Vitamin and Mineral Guide for Arthritis

Vitamins and minerals play a critical role in staying healthy, but getting enough of certain nutrients is even more important when you have arthritis. This guide provides thorough research of key vitamins and minerals to help you figure out what you may be missing. But remember: While some supplements may help arthritis symptoms, nothing can substitute doctor-prescribed medications, a healthy diet and exercise. Always talk to your doctor before adding a new supplement, vitamin or mineral to your regimen. Just because something is “natural” doesn’t mean it can’t cause side effects or interact with medications. For more tips on choosing safe supplements, read this article .

What it does: Calcium is an essential mineral that maintains strong bones and teeth; regulates muscle contractions; transmits nerve impulses; and helps release essential hormones and enzymes. It also helps prevent osteoporosis (loss of bone density) and fractures, which are higher risks among people with rheumatoid arthritis (RA) and those taking corticosteroids.

How much: Experts recommend 1,200 mg a day for healthy adults, but people with inflammatory arthritis may 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.

Too much: 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 greens and vegetables such as kale, broccoli and spinach; canned sardines and salmon with bones; calcium-fortified cereals, soy products (including tofu), orange juice and nut milks.

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

Research note: Dozens of studies have found that calcium supplements with or without vitamin D improve bone health in both men and women.

Whether calcium plus vitamin D can prevent fractures has been more controversial, with competing studies on both sides. But a 2016 meta-analysis found that calcium and vitamin D supplements reduced 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.

How much: 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.

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

Too little: 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.

Research note: 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.

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

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

Too little: 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.

Research note: 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 to suggest that wearing copper helps ease arthritis symptoms either.

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

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

Too much: 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.

Too little: 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: Folate occurs naturally in many foods, especially green leafy such as spinach and kale; orange juice and most fruits; dried beans and peas. Folic acid is added to enrich many grains, cereals and pastas.

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

Research note: A 2018 review of seven studies found that folic acid reduced common methotrexate side effects such as nausea, vomiting and liver toxicity. High and low doses (more than 25 mg a week and less than 10 mg a week, respectively) were equally effective, even with higher doses of methotrexate. Doses range from 1,000 to 5,000 mcg daily; sometimes a single weekly dose is taken the morning after a methotrexate injection. Studies also suggest folate and folic acid may reduce 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.

How much: 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.

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

Too little: 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.

Research note: Anemia – low red blood cell levels – is common in people with rheumatoid arthritis and 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.

How much: 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.

Too much: Tolerable upper limit (UL) = 350 mg.

Too little: 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.

Research note: 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 antioxidant and helps prevent damage 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.

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

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

Too little: Rare; impaired immunity and heart disease.

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

Research note: 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.

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

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

Too little: 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.

Research notes: 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.

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

Too much: 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.

Too little: 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 ).

Research note: 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 RA by 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, along with vitamin B6 and folate, also reduces the amino acid homocysteine, which increases with age and is found at high levels in people with RA.

How much: The recommended dietary allowance (RDA) is 2.4 mcg (micrograms) daily, although many experts, including the National Academy of Medicine believe 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 weekly shots followed by oral supplements.

Too much: 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.

Too little: Too little vitamin B12 can cause exhaustion, cognitive difficulties, nerve damage and anemia. B12 in food is broken down by hydrochloric acid in your stomach. If you don’t have enough, you won’t absorb B12 from food very well, but you can absorb it from supplements or shots. Experts often recommend that people over age 50 take a supplement 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, dissolvable tablets, sprays, liquids, shots and as a prescription drug.

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

Research note: High homocysteine is linked to an increased risk of heart attack and stroke as well as bone loss, fractures and cognitive decline in older adults. In 2018, an international panel of experts recommended treatment with B vitamins for all adults who have high homocysteine levels to reduce the risk of 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; also enriched 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 may play a role in cancer, heart disease and aging.

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

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

Too little: Deficiency is rare in a typical U.S. diet. However, malabsorption can occur with diseases such as alcoholism, celiac disease and certain malignancies.

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

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

Research note: 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 keeps the skin, nerves and digestive system healthy.

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

Too much: Tolerable upper intake level (UL) = 35 mg from supplements. Large doses – 500 to 2,000 mg – are often prescribed to help lower cholesterol levels but 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.

Research note: 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 involved in more 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.

How much: 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.

Too much: Tolerable upper limit (UL) = 100 mg for 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.

Too little: 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.

Research note: Many researchers believe that inflammation leads to low B6 in RA patients and low B6 makes inflammation worse. A 2013 study also found that treatment with NSAIDs, especially for longer than six months, significantly reduced B6 levels in people with rheumatoid arthritis. The study authors suggest that B6 levels should be monitored in arthritis patients 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 helps heal wounds.

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

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

Too little: 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.

Research note : 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 regulates many critical cellular functions: It aids calcium absorption, helping prevent osteoporosis and fractures; regulates the cells responsible for autoimmune function; fights inflammation, protects against disease-causing germs and helps 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.

How much: There’s no consensus on how much vitamin D is healthy. While the recommended daily dose is 800 international units (IU), the American Geriatrics Association recommends at least 1,000 IU. Harvard researcher Edward Giovannucci, MD, suggests up to 2,000 IU a day. A two-year study of osteoarthritis patients found that 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 have been linked to RA, inflammatory bowel 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 part because the body becomes less efficient at producing it over time. Your doctor can check your vitamin D levels with a simple blood test, though the usefulness of testing for healthy people is questionable. A good target is 30 to 50 ng/mL. (Blood tests may not be accurate for African Americans because they have little protein-bound vitamin D – the kind the test measures.)

Foods: Vitamin D naturally occurs in a few foods – mainly salmon, tuna, sardines and fish oil – and is often added to milk, yogurt, orange juice and breakfast cereals. Sunlight is the main source for most people, which is absorbed through the skin and converted into vitamin D by the liver and kidneys. Taking vitamin D with meals will increase absorption by 30% to 50%. If you can’t take it with meals, buy the oil-based form.

Research note: A 2016 meta-analysis of 15 studies involving more than 2,000 people found that vitamin D deficiency was more prevalent and blood levels significantly lower among rhuematoid arthritis patients than those without RA. Patients with the lowest levels also had the most severe disease. A different study had the same findings about low blood levels but didn’t see a link to RA disease severity. And a study that followed 37 early stage RA patients for a year reported that those with low vitamin D at the start of the study didn’t respond as well to treatment and were less likely to achieve remission than patients with normal vitamin D levels. On the other hand, in a 2016 study, patients with knee OA saw no improvement in cartilage loss or pain after taking vitamin D supplements for two years. (Study limitations may have affected 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.

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

Too much: 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).

Too little: 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.

Research note: 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, is essential for bone health. It also mops up excess calcium from places you don’t want 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 for combined K1 and both forms of K2 (sometimes called K2 complex), such as LifeExtension’s Super K.

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

Too Little: While rare, a deficiency can cause problems with blood clotting and can cause bruising and bleeding gums.

Foods: K1 occurs naturally in green leafy vegetables, some fruits and plant oils. Both forms of K2 are found in egg yolks, some cheeses and fermented

foods like sauerkraut and kefir.

Interactions: Antibiotics, blood-thinning drugs.

Research Note: Many studies have shown the importance of vitamin K in preventing bone loss and fractures. One meta-analysis of 20 randomized controlled trials found that vitamins K1 and K2 both helped prevent bone loss, but that K2 was superior for preventing hip, vertebral and other fractures. A 2018 analysis of patients in the large Osteoarthritis Initiative trial showed that those with normal levels of vitamins D and K were able to walk faster, were more flexible and functioned better than patients with low levels. Other studies have found that people who get too little vitamin 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 arthritis compared 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.