arthritic nutrition
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Arthritic Nutrition
Presented by Stacy Ison
University of Indianapolis Senior Athletic Training StudentMay 2007
OverviewArthritis BasicsNutrition BasicsArthritic Nutrition
What is Arthritis? Inflammation and pain
in the joints The degeneration and
inflammation of joints can cause joint stiffness, pain, swelling, deformity, and eventually disability
Also refers to joint damage, such as destruction of cartilage
Types of Arthritis Rheumatoid Arthritis Juvenile Arthritis Gout Fibromyalgia Osteoarthritis (OA)
• Most common form, affecting 21 million adults, according to the CDC• Characterized by degeneration of cartilage and the underlying bone
within a joint as well as bony overgrowth• The joints most commonly affected are the knees & hips; Spine,
ankles, and old fractures sites also affected
Risk Factors The exact cause is unknown Age
• More likely to develop as you age Weight
• Excess weight increases the likelihood Sex
• Women are more likely to develop Medical History
• Joint injury or acute trauma Genetics
• Specific gene found in some people Lifestyle
Arthritis Statistics According to the CDC:
• 46 million adults in the U.S. have some form of arthritis• By 2030, 67 million of Americans are projected to have arthritis• People who are overweight or obese report more doctor-
diagnosed arthritis• Among adults with knee osteoarthritis, engaging in moderate
activity at least 3 times per week can reduce the risk of arthritis-related disability by 47%
• In 2003, there were 418,000 total knee replacements performed due to arthritis
• In INDIANA• 29% of adults with arthritis, with 14% between the ages of 18-44• 71% of adults with arthritis who are overweight or obese• 18% of adults with arthritis who are physically inactive
Arthritis and Athletics The term arthritis typically stirs
up images of elderly and inactive people, but a number of younger, athletic adults are suffering
Injuries are common in athletics, but an injury that goes untreated or does not heal properly is the one that causes the degenerative process to begin
Repetitive low-grade impact may also be enough to start the arthritic process
Arthritis and Athletics CDC notes that those who suffer joint injuries,
such as ACL, meniscus, or rotator cuff, are SIX times more likely to develop OA
Participants in sports with a high degree of torsional loading and levels of impact are more likely to develop OA if they suffer sports-related injuries that do not heal completely
Football players appear to have an increased incidence of degenerative changes, with 30% with a history of knee injury showing evidence of OA 10-30 years after competing
How does this affect you? Even though exercise is believed to be
beneficial for arthritis because it increases the circulation of fluid that surrounds the joint… rigorous, high-impact, high-stress athletic activities may cause a greater risk for arthritis!
Those athletes are typically the kinds that you see here!
Think about many clients you have that are at risk for arthritis due to previous injury or their athletic activity… Or you may already have clients with arthritis
Nutrition 3 Main Goals
• Prepare for performance/training• Maintain the level of performance/training• Aid in recovery from performance/training
Based on a variety of factors• Age• Size• Physical Condition• Type of Exercise/Athlete
Nutrition is a science, but finding the right nutritional balance for each person is an art!
• What is good for one person is not always good for another
Nutrition If you drink enough water and eat a balanced
diet, your body can:• Make energy efficiently • Fuel top performance• Gain more power, strength, and endurance
6 Nutrients to Health• Carbohydrates• Fat• Protein• Vitamins• Minerals• Water
The Food Pyramid
GRAINSVEGETABLE
SFRUITS OILS MILK
MEAT & BEANS
Carbohydrates Most important source of fuel
• Made of Sugars, Starches, and Fiber• Found in pastas, breads, cereals, rice, fruits, and
vegetables• Top Choices: Bran Cereals, Oat Bran, Whole
Grain/Dark breads, Whole Grain Crackers In general, whole grains have more nutritional
value than products made from refined flour For an active population, carbohydrates should
provide about 60-70% of daily calories
Why are Carbohydrates important?
The body converts sugars and starches from carbs to energy (glucose) and stores it in the liver and muscle tissues (glycogen)• This gives endurance and power for high-intensity,
short-duration activities If the body runs out of carb fuel during activity,
it will burn protein for energy• This results in a decrease of performance level
To prevent depleting carbohydrate fuel:• Eat carbs for at least several days before
exercise/competition, so muscle begin glycogen-loaded
• Eat more carbs during exercise/competition lasting more than 1 hour to replenish energy and delay fatigue
Fats Small amounts of fat are needed for certain critical
functions and as an alternative energy source to glucose
Too much is associated with heart disease and other major health problems
Saturated Fats vs. Unsaturated Fats• Triglycerides (primary form)• Phospholipids• Trans Fat
• Like Saturated fat; Man-Made• Cholesterol
• LDL: “BAD” fat• Clogs arteries
• HDL: “GOOD” fat• Produced by body• Cleans arteries• Increased by exercise
For an active population, fats should be limited to no more than 25%
Why are Fats Important? Fat is an energy source and reserve Fat protects vital organs and provides thermal
insulation Fat is a vitamin carrier and hunger depressor The way the body uses fat for energy depends
on the situation• With rest or exercise at low intensity, it is the
primary fuel source• With increased intensity, the body uses more
carbohydrates for fuel rather than fat• If the body uses up its glycogen supply and you
continue to exercise, your body will burn fat for energy, decreasing exercise intensity
Protein Provides the body with power to build new
tissues and fluids• Found in meats, fish, poultry, eggs, beans, nuts,
dairy products• Top Choices: Lean beef, turkey, fish, peanut butter
Digested into amino acids, which are rebuilt into the protein in the muscle and other tissues• 9 essential amino acids: Consumed through diet;
body cannot synthesize• 13 non-essential amino acids: Body can
synthesize from other material For an active population, proteins should
provide about 15-20% of daily calories
Why are Proteins important? The body can not store protein, so it is burned
for energy OR converts it to fat The amount needed by an athlete depends on
many factors• Level of Fitness: Active people need more• Exercise Type, Intensity, & Duration:
Endurance athletes burn protein for fuel• Total Calories: The body burns more
protein if enough calories are not consumed to maintain body weight
• Carbohydrate Intake
How Do I Know If I’m Getting the Ideal Percentages?
If you kept track of total calories, total carbohydrate intake, total protein intake, and total fat intake for the day, how would you know if you were consuming the recommended percentages?
Must know that:• 1 gram carbohydrate = 4 kcals• 1 gram protein = 4 kcals• 1 gram fat = 9 kcals
EXAMPLE• Sally ate 1600 total calories, 250 g carbohydrate,
100 g protein, and 40 g fat for the day• 250g carbs x 4 kcals = 1000 ÷ 1600 = 62.5%• 100g protein x 4 kcals = 400 ÷ 1600 = 25.0%• 40g fat x 9 kcals = 360 ÷ 1600 = 22.5%
Caloric Balance
Caloric Balance = # of calories consumed - # calories expended
Calorie Consumption (previous slide) Caloric Expenditure
• Basal metabolism: Minimal amount of energy required to sustain body’s vital functions
• Work metabolism: Physical activities in 24 hour period
• Excretion
Vitamins & Minerals VITAMINS
• 4 Fat Soluble: A, D, E, K• Stored in the Body
• 9 Water Soluble: C, B1, B2, B6, B12, Niacin, Folacin, Biotin
• Not stored in the Body
• Antioxidants• May prevent premature aging, certain cancers, heart
disease• Include Vitamin A, Vitamin E, and beta-carotene
MINERALS• Function to maintain bone strength, muscle
contraction, and hormone synthesis• 3 Major: Calcium, Phosphorus, Magnesium• 9 Trace: Including Iron, Zinc, Copper
Hydration Water is the most critical factor Because the body does not make or store
water, you must replace what you lose through sweat and urine
Being thirsty is not a reliable way to tell if you need water – you are already dehydrated by then!
Don’t begin to feel thirsty until you have already lost 2% of your body weight
Urine should be colorless; dark urine indicates dehydration
Hydration Tips Drink at least 8 cups each day; often athletes
need more Drink before, during, and after activity to
maintain hydration and avoid overheating Drink small amounts of water frequently, not
large amounts less often Drink cooler beverages to cool your core body
temperature and reduce sweating Drink 2-3 cups of water for every pound lost
after exercise Sports drinks are beneficial for longer events,
but may work best to be diluted with 50% water
Nutrition & Arthritis Most of us have probably heard all of the more
common (and sometimes extreme) ways to treat and prevent arthritis• Lifestyle changes including regular exercise,
stretching, aerobic activity, and weight management
• Pharmacologic treatments including NSAIDs, COX-2 inhibitors, and glucocorticoids
• Supplements and Herbs How does simple nutrition play a role?
Arthritic Nutrition 101 How does Food Affect Arthritis?
• Arthritis is a disease of inflammation• Logical and effective treatment should
consist of anything that fights inflammation• Specific foods you eat can either make
inflammation in the body worse or can reduce the amount of inflammation produced by the body
Arthritic Nutrition 101 What Foods Should be Avoided?
• Saturated Fats• Fats found in and from animal products and
some oils• Avoid fatty beef or pork, poultry skin, ice cream,
butter, whole or 2% milk, regular cheese, bacon• Opt for low-fat or no-fat dairy products, lean
cuts of beef or pork, and skinless chicken or turkey
• Trans Fats• Man-made to give baked goods longer shelf-life• Mix of vegetable oil and added hydrogen
molecules that turn solid• Simple and Refined Carbohydrates
• Set up a state of inflammation in the body which causes an increase in cytokines and other pro-inflammatory compounds
• Sugary foods, white flour baked goods, white rice, bread
Arthritic Nutrition 101 What Foods Should be Included?
• Omega-3 Fatty Acids• Work to decrease inflammation in the body by
suppressing the production of cytokines and enzymes that erode the cartilage
• Many studies support fish oil to reduce symptoms of rheumatoid arthritis
• Salmon, herring, mackerel, sardines, anchovies, trout, oysters, omega-3 fortified eggs, flaxseed, walnuts, seaweed, and soybeans
• Extra Virgin Olive Oil• Protects body against inflammation because it
contains polyphenols (an antioxidant)• Substitute olive oil when cooking rather than using
vegetable oil or butter
Arthritic Nutrition 101 What Foods Should be Included?
• Antioxidants• Protect the body from the effects of free radicals,
which are cell-damaging molecules produced by inflammation
• Research has demonstrated certain antioxidants may help prevent arthritis, slow its progression, and relieve pain
• The best include Vitamin C, Selenium, Carotenes, and Bioflavonoids
• Guava, peppers, oranges, grapefruit, broccoli, brazil nuts, tuna, crab, shrimp, whole grains, sweet potatoes, carrots, kale, squash, and many more!
Arthritic Nutrition 101 What Foods Should be Included?
• Vitamin D• Critical for joint health• May reduce risk of arthritis• For those already with arthritis, a deficiency may cause a
worsening disability overtime• Basic daily requirement: 400 IU until age 70, 600 IU over
70• Wild salmon, mackerel, sardines, milk (skim, 1%, low-
fat), soy milk, egg yolks, and mushrooms• Spices
• Ginger• Shown to lessen pain of osteoarthritis if taken in
highly purified form.• Contains chemicals that work similar to anti-
inflammatory meds• Turmeric (curcumin)
• A mustard-yellow spice with its main ingredient being yellow curry
• Said to suppress inflammatory body chemicals and work similar to an anti-inflammatory med
Arthritic Nutrition 101 Should Supplements be Considered?
• Multivitamins• Provides 100% DV of Vitamin D, Vitamin C, Selenium, and Vitamin A• Beware of mega-dose varieties: Excess Vitamin C can make
certain cases of arthritis worse• Fish Oil
• Studies have shown doses from 1.2 grams to 3.2 grams for excellent relief in conjunction with an omega-3 rich diet
• Glucosamine + Chondroitin• Nutrients naturally found in and around cartilage cells• Thought to strengthen and stimulate growth of cartilage• Recommend 15 mg glucosamine and 1200 mg chondroitin daily
• SAMe• Possibly as effective as NSAIDs• Recommend 1200 mg daily• Beware of side effects: insomnia, rash, GI problems
• GLA• Found in evening primrose oil, borage oil, and black current oil• Thought to reduce pain, joint tenderness, and morning stiffness by
suppressing certain inflammatory substances• Recommend 1-2 grams daily
Arthritic Nutrition: 1Day Meal Plan Breakfast
• Vanilla Pumpkin Breakfast Pudding• 1 cup nonfat, vanilla yogurt mixed with ½ cup canned pumpkin
puree and topped with 2 TBS chopped walnuts Lunch
• The Ache-Less Salad• 3 cups leafy greens topped with 4 ounces of either salmon, crab,
shrimp, tilapia, turkey breast, or grilled chicken. Mix with ½ cup chopped tomato, ¼ cup chopped red onion, ¼ cup sliced mushrooms, 1 sliced red bell pepper, 2 chopped beats, ½ cup chopped carrots, ¼ cup corn. Toss with 1-2 teaspoons olive oil and unlimited balsamic vinegar
Afternoon Snack• Ginger Spiced Pumpkin Muffin • Includes whole-wheat flour, cinnamon, ginger, skim milk, pumpkin,
canola oil, and more• For full recipe, visit www.today.msnbc.com
Dinner• Chicken Curry and Cauliflower with Brown Rice• Includes curry powder, garlic, ginger, boneless chicken breast, onion,
chickpeas, fat-free yogurt, and more• For full recipe, visit www.today.msnbc.com
PM Snack• One cup of fresh berries
Questions or Comments?
THANK YOU!
Resources Clark, Nancy. Nancy Clark’s Sports Nutrition
Guidebook: Eating to Fuel Your Active Lifestyle. Leisure Press; Brookline, MA. 1990.
www.webmd.com www.today.msnbc.msn.com www.cdc.gov www.mypyramid.gov