Your questions on diet and arthritis

Q) I'm a 61-year-old man with gout and have been told that I shouldn't drink alcohol as it may exacerbate my symptoms and worsen my attacks. Does this include low or non-alcoholic beers?

James, Andover - 2007

A) Drinking alcohol can make gout worse and alcohol can work against the effect of drugs used to treat gout. The more alcohol, the more this is true. However, there are a few rays of hope. Firstly, not everyone who drinks gets gout, and people can get gout who've never touched a drop. The latter group is more common in my experience. Two common conditions where gout occurs are older women taking ‘water’ tablets (diuretics) and people with a strong family history of gout. Another fact worth knowing is that some forms of alcohol are worse for gout than others. Beer (including lager) is particularly bad and wine is better. So low alcohol drinks are definitely better than high alcohol drinks, but beer isn't the best way to take your tipple.

This answer was provided by Dr Philip Helliwell in 2007, and was correct at the time of publication.

Q) Is there any evidence to show that taking protein supplements can cause or worsen arthritis?

Antony - 2017

A) If you're at risk of gout, excessive protein intake may be problematic. Gout is the most common inflammatory arthritis and is caused by having too much uric acid in your bloodstream. Uric acid is the waste product created when the body breaks down purines – a type of protein found in many foods and all your cells.

Gout is a metabolic disease which is mainly influenced by our genes, age, gender and ethnicity. However, levels of uric acid are also affected by what we eat. If you're at risk of gout, eating a lot of protein in the form of red meat, soya or shellfish, all high in purines, makes attacks more likely. So, eating lots of protein is bad news for people with gout.

Protein supplements in the form of whey proteins contain gycomacropeptide, a component of milk that appears to reduce the risk of attacks of gout. However, people with gout should be careful about increasing their protein load with whey. The burden on the kidneys to excrete or clear the extra whey products might become excessive, so it’s always worth getting a blood test to check your kidney function if you have gout and are considering using whey protein supplements.

This answer was provided by Dr Tom Margham in 2017, and was correct at the time of publication.

Q) My friend eats tinned mackerel every day and suffers from arthritis, which is worsening. I understand there's a high content of mercury in oily fish and know that for this reason it's only recommended that you eat it twice a week when pregnant. Might there be a connection between mercury poisoning and arthritis?

Alison, Ormskirk - 2011

A) I think the main problem with eating too much oily fish in pregnancy isn't the mercury content but the vitamin A content. Oily fish is good for you in many ways: it's high in vitamin D (and vitamin A) and is full of omega-3 fatty acids, which are good for the heart. The omega-3 fatty acids are also of help in controlling the pain of arthritis. I think the scare with mercury related mostly to whale and dolphin but, in any case, mercury is more likely to cause damage to skin, nerves, lungs and kidneys, not arthritis. High quantities of vitamin A can harm the growing foetus, hence the strictures on oily fish intake.

This answer was provided by Dr Philip Helliwell in 2011, and was correct at the time of publication.

Q) As a long-term gout sufferer, I've been prescribed allopurinol at a hospital but it has tended to promote bouts of gout. The quick-fire cure I've found is colchicine, as the side-effects are not too dire. From being very young to the age of 30 I couldn't tolerate eating peanuts or ground nuts as they caused violent stomach ache. I've had gout since the age of 30 and from then to my present age, 64, I've enjoyed eating nuts again with no traumas to my digestion. I've had no bouts of gout for nearly two years and wondered if this was anything to do with being able to successfully ingest nuts? Food for thought?

Bob, West Totton - 2008

A) A fascinating observation. There are two important points to come out of your letter. Firstly, when people who have gout first start allopurinol there's a tendency for them to get acute attacks of gout. This happens during the first three months of treatment. Therefore, rheumatologists recommend taking something to help prevent these attacks (known as a prophylaxis). Usually that something is an anti-inflammatory drug such as ibuprofen but it could equally be colchicine or even steroids (cortisone) if the other two drugs couldn't be tolerated. Not giving this prophylaxis is the single most important reason why people don't persist with allopurinol treatment. And allopurinol is currently the best way of preventing gout attacks.

Secondly, nuts were originally thought to be bad for gout as they come from the legume family, but it's now believed that they're not rich in purines (which are bad for gout) but that they do contain essential fatty acids, some of which have been shown to have anti-inflammatory properties. So keep on taking the nuts is my advice, although I suspect taking the allopurinol has had something to do with your improvement.

For information, purine rich foods (to be avoided in gout) include beer and other alcoholic beverages, anchovies, sardines in oil, fish roes, herring, yeast, animal organs (liver, kidneys, sweetbreads), legumes (dried beans, peas), meat extracts and gravies, mushrooms, spinach, asparagus and cauliflower. On the other hand, beneficial foods include dark berries, tofu (which is made from soybeans), fatty acids found in fish (such as salmon and mackerel), flax or olive oil, and nuts.

This answer was provided by Dr Philip Helliwell in 2008, and was correct at the time of publication.

Q) I would like to know whether any research findings suggest links between osteoarthritis and diet. I am a 66-year-old active retired teacher. I had a total hip replacement in August 2011 and have recovered well. My surgeon has told me that it is likely I will require another hip replacement on the other hip in about five years although at present I am not experiencing any hip pain. I hope that exercise, weight control and sensible eating plus supplements such as glucosamine and fish oil will help to slow the progression of the disease. What does the latest medical research say about nutritional therapy (such as that in Marguerite Patten's 'Eat to beat arthritis') which claims that avoidance of specific foods that cause food sensitivities can relieve the pain and inflammation caused by osteoarthritis and rheumatoid arthritis? To put it simply, can food heal me?

Janet, Crook - 2013

A) Despite much interest and research in this subject there is little evidence that diet can cause arthritis and the converse that avoidance of certain foods can cure it. Some food supplements will help the pain, and these include fish oils, although there is still debate on the usefulness of glucosamine. An absolute minority of people may have arthritis as a result of an allergy, and food avoidance can help in these cases, but identifying the foods is a long, drawn-out process. Some years ago there was interest in dietary therapy when it was found that starvation could help inflammation in joints but this was found to be a specific effect of calorie withdrawal on the immune system and not food hypersensitivity. An ad hoc survey in our clinic found that the majority of people had tried some form of dietary manipulation, and many had lost weight, sometimes drastically, but rarely to their long-term benefit. So my advice is to eat a healthy balanced diet and to keep your weight within acceptable limits.

This answer was provided by Dr Philip Helliwell in 2013, and was correct at the time of publication.

Q) I once was told the hard, arthritic lumps on my finger joints were caused by excess calcium sediments hardening. Why then do I take recommended calcium and vitamin D tablets? Wouldn't this give me even more calcium in my body? Should I take them or not?

I'm 72 and have hip, knee, hands and feet problems but otherwise very healthy and happy.

Joyce - 2018

A) The lumps on your finger joints are called Heberden’s nodes and usually affect the joints closest to the ends of the fingers (the distal interphalangeal joints). Heberden’s nodes are caused by growth of bony spurs from the joint surface called osteophytes. They can happen when a joint is affected by osteoarthritis.

Heberden’s nodes aren’t caused by an excess of calcium and vitamin D. Supplements of calcium and vitamin D are usually used to help keep the bones strong and prevent fractures, but if you’re not clear why you're taking these supplements it'd be a good idea to ask your GP or pharmacist for help in making a decision about whether or not it would be beneficial for you to keep taking them.

This answer was provided by Dr Tom Margham in 2018, and was correct at the time of publication.

Q) I’m 26 years old and have been diagnosed with osteoarthritis in my thumb in my left hand. What vitamins can I take to help prevent getting this problem in the future? I feel very young to have this. Also, should I wear a thumb splint/compression support all the time?

Any advice would be great. I'm very new to this and have no one to ask.

Kym - 2018

A) It’s unlikely that you’ll be deficient in any vitamins if you eat a normal balanced diet, so supplements probably won’t make a difference to your symptoms or to the longer-term outlook for your thumb.

With thumb osteoarthritis it's important to work on joint stability and the range of movement. When a joint is affected by osteoarthritis the muscles that surround the joint can become weaker and lose their bulk very quickly. This can make the joint less stable, which is a problem when it comes to the function of the thumb, and it also causes pain.

Using exercises that work on increasing the strength of overall grip, pinch grip and other thumb movements will be beneficial. Changing your approach to lifting and carrying things to spread the load across your hands and arms can also make a big difference, reducing strain through the thumb.

Splints can be useful to protect the joint, particularly if you're experiencing a flare-up of pain or are doing a lot of activities that use the thumb, but I wouldn’t recommend using them all the time.

If you need specific advice on managing your thumb osteoarthritis, it’s worth asking your GP for a referral to a hand therapist.

This answer was provided by Dr Tom Margham in 2018, and was correct at the time of publication.