To many of us, arthritis exists in the distant 'never never' land of getting old and all the ailments that come with it. But there are many different types of arthritis and they can strike at any age.
A friend of mine has been plagued with arthritis in her hands since her thirties. Her finger joints are completely swollen and misshapen and the only solution is to undergo surgery to replace the joints. She is such a gorgeous girl and still so young, so it is really sad to see her in so much pain and with the hands of an arthritic 80-year-old woman.
There are many factors determining whether you develop arthritis and the severity of it. Advice and proper medical treatment are vital, but you can also do your own bit to manage the condition. Research shows that keeping a healthy weight, exercising and the right diet are all essential.
I wish I could dial back the clock for my friend and stop her drinking her much-loved fizzy drinks and get her to eat nutritious food instead of being on a perennial nutrient-deficient weight-loss diet. But hopefully going forward, my nagging will have some impact!
Arthritis sufferers need a well-balanced diet that is particularly rich in calcium, vitamin D, iron, fruits and vegetables and Omega 3 fatty acids. Many people find that limiting or eliminating sugar and alcohol also helps tremendously. I'm going to concentrate on all the good things you can eat to help your joints.
As we know, calcium is important for maintaining healthy bones. Calcium deficiency increases the risk of osteoporosis (brittle bones), which is particularly common in women after the menopause. Many people with arthritis also have a risk of developing osteoporosis, especially if they're taking steroids on a long-term basis. Lack of calcium in the diet can also increase your risk of developing a condition called osteomalacia (soft bones).
The best sources of calcium are:
* Dairy products such as milk, cheese, yogurt – low-fat ones are best.
* Calcium-enriched varieties of milks made from soya, rice or oats.
* Fish that are eaten with the bones (such as sardines).
* Green leafy veg such as broccoli, spinach, kale and cabbage.
* Nuts and seeds such as sesame seeds and almonds.
You should aim for a daily intake of calcium of 1,000 milligrams (mg), possibly with added vitamin D if you're over 60.
Skimmed and semi-skimmed milk contain more calcium than full-fat milk.
Vitamin D is being widely researched as it has more functions than previously understood, ranging from boosting your immune system, brain function and more. Relative to arthritis, vitamin D is needed for the body to absorb and process calcium and there's some evidence that arthritis progresses more quickly in people who don't have enough vitamin D.
Vitamin D is sometimes called the sunshine vitamin because it's produced by the body when the skin is exposed to sunlight. Therefore, a slight deficiency is quite common in winter. Vitamin D can also be obtained from the diet (especially from oily fish) or from supplements such as fish liver oil. However, it's important not to take too much fish liver oil. If you're over 60, dark-skinned or don't expose your skin to the sun very often and are worried about a lack of vitamin D, you should discuss with your doctor whether a vitamin D supplement would be right for you.
As a South African (used to sunny weather) living in Ireland (not quite so sunny), I was concerned about my Vitamin D levels, so my GP sent me off to get a blood test. You have to go into the hospital as the blood sample for this specific test has to be on ice going up to the lab as it is so sensitive. So the nurse yelling 'cocktails at 12!' in St Vincent's could be a little confusing if you didn't know this.
Iron is important to prevent anaemia. Many people with arthritis are anaemic. NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen and diclofenac help the pain and stiffness of arthritis but may cause bleeding and stomach ulcers in some people, leading to anaemia. The other main cause of anaemia in arthritis is anaemia of chronic disease, which often occurs with rheumatoid arthritis and similar conditions, and doesn't improve with iron supplements.
Research has shown that some foods and food supplements really can help with arthritis, although the effects are fairly specific to the type of arthritis you have.
Iron is absorbed better if there is also vitamin C in the meal, so have a good portion of fruit or vegetables when you eat. It's best not to drink tea with your meal as it reduces the amount of iron that your body can absorb.
Poor vitamin C intake has been linked with arthritis.
However, if you make sure you have your five portions a day of fruit and vegetables, then you're unlikely to have a problem with vitamin C, and shouldn't need supplements.
Good sources of iron are:
* Red meat.
* Oily fish, eg sardines.
* Pulses, eg lentils, chickpeas and beans.
* Dark green vegetables, eg spinach, kale and watercress.
If you prefer not to eat red meat or fish, then you should make sure you get plenty of pulses and dark green vegetables.
Mild selenium deficiency is quite common and may be associated with more rapid progression of arthritis. The richest natural source of selenium is Brazil nuts, but meat and fish also contain some. Selenium is nearly always included in antioxidant supplements, which you can buy in chemists and health food shops. However, current evidence suggests that selenium supplements aren't very effective in treating people with arthritis.
Omega 3 fatty acids
Omega-3 polyunsaturated fatty acids have been shown to help some people with inflammatory types of arthritis such as rheumatoid arthritis, reactive arthritis, psoriatic arthritis and ankylosing spondylitis. Omega 3s are found predominantly in oily fish such as salmon and sardines, omega-3-enriched eggs and nuts and seeds, such as walnuts.
Omega 3 fatty acids seem to be the cure-all for almost every ailment, but what are they exactly?
When the fats and oils we eat are broken down by the digestive system, they break down into fatty acids. Some fatty acids can be made by the body from other compounds; others cannot be produced in the body and must be obtained from food – these are called essential fatty acids (EFAs). These polyunsaturated fatty acids are divided into two main groups – omega-3 and omega-6.
Omega-3 fatty acids exist in two forms:
* Long-chain forms such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) – found in high levels in oily fish such as pilchards, sardines, mackerel, kippers and salmon.
* Short-chain forms, such as ALA (alpha-linolenic acid) – found in rapeseed oil, hemp oil, flaxseed oil and walnuts.
Omega-6 fatty acids are found mostly in plant seed oils such as sunflower and corn oil.
The body uses both these types of fatty acids to make chemicals called prostaglandins and leukotrienes; the right balance of these helps to control inflammation in the body.
Omega-3 fatty acids, especially the long-chain forms EPA and DHA, are thought to be of most benefit in inflammatory arthritis. It's possible that the short-chain forms may be converted within the body into the long-chain forms that benefit arthritis.
However, it's not yet clear whether these are as beneficial as the long-chain omega 3 fatty acids found in fish oil.
So, in summary, eat plenty of oily fish, calcium foods, Brazil nuts, leafy green vegetables, vitamin C-rich fruits and vegetables. And get some sunshine and exercise in the great outdoors!
Recipes taken from 'Relish' and 'Delish' cookbooks by Rozanne Stevens. For healthy cooking classes, private lessons and cookbook orders, log on to www.rozannestevens.com
Spinach and Feta Frittata
* 40g butter
* 450g spinach leaves, stalks discarded, washed and shredded
* 1 tbsp olive oil
* 150g sundried tomatoes
* 8 Omega eggs (the hens are fed Omega-3-enriched feed)
* 175ml single cream
* 200g feta cheese, cut into cubes
* 100g mature cheddar, grated
* Preheat the oven to 200C. Place a 25cm ovenproof frying pan on a medium heat, add 15g of the butter, and the spinach leaves, season with salt and pepper and stir over the heat until the spinach wilts. Drain the spinach and set aside.
* In a large bowl, whisk the eggs with the cream and cheeses, reserving a bit of cheese for topping.
* Mix in the spinach and sundried tomatoes and season with salt and pepper to taste.
* Put the pan back on the heat and add the remaining butter. When the butter is melted and foaming, pour in the egg, spinach and cheese mixture and turn the heat down to low. Cook for 3–4 minutes.
* Sprinkle the remaining cheese on top then place in the oven and cook for 8–10 minutes or until golden on top and just set in the centre.
* Slice into wedges and serve straight from the pan with a side salad or crusty bread. It can be served hot or at room temperature.
Salmon Nicoise Salad
* 2 salmon fillets
* 250g baby potatoes, halved
* 4 free-range eggs
* 250g cherry tomatoes, halved
* 1 bunch asparagus
* 2 baby cos lettuces, leaves separated and washed
* 2 tbsp capers, drained
* Juice of 1/2 lemon
* 1tbsp olive oil
* 1tsp Dijon mustard
* Salt and pepper
* Boil the baby potatoes for 15 to 20 minutes in a large pot of boiling water until just tender.
* Season the salmon fillets and pop under the grill for 4 to 5 minutes a side until just cooked. Flake into large pieces.
* Place the eggs in a pot of cold water and bring up to the boil. Reduce to a vigorous simmer and simmer for 6 minutes. Drain and cover with cold water, then peel off the shell and halve.
* Blanch the asparagus for 3 minutes then freshen in ice water.
* Pour the dressing ingredients into a clean jam jar and shake to emulsify.
* Gently toss together all the salad ingredients and scatter over some capers. Drizzle over the dressing and serve.
Five-Spiced Steamed Greens
This is my go-to dish when I need a green vegetable side. Steaming the veggies keeps them crunchy and vibrant green. One of my pet peeves are khaki-green vegetables. Chinese five-spice is an aromatic spice blend with hints of ginger and anise, perfect for seasoning crisp greens. I use a variety of green veggies: asparagus, frozen peas, green beans, broccoli and mangetout.
* 1 bunch tender stem broccoli, about 12 florets
* 1 courgette, diced into small cubes
* 150g mangetout or sugarsnap peas
* 1tsp Chinese five-spice
* 2tbsp olive oil
* Salt and pepper
* Steam the vegetables for 3 minutes in a steam oven or a stove-top steamer pot.
* Toss vegetables with five-spice, olive oil, salt and pepper.