7.1.5 Avocado
The rich, creamy texture of this fruit comes in part from its high content of antiinflam-
matory monounsaturated fat. Avocados are also rich in the carotenoid lutein. Unlike
most fruits, avocados are a good source of vitamin E, a micronutrient with antiinflam-
matory effects. Diets high in these compounds are linked to decreased risk of the joint
damage seen in early osteoarthritis.
7.1.6 Watermelon
Watermelon is another fruit with antiinflammatory action; studies show it reduces CRP.
It’s high in the carotenoid beta-cryptoxanthin, which can reduce the risk of rheumatoid
arthritis, according to studies that followed people’s dietary habits over time. It leads the
fruit pack in lycopene, an antioxidant that may help protect against certain cancers and
lower heart attack risk.
7.1.7 Grapes
Grapes, both white and darker-colored varieties, are a great source of beneficial antiox-
idants and other polyphenols. Fresh red and black grapes also contain resveratrol, which is
a potent antiinflammatory. Studies show that this bioactive compound acts on the same
cellular targets as NSAIDs.
7.1.8 Pomegranate
Pomegranate juice is rich in polyphenolic compounds that possess antioxidant and anti-
inflammatory activities, which can help with swollen and tender joints, pain intensity,
and ESR levels.
44
7.2 Vegetables
Vegetables are rich in antioxidants and other nutrients that protect against cell damage
and lower inflammation throughout the body, including joints.
7.2.1 Dark Green Leafy Vegetables
Energy production and other metabolic processes in the body produce harmful bypro-
ducts called free radicals, which damage cells. Free radicals have been implicated in the
development of rheumatoid arthritis (RA), and in the inflammation that attacks joints.
Green, leafy vegetables such as broccoli, spinach, Brussels sprouts, kale, Swiss chard,
and bok choy are packed with antioxidants such as vitamins A, C, and K, which protect
cells from free-radical damage. These foods are also high in bone-preserving calcium.
Broccoli and other cruciferous vegetables (Brussels sprouts, cabbage, bok choy, and
cauliflower) offer another benefit, a natural compound called sulforaphane. Research
shows sulforaphane blocks the inflammatory process and might slow cartilage damage
11Foods and Arthritis: An Overview
in osteoarthritis. And there’s some evidence that diets high in this vegetable family could
prevent RA from developing in the first place.
7.2.2 Sweet Potatoes, Carrots, Red Peppers, and Squash
These brightly orange- and red-hued vegetables get their distinctive color from caroten-
oids such as beta-cryptoxanthin. Plant pigments also supply sweet potatoes, carrots,
squash, and red peppers with antioxidants. Some research suggests eating more foods rich
in beta-cryptoxanthin could reduce the risk of developing RA and other inflammatory
conditions.
7.2.3 Red and Green Peppers
Peppers-no matter what their color or whether they’re mild or hot-are an abundant
source of vitamin C, which preserves bone and may protect cells in cartilage. Getting
less than the recommended 75 mg for women and 90 mg for men daily may increase risk
for OA of the knee.
7.2.4 Onions, Garlic, Leeks and Shallots
These pungent vegetables are all members of the allium family, which are rich in a type of
antioxidant called quercetin. Researchers are investigating quercetin’s potential ability to
relieve inflammation in diseases such as RA. Alliums also contain a compound called dia-
llyl disulfine, which may reduce the enzymes that damage cartilage.
7.2.5 Olives
Though technically a fruit and not found in the produce aisle, olives and olive oil can be
potent inflammation fighters. Extra-virgin olive oil contains the compound oleocanthal,
a natural antiinflammatory agent that has properties similar to the NSAID drug
ibuprofen.
7.3 Fish
Essential fatty acids called omega-3 s are among the most potent edible inflammation
fighters, particularly the kinds of fatty acids found in fish. Marine n-3 polyunsaturated
fatty acid (PUFA) is found in oily fish. Fish oils can slow the development of arthritis
by decreasing the arachidonic acid content of cells involved in immune responses and
decrease the production of inflammatory eicosanoids from arachidonic acid.
45
It is found
that peoples who adequately take vitamin D and calcium supplements are at decreased
fracture risk.
46
7.3.1 Omega-3 Fatty Acid
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are called marine fatty
acids because they come from fish. What makes these omega-3 sources worthwhile menu
12 Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
additions for people with arthritis is their ability to inhibit inflammation. Omega-3s
interfere with immune cells called leukocytes and enzymes known as cytokines, which
are both key players in the body’s inflammatory response. Research finds that people who
regularly eat fish high in omega-3 s are less likely to develop rheumatoid arthritis (RA).
And in those who already have the disease, marine omega-3 s may help reduce joint
swelling and pain.
The best sources of marine omega-3 s are fatty fish, such as salmon, tuna, sardines, and
mackerel. Eating a 3- to 6-oz serving of these fish two to four times a week is recom-
mended for lowering inflammation and protecting the heart.
Many fish that are rich in omega-3 s are also high in mercury, which can cause brain
and nervous system damage when eaten in large enough quantities. It’s important to
choose the smaller fish that have less mercury. Smaller fish are lower in mercury simply
by virtue of their position near the bottom of the food chain. When larger fish such as
swordfish, king mackerel, tuna, and shark feed on large numbers of small fish, mercury
from all those fish accumulates in their bodies.
7.3.1.1 Farm-Raised, or Wild-Caught?
The next question many fish eaters want to know is whether it’s better to buy farm-raised
or wild-caught fish. Some research has found that farm-raised fish contain higher levels of
polychlorinated biphenyls (PCBs) and other contaminants that have been linked to can-
cer. These chemicals come from the diet of farm-raised fish, which is primarily made up
of smaller fish.
Another concern is that farm-raised fish might contain fewer omega-3 fatty acids than
wild. On this issue, the research is conflicting, but both wild-caught and farm-raised fish
are considered good sources of omega-3 s.
7.4 Grains
Choosing which type of pasta to cook for dinner or what bread or cereal to have with
breakfast doesn’t seem like a big decision, until someone consider the effect certain grains
can have on their body. Eating the wrong types can aggravate inflammation, potentially
making joints hurt more than they already do.
7.4.1 Proinflammatory Grains
When contemplating options in the bread, cereal, and pasta aisles, you should avoid
refined grains. Not only are these highly processed grains limited in nutrition, but they
can also worsen inflammation throughout the body.
Grains are made up of three parts: The bran is the outer skin of the grain kernel, the
germ is the innermost part that grows into a new plant, and the endosperm is the center
part that provides food for the plant. Whole grains contain all three parts. Refined grains
13Foods and Arthritis: An Overview
have removed the bran and germ, where most of the vitamins, minerals, and protein are
centered.
Examples of food made with refined grains are white bread, white rice, cookies, and
cakes. Because of their simple structure, these carbs break down in the body rapidly. The
body turns them into sugar more quickly and sugar is highly inflammatory.
Refined grains have been linked to higher levels of inflammatory markers in the
blood. Inflammation throughout the body is not only bad for arthritis, but it can also
increase the risk for other inflammatory conditions such as heart disease and diabetes.
7.4.2 Better Grain Choices
To maximize nutrition while minimizing inflammation, stick to whole grains. Many of
these grains are also gluten-free (labeled with a GF below), if someone has celiac disease
or a gluten intolerance.
•Amaranth-GF: Although amaranth isn’t officially a grain, its nutrient composition
makes it similar to cereal grains. Amaranth is high in protein, has a nutty flavor,
and you can pop it like popcorn or turn it into porridge by boiling it in water.
•Barley: An ideal addition to soups, stews, and risotto dishes, barley is loaded with 6 g of
fiber per cup.
•Brown rice-GF: Because it has not had its bran and germ stripped away during proces-
sing, brown rice is nutrient-rich. Use it as a replacement in any recipe that calls for
white rice, but you’ll need to use more water and adjust cooking times.
•Buckwheat-GF: Another pseudocereal like amaranth, buckwheat is technically a fruit.
It may be used in noodles, crepes, pancakes, and muffins.
•Bulgur: This nutty-tasting grain comes from whole wheat that’s been partly cracked.
Use it in recipes, just as you would rice or couscous.
•Millet-GF: Millet is a grass that’s similar to corn. It can be used as an alternative to rice,
or added to bread and muffin recipes.
•Quinoa-GF: This versatile, high-protein seed is an ideal grain substitute. Research is
finding that quinoa might suppress the release of immune substances called cytokines,
which could be helpful for both preventing and treating inflammation.
•Sorghum-GF: This cereal grain is rich in protein. Use sorghum flour instead of white
flour in breads, cookies, and other recipes.
•Rye: Often used to make rye bread, whole rye has been shown in research to suppress
hunger, which might make it a useful weight-loss tool.
•Whole oats-GF: Steel-cut and other whole oats are high in protein and are naturally
gluten free (although most commercially available oats are contaminated with wheat).
Have them for breakfast or use them in recipes.
•Whole wheat: Swapping whole-wheat flour for white in recipes will increase nutrient
intake and potentially lower inflammation.
14 Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
7.5 Nuts and Seeds
Many nuts and seeds are a good source of polyunsaturated and monounsaturated fats,
which lower cholesterol and reduce the risks for heart disease that are high in people with
certain types of arthritis. They also are a good source of protein and antioxidant vitamins
and minerals. In addition, some nuts and seeds are high in alpha linoleic acid (ALA), a
type of antiinflammatory omega-3 fatty acid.
Some nuts are rich in magnesium, l-arginine, and vitamin E, which may play a role in
keeping inflammation under control. Studies have shown that people who eat a diet high
in these nutrients tend to have lower levels of some inflammation-causing molecules that
circulate in the bloodstream and higher levels of the antiinflammatory protein adiponec-
tin compared with those who consumed less.
7.5.1 Walnuts
With their high ALA content, walnuts head the nut pack in omega-3 content, and
researchers studying their effects have found that they lower C-reactive protein
(CRP), a marker of inflammation linked to increased risk of cardiovascular disease
and arthritis. Eating walnuts regularly can lower cholesterol, relax blood vessels to lessen
stress on the heart, and reduce blood pressure.
7.5.2 Peanuts
Technically a legume, peanuts are the “nut” with the most protein (about 7 g per 1-oz
serving). Peanuts are also a good source of monounsaturated and polyunsaturated fats, and
research shows adding them to the diet can help lower “bad” low-density lipoprotein
(LDL) cholesterol and reduce heart disease risk. Peanuts deliver about 12% of the daily
magnesium requirement and may help keep blood sugar under control.
7.5.3 Almonds
Almonds contain more fiber than most nuts; they’re a good choice for weight manage-
ment. They are also a good source of antioxidant vitamin E. Research suggests that the
monounsaturated fats from an almond-rich diet lower some markers of inflammation,
including CRP.
7.5.4 Pistachios
Snack on pistachios to help with weight loss. Dealing with the shell slows down con-
sumption, which is good for people with arthritis trying to lose a few pounds to take
pressure off joints. Pistachios can also help lower LDL cholesterol and are high in potas-
sium and antioxidants, including vitamins A and E and lutein.
15Foods and Arthritis: An Overview
7.5.5 Flaxseed
Flaxseed is one of the richest plant-based sources of the antiinflammatory omega-3 fatty
acid ALA. Studies show it may help lower overall and LDL cholesterol and reduce the
complications of diabetes and heart disease risk.
7.5.6 Chia Seeds
Chia seeds are also an excellent source of antiinflammatory ALA, but their biggest benefit
is their high fiber content. The fiber fills people up, which can help control weight.
7.6 Spices
Often when prepping a meal, food is the primary focus and spices are, at best, an after-
thought. But when following an antiinflammatory diet to help reduce the pain and joint
inflammation of arthritis, the potential benefits of the spices should be considered. The
more antiinflammatory the foods and spices, the more they will tamp down the chronic
inflammation. It is well known that increased levels of tumor necrosis factor (TNF)-α,
interleukin (IL)-1β, and IL-6 were found in the joint tissues of patients suffering from
RA.
47
Lipid extract from hard-shelled mussels (mytiluscoruscus) improves the clinical
conditions of patients with rheumatoid arthritis by decreasing TNF-α(tumor necrosis
factor α), interleukin (IL)-1β, and PGE2 (prostaglandin E2) and increasing IL-10.
48
7.6.1 Garlic
Garlic is a tasty addition to just about any savory dish. Like onions and leeks, it contains
diallyl disulfide, an antiinflammatory compound that limits the effects of proinflamma-
tory cytokines. Therefore, garlic can help fight the pain, inflammation, and cartilage
damage of arthritis.
7.6.2 Turmeric
Curcumin is the active chemical in turmeric root; it blocks inflammatory cytokines and
enzymes in two inflammatory pathways. Several human trials have shown an antiinflam-
matory benefit, which can translate to reduced joint pain and swelling.
49–51
7.6.3 Ginger
Gingerol and shogaol are the chemicals in ginger that block inflammation pathways in the
body. Along with ginger’s antiinflammatory properties, some studies have shown that it
can also reduce osteoarthritis symptoms.
52–54
7.6.4 Cinnamon
Cinnamon contains cinnamaldehyde and cinnamic acid, both of which have antioxidant
properties that help inhibit cell damage caused by free radicals. Cinnamon is delicious
mixed with oatmeal or added to smoothies, but it’s not strong enough on its own to offer
16 Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
a therapeutic effect. Used in combination with other foods and spices, it may offer a
cumulative antiinflammatory effect over the course of the day.
7.6.5 Chili
Chili peppers contain natural compounds called capsaicinoids, which have antiinflamma-
tory properties. It reduces cytokines and ESR levels and heals joint pain.
55
7.7 Oils
Some oils offer antiinflammatory action and other health perks for people with arthritis.
When part of a diet that emphasizes vegetables, fruits, whole grains, and lean proteins,
certain oils can help stave off heart disease, stroke, and diabetes, for which many people
with arthritis have an increased risk. Some may also help prevent inflammatory condi-
tions such as rheumatoid arthritis as well as certain cancers.
All oils are a mixture of fatty acids-monounsaturated, polyunsaturated, and saturated-
and it’s the ratio of these acids that determines whether an oil or fat is healthful or harmful.
Healthy oils and fats have a higher amount of unsaturated fatty acids and a lower amount
of saturated fatty acids than their less-healthy counterparts. Unsaturated fats-mono and
poly-have unique health benefits. Monounsaturated fats can help lower blood LDL
[bad cholesterol] level and raise HDL [good] cholesterol, which in turn can help prevent
cardiovascular disease. Polyunsaturated fats may lower total blood cholesterol, which also
helps prevent heart disease.
Squeeze the most health benefits out of your oils by understanding their best uses,
which often depend on their smoke point. This is the temperature at which different oils
begin to smoke and break down, which destroys the compounds that give them their
health benefits.
7.7.1 Olive Oil
High in monounsaturated fats and antiinflammatory and antioxidant compounds, olive
oils are among the best-studied fats, with many known health benefits. Extra-virgin olive
oil, the least refined type, is pressed mechanically rather than processed with heat or che-
micals that change its chemical properties. It contains biologically active compounds such
as the polyphenols oleocanthal, oleuropein, hydroxytyrosol, and lignans that have been
linked to reduced joint damage in rheumatoid arthritis.
7.7.2 Grapeseed Oil
This winemaking byproduct, which is pressed from the seeds of grapes, is high in poly-
unsaturated fatty acids and is a good source of vitamin E.
17Foods and Arthritis: An Overview
7.7.3 Walnut Oil
This oil is high in polyunsaturated fatty acids, including alpha-linoleic acid, that have car-
diovascular and cholesterol-lowering benefits. These fatty acids can also lower levels of
C-reactive protein (CRP), a measure of body-wide inflammation.
7.7.4 Avocado Oil
This pale green oil is rich in monounsaturated fats, which can lower heart disease and
stroke risks. Research also suggests avocado oil has an antiinflammatory effect, reducing
CRP. It’s also a good source of the antioxidant vitamin E.
7.7.5 Canola Oil
This oil is low in saturated fatty acids and is a good source of monounsaturated and poly-
unsaturated fats. Research shows it helps lower cholesterol and heart disease risk.
7.7.6 Soybean Oil
Soy protein decreases the rheumatoid arthritis by reducing the serum concentrations of
TNF-αand IL-6.
56
The beans contain significant amounts of phytic acid, dietary min-
erals, and B vitamins.
7.8 Beverages
7.8.1 Tea
Tea is one of the most-studied drinks when it comes to its benefits for arthritis patients.
Green, black, and white teas are all rich in polyphenols-compounds from plants that have
strong antiinflammatory effects. Green tea contain polyphenols, which reduce inflamma-
tion and slow cartilage destruction. Studies also show that an antioxidant in green tea
called epigallocatechin-3-gallate (EGCG) blocks the production of molecules that cause
joint damage in people with RA.
57–62
7.8.2 Coffee
Research shows that coffee also has antioxidant polyphenols. That means coffee can help
fight free radicals in the body, which cause cell damage. Other research suggests coffee
may have a protective effect against gout as well.
7.8.3 Milk
Drinking milk may help prevent gout and fight the progression of osteoarthritis, but one
should use low-fat milk to avoid consuming extra calories and saturated fat.
7.8.4 Juices
Orange, tomato, pineapple, and carrot juices are all high in vitamin C, which means they
have antioxidant properties that can neutralize free radicals that lead to inflammation.
18 Bioactive Food as Dietary Interventions for Arthritis and Related Inflammatory Diseases
Tart cherry juice has been shown to protect against gout flares and reduce osteoarthritis
symptoms. But be sensible when drinking juice: it’s delicious but also high in sugar and
calories.
7.8.5 Smoothies
Colorful fruits and vegetables are also high in antioxidants. Adding berries or leafy greens
such as spinach or kale can give big doses of vitamins and nutrients. Smoothies containing
yogurt are full of good bacteria known as probiotics as well as lots of vitamins. Also con-
sider exploring a fermented beverage such as kefir as an alternative. It too is full of pro-
biotics that can decrease inflammation in the body.
7.8.6 Alcohol
Red wine has a compound in it called resveratrol, which has well-established antiinflam-
matory effects. Studies have shown that wine consumption is associated with a reduced
risk of knee OA, and moderate drinking is also associated with a reduced risk of RA.
7.8.7 Water
If there’s a magical elixir to drink, it’s water. Hydration is vital for flushing toxins out of
the body, which can help fight inflammation. Adequate water can help keep joints well
lubricated and can help prevent gout attacks. Drinking water before a meal can also help
you eat less, promoting weight loss.
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