Can supplements or diet reduce symptoms of arthritis? Here's what the evidence says

Arthritis is a disease^[1] that affects body joints. There are more than 100 types^[2] of arthritis, with more than 350 million people^[3] affected around the globe, including about four million Australians^[4].

Arthritis causes pain and disability and commonly reduces quality of life. In Australia in 2015, about 54,000 people aged 45–64^[5] couldn’t work due to severe arthritis. Their median income was only a quarter of the income of full-time workers who did not have arthritis.

So it is not surprising some people want to try different diets, supplements or therapies to see if they alleviate symptoms or help them gain a sense of control^[6] over their condition.

However, a major review^[7] found specific supplements or food components were unlikely to lead to significant improvements in arthritis outcomes such as stiffness, pain and function.

The main nutrition recommendation was to adopt healthy eating patterns.

Remind me, what causes arthritis? And what are the symptoms?

Risk factors^[8] for developing arthritis include ones you can’t control – such as genetics, sex, and age – and some you may be able to, such as smoking, repetitive injuries, body weight, occupation and some infections.

Types of arthritis include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, juvenile arthritis, gout, systemic lupus erythematosus (lupus) and scleroderma.

Read more: Arthritis isn't just a condition affecting older people, it likely starts much earlier^[9]

Common symptoms include^[10]:

• pain
• stiffness or reduced joint movement
• swelling, redness and warmth in the joints.

Less specific symptoms include tiredness, weight loss or feeling unwell.

So what does the evidence say about supplements?

The European Alliance of Associations for Rheumatology^[11], the expert European group on arthritis, recently published a detailed critique on diet and supplement use in arthritis^[12]. It synthesised findings from 24 systematic reviews of existing research as well as an additional 150 extra studies, covering more than 80 different dietary components and supplements.

The alliance identified there were limited studies on each individual product with the majority of studies being of low quality. This means that for most supplements they couldn’t make recommendations about whether or not to use them.

However, for osteoarthritis and rheumatoid arthritis, although most studies were of low or moderate quality, a few supplements had positive effects.

Vitamin D, chondroitin and glucosamine

For osteoarthritis, there was moderate-quality evidence supporting a small positive effect on pain and function for taking vitamin D, chondroitin and glucosamine (both compounds found in cartilage) supplements.

Here, moderate quality means although the studies had some limitations and their results should be interpreted with caution, they can be used to guide recommendations.

This suggests people could choose to try these common supplements for a few months and see whether they get any benefit, but stop taking them if there is no improvement in their symptoms.

Fish oil

For rheumatoid arthritis, there was moderate quality evidence for a small positive effect on pain for omega-3 (fish) oils.

Again, people could try these supplements for a few months and see whether they get any benefit, but stop taking them if there is no improvement.

Other supplements

For all other arthritis categories, and other specific dietary components or supplements, the evidence was rated^[14] as low to very low (see tables 1–5 in this link^[15]).

This means any improvements in arthritis outcomes could be due to chance or bias, with positive results more likely to be published, or potential bias occurring when a trial was sponsored by a supplement manufacturer.

Read more: I'm taking glucosamine for my arthritis. So what's behind the new advice to stop?^[16]

What does it all mean?

Current research indicates it’s unlikely specific foods, supplements or dietary components affect arthritis outcomes to a large degree.

However, given the higher risk for heart disease^[17] associated with arthritis, the recommendation^[18] is to have a healthy diet and lifestyle^[19] in order to improve your overall health and wellbeing.

So how do you improve your health and wellbeing? Here are five key things to consider:

1. Eat a healthy, varied diet

Eating food – rather than taking supplements – means you get the other nutrients that foods contain, including healthy sources of fat, protein, dietary fibre and a range of vitamin and minerals essential to maintain a healthy body.

This is why the recommendation for people with arthritis is to eat a healthy diet, because vegetables, fruit, legumes and wholegrains contain a range of phytonutrients^[21] needed to help dampen down oxidative stress triggered by inflammatory processes associated with arthritis.

Read more: What is a balanced diet anyway?^[22]

A healthy diet includes foods rich in omega-3 fats such as fatty fish (salmon, tuna, sardines), chia seeds, flaxseed oil, walnuts, canola oil, and vitamin D (eggs, fish, and milk or margarine fortified with vitamin D). And don’t forget sun exposure^[23], which allows the body to produce vitamin D.

2. Avoid alcohol

Alcohol intake should be discussed with your doctor as it can interact with other treatments.

Small amounts of alcohol are unlikely to have negative impacts on arthritis, unless you have other health issues^[24] like liver disease or you take certain medications such as methotrexate^[25] or leflunomide^[26].

For rheumatoid arthritis, moderate alcohol consumption could increase the risk of arthritis flare ups^[27].

Alcohol can also increase the risk of gout flare ups.

Read more: Got gout? Here's what to eat and avoid^[28]

3. Aim for a healthy weight

Aiming for a healthy weight^[29] can help arthritis by reducing the load on affected joints such as hips and knees, and by boosting your intake of healthy foods rich in phytonutrients.

Ask your doctor for support to achieve well managed, intentional weight loss if you’re carrying excess weight. You may need referral to an accredited practising dietitian for personalised medical nutrition therapy or to a physiotherapist or exercise physiologist for specific help to improve mobility and physical activity.

Read more: Health Check: what's the best diet for weight loss?^[31]

4. Be cautious with supplements

If you decide to try specific complimentary therapies or dietary supplements, discuss potential side-effects or interactions with your regular medicines with your doctor and pharmacist.

Try the products for a few months (or as long as one container lasts) so you can monitor any side-effects versus your sense of wellbeing, reduction in use of pain medications and the cost. If you’re not getting any benefit then spend that money on more healthy foods instead.

Find out how healthy your diet is by taking our free Healthy Eating Quiz^[32].

References

1. ^{^} Arthritis is a disease (www.healthdirect.gov.au)
2. ^{^} 100 types (arthritisaustralia.com.au)
3. ^{^} 350 million people (globalranetwork.org)
4. ^{^} four million Australians (arthritisaustralia.com.au)
5. ^{^} 54,000 people aged 45–64 (pubmed.ncbi.nlm.nih.gov)
6. ^{^} sense of control (pubmed.ncbi.nlm.nih.gov)
7. ^{^} major review (pubmed.ncbi.nlm.nih.gov)
8. ^{^} Risk factors (www.cdc.gov)
9. ^{^} Arthritis isn't just a condition affecting older people, it likely starts much earlier (theconversation.com)
10. ^{^} symptoms include (arthritisaustralia.com.au)
11. ^{^} European Alliance of Associations for Rheumatology (www.eular.org)
12. ^{^} diet and supplement use in arthritis (pubmed.ncbi.nlm.nih.gov)
13. ^{^} Engin Akyurt/Unsplash (unsplash.com)
14. ^{^} rated (www.ncbi.nlm.nih.gov)
15. ^{^} see tables 1–5 in this link (rmdopen.bmj.com)
16. ^{^} I'm taking glucosamine for my arthritis. So what's behind the new advice to stop? (theconversation.com)
17. ^{^} higher risk for heart disease (www.thelancet.com)
18. ^{^} recommendation (pubmed.ncbi.nlm.nih.gov)
19. ^{^} lifestyle (pubmed.ncbi.nlm.nih.gov)
20. ^{^} Brooke Lark/Unsplash (unsplash.com)
21. ^{^} phytonutrients (theconversation.com)
22. ^{^} What is a balanced diet anyway? (theconversation.com)
23. ^{^} sun exposure (www.cancer.org.au)
24. ^{^} unless you have other health issues (pubmed.ncbi.nlm.nih.gov)
25. ^{^} methotrexate (www.nps.org.au)
26. ^{^} leflunomide (www.nps.org.au)
27. ^{^} increase the risk of arthritis flare ups (pubmed.ncbi.nlm.nih.gov)
28. ^{^} Got gout? Here's what to eat and avoid (theconversation.com)
29. ^{^} Aiming for a healthy weight (pubmed.ncbi.nlm.nih.gov)
30. ^{^} Olia Gozha/Unsplash (unsplash.com)
31. ^{^} Health Check: what's the best diet for weight loss? (theconversation.com)
32. ^{^} Healthy Eating Quiz (nomoneynotime.com.au)