Over the past three years, joint pain has become a fact of life for Dona Alexis. Although its intensity ebbs and flows, the ache in her knees and elbows is almost always present. “I look like a 90-year-old when I stand up from a chair now,” Alexis says. “I’ve stopped hiking and going to the gym, and even find it difficult to do yoga. As a result, I’ve gained weight, particularly around my midsection.”

To combat the ache, Alexis takes fish oil, glucosamine, and chondroitin supplements. On her chiropractor’s advice, she also now takes an anti-inflammatory nutritional support drink. It seems to help, but only if she drinks the concoction in place of two of her daily meals. “It’s been difficult to stay on this program,” she says. “I’d like to find more natural remedies so I can get back to doing the things I love.”

Q. Dona Alexis: My test for rheumatoid arthritis came back negative. What else could be causing my joint pain?

The natural health expert: James N. Dillard, MD, DC, CAc, attending physician at Columbia University Medical Center Eastside in New York City, assistant clinical professor at Columbia University College of Physicians and Surgeons, and author of The Chronic Pain Solution (Bantam, 2002)

A. James Dillard, MD, DC, CAc: If pain were present on only one side of your body, I might look at the possibility of a repetitive strain injury. But because you’re having symmetrical pain, I’d check for inflammatory arthritis (of which rheumatoid arthritis is one type). Other, more rare causes of this kind of pain include lupus, scleroderma, Lyme disease, psoriatic arthritis, and gout. Q. What foods do you recommend I eat—or avoid?

A. I’d look first at the types of fats you’re eating. Chronic inflammatory pain is a sign that you have higher-than-normal levels of pro-inflammatory prostaglandins. Prostaglandins, a kind of hormone, come in two types: One encourages inflammation, while the other inhibits it. Because both are constructed from fatty acids, the kind of prostaglandins that predominate in your body depends partly on the kinds of fats you eat.

You’ll want to stay away from pro-inflammatory fats, such as butter, whole milk, margarine, corn oil, sesame oil, coconut oil, and vegetable shortening. And steer clear of trans fats, which are often found in processed foods. At the same time, increase your intake of anti-inflammatory omega-3 oils. Good sources include salmon, herring, mackerel, flaxseed oil, and walnuts.

Finally, make sure you’re getting five to six servings of fresh fruits and vegetables a day and substituting whole grains for white bread and rice. A healthy diet will also help you lose weight.

Q. I’m already taking fish oil, glucosamine, and chondroitin. Would you recommend any additional supplements?

A. These are three great supplements. Make sure you’re taking enough fish oil to get between 1,000 and 2,000 mg of EPA (eicosapentaenoic acid) a day. Because this much fish oil can cause gastrointestinal upset, you might need to take it with food, and work up to this dosage slowly. Salmon pills can be more easily digested, but tend to be pricey. I like purified and distilled liquid cod-liver oil products because they’re the least expensive source of high-quality EPA and DHA (docosahexaenoic acid). Most products on the market are free of mercury contamination, but you should always check; you’ll find many product tests and reviews at www.consumerlab.com.

Also, check to see that you’re getting 1,500 mg of glucosamine and 1,200 mg of chondroitin a day. These are available in a combined supplement, as well as separately.

If you’re still having problems after cleaning up your diet and verifying these dosages, I’d recommend you take 300 mg daily of avocado and soy unsaponifiable (ASU) extract, which is made from avocado and soybean oils. Three research studies have shown this to be helpful with arthritic pain, and it can work well in combination with other supplements.

Q. I’d like to increase my physical activity, but I’m not sure how to do that because of the pain.

A. I would recommend low-impact exercise, such as swimming, walking, or Pilates. Also, even a brief run of physical therapy would be very beneficial. I’ve found that physical therapy works well when combined with restorative yoga.

Q. Weight-bearing yoga poses can be very painful. Should I try to push through the pain?

A. No. If you’re having moderate to severe pain, you should stop what you are doing. To avoid injury, it’s best to have a professional physical (or occupational) therapist guide you and track your progress. Gradually, the amount of physical movement you’re able to do will improve.

Q. Any other things I should try?

A. Try acupuncture. I do a lot of acupuncture with people experiencing joint pain and often get good results.