NMT150 NUT WK4 (1) PDF

INFLAMMATORY JOINT CONDITIONS AUTHOR: D R. M A R YA M YA VA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Nutritional status Role of food as a trigger Specific diets Fis...

INFLAMMATORY JOINT CONDITIONS AUTHOR: D R. M A R YA M YA VA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Nutritional status Role of food as a trigger Specific diets Fish oil Folate Iron TREATMENT GOALS Address presenting symptoms and improve patient comfort Support full and speedy recovery to return to regular activities Patient education Monitor and prevent complications NUTRITIONAL STATUS Malnutrition is common among patients with rheumatoid arthritis occurring in 26% of 50 patients in one study. Also the severity of malnutrition increase with increasing disease severity. FOOD ALLERGY When the immune system mistakes a protein in food as harmful. So it releases immunoglobulin E (IgE). With the next exposure, these antibodies trigger the release of histamine. Causing symptoms such as abdominal pain, hives, or tingling in the mouth or even anaphylaxis. Symptoms usually appear right after eating. COMMON FOOD ALLERGIES Eggs Tree nuts (walnuts, Milk pecans) Fish Wheat Shellfish (shrimp, Soy scallops, and crab) Sesame Peanuts FOOD SENSITIVITY Much more common than food allergies. Harder to track, since symptoms such as cramps, bloating, and diarrhea may not show up right away. IgG is elevated in food sensitivity. The elimination diet doesn’t work for everyone. But based on some reports 30 to 40% of people with RA feel much better when they cut sensitive foods from their diet. https://www.vitalityhealthandwellness.com/food-sensitivity-testing/ FOOD SENSITIVITY One-third of people with rheumatoid arthritis (RA) say certain foods worsen their symptoms. There's plenty of evidence to back this up. For example, red meat and dairy are known to trigger inflammation. Nightshade vegetables like potatoes, eggplant, tomatoes, and peppers sometimes trigger inflammation as well. SPECIAL DIETS: MEDITERRANEAN Mediterranean Diet: 2018 systematic review identified beneficial effects of the Mediterranean diet in reducing pain and increasing physical function in people living with rheumatoid arthritis. Another inflammatory joint condition: In a review of four studies on SLE, sticking to the Mediterranean diet appeared to improve mobility and reduce pain. SPECIAL DIETS: MEDITERRANEAN The Mediterranean diet is a plant-based diet that emphasizes the intake of foods such as olive oil, fish, and moderate amounts of red wine. The diet first was suggested to the public over 60 years ago, when data from the Seven Countries Study found that the diet may have benefit for preventing cardiovascular disease. MEDITERRANEAN DIET o Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts o Replacing butter with healthy fats such as olive oil o Using herbs and spices instead of salt to flavor foods MEDITERRANEAN DIET o Eating fish and poultry at least twice a week o Drinking red wine in moderation (optional) o Getting plenty of exercise SPECIAL DIETS: VEGAN One small study found that 4 weeks on a low-fat vegan diet improved RA joint pain, stiffness, and swelling. There isn’t enough evidence to justify recommending a vegan diet, or any restrictive diet, for everyone with rheumatoid arthritis. VEGETARIAN/VEGAN DIET o A vegetarian diet consists of a dietary pattern focused on consuming plant-based products and avoiding or minimizing the consumption of animal products. o Major types of vegetarian diets are: o the lacto-ovo-vegetarian diet: In lacto-ovo vegetarianism, meats are avoided, while milk and eggs are allowed. o the vegan diet: In the vegan diet, all products originating from animals are avoided SUPPLEMENTS TO CONSIDER o Fatty Acids o Folate o Iron FATTY ACIDS o Omega-3 fatty acids seem to prevent or improve experimental arthritis. o Omega-3 fatty acid supplements for RA have been widely studied. Fish oil, in particular, has been shown to reduce joint pain, as well as morning stiffness. FOLATE o A common RA medication, methotrexate, destroys folate. That’s why doctors will often prescribe folate supplements for those on this medication. https://www.hopkinsarthritis.org/arthritis-news/subcutaneous-versus-oral-methotrexate/  SOURCES Green vegetables, mushrooms, legumes Fruits: strawberries and oranges Also in fortified grains Since 1998, to help prevent neural tube defects, Canada requires the addition of 1.4 mg/kg of folic acid to be added to refined grain products, which were already enriched with niacin, thiamin, riboflavin, and iron. IRON Anemia is common in patients with chronic inflammatory joint conditions such as RA. SOURCES: HEME IRON o Heme iron is derived from hemoglobin and myoglobin and thus found only in animal products, such as meat, fish, poultry, oysters, and clams. o 50-60% of the iron in animal products occurs in the heme form. SOURCES: NON-HEME IRON o Meats o Beans, dark green leafy vegies, and dried fruits o Blackstrap molasses o Enriched foods: flour, breads, pastas, and cereals are fortified with Fe SUMMARY Food Allergy/sensitivity Special diets Fatty acids (2.7 grams per day of EPA plus DHA) Folate (5mg folic acid taken the day after the methotrexate dose) Iron (150-200 mg of elemental iron per day for adults with anemia) QUESTION Clara M. is a 49-year-old married mother. Seven months ago, she began noticing stiffness in both hands in the morning that lasted longer and stiffness. At her visit with the Rheumatologist she was diagnosed with RA. The Rheumatologist recommended her to start oral methotrexate and see a physiotherapist. Which one of the following supplements do you recommend Clara take? Vitamin B3 (niacin) Vitamin B6 (pyridoxine) Vitamin B9 (folate) Vitamin B12 (Cobalamin) REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. Wiley Blackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. REFERENCES James M, Proudman S, Cleland L. Fish oil and rheumatoid arthritis: past, present and future. Proceedings of the Nutrition Society. 2010 Aug;69(3):316- 23. Shea B, Swinden MV, Ghogomu ET, Ortiz Z, Katchamart W, Rader T, Bombardier C, Wells GA, Tugwell P. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database of Systematic Reviews. 2013(5). Wilson A, Yu HT, Goodnough LT, Nissenson AR. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. The American journal of medicine. 2004 Apr 5;116(7):50-7. Forsyth C, Kouvari M, D’Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, Kellett J, Naumovski N. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatology international. 2018 May;38(5):737-47. McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. The Journal of Alternative & Complementary Medicine. 2002 Feb 1;8(1):71-5. O'Bryan T, Rountree R. Food Sensitivities, Inflammation, and Autoimmune Disease: A Clinical Conversation with Tom O’Bryan, DC, CCN, DACBN, and Robert Rountree, MD. Alternative and Complementary Therapies. 2020 Feb 1;26(1):1-1. Li J, Yan H, Chen H, Ji Q, Huang S, Yang P, Liu Z, Yang B. The pathogenesis of rheumatoid arthritis is associated with milk or egg allergy. North American journal of medical sciences. 2016 Jan;8(1):40. Pacor ML, Lunardi C, Di Lorenzo G, Biasi D, Corrocher R. Food allergy and seronegative arthritis: report of two cases. Clinical rheumatology. 2001 Jul;20(4):279-81. THANK YOU!