Arthritic Nutrition

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  • Arthritic Nutrition

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

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