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If you suffer from rheumatoid arthritis, you may have heard that avoiding certain foods, like eggplant and bell peppers, and taking antioxidant supplements can help relieve pain, stiffness and fatigue.

Or, you might be among the two-thirds of Canadians struggling with arthritis who think physical activity will harm your joints.

When it comes to managing the pain, advice about diet and exercise is plentiful. While some of it's based on solid evidence, some lacks scientific backing.

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One in every 100 Canadians has arthritis, a painful condition that attacks the joints and connective tissue. One of the most severe forms is rheumatoid arthritis (RA), a debilitating disease caused when the body's immune system attacks its own joints, causing inflammation.

It most often diagnosed between the ages of 25 and 50, but the disease can strike people of all ages. Rheumatoid arthritis affects joints in the wrist, fingers, elbows, shoulders, neck, jaw, feet, ankles, knees and hips.

Since it triggers an autoimmune response, RA affects the whole body. Often joint pain is accompanied by fatigue, flu-like aches and pains, and weakness.

While medications are used to treat pain and swelling, many people often turn to natural remedies to help manage the disease. One widespread belief is that nightshade vegetables - potatoes, eggplant, bell peppers and tomatoes - can aggravate symptoms. However, not one study has proven this link.

It is known that a small percentage of people with RA have food allergies that worsen joint pain and stiffness. Removing allergy-causing foods such as wheat, corn, milk, pork and oranges has been shown to improve symptoms in some allergic people.

Another misconception is that exercise causes further joint damage. Yet including daily exercise that's appropriate for people with arthritis can help reduce joint pain and fatigue, strengthen muscles that support joints and improve joint mobility.

Studies do suggest that certain diets, foods and supplements may help ease RA symptoms and offset the side effects of certain medications. Before you adopt any of these strategies, check in with your health-care provider.

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Mediterranean diet

Adopting a Mediterranean-style diet -rich in fruits, vegetables, legumes, olive oil and containing little red meat - may help manage RA symptoms. Researchers have found that arthritis patients taking conventional medication who followed a Mediterranean diet had fewer inflamed joints and improved physical functioning than those assigned to a typical Western diet.

The hallmark foods of a Mediterranean diet provide monounsaturated fat, antioxidants, vitamins and minerals thought to reduce inflammation in the body.

Vegetarian diet

A number of studies have demonstrated that a strict vegetarian diet can bring about long-term improvements in RA symptoms. Diets plentiful in plant foods are believed to reduce inflammation and promote the growth of friendly bacteria in the gut that boost the immune system.

Other research has demonstrated the benefits of a vegetarian diet that eliminates gluten, a protein found in wheat, rye and barley.

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If you're considering the vegetarian route, consult with a registered dietitian to ensure your diet provides all the nutrients you need.

Antioxidant-rich foods

Inflammatory immune compounds generate free radicals, compounds thought to cause tissue damage in people with rheumatoid arthritis. When scientists have examined the blood and joint fluid of arthritis suffers, they've found increased free radical activity and lower levels of antioxidants such as vitamins C and E, beta carotene and selenium.

Foods, not supplements, are your best source of antioxidants. A 2007 review of 20 studies found no convincing evidence that antioxidant supplements, alone or in combination, were effective in treating rheumatoid arthritis.

The best food sources of vitamin C are citrus fruit, cantaloupe, kiwi, mango, strawberries, broccoli, Brussels sprouts, cauliflower and red pepper. Vitamin E-rich foods include wheat germ, nuts, seeds, whole grains and kale.

To increase your intake of beta-carotene include dark green and orange produce in your daily diet such as carrots, sweet potato, winter squash, kale, spinach, apricots, peaches, mango and papaya.

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Selenium is found in seafood, chicken, whole grains, nuts, onions, garlic and mushrooms.

Calcium and vitamin D

Corticosteroid drugs such as prednisone can thin bones and long-term use can lead to osteoporosis. If you're taking such a medication, it's critical that you consume 1,000 to 1,500 milligrams of calcium and 1,000 IU (international units) of vitamin D a day to preserve bone health.

Vitamin D also helps regulate the body's immune system. Low blood levels of vitamin D have been associated with rheumatoid arthritis disease activity, which is more severe in the winter months when a lack of sunshine prevents vitamin D synthesis in the skin. (A greater intake of vitamin D is also linked with a lower risk of developing rheumatoid arthritis.)

Fish oil

Research suggests that taking fish-oil capsules, alone or in combination with arthritis medications, reduces the number of tender joints and morning stiffness, improves walking distance and reduces pain.

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Fish oil contains EPA and DHA, omega-3 fatty acids that hinder the body's production of inflammatory immune compounds. Most studies have used a large dose of fish oil that provides 3.8 grams EPA and 2 grams DHA per day, an amount that's easier to get from a liquid fish-oil supplement than a capsule. (One fish-oil capsule contains much less DHA and EPA than one teaspoon of liquid fish oil.) It may takes a few months to notice a decrease in symptoms. Avoid fish-liver-oil supplements as most are concentrated in vitamin A, which, if consumed for an extended period of time, can decrease bone density.

Eating fish may help prevent RA. An American study found that women who ate at least two weekly servings of baked or broiled fish were almost half as likely to have the disease as women who ate fish less than once per week.

For more information on rheumatoid arthritis, visit www.arthritis.ca, the website of The Arthritis Society.

Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV's Canada AM every Wednesday. Her website is lesliebeck.com.

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