Osteoarthritis and diet

Osteoarthritis is the most common type of arthritis and is a leading and growing cause of disability globally. This Food Fact Sheet explains whether diet has a role in managing the condition.

What is osteoarthritis and who is affected by it?

There are 10 million people living with osteoarthritis in the UK, with knee osteoarthritis being especially common. Osteoarthritis commonly affects weight-bearing joints such as the knees and hips, but it can also affect the hands, the base of the big toe and the spine. It affects the entire joint, cartilage, the bone, ligaments, skeletal muscles and tendons. Inflammation within the area often leads to pain, discomfort and a reduced quality of life.

This condition may run in families or can develop because of joint injuries and often affects people later in life. There is currently no cure for osteoarthritis, so treatment options are generally limited to the management of pain and symptoms.

Why is a healthy weight important?

The most important relationship between diet and osteoarthritis is body weight. If you are carrying more body weight than necessary, this can place excess pressure on weight-bearing joints, such as your knees. Living with overweight can also cause inflammation in the body, which can be painful. There is also an increased risk of developing osteoarthritis in some non-weight-bearing joints, such as your hands.

If you are living with overweight or obesity, there is strong evidence that losing at least ten percent of your body weight will help reduce pain and improve mobility. Try to eat a healthy balanced diet with plenty of fruits and vegetables and incorporate physical activity/exercise. See our how to achieve a healthier weight Food Fact Sheet.

What about omega 3/6 fatty acids?

Long-chain omega-3 polyunsaturated fatty acids (omega-3 PUFAs) found in oily fish have attracted attention as an anti-inflammatory nutrient.    They also play a role in supporting heart health. However, more evidence is needed to show clear benefits of taking fish oil for osteoarthritis symptoms. There is limited evidence that omega-6 PUFAs are pro-inflammatory and not great for those with osteoarthritis. Nevertheless, having omega-3 in the diet is good for overall health. Aim to consume at least two portions of fish per week, one of which should be oily, e.g. sardines, mackerel or salmon.

What about the gut microbiome and osteoarthritis?

Early research suggests that the gut microbiome may play a role in osteoarthritis, through inflammation and gut health. The gut microbiome is essentially lots of bacteria that live in the gut. Fibre in your diet supports a healthy gut microbiome. Some types of fibre act as natural prebiotics, meaning they feed beneficial gut bacteria. A healthy gut microbiome may help reduce inflammation and persistent pain.

Good sources include fruits, vegetables, beans, pulses, nuts, seeds and wholegrains.

Some early studies on probiotics (live friendly bacteria) and prebiotics helping with osteoarthritis symptoms are also promising, but more research is needed to understand how much they can help your symptoms. See our fact sheets on fibre, probiotics and gut health.

Are dietary supplements of any benefit?

Research into whether you should take supplements to support your osteoarthritis symptoms often gives mixed results.

Supplements such as antioxidant vitamins, vitamin K, Boswellia, krill oil, glucosamine, turmeric, collagen, methylsulfonylmethane (MSM), rosehip, and chondroitin sulphate are often mentioned, but there is not enough good evidence to recommend them. If your diet is restricted or your appetite is poor, consider taking a general multivitamin and mineral supplement and speaking to a registered dietitian.

Examples of foods containing essential vitamins that may support a healthy diet for people with osteoarthritis:

• Vitamin A – carrots, sweet potato, cod liver oil
• Vitamin C – citrus fruits, green and red peppers
• Vitamin E – wholegrains, nuts and seeds
• Vitamin K – kale, spinach, broccoli
• Vitamin D –  oily fish, margarine, eggs, mushrooms, bread, foods with vitamin D added, like cereals

If you eat a healthy, balanced diet, you can get all these vitamins from your food.

Include plenty of fibre-rich foods such as fruit, vegetables, beans, pulses, nuts, seeds and wholegrains. These foods help to support a healthy gut and also provide important vitamins, polyphenols and antioxidants which are likely to be beneficial for your symptoms. Some fibre-rich foods also act as natural prebiotics.

What about vitamin D?

One important supplement you should consider taking is vitamin D. It’s essential for bone, cartilage and muscle health and many people in the UK have low levels. Between early April to the end of September, sunlight is the primary source of vitamin D, with smaller amounts coming from food. In the UK, adults and children over 4 years old are recommended to take a daily supplement to maintain vitamin D levels, particularly during winter months. See Vitamin D Food Fact Sheet for more information.

Are there any foods I should avoid that are making my osteoarthritis symptoms worse?

There is no evidence that cutting out certain foods such as tomatoes, potatoes, red meat, dairy or gluten will help with your osteoarthritis symptoms.

The Mediterranean diet has been found to help modestly improve osteoarthritis symptoms. This diet focuses on balance, adding more fibre and essential fatty acids like omega 9 (olive oil) and omega 3 (oily fish), whilst limiting high sugar/fat foods and ultra-processed foods such as canned soups, sauces, ready meals, sausages and cured/smoked meats.  

A plant-based diet has also been found to be helpful for people with osteoarthritis.

Top tips

• Cutting out food groups to manage your symptoms is unnecessary
• The Mediterranean diet or a plant-based diet can be beneficial
• If you are living with overweight or obesity, aim to reduce your body weight by at least 10%
• Combining regular exercise with healthy eating and achieving a healthy weight is one of the most effective ways to reduce joint pain
• Have omega-3 polyunsaturated fatty acids, found in oily fish, as part of an overall healthy diet
• Try to include plenty of fibre-rich foods such as fruit, vegetables, beans, pulses, nuts, seeds and wholegrains. These foods help to support a healthy gut and also provide important vitamins, polyphenols and antioxidants which are likely to be beneficial for your symptoms. Some fibre-rich foods also act as natural prebiotics
• Take a vitamin D supplement of at least 10µg/day or 400IU when you are not being exposed to the sun, including in the winter months. During the summer months, aim for daily sunlight exposure (use at least factor SPF 30 sunscreen) to increase vitamin D
• Be cautious of taking dietary supplements without clear benefits. Discuss any change in diet or nutritional supplements with your rheumatologist, GP or dietitian