Diet and do-don'ts (pathya - suitable versus harmful diet and lifestyle) have gained importance in our country since the period of Ramayan and Mahabharat. Food keeps alive our journey of life hence it is not unnatural for people to think that there is a relation between diet and disease. The importance of pathya is rooted deep in the minds of people over hundreds of years. Scientists all over world are looking for co-relation between diet and arthritis for over last seven decades. Although over half of the arthritis patients are following some or the other pathya, there is no sufficient evidence for some particular diet or dietetic item triggering or flaring or curing arthritis. Magic cure is certainly impossible with the help of diet therapy.

Diet and food supplements are advertised in various books, periodicals and on internet. There is no scientific proof in favor of diet supplements which are usually expensive. Patients fall prey to these advertisements which are usually more expensive than the actual disease modifying drugs. Companies rob these patients by paying hefty commission to their selling agents. Inflammatory arthritis, by its very nature, is a disease of relapse and remissions. Remission in a particular patient on starting with a particular therapy is advertised as success of that particular therapy. Poor people have no knowledge of checking the validity of tall claims in the advertisement.

The list of pathya is sometimes so long that there remains nothing to eat. Some practitioners advise fasting which is not advocated even in Ayurveda. Vagbhata says that insufficient diet reduces strength, nourishment as well as luster and causes all vata-diseases ( Sutra sthan 8/3). Some people advise liquid diet only. These measures may reduce pain to some extent but are not effective in shortening the duration of morning stiffness or controlling the disease or in improving the functional status. Patients start feeling better after 4-5 days of fasting. Fasting can lead to severe fatigue, weakness and weight loss. Switching back to regular diet brings the disease to original status once again. Fasting, liquid diet or other pathya is difficult to maintain indefinitely. Such diets have an overt risk of malnutrition.

It must be understood that arthritis is of more than 100 types which are classified into two major classes-degenerative and inflammatory. It obviously means that the pathya in these two classes of arthritis is not the same because of an altogether different disease process. It is usually advisable to change the diet step by step. One should identify a few dietary items that increase the pain or stiffness. Once identified, such items may be avoided for a month or so. Reappearance of symptoms on reintroduction of suspected item indicates a sort of allergy. Such food items should never ever be consumed again.

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  • Proper Diet

    Healthy balanced diet is most appropriate for all chronic diseases. Diet should consist of pulses, leafy vegetables, fruits and non vegetarian food (if acceptable). Leafy vegetables and fruits contain bioflavonoids which help in reducing swelling. All fresh sour fruits such as oranges and lemon can be included in diet. A balanced diet should give adequate proteins and calories. Pulses, milk and milk products and non vegetarian food contain proteins. Inadequate diet leads to weight loss and malnutrition.

    Omega 3 fatty acids have some role in reduction of inflammation. They are found in fish oil which may be considered if acceptable. These fatty acids show beneficial effects after about 3 months and they are required to be consumed later indefinitely. Fish oil capsules available in market are quite expensive and can cause gastric upset or diarrhea in some cases. Some patients do not like its smell. Almonds, soya and linseed (least expensive) oil also contain omega 3 fatty acids.

    Peanuts, almonds, apricot, pistachio and other dry fruits (30-50 gm per day) supposedly reduce risk of heart disease. 30 gm of dry fruits contain 200 calories. One may use them as far as possible. Leafy vegetables, fruits and spices contain anti-oxidants which are useful in reducing inflammation. Diet should contain sufficient Vitamins (B, C and D) and calcium. Milk is a rich source of Calcium. Vitamin D, which is essential for absorption from gut, can be obtained by exposure to sunlight between 10 am and 4 pm. People with inadequate sun exposure should opt for oral supplementation of Vitamin D. Calcium and Iron supplements can cause constipation in some patients. Dietetic fiber (leafy vegetables and fruits) is helpful in avoiding constipation.

    Patients of arthritis must control weight. An Ayurveda text by Vagbhat advises ‘Diet should be limited. Heavy food should be consumed only up to half of capacity of stomach. Even light food should not be consumed up to full capacity’. The simplest advice would be to stop fatty items completely and consume 75% of earlier diet in four servings.

    We attain our real body weight in mid twenties. Our muscles, bones and joints develop according to this weight. Any extra weight puts extra load on joints and leads to joint pain. Weight gain during later phase of life is due to excess fat and not due to muscles or bones. Fat cells secrete a toxic chemical which damages joints.

    Regular exercise and balanced diet are most effective keys of weight control. One should be careful while the weight is increasing as it is usually very difficult to reduce weight later. It is always good to consult a dietitian in this respect. Small changes in diet can lead to substantial reduction in its caloric value. Removing cream from boiled milk stored in refrigerator overnight substantially reduces caloric value of that milk. Ghee, oil, cream, butter, cheese, cakes and pastries must be avoided. We are usually unable to control ourselves while eating tasty fried and fast food. Sweet items should also be avoided as sugar contains calories only and does not have any nutritive value. One must remember that hot and spicy items such as shev, bhaji, samosa, wada are as bad as laddus and pedhas prepared in ghee. All patients of arthritis must make a sincere attempt to reduce weight by exercise and changes in diet. Drugs available for weight loss (Orlistat) can reduce weight up to 10% within about a year. Various surgical procedures are also available for patients who are too obese. It has been shown that even a 10% weight loss can lead to substantial reduction of pain in patients of knee arthritis.

  • Special Diets and Diet Supplements

    Vegetarian diet has some positive effects in rheumatoid arthritis. ‘Vegetables only’ diets are also advised. ‘Alkaline diets’ restrict sugar, coffee, meat, sour fruits, rice and wheat. Potatoes, brinjals and tomatoes are restricted in many diets. Some companies sell packets of predigested liquid diets containing glucose, amino acids, vitamins etc. There is no evidence as yet about effectiveness of these tasteless diets in rheumatoid arthritis though they reduce weight to some extent.

    Garlic powder reduces pain and turmeric reduces inflammation. Chilly ointment causes burning and reduces pain. 3-4 cups of green tea every day may help some patients of rheumatoid arthritis. The efficacy of Glucosamine, Chondroitin and Methyl sulphonyl methane remains unproven. They too may cause adverse effects in some cases. Chondroitin, an expensive supplement, is obtained from fish or prepared synthetically. People keep on wasting a lot of money on these unproven diet supplements. The effects of supplements wane off as soon as they are stopped. A particular diet or diet supplement should never be considered as an alternative to basic modern management. Never stop prescription medications while taking them.

  • Diet in Ayurveda

    There appear to be many misconceptions that people as well as Ayurveda practitioners have about diet in Ayurveda. Patients get sick with a long list of pathya. It must be realized that pathya cannot be same in different types of arthritis. It is altogether different in degenerative and inflammatory forms of arthritis. Pathya in inflammatory arthritis as advised in some original texts of Ayurveda viz. Nighantu-Ratnakara, Bhaishajya-Ratnavali, Yogaratnakar and Bhavprakash is given below:
    Pathya diet (include) for inflammatory arthritis-

    • Bitter and hot (chilly) items
    • Rice – one year old, horse gram, barley, samo rice and ragi
    • Garlic, ginger, ginger powder and marking nut
    • Snake gourd, drumsticks, bitter gourd, and brinjals
    • Buttermilk, hot or warm water
    • Castor oil, cow urine, old wine
    • Flesh soup of wild animals from dry, arid region
    • Soup of peas and gram

    There are many drugs for arthritis in Ayurveda. Some of their constituents are available in our kitchen. Some of these that can be used more often in our routine diet are – ginger powder, calamus (bach), cumin, black pepper, asafetida, aniseed, myrobalan (harad), rock salt and castor oil.
    Apathya diet (exclude) for inflammatory arthritis-

    • Heavy food, abhishyandi food (e.g. curd)
    • Milk, curd, jaggery, black gram, fish
    • Incompatible food (not digestible, not suitable and that increasing the ailment)
    • Vishama food – too much or too little untimely food
    • Viruddha food (see box) – do not mix and eat sweet with sour or hot or bitter items. One should not take fish, flesh, radish, drumsticks or sour items as well as water along with milk. Alcohol and hot water must not be consumed with honey.

    Though there are many such examples these restriction may be done away in young people, those who exercise regularly, those with adequate strength, and those who can tolerate and digest such food items.

  • Ayurveda Lifestyle for Arthritis

    Ayurveda gives detailed description about our daily routine from morning to night according to the different seasons. Viruddha routine behavior (contrarian lifestyle) is one of the causes of arthritis. Inactivity, sedentary lifestyle and lack of exercise are also described as causative factors for arthritis. Exercise (rushing to office after meals) or sexual activity should be avoided after heavy meals. Sleeping during daytime as well as late nights should be avoided. Constipation is undesirable. One should not restrain natural urges e.g. staying awake when sleepy and eating when not hungry.

    Viruddha diet is a scientific term used in Ayurveda. There are various classes of unsuitable diet alongwith appropriate examples. Such diet is leads to formation of Aam-visha (toxic substances).

    Some examples of viruddha diet that must be avoided are as follows (Charaka Sutrasthan chapter 26):

    • Fatty or cold items in rainy areas, dry items in the dry and arid regions
    • Cold and dry items in cold season.
    • Not suitable for individual digestive capacity.
    • Honey and ghee in equal proportions.
    • Eating hot by one who is used to eat sweet, eating items that cannot be tolerated.
    • Vata-increasing items by one who works hard and Kapha-increasing items by one who sleeps more.
    • Eating when not hungry, eating only when too much hungry.
    • Drinking cold water following oily fatty food.
    • Eating raw, burnt out or over cooked items.
    • Consuming milk and sour items together.
    • Eating items that one does not like.
    • Eating unripe, too ripe or spoiled food.
    • Eating curd at night.
    • Eating food prepared from mustard leaves.

    Some patients of arthritis feel better if they stay in hot weather and wear warm clothes whereas some do not need them. It seems that warm atmosphere reduces pain and fatigue in patients with rheumatoid arthritis but neither improves general health nor achieves better disease control. Warmth has no significant effect on other types of arthritis.

  • Diet in Anemia

    Incidence of anemia is very high in Indian females. Patients with inflammatory arthritis are particularly prone to develop anemia due cytotoxins. Control of disease in such cases improves blood hemoglobin levels. Patients should also be aware about Iron content of diet. Daily requirement of Iron is about 10 mg. Menstruating females need about 18 mg Iron every day.

    Only 20% Iron is absorbed from vegetarian diet. Use of Iron utensils for cooking increases Iron percentage in diet. A chapatti prepared on a griddle contains 19% extra Iron. Jaggery contains more iron than sugar. Black tea and coffee inhibit absorption of Iron. Absorption of Iron is dependent on acid in stomach. Suppressants of gastric acid (Omeprazole, Ranitidine) hinder absorption of Iron. Both Calcium and Iron are not absorbed properly if taken together. Milk and milk products (khova, basundi) in diet suppress iron absorption due to their high Calcium content.

    Vitamin B (Folic acid and Cyanocobalamin-B 12) is essential for formation of blood. Overcooking or repeated heating destroys these vitamins from food. Vitamin C (Lemon and sour fruits) helps absorption of Iron and thus helps in correction of anemia.

    Food items with high Iron content:

    Colocasia, spinach, dill, onion leaves, fenugreek leaves,Beetroot, carrot, knolkol, radish, potato,Jowar, bajra, ragi, soy beans,Sprouted beans (green gram, red lentil, green peas, red kidney beans,Sunflower, sesame, mustard oils,Turmeric, black pepper, black cumin, poppy seeds, cloves,Dates, cashew nuts, figs, almond, pistachio