The Role of Nutrition in Osteoarthritis Symptom Management
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In honor of National Nutrition Month in March, we at Mangiarelli Rehabilitation recognize the role that nutrition can play in managing osteoarthritis symptoms. Osteoarthritis (OA) is the most common form of arthritis and involves the breakdown of cartilage around joints, causing inflammation, pain, and swelling. A balanced, nutritious eating plan that includes whole foods like fruits, vegetables, and lean protein, and is rich in antioxidants and omega-3 fatty acids provides the body the nutrients it needs to prevent further damage to joints and improve OA symptoms. Combining targeted physical therapy with a whole-food nutritious diet can improve osteoarthritic symptoms and enhance OA patients’ overall quality of life, function, and mobility.
What is Osteoarthritis?
Osteoarthritis is the most common form of arthritis, affecting over 32.5 million adults in the United States, and is the leading cause of disability. With osteoarthritis, the cartilage around joints breaks down, causing the bones to rub together and resulting in inflammation, pain, and swelling. It commonly affects the knee, hands, spine, and hips. Symptoms can include stiffness in the affected joint in the morning or after prolonged sitting, pain during activity, locking or catching in the joint, inflammation, swelling, and redness around the joint, increased bone growth at the joint, and cracking, creaking, or crunching noises in the joint.
Osteoarthritis can develop during older age due to natural degeneration and aging of cartilage but can also occur due to a past injury to the joint or sports and occupations that place excessive stress on the joint. There are also lifestyle factors that can contribute to the development of osteoarthritis. Obesity can increase the strain on weightbearing joints and contribute to low-grade systemic inflammation, which can exacerbate osteoarthritis symptoms. Type 2 diabetes and high cholesterol are also risk factors for developing osteoarthritis. A diet high in processed foods, sugars, and omega-6 fatty acids can also increase inflammation in the body and contribute to osteoarthritis development.
Role of Nutrition in Osteoarthritis Management
Your diet and nutrition can help you manage inflammation associated with arthritis and improve symptoms. A balanced, nutritious eating plan that includes whole foods like fruits, vegetables, and lean protein and is rich in antioxidants and omega-3 fatty acids provides the body the nutrients it needs to prevent further damage to joints.
Diets with higher inflammatory potential are linked to accelerated OA progression or incidence of symptomatic OA. The Western diet is high in saturated fats and refined carbohydrates, which is strongly correlated with OA symptoms. The Western diet tends to have a high ratio of omega-6 to omega-3 fatty acids, which predisposes people to inflammation. In fact, OA joints can accumulate high levels of inflammatory omega-6 fatty acids, and an increase in omega-6 fatty acid intake has been associated with synovial inflammation and cartilage deterioration among obese individuals.
Recommended foods from the Mediterranean diet to add to your eating plan include:
Omega-3 rich foods, particularly oily fish, such as salmon, herring, mackerel, sardines, or trout. You can also supplement with fish oil.
Extra virgin olive oil, which contains high levels of oleocanthal, which is anti-inflammatory and antirheumatic.
Dark leafy greens, which are rich in vitamins A, C, and K and calcium and contain stress-fighting phytochemicals and antioxidants: spinach, kale, Bok choy, Swiss chard, collard greens, Brussel sprouts, and broccoli. Broccoli contains a compound called sulforaphane, which is thought to possibly slow the progression of OA.
Dairy contains calcium and vitamin D to strengthen your bones as well as protein which can help to build muscle: milk, Greek yogurt, and cheese.
Nuts & seeds, such as almonds, walnuts, pine nuts, and pistachios, are heart healthy and contain high levels of calcium, magnesium, zinc, vitamin E, fiber, and ALA. ALA can boost immune system function.
Beans, such as small red beans, pinto beans, and kidney beans, are loaded with fiber and phytonutrients that can help lower CRP, which is an indicator of inflammation in the blood.
Whole grains like quinoa, brown rice, oatmeal, and whole-wheat flour, contain fiber, which is beneficial for your gut health.
Garlic contains a compound called diallyl disulfide, which may work against enzymes in the body that damage cartilage. One study found that a diet rich in garlic and other alliums can protect against OA.
Green tea contain high levels of polyphenols, which are antioxidants that can reduce inflammation and slow the rate of cartilage damage.
Fruits, such as cherries, strawberries, raspberries, blueberries, and blackberries, are filled with antioxidants, which are the body’s natural defense system to help neutralize unstable molecules (free radicals) that can damage cells. Citrus fruits such as oranges, limes, and grapefruits are also rich in vitamin C, which helps prevent inflammation and maintains healthy joints.
It’s important to reduce inflammatory foods in your diet, such as processed sugars, saturated fats, and refined carbohydrates. Processed sugars like soda, sweet tea, or flavored coffee release inflammatory cytokines which can increase inflammation in the body. Saturated fats like fatty meats (bacon/sausage), cream, chocolate, and cakes cause inflammation in fatty tissue and can worsen or speed up the progression of OA. Refined carbs like white bread, white rice, and potato chips can also stimulate inflammation.
Research has shown that the Mediterranean diet can improve OA-related outcomes, improving pain, stiffness, and inflammation as well as biomarkers for cartilage degeneration. In a 2023 metanalysis, patients reported a decrease in OA impact and disability as well as improved knee and hip ROM while adhering to the Mediterranean diet. They also experienced decreased pain, decreased biomarkers of cartilage degradation, and decreased inflammatory biomarker levels.
Further research has noted the benefits of certain foods and vitamins for OA, such as Vitamin D and K, ginger, and turmeric, which are associated with improvements in OA symptoms and quality of life. Ginger contains compounds that reduce the expression of cytokines, which are tied to inflammation. Vitamin D plays an important role in building strong muscles, teeth, and bones and increasing calcium absorption. Researchers have noted that OA worsens three times faster in individuals with inadequate vitamin D in their diet compared to those who have sufficient vitamin D. Researchers have found that vitamin K can help in OA prevention and that supplementation with vitamin K can prevent joint space narrowing in individuals with a vitamin K insufficiency. Vitamin E, C, and curcumin have been shown to improve osteoarthritis symptoms by counteracting oxidative stress.
Physical Therapy Support for Osteoarthritis Patients
Physical therapy-led exercise programs can help patients with osteoarthritis manage pain, improve function, move safely, and slow the progression of the disease. Targeted exercise can improve OA-related outcomes through weight management and reduced joint loading, decreased systemic inflammatory biomarkers that are linked to degeneration of cartilage, and sufficient and proper loading of the articular cartilage, which is key for maintaining tissue health. Early physical therapy has been shown to improve the function and quality of life in patients with OA.
Physical therapy treatment for osteoarthritis can include:
Pain management using ice and heat to manage swelling and pain
Low-impact aerobic exercise to improve overall fitness
Targeted strengthening of the muscles around the affected joint to increase joint stability and mobility
Balance and gait training
Posture training to minimize stress on arthritic joints
Manual therapy soft tissue and joint mobilizations to gently increase joint mobility
Aquatic therapy, which allows patients to exercise in water with decreased stress on their joints
Lifestyle education on nutrition, regular movement, supportive footwear, and protecting the joint during daily activities
Combining targeted physical therapy with a whole-food nutritious diet can improve osteoarthritic symptoms and enhance OA patients’ overall quality of life, function, and mobility.
