The Role Of Diet And Exercise In Managing Osteoarthritis

Best foods for osteoarthritis (OA)

Introduction

OA is the fastest-growing cause of disability in the world and is the most prevalent form of arthritis. 18% of women and 9.6% of men suffer from symptoms of OA after the age of 60, a quarter of which struggle with their activities of daily living. It is believed that by 2050, if current trends are not bucked, 130 million people worldwide will suffer from OA. This, in turn, will hurt our health and social services.

The purpose here is to explore the effects of diet on OA and how, as a result, symptoms can be managed better. Slowing the progression of the disease, improving quality of life, and reducing strain on health and social services are the aims.

With education and a better understanding of OA, the focus will shift on to the patient to self-manage their condition and resulting function. 

What is OA?

OA typically affects large, load-bearing joints such as knees and hips. However, it’s also commonly found in the spine, hands and big toes. Most people will refer to it as ‘wear and tear’ as it is caused over a number of years when the cartilage (shock absorbers) in the joint breaks 

down.  As the cartilage reduces, the two ends of the joint essentially rub together. This causes friction, can leave bony spurs, and change the shape of the joint. 

When the load on the joints is higher, this makes the body more susceptible to OA. Therefore, obesity is a major risk factor. OA can also occur following injury, which can affect people in later life.

There is no cure for OA. Learning to manage the condition is essential for improving not just general health but quality of life. Bone rubbing on bone, over and again, is very painful and will worsen as the disease progresses. 

OA of the knee is the most common form and leading cause of disability. Figures in Australia showed that annual OA-related costs have gone above $2.1 billion in their healthcare system.

Full of half-joint replacements are a consideration, but these are usually reserved for the end stages of OA. As the nature of how OA progression is significantly impacted by heavy loading, it’s really important to consider how weight management and the effects of anti-inflammatory foods and drinks can manage pain and ease other symptoms.

The role of diet in OA

Clinical guidelines currently recommend exercise and weight management as first-line treatments. In particular, anti-inflammatory diets target both local and inflammatory body systems.

Excess weight adds pressure to the joints. A study found that 1lb of weight loss reduces 4 lbs of pressure on the knee as you take a step. People with a high BMI are twice as likely to have pain that persists. Add to this high body fat content, which will make inflammation more difficult to manage.

There is strong evidence supporting weight loss as a factor that will ease symptoms. Losing just 10% of your body weight if you have obesity will not just ease symptoms of OA. But improve your overall health.

A Dutch study found a correlation between obesity and OA of the hand. Because obesity and high body fat percentage lead to inflammation, disease at local and systemic levels were found. Weight reduction improved symptoms.

In Australia, a group of patients with OA of the knee were given a diet with an emphasis on whole foods with anti-inflammatory properties and minimised intake of processed foods that were 

considered pro-inflammatory. 27% of people stuck to the diet over 9 weeks, 68% most of the time, and 5% some of the time. The overall picture showed that symptoms improved with this eating plan.

Best foods for OA

1. Fruit and vegetables - Citrus fruits like oranges, grapefruits, and limes help maintain healthy joints as they are rich in vitamin C.
2. Good oils - extra virgin olive oil has properties that are similar to that of non-steroidal anti-inflammatory medication (NSAIDs). Avocado and safflower oil have also been shown to lower cholesterol, and the presence of omega-3s in walnut oil is ten times that of what is in olive oil. It has been suggested that there are links between high cholesterol and OA; therefore, lowering it can result in improvements. It will also support cardiovascular health.
3. Oily fish - the recommendation is to eat two portions of oily fish per week. For example, salmon, mackerel and sardines. These are packed with omega-3s and may help with reducing swelling and joint pain. 
4. Leafy greens - an example here would be spinach, as it is full of nutrients that can support the reduction of inflammation. Broccoli is rich in vitamins K and D and also contains a compound called sulforaphane. Researchers have found links showing broccoli to help prevent or slow down disease progression. It’s also rich in calcium, which helps strengthen bones.
5. High fibre - beans are full of fibre. We know that fibre helps lower C-reactive protein (CRP). CRP is made by the liver, and levels increase when there’s inflammation within the body. Beans also contain protein, the building blocks for muscle growth. Other beans such as red, kidney, and pinto are well known for protecting the heart and strengthening the immune system due to the presence of folic acid, magnesium, iron, zinc and potassium.
6. The Allium family - Allium is Latin for ‘garlic.’ However, as well as garlic, the Allium family includes onions, leeks, spring onions, chives and shallots. Studies have shown that people who ate these foods regularly showed fewer signs of OA. Diallyl disulphine, a compound found in garlic, may limit damage to cartilage.
7. Nuts - rich in protein, calcium, magnesium, zinc, vitamin E and alpha-linolenic acid (which boosts the immune system). Good for the heart and weight loss, in moderation. In particular, walnuts, pine nuts, pistachios and almonds.

Hydration and supplements

Green tea is full of antioxidants, which will help reduce inflammation and limit cartilage damage. Herbal teas containing turmeric are also well known for their anti-inflammatory properties.

If you don’t like fish, omega-3s can be taken in capsule form to supplement a healthier eating plan. Vitamin D and calcium are also essential for bone and cartilage health and can be taken to improve. By improving muscular strength and balance can help reduce the load on weight-bearing joints as your movement efficiency improves.

Physical activity coincides with food plans for OA

Think of activity and exercise as an adjunct to losing weight. Reducing body fat while increasing muscle mass will greatly improve not just your physical but also your mental health and quality of life.

Combining diet with exercise will give the best possible advantage to managing symptoms of OA. Losing weight will reduce the load on your joints and should result in improved mobility and function. You might find your exercise tolerance improves so you can walk further and more quickly without associated pain impacting your day.

Other benefits include:

• Reducing joint stiffness
• Better flexibility
• Making you happy and building your self-esteem.
• More restful sleep
• Feeling more energetic

Exercise can exacerbate symptoms of OA, depending on how far progressed the disease is. You must listen to what your body tells you. For example, keep a note of the walking distance you undertake during the day. If by evening you are struggling with pain, increased swelling and stiffness by evening, your body is saying you have exceeded your limit. This will help you plan for a shorter, perhaps less intense activity. If symptoms haven’t worsened after activity, you may be able to exert more next time.

Exercise is recommended by the National Institute for Health and Care Excellence (NICE). In addition to the above, it can lead to greater self-reliance and reduced disability and helplessness.

The EQ-5D questionnaire can be used for self-assessment. It covers 5 areas of your quality of life: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The idea is that you score yourself, undertake treatment and management of your OA (using good food and exercise), and then re-assess yourself to see if you’ve found improvements. It can be a handy tool for checking on changes in your quality of life. The answers you give are subjective and, therefore, meaningful to each person on an individual basis.

Summary

OA is a disease that cannot be cured. It’s, therefore, of utmost importance to understand what progresses OA more quickly and how to slow it down.

We know that OA can be caused by excessive, repeated loading of the joints. Obesity contributes to that load and can exacerbate the progression of the disease and the pain associated with it.

There are certain foods with properties that help reduce inflammation and swelling that also have other benefits, such as heart health. Losing weight and eating foods that may alleviate symptoms will reduce the load on your joints. Combining this with a tailored exercise programme will give you the best chance of managing symptoms. This means an increase in energy and activity levels and an improved quality of life.

Empowering people to self-manage their symptoms will also have a positive effect on health services across the world.