Arthritic Nutrition

Arthritic Nutrition Presented by Stacy Ison University of Indianapolis Senior Athletic Training Student May 2007 Overview Arthritis Basics Nutrition Basics Arthritic 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  Weight  Sex • More likely to develop as you age • Excess weight increases the likelihood • Women are more likely to develop • Joint injury or acute trauma • Specific gene found in some people  Medical History  Genetics  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 doctordiagnosed arthritis • Among adults with knee osteoarthritis, engaging in moderate activity at least 3 times per week can reduce the risk of arthritisrelated 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, highimpact, 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 Age Size Physical Condition Type of Exercise/Athlete  Based on a variety of factors  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 Carbohydrates Fat Protein Vitamins Minerals Water  6 Nutrients to Health The Food Pyramid GRAINS VEGETABLES FRUITS 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 • This results in a decrease of performance level  If the body runs out of carb fuel during activity, it will burn protein for energy  To prevent depleting carbohydrate fuel: • Eat carbs for at least several days before exercise/competition, so muscle begin glycogenloaded • 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 • Man-made to give baked goods longer shelf-life • Mix of vegetable oil and added hydrogen molecules that turn solid • Set up a state of inflammation in the body which causes an increase in cytokines and other proinflammatory compounds • Sugary foods, white flour baked goods, white rice, bread • Trans Fats • Simple and Refined Carbohydrates 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 • Protects body against inflammation because it contains polyphenols (an antioxidant) • Substitute olive oil when cooking rather than using vegetable oil or butter • Extra Virgin Olive Oil 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 antiinflammatory 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 • Studies have shown doses from 1.2 grams to 3.2 grams for excellent relief in conjunction with an omega-3 rich diet • 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 • Possibly as effective as NSAIDs • Recommend 1200 mg daily • Beware of side effects: insomnia, rash, GI problems • 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 • • Fish Oil Glucosamine + Chondroitin • SAMe • GLA Arthritic Nutrition: 1Day Meal Plan  Breakfast • Vanilla Pumpkin Breakfast Pudding Lunch • The Ache-Less Salad • 1 cup nonfat, vanilla yogurt mixed with ½ cup canned pumpkin puree and topped with 2 TBS chopped walnuts   Afternoon Snack • Ginger Spiced Pumpkin Muffin • • 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  Dinner • Chicken Curry and Cauliflower with Brown Rice • • • Includes whole-wheat flour, cinnamon, ginger, skim milk, pumpkin, canola oil, and more For full recipe, visit www.today.msnbc.com  PM Snack • One cup of fresh berries Includes curry powder, garlic, ginger, boneless chicken breast, onion, chickpeas, fat-free yogurt, and more For full recipe, visit www.today.msnbc.com 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