Although the evidence is less clear about how fish oil affects osteoarthritis, the anti-inflammatory effects of omega-3s are so potent that I recommend an omega-3-rich diet and fish oil supplements to all my clients with arthritis. I've seen some amazing results. Take Colleen-she was in her mid-40s, only about 10 pounds overweight, but she had a problem with high cholesterol. I put her on a cholesterol-lowering program, which included fish oil capsules. After a month, she returned for a follow-up appointment and I was pleased to see she had lost a couple of pounds, and her cholesterol had begun to return to healthy levels. But Colleen was ecstatic! She explained that her joint pain-which she'd never mentioned-had almost entirely disappeared. The fish oil supplements had made Colleen feel like a new person.

Emma was in her early 70s, and had diagnosed osteoarthritis. She needed to lose about 45 pounds, which contributed to her problem, but the extraordinary level of pain she felt in her knees and hands couldn't be explained by weight alone. I put her on a healthy, calorie-controlled food plan and recommended that she take fish oil capsules...she also began taking glucosamine plus chondroitin supplements, and she began seeing an acupuncturist. Today, Emma swims and walks on a treadmill without pain, and she is more active than she has been in years. She still has pain flare-ups, but she feels much, much better. We don't know which of the treatments was most effective, and Emma doesn't really care. She feels healthy, and she is unwilling to stop taking any of her supplements, which she sees as her lifeline. (For more information about fish oil and other supplements, see the Supplements section, Chapter 8.) BEST FOODS FOR OMEGA-3 FATTY ACIDS: Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans ANTIOXIDANTS: VITAMIN C, SELENIUM, CAROTENES, BIOFLAVONOIDS.

Inflammation produces free radicals, those cell-damaging molecules that are formed in response to toxins or natural body processes. The synovium is just as p.r.o.ne to this kind damage as the skin, eyes, or any other body tissue. Antioxidants protect the body from the effects of free radicals, and are a critical part of an anti-inflammation diet. Research has demonstrated that certain antioxidants may help prevent arthritis, slow its progression, and relieve pain. The most powerful antioxidants are vitamin C, selenium, carotenes, and bioflavonoids.

Vitamin C is one of the nutrients most responsible for the health of collagen, a major component of cartilage. In addition, research suggests that people who eat a diet low in vitamin C may have a greater risk of developing some kinds of arthritis. For those reasons, it is important to make vitamin C-rich foods an important part of your daily diet. is one of the nutrients most responsible for the health of collagen, a major component of cartilage. In addition, research suggests that people who eat a diet low in vitamin C may have a greater risk of developing some kinds of arthritis. For those reasons, it is important to make vitamin C-rich foods an important part of your daily diet. However However, researchers at Duke University found that long-term, high-dose vitamin C supplements may make your osteoarthritis worse worse. I say may may because the research was conducted on guinea pigs. The researchers' a.s.sumption is that it will have the same effect in people. I wouldn't want you to risk your health with supplements, so if you have osteoarthritis, I recommend you get vitamin C from food sources only-not from an individual supplement, but multivitamins are fine. because the research was conducted on guinea pigs. The researchers' a.s.sumption is that it will have the same effect in people. I wouldn't want you to risk your health with supplements, so if you have osteoarthritis, I recommend you get vitamin C from food sources only-not from an individual supplement, but multivitamins are fine.

BEST FOODS FOR VITAMIN C: Guava, bell peppers (yellow, red, green), orange juice, hot chile peppers, oranges, grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons, broccoli, kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, grapefruit (pink, red), white potatoes (with skin), mustard greens, cherry tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, tomatoes, raspberries, Chinese cabbage, blackberries, green tomatoes, cabbage, watermelon, tangerines, lemon juice, okra, lychees, summer squash (all varieties), persimmon Guava, bell peppers (yellow, red, green), orange juice, hot chile peppers, oranges, grapefruit juice, strawberries, pineapple, kohlrabi, papaya, lemons, broccoli, kale, Brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, grapefruit (pink, red), white potatoes (with skin), mustard greens, cherry tomatoes, sugar snap peas, snow peas, clementines, rutabagas, turnip greens, tomatoes, raspberries, Chinese cabbage, blackberries, green tomatoes, cabbage, watermelon, tangerines, lemon juice, okra, lychees, summer squash (all varieties), persimmon Low levels of the mineral selenium selenium are related to osteoarthritis severity, and possibly to rheumatoid arthritis. In a study of more than 900 people, those who had low levels of selenium were more likely to have osteoarthritis of the knee. People who ate very few selenium-rich foods were nearly twice as likely to have severe arthritis compared with those who ate a selenium-rich diet. are related to osteoarthritis severity, and possibly to rheumatoid arthritis. In a study of more than 900 people, those who had low levels of selenium were more likely to have osteoarthritis of the knee. People who ate very few selenium-rich foods were nearly twice as likely to have severe arthritis compared with those who ate a selenium-rich diet.

BEST FOODS FOR SELENIUM: Brazil nuts, tuna (canned light), crab, oysters, tilapia, whole wheat pasta, lean beef, cod, shrimp, whole wheat breads (including crackers, buns), turkey, wheat germ, brown rice, chicken breast, cottage cheese (fat-free or 1% reduced-fat), mushrooms, eggs Brazil nuts, tuna (canned light), crab, oysters, tilapia, whole wheat pasta, lean beef, cod, shrimp, whole wheat breads (including crackers, buns), turkey, wheat germ, brown rice, chicken breast, cottage cheese (fat-free or 1% reduced-fat), mushrooms, eggs Carotenes are a group of powerful antioxidant nutrients found in many fruits and vegetables. The best known is beta carotene, but there are many others. When it comes to arthritis, the carotene called beta cryptoxanthin may reduce the risk of developing inflammation-related disorders, including rheumatoid arthritis. Researchers from the United Kingdom found that people who ate diets high in beta cryptoxanthin were half as likely to develop a form of inflammatory arthritis as those who ate very few beta cryptoxanthin foods. They found that adding just one additional serving each day of a food high in beta cryptoxanthin helped reduce arthritis risk. are a group of powerful antioxidant nutrients found in many fruits and vegetables. The best known is beta carotene, but there are many others. When it comes to arthritis, the carotene called beta cryptoxanthin may reduce the risk of developing inflammation-related disorders, including rheumatoid arthritis. Researchers from the United Kingdom found that people who ate diets high in beta cryptoxanthin were half as likely to develop a form of inflammatory arthritis as those who ate very few beta cryptoxanthin foods. They found that adding just one additional serving each day of a food high in beta cryptoxanthin helped reduce arthritis risk.

BEST FOODS FOR BETA CAROTENE: Sweet potatoes, carrots, kale, winter squash (especially b.u.t.ternut), turnip greens, pumpkin, mustard greens, cantaloupe, red bell peppers, apricots, Chinese cabbage, spinach, lettuce (romaine, green leaf, red leaf, b.u.t.terhead), collard greens, Swiss chard, watercress, grapefruit, watermelon, cherries, mangos, red ripe tomatoes, guava, asparagus, red cabbage Sweet potatoes, carrots, kale, winter squash (especially b.u.t.ternut), turnip greens, pumpkin, mustard greens, cantaloupe, red bell peppers, apricots, Chinese cabbage, spinach, lettuce (romaine, green leaf, red leaf, b.u.t.terhead), collard greens, Swiss chard, watercress, grapefruit, watermelon, cherries, mangos, red ripe tomatoes, guava, asparagus, red cabbage BEST FOODS FOR BETA CRYPTOXANTHIN: Winter squash, pumpkin, persimmons, papaya, tangerines, red chile peppers, red bell peppers, corn, oranges, apricots, carrots, nectarines, watermelon, peaches Winter squash, pumpkin, persimmons, papaya, tangerines, red chile peppers, red bell peppers, corn, oranges, apricots, carrots, nectarines, watermelon, peaches The bioflavonoids bioflavonoids quercetin and anthocyanidins are both forms of antioxidants. quercetin and anthocyanidins are both forms of antioxidants.

The anti-inflammatory effects of quercetin quercetin may seem to be similar to those of nonsteroidal anti-inflammatory medications (such as aspirin and ibuprofen). For example, the synovial fluid in joints of people with rheumatoid arthritis contain highly inflammatory chemicals called may seem to be similar to those of nonsteroidal anti-inflammatory medications (such as aspirin and ibuprofen). For example, the synovial fluid in joints of people with rheumatoid arthritis contain highly inflammatory chemicals called tumor necrosis factor tumor necrosis factor (TNF). In research, quercetin was able to limit the inflammatory effects of TNF. (TNF). In research, quercetin was able to limit the inflammatory effects of TNF.

FAQSThere are so many different kinds of foods to avoid. I think I can figure this out for meals I cook at home, but are there guidelines for what to eat in restaurants?

You're right-it can be difficult at first, but after a few weeks, making smart food choices will become second nature. I recommend:American Fare - Grilled fish or skinless chicken breast in olive oil and seasonings-with brown rice or a baked or sweet potato-and lots of grilled, roasted, or steamed vegetables.

- Salad entrees: variety of vegetables (request extra red peppers) with grilled chicken, shrimp, turkey breast, or lean ham. For dressing, use vinaigrette or request olive oil and vinegar on the side, or top with fresh salsa.

- Sandwiches: Turkey breast, lean ham, or grilled chicken breast on whole grain bread, or whole wheat pita, or rolled in a whole grain wrap. Optional avocado, roasted peppers, onion, tomato, and other vegetables.

- Soups: gazpacho, black bean, lentil, vegetable, and low-fat b.u.t.ternut squash.

j.a.panese Food - Edamame, seaweed salad, California rolls (take advantage of sliced ginger!), and steamed vegetables.

Chinese Food - Steamed whole fish with ginger-plus steamed brown rice and sauteed or steamed vegetables.

- Steamed chicken and broccoli (or any other vegetables-request "with ginger") with 1 to 2 tablespoons black bean or garlic sauce-and steamed brown rice.

Indian Food - Tandoori salmon or chicken-with a variety of side vegetables.

BEST FOODS FOR QUERCETIN: Onions (red, yellow, white), kale, leeks, cherry tomatoes, broccoli, blueberries, black currants, elderberries, lingonberries, cocoa powder (unsweetened), apricots, apples with skin (especially Red Delicious), grapes (red, purple, black), tomatoes, tea (green, black), red wine, beans (green, white), lettuce (b.u.t.terhead, Boston, iceberg, Bibb), peppers (ancho, hot chile, green, yellow wax), celery, chives, red cabbage, lemons, grapefruit, horseradish root Onions (red, yellow, white), kale, leeks, cherry tomatoes, broccoli, blueberries, black currants, elderberries, lingonberries, cocoa powder (unsweetened), apricots, apples with skin (especially Red Delicious), grapes (red, purple, black), tomatoes, tea (green, black), red wine, beans (green, white), lettuce (b.u.t.terhead, Boston, iceberg, Bibb), peppers (ancho, hot chile, green, yellow wax), celery, chives, red cabbage, lemons, grapefruit, horseradish root Anthocyanidins and proanthocyanidins are powerful antioxidants known to reduce inflammation. They seem to inhibit production of certain inflammatory chemicals, including cytokines and prostaglandins. They contribute to the health of connective tissue, and are more powerful than vitamin C for defusing dangerous free radicals that can irritate body tissues and cause inflammation. and proanthocyanidins are powerful antioxidants known to reduce inflammation. They seem to inhibit production of certain inflammatory chemicals, including cytokines and prostaglandins. They contribute to the health of connective tissue, and are more powerful than vitamin C for defusing dangerous free radicals that can irritate body tissues and cause inflammation.

BEST FOODS FOR ANTHOCYANIDINS: Blackberries, black currants, blueberries, eggplant, elderberries, raspberries, cherries, boysenberries, grapes (red, black), strawberries, plums, cranberries, rhubarb, red wine, red onions, apples, peaches, cabbage (red, purple), red beets, blood oranges (and juice) Blackberries, black currants, blueberries, eggplant, elderberries, raspberries, cherries, boysenberries, grapes (red, black), strawberries, plums, cranberries, rhubarb, red wine, red onions, apples, peaches, cabbage (red, purple), red beets, blood oranges (and juice) GREEN TEA.

Green tea's health benefits are often underestimated. Compared with regular black tea, green tea looks weak and insubstantial. But this mild-mannered drink contains a natural antioxidant called epigallocatechin-3-gallate (EGCG). Studies suggest that EGCG works to stop the production of certain inflammatory chemicals in the body, including those involved in arthritis. Green tea also contains other antioxidants called catechins catechins, which may prevent cartilage from breaking down, so joints may be preserved longer.

OLIVE OIL.

Olive oil contains the "good" monounsaturated fat, which protects the body against inflammation because it contains antioxidants called polyphenols polyphenols. In animal studies, rats with arthritis were fed diets high in various kinds of oils. The researchers found that both fish oil and olive oil prevented arthritis-related inflammation. I recommend using olive oil when cooking, instead of vegetable oil or b.u.t.ter. Don't pour it on-just subst.i.tute one for the other in equal or lesser amounts. Ideally, you'll want to choose an olive oil high in polyphenols. That may sound like a tough call, but it is really very simple-just look for the words extra virgin extra virgin on the olive oil label and you'll get the highest antioxidant content available. on the olive oil label and you'll get the highest antioxidant content available.

VITAMIN D.

Although we mostly think of vitamin D as important for bone strength, it is also critical for a number of other body functions, including joint health. Studies have shown that getting adequate amounts of vitamin D reduces the risk of both rheumatoid arthritis and osteoarthritis. Among people who already have osteoarthritis, those who have a vitamin D deficiency are more likely to develop worsening disability over time. Getting even the basic daily requirements of vitamin D leads to greater muscle strength, improvement in physical functioning, and preservation of cartilage (that's at least 400 IU until age 70, and at least 600 IU for folks 70 and older).

BEST FOODS FOR VITAMIN D: Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), fortified soft tub trans fat-free margarine, fortified breakfast cereals Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), fortified soft tub trans fat-free margarine, fortified breakfast cereals SPICES: GINGER AND TURMERIC.

Most people don't realize that spices are for more than, well, spicing things up. They're an important source of essential nutrients. Like fruits and vegetables, spices come from plant sources, and they can have powerful effects on health. Certain spices seem to have anti-inflammatory effects, and therefore should be considered for arthritis treatment. Among the most promising are ginger and turmeric.

Ginger has been shown to lessen the pain of knee osteoarthritis when taken in highly purified, standardized supplement form. Ginger contains chemicals that work similarly to some anti-inflammatory medications, so its effects on arthritis pain are not surprising. However, ginger can also act as a blood thinner, so anyone taking a blood-thinning medication should limit their ginger use. Better yet, collaborate with your physician to monitor and possibly adjust your medication while adding foods and beverages seasoned with ginger.

GOUTImagine needle-sharp shards of gla.s.s inserted between the bones of your joints, grating and grinding with every move. That not-so-happy image is the pain of gout, one of the more common forms of arthritis. Of course it's not actually gla.s.s in the joints. In some people with a genetic susceptibility-men more often than women-the body converts excess uric acid into crystals which can acc.u.mulate in joints.In most cases, the extreme pain of gout starts in the big toe. I've known clients who have had so much swelling and agony that they can't wear shoes. At the very least, the discomfort is enough to make walking difficult (and according to one of my clients "ruin an otherwise great vacation"). Gout can also settle into other joints of the feet, ankles, knees, fingers, wrists, and elbows.Most cases of gout are controllable. Treatment involves medication, and avoiding anything that raises levels of uric acid. Because uric acid is a byproduct of the metabolism of purine, a substance naturally found in body tissues, you'll never get rid of it entirely. However, if you have gout, or have been told you're at high risk, there are several ways to keep uric acid levels as low as possible: - Maintain a healthy weight. Extra body tissue means extra uric acid production from normal processes of breakdown and turnover. Extra body tissue means extra uric acid production from normal processes of breakdown and turnover.

- Avoid purine-rich meats and seafood. The more purine-rich meats and seafood you eat, the more uric acid you'll produce, and the greater your risk of gout. Studies have shown that eating lots of these high-purine foods increases the risk of gout by about 50 percent. I've seen this in my practice. Some of my clients who never before had a gout attack found themselves suffering after following a super high-protein diet because many meats can contribute to uric acid load. (High-purine vegetables don't seem to increase risk of gout, but if you're suffering with an attack, I recommend eating them only in moderation to be safe.) High-purine foods to avoid: Anchovies, herring, mackerel, scallops, sardines, sweetbreads, liver, kidney, red meat, poultry, wild game, lentils, dried beans and peas, asparagus, cauliflower, spinach, mushrooms. The more purine-rich meats and seafood you eat, the more uric acid you'll produce, and the greater your risk of gout. Studies have shown that eating lots of these high-purine foods increases the risk of gout by about 50 percent. I've seen this in my practice. Some of my clients who never before had a gout attack found themselves suffering after following a super high-protein diet because many meats can contribute to uric acid load. (High-purine vegetables don't seem to increase risk of gout, but if you're suffering with an attack, I recommend eating them only in moderation to be safe.) High-purine foods to avoid: Anchovies, herring, mackerel, scallops, sardines, sweetbreads, liver, kidney, red meat, poultry, wild game, lentils, dried beans and peas, asparagus, cauliflower, spinach, mushrooms.

- Eat more reduced-fat dairy foods. People who eat two or three servings daily of reduced-fat dairy foods-especially milk and yogurt-can cut their risk of gout by about half, compared with those who eat few dairy foods. Add reduced-fat or fat-free milk or yogurt to your diet. People who eat two or three servings daily of reduced-fat dairy foods-especially milk and yogurt-can cut their risk of gout by about half, compared with those who eat few dairy foods. Add reduced-fat or fat-free milk or yogurt to your diet.

- Reduce alcohol intake-especially beer. Alcoholic beverages interfere with the body's ability to clear uric acid, increasing risk of gout. In 2004, Harvard researchers reported that beer was the greatest offender-men who drank two or more beers per day had more than twice the risk of gout compared with men who didn't drink beer. Spirits also caused an increase in gout, but to a lesser degree. Wine did not seem to increase risk of gout, but I still recommend limiting your consumption. Alcoholic beverages interfere with the body's ability to clear uric acid, increasing risk of gout. In 2004, Harvard researchers reported that beer was the greatest offender-men who drank two or more beers per day had more than twice the risk of gout compared with men who didn't drink beer. Spirits also caused an increase in gout, but to a lesser degree. Wine did not seem to increase risk of gout, but I still recommend limiting your consumption.

- Drink plenty of water. I recommend that my clients with gout drink at least eight gla.s.ses of water daily to help flush uric acid out of the body. I recommend that my clients with gout drink at least eight gla.s.ses of water daily to help flush uric acid out of the body.

- Use aspirin sparingly. Salicylates-the active ingredients in aspirin-can raise uric acid levels. Salicylates-the active ingredients in aspirin-can raise uric acid levels.

- Get a check up. About 75 percent of people diagnosed with gout also have the metabolic syndrome, a serious condition that increases the risk of heart disease. If you receive a diagnosis of gout, insist on testing for the metabolic syndrome. (More information about the metabolic syndrome is on Chapter 7.) About 75 percent of people diagnosed with gout also have the metabolic syndrome, a serious condition that increases the risk of heart disease. If you receive a diagnosis of gout, insist on testing for the metabolic syndrome. (More information about the metabolic syndrome is on Chapter 7.)

Turmeric, sometimes called curc.u.min, is a mustard-yellow spice from Asia. It is the main ingredient in yellow curry powder. Scientific studies have shown that turmeric may help arthritis by suppressing inflammatory body chemicals. Because of its effects on enzymes related to inflammation, turmeric may have the same mode of action as Celebrex and similar medications. Note: turmeric is also used as a dye, so use caution when handling it-it can discolor clothing and some surfaces. Dig in and enjoy my curry chicken recipe on Chapter 8!

BONUS POINTS.

- See a doctor about symptoms. Don't be complaisant about joint pain, stiffness, swelling, or weakness, and don't a.s.sume that joint pain is a normal part of growing older. Early treatment of OA, RA, or other arthritis can help slow the disease progression and provide a lot of pain relief. Don't be complaisant about joint pain, stiffness, swelling, or weakness, and don't a.s.sume that joint pain is a normal part of growing older. Early treatment of OA, RA, or other arthritis can help slow the disease progression and provide a lot of pain relief.

- Work to reduce cholesterol. Although no one knows what triggers RA, an interesting European study may provide at least one clue. Researchers a.n.a.lyzed 10-year-old blood samples of people who later developed RA, and compared them to blood of a random sample of individuals. They discovered that people who developed RA had higher than normal levels of low-density lipoprotein (LDL) cholesterol, triglycerides, and apolipoprotein B; and lower than normal levels of high-density lipoprotein (HDL) cholesterol. The theory is that these blood results indicate the start of atherosclerosis...and atherosclerosis means more inflammation in the body. (See C-Reactive Protein on Chapter 7 for more information about how heart disease is related to inflammation.) Could it be that a higher level of inflammation could turn into inflammatory joint disease? More research is needed, but it certainly gives added reason to treat your cholesterol problem as early as possible. Although no one knows what triggers RA, an interesting European study may provide at least one clue. Researchers a.n.a.lyzed 10-year-old blood samples of people who later developed RA, and compared them to blood of a random sample of individuals. They discovered that people who developed RA had higher than normal levels of low-density lipoprotein (LDL) cholesterol, triglycerides, and apolipoprotein B; and lower than normal levels of high-density lipoprotein (HDL) cholesterol. The theory is that these blood results indicate the start of atherosclerosis...and atherosclerosis means more inflammation in the body. (See C-Reactive Protein on Chapter 7 for more information about how heart disease is related to inflammation.) Could it be that a higher level of inflammation could turn into inflammatory joint disease? More research is needed, but it certainly gives added reason to treat your cholesterol problem as early as possible.

- Drink plenty of water. Cartilage is 65 to 80 percent water, so staying hydrated is important for the health and lubrication of joints. It isn't necessary to count the number of gla.s.ses of water you drink in a day-the latest research suggests that if you drink a gla.s.s of water whenever you feel thirsty, you'll probably do fine. My biggest recommendation is that you choose water, herbal tea, or green tea instead of sugary drinks or soft drinks. Cartilage is 65 to 80 percent water, so staying hydrated is important for the health and lubrication of joints. It isn't necessary to count the number of gla.s.ses of water you drink in a day-the latest research suggests that if you drink a gla.s.s of water whenever you feel thirsty, you'll probably do fine. My biggest recommendation is that you choose water, herbal tea, or green tea instead of sugary drinks or soft drinks.

- Exercise. Many people stop exercising at the first twinge of pain in a joint, but this can be a big mistake. Exercise can help you lose or maintain weight, which reduces the overall stress impact on joints. Strong muscles can absorb shock from daily movements, keep joints stable, and protect against additional joint injury. Stretching and yoga can improve flexibility and range of motion. Exercise of all sorts can also help you sleep better, although you should not exercise vigorously late in the day if insomnia is a problem. Talk with your doctor about the best kind of exercise for you, because the best choices will depend on your particular medical situation and pain levels. Swimming and water aerobics are usually good for everyone because they allow free movement without added stress on the joints. No matter which exercise you choose, don't overdo it when you are just starting out, and don't do anything that threatens your balance. By all means stop if the pain worsens. Many people stop exercising at the first twinge of pain in a joint, but this can be a big mistake. Exercise can help you lose or maintain weight, which reduces the overall stress impact on joints. Strong muscles can absorb shock from daily movements, keep joints stable, and protect against additional joint injury. Stretching and yoga can improve flexibility and range of motion. Exercise of all sorts can also help you sleep better, although you should not exercise vigorously late in the day if insomnia is a problem. Talk with your doctor about the best kind of exercise for you, because the best choices will depend on your particular medical situation and pain levels. Swimming and water aerobics are usually good for everyone because they allow free movement without added stress on the joints. No matter which exercise you choose, don't overdo it when you are just starting out, and don't do anything that threatens your balance. By all means stop if the pain worsens.

- Try acupuncture. Among people with osteoarthritis, studies suggest that traditional Chinese acupuncture can help reduce pain and improve function. People who had about one treatment per week felt better after just four weeks, and they felt better and better, week after week. It is important to choose a qualified, skilled acupuncturist who knows how to treat osteoarthritis. I prefer that my clients go to an acupuncturist who also has a traditional medical degree to be sure that they are receiving the best combination of Western medicine and Eastern acupuncture. (Ask your rheumatologist or primary care physician for a referral. You can also find certified acupuncturists at the website for the National Certification Commission for Acupuncture and Oriental Medicine at www.NCCAOM.org.) Also, watch out for those who are more concerned with business than with health care-the most reputable will treat you only when you have pain, and will not pressure you to come in for a set number of treatments. Among people with osteoarthritis, studies suggest that traditional Chinese acupuncture can help reduce pain and improve function. People who had about one treatment per week felt better after just four weeks, and they felt better and better, week after week. It is important to choose a qualified, skilled acupuncturist who knows how to treat osteoarthritis. I prefer that my clients go to an acupuncturist who also has a traditional medical degree to be sure that they are receiving the best combination of Western medicine and Eastern acupuncture. (Ask your rheumatologist or primary care physician for a referral. You can also find certified acupuncturists at the website for the National Certification Commission for Acupuncture and Oriental Medicine at www.NCCAOM.org.) Also, watch out for those who are more concerned with business than with health care-the most reputable will treat you only when you have pain, and will not pressure you to come in for a set number of treatments.

- Stop smoking. There are so many good reasons to stop smoking, but now we can add healthy joints to the list. Smoking delivers toxins throughout the body, causing inflammation and increasing the risks of rheumatoid arthritis and osteoarthritis. In one study, smokers were more than twice as likely to develop RA than people who didn't smoke. Smokers who also had a genetic susceptibility for RA were more than seven times more likely to develop the disease than the average person. The effects of smoking on osteoarthritis are less clear, but researchers from a multi-center study reported in 2005 that smokers had a greater risk of osteoarthritis of the knee, possibly because smoking interferes with the body's ability to repair its own cartilage. If you quit smoking, you'll immediately reduce your inflammation load, and you'll improve blood flow to all parts of your body, including your aching joints. There are so many good reasons to stop smoking, but now we can add healthy joints to the list. Smoking delivers toxins throughout the body, causing inflammation and increasing the risks of rheumatoid arthritis and osteoarthritis. In one study, smokers were more than twice as likely to develop RA than people who didn't smoke. Smokers who also had a genetic susceptibility for RA were more than seven times more likely to develop the disease than the average person. The effects of smoking on osteoarthritis are less clear, but researchers from a multi-center study reported in 2005 that smokers had a greater risk of osteoarthritis of the knee, possibly because smoking interferes with the body's ability to repair its own cartilage. If you quit smoking, you'll immediately reduce your inflammation load, and you'll improve blood flow to all parts of your body, including your aching joints.

- De-stress. Some experts believe that autoimmune disorders, including rheumatoid arthritis, can flare up in response to stress. Plus, people who feel stressed are more sensitive to pain. Stress reduction can be as important to your health as medication, so make it a priority. Carve out time in your schedule to relax and, if necessary, downsize your to-do list by asking others to help out. Chances are friends and family will offer to help when they learn of your condition-take them up on it. Check with your local hospital to see if it offers cla.s.ses in stress reduction techniques, such as guided imagery, meditation, and progressive relaxation. Some experts believe that autoimmune disorders, including rheumatoid arthritis, can flare up in response to stress. Plus, people who feel stressed are more sensitive to pain. Stress reduction can be as important to your health as medication, so make it a priority. Carve out time in your schedule to relax and, if necessary, downsize your to-do list by asking others to help out. Chances are friends and family will offer to help when they learn of your condition-take them up on it. Check with your local hospital to see if it offers cla.s.ses in stress reduction techniques, such as guided imagery, meditation, and progressive relaxation.

- Control your pain. When it comes to the pain of arthritis, don't try to be hero. You have nothing to gain by toughing it out. If you hurt, see your doctor. If your doctor prescribes medication, take it. If you still hurt, make another appointment. People in constant pain may stop doing the things they love and before long their quality of life takes a real turn for the worse. Some arthritis patients become depressed; small wonder, if they're in constant pain! If you don't have the pain under control, and your current doctor seems to have exhausted the options, research pain specialists in your area through organizations such as the American Academy of Pain Management (www.AAPainManage.org). When it comes to the pain of arthritis, don't try to be hero. You have nothing to gain by toughing it out. If you hurt, see your doctor. If your doctor prescribes medication, take it. If you still hurt, make another appointment. People in constant pain may stop doing the things they love and before long their quality of life takes a real turn for the worse. Some arthritis patients become depressed; small wonder, if they're in constant pain! If you don't have the pain under control, and your current doctor seems to have exhausted the options, research pain specialists in your area through organizations such as the American Academy of Pain Management (www.AAPainManage.org).

SUPPLEMENTS.

If you have arthritis and want to consider supplements in addition to in addition to the food fixes, I recommend: the food fixes, I recommend: FOR BOTH OSTEOARTHRITIS AND RHEUMATOID.

ARTHRITIS.

1. Multivitamin. If you would like to consider a multivitamin to supplement your healthy (I hope!) diet, I recommend brands that provide 100% DV of vitamin D (in the form of D If you would like to consider a multivitamin to supplement your healthy (I hope!) diet, I recommend brands that provide 100% DV of vitamin D (in the form of D3, or cholecalciferol, the most potent form of vitamin D), vitamin C, selenium, and vitamin A (with at least 50% coming from beta carotene and/or mixed carotenoids, and no more than 2,000 IU coming from retinol). Definitely do not choose mega-dose varieties do not choose mega-dose varieties, because some vitamins may make certain cases of arthritis worse.

2. Omega-3 fatty acids from fish oil. Eat foods rich in omega-3s, but for serious arthritis relief, you'll want to try fish oil supplements. Rheumatoid arthritis studies have tested the effectiveness of various dosages, from 1.2 grams to 3.2 grams. I recommend you start with a daily dose of 2 grams. If there's no relief after 4 weeks, speak with your physician about increasing to 3 grams. Store the supplements in the fridge to prevent rancidity. To prevent fishy burps, buy enteric-coated varieties, take with food, and split doses throughout day. Because fish oil acts as a blood thinner, it should not be taken by people who have hemophilia, or who are already taking blood thinning medications or aspirin (always consult your physician). People with diabetes should talk with their doctors before trying fish oil supplements because they may affect blood sugar. Eat foods rich in omega-3s, but for serious arthritis relief, you'll want to try fish oil supplements. Rheumatoid arthritis studies have tested the effectiveness of various dosages, from 1.2 grams to 3.2 grams. I recommend you start with a daily dose of 2 grams. If there's no relief after 4 weeks, speak with your physician about increasing to 3 grams. Store the supplements in the fridge to prevent rancidity. To prevent fishy burps, buy enteric-coated varieties, take with food, and split doses throughout day. Because fish oil acts as a blood thinner, it should not be taken by people who have hemophilia, or who are already taking blood thinning medications or aspirin (always consult your physician). People with diabetes should talk with their doctors before trying fish oil supplements because they may affect blood sugar.

FOR OSTEOARTHRITIS.

1. Glucosamine plus chondroitin. These nutrients are naturally found in and around cartilage cells, and are thought to strengthen and stimulate growth of cartilage. They have been rumored to be helpful for osteoarthritis pain for years, but until 2006 there was no research to back up those claims. The large-scale Glucosamine Arthritis Intervention Trial (GAIT) showed that arthritis sufferers with moderate-to-severe pain had significantly reduced pain after taking a combination of glucosamine plus chondroitin compared with those who took either supplement singly or a placebo. Arthritis sufferers with mild pain did not benefit from taking the glucosamine/chondroitin combo. The amounts generally recommended are 1,500 milligrams glucosamine and 1,200 milligrams chondroitin sulfate daily. These supplements are available anywhere you buy vitamins, and are sold individually or in pre-packaged combinations. This treatment is slow-acting-you may not feel any difference for 4 weeks. In Europe, where glucosamine and chondroitin are more commonly recommended by doctors, they are used in addition to other medical treatments and medications. So if you want to try glucosamine plus chondroitin, talk with your doctor to see how it might fit in with your current treatment. These nutrients are naturally found in and around cartilage cells, and are thought to strengthen and stimulate growth of cartilage. They have been rumored to be helpful for osteoarthritis pain for years, but until 2006 there was no research to back up those claims. The large-scale Glucosamine Arthritis Intervention Trial (GAIT) showed that arthritis sufferers with moderate-to-severe pain had significantly reduced pain after taking a combination of glucosamine plus chondroitin compared with those who took either supplement singly or a placebo. Arthritis sufferers with mild pain did not benefit from taking the glucosamine/chondroitin combo. The amounts generally recommended are 1,500 milligrams glucosamine and 1,200 milligrams chondroitin sulfate daily. These supplements are available anywhere you buy vitamins, and are sold individually or in pre-packaged combinations. This treatment is slow-acting-you may not feel any difference for 4 weeks. In Europe, where glucosamine and chondroitin are more commonly recommended by doctors, they are used in addition to other medical treatments and medications. So if you want to try glucosamine plus chondroitin, talk with your doctor to see how it might fit in with your current treatment. Important note Important note: Glucosamine is extracted from sh.e.l.lfish sh.e.l.ls (chitin), so if you have an allergy to sh.e.l.lfish, seek your doctor's advice. If you develop a rash or other symptoms of allergy, discontinue taking it immediately. Plus, these supplements may thin the blood. If you are already taking blood thinners, or if you have a clotting disorder, consult your doctor.

2. SAMe. Some studies have shown that SAMe (S-adenosylmethionine) may be as effective as nonsteroidal anti-inflammatory medications. One study conducted by researchers from the University of California, Irvine, compared the effects of SAMe with the anti-inflammatory medication celec.o.xib (Celebrex) in 56 people with osteoarthritis. After one month, people who took celec.o.xib had greater pain relief, but after two months, celec.o.xib and SAMe reduced pain to the same degree. Joint function also improved. So although SAMe took longer, it ended up working just as well as a prescription pain reliever. Recommended dose of SAMe for arthritis is 1,200 milligrams per day. Even though SAMe is generally thought to be safe, it can have side effects, including insomnia, rash, allergy, and gastrointestinal problems. To be safe, talk with your doctor before starting treatment with SAMe. Some studies have shown that SAMe (S-adenosylmethionine) may be as effective as nonsteroidal anti-inflammatory medications. One study conducted by researchers from the University of California, Irvine, compared the effects of SAMe with the anti-inflammatory medication celec.o.xib (Celebrex) in 56 people with osteoarthritis. After one month, people who took celec.o.xib had greater pain relief, but after two months, celec.o.xib and SAMe reduced pain to the same degree. Joint function also improved. So although SAMe took longer, it ended up working just as well as a prescription pain reliever. Recommended dose of SAMe for arthritis is 1,200 milligrams per day. Even though SAMe is generally thought to be safe, it can have side effects, including insomnia, rash, allergy, and gastrointestinal problems. To be safe, talk with your doctor before starting treatment with SAMe.

FOR RHEUMATOID ARTHRITIS.

GLA (gamma-linolenic acid). This fatty acid is found in evening primrose oil, borage oil, and black current oil. Studies show that GLA seems to reduce pain, joint tenderness, and morning stiffness of rheumatoid arthritis by suppressing certain inflammatory substances. Recommended dosage is between 1 and 3 grams per day. Because the action of this supplement may interfere with certain medications, always talk with your doctor before taking GLA. (gamma-linolenic acid). This fatty acid is found in evening primrose oil, borage oil, and black current oil. Studies show that GLA seems to reduce pain, joint tenderness, and morning stiffness of rheumatoid arthritis by suppressing certain inflammatory substances. Recommended dosage is between 1 and 3 grams per day. Because the action of this supplement may interfere with certain medications, always talk with your doctor before taking GLA.

JOY'S 4-STEP PROGRAM FOR ARTHRITIS Follow this program if you have osteoarthritis, rheumatoid arthritis, or other arthritis (except gout-see Chapter 8 for more information).

STEP 1...START WITH THE BASICS These are the first things you should do to take control of inflammation, which feeds your arthritis pain: - See a doctor if you have new or uncontrolled joint pain. It is important to get early and effective treatment for arthritis.

- Ask your doctor about whether taking omega-3 fish oil supplements makes sense for you.

- If you smoke, quit.

- Begin a program of gentle, low-or no-stress exercise.

- Drink plenty of water.

- Avoid foods high in saturated fats, trans fats, and omega-6 polyunsaturated fats.

- Avoid sugary and refined carbohydrate foods.

STEP 2...YOUR ULTIMATE GROCERY LIST This list contains foods with high levels of nutrients that help reduce inflammation and control arthritis pain, plus some foods used as ingredients in the meal plans and recipes. You don't have to purchase every item...but these foods should make up the bulk of what you eat for the week. If you find yourself getting bored with familiar items, try something new-perhaps a curry recipe like the Slow-Cooker Chicken Curry and Vegetables. If you have gout, limit your portions of foods marked with an asterisk.

FRUIT.

Apples with skin (especially Red Delicious)ApricotsBerries (blackberries, blueberries, boysenberries, elderberries, lingonberries, raspberries, strawberries)CantaloupeCherriesClementinesCranberriesCurrants, blackGrapefruit (and juice)Grapes (black, red, purple)GuavaKiwiLemons (and juice)Limes (and juice)LycheesMangosNectarinesOranges and juice (especially blood oranges)PapayaPeachesPersimmonsPineapplePlumsTangerinesWatermelon

VEGETABLES.

Asparagus*Beans, green,Beans (kidney, white)Beets, redBroccoliBrussels sproutsCabbage (including Chinese, red, purple)Carrots*CauliflowerCeleryChickpeas (garbanzo beans)ChivesCollard greensCornEggplantHorseradish rootKaleKohlrabiLeeksLettuce*Mushrooms (especially shiitake)Mustard greensOkraOnions (red, yellow, white)*Peas, sugar snapPeppers, (hot; yellow/red/green)Potatoes, sweetPotatoes, whitePumpkin (fresh, 100% pure canned pumpkin)RhubarbRutabaga.s.seaweedSnow pea.s.soybeans (edamame)*SpinachSquash, summerSquash, winter (especially b.u.t.ternut)Swiss chardTomatoes (including red ripe tomatoes, cherry tomatoes, green tomatoes)Turnip greensWatercress

SEAFOOD.

*AnchoviesCodCrab*Herring*Mackerel (not king)Oysters (including Pacific)Salmon, wild (with bones)*Sardines (with bones)ShrimpTilapiaTrout, rainbowTuna (canned light)

LEAN MEATS/EGGS/SOY FOODS.

*Beef, lean*Chicken breastEggs, omega-3-fortifiedTurkey

NUTS AND SEEDS (PREFERABLY UNSALTED).

Brazil nutsb.u.t.ternuts (white walnuts)Flaxseed, groundWalnuts

WHOLE GRAINS.

Breads, whole wheat (including crackers, buns)Cereal, fortified whole grainPasta, whole wheatRice, brownWheat germ

DAIRY.

Cheese, feta, reduced-fatCheese, ParmesanCottage cheese (fat-free, 1% reduced-fat)Margarine spread, vitamin D-fortified, soft tub, trans fat-freeMilk, fortified (fat-free, 1% reduced-fat)Soy milk, enriched/ fortified

MISCELLANEOUS.

AllspiceBaking powderBasil, freshCilantro, freshCinnamon, groundCocoa powder, unsweetenedFlour, whole wheatGarlicGinger, fresh and groundHoneyHot sauceMayonnaise, reduced-fatOil, canolaOil, flaxseedOil, oliveOil, walnutPepper, blackSugar, white and brownSugar subst.i.tuteTea (black, green)Turmeric/yellow curry powderWine, red

STEP 3...GOING ABOVE AND BEYOND If you want to do everything you can for arthritis pain and stiffness, here are some additional things you might try: - If you have osteoarthritis, ask your doctor about what supplements you might try. The ones with the best track record are glucosamine with chondroitin sulfate, omega-3s, and SAMe. (See the Supplements section, Chapter 8, for cautions and more information.) - If you have rheumatoid arthritis, ask your doctor about what supplements you might try. The ones with the best track record are GLA and omega-3s.

- Incorporate ginger and turmeric into your recipes and meals.

- Consult a qualified acupuncturist about pain relief.

- Try to find ways to reduce stress, which can amplify pain and even trigger flares of rheumatoid arthritis.

A GINGER PRIMERGinger is a versatile spice that has antiinflammatory properties. It can be used in any course, from appetizers to dessert. Look for fresh ginger in the produce section of most grocery stores-it is a tan root about the size of very fat fingers. Powdered ginger, found in the spice aisle, is used most often in baking and gives a stronger taste to foods-do not automatically subst.i.tute the same amount of powdered ginger for fresh ginger. A common accompaniment to sushi, pickled ginger (also called gari gari) is made by soaking thin slices of fresh ginger in rice vinegar and sugar for a week or longer. Candied or crystallized ginger is sweet, and can be eaten as an occasional treat, or baked in cakes and m.u.f.fins.