Osteoarthritis: Nutritional Considerations

The role of nutrition in OA is mainly related to the effects of diet on body weight. Obesity increases the risk for osteoarthritis of the hip5 and of the hand.⁶ Conversely, weight loss was found to significantly improve functional mobility and knee pain.^7,8 Some evidence suggests that a reduction in body fat, independent of body weight, may help relieve OA symptoms.⁹ To the extent that a low–fat, high–fiber diet in combination with exercise prevents weight gain, a nutrition–based approach is likely to be useful in preventing and treating OA.

Once the disease process is established, the combination of glucosamine sulfate (1500 mg/day) and chondroitin sulfate (1200 mg/day) has been suggested for knee osteoarthritis, based on favorable early studies.^10,11 Subsequent controlled trials, however, have been less favorable. Although older brands of glucosamine are made from shellfish, the possibility of allergic reactions led to the formulation of newer brands derived from corn.

Elevated serum cholesterol was independently associated with generalized OA in one study,¹² and with osteoarthritis of the knee in another study.¹³ Persons with lower blood concentrations of vitamin D appear to show greater risk for progression, as evidenced in part by joint space narrowing and loss of cartilage.^14,15

Ginger may provide significant pain relief for osteoarthritis patients. Its effects appear to be attributable to inhibition of both cyclooxygenase and lipoxygenase and to subsequent reductions of inflammatory mediators, such as prostaglandin  E2 (PGE2), nitric oxide,¹⁶ and chemokines.¹⁷ Effective doses range from 170 mg ginger extract 3 times per day to 250 mg 4 times per day.

Orders

See Basic Diet Orders and Obesity.

What to Tell the Family

In some cases, OA may be preventable through maintenance of a healthy weight with diet and exercise. Muscle–strengthening and low–impact exercises are the best options to avoid exacerbating the disease. Once diagnosed, OA may be improved in some patients through a combination of dietary changes for weight reduction, pain–relieving medications and/or botanical agents, and vitamin D. A dietitian can assist the patient and family with specific recommendations. In severe cases, replacement of the affected joint may be necessary to regain mobility and function.