FOOD INTOLERANCE NETWORK FACTSHEET

line1

Joint pain, arthritis and diet

Introduction
Diet for joint pain and arthritis

Common myths
Salicylates in medication

Reader reports
The science
References
More information

Keywords: arthritis, joint pain, salicylates

line1

Introduction

Arthritis is inflammation of a joint. It can be associated with pain, swelling, reduction of mobility and possible structural damage to the joint. There are various forms of arthritis including:

  • osteoarthritis - associated with ageing
  • psoriatic arthritis - associated with the skin condition psoriasis
  • rheumatoid arthritis - an autoimmune disease
  • juvenile arthritis - diagnosed in children under 16, most likely to be rheumatoid arthritis
  • gout
     

Diet for joint pain and arthritis

While doctors don't usually recommend diet for arthritis, we have received many reports from readers of all ages with various forms of arthritis who have improved on failsafe eating, see reader reports below. Salicylates are the food chemical most commonly implicated, but any of the usual culprits can be involved (about 50 additives, other natural chemicals called amines and glutamates, dairy foods and wheat or gluten).

We recommend a trial of the RPAH elimination diet - free of additives and low in salicylates, amines and natural flavour enhancers, with optional avoidance of dairy foods and wheat or gluten, depending on severity of symptoms - to pinpoint exactly which food chemicals trigger your arthritis. For more information see our Introduction to Food Intolerance.

Common myths

Some common myths you will hear about diet and arthritis are listed below - like many myths, they are half right.

  • People with arthritis have to avoid high acid foods like tomatoes or oranges. Wrong. It is true that tomatoes and oranges can contribute to arthritis, but this seems to be because they contain salicylates, not because they are "acid foods".
  • People with arthritis have to avoid all the foods in the nightshade family (tomato, sweet pepper, eggplant, potato). Wrong. It is true that tomatoes, capsicums and eggplants can contribute to arthritis but this seems to be because they contain salicylates. Some varieties of potatoes (such as Sebago with white flesh, brown skin) are low in salicylates and suitable for arthritics when large, old and thickly peeled.
  • People with arthritis should avoid wheat and/or gluten. Wrong. It is true that wheat and/or gluten may contribute to arthritis in some people but not every arthritic has to avoid them. A trial of the RPAH elimination diet can pinpoint dietary triggers for each individual.
     

Salicylates in medication

Paradoxically, many medications used for joint pain contain salicylates that can make arthritis worse in a salicylate-sensitive person. Aspirin and other Non Steroidal Anti-Inflammatory Drugs (NSAIDS) should be avoided on a low salicylate diet. Salicylates are easily absorbed through the skin so over-the-counter topical medications - such as lotions and ointments - can also cause problems. Some NSAIDS such as ibuprofen (Nurofen), naproxen and diclofenac do not contain salicylates but can affect salicylate-sensitive people with cross-reactivity problems. See reader report below.

[474] Stiffness, aching joints and eczema aggravated by salicylates in heat rubs for join pain (November 2006)

We solved my father in law's severe eczema after visiting your website. Dermatologist couldn't cure his problem at all, and he was using Wintergreen and Deep Heat to relieve the joint pain symptoms. Since following the low salicylate diet, he is 100%. He cannot believe that the stiffness and aching joints, and the bad eczema have disappeared. - Annelize, NSW

Reader reports

See collection of all stories on these symptoms (including those below)

One-liners

My husband has severe and crippling arthritis - failsafe foods have given him relief and mobility. – by email, NZ [368] March 2005

I have osteo-arthritis which is much less painful if I adhere to the diet – if I inadvertently eat something that upsets me, I become overwhelmingly weary, my arthritis flares up and I can get bloating and irritable bowel symptoms. l often say in jest, " I cheat! I pay!" – by email, ACT [368] March 2005

My daughter was diagnosed with juvenile arthritis when she was three. By the time she went to school, at five, she was crippled with it. She's now 25. Three weeks after she started her elimination diet, she told me: "Mum, the pain's gone. For the first time in 23 years, I have no pain". - by email, NT [600] February 2008

My mother, grandmother and aunt all have arthritis. I've been failsafe for six years and I'm pretty sure if I wasn't failsafe I would have arthitis too, because I can notice my hands get stiff if I break my diet and eat too many salicylates. - by email, NT[600] February 2008

My 8 year old daughter has rheumatoid arthritis. It's hard to believe, after three weeks on failsafe foods, she is free of pain for the first time in years. - by email, NT [600] February 2008

[601] Bernard's arthritis story (February 2008)

The most remarkable story comes from Bernard in Wollongong. Now active and virtually arthritis-free, Bernard suffered from painful and crippling arthritis for nearly 30 years. In 1994, he was told that if his arthritis was not controlled by daily use of medication, he had 'only four or five years of active life left'. After extensive reading, Bernard opted to try an elimination diet against the recommendation of his specialist, and achieved remarkable results. He warns that arthritis sufferers may need extra time. Bernard wrote:

'If you think that the time span of the food effects on children and their behaviour is long you should try solving the rheumatic and inflammatory disease problem. You are looking at an abstinence time of up to 12 weeks before challenges, symptoms that could take more than a week to identify, and challenges that could take four months or more to complete. I am still improving after eight and a half years on low chemical foods. NOTHING will make me eat the foods I once loved so much.' ...

When Bernard challenged salicylates, on the morning of the eighth day he found his arthritis had returned with such a vengeance that it took him an hour to get out of bed. Artificial food colouring took two days to aggravate his arthritis.

After so many years of needless pain and suffering it is not surprising that Bernard and others like him feel angry about misinformation from experts. When a well-known Australian nutritionist wrote that there is no truth in the rumour that people with arthritis should not eat tomatoes, Bernard added his own comment: 'like hell there isn't!'

You can read about the effects of additives and natural chemicals in fruit and vegetables in Bernard's "My life with arthritis" story: "I have suffered with the pain and swelling of arthritis in my arms, hands, neck, back, legs and feet for almost half of my adult life. At times my condition was so bad that I was only able to walk about 50 metres without a rest. The constant pain I suffered was unbearable ... " on http://members.ozemail.com.au/~btrudget/.

[602] Aching joints began during pregnancy (February 2008)

I began the elimination diet after reading Fed Up with Asthma [now out of print, the asthma information from this book has been incorporated into the 2008 edition of Fed Up]. I was pregnant with our second child. My first pregnancy was fraught with pain from aching joints, hips especially, from which I d never suffered before. The pain was very great and continued after childbirth, though not troubling me much, just now and then. My joint movement continued to be impaired. In this pregnancy the pain began in the first trimester, whereas it had begun late in the previous pregnancy. I suffered much sleeplessness and worried how I would last 9 months like this. After 2-3 weeks on the diet (dairy and gluten-free as well) I no longer needed ventolin at all, just one puff daily of my preventer (I'd been using ventolin up to 8 times daily with little effect and 4 puffs of the preventer). Also, no joint pain at all, and the return of a normal range of joint motion. - Elizabeth, by email

[603] Arthritis started after a car accident (February 2008)

My arthritis started after a car accident at the age of 19, also ringing in the ears. The arthritis was to the point where I would soak my hands in hot water each morning to get them ok to work. Both my arthritis and ringing in the ears disappeared totally on failsafe, it was incredible. Four years on, it remains largely stable, is clearly affected by mainly salicylates and sulphites and to a lesser extent amines and MSG. Medication was generally ineffective. - by email, Qld

[605] Joint pain from intolerance to soy (February 2008)

I am soy intolerant. More specifically I suffer from a legume intolerance which is only now apparent after 13 years of suffering and frustration. My intolerance manifests itself in the form of hives, large red itchy welts that, in a severe attack can cover almost all of the body, be unbelievably itchy and uncomfortable to say the least. In my situation, my symptoms got worst and extended to lethargy, aching and swollen joints, sleepless nights and eventually an emotional feeling of hopelessness of ever being able to stop the relentless onslaught. See the rest of this story on the website - story [314]: "13 years of intolerance to soy"

[604] 'Awful joint pains' from salicylates in 'loads of fruit and veg' (February 2008)

From the age of 15 I slowly became more and more tired and foggy headed. Gradually I found it impossible to walk to school anymore, and regularly got 12 hours of sleep or more a night. I found out a few years ago that gluten does awful things to my energy levels and brain function, I wish I had known that when I was at school as I'm sure it held me back. In the last two months I was put on a rotation diet where I had to eat a huge variety of fruit and vegetables but could only have each every fifth day. I have NEVER felt so foggy headed, had such blurry vision or had such awful joint pains. All from eating loads of fruit and veg. Consequently, I have high hopes for Failsafe!

[877] 621: Juvenile Rheumatoid Arthritis – pain free when avoiding MSG (November 2009)

SUCCESS!!! Our 12 year old daughter with Juvenile Rheumatoid Arthritis is pain free!!

We have finished all challenges on the elimination diet and have discovered glutamates - MSG and all 600 numbers to be extremely bad for our daughter with arthritis. Within 8 to 12 hours of having MSG our daughter went from no pain to all the symptoms of arthritis, swollen joints, very sore, trouble walking, and lots of pain. We continued the challenge for 48 hours and by then she had problems with all her joints, soreness, swelling and was absolutely miserable! Within 12 hours of stopping MSG her symptoms settled and she was back to "normal" – no pain! We now totally avoid MSG, all 600 numbers and unspecified 'flavour' listed on any product!

It has been 7 months now since we began the elimination diet and took our daughter off all arthritis medication. She is fantastic! We had a check up with the rheumatologist recently and she was amazed. We don't need to see her for another 6 months and she has classed our daughter as "in remission"!!!! No pain, No symptoms and No medication!

I hope this is of assistance to other sufferers of arthritis! It has made a huge difference to our daughter's life. Thank you for your wonderful information, without this we would be further down the track of a life of pain, misery and medications with nasty side effects for our daughter. To look at our daughter now, you would never know that she suffers from a chronic, debilitating condition, she is full of energy and her love for life is back again!

We completed all food challenges in this order: milk, wheat, bread, salicylates, amines, MSG, propionates, sorbates, antioxidants, colours, benzoates, nitrites and sulphites (all food not capsules). The only challenge our daughter reacted to was MSG, 600 numbers and naturally occurring glutamates. She had no reaction to any other challenge. Once we had completed all the challenges we challenged tomatoes, broccoli and those foods high in natural glutamates separately. She came out in an itchy rash if she ate too many tomatoes or broccoli (at least 6 to 8 serves a day) but the amazing thing for us was that she didn't have joint pains. We are tending to think that manufactured MSG must contain VERY HIGH levels of glutamic salt compared to those foods that have it naturally occurring such as tomatoes and broccoli. We have now restricted how much she has of these things. She is very good at knowing what she can and can't have. She reads labels everywhere, even when she stays over at friends or goes to birthday parties, she will read labels and decide if she can have it or not. We always send her with plain chips and 'safe' snacks for a party. Her friends have been very supportive and know that she can have plain hot chips at a party instead of pizza or party pies.

We saw the dietitian you recommended. She was very helpful, knowledgeable and thorough in what quantities etc to challenge. She was very interested in the results. She suspected MSG from early on because we had commented on how over the Christmas holidays (before elimination diet), our daughter had eaten CC's and was so sore the next day she could hardly walk. We kept a daily food diary and I also kept a dated scrap book with labels of products we had eaten so I could check back as a reference if needed.

For the MSG challenges we used "Coles Farmland" packet chicken noodle soup, about 500 mls to a litre a day (contains 621, 627 and 631) and soy sauce about 4+ tablespoons a day. (Need to check labels for soy sauce because not all list MSG or 600 numbers).

We are amazed at how many foods with unspecified 'flavour' (but no MSG or 600 numbers listed) affect her. We have found this with tomato soups, tomato pastes etc where they list 'flavour' and our daughter has been sore after having this. We have completed our own challenge with some of these products and her reaction varies. We avoid any savoury type products that have 'flavour' listed with no specific ingredient numbers on labels. The unknown is not worth the soreness for our daughter.

Foods previously eaten which we avoid completely now include: All packet soups, cup of soups, packet stocks, stock cubes, any chips or corn chips that have a flavour, BBQ shapes and all shape/savoury biscuits with flavour, tomato and BBQ sauce, some mayonnaise and dressings, packet pasta mixes (ie continental pasta packs), sausage rolls, pies, breads with savoury toppings, pizza, concentrated tomato paste, tomato soup - most have unspecified 'flavour' - and lots of other savoury foods. We never used to eat a lot of these foods, but even having things once to twice a week was enough to have our daughter in continuous pain.

She now is totally pain free, medication free and living a very active, sporting life. She plays netball weekly, has participated in the school athletics and cross country team this year and is currently in weekly training with the school volley ball team to go to Nationals in December. All of these activities were completely impossible 12 months ago! The difference is amazing! We are so thankful that your website and information has led us to finding an alternative to medication, and a way to manage our daughter's condition and allow her to live a very active life. I hope that there will be others out there that will try the elimination diet and find an alternative to medications and a life of chronic pain. - Sandra, Vic

[846] Pain like gout from milk (August 2009)

I have written before about my husband drinking milk and getting a pain like Gout in his foot. Now we just have A2 milk but he had a coffee one morning with Woolies Lite Milk (that’s all he could get and left the A2 for the kids) still got a pain in his foot, next time tried with A2 and didn’t have any pain. Tracey, by email (The medical recommendation for gout used to be avoidance of purine-containing foods - essentially failsafe foods with a few exceptions - but this has been disproved. I wonder whether gout is just another symptom of food intolerance because failsafe families often report the father’s gout improved when they changed their diet. I’d love some more reports: This email address is being protected from spambots. You need JavaScript enabled to view it.)

[966] Gout, red meat and the elimination diet (October 2010)

My husband and I have been doing the elimination diet for two weeks now. We are both feeling great, our tummies are not bloated, we are not sour in the stomach in the morning. Another thing that we are so pleased about! My husband can suffer with gout, if he has any red meat. There are also other triggers for him, but the red meat is really the big one. Over the past weekend, we were at friends, and enjoyed some beef and lamb (only seasoned with salt). I knew that we were pushing the boundaries, but I checked with my husband this morning, and there has been no sign of gout at all! Thank you. Things are really going well. - Carla, NT

FROM [964]

My husband is an amine responder and reacts to chocolate with gout like symptoms - Rose, WA

[965] Gout and salicylates (October 2010)

My partner's uncle tells me he used to be addicted to tomato sauce and had to give up because it was causing his bouts of gout.Now he longer gets it unless he goes to Fiji, which he does quite regularly, where he eats a lot of curry (so obviously salicylate related).He had no idea about the connection. Cherie (gout has been associated with low dose salicylates in medication, as shown in a paper available on PubMed)

The science

Scientists have been researching diet and arthritis for over 50 years using a wide range of diets. However, as with the diet-behaviour connection, most studies didn't eliminate enough foods, produced confusing and conflicting results, and seemed to suggest that only a few arthritis patients may benefit from diet.

Total fasting for 7-10 days has been found by many researchers to be an effective treatment for rheumatoid arthritis [2]. This would appear to confirm the food connection. However, the beneficial effects wear off when foods are reintroduced. From our point of view, this could be because fruits (salicylates) are considered to be very safe and are usually some of the first foods reintroduced or because other problematic foods are reintroduced.

An elemental diet is a simple liquid diet consisting of nutrients including amino acids, carbohydrates, vitamins, minerals, and fat (such as Neocate). This means that elemental diets may be free of additives and low in salicylates, dairy and gluten. Elemental diets have been found to effective at reducing a number of symptoms of arthritis. [3-6]. When researchers compared the effectiveness of an elemental diet to medication during a two week trial, they concluded that the elemental diet was as effective as oral prednisolone [3]. However, as with fasting, problems arise when normal foods are reintroduced. From our point of view, as with total fasting above, this is could be because fruits (salicylates) are considered to be very safe and are usually one of the first foods reintroduced, or because of some other foods. It’s a pity that foods aren’t reintroduced according to the RPAH challenge protocols.

In 2002, an American study showed that patients with moderate to severe rheumatoid arthritis who switch to a very low fat vegan diet could experience significant reductions in their arthritic symptoms within 4 weeks [7].  Lead author Dr John McDougall suggests that this diet works for about 70% of rheumatoid arthritis sufferers -   http://www.drmcdougall.com/med_hot_arthritis.html
 
Since a vegan diet can be very high in salicylates, we wonder whether the 30% for whom it doesn’t work could be salicylate-sensitive.  More recently, weight loss has been found to contribute to improvement in arthritic symptoms. It is possible to combine a low fat vegan diet with failsafe, see our failsafe weightloss factsheet.

 

Scientific references

1.Jenkins C and others, Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ. 2004 ;328(7437):434. 6-7. http://www.ncbi.nlm.nih.gov/pubmed/14976098

Researchers found that aspirin sensitivity in asthmatic adults was more prevalent than previously thought (about 20%) and that the majority of salicylate sensitive asthmatics demonstrated cross sensitivity to ibuprofen, 98%; naproxen, 100%; and diclofenac, 93%, whereas the incidence of cross sensitivity to paracetamol was only 7%. Although this study is about asthmatics, our experience suggests that the figures seem to apply to anyone who is sensitive to salicylates.

2.Sköldstam L, Magnusson KE. Fasting, intestinal permeability, and rheumatoid arthritis. Rheum Dis Clin North Am. 1991;17(2):363-71.

A review of 7-10 day fasting for otherwise healthy and well-nourished patients with rheumatoid arthritis concluded that fasting results in significant clinical improvement that are lost eating is taken up again. http://www.ncbi.nlm.nih.gov/pubmed/1862245

3.Podas T and others, Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone. Postgrad Med J. 2007;83(976):128-31.

This study from Leicester General Hospital UK found that an elemental diet for 2 weeks resulted in a clinical improvement in patients with active rheumatoid arthritis that was as effective as a course of oral prednisolone 15 mg daily in improving subjective clinical parameters. Researchers concluded that "this study supports the concept that rheumatoid arthritis may be a reaction to foods". http://www.ncbi.nlm.nih.gov/pubmed/17308218

4.Holst-Jensen SE and others Treatment of rheumatoid arthritis with a peptide diet: a randomized, controlled trial. Scand J Rheumatol. 1998;27(5):329-36.

Thirty Danish patients with rheumatoid arthritis followed an elemental diet for four weeks compared to a control group on normal foods. One patient experienced longterm clear remission and two patients dropped out. For the others there were significant improvements in some symptoms for the duration of the elemental diet that did not continue with introduction of normal foods. http://www.ncbi.nlm.nih.gov/pubmed/9808394

5.Kavanaghi R and others.The effects of elemental diet and subsequent food reintroduction on rheumatoid arthritis. Br J Rheumatol. 1995;34(3):270-3.

In this study with 24 patients at Addenbrooke's Hospital, Cambridge, UK, an elemental diet was supplemented with a small number of foods. There was a high drop out rate and initial improvements were not maintained after introduction of foods. http://www.ncbi.nlm.nih.gov/pubmed/7728405

6.Haugen MA and others. A pilot study of the effect of an elemental diet in the management of rheumatoid arthritis. Clin Exp Rheumatol. 1994;12(3):275-9.

In Norway, this controlled study compared an elemental diet with ten patients with a prepared soup from fresh additive free foods for seven controls for three weeks. In the 4th week, patients resumed their normal diet. There were some improvements in both groups. Researchers concluded that that some rheumatoid arthritis patients may respond to the elimination of offending food items. http://www.ncbi.nlm.nih.gov/pubmed/8070160

7.McDougall J et al, Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8(1):71-5.

This study evaluated the influence of a 4-week, very low-fat (approximately 10%), vegan diet on 24 free living subjects with rheumatoid arthritis, average age  56 +/- 11 years. All measures of RA symptomatology decreased significantly, except for duration of morning stiffness. Weight also decreased significantly http://www.ncbi.nlm.nih.gov/pubmed/11890437
 
8. Jacobs CL, Stern PJ. An unusual case of gout in the wrist: the importance of monitoring medication dosage and interaction. A case report. Chiropr Osteopat. 2007 Oct 9;15:16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174925/?tool=pubmed

 

Further information

Introduction to food intolerance

We recommend a trial of the RPAH elimination diet - free of additives, low in salicylates, amines and flavour enhancers, and with optional removal of dairy foods and wheat or gluten, depending on severity of symptoms - preferably supervised by a dietitian. Write to This email address is being protected from spambots. You need JavaScript enabled to view it. for our list of supportive dietitians, and see Failsafe Eating.

www.fedup.com.au

The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians 

© Sue Dengate update August 2013

line1