This book is a timely reminder that we are over half way through the Bone and Joint Decade (2000-2010), whose goal is to empower patients and improve quality of life. Experts in the field have tended to be sceptical about dietary approaches to arthritis but the authors argue that in the context of adverse side effects with non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors the dietary approach may be the proper and safest approach for many sufferers.
The focus is on osteoarthritis and rheumatoid arthritis, since these are the most common (and costly) forms of over 200 types of arthritis. The two diseases are often dealt with together and there is some blurring of the two in the book. In the chapter “Current management” one could be forgiven for thinking that joint replacements are a regular feature of rheumatoid arthritis. Although nutritional inadequacy is a concern for rheumatoid arthritis this may not be relevant for osteoarthritis. The authors point out the lack of scientific evidence for many popular diets used to alleviate symptoms and give details on diets that have shown some limited success when tested scientifically. Again the focus is on rheumatoid arthritis, with exclusion, meat avoiding, and Mediterranean diets. The evidence for the role of micronutrients in improving symptoms is critically reviewed. Margaret Rayman is a leading expert in selenium and it is not surprising that this nutrient is put under the spotlight. Vitamin D is another micronutrient that receives attention, although dietary calcium is ignored. Polyunsaturated fatty acids are given their own chapter detailing the rationale behind their use in inflammatory diseases and the evidence in support of and against a cytokine inhibitory effect.
The book covers safety issues surrounding the consumption of oily fish, including simple side effects (nausea), and peroxidation issues (recommending avoiding fish that is not fresh and not leaving defrosting fish in contact with air). It was refreshing to see the scientific data in the context of current legislation involving contaminants in fish and supplements (dioxins, polychlorinated biphenyls, and mercury) and the ethical issues surrounding depleting fish stocks. Although not part of a normal diet, the supplements glucosamine and chondroitin are discussed, which, according to the book, are now “top sellers in a $26 billion annual market.”
Although the book is aimed at rheumatologists, GPs, dieticians, and nutritionists, the inclusion of appendices on statistical interpretation of studies and a glossary of scientific terms suggests that its target audience should include students and could extend to lay people interested in these diseases. However a warning should be issued to readers to note which disease is being discussed. The book opens with the quote, “Leave your drugs in the chemist's pot if you can heal the patient with food.” It cannot provide definitive answers but gives food for thought for possible, but mainly unproven, approaches to alleviate the symptoms of two quite distinct diseases under the umbrella of “arthritis.”