Various elimination diets (diets that exclude specific foods from the diet) have been proposed since the 1960s as treatments for OA. The best-known of these is the Dong diet, introduced by Dr. Collin Dong in a book published in 1975. This diet is based on traditional Chinese beliefs about the effects of certain foods inincreasing the pain of arthritis. The Dong diet requires the patient to cut out all fruits, red meat, alcohol, dairy products, herbs, and all foods containing additives or preservatives. There is, however, no clinical evidence as of 2007 that this diet is effective.

Another type of elimination diet, still recommended by naturopaths and some vegetarians in the early 2000s, is the so-called nightshade elimination diet, which takes its name from a group of plants belonging to the family Solanaceae. There are over 1700 plants in this category, including various herbs, potatoes, tomatoes, bell peppers, and eggplant as well as nightshade itself, a poisonous plant also known as belladonna. The nightshade elimination diet began in the 1960s when a researcher in horticulture at Rutgers University noticed that his joint pains increased after eating vegetables belonging to the nightshade family. He eventually published a book recommending the elimination of vegetables and herbs in the nightshade family from the diet. There is again, however, no clinical evidence that people with OA will benefit from avoiding these foods.

Although some doctors recommend trying a vegetarian or vegan diet as a safe approach to weight loss for patients with OA, most will approve any nutritionally sound calorie-reduction diet that works well for the individual patient

DIETARY SUPPLEMENTS. Dietary supplements are.

commonly recommended for managing the discomfort of OA and/or slowing the rate of cartilage deterioration:

• Chondroitin sulfate. Chondroitin sulfate is a compound found naturally in the body that is part of a large protein molecule called a proteoglycan, which imparts elasticity to cartilage. The supplemental form is derived from animal or shark cartilage. Recommended daily dose is 1200 mg.
• Glucosamine. Glucosamine is a form of amino sugar that is thought to support the formation and repair of cartilage. It can be extracted from crab, shrimp, or lobster shells. The recommended daily dose is 1500 mg. Dietary supplements that combine chondroitin sulfate and glucosamine can be obtained over the counter in most pharmacies or health food stores.
• Botanical preparations: Some naturopaths recommend extracts of yucca, devil’s claw, hawthorn berries, blueberries, and cherries. These extracts are thought to reduce inflammation in the joints and enhance the formation of cartilage. Powdered ginger has also been used to treat joint pain associated with OA.
• Vitamin therapy. Some doctors recommend increasing one’s daily intake of vitamins C, E, A, and B⁶, which are required to maintain cartilage structure.
• Page 65 Avocado soybean unsaponifiables (ASU). ASU is a compound of the fractions of avocado oil and soybean oil that are left over from the process of making soap. It contains one part avocado oil to two parts soybean oil. ASU was first developed in France, where it is available by prescription only under the name Piascle´dine, and used as a treatment for OA in the 1990s. It appears to work by reducing inflammation and helping cartilage to repair itself. ASU can be purchased in the United States as an over-the-counter dietary supplement. The recommended daily dose is 300 mg.

CAM DIETARY THERAPIES. Two traditional alternative medical systems have been recommended in the treatment of OA. The first is Ayurveda, the traditional medical system of India. Practitioners of Ayurveda regard OA as caused by an imbalance among the three doshas, or subtle energies, in the human body. This imbalance produces toxic byproducts during digestion, known as ama, which lodges in the joints of the body instead of being eliminated through the colon. To remove these toxins from the joints, the digestive fire, or agni, must be increased. The Ayurvedic practitioner typically recommends adding such spices as turmeric, cayenne pepper, and ginger to food, and undergoing a three-to five-day detoxification diet followed by a cleansing enema to purify the body.

Traditional Chinese medicine (TCM) treats OA with various compounds containing ephedra, cinnamon, aconite, and coix. A combination herbal medicine that has been used for at least 1200 years in TCM is known as Du Huo Ji Sheng Wan, or Joint Strength. Most Westerners who try TCM for relief of OA, however, seem to find acupuncture more helpful as an alternative therapy than Chinese herbal medicines.

OA results from progressive damage to the cartilage that cushions the joints of the long bones. As the cartilage deteriorates, fluid accumulates in the joints, bony overgrowths develop, and the muscles and tendons may weaken, leading to stiffness on arising, pain, swelling, and limitation of movement. OA is gradual in onset, often taking years to develop before the person notices pain or a limited range of motion in the joint. OA is most likely to be diagnosed in people over 45 or 50, although younger adults are occasionally affected. OA affects more men than women under age 45 while more women than men are affected in the age group over 55. As of the early 2000s, OA is thought to result from a combination of factors, including heredity (possibly related to a mutation on chromosome 12); traumatic damage to joints from accidents, type of employment, or sports injuries; and obesity. It is not, however, caused by the aging process itself. Race does not appear to be a factor in

OA, although some studies indicate that African American women have a higher risk of developing OA in the knee joints. Other risk factors for OA include osteoporosis and vitamin D deficiency.

RA, by contrast, is most likely to be diagnosed in adults between the ages of 30 and 50, two-thirds of whom are women. RA affects about 0.8% of adults worldwide, or 25 in every 100,000 men and 54 in every100,000 women. Unlike OA, which is caused by degeneration of a body tissue, RA is an autoimmune disorder—one in which the body’s immune system attacks some of its own tissues. It is often sudden in onset and may affect other organ systems, not just the joints. RA is a more serious disease than OA; 30% of patients with RA will become permanently disabled within two to three years of diagnosis if they are not treated. In addition, patients with RA have a higher  risk of heart attacks and stroke. RA differs from OA, too, in the joints that it most commonly affects—often the fingers, wrists, knuckles, elbows, and shoulders. RA is typically a bilateral disorder, which means that both sides of the patient’s body are affected. In addition, patients with RA often feel sick, feverish, or generally unwell, while patients with OA usually feel normal except for the stiffness or discomfort in the affected joints.