Introduction

The term rheumatism covers diseases that affect the locomotor system - the bones and joints and all related structures such as muscles, tendons, and ligaments. These diseases cause pain and disability. There are two types of rheumatism: inflammatory or joint rheumatism (such as rheumatoid arthritis) and soft-tissue rheumatism. These forms differ from age-related and wear-related degenerative diseases such as knee or hip osteoarthritis.

The role of nutrition in rheumatic disorders

The causes of most rheumatic diseases are still largely unknown and frequently involve several factors. Studies indicate that nutrition directly influences the course of joint rheumatism, especially rheumatoid arthritis. Changing eating habits can lessen the symptoms of this disease, but not eliminate them. As in the case of other manifestations of rheumatism, the goal, above all, is to maintain a normal weight to avoid overloading the joints.

Certain ingredients in our food promote the inflammatory process. One, for example, is arachidonic acid, a polyunsaturated fatty acid. Although the human organism normally produces arachidonic acid itself, most (up to 90%) is supplied from food. It is contained in foods of animal origin only. Arachidonic acid fulfills an important function in our body, but in excess it promotes the formation of mediators and precipitators of the inflammatory process, especially the "free radicals."

Among substances that reduce the inflammatory process are the antioxidants: vitamins C and E, and beta-carotene; the minerals zinc and selenium; and the polyunsaturated omega-3 fatty acids. Whereas vitamins bind and neutralize free radicals, omega-3 fatty acids prevent the formation of inflammation mediators.

Fats and oils
The inflammatory process also depends on the quality and amount of fats and oils consumed. For this reason, it's important to eat low-fat foods. Reducing the amount of dietary fat decreases obesity, helps maintain normal weight, and reduces stress on the joints. For this reason, it's important to reduce the consumption of animal fats (lard, butter, cream), fat-laden meat dishes (sausage, bacon, pâtés, terrines, etc.), protein, and whole-milk products. These food groups contain many calories and also inflammation-promoting arachidonic acid.

In contrast, vegetables don't contain arachidonic acid. For this reason, vegetable oils are preferable. Wheat germ, sunflower seed, corn oil and thistle oil as well as oil-containing fruits (walnuts and almonds) are the main sources of the antioxidant vitamin E. Rapeseed oil, soy oil, walnut oil, linseed oil, or wheat germ oil contain significant amounts of omega-3 fatty acids.

Meat and meat products, eaten as sources of protein, can be easily replaced with legumes (chickpeas, linseed, peas) and soy products such as tofu - foods that are rich in protein and free of arachidonic acid.

Fish
Fat-rich fish from cold oceans such as herring, mackerel, wild salmon and eel (no hatchery fish) are an exception among the low arachidonic acid foods. These fish are rich in omega-3 fatty acids that inhibit inflammation. They should be consumed frequently and regularly.

Vegetables, fruit
Large quantities of these foods should be eaten since they ensure a large supply of antioxidant vitamins (vitamin C, beta-carotene) that make free radicals harmless. In people suffering from rheumatism, inflammation produces a high deficit of antioxidant vitamins . Supplementation of the cited vitamins may therefore be considered in consultation with your doctor.

Milk and milk products
A sufficient supply of vitamin D and calcium substantially helps prevent osteoporosis that can arise as a result of a rheumatic disease. Intake of cortisone, a frequently prescribed medication for rheumatism, also increases the need for calcium. It is therefore recommended to consume daily 3 to 4 portions of milk or milk products since these are rich in calcium. Low-fat products are preferable, both to restrict the amount of arachidonic acid consumed and to provide available calcium content. If you cannot tolerate milk products (i.e. you're lactose intolerant), your intake of calcium can be improved by drinking mineral water with a high calcium content, or by taking calcium supplements. The body can also create vitamin D through regular exposure to sunlight. Frequent outside activities are therefore healthy, provided the rules of sun protection are observed.

Rheumatism checklist

For all rheumatic diseases:

• Normalize body weight to protect your joints
• Eat calcium-rich foods (1000-1200 mg per day): 3-4 portions low-fat milk or milk products
• Undertake outdoor physical activity

For rheumatoid arthritis:

• Reduce your consumption of arachidonic acid by:
  - Selecting low-fat foods of animal origin
  - Eating more vegetable sources of protein (legumes, tofu) instead of meat
  - Using vegetable fats (oils and margarine)
  - Consuming more omega-3 fatty acids: fat-rich ocean fish 2-3 times per week and a small amount of omega 3-rich oils daily (rapeseed, soy, walnut and wheat germ oils)
• Get the appropriate amount of antioxidant vitamins and minerals (vitamin C, vitamin E, beta-carotene, zinc, and selenium) by eating substantial amounts of fruit, vegetables, nuts, and legumes.

Nutritional recommendations for inflammatory rheumatism

Many factors influence our eating behavior: desires, moods and individual needs, our state of health, our social environment, the food at hand, advertising, etc. The following recommendations ensure a sufficient supply of energy, nutrients, and protective substances (in the form of a balanced nutrition) and hence a healthy diet. These data are tailored for "average people," i.e. adults with normal physical activity and average requirements for energy and nutrition. They should be modified for other sections of the population (children and teenagers, performance athletes, pregnant women, etc.). The listed quantities and portions also represent average values, which of course cannot be fixed precisely from day to day.

Information in italics is especially for people who suffer from inflammatory rheumatism.

Oils and fats
Per day, 2 teaspoons (10 g) nutrient-rich vegetable oil such as untreated sunflower, thistle, corn, olive or rapeseed oil, for example in a salad dressing.

Per day, max. 2 teaspoons (10 g) frying fat or oil such as peanut oil or olive oil for preparing hot meals.

Per day, maximum of 2 teaspoons (10 g) vegetable spread (margarine).

Per day, a maximum of 1 fat-rich dish such as grilled or breaded food, cheese dishes, potato pancakes, sausages or hotdogs, cold cuts, sauce-based dishes, shortcake, puff pastry, cake, pies, chocolate, etc.

Sweets
Enjoy in moderation. Most candies contain hidden fat. Not more than one small sweet per day (a bar of chocolate, piece of cake or pastry, one portion of ice cream).

Meat, fish, eggs and legumes
At least 1 portion of the leanest meat 2 or 3 times per week (1 portion = 80-120 g); more is unnecessary, less is okay.

Avoid liver in sausage products, such as ham, sausages or bacon. Per month: maximum of one serving of internal organs such as kidney, tripe, or brains (1 portion = 80-120 g).

Per week 1-2 portions of fish (1 portion = 100-120 g). Preferably eat fat-rich ocean fish (herring, mackerel, sardines, etc.).

1 or 2 eggs per week including eggs used in baked goods, soufflés or crèmes.

Per week 2 or 3 portions of legumes and their derivatives, such as lintels, chickpeas, dried beans (1 portion = 40-60 g dry), tofu (1 portion = 100-120 g), etc.

Milk and milk products
Per day, 3 or 4 portions of milk products (1 portion = 2 dl milk or 1 cup of yogurt, or 30 g hard cheese, or 60 g soft cheese). Nonfat or low-fat milk products are preferable.

Grain- and potato-based products
Per day eat at least 3 portions of starch-containing products such as bread, potatoes, rice, grain, or pasta; whole-grains are preferable. The size of the portions depends on the frequency and intensity of your physical activity.

Fruit
Per day, 2 or 3 portions of fruit, raw if possible (1 portion = 1 apple, 1 banana, 3 plumbs or one bowl of berries).

Vegetables
Per day, eat 3 or 4 portions or vegetables of which at least one portion is raw with a dip, or a mixed salad (1 portion = 100 g raw vegetable, 150-200 g cooked vegetable, 50 g green salad or 100 g mixed salad).

Beverages and alcohol
Drink at least 1.5 liters of liquid per day, preferably unsweetened and alcohol-free drinks.
Alcohol: An adult should not consume more than 1 or 2 glasses of wine or beer per day.