Diet and Lifestyle for Joint Health
The pain of arthritis can be severe, and the functional limitations can even be debilitating. But there are diet and lifestyle choices you can make that can be helpful for managing arthritis symptoms. A joint-healthy lifestyle may improve your overall health in addition to your joints.
Osteoarthritis (OA) is the most common form of arthritis and primarily affects joints in the hands, hips, knees, and back. The cartilage in our joints provides a cushioning layer between the bones. In OA, joint cartilage breaks down, causing inflammation that leads to pain and swelling.
Treatment of OA entails individualized programs to reduce inflammation and pain, manage symptoms, improve physical function, and slow the progression of the disease. Programs may include dietary changes, physical therapy, exercise, or weight management, medications, and supplements if needed.
Lifestyle Factors That Can Influence OA
1. Achieve and maintain a healthy weight.
Even modest weight loss (5–10% of your body weight), achieved by limiting high-calorie foods, reducing portions, and becoming more physically active, can lead to big health benefits. Weight management can improve the course of OA and can help relieve pain and improve function, especially for weight-bearing joints like hips and knees. Find information and support for a healthy-weight lifestyle from reputable sources like the National Arthritis Foundation or the Academy of Nutrition and Dietetics.
2. Be physically active.
Stiff, arthritic joints obey the “use it or lose it” rule. Moving can help keep joints mobile and manage pain. Physical activity may also improve your overall mental outlook. Start slow, and aim for daily exercise rather than the “weekend warrior” pattern of overdoing it once in a while.
3. Choose a bone-and-joint-healthy diet.
Many of the nutrients needed for bone health are also important for good joint health. The optimal diet for OA is still being researched. However, a healthy diet featuring plenty of fresh fruits and vegetables and low-fat dairy, or other sources of calcium and vitamin D, makes good sense for overall health. Vitamin C (found in citrus, berries, and colorful produce), vitamin E (found in nuts and meats), and omega-3 fish oils are nutrients that are an important part of a healthy diet for bone and joint health.
4. Choose joint-healthy supplements.
Many people with arthritis try complementary therapies such as nutritional supplements. Glucosamine and chondroitin are supplements that may offer benefits to some individuals with osteoarthritis.
Glucosamine is a sugar that is naturally produced in your body. It is one of the building blocks for growth, repair, and maintenance of cartilage. Chondroitin also occurs naturally in your body and is part of a protein that gives cartilage its elasticity. Glucosamine and chondroitin also help cartilage absorb water and stay lubricated.
Several published peer-reviewed studies have examined the potential benefits of taking glucosamine and chondroitin. The results of these studies have been mixed. A number of studies suggest that people with OA who take glucosamine and chondroitin experience a reduction in pain and/or improved physical function.1-3
Glucosamine and chondroitin have been compared with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. While NSAIDs work more quickly, studies suggest that, with regular use, glucosamine and chondroitin may also provide relief from pain and other OA symptoms.1, 4 Glucosamine is safer, is easier on the stomach, and has fewer side effects than NSAIDs.
Additional research suggests that glucosamine and chondroitin supplementation may help to slow the loss of joint cartilage caused by OA, though it may take 2–3 years of use to have this effect.3, 5-7 Studies done in animal models of OA also suggest that glucosamine may have mild anti-inflammatory properties.1,8
How long will it take for glucosamine and chondroitin to work?
Many people who benefit from glucosamine will notice some relief from pain or stiffness as soon as after one month of regular use, though longer use may provide greater effects.2 The joint-protecting benefits of chondroitin (such as the maintenance of cartilage) are thought to take at least three months to begin.3, 9
If you decide to try a glucosamine and/or chondroitin nutritional supplement, here are tips to help you choose quality products:
- Choose glucosamine sulfate, not glucosamine hydrochloride. Glucosamine supplements contain either glucosamine sulfate or glucosamine hydrochloride. Studies that have used glucosamine sulfate have shown a range of outcomes; many had positive results, but some did not. However, most studies that used glucosamine hydrochloride have not shown benefit over placebo.1, 10, 11 Most popular products contain glucosamine hydrochloride and may not be effective.
- Choose products that offer glucosamine and chondroitin as separate pills. Although most products offer glucosamine and chondroitin together, this may not be the best way to take these supplements. Research suggests that when taken at the same time, less glucosamine is absorbed.12 Taking them in separate doses, for example taking glucosamine in the morning and chondroitin in the evening, permits the best absorption and may provide the best results.
- Choose products that deliver the optimal dosage. In studies that showed benefit, 1,500 mg of glucosamine sulfate was taken in a single daily dose. Taking 800 mg of chondroitin sulfate in one daily dose has also shown positive results. Therefore, taking a full daily dose of glucosamine (1,500 mg) at one time, and a full daily dose of chondroitin (800 mg) at another time, may offer the most benefit by allowing optimal blood levels of each nutrient to be reached.
- Choose a certified product. Not every nutritional supplement contains what is claimed on the bottle label. Studies have shown that the active ingredients in glucosamine and chondroitin products can deviate widely from the label claims; one study indicated that products contained anywhere from 25% to 115% of what was claimed.13, 14 Buy supplements with purity and content independently verified by non-profit certification programs run by either NSF® International or USP®.
Nutritional supplements can be part of the effective management of OA. They are a supplement to, not a substitute for, a healthy lifestyle with proper diet and regular physical activity. You can make the lifestyle choices that manage your OA and improve your health and quality of life.
References1. Towheed et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005; (2): CD002946.
2. McAlindon et al. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000; 283(11):1469-75.
3. Richy et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis. A comprehensive meta-analysis. Arch Intern Med. 2003; 163:1514–22.
4. Hochberg et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. Published Online first: 15 January 2015 doi:10.1136/annrheumdis-2014-206792
5. Pavelka et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double blind study. Arch Intern Med. 2002; 162:2113-23.
6. Reginster et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo controlled clinical trial. Lancet. 2001; 357:251-6.
7. Lee et al. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010; 30(3):357-63.
8. Setnikar. Active properties of chondroprotective drugs. Int J Tissue Reactions. 1992; 24:253–61.
9. Kahan at al. Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo controlled trial. Arthritis Rheum. 2009; 60(2):524-33.
10. Hochberg. Nutritional supplements for knee osteoarthritis—still no resolution. N Engl J Med. 2006; 354(8):858-60.
11. Sawitzke et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis. 2010; 69(8):1459-64.
12. Jackson et al. The human pharmacokinetics of oral ingestion of glucosamine and chondroitin sulfate taken separately or in combination. Osteoarthritis Cartilage. 2010; 18(3):297-302.
13. Adebowale et al. Analysis of glucosamine and chondroitin sulfate content in marketed products and the caco-2 permeability of chondroitin sulfate raw materials. Journal of the American Nutraceutical Association. 2000; 3(1):Spring Issue.
14. Russell et al. Active Ingredient Consistency of Commercially Available Glucosamine Sulfate Products. J of Rheum. 2002; 29:2407-9.