Lactose and arthritis

Q: Does the lactose in dairy products cause pain and stiffness in the joints of people with arthritis?

A: There is no known association between lactose in dairy products and arthritis; however, our understanding of the causes of and effects of diet on most types of arthritis is limited. At some point in the future, researchers could discover an important role for lactose or other nutritional components in the development of arthritis.

There are more than 100 types of arthritis and for most there is no known dietary connection. However, diet can play an important role for a few forms of arthritis, such as gout and osteoarthritis.

Attacks of gout can be triggered in susceptible people by alcoholic beverages and foods rich in purines. Examples of foods with a high purine content include sardines, liver, and other organ meats. Even among people with gout, though, the effect of food choices is usually small. Recent studies suggest that newly diagnosed gout is more common among people who consume a lot of meat, seafood and high fructose corn syrup, while risk appears to be lower among those with high intake of vitamin C and dairy products. Another connection between diet and gout is that the risk of developing gout climbs as your weight increases.

The risk of osteoarthritis is higher among overweight people and weight loss is routinely recommended for people with this type of joint disease. In addition, recent studies report an association between a diet low in vitamin D and a higher risk of osteoarthritis. However, increasing vitamin D in the diet is not thought to treat the condition, nor is it clear that low vitamin D actually causes or contributes to the development of osteoarthritis.

Other than these specific conditions, the role of diet is not considered by most experts to be important in the management of the common forms of arthritis. Increasing certain foods or eliminating others has demonstrated no consistent benefit for arthritis sufferers, so, while I do routinely encourage a balanced diet (and calorie restriction for people who are overweight), I do not recommend that people with arthritis avoid foods containing lactose.

(Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center, Boston, Massachusetts.)

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