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Arthritic Nutrition

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    • 1. Arthritic Nutrition Presented by Stacy Ison University of Indianapolis Senior Athletic Training Student May 2007
    • 2. Overview
      • Arthritis Basics
      • Nutrition Basics
      • Arthritic Nutrition
    • 3. 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
    • 4. 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
    • 5. 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
    • 6. 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
    • 7. 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
    • 8. 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
    • 9. 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
    • 10.  
    • 11. 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
    • 12. 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
    • 13. The Food Pyramid GRAINS VEGETABLES FRUITS OILS MILK MEAT & BEANS
    • 14. 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
    • 15. 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
    • 16. 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%
    • 17. 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
    • 18. 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
    • 19. 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
    • 20. 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%
    • 21. 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
    • 22. 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
    • 23. 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
    • 24. 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
    • 25. 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?
    • 26. 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
    • 27. 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
    • 28. 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
    • 29. 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!
    • 30. 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
    • 31. 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
    • 32. 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
    • 33.  
    • 34. Questions or Comments?
    • 35. THANK YOU!
    • 36. 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