The Mediterranean diet and osteoarthritis joint pain

Marion Hauser, MS, RD

Many people ask for nutritional guidance when it comes to helping their chronic knee pain. One constant in these people’s asking is “what works best?” It is not easy to convince people that what works best is compliance. You have to stick with an optimal diet plan and lifestyle changes if you want to impact knee, back, or any joint pain. You also must have a realistic expectation of what diet can do for your knee pain. If you are determined to avoid surgery and have a better quality of life, diet can help, but diet or the taking of any supplement may not offer the complete healing you are looking for. Regardless let’s look at the Mediterranean diet

Many researchers and doctors consider the Mediterranean diet a healthy eating lifestyle. The diet is modeled around the everyday eating habits of people who live in the dominance of the Mediterranean Sea. These are the people of Spain, Greece, and the southern portions of Italy, France, et al.

In many of my articles, I have discussed olives, red wine, spices, and other components of the Mediterranean diet as having a healthy impact on osteoarthritis and quality of life. In this article, we will look at the Mediterranean diet as a whole.

As we discussed, the key components of the Mediterranean diet are:

The Mediterranean Diet also requires a person have an active lifestyle.

The anti-inflammatory characteristics of the Mediterranean Diet

In the context of our work, we will focus on the aspects of the Mediterranean diet that have been shown to help people with arthritic joint pain.

For background please see my articles on foods that have a positive impact on joint pain and are recognized as key components of the Mediterranean diet

An October 2020 study in the aptly named medical journal Nutrients (1) suggested that “food and nutritional interventions are considered beneficial in the treatment of pain and inflammatory conditions. For example, vegan and Mediterranean diets and the consumption of blueberry, strawberry, passion fruit peel extract, argan oil, fish oil (omega-3), olive oil, and undenatured type II collagen (a supplement from chicken sternum cartilage) and vitamin D gel capsules reduce musculoskeletal pain, specifically in adults with osteoarthritis. Besides pain improvement, nutritional interventions, including the consumption of strawberry and vitamin D gel capsules, decrease the levels of several inflammatory markers including IL-6, IL-1β, and TNF-α.”

In other words, these types of nutritional programs have an anti-inflammatory effect. The researchers also cited previous research that assessed and compared the effects of a Mediterranean diet and a normal diet and demonstrated significant reductions in musculoskeletal pain with specific diets.

Three more studies on the Mediterranean type diet

At the University of Kent in the United Kingdom, researchers  published a paper entitled: “Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis.”(2)

Here are the learning points:

Please see our related articles on the impact of weight and joint pain.

Okay, it works great in Europe but how about in the US?

Researchers from England, the United Kingdom, and Italy measured the impact of the Mediterranean diet on over 4,000 North Americans. The results were published in the American Journal of Clinical Nutrition. (3)

The average age of the study participants was 61 years old and the majority were women.

Here are the learning points of their study:

Nicola Veronese of the Italian national research council, the lead researcher on the above study, lead another research team in publishing the 2018 follow-up in the journal Clinical Rheumatology. In this study on the diet’s effect on knee osteoarthritis, the researchers noted that: “Higher adherence to a Mediterranean diet was found to be associated with a significant improvement in knee cartilage as assessed by MRI.”(4)

In December 2019 writing in the journal of Clinical Nutrition, Dr. Veronese as lead researcher followed up on his previous research by summarizing his findings this way in pati9ents examined in North America.

“(The) Mediterranean diet has several beneficial effects on health, but (research) regarding the association between the Mediterranean diet and knee osteoarthritis are limited. . . We investigated whether higher Mediterranean diet adherence is prospectively associated with lower risk of radiographic osteoarthritis, radiographic symptomatic knee osteoarthritis and pain worsening in North American people at high risk or having knee osteoarthritis.”

If we put the Mediterranean Diet all together, we have the olive oil, vegetables, legumes, fish, chicken, fruits, and red wine. What you also have is FRESH food. Those in the Mediterranean parts of the world typically shop at fresh markets a couple of times per week. They are not consuming food out of boxes or cans. They are definitely not using microwaves to cook their food and are certainly not eating at fast-food restaurants. On top of these facts, the Mediterranean’s perception of life, food, and culture is very different from Americans. Italians in particular have a reverence for food and good conversation. Meals are pleasurable. People enjoy their food and fellowship, meals are a family and friends event. Certainly, this interaction with our friends and families can have a positive impact on our quality of life.


1 Mendonça CR, Noll M, Castro MC, Silveira EA. Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients. 2020 Oct;12(10):3075. [Google Scholar]
Dyer J, Davison G, Marcora SM, Mauger AR. Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. The journal of nutrition, health & aging. 2017 May 1;21(5):562-6. [Google Scholar]
3 Veronese N, Stubbs B, Noale M, Solmi M, Luchini C, Maggi S. Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative. The American journal of clinical nutrition. 2016 Nov 1;104(5):1403-9. [Google Scholar]
4 Veronese N, La Tegola L, Crepaldi G, Maggi S, Rogoli D, Guglielmi G. The association between the Mediterranean diet and magnetic resonance parameters for knee osteoarthritis: data from the Osteoarthritis Initiative. Clinical rheumatology. 2018 Apr 3:1-7. [Google Scholar]
5 Veronese N, Koyanagi A, Stubbs B, Cooper C, Guglielmi G, Rizzoli R, Punzi L, Rogoli D, Caruso MG, Rotolo O, Notarnicola M. Mediterranean diet and knee osteoarthritis outcomes: A longitudinal cohort study. Clinical Nutrition. 2019 Dec 1;38(6):2735-9.

This article was updated June 21, 2021


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