Osteoarthritis is like any chronic ongoing health complaint you may have, it will be aided by superior nutrition. Nutritional factors are very important in the successful treatment of arthritis, and it is important to focus on foods to avoid as they may well aggravate arthritic problems. Let’s take a look at food allergies and the nightshade family of foods.

Should you avoid the nightshade family? : Food allergies : A basic exclusion diet for osteoarthritis : Common Osteoarthritis Investigations and Diagnosis : Osteoarthritis management

Should you avoid the nightshade family?

The nightshade family includes tomatoes, potatoes, peppers (capsicum), chilli, and eggplant along with tobacco in any form. I have found over the years that a sensitivity to certain natural chemicals called alkaloids (naturally present in the nightshades) only cause pain and swelling in a minority of individuals with arthritis. The problem with nightshade sensitivity is that it is not detectable by any current laboratory tests, so you will only determine this by trial and error, and the only way to figure out whether nightshade vegetables bother you is to totally eliminate them. Even if you believe that you are nightshade sensitive and totally eliminate all of these, it can still take three to four months for symptoms to recede.

I have found in my clinic over many years that only a handful of those who have entirely avoided nightshades have ever noticed significant relief. Many natural medicine practitioners automatically exclude nightshade family foods from a person’s diet if they complain of OA or RA (rheumatoid arthritis) as if it is “standard treatment” in naturopathic practice. In my practice, firstly I like to see how much of the nightshade the person consumes, in what form/s and if it is possibly connected to their aggravations. The problem with many “self-help” books the internet with regard to health related information is that one website may simply regurgitate information from another website, and so the nonsense is perpetuated. Mark Twain once said: “Be careful when reading health-books, you may die of a misprint”. If Mark Twain lived today, he would have meant “Be careful when browsing the internet and viewing websites”. I question how many people who set these sites up ever see patients with arthritis to know whether nightshades really cause the pain and aggravations they claim.

Would I exclude nightshades from a person’s diet who complains of arhritis? Possibly, but then I probably would exclude just the one night shade food from that person’s diet they consumed the most, and then only after having worked with the Hypoallergenic Diet and having repaired the digestive system first. This to me is like taking a person off all gluten and wheat products before you eliminate dairy products, peanuts and the most likely allergenic foods first. And remember, nightshade sensitivity is that – a sensitivity, NOT an allergy.

Food allergies

Food allergies have nothing to do with nightshade sensitivity. Immediate (IgE) and delayed (IgG) food allergies can cause all sorts of grief for the patient, and in my opinion are more of an issue than nightshade sensitivities. I have certainly seen many OA patients improve their pain levels after being placed on a “low-allergy” diet.

I have a special Hypo-Allergenic Diet sheet which I give to patients who see me, it has proven to be very effective and pinpoints the foods you are most likely to react to. If you’ve had allergies in the past, have them now, or if a member of your family has allergies, this is a definite possibility. But why would allergies increase the inflammatory responses, how is it linked? This is easy to explain, especially if you have a history of “pain killers” like Paracetamol, Ibuprofen, or various other drugs your doctor may have recommended. Such drugs dramatically affect your digestive system over time, and one of the biggest issues your small bowel will face is “leaky bowel syndrome” where the small intestine becomes “leaky” or permeable allowing tiny protein molecules to come into contact with your immune system more readily, setting up an antigen-antibody response. What this means in English is that your immune system will come into contact with foreign molecules from your diet which it isn’t supposed to. When this occurs, chemicals are produced in turn by the immune system which in turn wreak havoc on your system and produce symptoms like pain and inflammation.

A good tip for you is to go on a ten-day cleanse which can bring about symptom relief, and sometimes dramatic. If you do find relief in the ten day period then it’s very likely you have significant food allergies. If this occurs, then I’d highly recommend you stay on the Hypo-Allergenic Diet for 3 months.

A basic exclusion diet for OA

Exclusion diets produce the best results in the earlier, more painful stages of the drawn out disease process known as flavouringsn any long-term chronic health complaint, it will be found that there is a balance that must be found between a very rigid nutritional program that might not be too effective as well as eating habits that have a positive psychological effect on the person. I try to achieve this in a clinical sense, but it can be a real challenge at times with some people! Try these following exclusion suggestions for 3 months to see if they have any effect on your arthritis:

  • Alcohol and coffee.
  • Red meat.
  • Vegetables that contain high levels of plant acids. e.g. tomatoes and rhubarb.
  • Berries rich in fruit acids such as gooseberries, red and black currants
  • Refined sugar and products that contain it.
  • Refined white flour and its multitude of products.
  • Artificial additives, flavorings and preservatives.
  • Processed foods, many supermarket foods. Cook at home & prepare your own meals.
  • Carbonated drinks. Avoid all forms of “fizzy” drinks, including soda and sparkling water.
  • Any food or beverage that causes you to aggravate or feel worse in any way.

Common Osteoarthritis Investigations and Diagnosis

  • Case taking: it is not hard to find out if a person has OA or not, careful case taking will most always reveal this. Was the person an athlete or serious about sport, particularly a contact sport like football, hockey, etc? Was the person a manual labourer for example a bricklayer, builder, truck driver, etc? You don’t have to look too far. Often times an earlier injury or excessive use will point to arthritis, other times it won’t however.
  • Clinical examination: diagnosis is usually based on clinical examination of the patient’s knee, hip, back, etc.
  • Plain X-rays: when disease is advanced it can be seen on plain X-rays. The diagnostic features that can be seen on X-ray are shown below:
  • Body weight and body mass index: should be recorded. The Body Mass Index (BMI) is a calculation of the ratio between your weight and your height. The formula is used to determine the amount of body fat you carry. The formula is your weight divided by your height squared (BMI = kg/m2)
  • MRI: may be useful to distinguish other causes of joint pain.
  • Blood tests: are normal in osteoarthritis (OA). Consider checking baseline FBC, creatinine and LFTs before starting a patient on non-steroidal anti-inflammatory drugs (NSAIDs).
  • Joint aspiration: This means poking a hypodermic needle into the joint and taking out some fluid to examine the cells. It may be considered for swollen joints to exclude other causes such as septic (infected) arthritis and gout. The synovial fluid in OA is non-inflammatory. The white blood cell count (leukocyte count) will be in the normal range.

Osteoarthritis Management

Conventional treatment of osteoarthritis

Mainstream medical treatment for degenerative arthritis includes aspirin, other non-steroidal anti-inflammatory drugs, synthetic forms of cortisone both swallowed and injected, and surgery. Although all of these drugs relieve symptoms, there is increasing evidence that they accelerate the deterioration of cartilage and actually make the underlying condition worse. I spent six years after qualifying as a naturopath working in conjunction with a British doctor who said that steroid injections in and around a joint was a ridiculous thing to do and a “medical travesty”. I couldn’t agree more, it gives temporarily relief only and ends up destabilising the joint in time. The patient gets a false sense of security, they think that the arthritis is cured. Their arthritis is no more “cured” than a mortgage is paid for by credit, it is only deferred to a later time when it becomes increasingly inconvenient to pay back the debt.

The treatment of osteoarthritis depends on how far advanced the condition is. In the early stages, treatment for osteoarthritis is usually directed at decreasing the inflammation in the joint. Anti-inflammatory medications, such as aspirin and ibuprofen, are used in decreasing the pain and swelling from the inflammation. It pays to start with a more natural treatment approach you experience severe pain, rather than having high expectations of natural medicines acting like a strong painkilling drugs, which they don’t.

If the symptoms continue, a cortisone injection may be used to bring the inflammation under better control and ease your pain. Cortisone is a very powerful anti-inflammatory medication, and does have secondary effects that limit its usefulness in the treatment of osteoarthritis. The major drawback in the use of intra-articular injections of cortisone is the fact that it may actually speed the process of degeneration when used repeatedly. I highly recommend that if you do contemplate cortisone, that you use it most sparingly, and definitely avoid multiple injections!

First-line drug treatments your doctor will use

Paracetamol: either as required or in regular doses.

Topical NSAIDs (Non Steroidal Anti Inflammatory Drugs): Topical means “applied to the skin”, these may be used alone or in conjunction with paracetamol. Topical NSAIDs may be first-line treatment in people with knee or hand OA. The American College of Gastroenterology has a good page on The DANGERS OF ASPIRIN AND NSAIDS

Other osteoarthritis drug treatments:

Oral NSAIDs (Non-Steroidal Anti Inflammatory Drugs): these can be used if paracetamol and/or topical NSAIDs to provide insufficient pain relief. Standard NSAIDs or “COX-2 inhibitor” drugs are often first choice. They should be co-prescribed with a proton pump inhibitor. Proton pump inhibitor drugs (PPIs) are a group of pharmaceutical drugs that decrease the amount of acid in the stomach and intestines. Doctors prescribe PPIs to treat people with recurring reflux, ulcers in the stomach or intestine, or other digestive disorders that may cause excess stomach acid like taking a regular drug to “kill” the pain of arthritis. Now instead of taking one drug, you are taking two, and it doesn’t take a rocket scientist to figure out that it may not be the smartest thing to “block” stomach and intestine acid production because you need that stuff to digest and absorb food. And – if you digestion doesn’t work favourably, how on earth can you ever rebuild and repair a dysfunctional joint? You will always stay symptomatic and look for those “pain-killing” pills.

NSAIDs can be prescribed in addition to paracetamol. You doctor is supposed to prescribe these drugs in the lowest effective dose for the shortest possible period of time, but in my 20yrs of experience the patient is dumped on the drug and left on the drug. Risks and benefits should be considered, particularly in the elderly. If the patient is already taking low-dose aspirin, other analgesics (of a more natural type, free from side effects) should be considered before adding an NSAID/COX-2 inhibitor.

Opioids: may be useful if paracetamol and NSAIDs are not sufficient for pain control. Opiods are very powerful pain killers derived from the opium poppy, the same substance from which heroin is produced. They are also very addictive indeed.

Corticosteroid injections into or around the joints, like knees, hips or shoulders: these should be considered as an adjunct to core treatment for the relief of moderate-to-severe pain. I am NOT a fan at all of steroid injections!

It is very important note the drugs like Voltaren and Ibuprofen can significantly increase your risk of a stroke, by up to 86%.

Those with established ischaemic heart disease, cerebrovascular disease, peripheral arterial disease or heart failure need to be exceedingly cautious of taking any pain-killing drugs due to the increased risk of thrombotic (potential stroke) events.

We also have an Introduction to Osteoarthritis here

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Eric Bakker is the clinical director of The Naturopaths and holds a Bachelor Degree of Science majoring in Complementary Health Care, as well as separate diploma qualifications in Naturopathy, Herbal Medicine and Homeopathy. Eric has 20 years clinical experience in natural medicine, and received post-graduate natural medicine training in Australia, India, America as well as New Zealand. Eric has four children and lives in the sunny Hawkes Bay

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