All about Joints – november newsletter

Welcome to my November newsletter

As I sit writing this months newsletter there is a howling gale outside – it’s feeling cold and damp and miserable and for those of you suffering any kind of joint problem, this weather does not help! So this month pre my Christmas newsletter I thought I’d talk a little about osteoarthritis and rheumatoid arthritis. It’s a huge subject as you can imagine and cannot be covered here in full, but I’ll do my best to outline the key symptoms and some basic tips for you.

As my regular readers are no doubt aware (!), good nutrition plays a vital role in the prevention of disease and the reduction of symptoms. Arthritis and osteoporosis cost the NHS billions each year and much can be done to help not only prevention but alleviate pain. There are many factors to be taken into consideration with these complicated diseases and wear and tear and hereditary factors also have a role to play. Often overlooked and crucial to recovery is looking at gut health as this is where inflammation can start.


Almost three million people in the UK are estimated to have osteoporosis. In the UK, one in two women and one in five men over the age of 50 will break a bone mainly because of poor bone health. Osteoporosis costs the NHS and the government £2.3 billion a year – that’s a staggering £6 million per day. It’s a silent disease that can rob your skeleton of up to 25% of its core mass by the time you reach fifty. Bones become porous due to the progressive loss of minerals, mass and density, which can subsequently result in fractures of the hip, shoulder, ribs, vertebrae, ankle and wrist. Ankle and wrist fractures are common in young middle aged women often after a minor bump or fall. Vertebral fractures are more common in the over 50’s and can be debilitating and painful. Women are more at risk of osteoporosis as the female hormones oestrogen and progesterone are protective to women’s bones. From the age of 35 onwards women regularly fail to ovulate which leads to minimal production of progesterone, the major hormone for bones. Major risk factors include: an early menopause, anorexia, bulimia, over dieting, over/under exercising, smoking, high alcohol intake and high use of steroids.

The most common treatment for osteoporosis is calcium supplementation and sometimes HRT will still be considered. Both treatments have a sound basis. However they are simplistic approaches to a complex health crisis. Looking at nutrition and mineral balance is key in prevention of this disease. There are for example factors that can affect calcium balance and these can include a lack of: vitamins and minerals, thyroid and parathyroid hormones, oestrogen, exercise, sunlight, or an excess of protein, refined carbohydrates, stress, alcohol and stimulants.

Taking calcium is not the “cure all” answer as calcium absorption is a complicated process. Calcium needs a balance of phosphorous and magnesium to work properly. As junk foods are high in phosphorous and dairy produce high in calcium but low in magnesium, eating these foods in excess can cause an imbalance. Magnesium is needed to absorb and use calcium in the body. Nuts, seeds and green vegetables are rich sources of both calcium and magnesium. Vitamin D, the “sunshine vitamin” is vital for absorption of calcium and phosphorus. Therefore calcium, magnesium and phosphorous are all needed in the right balance for healthy bones. More and more patients that I test have low levels of Vitamin D. Recently Gwyneth Paltrow has hit the headlines as having the beginnings of osteoporosis. We seem to be scared of getting out in the sun and as our winters can be long its really important to expose yourself to sunlight. So get outdoors as much as you can!

Tips for Osteoporosis

Take regular exercise, including weight bearing if possible
Eat plenty of whole grain foods
Eat plenty of nuts, seeds and vegetables with colour and green leafy vegetables
Include soya milk and tofu
Limit the amount of animal protein. Eskimos are typical of a high protein diet. Although they have a low rate of heart disease, they have a high rate of osteoporosis, as their diet is high in seal meat and fish and low in fruit and vegetables
Avoid junk foods, smoking and limit alcohol and caffeine intake
Take a good calcium and magnesium supplement plus vitamin D
Get outside in the sunlight every day
If you suspect that you are at risk of developing osteoporosis ask your GP for a bone mineral density scan.


More than 6 million people in the UK have painful OA in one or both knees. One in five adults between 50-59 yrs and one in two adults aged 80 yrs + have OA in their knees. It usually develops gradually, over time. Several different joints can be affected, but it’s most frequently seen in the hands, knees, hips, feet and spine.

Osteoarthritis cannot be cured, but the condition may settle down after a number of years and there is plenty you can do to relieve your symptoms. It can develop at any age, although it occurs more frequently in older people. There are a few factors that can increase your chances of getting OA – these include: Poor lubrication of joints, hormonal balance, allergies and sensitivities, free radical damage, wear and tear, infection from a virus or bacteria, bone strain and deformities, bowel health and state of mind – (hidden anger, fear or worry often accompanies the beginning of arthritis).

Tips for arthritis

Eat more sulphur containing foods such as asparagus, eggs, garlic and onions. Sulphur is needed for the repair and rebuilding of bone, cartilage and connective tissue and it also aids in the absorption of calcium. Other good foods include fresh fruit and vegetables (especially green leafy vegetables which supply vitamin K), non acidic fresh fruits, whole grains, oatmeal, brown rice, soybeans and avocadoes.

Eat fresh pineapple. This contains bromelain, an enzyme which is excellent in the reduction of inflammation. The pineapple must be fresh, freezing and canning destroys the enzyme.

Eat some form of fibre daily such as ground flaxseeds, oat bran or rice bran.

Reduce the amount of fat in your diet. Do not consume milk, dairy products or red meat and avoid caffeine, citrus fruits, paprika, salt, tobacco and white sugar.

Avoid the nightshade vegetables e.g. peppers, aubergine, tomatoes and white potatoes. People suffering from arthritis can be highly sensitive to this group of foods (although it does not work with everyone).

For pain relief: Try cold gel packs, castor oil packs, hot tubs/baths. Physiotherapy and accupuncture can help together with NSAID’s in pill or topical form.

Check for possible food allergies. Many sufferers of neck and shoulder pain have found relief when they eliminate certain foods which trigger inflammation – this is especially true in rheumatoid arthritis (see below).

Get regular moderate exercise – it is essential for reducing pain and retarding joint deterioration. Cycling, walking and water exercises are good choices.

If you are overweight lose the excess pounds. Being overweight can aggravate osteoarthritis.

Omega 3 and 6 may ease symptoms by suppressing the production of prostaglandins that trigger inflammation. Evening primrose oil and borage seed oil contain GLA and omega 3 is found in fish oil or flaxseed oil.

Helpful supplements
(please get professional advice before starting a supplement plan). These include bromelain, chondroitin, essential fatty acids, glucosamine sulphate, vitamin E, calcium and magnesium and vitamin B complex.

Rheumatoid Arthritis

There are around 400,000 adults in the UK with rheumatoid arthritis. Prevalence is more common in women than men by a factor of 3:1. RA is now considered an auto immune disease whereby antibodies develop against components of joint tissue. What triggers this autoimmune reaction remains largely unknown. Speculation and investigation have centred around genetic factors, abnormal bowel permeability, lifestyle and nutritional factors and food allergies etc. RA is a classic example of a mutlifactorial disease i.e. there are many causes.

About 70% of patients have a genetic marker (HLA- DRw4). The fact that a person has a strong genetic predisposition for RA does not mean that he or she will go on to develop it. Individuals with RA tend to have increased intestinal permeability to dietary and bacterial components against which the body forms antibodies. It is prevalent in people under 40 yrs and can occur after a stressful event or viral infection. Symptoms include; Morning stiffness, pain on motion or tenderness in at least one joint, swelling in a least one joint, nodules under the skin, x ray changes include bony decalcification, positive RA blood test and raised ESR (blood tests for inflammation).

Tips for RA (see tips for arthritis as well)

Virtually any food can aggravate RA, the most common offenders are wheat, corn, milk and other dairy products, beef, the nightshade family and gluten.

Opt for a diet rich in whole foods, vegetables and fibre, and low in sugar, meat, refined carbohydrates and animal fats. Cold water fish e.g. mackerel, herring, sardines, salmon and fruit including berries; cherries, blueberries and blackberries are particularly useful.

Several anti inflammatory compounds e.g. curcumin, bromelain and ginger have shown positive effects in treating RA.

Reduce the amount of fat in your diet. Do not consume milk, dairy products or red meat as these are particularly hard to digest if gut permeability is relevant to your condition. Also avoid caffeine, citrus fruits, paprika, salt, tobacco and everything containing refined white sugar (if you can!).

Avoid taking iron supplements or a multivitamin containing iron. Iron is suspected of being involved in pain/swelling and joint destruction. Consume iron in foods instead. Good sources include blackstrap molasses, broccoli, Brussels sprouts, cauliflower, fish, lima beans and peas.

Spend as much time outside – exposure to the sun prompts the synthesis of vitamin D which is needed for proper bone formation.

In a recent study people with RA were found to have lower levels of folic acid, protein, and zinc then healthy people. The researchers concluded that drugs prescribed for arthritis had bought about biochemical changes in the subjects bodies increasing their need for nutrients. So watch out for vitamin and mineral deficiencies.

With all these diseases it is vital to have a healthy gut. This means a bowel that is not inflamed, has enough good bacteria, is not sensitive to any foods and is not constipated. Often particularly with OA and RA and indeed fibromyalgia it’s the gut that needs looking at first. That may seem an odd place to start but we need to work out where the inflammation is coming from, often it is localised as in a wear and tear situation but more often than not it is systemic. It is often useful to have a stool test to assess the state of the gut . Diet is also crucial – an anti-inflammatory diet is what is needed. Do not self medicate with supplements – do get professional help as some can make the pain worse.

Swede – vegetable of the month

The swede is thought to have originated in central Europe and has a relatively short culinary history compared with many vegetables. It was known in France and England in the seventeenth century and became an important European crop by the eighteenth century. During the nineteenth century it reached the USA (where it is known as rutabaga) and then Canada. To this day it is a much more popular food in North and East Europe than any other region. A member of the Cruciferae family, Brassica napus is a hardy plant that is frost-tolerant and thrives in moist soil.

Swede has a good mineral content including calcium, magnesium, phosphorus, potassium and manganese. It is low in saturated fat and relatively high in sugars. It also provides some fibre and vitamins A and C. Really this is all you need to do with swede – mash it with a few herbs!:

1 large swede, peeled and chopped into chunks
75g butter
plenty of freshly ground white pepper
For the butter with sage
75g butter the leaves taken from a small bunch of sage

Boil the swede in salted water until very tender. Drain well in a colander for at least five minutes. Now pass it through the coarsest blade of a vegetable mill (mouli-legumes) or by using various other manual methods; please, do not electrically work swede into the consistency of baby-food, as it seems to lose all credibility when treated so luxuriously. Beat in the butter and pepper and spoon into a heated vegetable dish. To complete the dish, melt the final amount of butter and, once it has begun to froth, throw in the sage leaves and allow to crisp in the fat until they have darkened slightly and are giving off every last vestige of their scent. Spoon over the mashed swede and serve up promptly.

See you next month for my pre christmas bumper newsletter!

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