Jennafer Butcher MS, RD/LD, NASM-CPT Sodexo @ OU Medical Center Edmond

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� Rheumatoid Arthritis & Nutrition Side Effects � Sjogren’s Syndrome & Nutrition Side Effects � Lupus & Nutrition Side Effects � Scleroderma & Nutrition Side Effects � Anemia

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� Chronic Inflammation that primarily affects the joints

� It is characterized by: ¡  Changes in the synovial membranes

¢  Layer of connective tissue that lines the cavities of joints and related tissue

¡  Atrophy of joints ¡  Osteopenia

¢  Bone mineral density is lower than normal

(1) 3

� Aspirin may be commonly prescribed ¡  Chronic Aspirin use could cause GI bleeds and depletion

of Vitamin C ¢  Take Aspirin with a meal, milk, or antacid could improve side

effects ¢  Vitamin C supplement may be recommended

� Methotrexate may also be prescribed ¡  Folate deficiency could occur secondary to the

immunosuppressive agent methotrexate (MTX)

(1) 4

� Steroids are commonly prescribed ¡  Steroid such as Prednisone could cause decrease in

absorption of calcium ¢  Increasing risk for Osteoporosis (thinning of the bones)

¡  Steroids could also cause edema (swelling) ¢  Low Sodium Diet and or Fluid Restriction may be required

¡  Steroid induced Diabetes may also occur ¢  Diabetic Diet/ Consistent Carb Diet

� Activities of Daily Living (ADL) may be affected ¡  Grocery shopping, food prep, and eating

(1) 5

� Diet modifications may be needed depending on chewing/swallowing abilities if the joints in jaw bone are effected

� Taste changes and dysphagia may occur due to dryness in the nasal and oral cavities

� Anorexia may be present as a side effect of medication ¡  Appetite stimulant may be indicated

(1) 6

� Fatigue and pain may decrease oral food intake

� Elimination and trials may be needed to treat underlying food allergies ¡  Recommend working with a Registered Dietitian

(1) 7

� A Low Fat Diet is NOT recommended � Changing the TYPE of fat in our diet is

recommended ¡  Omega 3 Fatty Acids have an anti-inflammatory

effect ¢  Salmon, mackerel, herring, tuna, some fish oils,

flaxseed, walnuts, soy, and canola oils ¢  Note Fish Oil Supplements may cause increased

bleeding time, GI distress, and fishy taste/ odor

8 (1)

� The following are complementary therapies that likely need further research but have shown positive effects for RA ¡  Gamma-Linolenic Acid (GLA) ¡  Thunder God Vine ¡  Curcumin – powerful antioxidant in turmeric

which is what give curry it’s yellow color

(1) 9

� Regular aerobic and resistance exercise can improve: ¡  Range of motion ¡  Strength & endurance ¡  Bone mass ¡  Lean body mass ¡  Fatigue ¡  Depression

(1) 10

� 2nd most prevalent autoimmune disorder ¡  WBCs attack the moisture producing glands

� It can occur by itself or with another autoimmune disorder

� It has been estimated that about half of those with Sjogren’s Syndrome have rheumatoid arthritis as well

(1, 2) 11

�  Xerostomia (dryness of mouth) ¡  Increased risk for:

¢  tooth decay, gingivitis, and difficulty chewing/swallowing ¢  Ways to reduce the risk of dental decay:

�  Rinse mouth frequently with water �  Brush teeth often �  Topical fluorides �  Limit sugary foods

¡  May consider lemon drops, lemon or lime in water, and squeezing lemon or lime on food to perk up saliva glands

¡  Artificial saliva & prescription mouthwashes, sprays, and gels may be helpful

�  Avoid mouthwashes with alcohol

¡  Limiting caffeine and alcohol ¡  Chew sugar free gum

(1,2) 12

�  Lack of appetite ¡  Eating multiple small meals/day may improve appetite

�  Weight loss ¡  Increasing calories and protein without increase quantity

¢  “More bang for your buck”

�  Fatigue ¡  Family member or friends may need to assist with food

prep if possible ¡  Cook in big quantities when you do feel good and freeze

for easy prep days when your feeling very fatigued ¡  Assure adequate intake of B vitamins ¡  Make sure you have adequate levels of Vitamin D ¡  Establish a healthy sleep pattern

(1, 2) 13

� Difficulty chewing/swallowing ¡  May consider a referral to a Speech Language

Pathologist ¡  Soft moist foods are general best ¡  Avoid hard breads, sticky foods such as candy,

and raw fruits/ veggies ¡  Meats may need to be chopped or ground with

gravy

� Anemia – will be discussed later in presentation

(1, 2) 14

� Reflux ¡  Elevate head of bed > 45 degrees ¡  Do not eat with in 3 hours before bedtime ¡  Aim for a healthy body weight ¡  Avoid spicy, fatty (fried), and acidic foods ¡  Limit caffeine ¡  Stop smoking ¡  Depending on personal tolerance, may avoid

chocolate, tomato juice, and alcohol ¡  Avoid exercise until 2 hours after a meal

� Constipation- increase fluid and fiber intake

(2) 15

� Avoidance of possible food allergens or intolerances

� Omega-three fatty acid supplementation �  Anti-Inflammatory Diet

¡  Variety of fresh fruits and vegetables ¢  Eat the Rainbow!!

¡  Whole grains ¡  Lean proteins ¡  Adequate fiber (up to 25g/day as tolerated) ¡  Sufficient fluid intake ¡  Low fat cooking methods yet focusing on un-saturated

fats ¡  Celiac Disease is a common diagnosis with Sjogren’s

¢  Gluten Free Diet

(2) 16

� Iron Deficiency – iron supplement is usually needed ¡  Foods high in Iron is discussed later

� B12 Deficiency – B12 supplement may be needed ¡  Food high in B12: liver, salmon, sardines, and

most ready to eat cereals

� Folate Deficiency – folate supplement may be needed ¡  Food high in Folate: fortified cereals and rice

(1) 17

� ~25% of those with Lupus develop Sjogren’s � No specific dietary approach at this time

¡  Tailored diet modifications may be needed depending on the person’s medication side effects and Lupus complications ¢  Renal Complications

�  Possible things to monitor: protein, fluid, potassium, sodium, and phosphorus intake

¢  Sodium and Fluid Restriction secondary to steroid medication

¢  Anemia ¢  Low Saturated Fat Diet recommend but more research

needed �  Limit full fat dairy products, butter, lard, meat fat,

poultry skins , palm oil, coconut oil, shortening

(1, 3) 18

� Fats: limit saturated fat & Omega 6 Fatty Acids ¡  Omega 6 Fatty Acids: safflower, sunflower oil, poppy

seed oil, and corn oil

� Vitamin E, Vitamin A, & Selenium: ¡  all have anti-inflammatory properties

� Vitamin C: antioxidant ¡  Citrus fruits, tomatoes, broccoli, strawberries,

cantaloupe, cabbage, and green peppers

� Vitamin B6:eat balanced diet with adequate B6 ¡  Whole grains, fish, poultry, meat, bananas, nuts,

avocados, green beans, potatoes, and green leafy veggies

(3) 19

�  Iron: maintain iron levels ¡  Meat, poultry, eggs, liver, cream of wheat, beans,

prunes, apricots, green peas, enriched breads/cereals � Fish Oils: supplement or food sources � Bromelain: found in pineapple and is a newly

researched area for Lupus � Calcium & Vitamin D: supplement recommended

for anyone one taking a steroid � Heart Healthy Diet: those with Lupus are at

increased risk for early and aggressive heart disease

� DHEA Supplements: studies have not yet proven the safety and effectiveness of this hormone but are on-going

(3) 20

� Deposits fibrous connective tissue in the skin and visceral organs ¡  Including GI tract ¡  Raynaud’s can occur which is stiffness or coldness

in the extremities such as your hands ¢  This may cause difficulty with food prep

� Sjogren’s is often present with Scleroderma � GI side effects of Scleroderma:

¡  Heartburn, nausea, vomiting, dysphagia, diarrhea, constipation, weight loss

¡  Malabsorption may also occur

21 (1)

� Common problem with autoimmune disorders such as rheumatoid arthritis and lupus

� Anemia means you have low levels of hemoglobin ¡  Hemoglobin carries oxygen to all parts of your

body ¢  If you are anemic, then your body is not getting

adequate oxygen throughout your body �  Symptoms: Shortness of breath, fatigue, chest pain,

dizziness

(4) 22

� Anemia of Chronic Disease (ACD) vs Iron- deficiency Anemia (IDA) ¡  Depending on the root cause of the anemia such

as a chronic disease verses inadequate iron intake, an iron supplement may or may not help

� A well balanced diet may aid in those with anemia from chronic disease

� Good Sources of Iron: beef, liver, veal, clams, sardines, shrimp, bran flakes, cream of wheat, baked potato with skin, beans (kidney, lentils, lima, navy)

(4, 5 ) 23

� Focus on an overall balanced diet when dealing with an inflammatory disease

� Consult a Registered Dietitian to aid in managing side effects of medication and other medical conditions

� Communicate with your physician about vitamin and mineral supplementation that may be needed

� Talk to your physician first before taking any herbal supplement

� May consider elimination diets to rule out any allergies ¡  Consult a Registered Dietitian

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� Contact Information: ¡  Jennafer Butcher MS, RD/LD, NASM-CPT

¢  Clinical Nutrition Manager & Out-Patient Dietitian ¢  Sodexo @ OU Medical Center Edmond

�  1S Bryant Ave Edmond, OK 73034 ¢  Phone: 405-844-5719 ¢  Email: jennafer.butcher@hcahealthcare.com

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�  (1) Mahan, L. Kathleen, and Sylvia Escott-Stump. "Medical Nutrition Therapy for Rheumatic Disorders." Krause's Food, Nutrition, & Diet Therapy. 11th ed. Philadelphia: Elsevier, 2004. 1121-1142. Print.

�  (2) Cook, RD, Sarah. "Sjogren's Syndrome: What You Need to Know." Http://www.nutrition411.com. Nutrition411.com, 1 July 2013. Web. 26 Aug. 2014.

�  (3) “Lupus Professional Refresher”. Http://www.nutrition411.com. Nutrition411.com, 1 Feb. 2010. Web. 26 Aug. 2014.

�  (4) “Anemia of Chronic and Inflammatory Disease: What you need to know.” Http://www.nutrition411.com. Nutrition411.com, 1 Aug. 2012. Web. 26 Aug. 2014.

�  (5) “Anemia of Chronic and Inflammatory Disease (ACD)." Http://www.nutrition411.com. Nutrition411.com, 1 Aug. 2012. Web. 26 Aug. 2014.

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