Foods and Arthritis

The Physicians Committee

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Foods and Arthritis

Millions of people suffer from painful and swollen joints caused by arthritis. Unfortunately, health care providers often don’t discuss diet change with patients who have arthritis. This is likely because older research, which tested diets with dairy products, oil, poultry, or meat, showed little benefit.[1],[2] Now, though, research shows that foods can play a substantial role in arthritis. It is clear that, at least for some people, a healthier menu is the answer.

Different Types of Arthritis

Arthritis is actually a group of several diseases. Osteoarthritis is a gradual loss of cartilage and overgrowth of bone in the joints, especially the knees, hips, spine, and fingers. More than 20 million Americans, mostly over age 45, suffer from osteoarthritis as a result of accumulated wear and tear. The condition typically develops gradually and can cause pain and stiffness, although it typically does not does not cause major interference with the use of the hands.

Rheumatoid arthritis (RA), which affects more than 2 million people, is a more aggressive form of the disease. It causes painful, inflamed joints, and can result in permanent damage. Rheumatoid arthritis is one of medicine's mysteries. The disease does not appear in medical reports until the early 1800s, and some suspect that a virus or bacterium may play a role by setting off an autoimmune reaction. Certain genes also make some people more likely to develop RA.

The Role of Diet

For years, many have suspected food plays an important role in the development of RA in particular. Some people notice improvements when they avoid dairy products, citrus fruits, tomatoes, eggplant, and certain other foods.

Initially, these claims relied on anecdotal evidence. A woman from the Midwest once suffered from painful arthritis. After removing dairy from her diet, she became the picture of health: slim, athletic, and free from arthritis.

Another woman, from Wisconsin, also found a clear link between dairy consumption and her arthritis. Although raised on a dairy farm, she learned that avoiding dairy products relieved her symptoms.

A survey of more than 1,000 arthritis patients revealed that red meat, sugar, fat, salt, caffeine, and nightshade plants (e.g., tomatoes, eggplant) most commonly worsen the condition.[3] Once someone eliminates the offending food completely, symptoms typically improve within a few weeks. Research shows that dairy protein may exacerbate symptoms, so skim milk and low-fat dairy products are as much a problem as whole milk.[4]

While not all research has found a connection between food and arthritis,[5] a number of studies show that dietary changes can help relieve symptoms. For example, one study looked at the effects of a very low-fat vegan diet on people with moderate-to-severe RA. After only four weeks on the diet, people had significant improvements in morning stiffness, RA pain, joint tenderness, and joint swelling.[6] Another study, published in Rheumatology, found a gluten-free, vegan diet improved the signs and symptoms of RA.[7] Following a raw vegan diet rich in antioxidants and fiber can also decrease joint stiffness and pain in patients with RA.[8] And a systematic review concluded that fasting followed by a vegetarian or vegan diet might be useful in the treatment of RA.[9]

People with osteoarthritis can also benefit from dietary changes. A 2015 study found that people eating a whole-food, plant-based diet significantly decreased their osteoarthritis pain—in just two weeks. By the end of the six-week study, they reported more energy and better physical functioning, too.[10]

Why might these benefits occur?

Vegan diets are often lower in fat and contain different kinds of fat than diets containing animal products. For example, many whole plant foods have an optimal ratio of omega-6 to omega-3 fatty acids. Vegan diets are also typically low in saturated fat. These changes in the amount and type of fat eaten are anti-inflammatory. Healthful weight loss that results from eating a healthy vegan diet is also anti-inflammatory, further helping cool irritated joints.

Another problem with diets containing animal products is that meats can supply an overload of iron. Too much iron triggers production of dangerous free radicals—basically causing “rusting” inside the body. In fact, excess free radicals can attack the joints and even contribute to heart disease and cancer.

Vegetables and beans, on the other hand, contain ample iron, but in a form the body absorbs only when needed.

Moreover, fruits and vegetables like berries, tropical fruits, and leafy greens contain antioxidants like vitamins C and E to keep free radicals in check. Interestingly, some arthritis medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs), work at least partly in the same way: by neutralizing free radicals.[11]

The Four-Week Anti-Arthritis Diet (adapted from Foods That Fight Pain, by Neal Barnard, M.D.)

For four weeks, include generous amounts of foods from the pain-safe list in your routine.

At the same time, avoid major triggers. It is important to avoid these foods completely, as even small amounts may cause symptoms.

Foods that are not on either list can be consumed, so long as you focus on arthritis-safe foods and scrupulously avoid the major triggers.

You may well start feeling better earlier than four weeks, but it often takes at least four weeks  for chronically inflamed joints to begin cooling down.

Pain-Safe Foods (table format)

Pain-safe foods virtually never contribute to arthritis or other painful conditions. These include:

  • Brown rice
  • Cooked or dried fruits: cherries, cranberries, pears, prunes (but not citrus fruits, bananas, peaches, or tomatoes)
  • Cooked green, yellow, and orange vegetables: artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, summer or winter squash, sweet potatoes, tapioca, and taro (poi)
  • Water: plain water or carbonated forms, such as Perrier, are fine. Other beverages—even herbal teas—can be triggers.
  • Condiments: modest amounts of salt, maple syrup, and vanilla extract are usually well-tolerated.

After four weeks, if your symptoms have improved or disappeared, the next step is to nail down which one or more of the trigger foods caused your problem. Simply reintroduce the foods you have eliminated back into your diet one at a time, every two days.

Have a generous amount of each newly reintroduced food, and note if your joints flare up again. If so, eliminate the food that seems to have caused the problem, and let your joints cool down again. Then continue to reintroduce the other foods. Wait at least two weeks before trying a problem food a second time. Many people have more than one food trigger.

It is not recommended to bring meats, dairy products, or eggs back into your diet, as many cite these foods as major triggers. Other research shows links between meat, dairy, and eggs and hormone imbalances that may contribute to joint pain and other health problems.

Avoid Major Arthritis Triggers (table format)

  1. Dairy products*
  2. Corn
  3. Meats**
  4. Wheat, oats, barley, rye
  5. Eggs
  6. Citrus fruits
  7. Potatoes
  8. Tomatoes
  9. Nuts
  10. Coffee

*All dairy products should be avoided: skim or whole cow’s milk, goat’s milk, cheese, yogurt, etc.

**All meats should be avoided: beef, pork, chicken, turkey, fish, etc.

Other Approaches

The first line of defense in arthritis is a lower-fat, plant-based diet with plenty of fruits and vegetables, and medications as prescribed by your health care provider.

However, some studies suggest that supplementing with the omega-3 fats DHA and EPA may help people with rheumatoid arthritis. If you wish to try omega-3s, look for a vegan DHA/EPA supplement (made from algae) with no more than 2 grams of DHA/EPA combined. High omega-3 intakes can increase bleeding risk and interact with some medications, though, so check with your health care provider before using.[12]

Limited research also suggests that curcumin, found in turmeric, may help ease osteoarthritis pain. Until more data is available, we suggest seasoning food, such as chili, soup, and curries, with turmeric instead of using supplements.[13]


[1] Panush RS, Carter RL, Katz P, Kowsari B, Longley S, Finnie S. Diet therapy for rheumatoid arthritis. Arthritis Rheum. 1983;26:462-471.

[2] Lithell H, Bruce A, Gustafsson IB, et al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol. 1983;63:397-403.

[3] Sobel D. Arthritis: What Works. New York, NY: St. Martin's Press; 1989.

[4] Sköldstam L, Larsson L, Lindstrom FD. Effects of fasting and lactovegetarian diet on rheumatoid arthritis. Scand J Rheumatol. 1979;8:249-255.

[5] Smedslund G, Byfuglien MG, Olsen SU, Hagen KB. Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc. 2010;110:727-735.

[6] McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8:71-75.

[7] Hafström I, Ringertz B, Spångberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford). 2001;40:1175-1179.

[8] Hänninen, Kaartinen K, Rauma AL, et al. Antioxidants in vegan diet and rheumatic disorders. Toxicology. 2000;155:45-53.

[9] Müller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001;30:1-10.

[10] Clinton CM, O'Brien S, Law J, Renier CM, Wendt MR. Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis. Arthritis. 2015;2015:708152-708161.

[11] Merry P, Grootveld M, Lunec J, Blake DR. Oxidative damage to lipids within the inflamed human joint provides evidence of radical-mediated hypoxic-reperfusion injury. Am J Clin Nutr. 1991;53:362S-369S.

[12] Omega-3 Fatty Acids. National Institutes of Health Office of Dietary Supplements website. Available at: Updated November 2, 2016. Accessed December 21, 2017.

[13] Turmeric. National Center for Complementary and Integrative Health website. Available at: Updated September 2016. Accessed December 21, 2017.

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