Breakthrough research from the US and Europe

Osteoarthritis has long been considered a “wear-and-tear” disease associated with age-related changes that occur within cartilage and bone.

Now: A growing body of evidence shows that osteoarthritis may have a metabolic basis. Poor diet results in inflammatory changes and damage in cartilage cells, which in turn lead to cartilage breakdown and the development of osteoarthritis.

A recent increase in osteoarthritis cases corresponds to similar increases in diabetes and obesity, other conditions that can be fueled by poor nutrition. Dietary approaches can help prevent — or manage — all three of these conditions.

Key scientific evidence: A number of large studies, including many conducted in Europe as well as the US, suggest that a diet emphasizing plant foods and fish can support cartilage growth and impede its breakdown. People who combine an improved diet with certain supplements can reduce osteoarthritis symptoms — and possibly stop progression of the disease.


By choosing your foods carefully, you can significantly improve the pain and stiffness caused by osteoarthritis. How to get started…

  • Avoid acidic foods. The typical American diet, with its processed foods, red meat and harmful trans-fatty acids, increases acidity in the body. A high-acid environment within the joints increases free radicals, corrosive molecules that both accelerate cartilage damage and inhibit the activity of cartilage-producing cells known as chondrocytes.

    A Mediterranean diet, which includes generous amounts of fruits, vegetables, whole grains, olive oil and fish, is more alkaline. (The body requires a balance of acidity and alkalinity, as measured on the pH scale.) A predominantly alkaline body chemistry inhibits free radicals and reduces inflammation.

    What to do: Eat a Mediterranean-style diet, including six servings daily of vegetables… three servings of fruit… and two tablespoons of olive oil. (The acids in fruits and vegetables included in this diet are easily neutralized in the body.) Other sources of healthful fats include olives, nuts (such as walnuts), canola oil and flaxseed oil or ground flaxseed.

    Important: It can take 12 weeks or more to flush out acidic toxins and reduce arthritis symptoms after switching to an alkaline diet.

  • Limit your intake of sugary and processed foods. Most Americans consume a lot of refined carbohydrates as well as sugar-sweetened foods and soft drinks — all of which damage joints in several ways. For example, sugar causes an increase in advanced glycation endproducts (AGEs), protein molecules that bind to collagen (the connective tissue of cartilage and other tissues) and make it stiff and brittle. AGEs also appear to stimulate the production of cartilage-degrading enzymes.

    What to do: Avoid processed foods, such as white flour (including cakes, cookies and crackers), white pasta and white rice, as well as soft drinks and fast food. Studies have shown that people who mainly eat foods in their whole, natural forms tend to have lower levels of AGEs and healthier cartilage.

    Important: Small amounts of sugar — used to sweeten coffee or cereal, for example — will not significantly increase AGE levels.

  • Get more vitamin C. More than 10 years ago, the Framingham study found that people who took large doses of vitamin C had a threefold reduction in the risk for osteoarthritis progression.

    Vitamin C is an alkalinizing agent due to its anti-inflammatory and antioxidant properties. It blocks the inflammatory effects of free radicals. Vitamin C also decreases the formation of AGEs and reduces the chemical changes that cause cartilage breakdown.

    What to do: Take a vitamin C supplement (1,000 mg daily for the prevention of osteoarthritis… 2,000 mg daily if you have osteoarthritis).* Also increase your intake of vitamin C–rich foods, such as sweet red peppers, strawberries and broccoli.

  • Drink green tea. Green tea alone won’t relieve osteoarthritis pain, but people who drink green tea and switch to a healthier diet may notice an additional improvement in symptoms. That’s because green tea is among the most potent sources of antioxidants, including catechins, substances that inhibit the activity of cartilage-degrading enzymes. For osteoarthritis, drink one to two cups of green tea daily. (Check with your doctor first if you take any prescription drugs.)
  • Eat fish. Eat five to six three-ounce servings of omega-3–rich fish (such as salmon, sardines and mackerel) weekly. Omega-3s in such fish help maintain the health of joint cartilage and help curb inflammation. If you would prefer to take a fish oil supplement rather than eat fish, see the recommendation below.


Dietary changes are a first step to reducing osteoarthritis symptoms. However, the use of certain supplements also can be helpful.

  • Fish oil. The two omega-3s in fish — docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) — block chemical reactions in our cells that convert dietary fats into chemical messengers (such as prostaglandins), which affect the inflammatory status of our bodies. This is the same process that’s inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin).

    What to do: If you find it difficult to eat the amount of omega-3–rich fish mentioned above, ask your doctor about taking fish oil supplements that supply a total of 1,600 mg of EPA and 800 mg of DHA daily. Look for a “pharmaceutical grade” fish oil product, such as Sealogix, available at, 888-966-3423,… or RxOmega-3 Factors at,

    If, after 12 weeks, you need more pain relief — or have a strong family history of osteoarthritis — add…

  • Glucosamine, chondroitin and MSM. The most widely used supplements for osteoarthritis are glucosamine and chondroitin, taken singly or in combination. Most studies show that they work.

    Better: A triple combination that contains methylsulfonylmethane (MSM) as well as glucosamine and chondroitin. MSM is a sulfur- containing compound that provides the raw material for cartilage regrowth. Glucosamine and chondroitin reduce osteoarthritis pain and have anti-inflammatory properties.

    What to do: Take daily supplements of glucosamine (1,500 mg)… chondroitin (1,200 mg)… and MSM (1,500 mg).

    Instead of — or in addition to — the fish oil and the triple combination, you may want to take…

  • SAMe. Like MSM, S-adenosylmethionine (SAMe) is a sulfur-containing compound. It reduces the body’s production of TNF-alpha, a substance that’s involved in cartilage destruction. It also seems to increase cartilage production.

    In one study, researchers compared SAMe to the prescription anti-inflammatory drug celecoxib (Celebrex). The study was double-blind (neither the patients nor the doctors knew who was getting which drug or supplement), and it continued for four months. Initially, patients taking the celecoxib reported fewer symptoms — but by the second month, there was no difference between the two groups.

    Other studies have found similar results. SAMe seems to work as well as over-the-counter and/or prescription drugs for osteoarthritis, but it works more slowly. I advise patients to take it for at least three months to see effects.

    What to do: Start with 200 mg of SAMe daily and increase to 400 mg daily if necessary after a few weeks.

    *Check with your doctor before taking any dietary supplements.