Healthy eating

Arthritis NZ takes great care to ensure that any nutrition information is true, correct and as accurate as possible. However, the organisation makes no guarantees that trying a certain diet or food plan mentioned will heal or improve your arthritis.

It is always recommended to discuss nutrition with your doctor or other health professional.

Below is a list of diets and styles of eating that have been related to arthritis. Each one comes with its own set of benefits, some scientifically proven and others not.

It is important to understand your relationship with food. The tastes, smells, emotions and memories associated with what you consume are a strong factor when choosing what to eat. The thought of changing your eating behaviours that you are accustomed to can be daunting.

Another factor that often controls many food choices is the cost of food. Not everyone is in a position to buy only healthy food. Sacrifices often need to be made in order to make sure the food budget feeds all of the hungry tummies in the home.

• Choose the plain packaging. Just because the packaging is attractive doesn’t mean the food brand is better than the product in plain packaging on the shelf next to it. Check the label, often the nutritional content is very similar and the cheaper option is the plain packaged one
• Buy vegetables that are in season, as they are cheaper
• Buy canned legumes and frozen vegetables
• Bulk out meat meals with beans and vegetables
• Add fibre to your diet as it is more filling
• Choose a wheat biscuit cereal, porridge or oats for breakfast over the more sugary breakfast cereals. Fibre fills you up so you won’t be going back for seconds at breakfast time

Portion control can help a tight budget as well. The Ministry of Health recommends a healthy plate, which is:

• 1/4 plate of protein foods (this could be meat, eggs, fish, chicken, beef, etc, or you can use your palm as a guide for the size)
• 1/4 plate of carbohydrate foods (this could be rice, kumara, potatoes, pasta, bread, etc, or you can use your closed fist as a size guide)
• 1/2 plate of non-starchy vegetables, or two palms full (aim for colour and variety, but remember starchy vegetables such as potatoes, kumara and taro fit into the carbohydrate portion of your plate)

Making dietary changes can be difficult for many people and often the information becomes too overwhelming. The trick is to make small, manageable changes until they become natural, and then make another change when you are ready.

As a start, pick one thing from the list below to add or change, then come back to the list when you are ready to make another change:

• Replace one of your daily sugary drinks with a glass of water
• If you love your cakes and chocolate, opt for a smaller portion
• Swap your white bread for whole grain bread. Try a few to find which ones you like
• Replace one of your takeaway meals with a meal that has vegetables (such as a chow mein)
• Use one less teaspoon of sugar or salt in your food or hot drinks while preparing
• Instead of forcing yourself to eat veggies you don’t like, have more of the ones you do like
• Replace one unhealthy snack a day with a snack that is healthier one (fruit, veggie sticks with hummus)
• If you often eat dessert, try to skip one or two servings each week or swap it out for reduced sugar or sugar-free options (have yoghurt instead of ice cream)
• Be mindful while you are eating, slow down when eating your meals
• Use the ¼ ¼ ½ plate method when eating lunch and dinner meals. ¼ protein, ¼ carbohydrates, ½ plate non-starchy vegetables

The Mediterranean diet is not a rigid set of rules but rather a flexible eating pattern inspired by the traditional foods eaten in countries like Greece, Italy, Spain, and southern France. Its origins trace back centuries and are characterised by eating seasonal, locally sourced foods in the Mediterranean region. These days, we can access these foods here and also have cultural foods here in New Zealand, with similar health benefits. 

The Mediterranean diet is rich in vegetables, fruits, legumes, nuts, whole grains, fish, and healthy fats. It includes small amounts of red meat and low‑fat milk products. It is a way of living and eating that also features daily exercise, social connectivity, and living well.

The Mediterranean diet emphasises

• Abundant plant foods: fruits, vegetables, whole grains, nuts, seeds, legumes, and olive oil form the foundation of the diet
• Moderate consumption of fish and poultry: fish, especially oily varieties like salmon and sardines, are rich in heart-healthy omega-3 fatty acids
• Limited red meat: red meat is consumed sparingly, with meals often featuring leaner options like lamb or grass-fed beef as occasional treats rather than dietary staples
• Dairy in moderation: Greek yoghurt and cheese can be enjoyed in moderation. They provide calcium and probiotics while keeping saturated fat intake in check. Moderate low-fat dairy intake has been associated with low inflammation
• Limited processed food and refined carbohydrates/sugar
• Red wine in moderation: although a hallmark of the Mediterranean diet is the enjoyment of red wine in moderation, typically with meals, there is agreement that the negative impacts on health from alcohol itself outweigh any benefits from the antioxidants in red wine, and it’s better to eat grapes for antioxidants rather than drink wine

The cultural and social aspects

Beyond its nutritional benefits, the Mediterranean diet encompasses cultural and social elements contributing to its overall appeal. Meals are often enjoyed leisurely with family and friends, fostering community and connection. The emphasis on fresh, seasonal ingredients also encourages a closer connection to local food systems and sustainable agricultural practices. There are similar food practices in the traditional Māori way of eating, where gathering kai, eating in season, having family gardens, and eating together are everyday norms. Although sometimes this isn’t always possible, it’s still common practice for many Māori and other New Zealanders.

Research

The Mediterranean diet is well-studied and offers overall general health benefits for everyone. According to research, people following the Mediterranean diet are more likely to live longer and less likely to die from heart disease, stroke, or cancer. For arthritis, research suggests that a Mediterranean Diet is an anti-inflammatory way of eating by promoting good health, and is an uncomplicated way of eating to maintain a healthy weight. A healthy weight protects joints from being overloaded and reduces symptoms of osteoarthritis and inflammatory arthritis. The American College of Rheumatology Guidelines are followed by Aotearoa New Zealand health professionals, and the updated 2022 guidelines recommend the Mediterranean Diet for Rheumatoid Arthritis and are against any other type of defined diet or nutritional supplements.

There’s growing evidence that for people with inflammatory types of arthritis, an elimination-type diet may benefit in identifying trigger foods. Still, the Mediterranean diet is a great place to start before you try eliminating foods and food groups unnecessarily.

Nightshade vegetables are members of the Solanaceae family. They include tomatoes, potatoes, eggplant, and peppers. Some people claim that cutting out nightshades helps improve arthritis and other health conditions.

Research

Cutting out or reducing nightshade vegetables in the diet has been shown to help people with their pain, but there is no concrete evidence that they actually cause inflammation. It has been reported that solanine, present in the green parts of these vegetables, is probably responsible for joint pain. However, scientific documentation on a correlation between solanine consumption and joint inflammation is lacking.

In the short term, the keto diet may give the desired effect of weight loss, but there are no long-term studies to prove that the diet is safe. Keto only looks at weight and not overall health. The keto diet involves putting your body into ketosis, which means burning fat as energy instead of carbohydrates. This involves strongly limiting your carbohydrate intake and consuming more fat in your diet.

Research

By following a Keto diet you will have to eliminate even the healthy carbohydrates, including whole grains, legumes, most fruit, and some vegetables. This may cause you to lose out on essential vitamins, minerals and fibre.

It is easy to consume too much saturated fat if you are eating a lot of animal-based fat found in meat and butter. This can raise your ‘bad’ LDL-cholesterol levels and increase your risk of heart disease. You should always focus on choosing heart-healthy unsaturated fats like avocado, olive oil, nuts, and seeds and limit saturated fats like butter, coconut oil and fat from meat.

Keto focuses on weight loss rather than eating healthily, and its long-term effects aren’t yet known.

It promotes a plant-based diet with an elimination and reintroduction phase as well as physical activity and stress reduction. 

Research

There has been no independent scientific research on the Paddison Program, but some people claim that it has helped reduce their rheumatoid arthritis symptoms. There are testimonials from some people who have tried the programme, but the results will vary for different individuals.

It was developed by Clint Paddison, who developed rheumatoid arthritis at age 31 and claims to have controlled his symptoms with this programme.

The American College of Rheumatology and Arthritis NZ do not recommend this diet for people with rheumatoid arthritis.  

If you want to try this or any other diet that removes food groups you currently eat, speak to your doctor or specialist so they know you are doing this and consult a registered dietitian for advice before beginning the programme.  

The Health At Every Size (HAES) plan challenges the medical community's weight-based focus. Instead of focusing on body weight, shape, or size, the HAES approach encourages us to create a “fulfilling and meaningful lifestyle” through intuitive eating, body acceptance (regardless of size or shape), adequate sleep, and regular physical activity for movement and mental wellbeing, to optimise our physical and mental health at any size.

It is not anti-weight loss but doesn’t promote or focus on weight loss as a health strategy. A key reason is that weight is not a behaviour, and HAES focuses on health-improving behaviours. What’s more, focusing on weight while discussing healthy lifestyles perpetuates the myth that weight is modifiable and the ongoing weight stigma many people experience daily.

If someone loses weight while changing their health behaviours, that’s considered a side effect of HAES, but not the primary goal.

Research

There have been studies that show that HAES improves metabolic health, lowers blood pressure and lipids, improves energy expenditure, and improves eating habits and mental health. There is also research that shows the HAES approach as a possible means of improving the health-related quality of life for patients with arthritis, instead of fixating on weight loss.

Tips to follow the HAES method

• Listen to your body’s hunger cues, rather than eating by the clock. Hunger signs can start with rumbling tummies and lack of energy, through to light-headedness, difficulty concentrating, uncomfortable stomach pains, irritability, feeling faint or even a headache. Ideally, eat when you’re comfortably hungry, rather than over-hungry. When we’re over-hungry, we tend to overeat past comfortable fullness
• Treat all food as equal – don’t label foods as ‘good’ or ‘bad’. All foods can be part of a healthful lifestyle. One choice at one mealtime doesn’t make or break your health, so don’t feel guilty about enjoying a variety of foods. Think of food as being on a spectrum from “more nutritious foods” through to “play foods” and allow yourself to eat freely in a way that nourishes your body and still satisfies you. Removing the “restricted” label from foods typically reduces cravings in the long-term
• Eat more of the nutritious foods you enjoy: Instead of forcing yourself to eat foods you don’t like, think about which of those whole foods are your favourites. Which vegetables and fruits are your favourites? Eat those more often
• Eat until you are comfortably full, instead of eating everything on the plate: Listen to your tummy – when it says it’s full – stop eating. Save leftovers for another meal or snack-time, rather than eating past full and not enjoying those last over-stuffed mouthfuls of food