Ask the Expert: Deborah McInerney, Nutritionist, Answers Your Questions on Nutrition & Arthritis

by Deborah McInerney
Food-sources-of-vitamin-D

Q1.  What are some foods that are a good source of vitamin D for people with arthritis?

Vitamin D is not the easiest vitamin to get from food, mainly because its food sources aren’t the most popularly consumed. Cod liver oil and swordfish are the best natural food sources, followed by fatty fish like salmon (especially wild-caught like sockeye) and mackerel. Next would be canned tuna fish and vitamin D-fortified milk, yogurt and orange juice. Sardines, eggs (yolk) and fortified cereals have fair amounts of vitamin D, but most people need to take a supplement, as the typical U.S. diet lacks a sufficient amount of vitamin D-rich foods.

Q2.  What kind of foods should people with arthritis eat to keep their joints healthy?

There are no magic foods specific to joint health. The goal is to maintain a healthy weight (lose weight if overweight), and follow a diet rich in vegetables, fruit, low-fat dairy, lean protein and whole grains, to ensure you receive adequate amounts of protein, fat, carbohydrates, vitamins and minerals everyday. Many people who suffer from joint inflammation choose to focus on omega-3 fatty acids from fish oil and/or flaxseed (food or supplements).

 Q3.  I have gout – what foods and drinks should I avoid?

If you have gout, it is advisable to avoid foods high in purine, to reduce the amount of uric acid in the blood. High purine foods include alcoholic beverages, organ meats (liver, kidney, sweetbreads, tripe), fish and seafood (sardines, mussels, herring, fish roe/eggs, anchovies, scallops), meat (beef, poultry, pork), cured meats (bacon and hot dogs) and meat products like deli meat, gravies, broths and soups. It is also a good idea to limit quantities of lentils, beans, cauliflower, mushrooms, spinach, asparagus and peas, as well.

It is best (and easier) to focus on incorporating the following foods into your diet, that contain low levels of purine: low-fat dairy, eggs, fruit, nuts and vegetables (except the above mentioned ones).

 Q4.  Are there foods I should avoid to prevent my rheumatoid arthritis from exacerbating?

There are no foods proven to worsen Rheumatoid Arthritis symptoms, but some claim to benefit from eliminating nightshade vegetables such as tomatoes and tomato products (even ketchup), eggplant, potatoes and peppers. If you notice a positive change by eliminating these, it’s probably working; if you feel no different, then it’s probably not worth continuing.

For most medical conditions, the focus should be an overall healthy diet, rich in fruit, vegetables, whole grains, low-fat dairy and lean proteins such as fish, chicken, and beans. To help manage or decrease inflammation, try to incorporate salmon, tuna, mackerel, trout and herring into your diet on a regular basis, or adding flaxseed if you’re not a fan of fish.

Q5.  My child has juvenile arthritis.  Any recommendations on the types of nutrients and how much she should be getting to prevent her arthritis from getting worse?

Juvenile Arthritis does not have specific nutritional recommendations, but focus should be, as for all kids, on proper nutrition for growth and development. Calcium and vitamin D should also be a priority, as U.S. diets now seem to be deficient in foods rich in these crucial bone health nutrients. If your child is taking a corticosteroid, then bone health should absolutely be a focus, as long-term steroid use can have a detrimental effect on bone density.

Deborah McInerney is a clinical nutritionist at the Hospital for Special Surgery.

Topics: Facebook Notes, Nutrition, Rheumatology
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Elizabeth Kastanis says:

Why are vitamin D supplements stopped before hip surgery , is vitamin D toxic and if one is deficient can vitaminD be resumed.

HSS on the Move says:

Hi Elizabeth – Thanks for reaching out with your question. Deborah McInerney, Nutritionist, says, “It common for prescribers to recommend patients to stop taking all supplements (vitamins and herbals included) prior to surgery, but if vitamin D levels are low and you are taking supplementation to correct a major deficiency, then it may be fine to continue – this will vary by practitioner (doctor). Vitamin D is typically restarted the day or two after surgery, unless otherwise directed by your physician. Since vitamin D is a fat soluble vitamin, toxicity is possible because whatever your body doesn’t need/use, will be stored in fatty tissue. Best to know what your vitamin D level is, by consulting with a physician, before supplementing on your own.”

Debra Schantz says:

I have been low vitamin D for almost three years. This was misdiagnosed. I have recently got it back up to the levels I am suppose to be at, but am still suffering with muscle issues. Taking Calcium, Magnesium, multi-vitamin, Vitamin D daily, B12. I am in weekly therapy. I also have lost 148 lbs since February. Frustrated not to be able to do basic things most people can do.

HSS on the Move says:

We”re sorry to hear that but encouraged to learn that your levels are returning to normal. Hopefully, the therapy and supplements will soon get you back to where you want to be.

R Small says:

Can you comment on the low-starch diet that”s been studied by Dr. Ebringer, King”s College London, at the Ankylosing Spondylitis clinic? Is anyone at HSS working with a low-starch diet for their patients with AS?

HSS on the Move says:

Thanks for your question. Rheumatologist Dr. Theodore Fields responded that this still an experimental practice and more scientific evidence is needed. HSS nutrition staff, in conjunction with the interdisciplinary health care team, work closely with our patients to provide comprehensive nutritional care that will promote recovery.

Agustin Paolello says:

Ankylosing spondylitis is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as “bamboo spine”.

Viola Lickert says:

The exact cause of rheumatoid arthritis is unknown, but it is thought to be due to a combination of genetic, environmental, and hormonal factors. With rheumatoid arthritis, something seems to trigger the immune system to attack the joints and sometimes other organs. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the joints. Other theories suggest that smoking may lead to the development of rheumatoid arthritis.

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April 19, 2014 at 12:00 pm

The NHL playoffs are underway, and having a strong abdominal and core muscle strength is important for keeping players in top form. Gregory Reinhardt, HSS Physical Therapist, says: "While skating, the activation of a hockey player's oblique muscles is crucial for their ability to constantly push off from their skates." To read more about core strength for hockey players, visit http://hss.edu/onthemove/core-strength-for-hockey-players/.

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