Eating Plants to Heal Your Joints

In 2019 about 528 million people worldwide were being affected by the joint pain, stiffness and swelling of arthritis and the numbers have steadily increased since then. In Canada 1 in 5 people suffer from arthritis pain from conditions such as rheumatoid arthritis and osteoarthritis. Damage to joints can be significant and often irreparable, resulting in losses of joint function and disability. (1,14)  Consequently, it is extremely good news that eating a plant-based diet may have the same effectiveness in relieving arthritic symptoms as taking painkillers and anti-inflammatory medications.  The most recent science behind this statement comes from research performed in Amsterdam and published in 2024. (2)

Notes (3,4): Rheumatoid arthritis is an autoimmune disease in which the immune system begins to attack its own cells.   Normally the immune system can recognize self from non-self, but this autoimmune disease causes it to malfunction so that it targets its own tissues, specifically those that line the inner surface of joints.  This leads to chronic inflammation that deforms joints and the surrounding tissues.  Risk factors that increase the development of rheumatoid arthritis include obesity, smoking and genetic aspects.

Osteoarthritis is a chronic condition that occurs when the protective cartilage that cushions the ends of bones wears down over time and causes inflammation and degeneration of joints. But this is not simply a disease of aging.  Osteoarthritis has risk factors, some of which are controllable, including obesity, joint injuries and/or repeated stress of a joint, weak muscles and certain metabolic conditions including obesity and diabetes.   

In the Amsterdam study, “Plants for Joints”, arthritic participants were randomly divided into two groups.  Both groups included individuals with rheumatoid arthritis and osteoarthritis.  Group 1 followed a lifestyle program which included eating a plant-based diet and receiving guidance on physical activity, management of stress, fostering social connections, good sleep and avoidance of harmful substances.  Participants in this group were provided with weekly menus containing recipes, articles, podcasts and adherence-promoting webinars covering topics like how to lose weight, the importance of eating unprocessed foods and how the gut microbiome can help to lower inflammation.  Group 2 maintained their usual habits of eating and exercising and continued with their established arthritis treatment.  Improvements in participants of the lifestyle program group began to appear after eight weeks and, after sixteen weeks, those in the lifestyle program group showed major advancements in their joint health that rivaled results achieved through the use of medication.  Participants with rheumatoid arthritis saw their disease activity score (DAS28) improve significantly with substantial reductions in joint swelling and tenderness.   Results of this paper ascertained that it was the dietary changes that played the largest role in these positive results. (2)

One year after the start of the “Plants for Joints” trial, the drop-out rate of participants remained low.  In addition, 50% of those with rheumatoid arthritis had been able to decrease or discontinue their medications altogether. Plant-based dietary interventions are often considered to be difficult to accept and to adhere to. However, in this report, the acceptability and sustainability of eating plant-based was quite high indicating that the participants understood that the effectiveness of the interventions utilized in this trial made the dietary changes worthwhile.  (2)

A follow-up analysis examined changes in body composition as a result of sticking to the tenets of the “Plants for Joints” trial.  Results showed that muscle mass, strength and BMD (Bone Mineral Density) were maintained in participants in the lifestyle program arm of the study in spite of their sizeable reductions in body weight and fat mass (including liver fat) and in their intake of protein.  An additional bonus was the reduction in insulin resistance and the resultant lowering of the risk of prediabetes and type-2 diabetes.  (5)

 

PREVIOUS INVESTIGATIONS CONCERNING THE POSITIVE EFFECTS OF EATING PLANTS ON ARTHRITIC CONDITIONS:

Researchers of the “Plants for Joints” trial noted a long-established association between nutrition and arthritis, citing a 1991 study published in the Lancet which revealed improvements in arthritic symptoms after a week of fasting followed by transitioning to a plant-based diet. (6,7)

Other studies have shown similar effects.

• In 1999 a randomized controlled trial of rheumatoid arthritis patients looked at the effects of fasting for 7 to 10 days then switching to a plant-based diet for 3.5 months. The plant-based eating group showed decreased pain, less morning stiffness and fewer swollen, tender joints after one month of the trial compared to those in the control group.  After one year, the improvements in arthritis not only remained but, in many participants, were even greater than those observed at one month into the trial. (8)
• A 2003 examination of patients with rheumatoid arthritis randomized its participants to either a Mediterranean diet or to continuing with their regular diet. The Mediterranean diet emphasized fruits, vegetables, whole grains, legumes and nuts.  Results after 12 weeks showed fewer swollen joints and less pain in the Mediterranean diet group compared with those eating their regular diet and their disease activity scores (DAS28) had decreased by almost 50%.  (9)
• In 2006 a large study from California found that eating meat just once a week was linked to increased risk of osteoarthritis compared to eating no meat. The increased risks were substantial with a 31% increased risk in women and a 19% increased risk in men. Moreover, meat consumption of more than once a week was linked to a 49% increased risk of osteoarthritis in women and a 43% increased risk in men.  (10)
• Research from 2015 investigated the effects of a whole-food, plant-based (WFPB) diet on osteoarthritis. Participants with osteoarthritis were randomly assigned to eat either a WFPB diet or to continue on their usual omnivorous diet.  By two weeks into the trial, participants who were eating the WFPB diet reported significant reductions in pain and improvements in the function of joints compared to participants who were continuing to consume their usual diet. Improvements in arthritic pain in the WFPB group continued to increase steadily over the 6 weeks of the study.  (11)

 In 2017, another analysis used data from two large cohorts, the Osteoarthritis Initiative (4796 participants) and the Framingham Offspring Osteoarthritis Study (1268 participants). It examined the association between fiber intake and the risk of osteoarthritis of the knee.  Results revealed that those who ate the highest amounts of fiber experienced a 30% lower risk of developing knee osteoarthritis in one cohort and a 61% lower risk of developing knee osteoarthritis in the other cohort.  Fiber is present only in plants, not animals.  Those who displayed a lower risk of the development of osteoarthritis were consuming a high proportion of plant-sourced foods.  (12)

 

WHY DOES EATING A PLANT-BASED DIET HELP TO RELIEVE PAINFUL JOINTS? (2)

The effects of a healthy diet on arthritis likely originate along several different pathways.

• Inflammation is at the root of the development of arthritis. Plant-sourced foods are anti-inflammatory while animal-sourced foods cause inflammation.
• Being overweight or obese is associated with the development of arthritis. Diets composed of mostly plants promote both satiety and healthier weights.
• The gut microbiome is also playing a role here. High-fiber intake protects the gut by reducing inflammation and maintaining the integrity of the gut barrier.  A plant-based diet is rich in the fiber that stimulates and supports the growth of healthy intestinal bacteria who in turn use that fiber in their production of protective anti-inflammatory compounds.  Conversely, a meat-heavy diet encourages the growth of bacteria that induce inflammation.  In addition, saturated fat from animal-sourced foods can promote dysfunction of the microbiome.  Plants contain very little saturated fats.  The researchers of this study observed that participants who adhered to a plant-based eating program at least 80% of the time experienced substantial improvements in their joint health. On-going studies are further exploring the effects of the microbiome on arthritis.
• Inactivity and stress increase chronic inflammation. Guidance on other lifestyle factors which can relieve inflammation such as exercise, stress reduction and improvement of sleep were also provided to the participants of this trial.

 

PRACTICAL LIFESTYLE SUGGESTIONS FOR IMPROVING JOINT PAIN, STIFFNESS AND SWELLING IN ARTHRITIS:

• Make vegetables and fruits the majority of your diet.
• Include legumes such as beans, lentils and chickpeas and whole grains like oats, bread and pasta in your daily diet. They are particularly high in protein and fiber.
• Avoid animal-sourced foods (meat, eggs and dairy) most of the time.
• Eat nuts in moderation.
• Stay away from highly processed foods. They are low in fiber and high in unhealthy, inflammation-causing nutrients like fat, sugar, salt and harmful food additives.
• Minimize alcohol consumption as it increases inflammation.
• Exercise regularly. Aim for at least 2.5 hours each week of activity, focusing on moderate to vigorous aerobic activity (fast walking, jogging, hiking, skipping, cycling) for at least 150 minutes per week as well as activities that target muscles and bones on at least two days per week.  Muscle-strengthening activities include push-ups, sit-ups, lifting weights and climbing stairs.   Bone-strengthening activities include skipping, running and yoga. (13)

 

FINAL THOUGHTS: (2,5)

One year after the completion of the “Plants for Joints” trial, the pain, stiffness and joint dysfunction that are the hallmarks of arthritis remained significantly improved for the participants who followed the lifestyle program.  Additionally, there was a considerable decrease in the use of medications to relieve arthritis.  Metabolic benefits (maintenance of muscle mass, strength and BMD (Bone Mineral Density) along with sizeable reductions in body weight and fat mass (including liver fat) and insulin resistance) were also largely sustained.

Changing the composition of a diet is a step that can be made by individuals on their own.  If you suffer from arthritis, why not transition to a way of eating that emphasizes plant-sourced foods and try to stick with it for at least six months?  You may find that your arthritis symptoms will diminish enough that you can lower or even discontinue your medications.  Using food as medicine is a healthy choice and you will likely be pleasantly surprised as the many other benefits of emphasizing plants in your diet show up to lighten up the burdens in your life.

 

 SOURCES:

1  https://arthritis.ca/about-arthritis

2   Wagenaar, C.A., Walrabenstein, W., van der Leeden, M., Turkstra, F., Gerritsen, M., Twisk, J.W.R., Boers, M., van der Esch, M., van Middendorp, H., Weijs, P.J.M., van Schaardenburg, D. Long-term effectiveness of a lifestyle intervention for rheumatoid arthritis and osteoarthritis: 1-year follow-up of the ‘Plants for Joints’ randomised clinical trial. RMD Open. 2024 Feb 27;10(1):e004025. Doi: 10.1136/rmdopen-2023-004025. PMID: 38413171; PMCID: PMC10900348.

3  https://www.forksoverknives.com/health-topics/diet-and-arthritis/

4  https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925

5  C.A. Wagenaar, W. Walrabenstein, C.S. de Jonge, M. Bisschops, M. van der Leeden, M. van der Esch, P.J.M. Weijs, M.A. Troelstra, M.A. Korteweg, A.J. Nederveen, D. van Schaardenburg, Effect of a multidisciplinary lifestyle intervention on body composition in people with osteoarthritis: Secondary analysis of the “Plants for Joints” randomized controlled trial. Osteoarthritis and Cartilage Open, Volume 6, Issue 4,2024, 100524, ISSN 2665-9131; https://doi.org/10.1016/j.ocarto.2024.100524.

6  Kjeldsen-Kragh, J., Haugen, M., Borchgrevink, C.F., Laerum, E., Eek, M., Mowinkel, P., Hovi, K., Førre, O.  Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis.  Lancet. 1991 Oct 12;338(8772):899-902. Doi: 10.1016/0140-6736(91)91770-u.

7  Kjeldsen-Kragh, J., Haugen, M., Borchgrevink, C.F., Laerum, E., Eek, M., Mowinkel, P., Hovi, K., Førre, O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991 Oct 12;338(8772):899-902. Doi: 10.1016/0140-6736(91)91770-u. PMID: 1681264.

8  Kjeldsen-Kragh, J. Rheumatoid arthritis treated with vegetarian diets. Am J Clin Nutr. 1999 Sep;70(3 Suppl):594S-600S. Doi: 10.1093/ajcn/70.3.594s. PMID: 10479237.

9  Sköldstam, L., Hagfors, L., Johansson. G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003 Mar;62(3):208-14. Hoi: 10.1136/ard.62.3.208. PMID: 12594104; PMCID: PMC1754463.

10  Hailu, A., Knutsen, S.F., Fraser, G.E. Associations between meat consumption and the prevalence of degenerative arthritis and soft tissue disorders in the adventist health study, California U.S.A. J Nutr Health Aging. 2006 Jan-Feb;10(1):7-14. PMID: 16453052.

11  Clinton, C.M., O’Brien, S., Law, J., Renier, C.M., Wendt, M.R. Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis. Arthritis. 2015;2015:708152. Doi: 10.1155/2015/708152. Epub 2015 Feb 28. PMID: 25815212; PMCID: PMC4359818.

12  Dai, Z., Niu, J., Zhang, Y., Jacques, P., Felson, D.T. Dietary intake of fibre and risk of knee osteoarthritis in two US prospective cohorts. Ann Rheum Dis. 2017 Aug;76(8):1411-1419. Doi: 10.1136/annrheumdis-2016-210810. Epub 2017 May 23. Erratum in: Ann Rheum Dis. 2017 Dec;76(12):2103. Doi: 10.1136/annrheumdis-2016-210810corr1. PMID: 28536116.

13  https://www.canada.ca/en/public-health/services/publications/healthy-living/physical-activity-tips-adults-18-64-years.html

14  https://www.who.int/news-room/fact-sheets/detail/osteoarthritis/