The right diet to tackle osteoarthritis

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Brand-new research brings hope that what you eat can ease your pain

If you thought the last word on osteoarthritis was, "Pop painkillers and suffer," you haven't been talking to the right sources. Our sources--cutting-edge researchers in the field--tell us they're more and more convinced that how you eat can really make a difference. Ready to relieve your aching joints? Listen up. ...

RUBBING YOU THE WRONG WAY
Where two bones come together, you have a joint. And if the joint is healthy, the ends of those bones should be covered with a resilient padding--called cartilage --that reduces friction and absorbs shock as you move about. But for nearly 16 million Americans with osteoarthritis (OA), the cartilage in certain joints begins to deteriorate, sometimes wearing away entirely. Why this happens is still uncertain, though heredity is thought to be part of the cause.

The outcome, unfortunately, is less uncertain. When poorly padded bones rub together, pain results. Joints affected most by OA seem to be hands, hips and knees--usually resulting in the most disabling form of OA. Sometimes inflammation and swelling accompany the pain. Another common consequence is stiffness and loss of mobility, as sufferers avoid activity in an attempt to avoid the hurt.

TAKING THE BURDEN OFF
Now, thanks to a brand-new study, there's growing confidence among OA experts about the most effective dietary strategy to soothe your joints: If you're beyond a healthy weight (as many OA sufferers are), try losing a few pounds, especially through a combination of diet plus exercise.

Look what happened to 48 overweight postmenopausal women with knee osteoarthritis who participated in a just-announced diet-exercise trial at the University of Maryland School of Medicine,College Park. After 6 months of walking on a treadmill 3 times a week (up to 45 minutes per session) and following a reduced-calorie, low-fat diet, the women lost an average of 15 1/2 pounds each.

And here's the key payoff: They had much less knee pain. Using a reliable measure called the WOMAC pain score, 40% of the women reported only half as much pain. A third of the women experienced a 50% improvement in functions such as walking up stairs and getting in and out of cars. And compared to the beginning of the study, on average, the women walked 12% farther on a 6-minute walking test (annual meeting of the American College of Rheumatology, Orlando, FL, October 1996).

More good news: There's evidence that losing even less weight may be enough to relieve pain. In a study last year at Bowman-Gray School of Medicine of Wake Forest University, NC, men and women over age 60 with knee OA lost an average 19 pounds over 6 months with a diet-and-exercise combo. Again pain declined, performance improved. "But some people who lost only 10 pounds experienced as much improvement in pain and disability as those who lost much more," says researcher Walter Ettinger, MD (annual meeting, American College of Rheumatology, San Francisco, October 1995).

Why does losing just a few pounds seem to help so much? Rheumatologist Marc Hochberg, MD, who headed the University of Maryland study, explains it this way: When you walk, with each step your knee absorbs a force equal to about three times your body weight. So losing even 10 pounds actually relieves each knee of more like a 30-pound load with every stride.

Can losing weight help in more ways than reducing pressure? Maybe. "It's well-known that being overweight raises the risk of getting OA in the first place. But why do obese women get more osteoarthritis of the hand, an area that wouldn't be stressed from being overweight?" asks researcher David Felson, MD, of Boston University School of Medicine. "Perhaps," he suggests, "obesity in itself exerts some metabolic influence on bone and cartilage."

Bottom line: If you're overweight and have OA, lose at least 10 pounds. Dr. Hochberg stresses it's critical to both exercise and cut calories to lose weight. "Studies show the combo is more effective for losing weight. Plus we know sticking with exercise helps keep weight off for the long haul." (Before starting an exercise program, check with your doctor to find out how much exercise is safe for you.)

If you weigh 175 pounds and you walk on a treadmill at a very easygoing 2 miles per hour for half an hour three times a week, you'll burn about 360 calories.

Then, on the diet front, just cut back 150 calories a day (for a total of 1,050 a week). With this combination, you should be 10 pounds lighter in 6 months.

A VITAMIN C CONNECTION
For 10 years, researchers have kept track of 640 residents of Framingham, MA, who have OA, including recording what they ate. Turns out those getting the most vitamin C had a threefold reduction in OA progression--meaning they lost less knee cartilage over time--compared with those getting the least vitamin C (Arthritis and Rheumatism, April 1996).

"Vitamin C may help because it plays a role in making collagen, a material necessary for repairing cartilage," says Boston University's Tim McAlindon, MD, lead researcher of the study. He notes that people getting the middle range of vitamin C daily (about 150 to 175 milligrams--an amount easy to get with food) had the same reduced risk of OA progression as those taking the most vitamin C (430 to 500 mg.). His conclusion? Just in case vitamin C is simply a marker for fruits and vegetables rich in other healing compounds, it's best to stick with foods high in vitamin C.

Bottom line: Eat at least 5 servings of fruits and vegetables daily, making sure to include rich sources of vitamin C. December's one of the best times of year to do that, with citrus season in full swing.

If you live east of the Mississippi, look for an unexpected source of vitamin C in specially bred fresh pineapples called Del Monte Gold. One cup of Del Monte Gold pineapple (about 2 slices) has 60 mg. vitamin C, compared with 15 mg. for regular pineapple. Delicious bonus: Del Monte Gold pineapple tastes extra sweet, too. See "Serving Up Vitamin C" on p. 70 for top sources.

A ROLE FOR VITAMIN D
Another new finding from the Framingham study offers one more potential clue to slowing OA with diet: getting at least 360 international units of vitamin D a day. People with vitamin D intakes less than this level were about three times more likely to have progression of knee OA (Annals of Internal Medicine, September 1996).

How might vitamin D help slow OA? It's known to play a role in keeping bone healthy. Dr. McAlindon notes that once OA breaks down cartilage in a joint, the underlying bone is subjected to greater stress. Low levels of vitamin D may impair the ability of bone to respond to this increased wear and tear.

Bottom line: One way to ensure you consume enough vitamin D per day is to look for a multivitamin with 400 I.U. (equal to 100% Daily Value). The only other substantial dietary sources of vitamin D: 1 cup of any type of milk has 100 I.U. (25% DV); 1/3 cup of nonfat dry milk has 100 I.U.; some breakfast cereals are fortified with 40 I.U. per serving (10% DV). Experts recommend getting no more than 800 I.U. of vitamin D on a regular basis.

MAKE IT A JOINT EFFORT
Though we'll need more studies to confirm the benefits of losing weight and especially of getting enough vitamins C and D, why wait to start? We already know these measures boost your health in plenty of other ways. But suffering less OA pain--now and years down the road--could be your most welcome reward of all.

REPRINTS OF ARTHRITIS ARTICLES NOW AVAILABLE

Do you have arthritis or know someone who does? Why not get Prevention's newest reprint, which includes this month's "The Right Diet to Tackle Osteoarthritis" and last month's feature "Tackle Arthritis With a Knife and Fork." To order, send your check or money order for $5 to Prevention's Arthritis Reprint, Dept. 126A, 33 E. Minor St., Emmaus, PA 18098.

SERVING UP VITAMIN C

FOOD VITAMIN C (mg.)

1 guava 165
1 sweet red pepper 141
1 c. fresh-squeezed
orange juice 124
1 c. cranberry juice
cocktail 108
1 c. orange juice
from concentrate 97
1 c. papaya 87
1 c. strawberries 85
1 c. grapefruit juice
from concentrate 83
1 c. raw broccoli 82
1 kiwi 75
1 orange 70
1 c. cantaloupe cubes 68
1 sweet green pepper 66
1 c. Del Monte Gold
pineapple 60
1 mango 57
1 c. raw cauliflower 46
1/2 grapefruit 41
PHOTO (COLOR): Woman on treadmill

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By Janis Jibrin, MS, RD and research assistance from Gloria McVeigh

ADDITIONAL SOURCE: Howard Sauberlich

Howard Sauberlich, PhD, is a professor of nutrition, University of Alabama, Birmingham.

CAN YOU `B' HAPPY?
Could two B vitamins--B12 and folic acid--work better than drugs on your osteoarthritis? That's what one small yet promising study we reported on in January, 1995, hints. Researcher Margaret Flynn, PhD, RD, professor emeritus at the University of Missouri, gathered a group of 26 patients with OA of the hand and took them off all nonsteroidal inflammatory drugs for pain. Patients were allowed the milder OTC medicine acetaminophen, as needed. Dr. Flynn found that patients taking 20 micrograms of B12 plus 6,400 mcg. folic acid for 2 months had the same grip strength but fewer tender joints compared with when they started the study and compared with when they took just folic acid or a placebo for 2 months. Some patients on the combo of B12 and folic acid were able to decrease their acetaminophen dose (American Journal of Clinical Nutrition, August 1994).

To evaluate this very preliminary finding, we went to Ronenn Roubenoff, MD, a rheumatologist and nutritionist at Tufts University. He made several points:

* Though intriguing and worth following up, until other studies repeat these results, B12-plus-folic acid is not recognized as a treatment for OA.

* The amounts of B12 and folic acid (though far above Daily Value levels) are within the safe range as long as both vitamins are taken together. Taking this much folic acid alone could mask a serious deficiency of B12 in some older people.

* Anyone considering trying B12 and folic acid should definitely check with their doctor first.

One OA patient who heard about the study and decided to give B12 and folic acid a try was Judy Miles, MD, a 46-year-old physician and PhD who's director of medical genetics at the University of Missouri School of Medicine. "I was getting incapacitated from OA of the hands, waking up at least twice a night to take acetaminophen," she recounts. "And I knew trying B12 and folic acid at these levels wasn't going to hurt me."

Gradually, on 20 mcg. B12 plus 6,000 mcg. folic acid daily, Dr. Miles found her need for acetaminophen tablets dropping. In 2 months, she went from 10 a day to none--a sign of dramatic reduction in pain, she says.

Dr. Miles agrees her experience in no way constitutes scientific proof that the B12-plus-folic-acid combination works against OA pain (her story is what's called "anecdotal evidence") and that there could be other explanations for her relief. But this does add to Prevention's hope that researchers will follow up this tantalizing lead with more studies.

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