The Arthritis NewsletterWinter 2013
Nutrition for Arthritis: An Interview with Kathleen Beggs, Registered DietitianBy Sharan Rai and Erin Carruthers
Consumer Advisory Board member Sharan Rai sat down with Kathleen Beggs, a registered dietitian with Vancouver Coastal Health, to learn all about the importance of proper nutrition and its impact on inflammatory arthritis.
What is the role of a dietitian in a multidisciplinary healthcare setting?
The role of a registered dietitian (RD) is to assess those clients who have arthritis who are at risk for nutrition-related issues. Patients may have poor nutrition intake or be struggling with weight issues. They may need advice on how to meal plan given their fatigue level or arthritis-related disabilities.
Dietitians work within a team of healthcare professionals to help arthritis clients optimize their health.
- Occupational Therapists assist with activities of daily living such as meal preparation.
- Pharmacists provide expertise on vitamin/mineral supplementation and drugs with nutritional implications like prednisone or methotrexate
- Physiotherapists provide guidance on activity and exercise recommendations
- Social Workers provide resources around coping with health changes including the financial issues that occur
- Physicians manage the clients’ disease and monitor concurrent conditions like anemia which have nutrition implications
Where does one go to find a dietitian?
Dietitians in BC are regulated under the College of Dietitians of BC. To speak to a dietitian in BC without going to a facility, the general public can call 811 through HealthLink BC. This is a great resource for people as they can receive counselling and nutritional information at no cost. The Dietitians of Canada website can also assist users with finding a registered dietitian who is practicing in their area.
Are visits to see a dietitian covered by Medical Service Plan (MSP)?
Most dietitians work in hospitals and other healthcare settings. A doctor’s referral is generally required in order to see a registered dietitian on an outpatient basis, and the consultation would be covered under your provincial Medical Services Plan (MSP). If you choose to seek nutrition consultation from a dietitian working in private practice, then fees will vary.
How does one get started with changing their eating habits? What are some good initial steps to take?
Making dietary changes can be very challenging as we need to eat several times per day and as a result, we develop certain habits. Successful weight loss occurs with a combination of dietary modification and exercise, and can be difficult for individuals who have mobility issues. I recommend starting with small changes, and building on these over time. For example, start to eat breakfast if you would usually skip breakfast. Talk to your physician before starting a new exercise regimen, and consult a physiotherapist for exercises specific to your condition.
How does one build and keep momentum?
For some individuals, keeping a food intake and exercise diary helps keep them on track. Finding a support partner can also help, whether within their circle of friends or from an external support group. Clients seeking weight management strategies, can access services through the OASIS program within Vancouver Coastal Health. OASIS provides access to free nutrition classes and focuses on how to make long-term changes to nutrition intake.
What does the evidence say about specific foods and their effect on inflammatory arthritis?
Current evidence suggests that antioxidants and omega-3 fatty acids found in some foods can reduce inflammation and be beneficial. Colorful fruits and vegetables contain antioxidants and cold water fish (e.g., salmon, herring) contain omega-3 fatty acids. Increasing your intake of these foods can help reduce inflammation. Arthritis symptoms fluctuate and for that reason it is difficult to study the effects of diet. Some individuals report feeling worse after eating certain foods, so in those instances it may be helpful to keep a food and symptom diary to pinpoint the food that may be triggering an inflammatory response. The client can remove the food from their diet, monitor symptoms, and then re-introduce the food to see if there truly is a problem. It is not harmful to remove a single food from your diet, but eliminating too many foods at one time is discouraged as it can lead to deficiencies.
Is there a specific list of foods that have been shown to maintain bone health?
For bone health, it’s all about the two nutrients: calcium and vitamin D. Many clients need to increase their calcium and vitamin D intakes to help protect their bones. Individuals who do not consume calcium-rich foods (e.g., dairy products, fortified substitutes like soy or almond milk) may require a supplement. It is challenging to obtain adequate vitamin D from diet alone, and sunshine is not a reliable option for vitamin D intake in British Columbia, so a supplement is usually recommended. For individuals over 50, a daily intake of 1200 mg of Calcium and a minimum of 800 IU of Vitamin D are recommended. Clients should consult with their physicians to determine how much supplementation they require.
What can patients do to curb the “weighty” issues that come with prednisone? What can patients do to protect their bone health while on prednisone?
Prednisone is a steroid which is often prescribed for arthritis clients to control inflammation. While an effective medication, it brings with it the unwanted side effects of weight gain (often related to fluid retention and increased appetite). As such, limiting salt intake can help reduce fluid retention.
In terms of appetite control, choosing foods that are low calorie but high in nutrients (e.g., raw veggies) would be a good strategy. Of particular importance, blood sugar and cholesterol may increase while on a steroid, so these should be monitored.
Further, calcium absorption is affected, thus increasing individual requirements. Adequate protein intake is also recommended; I encourage including a source of protein like nuts, low-fat dairy, lean meats, fish, or legumes at each meal, which can also help with appetite as it slows digestion and prevents you from feeling hungry.
- OsteoArthritis Service Integration System (OASIS)
- OASIS Free Classes (e.g., Nutrition & Supplements, Osteoarthritis & Exercise, Weight Control, Mindful Eating)
- The Rheumatologist (An official publication of the American College of Rheumatology)
- HealthLink BC: Call a dietitian (8-1-1-) or email a dietitian
- HealthLink BC Healthy Eating for Arthritis
- College of Dietitian of BC:
- Wealth of Health
- Canadian Living
- Dietitians of Canada
Tools and Apps
- MyFitnessPal: MyFitnessPal is a free calorie counter and diet/exercise tracker. Users can access a large interactive community, and have access to an enormous nutritional database. This tool is accessible through a computer web browser, or via mobile app download.
- Canadian Living: This app contains a number of easy, healthy, and delicious recipes.
- Fit Bit: Note – The Arthritis Research Centre of Canada currently has a study underway to evaluate the use of Fit Bit for those with arthritis.
- Dieticians of Canada eTracker