They Need Good Advice
A study conducted last year found RA patients frequently ask their rheumatologists about diets, and even in the absence of advice from physicians, they undertake various dietary interventions they’ve heard may help their condition.2
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Explore This IssueOctober 2019
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This can backfire, says Jenny Janov, MPH, RD, CSP, a clinical dietitian at the University of California, San Francisco (UCSF), Medical Center/Benioff Children’s Hospital, because fad diets can put patients at risk of developing nutritional deficiencies.
Ms. Janov meets with newly diagnosed lupus patients and then conducts annual comprehensive follow-up visits to see if patients have any new concerns, such as weight loss or gain, loss of appetite or decreased energy. Patients often ask whether adding or eliminating certain foods will cure their disease and whether supplements may benefit their condition.
“Sometimes, rheumatologists don’t refer patients for a nutrition consult unless they’re overweight or underweight,” Ms. Janov says. “Yet it’s easier to address nutrition concerns ahead of time, before they become problematic, and to ensure the information patients receive is credible.”
Although many rheumatic patients only require one or two consults with a dietitian, Ms. Janov says they continue to follow patients who may be at risk of developing diabetes or who put on weight quickly. Sometimes, Ms. Janov says, patients just need to have nutrition information presented in a way they can understand.
“When a pediatric rheumatologist tells a family to reduce fat and sugar in their child’s diet, parents don’t know what that means,” Ms. Janov says. “It’s not a recommendation to cut all sweets from your child’s diet, but for sweets to be served in moderation and to seek out healthier alternatives [such as flavored waters instead of juice or soda].”
Ms. Janov, who works in the Rheumatology Clinic at UCSF/Benioff once a week, says rheumatologists who don’t have access to a dietitian may consider aligning themselves with a community dietitian who knows rheumatic disease.
Offer Personalized Plans
As a dietitian at Spectrum Health, Grand Rapids, Mich., Kristi Veltkamp, MS, RDN, not only meets with patients individually, she also offers grocery store tours to help patients learn to read labels and make healthy shopping lists.
Rather than recommending supplements to patients, Ms. Veltkamp shows how it’s better to obtain the nutrients they need from food.
“[Because] patients with rheumatic disease suffer from inflammation, we don’t want to see them fuel the fire by eating such foods as red meat and sugary snacks that increase inflammation,” Ms. Veltkamp says. “Inflammation can also play a huge role in depression.”
Studies have shown that depression and arthritis are often interlinked in older adults, offering evidence that an anti-inflammatory diet can also benefit a patient’s mental health.3
In addition to grocery store tours, Ms. Veltkamp shows patients how to make healthy substitutions, such as eating lean meats and fish instead of red meat, and how fruit or a piece of dark chocolate can curb their sugar cravings without adding inflammation.
“I help patients rewire their brain to make healthier food choices,” Ms. Veltkamp says. “Rather than advocating a restrictive diet, I work with patients to adopt a healthy lifestyle they can live with.”