The #1 Vegetable to Help Manage Arthritis Pain, According to Experts

From eatingwell.com

Here’s why experts think this vegetable is a must for managing arthritis pain 

• Diet is key in managing arthritis, and broccoli has earned the top spot among vegetables.
• Broccoli provides vitamins C and K, the antioxidant sulforaphane and fibre.
• From sautéing and roasting to making pesto, there are many ways to get more broccoli in your life.

                                                         Credit: 

Photographer: Victor Protasio, Food Stylist: Chelsea Zimmer, Prop Stylist: Christina Daley

From troublesome joint pain to stiffness and swelling, arthritis can be incredibly uncomfortable. It’s also extremely common, affecting about 20% of adults in the United States—a stat that increases drastically with age.

Medication, physical therapy and staying active are all key to managing arthritis. But there’s another important piece of the puzzle that’s often overlooked—diet. Among the many foods that may help with arthritis symptoms, broccoli stands out, especially among vegetables. Packed with antioxidants, essential nutrients and a powerful compound called sulforaphane, broccoli is a solid choice if you’re dealing with pain, inflammation and other arthritis symptoms. “Including broccoli as part of your regular eating pattern may help support long-term anti-inflammatory benefits,” says Diane Han, M.P.H., RD.

Curious what it is about broccoli that makes it a good option for those dealing with arthritis? Here’s what registered dietitians and a rheumatologist have to say.

Why Broccoli Is the #1 Vegetable for Arthritis 

Chock-full of Vitamin C

Broccoli is loaded with vitamin C. “Vitamin C is an antioxidant that helps protect your cells from damage, reduce inflammation and support the production of collagen, which is essential for healthy joints and connective tissues,” says Maxine Yeung, RD. Just 1 cup of raw broccoli provides nearly 70 milligrams of vitamin C, meeting approximately 75% of the daily needs for adult men and about 100% of the recommended daily amount for women.

Loaded with Vitamin K

Broccoli is rich in vitamin K, an essential nutrient that’s important for bone health. It also has antioxidant properties, which help protect against inflammation and other damage from free radicals. “Vitamin K supports bone health and is linked to reducing inflammatory markers in the blood,” Yeung says. Research has found a potential connection between higher vitamin K intake and a lower risk of developing osteoarthritis. Vitamin K may help slow the progression of the disease in those who already have the condition.

Offers Sulforaphane

Broccoli is rich in a compound called sulforaphane that may help reduce joint inflammation and protect against cartilage breakdown, says rheumatologist Swati Medhekar, M.D.: “There is also some research showing that broccoli could prevent or slow the development of rheumatoid arthritis.”  Beyond broccoli, you’ll also find sulforaphane in other cruciferous vegetables like cauliflower and cabbage.

A Source of Fibre

Broccoli is rich in fibre, which directly supports gut health and indirectly helps with joint health. “Gut health and joint health are interconnected through what we call the gut-joint axis,” Medhekar says. “An imbalance in the gut microbiome can lead to inflammation affecting joint health.” Among many benefits, fibre supports gut health by feeding the good gut bacteria that help reduce inflammation. In a study published in the journal Med, researchers identified a link between poor gut health and increased rheumatoid arthritis severity.

“Diets that are higher in fibre, especially those with at least 19 grams a day, have been linked to lower levels of inflammation and a reduced risk of developing rheumatoid arthritis,” Yeung says. For every cup of broccoli you eat, you’ll get about 2 grams of fibre. 

How to Get More Broccoli

• Sauté it up for an easy side dish. We love this Sautéed Broccoli & Kale with Toasted Garlic Butter. One of the best perks of this recipe? You can make it ahead.  
• Roast it. From Melting Broccoli to Roasted Lemon-Feta Broccoli and Roasted Romesco Vegetables, you have plenty of options for savoury side dishes that work well with a variety of mains.
• Turn it into pesto. Try a new twist on classic pesto with this Broccoli-Pesto Pasta. With broccoli and artichoke hearts, this recipe packs in more fibre than your standard basil pesto. 
• Toss it in a sandwich. Level up your standard grilled cheese by adding some crisp broccoli into the mix. Next time you’re at the supermarket, grab some fontina and whole-wheat bread to make these cheesy Broccoli Melts. 

Other Strategies to Manage Arthritis Symptoms

• Get moving: Regular, low-impact physical activity can reduce pain and improve physical function for people with arthritis. It also helps keep your joints and muscles strong. Aim for 150 minutes of moderate-intensity physical activity each week.
• Maintain a healthy weight. Research shows that maintaining a healthy weight can slow the progression of arthritis symptoms. For people with obesity, even a small reduction in weight can improve symptoms and reduce pain. “While diet alone won’t resolve arthritis symptoms, making dietary changes, like cutting back on saturated fats and added sugars and eating more fruits, vegetables, whole grains and unsaturated fats, can be an important part of your overall management plan,” Yeung says.
• Support your gut health. Eating lots of nutrient-rich whole foods supports a healthy gut, “allowing the body to better absorb and utilize nutrients that promote bone and joint health,” Han says. 
• Eat more ginger and turmeric. “Ginger and turmeric both have anti-inflammatory properties and hence help reduce pain and inflammation in arthritis patients,” Medhekar says. “Turmeric is especially helpful since it contains curcumin, which has very potent anti-inflammatory properties.”
• Take your prescribed medication. “It is important to eat healthy to help with your joint health but also important to take your prescribed medications for your arthritis,” Medhekar says.

Our Expert Take 

If you’re looking to revamp your diet to be more arthritis-friendly, incorporating broccoli is a great choice. This powerhouse vegetable provides vitamins C and K, which support collagen production and have antioxidant properties, helping protect against inflammation. Meanwhile, the fiber in broccoli helps support a healthy gut microbiome, which has anti-inflammatory benefits and may even lower arthritis severity. Finally, broccoli is an amazing source of sulforaphane, a compound found in many cruciferous vegetables that has been linked with reduced cartilage breakdown and inflammation, among other benefits. 

Broccoli is surprisingly versatile, giving you endless options to add more to your meals. Consider roasting it, transforming it into pesto, grilling up a cheesy broccoli melt or sautéing it for an easy side dish.

https://www.eatingwell.com/best-vegetable-for-arthritis-pain-11762058

Can Occupational Therapy Help With Rheumatoid Arthritis Symptoms?

From everydayhealth.com

The joint pain, fatigue, and other symptoms of rheumatoid arthritis (RA) can make everyday tasks challenging. 

Pain often occurs in the small joints of the fingers, wrists and toes, and unlike some other forms of arthritis, RA typically affects joints symmetrically. “Everything from washing your hair to preparing food to taking care of children and pets can become difficult if your joints are swollen, stiff, and painful,” says Cheryl Crow, an occupational therapist and the founder of Arthritis Life, an advocacy organization for people with inflammatory arthritis, and who also has RA. 

“Fatigue and joint instability can further hinder mobility and independence,” adds Crow. “Over time, these limitations can affect one's ability to work, care for oneself, and engage in social activities.”

One approach that can help is occupational therapy (OT), teaching you strategies that allow you to be independent for longer and keep participating in activities you enjoy.

How Occupational Therapy Can Help

“The three main challenges people with RA tend to face are joint pain, fatigue, and stress or overwhelm,” says Crow. The ultimate goal of OT is to address those challenges and help people successfully function in their daily life, despite the symptoms and disability caused by RA, she says.  

Therapists often start by walking you through “a day in the life.” As experts in breaking down and analysing a person’s daily activities, they can troubleshoot what’s hard for you and use a multipronged approach to address those issues.

Most people with RA will only need about four to six sessions of OT to achieve their goals, though it’s recommended that they have “booster visits” throughout the course of their disease as their condition, and needs, may change.

One of the upsides of occupational therapy is that simple adjustments often make a big difference. “We really are obsessed with finding creative ways to improve your quality of life,” says Crow.

Activity Modifications

Some tasks may exacerbate symptoms or feel nearly impossible to achieve. An OT can suggest modifications to make them more manageable and less painful. For example, an OT might teach you an alternate way to hold your pencil or toothbrush that will put less strain on sore joints.

Even people with low disease activity report issues with tasks that require hand dexterity and strength. OTs can walk you through exercises to help build grip strength and address limitations in movement, coordination and sensation.

Therapists may also suggest simple “life hacks” such as using a jar opener or an easy-to-grip knife, says Crow.

Depending on your situation and insurance coverage, the therapist may be able to visit your home or work environment to personalize their guidance.  

“For example, we might help you rearrange your kitchen so items you use frequently are in easy reach,” says Crow.

At work, adjusting the height of a work surface or changing the adjustments on your office chair can ease joint stress and pain.

Joint Protection Techniques

“Occupational therapists can teach patients good ergonomics and body positioning so they can protect sore joints and prevent themselves from repetitive strain. For example, if your fingers are sore, we can teach you ways to use your larger joints when performing daily tasks,” says Crow.

But there has to be a balance between activity and rest for the joints, she says.

“We say, ’motion is lotion,’ and if you don't move your joints at all, they may become even more sore. An occupational therapist or certified hand therapist can help you determine when to move and when to rest sore joints,” says Crow. 

They can also perform a skilled assessment and fabricate a custom splint if needed, she says. When used appropriately, a splint can do many things, including provide support, improve alignment, allow for rest, reduce pain, and help with grip strength.

Energy Conservation

“The inflammation from rheumatoid arthritis can cause fatigue and difficulties with stamina, which can make it difficult to get everything done that you need or want to do in a day,” says Crow.

Fatigue is different from just being tired — it’s a feeling of being sapped of all energy, making it hard to find the strength or motivation to do even basic tasks.

While there’s no quick fix for fatigue, an occupational therapist can help you with energy levels in a few different ways, says Crow.

“We help you figure out ways to reduce fatigue levels, which includes ways to ‘conserve’ or minimize energy output throughout the day,” she says. OTs can also teach you how to prioritize tasks, pace yourself, and how to space out rest breaks.

But OTs also use their expertise to help you push yourself just the right amount to build stamina so that you have more energy throughout the day.

“There's a bit of a paradox with fatigue where you have to spend a little energy on exercise in order to gain more stamina, so it's not as simple as always conserving energy. We help you work through how to implement these strategies in your daily life,” says Crow.

Often that can mean "exercise snacks" or small bits of movement rather than a huge trip to the gym, she says.

Adaptive Equipment

Specialised tools can make everyday tasks easier for you to do without assistance.

Adaptive tools that you can buy right off the shelf are designed to work for most people, and tools can also be custom made by your OT or rehab company.

These include utensils, bathing devices like long-handled sponges, button hooks, and magnet closures on a bra. “These can help you perform the same tasks more easily or independently, and they’re useful if you can''t perform the task you need to do in the typical fashion,” says Crow.

These tools aren’t always specially designed for arthritis — items like step stools, lightweight cookware, and reachers are all examples of adaptive equipment that can make life easier. 

Crow uses adaptive scissors that put less strain on the base of her joint, an under-cabinet jar opener, and compression gloves.

She also uses assistive technology in the form of voice-to-text to keep from typing with sore fingers.

All-Around Life Help

RA affects more than your joints. “It can be a very expensive, time intensive, and painful condition to manage. Occupational therapists look at the big picture of the person's quality of life and strive to help them on all levels, not just pain,” she says.  

Skills learned in occupational therapy can help those with RA stay active and engage with the people and activities they enjoy. That’s important, because people with RA have a higher risk of stress, anxiety, and depression than people without rheumatoid arthritis, says Crow.

The Takeaway

• Occupational therapy (OT) can play a crucial role in helping people with rheumatoid arthritis (RA) maintain independence, manage daily activities, and reduce joint pain.
• OT offers practical strategies like activity modifications, joint protection techniques, and energy conservation to address fatigue, pain, and stiffness that often limit mobility and participation.
• Adaptive equipment and personalized tools, such as ergonomic utensils, splints, or voice-to-text technology, can make everyday tasks easier and less painful.
• OTs can help address the emotional impact of RA by teaching coping strategies, reducing stress through routine planning, and supporting overall quality of life.

 https://www.everydayhealth.com/rheumatic-conditions/can-occupational-therapy-help-with-ra-symptoms/

Why your joints crack—and what it means for your health

From nationalgeographic.com 

From gas bubbles to worn cartilage, here’s what makes your joints pop—and how to know if it’s something to worry about

Snap. Crackle. Pop. If your knees sound like a bowl of cereal every time you stand, you’re not alone.

“Those cracking or popping sounds people hear are really common. We call it ‘crepitus’ in the medical world and, most of the time, it’s just a normal part of joint mechanics,” says Mitchell McDowell, an orthopaedic surgeon, osteopathic physician, and president of M Bone and Joint. “It could be tiny gas bubbles in the joint fluid popping, or even tendons or ligaments shifting a bit as you move.”

However, when the noise accompanies pain or stiffness, it may signal something more serious.

Starting as early as your thirties, the smooth, springy padding inside your joints—called cartilage—can begin to wear down. That doesn’t mean arthritis is inevitable, but without that shock-absorbing layer inside your joints, your bones may start to grind instead of glide—leading to pain, stiffness, and reduced mobility. And while age plays a role, emerging research suggests that lifestyle, diet, and inflammation may also play a part.

Here’s what researchers are learning about why joints get creaky—and what you can do now to stay limber for life.

Is your stiffness a sign of aging?

Joint wear tends to become more noticeable in your 40s and 50s, says Barry L. Bently, an associate professor in bioengineering at Cardiff Metropolitan University. Roughly 30 percent of Americans between 45 and 64—and over 50 percent of those 65 and older—have arthritis, according to the CDC. But it’s not as simple as ticking off birthdays.

“Chronological age, or the number of years since birth, is only loosely correlated with biological age and the accumulation of physiological damage,” Bentley explains. “It is far from straightforward to define what should be considered ‘normal’ aging.” Genetics, past injuries, and lifestyle habits all influence when joint problems show up—and how severe they become.

So, how can you tell the difference between natural stiffness and something more serious? “Most of us feel a bit stiff now and then, especially after sitting too long or waking up in the morning, and that kind of stiffness usually eases up once you get moving,” says McDowell. “But with early arthritis, the stiffness tends to hang around longer, sometimes even getting worse with activity.”

A 2021 study in Rheumatology found that morning stiffness lasting an hour or more is a key warning sign of arthritis. If that stiffness is accompanied by swelling, pain, or a nagging ache that doesn’t go away, “it’s smart to get it looked at early,” says McDowell. “It’s always easier to manage arthritis in the beginning stages.”

Why do your joints wear down over time?

“For significant joint wear that leads to osteoarthritis, there have been some studies showing that chronological age only accounts for about half the risk, with the other half being attributable to modifiable environmental and lifestyle factors,” says Bentley.

That includes physical stress. “There is ample evidence that activities that place repetitive or excessive loads on the joints can lead to cartilage wear and bone changes,” says Bentley. High-impact activities, such as running on hard surfaces, manual labour, or heavy lifting, can overburden joints, especially if you’re not recovering sufficiently.

But it’s not just wear and tear. Low-grade, chronic inflammation plays a major role in joint aging. “Consuming a diet high in processed foods, excessive alcohol consumption, and smoking, can play a significant role in accelerating biological aging, including exacerbating joint damage,” explains Bentley. “Those behaviours promote systemic inflammation, which impairs cartilage repair mechanisms and accelerates tissue degradation.”

How to protect your joints in your 40s and beyond

The good news? You can take action to protect your joints—even if they’re already a little creaky. “I see a lot of patients who worry it’s ‘too late’ to do something about their joints, but that’s just not true,” McDowell. “Even in your 40s or 50s, small changes can make a big difference.”

Those changes can include maintaining a healthy weight to take pressure off your joints or eating a nutrient-rich diet that contains omega-3 fatty acids—found in fatty fish like salmon—which have anti-inflammatory effects. Antioxidants like vitamins C and E help protect cartilage from oxidative damage, while calcium and vitamin D support both bones and cartilage. In addition, McDowell recommends cutting back on nicotine, which limits blood flow to the joints, and excessive alcohol consumption, which depletes the body of nutrients.

Consistent, low-impact activities like walking, swimming, tai chi, or cycling are gentle on your joints while helping improve strength and flexibility. Strength training is also key, says McDowell. Stronger muscles stabilize the joints and act as shock absorbers, especially in key areas such as the hips and knees. A 2021 study in Frontiers in Physiology found that regular exercise can slow cartilage degeneration, reduce inflammation, and prevent bone loss in people with osteoarthritis. Another 2019 study in Arthritis & Rheumatology suggests it may even reduce the risk of developing rheumatoid arthritis.

“Think of the joints like tyres on a car,” says McDowell. “If you drive 300 miles a day, especially if you’re carrying some extra cargo, the tires wear out quickly. It’s even worse if there was trauma or the alignment is off.” He continues, “On the other hand, if you park the car in the garage, you lose air pressure/ belts bend and the engine stops working. It’s all about balance.”

https://www.nationalgeographic.com/health/article/why-joints-crack-with-age

PODCAST: How To Lose Weight for Arthritis

From arthritis.org/liveyes

Losing excess weight is especially important when you have arthritis, and there are more tools now than ever to help. In this episode, a rheumatologist (who is also a fitness trainer) talks about why weight management is important for all forms of arthritis. He also discusses the pros and cons of GLP-1 agonist drugs and bariatric surgery for weight loss, and he offers some real-world tips for lifestyle changes, including diet and exercise, to lose extra fat 

PODCAST OPEN: Thank you for tuning in to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. You may have arthritis, but arthritis doesn’t have you. Here, you’ll get information, insights and tips you can trust — featuring volunteer hosts and guest experts who live with arthritis every day and have experience with the challenges it can bring. Their unique perspectives may help you — wherever you are in your arthritis journey. The Arthritis Foundation is committed to helping you live your best life through our wide-ranging programs, resources and services. Our podcast is made possible in part by the generous financial contributions of people like you. Now, let’s listen in.

Jamie Nicole: Hi everyone, I am Jamie Nicole, and welcome to this episode of the Live Yes! With Arthritis podcast, where we will be discussing weight management for arthritis. As someone myself navigating both osteoarthritis and rheumatoid arthritis, I know first-hand that the conversation around weight can be complex and, honestly, sometimes exhausting. You've likely been told that losing weight can help ease joint pain. But rarely is there enough discussion about how hard that is when you're also dealing with fatigue, inflammation, mobility limitations and the emotional weight of chronic illness. 

The good news is: Even small shifts in weight can lead to meaningful improvements in arthritis symptoms. And today there are more tools than ever to support people in making those shifts in a way that's realistic and sustainable. Joining me today is Dr. Brian Andonian, a rheumatologist and researcher at Duke University School of Medicine. We'll talk about the role of medications, like GLP-1s, and lifestyle strategies. Dr. Andonian, I'm glad that you're here and thank you for joining us. 

Dr. Brian Andonian: Thanks so much for having me. 

Jamie Nicole: So, we're going to hop right into it, and first I want you to just kind of give the audience a little bit more about yourself and your focus at Duke. 

Dr. Brian Andonian: Sure. I'm a rheumatologist at Duke, so I treat, broadly, patients with different kinds of autoimmune and inflammatory conditions, as well as arthritis of all kinds, including osteoarthritis, rheumatoid arthritis, spondyloarthritis. I'm also an athletic trainer, and I have a background in exercise science. And so, I really try to apply my background in lifestyle medicine, and that includes nutrition, physical activity, stress management, restorative sleep, social connection, really to the care of my patients. I'm also a clinician scientist. And that means I do research on top of my clinical work, and I study really the effects of lifestyle, especially diet and exercise, for improving the health for my patients with arthritis and autoimmune disease.

Jamie Nicole: That is wonderful. I'm excited for this conversation. How does excess weight impact people living with arthritis — and not just osteoarthritis, but the inflammatory types as well?

Dr. Brian Andonian: Excess weight can affect arthritis in multiple ways. For one, it can impact the development of arthritis. As you mentioned, not just osteoarthritis, but also inflammatory types of arthritis, including rheumatoid arthritis. And we also know that it affects arthritis management. We know that patients who are overweight or obese don't respond to our medications as well, and that's particularly true of rheumatoid arthritis and other inflammatory diseases.

I think there's a few reasons for this. One, people commonly think about stress on the joints related to added weight, but there's also other factors related to having overweight or obesity, and that's inflammation. There's inflammation contributions to arthritis both from osteoarthritis and from an inflammatory arthritis standpoint as well.

Jamie Nicole: There are certain people, due to age, gender, hormone changes or other factors — how are they affected differently?

Dr. Brian Andonian: Women in particular have higher risk for arthritis, first mention that. That includes osteoarthritis and other inflammatory types of arthritis like rheumatoid arthritis. And around age 50 is where we start to see an inflection point in terms of arthritis onset and when patients start to develop arthritis. And so, we think that there could be a connection with hormonal changes in perimenopause in women.

But there's also… Men tend to get arthritis more around age 50. So, there's multiple factors that are contributing here. Age is certainly a large factor in arthritis. And potential reasons for this are multiple. Things that I think about, in particular, are loss of muscle as we age. Unfortunately, we all lose muscle mass; it's just part of the aging process. And that can contribute to arthritis in and of itself, with or without having excess adipose or fat mass as well.

We know that our patients with arthritis, and particularly rheumatoid arthritis, can have low muscle mass, a normal BMI, but still have a lot of problems related to the adipose tissue contributing to arthritis and overall health risks.

Jamie Nicole: So, if you're a woman close to 50 going through perimenopause, you're just going to get hit from all angles and should really be paying attention to making sure, if I heard you correct, maintaining the muscle that we have.

Dr. Brian Andonian: Yeah, I agree. I think the more we can try to maintain muscle and build muscle… I'm not saying you can't build muscle as you get older. It's that if you don't do anything to combat it, you will lose muscle.

Jamie Nicole: That kind of leads into the next set of questions that I have is: understanding the challenges. Why is weight management so much more difficult when you're dealing with arthritis, especially losing weight and then also keeping it off?

Dr. Brian Andonian: Well, it's more complicated than just calories in, calories out, the calories we burn off. Metabolism is really affected within patients with obesity or who are overweight. And at the cellular level, there's multiple things that prevent us from losing weight. For example, our fat cells have memory, things that occur, called epigenetic changes, or changes to the way our DNA is programmed that affect the way that we are able to maintain our weight over time.

There are multiple systems, including our brain and our nervous system, that connect with our gut and hormones throughout our body that really want us to maintain the amount of adipose tissue or fat over time. This was likely beneficial when, during our ancestral past, when we had to hold on to store calories when it wasn't clear when our next meal would be, but much less helpful now. And I think arthritis just compounds the problem even more. It's really not as simple as you just need to eat less.

Jamie Nicole: I'm so glad that you said that, but because before I was diagnosed, I was living on the theory that we oftentimes hear, you know, number one: no pain, no gain. And what you said, calories in versus calories out. And I was working out multiple times a week. I knew that my calories in was less than my calories out, and I ended up making myself worse with inflammation by overdoing it at the gym.

But it wasn't until I started focusing on some of the other factors that you mentioned, like gut health and inflammation, where I can start eating more and working out less. And I actually lost 70 pounds that way. And it wasn't calories in or calories out. There has been a lot of buzz about GLP-1 drugs like Wegovy and Ozempic. Can you break down what they are and how they work?

Dr. Brian Andonian: I'll do my best. The glucagon-like peptide, or GLP-1 receptor agonist, we can say GLP-1 for simplicity: These are injections under the skin that were originally studied for management of diabetes and to help lower blood sugar through control of insulin secretion and limiting glucagon. But we really learned over time, from the studies that were looking at diabetes care, that patients lost a lot of weight, and that seemed to be different from the mechanisms that were affecting blood sugar.

It seems these medications have direct effects on reducing appetite. And there's likely impacts both in the gut and in the brain and nervous system that really help give a signal of fullness and prevent cravings and prevent people from overeating. So, we're still learning more actually about how exactly the medications work, and there are a lot of other medications similarly in the pipeline. I think patients should stay tuned to other options that’ll actually be available hopefully in the next few years.

Jamie Nicole: I've seen some people saying that it helps with inflammation. Is there really an impact on inflammation, and that's what's causing them to be more successful at weight loss? And then what are the pros and cons and other things we should be considering when we consider GLP-1s?

Dr. Brian Andonian: Yeah, great question, and ongoing area of study. It does seem that patients do reduce inflammation. The question is a little bit: How? Is it related to weight loss itself? I already mentioned that just having more adipose tissue, or being obese, can contribute to inflammation in the body. So, we're really trying to understand if there are other mechanisms, because that'd be really fascinating. If independent of how much weight you lost, we still could make an impact on inflammation. So, there are a lot of pros and cons. One, for arthritis, we're seeing a lot of signals that this can help arthritis directly. In particular, there's a large study looking at improvements in knee osteoarthritis after using these medications.

And anecdotally I can say that other patients with, say, rheumatoid arthritis and other types of arthritis also have had benefit, but it hasn't been studied as rigorously yet. I think to be determined. We do know that these medicines can really help with weight loss. We've seen that in multiple studies, and they also seem to have other effects, too, that are important to our patients with arthritis, including improving cardiometabolic disease. So, improving cardiovascular risk, improving diabetes and other things, as well as improving addiction that can help with kidney disease.

There are some downsides potentially. Some patients do have side effects. Most of these are GI-related, so having nausea or vomiting or changes in the way your gut moves food through, which can cause more symptoms. I think the biggest question with these medications is the long-term impact and whether you need to be on them for forever, basically, to get the benefit. Or can you just be on it for a certain amount of time and get really the benefits you need and not have to stay on the medication? So, there's a lot of interest in how long we prescribe them and how we really utilize them in the long term.

The other thing I should mention is another question. Is it… What kind of weight are patients losing? Is it just fat or adipose tissue (which would be ideal)? Or is it also muscle loss? Because we already mentioned that muscle can be really important. One question is: If we lose a lot of muscle with these medications, can that have negative effects down the road?

Jamie Nicole: Bariatric surgery… Is this still a good option for people with arthritis?

Dr. Brian Andonian: It's definitely still an option. There's plenty of evidence showing that it can help patients lose weight but also improve that cardiometabolic risk. So, decreasing risk for cardiovascular disease, improving diabetes. Also, studies suggesting it can help with arthritis symptoms, including osteoarthritis, pain and function, as well as rheumatoid arthritis disease activity.

There are some potential issues. One is this access to surgeon; there's complications from surgery potentially. With the older surgeries there was some potential for having malnutrition and not getting the nutrients absorbed appropriately, which is less of an issue now. So again, it is an option. There are some potential downsides, but for weight loss it can be very effective, and that could have downstream effects to arthritis.

Jamie Nicole: How do these medications, the GLP-1s that we just talked about, compare to bariatric surgery in terms of risk, access and results?

Dr. Brian Andonian: Both potentially have access-related issues in terms of costs and getting approvals, and there's a lot of factors that go into which patients right now qualify for surgery or the medications. So that's a big issue, I think, for both. Surgery is obviously going to have the risks inherent to any surgery, and there's just more that's involved in terms of anaesthesia and the risks there. And it's harder to reverse the effects of surgery.

There was a thought that potentially you'd lost more weight with surgery. But what we're seeing for some of these drugs is that potentially patients are losing as much weight, if not more, in some cases. So, it's not for sure that surgery is better in terms of weight loss. And you mentioned a really important point: that there's not necessarily one that's better than the other. It really should be personalized, based on discussions with your providers, dieticians, family and support groups.

Jamie Nicole: We have a question about both from Alicia Cunningham. And from the question, it seems as though those factors that you mentioned earlier — being over 50, being a woman and being in a hormonal transition — is related to her question. She says, " Does bariatric surgery and GLP-1s cause and/or affect osteoarthritis post-menopause?" Can you speak to that?

Dr. Brian Andonian: Yeah, it's a great question, Alicia. And I mentioned that hormonal factors certainly play a role in arthritis development. And they also can play a role in our metabolism and obesity and weight loss. But it's unclear if surgery or medications, for example, can really prevent arthritis in the first place. That's an ongoing question. For example, if you lose weight at some point in your life, even around the perimenopausal phase, will that prevent you from getting arthritis? That's an interesting question.

Going back to that question about muscle loss: Is there an issue with losing a lot of weight during that time in your life, that if it's mostly muscle: Does that have a potential negative effect on arthritis development? I think more needs to be learned here, but we do know that that's a very sensitive time in terms of women developing arthritis in the perimenopausal phase.

Jamie Nicole: I wanted to ask you about supplements. Are there any that truly help with weight loss and/or inflammation?

Dr. Brian Andonian: I generally counsel patients against taking weight loss supplements. I think for the most part the risks outweigh the potential benefits, and that's especially true of some of the older supplements that were tried for weight loss. I think of Ephedra and other stimulant-type supplements. There's not a lot of evidence supporting supplements specifically for weight loss.

Inflammation, I think, is a different conversation. There is, I think, growing and a good amount of evidence supporting a few supplements for inflammation and arthritis management. Two of them would be turmeric and ginger; they are two related roots that I think can have anti-inflammatory benefit. The other is omega-3 supplement. They've been all studied and potentially have benefit for arthritis. And the point also should be that, just because it's a supplement doesn't mean that it's safe. Supplements aren't necessarily regulated the same way as medications.

And even ginger and turmeric, things that we include in our diet, when taken at high doses still can have negative effects. And that's especially true of patients who are on blood thinners. They can actually contribute to thinning the blood and cause bleeding, and it can rarely cause liver injury. So, there's just things you have to think about; that it's not all benign. But for the most part, either incorporating ginger or turmeric, or taking those as supplements, can be helpful for arthritis.

Jamie Nicole: On to the next section — we talk about lifestyle changes, diet and movement, one of my favourite topics. Diet and exercise are usually the first tools that are mentioned. What does the research say about how effective they are for arthritis?

Dr. Brian Andonian: One of my favourite topics as well. In my opinion, diet and exercise really should be a cornerstone for weight loss programs, as well as just arthritis care and maintaining health in general. And that's including those who are considering trying medications and surgery. I think this is the base for any program that we're considering.

And there's data from observational studies all the way through randomized control trials. High levels of evidence supporting diet and exercise, for both weight loss and arthritis. For example, our team at Duke has studied the effects of an intensive supervised weight loss diet and exercise training program we called SWEAT for patients with rheumatoid arthritis. And we found benefits for patients with RA across multiple aspects of health. And this includes inflammation, disease activity, their cardiometabolic health, as well as physical function. And even mental health and fatigue improve, so not just one aspect; we're really hitting multiple different areas.

Hopefully, we can figure out how to individualize these, like what factors about an individual can actually benefit from certain programs and certain diets. I think that's the holy grail in lifestyle medicine research. But we are getting closer. So, I would say stay tuned. And hopefully we'll have more answers for you guys soon enough.

Jamie Nicole: Instead of thinking about diet and exercise versus medication — and we've talked about this a little already — can you talk a little bit more about how these approaches work together?

Dr. Brian Andonian: As I mentioned, I think diet and exercise really should be the base that's always there and always an ongoing process, and then the medications would be an add-on. But when you're looking at each alone, like comparing lifestyle versus medications, it seems clear that the medications can potentially contribute to more weight loss, if we're just looking at what the evidence would show us. Like, for the medications losing 15 to even 25% of body weight versus maybe five to 10% of body weight with diet and exercise programs.

The question is still about sustainability. Do you need to take a medicine for the rest of your life, versus a diet and exercise program. If you try to have a program that you don't like to do, for example, a diet that you don't like to eat or exercise that you don't like to do, it's unlikely to be sustainable. So, you have to think about things that you really can do in the long run.

Jamie Nicole: So, if someone had to focus on just one, diet or exercise, and I know you're going say that both are important, which one tends to be the most impactful in your opinion?

Dr. Brian Andonian: Yeah, it's a bit of a trick question. The answer is certainly combining the two. But when you're really comparing them head to head, I think diet wins out, strictly from a weight loss standpoint. Exercise alone, I often tell patients, is not necessarily the right way to lose weight. You really just can't exercise and assume that alone is going to contribute to weight loss. But there's so many other benefits to exercise, and in combination with diet, it really can contribute to weight loss. So don't just discount exercise, because it alone doesn't work as well.

We already talked about the potential benefit of increasing muscle mass, which you really need exercise, and particularly resistance or strengthening-type exercise, to get there. So, don't sleep on exercise, it's something you need to keep doing. But if you're thinking about weight loss alone, there has to be some diet component. 

Jamie Nicole: Is there a particular diet that shows promise for people with arthritis? Things like intermittent fasting or keto or any anti-inflammatory plans? 

Dr. Brian Andonian: Another tough question. The answer really might depend on who you ask and also depends on the individual. But if you're trying to compare — Is it a low-fat diet? Is it a low-carb diet? Is it a keto diet, a high protein diet, a well-balanced but plant-based diet, Mediterranean style diet? — I think all have had evidence for some potential benefit. 

But we're talking about weight loss. One thing that's always true of these diets is there has to be some form of calorie restriction, meaning you're cutting back on how much you're eating to a certain extent. And this ranges from very low-calorie diets, where you're really only eating, you know, 200 to 500, 800 calories a day, which can lead to rapid weight loss but are really not sustainable in the long term. And I tend to not recommend really substantial or drastic cuts in calories.

Most evidence would point towards a more modest reduction in calories, maybe five to 10%, or reducing calories by maybe 300 to 500 max calories per day, which will lead to weight loss slowly. But again, I think sustainability is probably one of the most important things. And regardless of diet, I think diet quality has to be there. It's not just reducing the calories; it has to be some thought into improving the nutrition that you're getting from the program. And there's a lot of questions about what an anti-inflammatory diet is. And honestly, the best evidence overall would point to either the Mediterranean-style diet or more of a plant-based diet as having best benefit for improving inflammation.

 Intermittent fasting is a hot topic, and there's a lot of consideration and study ongoing for what intermittent fasting can do. We know there's a lot of health benefits from fasting periodically, and that can include kind of improvements in cardiometabolic health, improving diabetes, cardiovascular risk. But it hasn't necessarily been shown in and of itself to be better at weight loss than other diets. But potentially, because of the other benefits, intermittent fasting is something that can be helpful.

And we're learning more about how it can be useful for improving inflammation. I think we need to study it better, but anecdotally, and in some observational studies, intermittent fasting, for example, studying patients during Ramadan, where they fast as part of that period of the year, really can get benefit in terms of arthritis inflammation. Another area we need to learn more about.

Jamie Nicole: You often hear what you have to take out of your diet, but no one focuses on what you need to put into your diet as far as nutrients and nutrient density. Making sure that you are looking at the nutrients and your nutrient intake is just as important as those things that you're removing from your diet.

Dr. Brian Andonian: Yeah. And I would add that if you research anti-inflammatory diet, there's a lot of thoughts about things that you can take out, or elimination-type diets. And while those can be helpful, the goal of all those diets is try to reintroduce as many foods back into it as possible.

So, when I see patients getting into trouble is that they take out all these things from their diet, they actually don't know what was the trouble point and then they just continue on that way. And that can lead to nutritional problems and more issues down the road. If you're considering taking something out, really try to do one thing at a time, and really make sure that actually was giving you the problem. And then, if it really wasn't, try to add it back in. Trying to add more good foods is really the way to go, as you said, Jamie.

Jamie Nicole: I'm an autoimmune protocol coach, and that's one of the things that we have issues with, with people, is they want to take everything out, and they feel good, not understanding it's just supposed to be defined what your trigger is. So, moving on to the next question: What types of movement help with weight loss without flaring symptoms? And then, are there any favourites that you may recommend to your patients?

Dr. Brian Andonian: I love the question, that’s great. There is some misconception that just exercise is going to cause my joints to flare, like hard stop. I think there's a lot of considerations in terms of exercise and types of movements you should do. But for any type of movement program, the recommendation is always to start slow. We have guidelines that would suggest that we should be getting 150 minutes of moderate intensity aerobic activities, or two days a week of muscle strengthening exercise. For someone who's really not doing a lot to begin with, especially our patients with arthritis, that can be a lot. 

But as long as you're progressing slowly and not really pushing through pain, you know, usually... You should use pain as your guide and not go too hard through it. You’ve really got to listen to your body. Because we know that both aerobic exercise —that includes biking, walking, swimming, aerobics classes; and resistance-type exercise, which includes weight training, using resistance bands —that both of those are really helpful and important. 

In my opinion, I think resistance or muscle strengthening exercise is the one thing that's really missed. Using weights or machines, or even just how to use your body, using body weight to do resistance-type exercise, requires a little bit more learning, but perhaps is the most important in terms of building muscle, versus, say, aerobic-type exercise. So, I'll keep going back to muscle being important, maybe just as important as losing fat weight. So, I think we really need to consider resistance training exercise. 

Jamie Nicole: These lifestyle changes that you have mentioned can be hard to some that are not familiar with them or who are just easing into them, especially when you're managing chronic pain. What strategies help people actually stick with it for the long term? 

Dr. Brian Andonian: Yeah, as mentioned, every program has to be individualized. I think people have this idea about what they really want to do in their mind, in terms of the perfect diet or the perfect exercise program. And often those are really not attainable right away, depending on a lot of things, just our day-to-day life and trying to get through the day. So, my first recommendation is just starting slow and then really setting small, attainable goals. For diet, that should be something relatively easy to do. 

One of the simplest things we talk about is just, you know, consider reducing sugary beverages that you have during the given week, as opposed to patients, "Well, give me a goal of I'm going to eliminate all sugar from my diet." And I say, "Well, that's potentially a good goal, but it's not necessarily realistic to cut out sugar completely." So, I think starting with kind of baby steps is the way to go. 

For exercise, it would also be just increasing your activity any amount that's more than you're doing, and that can just be two or three minutes at a time. We know that even getting two to five minutes of exercise in a given day can have a lot of health benefits. And so, if you do that, you can feel good about it, and you've achieved that goal. Let's keep building towards doing more as your body allows. 

Jamie Nicole: What about combining tools, like using medication or surgery to drop weight, and then using that momentum to start exercising? Is that effective? 

Dr. Brian Andonian: Consider medications to help us get going first. And I think there is some thought that that could be helpful. But the idea, as I said, I think every person, for example, can exercise. It's just a matter of what that kind of exercise looks like. Even my patients who have, say, significant physical disabilities, or have really severe arthritis, I get creative with the things that they can do in terms of increasing physical activities, and that can be using like a foot pedal bike at home, just to get their legs moving a little bit, doing minor exercises while they're sitting in a chair, or even in bed using resistance bands. 

But I do think that combining different tools — including surgery, including medications, with the lifestyle things that are potentially beneficial — I think we need to think about combined strategies. And there's a lot of, I think, studies coming on looking at even combining medications, for example, for those really struggling to lose weight.

Jamie Nicole: Are there any lesser known tools, like apps or coaching or community support, that you've seen help people sustain these changes for the long term?

Dr. Brian Andonian: Well, first I think that working with a dedicated professional can be very helpful, and that can be a registered dietician, a health coach, exercise physiologist, someone to really help guide you through the process. I think it's really beneficial. There's a lot of options within a given community. I found that there's a lot of apps and programs that can be helpful for patients in sustaining lifestyle change, but I can't necessarily recommend one. I have some patients who swear by certain tools and apps and others that didn't really care for it. So, the point there is to explore. See what options there are, see what might work with you, and something might really fit well with you, even if it didn't work for someone else.

The other thing I really want to stress is that there are other lifestyle factors that play a role in weight loss and just overall health. And one would be stress management, and then restorative sleep. I think patients don't necessarily connect that if we're really sleeping poorly and really stressed out, that really can cause biologic changes that prevent us from losing weight and can prevent us from even being active and cause more pain, more fatigue. So, if we're struggling with, say, the diet and exercise piece, let's look at the other things. And usually I go to stress management and sleep as the first places to go.

The other point I'll make is thinking about medications. A lot of our patients with arthritis are on multiple medications, and some medications can contribute to weight gain or actually make it harder to lose weight. For example, we use steroids like prednisone for the management of arthritis, but we've long known that those can cause weight gain. And they reduce muscle mass. So, there's two bad problems from using steroids right there. Actually, some of the biologic medications we use for, say, rheumatoid arthritis, like the TNF inhibitors, for example, adalimumab or etanercept, some patients can gain weight on those and actually can have difficulties with losing weight while they're on those medications. So, let's think about other things that could be contributing and not just to say that “this program isn’t working for me. There might be other factors that are relatively easy, just with changing medications or thinking about some other lifestyle change that could help.

Jamie Nicole: As we wrap up, I wanted to go over some answers from the question that we asked our social media followers. And that question was: If you're losing weight to help your arthritis, what's working for you? And so, we have a couple of responses that I want to share with you. The first one is from Chrissy Livergood. She says, “Planning and tracking, and frankly,” she says, “being honest about how much I eat, what I eat and how much I move," et cetera… That's what really has helped her. 

And I'll read one more and let you respond. Rose Cramer, she mentioned — and these are things that you've mentioned throughout the podcast as well — making sure that she eats enough protein, veggies and fruits. She adds in a protein shake if she's too low for the day. And so far, she has been... She's 31 pounds down since January, so she emphasizes tracking her calories, and she says no sugar and no soda. 

Dr. Brian Andonian: Well, I appreciate those thoughts and congratulate them on their success. It’s not an easy thing to do. I think one of the things I hear is it's more about quality and not the quantity. Although you have to potentially reduce calories, you’ve really got to think about what you’re eating as maybe the most important thing. 

Jamie Nicole: And then I believe it’s Charla Ather, she is on Wegovy and has lost 60 pounds. She says, “I’m one of the lucky ones. My health insurance paid the bill. I can move around better…” with the extra weight off of her joints.

Dr. Brian Andonian: Yeah, there's multiple ways to do it. 

Jamie Nicole: Yeah, absolutely. So, based on everything that we've covered today, is there any final insight or reminder you'd like to leave our listeners with? 

Dr. Brian Andonian: Sure. I always go back to the point that weight is only a number and that our weight is made up of multiple things, including fat and muscle. And perhaps just focusing on the scale and the number on the scale is not the way to go. And trying to focus on the process. Meaning, you're making healthy lifestyle changes, you're trying new things to really help your health and potentially lose weight, even if you're not yet. But then focusing on symptoms and how you feel and your overall just well-being, maybe those are more important than is the number on the scale. 

And then the other thing is, again: Everyone is going to respond differently. It's tough when maybe you're doing a program with a friend, for example, and they're getting all the success and you're not. But there's so many factors that have to do with our biology, genetics, among other things, that really can make one person do well and another do well with another program. So, it's easy to give up hope when you see that you're not responding as maybe you'd like. It just means that we need to try different things. Hopefully one day we'll be able to assess: This one person will benefit from that program. But we're not quite there yet. Unfortunately, it's a little bit of a trial and error, and so I encourage people just to continue trying. 

Jamie Nicole: And what came to mind is not to let the perfect be the enemy of the good. For me, that was something that hindered me at the beginning of this journey. I thought that my journey should look similar to others. But I soon found out that there were other factors, as you mentioned. It wasn't all about calories in versus calories out, and that I really did have to learn about my body. If you want to learn more about weight management, the Arthritis Foundation has lots of good information on their website, where you'll find additional resources, insights and stories from others on a similar journey like you. Dr. Andonian, thank you again for joining us. 

Dr. Brian Andonian: Thanks so much for having me. I really enjoyed our conversation.

https://www.arthritis.org/liveyes/podcast/episodes/how-to-lose-weight-for-arthritis