Food Fact Sheet

Diet and osteoarthritis

Arthritis is a condition that
causes joint pain. This Food Fact
Sheet is about the role diet has
in managing symptoms of the
most common arthritic condition,
osteoarthritis (OA).
What is osteoarthritis? is the dose that improved pain and function in a trial
OA commonly affects the large joints such as the on knee OA patients and the dose recommended for
knees and hips but frequently occurs in the hands, reducing cardiac death. Omega-6 polyunsaturated
the base of the big toe and the spine. It is a condition fats (found in sunflower safflower, corn and grapeseed
that affects the whole joint, where cartilage breakdown oils) are somewhat pro-inflammatory so may make
and inflammation can lead to pain, discomfort and symptoms worse, as may saturated fats. Replace them
a reduced quality of life. In the UK, it is the fastest by oils and spreads rich in mono-unsaturated fats such
growing cause of disability. OA may run in families as rapeseed oil and olive oil.
or can develop as a result of injury. It largely affects Cholesterol reduction
people later in life and obesity is a major risk factor.
OA patients are more likely to have raised blood
There is currently no cure for OA, so treatment cholesterol than those without OA. There is some
options are generally limited to the management of suggestion that lowering blood cholesterol will improve
pain and symptoms. Though there is no evidence OA. In any case, if blood cholesterol is raised, it is
that elimination diets are effective in OA, there are a important to make dietary changes to lower it – this will
number of dietary strategies that may help you to ease also benefit cardiovascular health. Collective dietary
its symptoms, as explained below. measures include:
Maintaining a healthy weight • 2g/day of plant stanols/sterols - these can be
The most important relationship between diet and OA found in proprietary fortified drinks, spreads, and
is weight. Not only does being obese or overweight yogurts;
increase the strain on joints, but excess fat causes • reducing the intake of foods high in saturated fat;
inflammation which can exacerbate symptoms. There • increasing the intake of oats and other soluble
is strong evidence that losing weight can reduce pain fibres;
and improve physical function and mobility. If you are • eating nuts (30g /day);
overweight or obese, losing 10% of your body weight
• consuming soy protein (25g /day) e.g. tofu, soy
will give optimum benefit, not only for symptoms but
milk, soy beans /edamame beans.
for overall health. This can be achieved by eating
a healthy diet with plenty of fruits and vegetables. For more information on dietary changes to help lower
Incorporating exercise helps to maintain muscle while blood cholesterol, please see the BDA Food Fact
losing weight. OA has been linked to type 2 diabetes Sheet on Cholesterol.
and cardiovascular disease; losing excess weight Antioxidants
will also help to prevent or manage these conditions.
Antioxidants, found in certain animal and plant
What fats should I be consuming? products, protect the body from damaging oxidation,
The long-chain omega-3 polyunsaturated fatty acids so-called ‘oxidative stress’ which may be involved in
found in oily fish have anti-inflammatory properties the development and progression of OA. Antioxidants
that may well be of benefit in OA. Aim to consume at that may be relevant include vitamins A, C and E.
least one portion of oily fish a week, preferably two, Though evidence for the effect of these vitamins in OA
e.g. sardines, mackerel, salmon and tuna (though not is weak, it would be wise to ensure an adequate daily
tinned tuna). If this is not possible, consider a trial of intake as part of a healthy balanced diet (Table 1 gives
fish-oil capsules; 1-2 capsules should supply 450 mg rich sources). Getting these nutrients from food as
EPA+DHA per day. Although, strictly speaking, this opposed to supplements is always preferable because
is not enough to produce anti-inflammatory effects, it they come with other nutrients.
 www.bda.uk.com/foodfacts
Key nutritional and lifestyle recommendations
The importance of vitamin D for OA
Vitamin D is essential for bone and cartilage health. • Aim for a healthy BMI, i.e. between 18.5 and 25 kg/m2.
Between the months of April and October in the UK, • If you are overweight or obese, take action to reduce your
sunlight is the primary source of vitamin D although it body weight by 10%.
can also be obtained from dietary sources (Table 1). • Regular exercise is likely to help symptoms by preserving
Studies have shown that it may have a positive muscle strength.
effect on muscular strength and balance. However, • Consume 1-2 portions of oily fish a week. If you cannot do
most people consume only small amounts in their that, consider trialling a fish-oil supplement (≥ 1.5 g fish-oil/
diet. Taking a daily vitamin D supplement (e.g. 10- day).
25 µg/day), especially during the winter months, • Use oils rich in mono-unsaturates (e.g. rapeseed oil and
will help to ensure sufficient status throughout the olive oil).
year. Maintaining a healthy weight may also improve • Take dietary action to reduce your blood cholesterol, if
the ability of your body to access vitamin D as it is elevated.
sequestered in fat. • During the summer months, aim for daily sunlight exposure
(10-15 minutes without sunscreen) to increase vitamin D.
Should I be having more vitamin K? • Take a vitamin D supplement of 10-25 µg /day, when there
Vitamin K may influence OA through its role in making
is no sun exposure.
bone and cartilage. Although evidence of benefit in
• Consume rich sources of vitamin K and the antioxidants, A,
OA is suggestive but currently limited, there is some
C, and E as part of a healthy balanced diet.
suggestion that increasing vitamin K may be of benefit
to those who are deficient, hence it is important to
obtain it as part of a healthy balanced diet. Certain
Dietary supplements
fats and oils (e.g. olive oil, margarine) contain small There is no good trial evidence to show that
amounts of vitamin K and may also help its absorption glucosamine, chondroitin, rose hip or turmeric help
from foods. OA symptoms; studies claiming beneficial effects
are more likely to be published than those that don’t.
Food Avoidance Recent analysis of patient data has failed to find
Several popular diet books on arthritis advocate any support for glucosamine. However, if your diet
avoiding foods such as dairy products or the is restricted or your appetite is poor, you should
nightshade vegetables (tomatoes, potatoes, bell consider taking a multivitamin/mineral supplement
peppers and aubergines). Though there is some containing the recommended intake amounts (RNI
evidence that food avoidance may help rheumatoid or RDA) of the nutrients listed in Table 1.
arthritis patients, there is no evidence of benefit in OA
patients. Summary
If you are overweight or obese, combining regular
Table 1. exercise with healthy eating to achieve weight
Dietary sources and recommended intakes of loss is the most effective strategy to reduce joint
selected micronutrients pain. Increasing intake of long-chain omega-3
fatty acids and reducing blood cholesterol may be
Vitamin A Vitamin C Vitamin E Vitamin D Vitamin K of some benefit and will improve cardiovascular
health. To optimise intake of relevant micronutrients,
carrots*, citrus fruits, vegetable oily fish, kale,
eat food sources shown in Table 1. Discuss any
curly kale*, blackcurrants, oils, egg yolks spinach,
change in diet or nutritional supplements with your
sweet raw green margarine, and certain lettuce,
rheumatologist, GP or dietitian.
potato*, liver and red wholegrain fortified broccoli
products, peppers cereals, products and Brussels Useful links: NHS: www.nhs.uk/Livewell/healthy-eating
cod liver oil RNI: 40 mg/ nuts and (e.g. sprouts Arthritis UK:www.arthritisresearchuk.org
RNI: 600-700 day seeds spreads Safe intake: Arthritis Action: www.arthritisaction.org.uk
µg retinol Safe and 1 µg per
Further information: Food Fact Sheets
equivalents/ intake: 3-4 cereals) kilogram
on other topics including Weight loss,
day mg/day RNI: 10 µg/ body weight/
Omega-3, Cholesterol, Vitamin D and
day day
Healthy eating are available at
*as beta-carotene, a vitamin A precursor. Abbreviations: RNI: Recommended Nutrient Intake. www.bda.uk.com/foodfacts

This Food Factsheet is a public service of The British Dietetic Association (BDA) intended for information only.
It is not a substitute for proper medical diagnosis or dietary advice given by a dietitian. If you need to see
a dietitian, visit your GP for a referral or: www.freelancedietitians.org for a private dietitian. To check your
dietitian is registered check www.hcpc-uk.org
This Food Fact Sheet and others are available to download free of charge at www.bda.uk.com/foodfacts
Written by Heather Browne BSc Dietitian, Sally Thomas BSc Dietitian, and Margaret Rayman, DPhil, RNutr.
Reviewed by Dr Sarah Schenker, Martin Lau and Sian Porter, Dietitians.
The information sources used to develop this fact sheet are available at www.bda.uk.com/foodfacts
© BDA December 2017. Review date December 2020.