Anyone been counseled on dietary changes to reduce inflammation? If so has it worked have you noticed?
Only thing I've been told is to watch carb intake, but think that was mainly for weight control. I've read that night shade veges should be avoided, but the rheumy has never said a word about it.
I've had no guidance from my doctor but when I look at my diet it does reasonably match what is supposed to be good to fight inflammation. As I have PMR I guess it didn't work, although I do seem to be a lot better off than some of the people who post on this forum so, who knows, maybe it has helped? I'd like to eat more oily fish but the state of the fisheries means that I tend to avoid salmon now.
Rheumatologists aren't taught this sort of thing. There is a whole body of literature about this subject, all of it confusing and cotradictory. I have been put on a rather severe diet cutting out all wheat and dairy, corn, and nightshade veggies. Also told to avoid sugar, syrup, honey. Of course I am not 100% faithful.
Wow what is the state of fisheries? I am in the eastern U. S.
The effect of diet is always present.
To the extent that a pmr patient takes a much-insufficient dosage of corticosteroid, appetite loss seems to occur, leading to a fasting effect that would tend to diminish one's systemic inflammatory response.
So exercise (exercise being an accelerated fasting) and dietary restriction together should allow one to have a lower dosage requirement, and the severity of pmr symptoms may self-regulate to some degree when a "flare" that approaches feverish illness causes one to restrict their caloric intake. Unfortunately though, most people will also cut down on their physical activity when symptoms become severe.
It should be every pmr patient's goal to determine the best-tolerated types of exercise allowed by their real-time condition, and to maximize the duration of such exercise.
I've taken this apprach to it's limits lately, riding 30+ miles every day in the hills on a bike (2-3 hours), and literally skipping every other day of the 5-6mg of prednisone that I otherwise require. I'm still holding back on conclusions as I have been at this for just one month and did even over-do it by skipping two days in a row a couple of times (the prednisone, not the riding). I've had to resume normal daily dosing for this past 8 days, and just today skipped my first daily dosage since then.
I now avoid restaurant meals since they tend to be fully double the size of what I should be eating. I really noticed the "day after" effect of a typical Mexican-style meal with all the chips and "heavy" ingredients.
By the way, the effect on systemic inflammatory response to dietary restriction is described in much detail in several of Barry Sears' "Zone" series of books, modern-day classics from the 1990's that have maintained their relevence and credibility.
As a pmr patient of nearly two years, I am intensely interested in this topic of the effects of diet and exercise. I am learning to enjoy even the morning rides that head out into near-freezing temperatures, and which are also improving my quality of sleep a great deal.
I will post further updates on my progress in the weeks ahead, and am looking forward to other's postings (here) on what they have learned about therapeutic response from dietary modifications.
So thanks for asking!
Yes, the types of carbs that might "spike" one's insulin level are surely implicated in a stimulated systemic inflamatory response. This is key.
As well, sugars and starches (which immediately become sugars in the stomach) stimulate appetite as they stimulate insulin, leading to a self-energizing condition of sustained elevated insulin. Such is the recipe for excess inflammation, and if one pays attention they can actually feel it in their muscles and joints within a not-so-long period of time.
Human's intake of simple carbohydrates and high-glycemic meals has drastically increased over the last 20 years, causing much of the "age-related" sort of illnesses like diabetes and inflammatory conditions like heart disease and arthritis.
Carbohydrates eaten together with fats and soluble fiber have a lesser effect on the "glycemic load" that the liver must pass and attempt to regulate through various chemical storage mechanisms. This is because the fat and soluble fiber slow the absorption of sugars into the blodstream, making life much easier on one's regulatory organs and tissues (liver, pancreas, muscle), which together must prevent blood sugar from risng to harmful levels.
Post-meal exercise also has a regulating effect on blood sugar control, lessening the need for as much insulin secretion.
I did mean to type 200 years, but it came up printed as 20 years.
I think it may be the toxins found in "Atlantic" salmon (raised in river farms in Alaska btw) that comes from the food they are fed.
Also, wild populations of salmon are said to be threatened by new genetically-modified species that were/are supposed to boost yields of "wild-caught" salmon.
I eat canned wild salmon and sardines every week, every few days at least. Lucky for me, canned fish is inexpensive and I like eating it.
As our ever-so-helpful, resident educator EileenH might remind us, inflammation is not the root cause of PMR, it is merely a symptom (expressed as arteritis) that causes symptoms (such as pain and I suppose GCA).
So we can't quite expect that our eating what we understand to be a good, anti-inflammatory diet will prevent the onset of pmr in every case.
And as good of a diet as we pursue, I think that we all know that our efforts fall well short of perfect, or even of perfect "regulation" of known insulin-stimulating and liver-challenging "pro-inflammatory" foods and drink.
I would really love to know where PMR comes from. Is it a virus? a buildup of toxins from not eating the "right" diet? Genetic? Why do some people get it and not others?
Dan keep me up to date on your cycling and skipping pred every other day. I used to ride 35-50 miles but not daily. And not in cold weather. Now I'm happy if I can get on the bike.
I don't think there is a viable wild Atlantic salmon industry any more. The cod fishery collapsed decades ago (taking many fishing communities in Newfoundland with it). Giant trawlers from several nations are wrecking the habitat of the ocean floor. Climate change and warming water are changing the entire ecology of the North Atlantic. Exploration for new sources of oil and natural gas continues apace. Very bad scene. I only eat closed containment (land based) sustainably raised fish, or what little we can get (never oily fish) from a small hook and line business.
in the early days of pmr the fatigue was overwhelming, much pacing required, small doses and rest, too much activity one day nothing the next.
More recently, pred down to 4.5mg, less fatigue, I've been able to exercise more. Helped by coronary rehab.
I suspect there's a vast difference in nature and effect of exercise/activity. Carrying groceries from the car, hacksawing through a piece of steel, polishing, etc. which require a bit of strength or are very repetitive or stress the muscles most effected by pmr can be painful.
Stationary cycle and other gym equipment with relatively moderate exercise seem to have no bad effect on the pmr and all the good effects of exercise. The exercises seem to exercise muscles not obviously effected by pmr. Hard enough to get heart rate and breathing well up. Its getting easier as I become fitter.
On the diet front there seems to be a good corelation between what's good for the heart is also good for less inflammation (why am I not surprised!). Whether it changes the pmr symptoms I don't know. My pmr was stable before the coronary thing. My diet changed about 6 months ago.
Mainly through smaller portions, but also big reduction in carbs, I've been losing weight at 200g/week for the last 6 months, which adds up to more than 5kg. Feeling "normal" again.
Perhaps a sense of generally the things one would do for "healthy living" regardless of pmr.
I have only been diagnosed with PMR since June - and nobody has discussed diet with me - Until now, the only "condition" I have had was hereditary high blood pressure which is well managed with medication - and I have discussed diet in that regard with my GP. Like many who have responded, I find the remarks by EileenH to be very helpful, and spot on where I am concerned. If she responds to your discussion, you can probably go to the bank with what she says. Good luck to you.
I have made a number of life style changes since being diagnosed with PMR in April and am doing very well so far. Don't know if any one change has made the difference, but let me share with you what seems to be working for me. I've gone to a Mediterianian type diet. Mostly salads, fruit, veggies, seeds, nut and beans. I do cheat sometimes on special occasions, but try not to eat any refined sugars, most breads, too much meat(more chicken and fish), soda, candy, etc. I was also always veery active, physically and am keeping up with my running and exercise. Started meditating every morning too. So I don't know if any specific change has made the difference, but from all I've read, an anti-inflammatory diet is a big help to the immune system. My lab numbers are all within normal range now and I feel pretty good. Started on 20mg of pred in April and am now on 12.5. Slowly tapering. Hope this is helpful. Good luck.
Dan, I agree with your approach to handling PMR. I run regularly and try to eat healthy(fruits, salads, seeds, nuts and beans. Do eat some chicken and fish and less meat. Energy level is good and no pain. Only problem with me is my sleep and frequent need to urinate. I'm up usually up for the day between 4-5 am, but am not tired at all. My energy level is great. Starting to go to bed earlier(around 10pm). Also stopped drinking after dinner. Some improvement in night-time getting up to urinate. Any other suggestsions?
One lady on the forum included antiinflammatory foods in her diet - oily fish 3 times a weeks, turmeric and garlic plus other things - and said she always noticed when she'd been down on her normal intake.
Several of us have tried the "no nightshades" - all it did for me was make my diet boring! I don't eat much in the way of carbs - and have lost the pred weight as a result and that is a common thread for a lot of people - some kept carbs low from the start and didn't gain weight, others cut carbs and were able to lose weight even though stilll taking pred.
I was eating a gluten-free diet when the PMR started - I'm allergic to something in the structure of highly commercialised wheat, not gluten but the starch, in the UK then if you wanted wheat-free it meant gluten-free. Here I eat gluten-containing grains, rye, spelt and kamut, with no problem.
What causes PMR? It is the symptoms of an underlying autoimmune disorder: something tips the immune system off-balance and it doesn't recognise your body's tissues as self so it attacks various tissues. What label you get for the illness depends on which tissue/s are being damaged and causing inflammation. In PMR and GCA it is damage to the vascular system, in GCA arteries with an elastic component to the wall. In PMR it is most likely the microcirculation, the tiny capillaries which supply blood/oxygen and nutrients to the muscles. There is some thought that in GCA, a large vessel vasculitis, it may also be the tiny vessels supplying the walls of the larger arteries that are affected. The walls of the blood vessels become swollen - and the internal diameter reduced so the blood flow is reduced. Pred combast the inflammation, the swelling reduces.
What tips the immune system out of kilter? No-one knows, there is no one identifiable factor, viral/bacterial infections have been suggested and all ruled out to date. There could be environmental factors - and stress can also affect the immune system in various ways. Genes are also implicated, it is far more common amongst populations with Scandinavian forebears. It often rends to appear in various generations of a family - but not because it is hereditary but because you have the same gene pool.
Cutting sugars and simple carbs is good for weight control and also they are inflammatory. But, personally, I'd say your diet is a bit extreme in cutting all dairy and so many veggies and unnecessarily so. Be careful you don't develop dietary insufficiencies - and pills aren't as good as the natural version. A study did show that an extreme vegan diet reduced joint pain in 50% of patients with RA but any reintroduction of animal protein, even in tiny amounts, negated the result. It only worked in half though so there are obviously differing mechanisms in different people and few of them were able to sustain the diet longterm because it was too extreme. PMR isn't really joint pain though.
"...causing much of the "age-related" sort of illnesses like diabetes and inflammatory conditions like heart disease and arthritis" - not entirely true to say it is the only cause. You have to remember we live much much longer than in the past - people were dead of infections and other diseases long before they were old enough to develop "age-related" illnesses. Even Oetzi, the man found up a mountain in the Alps, has been found to have cardiovascular disease and tooth decayin his 40s - and the only sugar he might have eaten was honey!
"Since Ötzi's discovery in an alpine glacier more than two decades ago, scientists have subjected his mummy to a full-body health check. The findings don't make pretty reading. The 40-something's list of complaints include worn joints, hardened arteries, gallstones, and a nasty growth on his little toe (perhaps caused by frostbite).
Furthermore, the Iceman's gut contained the eggs of parasitic worms, he likely had Lyme disease, and he had alarming levels of arsenic in his system (probably due to working with metal ores and copper extraction). Ötzi was also in need of a dentist—an in-depth dental examination found evidence of advanced gum disease and tooth decay."
So glad i didn't live in the ice age! Your post is fascinating. There is so much we don't know and we are so lucky to live in an age when we can learn so much. The world is, literally, at our fingertips!
I have to confess - to my shame - I haven't visited the Ötzi museum which is a mere 70 miles away! It was originally thought he was Austrian, at least found on the Austrian side of the border, but in fact her was on the Italian side so once all the investigations had been done in Innsbruck he was repatriated and a beautiful museum built for him in Bozen.
If we have blood vessels all over the body, I wonder why it inflames the shoulder, hip flexor, groin and hamstring area tendons/bursas? And maybe Trocanteric as well.
All at same time?