Dietary precautions in Rheumatic Diseases
The moment, we tell our patients their diagnosis and explain the prescribed treatment, immediately comes the standard question from practically all our patients: “Doctor, khaane ka Kya? / Kaay Pathya Padayche? /Khavaanu Shoo? What food should we eat and what should we avoid?” Dietary Prescription in most rheumatic diseases (Most Not All) is straight forward and simple. EAT Everything! There are no food restrictions in Rheumatology barring a couple of exceptions such as Gout, Anti Phospholipid Antibody Syndrome etc which we will address separately. Confused right? That’s exactly what happens in our office too! Patients look at us with disbelief “but Doctor, So and So says don’t eat sour foods, don’t eat Tomatoes, don’t eat Pickle, don’t eat Brinjals ….etc etc Blah! Blah!” That’s exactly what it is… Blah Blah! Look at it this way:
- You won’t eat curds or yoghurt or buttermilk out of fear so now you don’t get adequate calcium in your diet. We will have to give you more calcium tablets.
- You won’t have lemons because they are sour. So your lining of your gums and your cheeks will not get adequate nourishment and you will get more mouth ulcers. Additionally you will get more colds and coughs and iron will not be well absorbed from your stomach so Hemoglobin will not rise. To counter all this we will need to give you vitamin C tablets.
- You won’t have Brinjals which are rich in Iron so we will need to give you more Iron tablets.
- And you won’t have Tomatoes so we will need to give you Riboflavin (Vitamin B2) supplementation!
Does this sound good or downright silly? Sadly this is exactly what most, if not all of our patients do. Patients with rheumatic diseases are in so much pain that they are willing to listen to anyone and everyone in the desperate hope of finding some avenue to relieve them of their misery. And So when they are told to follow dietary restrictions they are quietly accept the diktat. In our society a lot of people love giving unsolicited advice when they do not even know the spelling of “Rheumatoid Arthritis” or “Ankylosing Spondylitis” or “Systemic lupus Erythematosus”. The reality is that so far there has been no scientific evidence that dietary restrictions are helpful in management of Rheumatic diseases. So why make yourself miserable?? Very often patients come to us after having tried all kinds of alternative medicine in a state of desperation due to uncontrolled disease and significant disability. These patients have already been on dietary restrictions and have become weaker due to malnutrition compounding the disease. When we ask them whether they have felt any improvement after being on restriction they all say no! We then tell them “Now you know that the disease will not subside or improve with all your dietary sacrifice so why don’t you enjoy the food at least?”They look at us with an expression which is a mixture of realization and sadness at having gone through additional misery for no reason. Next question comes “Then why did that so and so doctor ask us not to eat sour foods or this food or that food?” How can we answer that? Easiest answer for us to give at that time is; go ask that Doctor! The fact is that in Ayurveda or in Homeopathy there are restrictions prescribed and we cannot help you with satisfactory explanations for the restrictions as we are not experts in those fields. It probably has something to do with the principles of their science and their method of prescribing their drugs. Maybe some foods do interfere with their medications. However there are a lot of people who hear about these restrictions from a patient known to them who is taking alternative medicine and they then pass it on to you and you follow it blindly. That is like an old wives tale passed from generation to generation. Having said the above, dietary restrictions are extremely important in certain diseasessuch as Gout, Anti Phospholipid Antibody Syndrome or while prescribing certain medications.A few examples are given below to illustrate our point.
- In Gout it is extremely important to avoid Alcohol, red meat and foods containing Sugar. Additionally if your gouty arthritis is associated with uncontrolled diabetes or abnormal Lipid profile then appropriate restrictions for that disorder will need to be adhered to. A detailed chart on diet modification in Gout is given separately.
- Similarly in patients with Anti Phospholipid Antibody syndrome who are on anticoagulation it is important to avoid foods rich in Vitamin K such as green leafy vegetables. Advice on the same is also given separately.
- Another example is when you are prescribed a particular medicine called cyclosporine where foods rich in potassium such as coconut water or citrus fruit juices etc need to be restricted.
- For that matter if you have Diabetes or Hypertension in addition to your rheumatic disease then you will need to follow dietary restrictions for that particular ailment.
In cases such as those cited above, you will be informed and guided appropriately by us or your treating rheumatologist. There is no harm in asking whether the prescribed medication needs any dietary modification however if we say “no restriction” then believe us and eat well. You have enough problems already so why add to them? At least enjoy your food! But don’t overeat and gain weight because else your knees and ankles will have to bear further strain!!