Eating a healthy diet is crucial for all growing children, especially those with juvenile idiopathic arthritis (JIA). Children with JIA face the challenge of consuming foods that not only promote growth and development but also help to reduce inflammation. While no specific diet can cure arthritis, and there's no definitive evidence that certain foods can prevent JIA complications, a well-planned diet can play a supportive role in managing the condition.
The Role of Diet in JIA
Parents often explore various diets to alleviate painful arthritis symptoms in their children, recognizing the link between diet and inflammatory processes. However, it's important to understand that diet is just one aspect of managing JIA.
Kenneth N. Schikler, M.D., a pediatric rheumatologist with Norton Children’s Rheumatology, states, “There is no evidence-based data to show that diet has an effect on JIA. Unless a child with JIA has another underlying health condition, elimination of any foods or adding supplements have not been shown in valid placebo-controlled studies to have an effect on JIA."
Despite the lack of a specific curative diet, an anti-inflammatory dietary approach can be beneficial. This involves prioritizing certain foods and limiting others to help manage inflammation, the primary source of arthritis pain.
Key Dietary Recommendations
Here's a breakdown of dietary recommendations for children with JIA.
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1. Fiber-Rich Foods
Research indicates that a diet rich in fiber can protect against inflammation. Jennifer Hyland, RDN, from the Pediatric Nutrition Support Team at Cleveland Clinic, advises, “So, instead of white rice, white bread and processed snacks, opt for whole grain varieties of these foods.” Good sources of fiber include:
- Quinoa
- Sweet potatoes
- Beans
- Lentils
- Whole grain bread
2. Clean Protein
Protein is essential for growth, development, and supporting the immune system. Rajat Bhatt, MD, a rheumatologist based in Houston, Texas, explains, “Protein is important for growth and development and to navigate the added demands of a long-term illness.” Protein also serves as a key building block for muscles and tissues.
3. Colorful Fruits and Vegetables
Plant-based diets have been shown to support health and prevent chronic diseases in adults. Dark green leafy vegetables, rich in folate, are particularly important for children taking methotrexate, as this medication can cause folate deficiencies. The darker and more colorful the produce, the more disease-fighting chemicals it contains. Examples include:
- Beets
- Berries
- Tomatoes
- Cherries
- Broccoli
- Kale
Hyland suggests incorporating colorful vegetables into familiar foods like smoothies, casseroles, and chips.
4. Herbs and Spices
Many herbs and spices possess anti-inflammatory properties. These include:
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- Ginger
- Turmeric
- Cinnamon
- Rosemary
Turmeric, commonly used in curries, contains curcumin, an active ingredient known to reduce inflammation. Ginger can also help with medication-related side effects like nausea and stomach pain.
5. Omega-3-Rich Foods
Omega-3 fatty acids, found in fatty fish like salmon, tuna, and sardines, are beneficial for heart health and have anti-inflammatory effects. However, it's important to monitor the amounts consumed due to potential mercury contamination, which can be risky for a developing brain. Plant sources of omega-3s include walnuts and seeds like flax, chia, and hemp, which contain alpha-linolenic acid (ALA), a precursor to omega-3 fatty acids. The body can convert ALA into omega-3s, but not as efficiently.
6. Calcium and Vitamin D-Rich Foods
Calcium and vitamin D are crucial for building strong bones. Vitamin D also has immune-boosting properties. Costanzo notes, “A lot of kids with arthritis need to take some combination of calcium and vitamin D.” For children with JIA, medications like corticosteroids and methotrexate may limit calcium absorption.
Foods to Limit or Avoid
The typical American diet, high in processed meats, sugar, and chips, can increase inflammatory processes in the body.
1. Sugar
Sugar, found in obvious sources like cookies, cakes, and sweets, as well as less obvious ones like enriched "wheat" bread, ketchup, and salad dressing, can elevate blood sugar levels and contribute to bacterial overgrowth in the gut.
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2. Saturated and Trans Fats
These fats are found in animal products, coconut oil (saturated), and manufactured foods containing partially hydrogenated oils (trans). They can release inflammatory proteins into the bloodstream. Popular high-fat diets like the Keto diet may be problematic due to their high content of fatty and processed meats and butter.
3. Artificial Ingredients
Artificial ingredients like partially hydrogenated oils, high fructose corn syrup, and artificial dyes and sweeteners can further overwhelm the immune system. Bhatt advises steering clear of these substances.
4. Charred Foods
Grilled foods, especially fatty meats and foods charred black, contain more pro-inflammatory compounds. It's better to use stovetop or oven cooking methods instead of grilling or blackening foods.
Addressing Nutritional Challenges in JIA
Children with JIA may face specific nutritional challenges due to the disease itself, medications, and potential food intolerances or allergies.
Appetite and Eating Difficulties
During flares, some children may experience a loss of appetite. Growth can be impaired if children don’t get the necessary amounts of protein and other nutrients required to build bone and muscle. Eating can be challenging given that the disease or the medications used can suppress the child’s appetite. It can also be painful for children with jaw pain to chew or swallow food, and those with arthritis in the hands, fingers or wrists can have difficulty cutting food or opening containers.
In such cases, softer foods that don’t require a lot of chewing or cutting can be used, like oatmeal, scrambled eggs, soups and smoothies. Meals should have enough protein, carbohydrates, fruits, vegetables and healthy fats to help the child’s mind and body grow.
Medication-Related Nutritional Issues
- Methotrexate (MTX): MTX is a folic acid antagonist, leading to potential folic acid deficiencies. Supplementation with folic acid is often recommended to improve gastrointestinal side effects and correct low serum levels. The Methotrexate Advice and Recommended Actions on Juvenile Idiopathic Arthritis (MARAJIA) expert group recommends oral nutrient supplementation (ONS) with folic/folinic acid for the prevention of MTX side effects. The advised dose corresponds to 1/3 of the respective MTX dose for folinic acid, administered >24 h after the weekly MTX dose. For folic acid, the intake of 1 mg/day is advised, skipping the day when MTX is being administered.
- Glucocorticosteroids (GCC): Long-term GCC administration can lead to hyperglycemia, insulin resistance, and growth delay.
Growth and Malnutrition
Children with JIA are prone to malnutrition, encompassing both undernutrition (including underweight and short stature) and overnutrition (overweight and obesity). Short stature, defined as a height-for-age z-score (HAZ) < -2 standard deviations (SD), is a common finding in JIA. The etiology of growth retardation is multifactorial, stemming from frequent infections, the stress associated with chronic illness, the inflammation, the underlying malnutrition and altered body composition, the adverse events of therapy (including CCS treatment), and the delay in pubertal onset, or the slow pubertal progression.
Additional Considerations
- Gluten: For individuals with celiac disease or gluten sensitivity, avoiding gluten-containing foods is essential.
- Nightshade Vegetables: While some believe that nightshade vegetables (eggplant, tomatoes, peppers, and potatoes) can trigger arthritis flares, there's limited scientific evidence to support this theory.
- Family Involvement: "Healthy eating should really be a family affair,” emphasizes Bhatt. Hyland suggests that the family follows a Mediterranean-style diet, which including olive oil, fish and lean protein, fruits, vegetables and nuts and seeds.
The Importance of Professional Guidance
It’s important to recognize that some kids with arthritis may have different dietary needs, depending on which medications they take and if they have any food intolerances or allergies. During flares, some kids may even lose their appetite.
“Work with a dietitian to help ensure your child is meeting requirements for growth and development,” says Costanzo. Consulting with a registered dietitian is crucial to ensure that a child's nutritional needs are met, especially considering individual medication regimens, food intolerances, and allergies. A dietitian can help create a personalized meal plan that supports growth, manages inflammation, and addresses any specific dietary challenges.
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