A patient with rheumatoid arthritis (RA) asks if diet can help ease their symptoms. Or maybe a patient with severe knee osteoarthritis (OA) seeks diet advice because they want to lose weight and relieve pressure on their joints. Although there’s no specific nutrition plan for patients with rheumatic diseases, research has shown many dietary factors can help ease symptoms associated with arthritis, including pain caused from inflammation.1
By meeting with patients and their families, dietitians with a background in rheumatic diseases can answer specific nutritional questions, offer advice on how to successfully manage weight loss or gain, and advise on the best nutritional plan for those who have multiple chronic health conditions.
The Rheumatologist recently spoke to several dietitians with experience counseling patients with rheumatic disease to learn how including dietitians on the interdisciplinary team can ensure better patient outcomes.
Access to Nutrition
Despite the old adage “food is medicine,” medical students typically receive very little training in nutrition. Studies have shown medical schools devote fewer than 20 hours to nutrition, and continuing education classes on the topic aren’t widely available.
Laura Gibofsky, MS, RD, CSP, CDN, a clinical nutritionist at the Hospital for Special Surgery, New York, says proper nutrition doesn’t replace the need for medications, but rather enhances a patient’s overall care plan.
“[Although] there are no medications that can cure RA or prevent flares, following a plan, such as the Mediterranean diet, can help prevent and better manage an RA flare,” Ms. Gibofsky says. “As dietitians, we work to help patients get the nutrients they need through a healthy diet, as opposed to supplements that can interfere with medications.”
Dietitians can also help patients who have food insecurity issues and don’t have access to sufficient quantities of affordable, nutritious foods. These can include the elderly, children, patients living in rural communities and others.
“We can refer patients to local public health professionals and food assistance programs to ensure patients who may be struggling have access to good nutrition,” Ms. Gibofsky says.
Medication Side Effects
“Eating a well-balanced diet can help combat some of the side effects of medications and also alleviate symptoms of the disease,” Ms. Gibofsky says. “For example, steroids, such as prednisone, can cause weight gain and increase a patient’s glucose, cholesterol and triglyceride levels.” To help patients maintain a healthy weight and avoid fluid retention caused by prednisone, Ms. Gibofsky recommends a low sodium diet, featuring fresh, lean meats, seafood and poultry, as well as vegetables and whole grains.
For patients experiencing medication side effects, such as nausea, Ms. Gibofsky recommends such strategies as eating five small meals a day. She also frequently answers questions about food sensitivities and how to prepare meals for picky eaters.
“We want to ensure patients don’t have any nutritional deficiencies that exacerbate their health condition,” Ms. Gibofsky says.
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
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.”
Because patients with arthritis are at risk of developing comorbidities, consulting with a dietitian ensures they receive nutritional advice that applies to their overall health. A recent study found that although patients with RA are at risk of developing cardiovascular disease, most were unaware of their increased risk.4
Ms. Janov says she often consults with arthritis patients who have other chronic conditions or are at risk of developing conditions such as obesity, diabetes or heart disease.
“I also meet with teens as they prepare to head to college and live independently,” Ms. Janov says. “We’ll talk about how they balance school with work and learn to cook, and I’ll offer ideas on how they can make healthy food choices that are easy to make and fit their budget.”
The Right Tools
Ms. Veltkamp says preparing healthy meals can often prove challenging for patients who have arthritis in their hands or joints.
“I think most people prefer healthy foods, but when it’s hard to prep a meal, it can seem easier to just order a meal to go,” she says.
Rather than relying on fast food, Ms. Veltkamp shows patients how they can purchase pre-cut vegetables, instead of having to chop them. A lot of stores have also begun selling meal kits that are easy to put together and place in the oven.
“When people don’t plan their meals ahead of time, they tend to make poor choices and also spend more money on food,” Ms. Veltkamp says. “There are a lot of really good, free, meal-planning websites where people can choose from low-carb or veggie [options] and choose the number of servings they’d like. The site then gives them a weekly menu and shopping list they can follow.”
Linda Childers is a health writer located in the San Francisco Bay Area.
- Wolman PG, Smith JD, Phillian BL, et al. Prevention and treatment of arthritis: The South Carolina Plan for Nutrition and Complementary Care [conference abstract]. J Am Diet Assoc. 2005:105(8 suppl);32.
- Badsha H. Role of diet in influencing rheumatoid arthritis disease activity. Open Rheumatol J. 2018 Feb 8:12;19–28.
- Brooks JM, Titus AJ, Polenick CA, et al. Prevalence rates of arthritis among US older adults with varying degrees of depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey. Int J Geriatr Psychiatry. 2018 Dec;33(12):1671–1679.
- Ghosh-Swaby OR, Kuriya B. Awareness and perceived risk of cardiovascular disease among individuals living with rheumatoid arthritis is low: Results of a systematic literature review. Arthritis Res Ther. 2019 Jan 22:21(1);33.