Aching from arthritis?
Relief is as near as your kitchen, according to three just-published books that claim you can cure, or ease, arthritis symptoms through your diet.
The authors point to familiar magic bullets, including antioxidants and bioflavonoids, found in fruits and vegetables and already touted as helpful to good health ' from staving off old age to helping prevent cancer.
But it's not so simple, many doctors say. "There is no one magic food, diet or supplement that will cure or even dramatically improve your arthritis," says Dr. Doyt Conn, senior vice president of medical affairs for the Arthritis Foundation.
The latest spate of books continues decades-long debates about food and its connection with arthritis. With 40 million Americans - nearly one in every six - affected by one or more of the 100-plus types of arthritis-related problems, there's an audience for anything that claims to ease chronic pain.
Doctors, in fact, do consider diet important in treating arthritis and don't disregard food-related research. But many argue that enough clinical studies haven't been done to prove specific claims.
"Through the years, people have tried a lot of different diets," says Dr. Marc Hochberg, head of the rheumatology division at the University of Maryland School of Medicine. "Some eliminated foods with high acid content, like citrus and tomatoes. Some eliminated whole food groups. The problem is, there are so few well-done studies out there that can support the claims."
To support their positions, the authors, who aren't rheumatologists, rely on selected studies, and they note that medical science is limited in what it can offer. By changing your diet, they write, you can help yourself.
"If you suffer from the chronic pain of osteoarthritis, your doctor will probably tell you there's noting to be done except take painkillers that only mask the symptoms and can make you sick," says Brenda Adderly, who wrote "The Arthritis Cure Cookbook" (LifeLine Press, $24.95) with Lissa De Angelis. "But there's more you can do."
Adderly, who has a master's degree in health administration, and Drs. Joseph Kandel and David Sudderth, neurologists and authors of "The Anti-Arthritis Diet" (Prima Health, $16) focus on easing symptoms of osteoarthritis, which affects the joint cartilage and is the most common type.
A third book, "Foods That Fight Pain" (Harmony Books, $25), is by Dr. Neal Barnard, a psychiatrist and president of the %o Physicians Committee for Responsible Medicine, which promotes preventive medicine. In addition to osteoarthritis, his book looks at rheumatoid arthritis, which can be disabling, and fibromyalgia, which affects the muscles and their attachment to the bones.
The recipes in all three books call for eating whole foods, with an emphasis on nutrient-rich vegetables, whole grains and fresh fruits. For instance, an "Eternal Life Stew" from Adderly's book uses seven vegetables, including eggplant, snow peas and turnips. In the Kandel-Sudderth book, a grilled chicken breast recipe gets a vitamin boost with a sauce made from bananas and grapes.
Part of Barnard's approach is, for four weeks at a time, to eliminate such "trigger foods" as eggs, citrus fruits and dairy products that some research links to arthritis flare-ups. If your symptoms disappear or improve, he says, avoid that food. His book includes such recipes as rice pasta with zucchini pesto.
All three authors stress eating food with antioxidants - vitamin C, A (or beta-carotene) and E, plus the mineral selenium - which are found in fruits and vegetables, including carrots, bell peppers and asparagus. The reason: Unstable molecules known as "free radicals" roam about the body, attacking and destroying healthy tissue, including tissue found in the joints. The theory is that antioxidants stabilize these molecules and prevent them from doing more damage.
Two of the three books also tout the power of bioflavonoids, plant pigments believed to help like antioxidants. They're found in citrus, onions, green beans and broccoli, among other plants.
Some doctors find the antioxidant theory intriguing, but unproven. In inflammatory types of arthritis, such as rheumatoid, there's evidence of joint damage that could be linked to free radicals. "In that case, the antioxidant theory could potentially have some credibility," says Dr. Alan Matsumoto, a rheumatologist and assistant professor of medicine at Johns Hopkins School of Medicine. "But there's no good clinical research to back it up."
The authors also focus on oils from cold-water fish, such as salmon and mackerel. Some studies show that people with rheumatoid arthritis may have a modest improvement in tender joints after eating these so-called omega-3 fatty acids over time.
"But the question is, can you safely eat enough to get the positive effect?" says Conn, of the Arthritis Foundation. "Maybe, maybe not."
People with arthritis are not particularly impressed with the eat-your-pain-away arguments.
"I have nothing against these cookbooks, but I've heard so many theories by now," says Cindy Lorenz, 24, of Cockeysville, who was diagnosed with juvenile rheumatoid arthritis at 11. "What works for one person doesn't necessarily work for someone else. I do know that I don't notice any correlation between food and how my joints feel."
Lorenz, a former cable TV show producer and host who recently was honored as one of 50 national arthritis heroes by the Arthritis Foundation, eats for general good health, not her illness. She follows a low-fat diet and includes an assortment of fruits and vegetables. Like some people with rheumatoid arthritis, she also developed osteoporosis, a disease that causes bone loss. So she includes lots of calcium in her meals.
In Catonsville, Vickie Burns, 40, leads a fibromyalgia support group for the Maryland chapter of the Arthritis Foundation. With fibromyalgia, pain is the most prominent and chronic symptom.
"I know desperate people who'll read about some cure and pounce on it," Burns says. "As a support group leader, I don't tell anybody 'No.' I say, if you'd like to try it, it's up to you. But you do need to be sensible. There's so much stuff out there."
To sort through the "stuff," medical experts suggest starting with the obvious:
"If someone finds that certain food makes their arthritis worse, it's only common sense that they avoid these foods," says Hochberg, of the University of Maryland.
No one disputes the importance of maintaining a healthy weight either. Osteoarthritis is made worse and may even be initiated by excess pounds. Diets low in calcium or high in alcohol also can increase the chances of developing osteoporosis.
As to what arthritis sufferers should stock in their kitchens: "The standard that most of us follow is overall good nutrition," says Matsumoto, of Johns Hopkins. "A variety of food in moderation. Lots of fresh fruit and vegetables. No gimmicks."
KEY ARTHRITIS TYPES
When doctors speak of arthritis, they're referring to more than 100 rheumatic diseases and musculoskeletal conditions. Many of the conditions are chronic, though some can go into long-lasting remissions. Among the most common types:
* Osteoarthritis: A degenerative joint disease in which cartilage that covers the ends of bones in the joint deteriorates. Develops in fingers and weight-bearing joints, including knees, feet, hips and back.
Affects: 20.7 million people, men and women, mostly after 45.
Symptoms: Pain and difficulty moving the affected joints.
Treatment: Pain relievers or anti-inflammatory drugs, exercise, applications of heat or cold, and surgery.
* Fibromyalgia: Affects muscles and their attachments to bone, causing widespread pain and "tender points" in certain places like knees and elbows. Can result in disturbed sleep, fatigue, stiffness. Emotional distress can be a problem because the patient looks healthy, leading others to believe pain is imaginary; reinforced by doctors who aren't familiar with the syndrome. Can feel like a joint disease but not a true form of arthritis and doesn't cause joint deformities.
Affects: 3.7 million Americans, mainly women.
Symptoms: Pain that occurs throughout the body, though it may start in one region - neck, shoulders - and spread over time. Patients describe pain in varied terms: burning, gnawing, aching.
Treatment: Exercise and medications to encourage sleep.
* Rheumatoid arthritis: A problem in the body's immune system causes inflammation or swelling. Begins in joint lining, then can damage both cartilage and bone. Often affects the same joints on both sides of the body: hands, wrists, feet, knees, ankles, shoulders, elbows.
Affects: 2.1 million Americans, mainly women. Juvenile rheumatoid arthritis, diagnosed in those under 17, affects 50,000 children.
Symptoms: Joints that are swollen, tender, painful and difficult to move.
Treatment: Anti-inflammatory and disease-modifying drugs, exercise, applications of heat or cold and surgery.
* Gout: Results when the body can't rid itself of a natural substance called uric acid. Needle-like crystals form in the joint, usually big toe, ankles or knees.
Affects: 2.1 million Americans, mostly men.
Symptoms: Pain and swelling in affected areas.
Treatment: Anti-inflammatory and gout drugs and a diet low in purines. Organ meats, beer and wine can contribute to high levels of purines.
'SOURCE: Arthritis Foundation
INTERPRETING YOUR PAIN
How do you know if a gnawing pain is arthritis?
Only a doctor can tell for sure, and even then, don't expect a quick diagnosis.
"It isn't always easy to figure out, even for rheumatologists or orthopedic surgeons," says Dr. Alan Matsumoto, a rheumatologist and assistant professor of medicine at Johns Hopkins School of Medicine.
The reason: The term "arthritis" covers more than 100 conditions, each with its own symptoms that may mimic other ailments.
Arthritis generally refers to problems in the joints or joint structures. But other conditions, such as tendinitis and bursitis, which feel like joint pain, actually affect the soft tissue.
In diagnosing your problem, your doctor is likely to ask where and when the pain began, whether you've experienced swelling and which daily tasks are hard to do. Your physician will want to know about injuries or overuse in any joint areas. Tests may be necessary, including blood, urine, joint fluid or X-rays.
An accurate diagnosis is important because treatments vary. For instance, fibromyalgia, which affects muscles and their attachments to bones, has tender points similar in location to tender areas in other common problems, including a type of bursitis that affects the outer side of the hip. But fibromyalgia is treated with medications to diminish pain and improve sleep. Bursitis is treated with heat or cold applications and anti-inflammatory drugs.
Liz Doup
TO LEARN MORE
For more reading material about diet and good health:
* "Diet and Your Arthritis," a free brochure from the Arthritis Foundation.
* "Help Yourself - Recipes and Resources From the Arthritis Foundation" (Arthritis Foundation; $16.95, includes shipping). To order: 800-207-8633.
* "The American Dietetic Association's Complete Food & Nutrition Guide" (Chronimed Publishing, $29.95). The ADA Web site, which lists more books on healthy eating: www.eatright.com.
For more information, contact:
* Arthritis Foundation: 800-283-7800; Web site: www.arthritis.org.
* Arthritis Foundation, Maryland chapter: 800-365-3811, Ext. 239; Reisterstown Road, No. 150, Baltimore, Md. 21208; e-mail: mdchaprthritis.org.
Coming Next Sunday
The promise of drugs: the new generation of painkillers; and a popular nutritional supplement. See next week's Health page.
Pub Date: 7/19/98