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OT Role in Meal Planning for Symptom Management: A Modifiable Factor to Treat Joint Pain

Published On 2.28.20

By Chelsea Clements, MS, OTR/L

Occupational Therapist

In the world of older adult rehab, arthritis is a condition encountered by clinicians almost every day. Complaints of pain can be prevalent and severely impact day-to-day functioning. However, you know that arthritis and chronic pain are not mutually exclusive. It is now recognized that nutrition plays an important role in the management of chronic disease.

Dietary changes can be used as an effective treatment for arthritis pain. Improving nutrition can impact the amount of pain reported/experienced by decreasing sugar/omega-6 foods, increasing Mediterranean-based dietary choices, and including a daily intake of specific berries. Occupational therapists can and should address this type of symptom management through skilled education in meal planning.

Chronic Inflammation’s Connection to Joint Pain

The key to unlocking many chronic conditions, including arthritis, may lie in a better understanding of the relationship between sugar and inflammation. In recent years, the rise in daily sugar intake has been well documented, especially in the standard American diet (SAD). This change comes at a price to one’s health in more ways than we have been able to fully understand, but research continues. Approximately 72% of the energy consumed by the average American is made of refined sugars, refined vegetable oils, highly processed cereals, and dairy products. Patient reports have shown that soda and sugary desserts were specifically noted to worsen arthritis symptoms. When these types of foods are digested, depending on quantity and other factors, they transform through digestion and initiate either pro- or anti-inflammatory pathways that can increase one’s pain.

An imbalanced intake of pro-inflammatory, omega-6 foods (meat, eggs, oils) and the intake of anti-inflammatory omega-3 foods (fish, nuts, berries, greens) compete for a limited number of digestive enzymes that are able to break them down. Once digested, they become signaling molecules responsible for both immune and inflammatory reactions in the body. If not enough omega-3 and too much omega-6 classified foods are eaten, the body moves into a condition of low-grade chronic inflammation (LGCI). LGCI is a state of persistent and unresolved inflammation, where pro- and anti-inflammatory cytokines are elevated and inflammation is not resolved. LGCI can impact digestion, energy, cause overall poor health, and exacerbate symptoms of chronic conditions.

For an older adult, even slight changes in joint pressure can mean the difference between tolerable and debilitating pain impacting function.

Both inflammation and adipose tissue (fat) can be detrimental to one’s bone health in a more specific way. Increased amounts of adiposity results in activation of IL-6 osteoclasts. IL-6 is a bone-resorbing cell (breaks down bone), along with other cytokines responsible for inflammation: IL-1 and TNF-a. TNF-a is associated with lower muscle mass in older adults. It can be concluded that a negative cycle is formed when increased Omega-6 intake causes inflammation and leads to increased joint pain. Inflammation leads to bone and muscle breakdown, which also makes movement difficult. The best way to discontinue this dysfunctional cycle is by intervening in one’s nutrition through education on how food impacts the body’s function and its ability to heal or cause inflammation.

Nutritional Interventions for Joint Pain

OTs can focus on meal planning techniques and routines that will manage chronic pain symptoms. Scheduling and planning of both what and when one eats in order to maintain healthy blood sugar and a balanced diet. By planning ahead, one can avoid imbalanced omega-6 to omega-3 ratios that can cause pain symptoms, bone, and muscle breakdown.

Mediterranean diet and Arthritis

The Mediterranean diet is rich in vegetables, beans, whole grains, olive oil, fish, and less red meat than the average SAD. This diet has demonstrated moderate reductions in joint inflammation in patients with rheumatoid arthritis. Mediterranean foods are high in several bioactive compounds, especially those which have benefits including antioxidant, anti-inflammatory, and anti-diabetic effects that have shown to alleviate arthritis in animal studies. One four-month study of the Mediterranean diet in older adults resulted in not only decreased BMI but decreased inflammatory biomarkers IL-1 and IL-6. It also resulted in statistically significant improvement in ROM of the knee and hip when other variables such as exercise had been removed.

For higher functioning older adults who still grocery shop and cook on their own, OTs should educate on the results of a Mediterranean diet on arthritis pain and its overall health benefits. Alternative sources of information can be given or referred to a Registered Dietitian for more in-depth meal planning if required. However, there are a few easier dietary changes that an OT can recommend which may prove benefits without having to overhaul an entire diet, which is not always possible.

If Only One Dietary Change is Possible: Berries

For the older adult population that is not doing their own grocery shopping or cooking, adding one specific and commonly available food to their daily routine has shown promising results in decreasing arthritis pain. Berries, specifically: blueberries, raspberries, strawberries, and pomegranates have demonstrated a reduction in both pain and inflammation in clinical studies in animals and in the subjective human survey reporting with noted symptom improvement on rheumatoid arthritis. Animal study results for blueberry extract in even small quantities (~12mg/day) demonstrated a 30% decrease in tissue edema and a decrease in inflammatory molecules assessed via histological scores when compared to the control group. In a New Zealand animal study looking at pomegranate fruit extract, results showed several chondroprotective (delays progressive joint space narrowing characteristic of arthritis) effects, including decreasing mRNA expressions of matrix metalloproteinases (which is a group of cartilage degeneration enzymes), as well as decreasing synovial fluid and plasma levels of inflammatory interleukins. These significant associations between the treatment of berry extracts persisted when researchers accounted for confounding factors, such as exercise, sleep, vitamin use, and warm room temperature for the cohort.

Clinicians can educate on the benefits of opting for one or more servings of these specific fruits into a meal plan or incorporate specific snack scheduling times to include them into someone’s daily routine for optimal carryover. It may be a good idea to suggest replacing similar sugary fruit juices with health-promoting berries. It is important to note that sugar fruit juices are not the same and will not carry the same health benefits as real fruit.

The aging population relies on occupational therapists to provide skilled symptom management, facilitate functional independence, and maximize independent ADL/IADL performance. Educating patients and/or their caregivers to fully understand how dietary choices impact one’s body and how these can contribute to the progression of arthritis, muscle wasting, unhealthy BMI leading to increased joint pressure, and increased inflammation should be included in all arthritis management plans of care.

By making health-promoting food choices, you can decrease pain reports, maximize ROM, improve functional performance, and ameliorate further joint damage.

 

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