In a previous exploratory study, the investigators observed an effect on disease activity outcomes of anti-inflammatory diet. The investigators also observed change in microbiome and circulating metabolites. The current study will determine whether or not the addition of anti-inflammatory diet improves the clinical outcomes in participants with Osteoarthritis, and the role of microbiome and circulating metabolites.

Inclusion Criteria:

• Unilateral radiographic symptomatic KOA
• No changes in therapy during the previous 3 months
• Interested in dietary intervention and able to provide consent and attend follow-up visits

Exclusion Criteria:

• Previous knee surgery
• Severe radiographic disease (KL grade 4)
• Rheumatoid Arthritis
• Any Abnormal blood values in the comprehensive metabolic panel test at screen (Abnormality will be defined based on standard reference ranges)
• Use of corticosteroids and/or intra-articular injections during the preceding 3 months
• Use of fish oils and glucosamine
• Participation in a weight loss program in the preceding 6 months
• Recent changes in physical activity levels
• Regular smoking
• Patients with food allergies
• Patient with other medical conditions that will impair the ability to participate in a nutritional study
• Plan to change systemic therapy
• Patients unwilling to change dietary habits