Gout, an inflammatory disease of hyperuricemia (high uric acid,) is caused by monosodium urate crystals in joints and other tissues. It is associated with the metabolic syndrome and the consumption of high purine foods. The risk of gout is increased by high protein diets and by alcohol. Low purine diets are difficult for many people to follow. Diets low in calories, refined carbohydrates and saturated fats are beneficial in gout.
Men who eat the most meat have a 41% higher risk of gout than those who consume the least. Men who eat the most fish have one-half the risk of gout of those who eat the least fish. People who consume the most vegetable and dairy protein have a reduced risk of gout. Even high purine vegetables reduce the risk of gout.
Alcohol use, especially beer, but, not wine, is strongly associated with higher gout risk and increases uric acid levels. Use of fructose, including fructose beverages, fruit juices and high fructose fruit, increases uric acid levels and the risk of gout. Coffee reduces the risk of gout.
Osteoarthritis (OA,) an inflammatory arthritis, is benefited by weight loss diets. A goal of 10% weight loss at a rate of 1 to 2 pounds per week is suggested. This will result in an average increase in function of 28% in time. Weight loss plans should attempt to reduce body fat, especially abdominal fat, which tends to be omega-6 fatty acid. Low energy diets are good for OA patients and result in more rapid weight loss.
Loss of fat may be more important in OA than loss of weight since fat loss may result in less chronic inflammation. OA patients should concentrate on loss of body fat, especially abdominal fat and exercise for maintenance of lean muscle mass. Polyunsaturated fatty acids (PUFAs) include omega-3, omega-6, and omega-9. Omega-3 PUFAs tend to be anti-inflammatory.
Antioxidants, such as vitamin C (citrus fruits, rose hips, black currants, strawberries, Brussels sprouts, broccoli, peppers, cabbage, potatoes and parsley) are beneficial in OA where there is excessive inflammation. One gram of calcium ascorbate (vitamin C) twice daily reduces the pain of OA more than placebo. Vitamin E (vegetable and nut oils, safflower oil, nuts, sunflower seeds and whole grains) reduces the pain of OA more than placebo.
Rheumatoid arthritis (RA) patients benefit from improved bowel flora, reduced permeability to bacteria and toxins and the elimination of any foods which worsen symptoms. Studies of the Mediterranean diet (high in plant foods and olive oil and low in red meat) and RA show benefit, especially over a long duration.
Vegetarian diets can improve RA through loss of weight and reduced inflammation. The diets are high in fruits and vegetables and low in saturated fatty acids. A juice fast can be followed by a vegan diet. Then, gradual reintroduction of foods which don’t worsen the joint symptoms may be highly beneficial.
Elimination diets for RA are used to remove foods that are believed to cause joint symptoms. The most common foods to increase RA symptoms are corn, wheat, bacon or pork, oranges, milk, oats, rye, eggs, beef and coffee. The foods can, gradually, be added back to see which foods accentuate the symptoms. This method can result in significant improvement.
An elemental diet is artificial, using supplements and amino acids in place of protein. The diet can improve rheumatoid arthritis symptoms, but, there is a high dropout rate because of the synthetic nature of the diet.
Fibromyalgia (FM) is an inflammatory disease with diffuse musculoskeletal pain, muscular and bone tenderness and general fatigue. The cause could be “altered central nervous system pain processing.” Often, people with FM feel their symptoms are related to diet. However, studies of diet are inconclusive. Vegetarian and vegan diets seem beneficial, but, patients prefer to use the drug, amitriptyline, rather than to follow these diets. It is not clear that weight loss improves FM.
Elimination diets have been studied with FM. According to the lymphocyte response assay, the most common causes of problems in FM patients are monosodium glutamate, caffeine, food coloring, chocolate, shrimp, dairy products, and aspartame. It is hard to be sure of the study results because of shortcomings in the design study. Some of the chemicals involved are excitatory neurotransmitters, which may play a role in pain perception and deserve further studies.
CONCLUSION: Diet, nutrition, and weight loss help, especially in gout and osteoarthritis. Other studies had poor study design and high dropout rates, especially in vegan and vegetarian diets, elimination diets and artificial diets. Antioxidants and omega-3 fatty acids do show some benefits in inflammatory arthritis by reducing inflammation.