Printer icon

Paleo and Osteoarthritis

Bones and joints

If we’re talking about diet and arthritis, the first thing to realize is that “arthritis” isn’t just one problem. Without even going into the different classifications in children, it has several different forms just in adults. A few of the most common are:

There are also a few other types, like infectious arthritis, but the three above are the most common. Considering that these three types of arthritis have very different causes, the potential ways of addressing them will obviously be different.

Since rheumatoid arthritis has an autoimmune component, anyone fighting it might be interested in Paleo approaches to autoimmune disease.

Gout has its own article – especially if you’ve been avoiding meat for fear of purines, this one might be an interesting read.

Osteoarthritis is a little different, though, because it’s usually treated as unavoidable. It’s just something you have to deal with: maybe you pushed it too hard on the soccer field in college, or you worked for 30 years as a carpet ripper and permanently damaged your hands. Take some ibuprofen and put a cold pack on it.

If that’s really true, though, then why do people report such dramatic success stories from switching to Paleo? Changing your diet didn’t rewind time and undo those 30 years of carpet ripping, so what gives? It’s hard to tell for sure, but here are some ideas and suggestions:

Paleo and Osteoarthritis

Weight Loss and Mechanical Stress

One of the most obvious reasons why Paleo might help with osteoarthritis is that weight loss reduces mechanical stress on your joints. More mechanical stress on the joints means more pain from the arthritis.

It’s pretty clear in clinical trials that if an arthritis patient is overweight to begin with, losing weight will help reduce pain – but the problem is that losing weight is extremely hard and keeping it off is even harder. In this study, for example, researchers tried to feed their study subjects (38 patients with arthritis) a special diet to see whether reducing BMI would improve symptoms, but the subjects either couldn’t or wouldn’t follow it.

Since Paleo is such a painless method of weight loss, it might help arthritis sufferers just by helping them drop some extra pounds.

Inflammation

olive oil

Anti-inflammatory fats like olive oil: a good idea for everyone, but especially arthritis!

Mechanical stress isn’t the only reason why weight loss can help improve arthritis, though. There’s an even more interesting line of research that goes into all the other ways obesity affects arthritis.

For example, the “more strain on the joints” explanation can’t tell us anything about why obesity is a risk factor for arthritis in the fingers, since even a morbidly obese person’s thumb doesn’t weigh that much more than a thin person’s. But obesity is a lot more than just extra fat tissue: it also involves systemic inflammation and usually various metabolic problems as well. It seems likely that the inflammation involved in obesity can independently contribute to arthritis – which means that the best weight-loss diet for reducing arthritis symptoms would not only be reasonably possible to stick with; it would also be anti-inflammatory.

This also fits with everything else we know about arthritis as an inflammatory disease. Even in people of completely normal weight, arthritis is still related to inflammation. As this study explains, systemic inflammation can change gene expression and cause arthritic changes in affected joints:

Inflammation is a major factor associated with the risk of both progression of cartilage loss and signs and symptoms of disease, including joint pain, swelling, and stiffness, indicators of synovitis.

This could happen in obese people thanks to the inflammation involved in obesity, or in thin people thanks to inflammation from another cause (e.g. autoimmune disease, chronic stress, overexercising, or an overload of Omega-6 PUFA).

If inflammation is important in the development of arthritis, you’d expect to find that anti-inflammatory interventions improve the symptoms – and that’s exactly what happens. Even though most of the research so far has been in rats and test tubes, anti-inflammatory Omega-3 fats and antioxidants are promising as therapies for osteoarthritis.

Diet and Arthritis: Summing it Up

If you put the two sections above together, the conclusion is simple: an ideal diet for osteoarthritis would be anti-inflammatory, reasonably possible for a normal human being to stick to, and effective for weight loss. It would probably…

Hey, has anyone heard of a diet like that?

Managing Pain Without NSAIDS

Even for someone at a healthy weight on a perfect, anti-inflammatory diet, arthritis can still be painful. It’s not because you’re doing anything wrong; it’s because you have a serious disease.

Unfortunately, most people’s first choice of pain management is some form of non-steroidal anti-inflammatory drug (NSAID), like ibuprofen. The problem with this is that ibuprofen is not doing your gut health any favors: in this study, for example, 71% of patients taking NSAIDs showed some sign of damage to the small intestine. Since gut health is so incredibly important for moderating inflammation, damaging your gut in an effort to manage an inflammatory disease like arthritis is a great way to shoot yourself in the foot.

Just for your reference, here’s a chart of which over-the-counter painkillers are and aren’t NSAIDs:

NSAIDs Not NSAIDs
Aspirin (Bayer)Ibuprofen (Advil, Motrin)Naproxen (Aleve) Acetaminophen (Excedrin, Tylenol)

Moderate exercise has also been shown to reduce pain and symptoms in some trials, and the familiar physical therapy standbys like hot or cold compresses are always worth a try.

Summing it Up

Osteoarthritis might be partly caused by previous physical stress (as in athletes), bad genes, or “just getting old.” But there’s also an inflammatory component that makes it a prime target for potential diet therapies.

It’s important to note that none of this can “cure” arthritis: arthritis has no cure. But what it does have are effective management strategies – and diet is definitely worth a try.