What not to eat - Bath Institute for Rheumatic Diseases

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Annual Psoriatic Arthritis Information Day
Nutrition – what not to eat.
Hayley Everson
Senior Dietitian
Royal National Hospital for Rheumatic Diseases
NHS Foundation Trust, Upper Borough Walls, Bath, BA1 1RL
Aim and objectives
Aim for the group to have an understanding of how a balanced
healthy diet and maintaining a healthy weight can benefit the
effects of arthritis.
By the end of the session the group will
• List the 5 food groups on the eat well plate
• Compare food labels
• Give examples of appropriate serving sizes
www.rnhrd.nhs.uk
Introduction
• Common symptoms experienced include poor appetite, increased
appetite, weight gain/loss, IBS symptoms, lack of energy/sleep,
nausea, pain. Depression.
• This is highly individual and varies from person to person, but can
lead into adapting your diet.
• If your diet is not balanced your general health will suffer making
your arthritis worse.
• If you are keen to try changing your diet please seek advise from a
specialist so as to not cause any nutrient deficiencies.
The Mediterranean Diet
In order to help your arthritis it is important to
• Eat a regular balanced diet and maintain a healthy BMI
• Eat more fruits and vegetables
• Substitute saturated fats for mono-unsaturates (MUFAs)
• Eat plenty of fish
• Cut down on sugar and salt
• Drink alcohol in moderation
Weight
• Carrying excess weight is a common problem. Certain drugs can
cause weight gain.
• Even a small weight loss can reduce the strain on your joints
• A healthy body weight is achieved by balancing the energy in our
diet and the energy we use in activity.
• A healthy BMI is between 20-25kg/m2.
• BMI is weight
Height 2
BMI
Serving up meals – weight maintenance and loss
Carbs
Carbs
Salad/veg
Salad/veg
Salad/veg
Protein
Protein
Handy measures are:
• Carbs = approx 30g, 1 slice bread, 4 tbsps cereal, 1-2 tbsps rice/pasta
(2-3 servings allowed per meal)
• Protein = approx 100g, deck of cards or a cheque book size (2 per day)
• Fruit and Veg = approx 80g or a handful. (up to 5 per day)
• Dairy = 30g matchbox of cheese, 200ml milk or small pot yoghurt. (2-3
per day)
Carbohydrates
• Have a regular eating pattern – 3 main meals per day
• Include low GI (glycaemic index) carbohydrates with each meal.
• Provides regular energy as glucose to help stabilise mood and
reduce fatigue.
• Breakfast kick starts metabolism, brain and body's normal
functioning
• Skipping meals leads to weight gain, low mood and fatigue. Also
poorly controlled diabetes.
Fruit and Veg
• Aim for 5 fruits and vegetables portions (80g) per day.
• These can be dried, juiced, frozen, tinned or fresh.
Benefits;
• Reduces pain and inflammation.
• Low in fat and high in fibre
• Contain anti-oxidants which help protect against disease causing
chemicals
• Can help regulate blood pressure and blood fats
• Vitamin supplements do not provide the same benefits
Dairy
• Aim for 2-3 portions of dairy foods per day
• These include yoghurts, cheese and milk
• Low fat if possible
• Skimmed milk contains more calcium than full fat. Ensure all
types of milk are fortified with calcium.
• Helps keep bones and teeth healthy and strong, reducing the
risk of osteoporosis.
• Ensure you get plenty of sunlight for vitamin D which helps
absorb calcium
• Other sources of calcium include fish, dark green leafy veg,
pulses, cereals and some nuts and seeds.
Fats – all have the same kcal content!
• MUFAs – Have nuts, avocado, olives, and rapeseed oils to lower
cholesterol.
• Avoid trans/saturated fats from items such as lard, dripping,
cakes, biscuits, chocolate, crisps, pies and pastries and all animal
products. They can inhibit absorption of N3 fats and cause high
cholesterol.
• Take omega 3 oils in the form of fish oil to reduce inflammation.
Sources include pilchards, salmon, sardines, mackerel and non
tinned tuna. Non fish sources are flaxseed, walnuts, sweet
potatoes, soya.
Calcium and Vitamin D
• Reduces risk of developing OA
• The richest source of calcium is milk and dairy
• Non dairy sources include soya/rice milk with added calcium, fish,
beans, bread, fortified cereals some nuts, fruit and dark green veg.
• Vitamin D is required to absorb calcium. The main source is
sunlight between April and Sept.
• Other sources of Vit D include oily fish, cereals, eggs and
margarines
Alcohol
Consume in moderation as can lead to weight gain, high cholesterol,
inflammation and IBS symptoms.
Sensible limits: Men:
3-4 units/day
Women:
2-3 units/day
2 alcohol free days/week
Calculate the units using the equation..
Amount of alcohol in ml x strength i.e. percentage (ABV)
1000
Myth busting
• Iron – relieves anaemia associated with arthritis, found in red meat, fish,
cereals, beans and pulses, dried fruit, nuts and dark green veg.
• Vitamin C – Reduces risk of developing OA and enhances absorption of iron
• Tea/coffee – Inhibits absorption of iron and can contain caffeine which affects
mood and energy levels
• Probiotics – can reduce symptoms of diarrhoea, take daily for 1 month.
Always keep bacteria strain consistent.
• MSM, cider vinegar, honey and CMO – no evidence
• Mild selenium deficiency may be associated with a progression of arthritis,
but this can be toxic if too much is taken. Sources include meat, fish and brazil
nuts.
• All fruits and vegetables contain different antioxidants which have health
benefits, it is therefore not advised to cut out various ‘families’.
Symptom management - IBS
• First line approach – Healthy eating, reducing sweeteners, fatty
and spicy foods, caffeine, alcohol and fizzy drinks. Relaxation and
stress management.
• Fluid – Increase to 8-10 cups per day minimum
• Fibre – If constipated increase, if diarrhoea reduce this
• Intolerances – Rare, ask GP for tests for these if symptoms
remain and you are losing weight
• FODMAPS – New evidence based approach to IBS, excludes
various types of carbohydrates (with support from Dietitian only.)
Food and Mood
Carbohydrates
TRYPTOPHAN –
an amino acid
found in
protein foods:
SEROTONIN – a
neurotransmitter
responsible for
good mood, sleep
& appetite control
CO-FACTORS
Vitamin B6: yeast/ meat/ fish/ cereals/ fruit &
vegetables
Vitamin C: fruit & vegetables
Zinc: seafood/ fruit/ nuts/ poultry/ meat/ cereals
Folic Acid: beans/ citrus fruits/ grains/ green
vegetables/ meat/ shellfish
Food labelling – per 100g
A lot
A Little
20g fat or more
3g fat or less
5g saturated fat or more
1g saturated fat or less
10g sugars or more
2g sugars or less
Rich tea vs digestive ‘light’
Further help
• Keeping a food diary may help you make associations between
symptoms and food or feelings
• Ask your GP for a referral to a community Dietitian
• See www.BDA.uk.com website for local freelance Dietitians and
health factsheets
• NHS choices website www.nhs.uk
• Within Wiltshire there are free courses which help with mood and
wellbeing – contact LIFT psychology
Thank you for listening
Any questions?
www.rnhrd.nhs.uk
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