Vitamins and Minerals for Arthritis (2024)

Whatit does:Calciumis an essential mineral that maintains strong bones and teeth; regulates muscle contractions; transmits nerve impulses; and helps release essential hormones and enzymes.It alsohelps prevent osteoporosis(loss of bone density) andfractures, which are higher risksamong people with rheumatoid arthritis (RA) and thosetaking corticosteroids.

Howmuch: Experts recommend 1,200 mg a day for healthy adults, but people with inflammatory arthritismay need more – up to 1,500 mg for men and postmenopausal women. Recent research has debunked the claim that calcium supplements raise heart attack risk.

Toomuch: Tolerable upper limit (UL) = 2,500 mg.

Too Little: Contributes to bone loss, tooth loss, muscle cramps and hypertension.

Foods: Low-fat milk, yogurt and cheese;leafy greensand vegetables such askale, broccoli and spinach; canned sardines and salmon with bones; calcium-fortified cereals,soy products(including tofu),orange juiceandnut milks.

Interactions: Aluminum-containing antacids, antibiotics, anti-convulsants, bone drugs, corticosteroids, calcium channel blockers, diuretics, laxatives and multivitamins containing iron, magnesium and zinc.

Researchnote: Dozens of studies havefound that calcium supplementswith or without vitamin D improvebone health in both men and women.

Whether calcium plus vitamin Dcan prevent fractures has been morecontroversial, with competing studieson both sides. But a2016 meta-analysis foundthat calcium and vitamin D supplementsreduced fracture risk by 15% and hip fracture risk by 30%.

What It Does:Chromium helps the body produce energy from foods, helps the brain function and helps the body break down insulin, keeping the body's blood sugar level normal.  

Howmuch: Adequate intakes (AI) = 35 mcg for men age 14 to 50; 30 mcg for men age 50 and older; 25 mcg for women age 14 to 50; 20 mcg for women age 50 and older.

Toomuch: No tolerable upper limit (UL) has been determined.

Toolittle: Impaired glucose tolerance.

Foods: Brewer's yeast, wheat germ, broccoli, chicken, beef, eggs, green peppers, black pepper, molasses, apples, spinach and wheat germ.

Interactions: Insulin, thyroid medications, antacids, corticosteroids, H2-blockers and proton pump inhibitors.

Researchnote: Chromium may add to the effects of diabetes medications, but there is no conclusive evidence that chromium supplements can prevent or treat diabetes.

What it does:Copper helps build red blood cells by transporting iron; makes connective tissue; keeps the immune system, nerves and blood vessels healthy; and serves as an antioxidant by removing free radicals.

Howmuch: Recommended dietary allowance (RDA) = 900 micrograms (mcg) daily for adults.

Toomuch: Tolerable upper limit (UL) = 10,000 mcg.

Toolittle: Rare; anemia and osteoporosis.

Foods: Organ meats, whole grains, seafood, beans, nuts, potatoes, dark leafy greens and dried fruits.

Interactions: Non-steroidal anti-inflammatory drugs (NSAIDs), gout medications, reflux medications, birth control pills and zinc.

Researchnote: Although copper does have anti-inflammatory properties and has shown benefit for reducing heart disease and Alzheimer’s disease, there currently is no research to support dietary copper or supplements as a treatment for arthritis.There is no evidence tosuggest thatwearing copperhelps easearthritis symptoms either.

What it does:Folate andthe supplement form, folic acid,areboth forms of the vitamin B9.Folateis essential for healthy cell growth, the formation of DNA and RNA and the prevention of birth defects and somecancers.Methotrexate,a common RA drug,destroys folate, so it’s recommended that doctors prescribe supplements for all patients taking it.

Howmuch: Recommended dietary allowance (RDA) = 400 micrograms (mcg) for adults; 600 mcg for pregnant women.

Toomuch:More than 1,000 mcg of supplemental folic acid per day may mask a vitamin B-12 deficiency, leading to anemia, especially in older adults. If you’re older than 50, have your B12 levels checked before taking folic acid supplements.

Toolittle: A folate deficiency can cause fatigue, mouth ulcers, swollen tongue, weight loss and poor growth. It can also cause an increased risk for certain cancers, anemia, depression, heart disease and Alzheimer's disease. Low levels in pregnant women increase the risk of neural tube defects in their babies.

Foods: Folateoccurs naturally in many foods, especiallygreen leafy such as spinach and kale; orange juice and most fruits; dried beans and peas. Folic acid is added to enrich manygrains, cereals and pastas.

Interactions: Antiseizure medications; ulcerative colitis medications; antacids; alcohol, antibiotics; aspirin; some cholesterol-lowering drugs; oral contraceptives; cholesterol-lowering medications.

Researchnote: A 2018 review of seven studiesfound that folic acid reduced commonmethotrexate side effects suchas nausea, vomiting and liver toxicity.High and low doses (more than 25 mga week and less than 10 mg a week, respectively)were equally effective, evenwith higher doses of methotrexate.Doses rangefrom 1,000 to 5,000 mcg daily; sometimes a single weekly dose is taken the morning after a methotrexate injection.Studiesalso suggestfolate and folic acidmayreduce the risk of stroke.

What it does:Iron helps prevent anemia by helping produce hemoglobin, the protein in red blood cells that carries oxygen throughout the body.

Howmuch: Recommended dietary allowance (RDA) = 8 milligrams (mg) daily for men; 18 mg daily for women until menopause; 8 mg for women after menopause.

Iron supplements can cause constipation, nausea and stomach upset. Take with vitamin C to aid iron absorption.

Toomuch: Tolerable upper limit (UL) = 45 mg per day.

Toolittle: Iron deficiency is the most common form of nutritional deficiency. Symptoms of mild deficiency include tiredness, shortness of breath, decreased mental performance, poor appetite, unstable body temperature and decreased immunity.

Foods: Liver, beef, turkey, fish; dried beans, peas and lentils; spinach, raisins. Iron from animal sources is better absorbed by the body than from vegetarian sources – but vegetarian sources are still good choices.

Interactions: Cholesterol medications, anti-ulcer medications and antibiotics.

Researchnote: Anemia – low red blood cell levels – is common in people with rheumatoid arthritisand may result from inflammation, which inhibits iron absorption, or from digestive tract bleeding caused by medications. Studies show that people who have both RA and anemia have more severe disease and joint damage than people who don’t have anemia.

What it does:Magnesium strengthens bones; maintains nerve and muscle function; regulates heart rhythm and blood sugar levels; and helps maintain joint cartilage.

Howmuch: Recommended dietary allowance (RDA) = 420 milligrams (mg) daily for men 31 and older; 320 mg for women. For best absorption, choose magnesium orotate, oxide or citrate.

Toomuch: Tolerable upper limit (UL) = 350 mg.

Toolittle: Rare, but early symptoms include loss of appetite, nausea, vomiting, fatigue and weakness.

Foods: Almonds, cashews, peanuts and peanut butter; soybeans; spinach; dried beans; potatoes; and whole grains.

Interactions: Some diuretics, antibiotics, antacids and laxatives.

Researchnote: Many studies, including the Framingham Heart Study, have found that eating foods high in magnesium and potassium increases bone density and may help prevent postmenopausal osteoporosis.

What it does:Selenium is an antioxidantandhelpspreventdamage from free-radicals, or toxic by-products of natural bodily processes.It is also essential for proper functioning of the thyroid gland and immune system.

Howmuch: Recommended dietary allowance (RDA) = 55 mcg daily.

Toomuch: More than 400 mcg per day of supplemental selenium may be toxic.

Toolittle: Rare; impaired immunity and heart disease.

Foods: High-selenium yeast; nuts, especially Brazil nuts; shrimp; tuna; turkey; chicken; and whole grains.

Researchnote: Some research suggests selenium may help prevent rheumatoid arthritis, but it has not been shown to relieve pain or stiffness in people with established disease.

What it does:Sodium helps nerve impulse function and muscle contraction. It also helps the body regulate body fluids and affects blood pressure.

Howmuch: Adequate intake (AI) is 1,500 milligrams (mg) for adults.

Toomuch: Tolerable upper limit (UL) = 2,300 mg.

Toolittle: Sodium deficiency is rare except for those who work or exercise in a hot climate. Symptoms for these individuals include, headache, nausea, dizziness, fatigue, muscle cramps and fainting.

Foods: Salt, soy sauce, processed meats, canned soups, monosodium glutamate (MSG) and fast food.

Interactions: Corticosteroids, diuretics, NSAIDs, opiates and tricyclic antidepressants.

Researchnotes: One study found women who consumed a high-salt diet (9 grams [g] daily) lost 33% more calcium and 23%more of a bone protein than those on a low-salt diet (2 g per day).

What it does:Vitamin A is an antioxidant that maintains the immune system; protects eyesight; keeps skin and tissues of the digestive tract and respiratory system healthy; and supports bone growth.

Howmuch: Recommended dietary allowance (RDA) = 3,000 international units (IU) for men and women.

Toomuch: Tolerable upper limit (UL) = 10,000 IU from retinol. Vitamin A is obtained in two ways: as vitamin A from animal sources such as fish oil, egg yolks and dairy products; and as pro-vitamin A carotenoids (including beta carotene) from fruits and vegetables, which your body then converts into vitamin A.

Three or more times the recommended amount of vitamin A from animal sources or supplements may increase hip fracture risk. Beta- carotene supplements have been linked to an increased risk of lung cancer in smokers.

Toolittle: Rare; night blindness and weakened immune system.

Foods: Liver, eggs, fortified milk; richly colored fruits and vegetables, such as carrots, cantaloupes, sweet potatoes and spinach.

Interactions: Orlistat (Alli, Xenical); mineral oil; oral contraceptives; isotretinoin (Accutane); acitretin (Soriatane); and bexarotene (Targretin).

Researchnote: Studies suggest a form of vitamin A called all-trans-retinoic acid – used to treat acne and some types of cancer – may be helpful in controlling RAby suppressing inflammatory cytokines.

What it does:Vitamin B12 is essential for normal brain and nervous system function, to make red blood cells and DNA and to produce energy. B12, alongwith vitamin B6 and folate, also reduces the amino acid homocysteine, which increases with age and is found at high levelsin people with RA.

Howmuch: The recommended dietary allowance (RDA)is2.4 mcg (micrograms) daily, although many experts, including the National Academy of Medicinebelieve that is far too low. As much as 1,000 mcg a day may be needed for people with a diagnosed deficiency.If your B12 is very low,your doctor may recommend weeklyshots followed by oral supplements.

Toomuch: There is no tolerable upper limit (UL) for vitamin B12.It’s generally safe to take higher doses; the body absorbs only what it needs and then passes the rest through urine.

Toolittle: Too little vitamin B12 can cause exhaustion, cognitive difficulties, nerve damage and anemia.B12 in foodisbroken down by hydrochloricacid in your stomach. If youdon’t have enough, you won’t absorbB12 from food very well, but you canabsorb it from supplementsor shots.Experts often recommend that people over age 50take asupplement because the ability to absorb B12 from food declines with age.

Foods: Vitamin B12 occurs naturally in animal foods, especially liver, clams, egg yolks and salmon. Easier-to-absorb synthetic forms are added to supplements and some cereals, pastas and breads.It’s also available in pills, dissolvabletablets, sprays, liquids,shotsand as a prescription drug.

Interactions:Methotrexate, proton pump inhibitors, the diabetes drug metformin and the gout drug colchicine interfere with B12 absorption.

Researchnote:High homocysteine is linkedto an increased risk of heart attack andstroke as well as bone loss, fracturesand cognitive decline in older adults.In 2018, an international panel ofexperts recommended treatment withB vitamins for all adults who have highhomocysteine levels to reduce the riskof memory loss and dementia.

What it does:Also called thiamine, vitamin B1 converts glucose to energy. It is essential for normal functioning of the heart, brain, nervous system and muscles.

How Much:Recommended dietary allowance (RDA) = 1.2 mg for men; 1.1 mg for women.

Too Much:No known symptoms.

Too Little:Deficiency can cause weakness, fatigue, psychosis and nerve damage.

Foods:Vitamin B1 in the form of thiamine is found in whole grains, brown rice, pork fish and dried beans; alsoenriched pasta, bread, cereals and rice.

Interactions:Furosemide (Lasix); antacids; Digoxin; Phenytoin (Dilantin).

Research Note:Small studies have suggested vitamin B1 might be important for people who have heart failure and in preventing cataracts – both associated with RA.

What it does:Also called riboflavin, vitamin B2 converts glucose to energy; may help prevent migraine headaches and cataracts; converts other B vitamins into forms the body can use; is essential for normal cell function and growth; and helps protect against free radical damage, or toxic molecules made in the body that mayplay a role in cancer, heart disease and aging.

Howmuch: Recommended dietary allowance (RDA) = 1.3 mg daily for men; 1.1 mg daily for women.

Toomuch:  A tolerable upper limit (UL) has not been determined.

Toolittle: Deficiency is rare in a typical U.S. diet. However, malabsorption can occur with diseases such as alcoholism, celiacdiseaseand certain malignancies.

Foods: Fortified grains and cereals; meat; organ meat;yogurt, milk, eggs; spinachand broccoli.

Interactions: Some drying medications or anticholinergic drugs; antidepressants; anti-seizure medications; methotrexate; and probenecid.

Researchnote: Vitamin B2 helps change vitamins B6 and folate into usable forms for the body. Methotrexate and the anti-gout medication probenecid (Benemid) may interfere with absorption of B2, although to what degree is in debate.

What it does:Known as niacin, vitamin B3 helps with producing energy from food (sugars and fats)and keepstheskin, nerves and digestive system healthy.

How Much: Recommended dietary allowance (RDA) = 16 milligrams (mg) for men; 14 mg for women.

Toomuch: Tolerable upper intake level (UL) = 35 mg from supplements. Large doses – 500 to 2,000 mg – are often prescribed to help lower cholesterol levelsbut should be taken only under a doctor’s supervision.High doses may cause niacin flush, a harmless but uncomfortable side effect that includes reddening and tingling of the skin on the face and upper body.

Foods: Chicken, tuna, turkey, fish, beef, salmon, green vegetables, tomatoes, yeast, eggs, peanut butter, sweet potatoes and beans.

Interactions: Diabetes medications; cholesterol medications and gout medications.

Researchnote: Preliminary studies suggest a type of vitamin B3 called niacinamide may improve osteoarthritis (OA) symptoms and reduce the need for nonsteroidal anti-inflammatory drugs (NSAIDs) by suppressing inflammation.

What it does:B6 helps your body use proteins, carbohydrates and fats and is needed for normal brain development, immune and nerve function. It is also involvedinmore than 100 chemical reactions in the body and for forming amino acids, red blood cells, vitamin B3 and antibodies.Low B6 is common in RA, where it’s associated with higher inflammation levels.

Howmuch: Recommended dietary allowance (RDA) = 1.3 milligrams (mg) for all adults up to age 50; age 50 and older, 1.7 mg for men, 1.5 mg for women.

Toomuch: Tolerable upper limit (UL)=100 mgfor adults over 19. Long-term use of more than 100 mg per day from supplements can temporarily damage nerves in the arms and legs.Discontinue supplement use if you experience any unusual numbness in the body.

Toolittle: Rare; symptoms include skin inflammation, swollen tongue, depression, confusion and convulsions. Lower than optimal levels are linked to high levels of homocysteine, which can increase the risk of stroke and heart disease.

Foods: Liver, chickpeas; fish, chicken, turkey; potatoes;vegetables; and non-citrus fruits.

Interactions: Drugs for epilepsy, tuberculosis and asthma.

Researchnote: Many researchers believe thatinflammation leads to low B6 inRA patients and low B6 makes inflammationworse. A 2013 study also foundthat treatment with NSAIDs,especiallyfor longer than six months, significantlyreduced B6 levels in people with rheumatoid arthritis.The study authors suggest that B6levels should be monitored in arthritispatients and supplemented if necessary.Suggested dose: 100 mg a day,preferably with the entire B complex.

What it does:Vitamin C is an antioxidant. It protects cells from free-radical damage; builds and maintains collagen and connective tissue; improves iron and folate absorption; and helpsheal wounds.

Howmuch: Recommended dietary allowance (RDA) = 90 milligrams (mg) daily for men; 75 mg for women. Smokers need an additional 35 mg daily.

Toomuch: Tolerable upper limit (UL)=2,000 mg daily.

Toolittle: Weight loss, fatigue; inflamed or bleeding gums, slower healing times; repeated infections and colds.

Foods: Citrus and other fruits, including strawberries, kiwifruit, cantaloupe and tomatoes; bell peppers, broccoli, Brussels sprouts and potatoes. Cooking can destroy the vitamin C content of food.

Interactions: Aspirin; non-steroidal anti-inflammatory drugs (NSAIDs); certain types of cancer treatments and radiation; statins; certain drugs for HIV/AIDS; and blood thinners.

Researchnote: Vitamin C helps prevent gout by lowering uric acid levels. One large study found 1,500 mg of vitamin C per day – the equivalent of 30 oranges – reduced gout risk by half. Research also suggests that getting at least 500 mg of daily vitamin C can lower blood pressure three to five points – enough to reduce the risk of stroke.

What it does:Vitamin D regulatesmany critical cellular functions: It aidscalcium absorption, helping preventosteoporosis and fractures; regulatesthe cells responsible for autoimmunefunction; fights inflammation, protectsagainst disease-causing germs andhelps create a healthy gut microbiome.Adequate amounts are linked to improved heart health. In the body, vitamin D also gets converted to a steroid hormone capable of turning genes on or off, signaling them to make enzymes and proteins crucial to maintaining health and fighting disease.

Howmuch: There’s no consensus on how muchvitamin D is healthy. While the recommendeddaily dose is 800 internationalunits (IU), the AmericanGeriatrics Association recommendsat least 1,000 IU.Harvardresearcher EdwardGiovannucci,MD, suggests up to 2,000 IU a day. Atwo-year study of osteoarthritis patients foundthat 50,000 IU per month is safe.When buying a supplement, look for vitamin D3 (cholecalciferol) – the same form the body makes from sunlight. It is better absorbed and more effective than vitamin D2 (ergocalciferol).

Too little:Low vitamin D levels havebeen linked to RA, inflammatorybowel disease, colorectal cancer risk,memory problems, respiratory infections,asthma and chronic pain.More than 60%of older adults don’t get enough vitamin D,in partbecause the body becomes less efficient at producing it over time.Your doctor can check your vitaminD levels with a simple blood test,though the usefulness of testingfor healthy people is questionable.A good target is 30 to 50 ng/mL.(Blood tests may not be accurate forAfrican Americans because theyhave little protein-bound vitaminD – the kind the test measures.)

Foods: Vitamin D naturally occursin a few foods – mainly salmon, tuna,sardines and fish oil – and is oftenadded to milk, yogurt, orange juice andbreakfast cereals.Sunlight is the main source for most people, which is absorbedthrough the skin andconverted intovitamin D by the liver and kidneys.Taking vitamin D with meals willincrease absorption by 30% to 50%.If you can’t take it with meals,buy the oil-based form.

Researchnote: A 2016 meta-analysis of 15 studiesinvolving more than 2,000 people foundthat vitamin D deficiency was moreprevalent and blood levels significantlylower among rhuematoid arthritispatients thanthose without RA.Patients with the lowest levelsalso had the most severe disease.A different study had the same findingsabout lowblood levels but didn’tsee a link to RA disease severity.And a study that followed 37 earlystageRA patients for a year reportedthat those with low vitamin D at thestart of the study didn’t respond aswell to treatment and were less likelyto achieve remission than patientswith normal vitamin Dlevels.On the otherhand, in a 2016 study,patients with knee OA saw no improvementin cartilage loss or pain aftertaking vitamin D supplements for twoyears. (Study limitations may haveaffected the outcome.)

What it does:Vitamin E acts as an antioxidant, helping protect the body from free radicals, which are compounds that can damage the body. Vitamin E also supports the immune system and helps make red blood cells.

Howmuch: Recommended dietary allowance (RDA) = 15 milligrams (mg), or 22.4 international units (IU), for adults.

Toomuch: More than 1,000 mg, or 1,500 IU, daily in supplement form may increase bleeding risk, especially when used with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

Toolittle: Consumption of too little vitamin E is rare in healthy people. However, people with conditions such as Crohn's disease, cystic fibrosis and liver disease may need extra vitamin E.

Foods: Vitamin E can be found in healthy vegetable oils, such as canola, almonds, sunflower seeds, peanut butter; spinach, and broccoli.

Interactions: High amounts may increase bleeding, especially if blood-thinning medications also are used; statins; aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs); and when undergoing chemotherapy or radiation treatments.

Researchnote: Once hailed as a cure-all, vitamin E has been disappointing in studies. Current research has failed to show that it helps prevent cancer, heart disease or arthritis.

What it does:A group of vitamins,including K1 and K2 (MK-4 and MK-7).K1 helps blood clot. K2,along with vitamin D and calcium, isessential for bone health. It also mopsup excess calciumfrom places you don’twant it, like your heart and brain.

How Much: Recommended dietary allowance (RDA) = 120 micrograms (mcg) for men; 90 mcg for women. However, most Americans fail to get the RDA from their diets. In supplements, look forcombined K1 and both forms of K2(sometimes called K2 complex),such asLifeExtension’sSuper K.

Too Much: A tolerable upper limit (UL) for vitamin K has not been determined.

Too Little: Whilerare, a deficiency can causeproblems with blood clotting and can cause bruising and bleeding gums.

Foods: K1 occurs naturally in green leafyvegetables, some fruits and plant oils.Both forms of K2 are found in eggyolks, some cheeses and fermented

foods like sauerkraut and kefir.

Interactions: Antibiotics, blood-thinning drugs.

Research Note: Many studies have shown theimportance of vitamin K in preventingbone loss and fractures. One meta-analysisof 20 randomized controlledtrials found thatvitamins K1 and K2both helped prevent bone loss, but thatK2 was superior for preventing hip,vertebral and other fractures. A 2018analysis of patients in thelarge OsteoarthritisInitiative trial showed thatthose with normal levels of vitaminsD and K were able to walk faster, weremore flexible and functioned better thanpatients with low levels. Other studieshave found that people who get too littlevitamin K are more likely to develop OA.

What it does:Zinc is involved in wound healing, cell reproduction and tissue growth, sexual maturation, and taste and smell. It is also associated with more than 100 enzymatic reactions in the body.

How Much: Recommended dietary allowance (RDA) = 11 mg daily for men; 8 mg daily for women.

Too Much: Tolerable upper limit (UL) = 40 mg daily.

Too Little: Hair loss, eye and skin sores, diarrhea, and loss of appetite.

Foods: Oysters, crab, lobster; red meat, chicken, turkey; zinc-fortified breakfast cereals; beans, nuts, whole grains.

Interactions: Antibiotics, diuretics and calcium.

Research Note: Studies show significantly lower zinc levels in people with rheumatoid arthritiscompared to those without it. The lowest levels are associated with more severe disease. Researchers say zinc may help improve RA symptoms by supporting the immune system and cartilage.

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