Mediterranean Diet for Osteoarthritis

What you eat can have a positive or negative impact on arthritis symptoms. Studies suggest that eating like some Europeans can reduce inflammation in people with osteoarthritis (OA) and protect against weight gain, fracture risk and disability.

The so-called Mediterranean diet emphasizes locally grown fruits and vegetables, healthy fats like olive oil and nuts, whole grains and some fish, yogurt and red wine. It’s the way people in Greece and southern Italy have eaten for centuries, and it’s credited for their long lives and low rates of diabetes, obesity, heart disease and dementia.

This disease-fighting power stems from the diet’s ability to regulate inflammation by focusing on anti-inflammatory foods (berries, fish, olive oil) and excluding or limiting pro-inflammatory ones (red meat, sugar and most dairy). OA is now known to have an inflammatory component, so this way of eating can lead to real improvements in joint pain, says Michelle Babb, MS, RD, a Seattle-based nutrition educator.

“There are a variety of foods in the Mediterranean diet that are high in fiber, beta carotene, magnesium and omega 3s, which have been found to actively reduce inflammatory markers in human studies. And if people are also reducing their intake of meat, sugar and processed foods, the results are usually favorable. I’ve had [arthritis] patients who have been able to discontinue the use of non-steroidal anti-inflammatory drugs (NSAIDs) because of transitioning to a Mediterranean diet. Some even report a noticeable difference in pain in the first week,” she says.

Research backs this up. A 2015 study published in Arthritis reported that patients with osteoarthritis had a significant reduction in pain just two weeks after switching to a plant-based diet. Patients in the study also lost weight without counting calories or limiting portions.

Weight loss, in fact, is one of the unintended consequences of a Mediterranean-type diet. Many studies have found that people who follow it shed unwanted pounds.  Each pound of lost weight relieves four pounds of pressure on overburdened joints. And because fat produces inflammatory cytokines, inflammation goes down, too. 

Slowing Disease Progression

Who wouldn’t want to ease painful joints and drop a few pounds while enjoying almond-crusted trout, asparagus grilled in olive oil and a glass of red wine?

But what about the long term? Osteoarthritis is progressive. But it’s possible an anti-inflammatory diet might help to slow down disease progression. Research has shown that certain foods not only lower inflammation in the short-term, but actually change the expression of pro-inflammatory genes and immune cells that can drive disease.

A study published in 2017 in The Journal of Nutrition, Health & Aging found that 99 patients who had OA and followed a Mediterranean diet for 16 weeks showed a reduction in a biomarker for cartilage degeneration. But it’s impossible to draw definite conclusions from a small four-month study as the biomarker change could have been impacted by other factors, like weight loss or exercise.

A much larger study, published in 2016 in the European journal, Clinical Nutrition used frailty (defined as low energy, trouble rising from a chair and muscle loss) as a stand-in for disease progression. After following 4,000 patients who had or were at high risk of OA for eight years, researchers found that participants who ate a typical American diet were twice as likely to become frail compared with those on a Mediterranean-style food plan.

In a different study published in 2016 in the American Society for Nutrition, the same research team reported that a Mediterranean or anti-inflammatory diet led to healthy weight loss, lower rates of diabetes, heart disease and fractures as well as less arthritis-related pain, disability and depression and to a better overall quality of life. 

They also found that the Mediterranean diet might influence whether someone developed knee OA. The researchers tracked the diets of more than 4,000 patients and found that the more closely participants followed the diet, the less likely they were to develop joint problems. Interestingly, when they looked at the effect on OA of individual foods, only whole grains were associated with reduced osteoarthritis risk.