By asking clients with arthritis a few pertinent questions, and working with their health care providers, you can help them better manage their condition, says dietitian Kim Arrey.
As the market for training older adults grows, so does the number of clients with arthritis. These clients are looking for ways to maintain their mobility and reduce the amount of pain that they are in. While modern medicine offers individuals with arthritis a wider and more effective choice of treatments than ever before, fitness professionals can also help arthritic clients modify certain lifestyle factors in order to maintain a healthy, active life. Diet can play a key role in increasing or decreasing inflammation. Reducing inflammation will help to decrease the pain and stiffness that occurs in osteoarthritis and rheumatoid arthritis. Here are five key questions you should ask clients with arthritis.
Question 1: Have you lost or gained weight recently?
Any change in weight is important. If weight loss is unintentional it could be an indication that clients are not eating well.
One of my clients came to me after having lost about 4.5kg from her already slim frame. She was suffering from ‘tea and toast’ syndrome, a result of struggling with grocery shopping and meal preparation. Clients like this should be referred to a dietitian to be assessed for malnutrition, as well as to determine whether they need help with meal preparation. Encourage them to learn what services are available in their local communities, and help them to work with dietitians or occupational therapists so that they can improve their eating habits.
Conversely, of course, other clients, especially those with arthritis that affects their weight bearing joints (hip, knee and ankle) would like to lose weight. Doing so can reduce pain and stiffness. Many clients who want to lose weight, however, have goals which, although admirable, are not always achievable, such as my client who wanted to lose over 20kg within six months. Due to the arthritis in her knees she was unable to do the amount of physical activity needed to create the necessary caloric deficit. Instead, she lost weight gradually, and after losing 11kg decided it was time to maintain her weight. Even this degree of weight loss, however, was sufficient to significantly reduce the knee pain she suffered.
Another client was steadily gaining weight at a rate of nearly half a kilogram a month. The goal in this case was more modest: to stop him gaining any more weight. Just maintaining his weight was an achievement.
Question 2: Are you taking any nutritional supplements?
Numerous nutritional supplements claim to either reduce inflammation or help alleviate the pain of arthritis. Always ask clients whether they are taking any supplements. This is important because supplements can interact with medications and with other diseases.
One of my clients with osteoarthritis had type 2 diabetes that was controlled with medications. He complained of being unable to exercise because his diabetes was no longer controlled and he was suffering from low blood sugar levels during his exercise sessions. This was confusing because he stated he had not changed his eating habits or his exercise regimen. However, he then confided that he’d started taking glucosamine sulfate, which had actually caused his blood sugar levels to fall beneath usual levels.
Make sure that any client taking a supplement has checked with their health care team to ensure that there is no interaction between the supplement and the disease or other medications.
Question 3: Are you avoiding any particular food or food groups?
An arthritic client came to see me almost in tears. She was tired of not eating any wheat products, nightshade vegetables (including potatoes, tomatoes and eggplant), soy, dairy or eggs. Even with all this effort, she felt that there was no change in her level of pain. Unfortunately, this eating plan had left her with low energy levels and lacking nutrients. After experimentation we found that there were some specific foods that seemed to aggravate her symptoms, which she proceeded to avoid.
Many different diets suggest that eliminating a food group or specific type of food from the diet will ‘cure’ osteoarthritis or rheumatoid arthritis. Some suggest eliminating all gluten from the diet; others suggest eliminating foods from the nightshade family, while others advocate the elimination of all dairy-based foods. There is little, if any, scientific evidence to support these theories. The best thing to do is encourage your clients to eat a varied diet, and to use a food diary and self-observation of symptoms to gauge if they have intolerance to a specific food.
Question 4: Are you choosing anti-inflammatory foods?
Certain foods will actually help to reduce inflammation. It is important to make sure your clients start to slowly include these anti-inflammatory foods. Ask your clients what they are eating and encourage them to gradually make the transition to low glycaemic index foods, and to incorporate more fish and other sources of omega-3 fats into their diets. Including more vegetables and fruits in the diet can also, often, help to reduce inflammation.
Question 5: Who are your health care providers?
Find out who your clients’ health care providers are. These people are valuable resources and allies for you, just as you are to them. As a part of the team that is caring for someone with arthritis you can help increase mobility, strength and muscle mass, and improve balance. The work that you do is very important, and you may well see the client more frequently than the other members of the health care team. This puts you in the optimal position to reinforce the messages about diet, relaxation and daily activities.
The most important decision an arthritic client can make is to commit to choosing a healthy diet and exercise program to help manage the symptoms of arthritis. When we all work together, we can help clients achieve this goal.
Kim Arrey, BSc
Kim is a consulting dietitian with over 20 years’ experience. Her new book The Complete Arthritis Health, Diet Guide & Cookbook, published by Exisle Publishing, contains information about how to manage arthritis, and includes over a hundred recipes to simplify meal planning. For more information visit www.exislepublishing.com