tablespoons minced fresh rosemary

2.

cloves garlic, minced .

teaspoon paprika Salt subst.i.tute Ground black pepper

1.

tablespoons olive oil

1. Preheat the oven to 400F.

2. Tear a large piece of aluminum foil, about 24 long. Spread the carrots out evenly over one half. Sprinkle with the vinegar, rosemary, garlic, and paprika. Season with salt subst.i.tute and pepper. Drizzle with the olive oil and fold the opposite end over, folding around the edges to make a neat package with no openings. Place the package on a baking sheet and bake 20 to 25 minutes, until the carrots are tender when pierced with a knife. Serve immediately.

PER SERVING.

90 calories, 1 g protein, 15 g carbohydrate, 4 g fat (0 g saturated), 0 mg cholesterol, 79 mg sodium, 4 g fiber; plus 540 mg pota.s.sium (15% DV) TUSCAN BEAN DIP.

Vegetables go down easy when you have something delicious to dip them in. A friend once watched in shock as her vegetable-hating daughter cleared a plate of crudites with this dish. Give it a try-it's loaded with taste and, thanks to the beans, provides lots of protein and fiber.

Makes 3 servings, cup each

1.

can (16 ounces) cannellini or navy beans, rinsed and drained

2.

tablespoons balsamic vinegar

2.

teaspoons olive oil

2.

tablespoons thinly sliced basil leaves .

teaspoon chopped fresh sage or rosemary

2.

cloves garlic, minced 1/8.

teaspoon hot red pepper flakes Ground black pepper Salt subst.i.tute

In a large bowl, mash the beans with the back of a fork or a hand-held potato masher. Stir in the vinegar, olive oil, basil, sage or rosemary, garlic, and pepper flakes. Season to taste with salt subst.i.tute and pepper. Serve immediately with vegetable sticks.

PER SERVING.

210 calories, 12 g protein, 33 g carbohydrate, 3.5 g fat (0 g saturated), 0 mg cholesterol, 30 mg sodium, 8 g fiber; plus 75 mg magnesium (20% DV), 462 mg pota.s.sium (13% DV), 96 mcg folic acid (25% DV)

CHAPTER 8.

ARTHRITIS.

As anyone with arthritis can tell you, arthritis sufferers truly suffer. Osteoarthritis can wear down the knees. Rheumatoid arthritis can twist and deform the fingers. And gout can make walking an exercise in masochism.

Arthritis is not a single disease, but a category that includes about a hundred joint-related disorders. According to the National Inst.i.tutes of Health, arthritis affects about one in every five people in the United States-most of whom don't realize how much nutrition can improve the way they feel. In some cases, such as with gout, a change in diet can often dramatically reduce symptoms. Because arthritis can have such debilitating effects, stumbling on even a single piece of helpful information can feel like unearthing a buried treasure. I remember the first time I talked about arthritis on the Today Today show, I got an overwhelming number of phone calls-hundreds of them!-asking for more details. That's what this chapter is all about...helpful details that could bring your pain level down a few critical notches. show, I got an overwhelming number of phone calls-hundreds of them!-asking for more details. That's what this chapter is all about...helpful details that could bring your pain level down a few critical notches.

WHAT AFFECTS ARTHRITIS?.

In medical lingo, the suffix-itis means means inflammation inflammation. Arthritis, then, means any disease that involves inflammation of the joints. But let's start at the very beginning and talk about what joints are made of.

Joints are places where bones come together. Some, such as the joints that connect the bones of the skull, are stable and immovable. Others have minimal mobility, such as the joints connecting the vertebrae of the spine. But most joints of the body are synovial joints synovial joints, which allow for varying degrees of movement, depending on their structure. For example, shoulders and hips are able to move freely in every direction because of their ball-and-socket design, while elbows and knees bend in a single direction, like a hinge.

All synovial joints share certain features: 1. The ends of the bones are coated with a soft, smooth substance called cartilage cartilage, which helps to cushion the bone and reduce friction.

2. The joint is encased by a ligament that holds the bones together. This ligament forms a capsule around the entire joint.

3. The inside of the capsule is covered by a special lining called the synovial membrane synovial membrane.

4. The synovial membrane secretes a lubricating fluid called, you guessed it, synovial fluid synovial fluid.

Of all the different types of arthritis, the two most common are osteoarthritis osteoarthritis and and rheumatoid arthritis rheumatoid arthritis.

OSTEOARTHRITIS.

Osteoarthritis (OA) occurs when the cartilage covering the end of the bone deteriorates, causing pain and swelling when the bones rub against each other. Over time, the bones can become misshapen from wear, and small bone spurs can grow at the bone ends, causing even more pain. If pieces of bone or cartilage break off, they can remain in the joint, causing still greater pain. In some people, the damage can be so extensive that the joint may have to be replaced.

Although we tend to think of OA as the logical outcome of wear and tear on the joints, scientists aren't so sure. Yes, wear and tear can affect some people's joints, but not everyone's. OA is due to a combination of factors, including genetics, past injury, joint use and overuse, and the aging process in general. We can't help our genetics, past injuries, or the aging process. And I'm certainly not going to recommend that you stop walking or partic.i.p.ating in your favorite sport just to preserve your joints. In fact, exercise can help keep joints mobile. (More about that later!) However, there is something you can do to protect your joints from overuse. The word overuse overuse implies that it's a problem for serious athletes-and it is-but it also happens when there is too much stress placed on the joint...the kind of stress caused by excess body weight. implies that it's a problem for serious athletes-and it is-but it also happens when there is too much stress placed on the joint...the kind of stress caused by excess body weight.

Being overweight can compress joints. Imagine that you are balancing a book on your head, and someone comes along and places another book on top...and then another, and then another. With each book, the vertebrae in your neck will become jammed closer and closer together. When you carry too much weight, that same kind of compression affects your knees and hips. Weight loss can help...in a big way. Every I pound of weight you lose equates to 4 pounds less stress and pressure on your knees.

The benefits of weight loss go beyond knees. For example, one study followed 48 men and women who had gastric bypa.s.s surgery for extreme weight loss. Before surgery, all 48 had musculoskeletal pain, including joint pain, usually in more than one part of their bodies. After surgery, only 11 of them (23 percent) reported musculoskeletal pain, and there was improvement in pain in the spine, neck, arms, hands, legs, and feet. Osteoarthritis stiffness and joint function improved significantly, and the partic.i.p.ants reported better quality of life. Surgery for weight loss is a drastic step, and it isn't necessary for most people. The vast majority of overweight people can lose enough weight to reduce their osteoarthritis symptoms through dietary changes alone. (See Weight Loss on Chapter 3 for more information about the best ways to lose weight.) RHEUMATOID ARTHRITIS.

Rheumatoid arthritis (RA) is a disease that causes inflammation of the lining of the joint capsule-the synovial membrane synovial membrane. Early in the disease process, affected joints can feel swollen, painful, hot, and tender to the touch. As the disease progresses, the synovial membrane thickens and begins to release enzymes that can dissolve bone and cartilage inside the joint. If these enzymes eat away at enough tissue, the joint can become deformed-and the pain can be excruciating. Although some people have constant active disease, others have periods of rest or remission when symptoms may ease up or disappear.

RA is an autoimmune disease, which means that the immune system, which typically defends the body against foreign invaders (such as bacteria or viruses), suddenly turns on itself. In this case, the immune system attacks synovial membranes. Scientists don't know what triggers the process, why it goes into remission, or why it flares up periodically. Genetics play at least some role. Hormones may also play a part, as RA affects women more often than it affects men, and because flares often occur after a pregnancy. Some researchers believe that a bacterial or viral infection may set the wheels in motion, but that has not been proven. What we do know is that although RA cannot be cured, it can be managed with medication and lifestyle changes.

HOW FOOD AFFECTS ARTHRITIS.

Because arthritis is a disease of inflammation, the most effective-and logical-treatment is anything that fights inflammation. Medical management of arthritis usually starts with ibuprofen and other anti-inflammatory medications, and nutritional care starts with anti-inflammatory foods.

Inflammation is a complex physiological reaction that begins whenever there is some a.s.sault to the body, such as injury, viral or bacterial infection, or exposure to allergens or chemicals. Whenever the body senses danger, it goes on high alert and bursts into action-it begins manufacturing and pumping out interleukins, cytokines, and other substances that rush to the site of the problem. The purpose of those substances is to protect tissue from the a.s.sault of foreign invaders.

Most of the time, this defensive system works marvelously well, but not always. Imagine that your house has an infestation of houseflies. If you wanted to be certain to eliminate the problem, you could buy a flyswatter, and and set glue traps, set glue traps, and and fumigate with a powerful insecticide, fumigate with a powerful insecticide, and and bring in a thousand spiders to spin webs to trap the flies. But that response would be overkill. Once the flies were gone, you would have a new set of problems-namely a house full of airborne toxins and way, way too many spiders. The immune system often opts for overkill, and we're left with hot, red, swollen, painful joints. The inflammation comes and stays, and there's no way to just turn it off. That's why the best way to fight the pain of nearly any kind of arthritis is to fight inflammation with medication and/or with nutrition. bring in a thousand spiders to spin webs to trap the flies. But that response would be overkill. Once the flies were gone, you would have a new set of problems-namely a house full of airborne toxins and way, way too many spiders. The immune system often opts for overkill, and we're left with hot, red, swollen, painful joints. The inflammation comes and stays, and there's no way to just turn it off. That's why the best way to fight the pain of nearly any kind of arthritis is to fight inflammation with medication and/or with nutrition.

FAQSI keep hearing about different herbal remedies for my arthritis. How do I know which ones are worth trying?

Herbs have been used as medical treatments for thousands of years by many cultures around the world. Research, however, is limited and the results are inconsistent. Depending on which herbs you choose, they can help or hurt or hurt your health, sometimes in ways we can't predict. That's why I recommend that you talk with your doctor if you have specific questions or health concerns. Among the dozens of potential herbal treatments for arthritis, the most promising are boswellia, devil's claw, and cat's claw. your health, sometimes in ways we can't predict. That's why I recommend that you talk with your doctor if you have specific questions or health concerns. Among the dozens of potential herbal treatments for arthritis, the most promising are boswellia, devil's claw, and cat's claw.Boswellia comes from the boswellia serrata tree, which grows in some parts of India. Its anti-inflammatory properties may help relieve some of the pain and stiffness of both osteoarthritis and rheumatoid arthritis. If you want to try boswellia, look for extracts standardized to 60 percent boswellic acids. The typical dosage is 300 to 400 milligrams of boswellic acids, three times daily.Devil's claw is an African plant used to treat arthritis pain. Typical dosage is 750 milligrams, three times per day. Look for an extract standardized to contain 50 to 100 milligrams of the active ingredient harpagoside. Long-term safety hasn't been tested, and short-term side effects can include diarrhea, headache, and loss of taste. Because devil's claw can lower blood sugar, it may not be safe if you have diabetes or hypoglycemia.Cat's claw is a vine that grows in rainforests in South America and Asia. Limited studies have shown that it may be helpful for relieving the pain of osteoarthritis and rheumatoid arthritis. It's available in capsules, tablets, liquid, and tea bags-dosage varies. The public is advised to only buy products that contain uncaria tomentosa uncaria tomentosa. Another plant (acacia greggi), also called cat's claw, is highly toxic. For osteoarthritis, 100 milligrams daily of a specific freeze-dried aqueous cat's claw extract has been used. For rheumatoid arthritis, 60 milligrams daily in three divided doses of a specific cat's claw extract (free of tetracyclic oxindole alkaloids) has been used. Cat's claw can cause allergic reactions and gastrointestinal upset. There has been at least one report of kidney failure possibly triggered by cat's claw. For all these reasons, I recommend talking with your doctor before trying cat's claw.

An anti-inflammatory diet excludes foods that fan the flames of inflammation...and embraces plenty of foods that reduce it. To get the most out of nutritional changes, you should adopt both sets of recommendations.

FOODS TO AVOID.

I already mentioned that being overweight puts extra stress on the joints, which increases the risk of wear and tear. But there is another reason being overweight is a problem. Body fat is not an inert substance, it is metabolically active, capable of producing hormones and chemicals that actually increase levels of inflammation actually increase levels of inflammation. By losing weight-and avoiding excess calories that can cause weight gain-you'll automatically reduce the level of inflammation in your body.

Specific food groups that increase inflammation include: SATURATED FATS.

This category includes fats in and from animal products, such as fatty beef or pork, poultry skin, ice cream, b.u.t.ter, whole or 2% reduced-fat milk, regular cheese, bacon, bologna, salami, pepperoni, beef sausage, and other fatty foods. Saturated fats are also found in palm oil and palm kernel oil. My guess is that you won't find bottles of any of those oils in your pantry, but chances are you will find them in the ingredient list of any number of items on your shelves, including crackers, cookies, nondairy creamers, and other packaged baked goods-try to dramatically limit your intake. In addition to carefully reading labels, choose reduced-fat or fat-free dairy products, lean cuts of beef and pork, and skinless chicken and turkey.

TRANS FATS.

Trans fats are man-made. In an effort to give baked goods a longer shelf life, scientists took common vegetable oil and added hydrogen molecules in the right places. The result was that the liquid oil turned solid...and dangerous. Trans fats are thought to be at least as damaging as saturated fats in terms of inflammation and other health problems. Maybe worse. You won't have to go to great lengths to determine whether a food contains trans fats or not. Food producers are well aware of the dangers of these ingredients and growing public awareness of them, so companies that don't use trans fats are proclaiming it all over their product packaging. Plus, manufacturers are now required to list the amount of trans fats, right after the listing for saturated fats on the nutrition label.

OMEGA-6 POLYUNSATURATED FATS.

Polyunsaturated fats come in two main varieties-omega-3s and omega-6s. Omega-3s are the healthy fish oils (discussed below), but omega-6s are another story. While they are not as overtly dangerous for health as saturated fats or trans fats, omega-6 fats are still considered inflammatory, which means that, in high doses, they could make arthritis pain worse. Omega-6 fats are found in mayonnaise, corn oil, cotton seed oil, safflower oil, soybean oil, and sunflower oil. Whenever possible, choose healthy monounsaturated olive oil instead of these omega-6 oils.

SIMPLE AND REFINED CARBOHYDRATES.

Sugary foods, white flour baked goods, white rice, bread, crackers, and other refined carbohydrates set up a state of inflammation in the body, causing increases in cytokines and other pro-inflammatory compounds. Limit these foods if you want the best chance of reducing arthritis pain and progression.

FOODS TO ADD.

These foods all help to reduce some aspect of inflammation: OMEGA-3 FATTY ACIDS.

The healthiest of fats for people with arthritis or other inflammatory disorders are omega-3 fatty acids, one of the polyunsaturated fats. While other foods increase levels of inflammation in the body, omega-3s actually work to decrease inflammation by suppressing the production of cytokines and enzymes that erode cartilage.

More than a dozen studies have demonstrated that omega-3 fish oils can reduce symptoms of RA. Study partic.i.p.ants reported greater strength, less fatigue, reduced joint swelling and tenderness, less joint stiffness, and less pain.