Polymyalgia rheumatica (PMR) is a common inflammatory disorder primarily affecting individuals over 70, though rarely seen in those under 50. It is characterized by pain and stiffness, usually in the shoulders and upper body. While there's no known cure, and the exact cause remains unclear, treatment mainly focuses on symptom management. Typically, this involves corticosteroids, but dietary changes can also significantly impact symptoms. This article explores how diet influences PMR symptoms, outlining which foods to eat and avoid.
Understanding Polymyalgia Rheumatica
PMR is an inflammatory condition where the body mistakenly triggers inflammation in the joints, even without any harmful substances present. Inflammation, the body's natural response to protect against harmful germs, involves drawing extra blood and white blood cells to the affected area, leading to swelling, stiffness, and pain. In PMR, this process occurs even when there are no germs to fight.
Common symptoms of PMR include:
- Muscle stiffness
- Joint pain
- Swelling around the joints
- Fatigue
- Appetite loss
- Weight loss
It's important to note that PMR is distinct from fibromyalgia, which isn't an inflammatory condition. PMR can also lead to more severe conditions, such as giant cell arteritis.
The Role of Diet in Managing PMR Symptoms
A healthy diet is crucial for everyone, but for those with PMR, the foods consumed can significantly impact symptoms. Certain foods can either aggravate or suppress joint inflammation and pain. Eating the right foods can support the immune system and potentially prevent inflammation from starting, while also combating potential medication side effects like high blood sugar, weight gain, sleeplessness, osteoporosis, bruising, and cataracts.
Read also: The Hoxsey Diet
While no specific diet is proven to make PMR significantly better or worse for most, individual reactions to foods vary. It's essential to pay attention to which foods help you feel your best and keep track of them. A well-balanced diet that includes all major food groups is also crucial.
Foods to Embrace: An Anti-Inflammatory Approach
The cornerstone of a PMR-friendly diet is incorporating foods with anti-inflammatory properties. These foods contain chemical compounds known to reduce joint inflammation and pain.
Anti-Inflammatory Powerhouses
- Nuts: Almonds, walnuts, and other nuts offer healthy fats and anti-inflammatory compounds.
- Fruits: Berries, tomatoes, and oranges are packed with antioxidants and vitamins.
- Leafy Greens: Spinach, kale, and collard greens provide essential nutrients and anti-inflammatory benefits.
- Cold Water Fish: Salmon, tuna, and sardines are rich in omega-3 fatty acids.
- Tofu: A plant-based protein source with anti-inflammatory properties.
- Whole Grains: Provide fiber and nutrients without promoting inflammation.
- Green Tea: Contains antioxidants that combat inflammation.
- Olive Oil: A healthy fat source with anti-inflammatory benefits.
The Mediterranean and DASH diets exemplify eating plans that emphasize these anti-inflammatory foods.
Omega-3 Fatty Acids: Reversing Inflammation
Omega-3 fatty acids can help reverse immune system responses to inflammation and protect against PMR recurrence. These healthy fats can be obtained from:
- Fish (salmon, sardines)
- Walnuts
- Flax seeds and flaxseed oil
- Chia seeds
- Leafy greens
Studies have shown that fish oil has anti-inflammatory effects in people with rheumatoid arthritis, inflammatory bowel disease, and asthma, suggesting that omega-3s can have anti-inflammatory effects in people with a wide range of conditions.
Read also: Walnut Keto Guide
Calcium and Vitamin D: Protecting Bone Health
Steroid treatment for PMR increases the risk of osteoporosis, fractures, and bone damage. Adequate calcium and vitamin D intake are crucial.
Calcium-Rich Foods:
- Spinach
- Broccoli
- Soybeans
- Chickpeas
- Almonds
- Calcium-fortified juices
- Sardines with bones
- Non-dairy milk (soy, almond, hemp, and rice)
- Okra
- Kale
Vitamin D Sources:
- Tuna
- Egg yolk
- Salmon
- Beef liver
- Fortified non-dairy milk
- Fortified breads
- Fortified dairy products
- Direct exposure to sunlight (preferably at noon)
Hydration: Combating Inflammation
Staying hydrated is important for combating inflammation. Adults should aim for 2-3 liters of fluid per day. Carry a reusable water bottle to track intake. For flavor, add lemon, lime, or orange slices.
Coffee Consumption
Coffee's effects on inflammation vary. Some experience anti-inflammatory benefits, while others see increased inflammation. Monitor your symptoms after drinking coffee. If symptoms improve, moderate consumption may be acceptable. If symptoms worsen, consider decaf or herbal tea.
Boosting Steroid Production (Further Research Needed)
Some foods and supplements, like curcumin (turmeric), devil’s claw, methyl-sulfonyl-methane, Boswellia (frankincense), and willow bark, have shown pain-relieving properties in arthritis and fibromyalgia. While direct evidence for their effects on PMR is lacking, they may be worth exploring.
Foods to Avoid: Minimizing Inflammation
Abstaining from foods that promote inflammation is essential when following a healthy diet for PMR.
Read also: Weight Loss with Low-FODMAP
Inflammation Triggers
- Deep-fried foods: High in unhealthy fats and inflammatory compounds.
- Red meat: Can contribute to inflammation in some individuals.
- Refined and/or processed foods: Including meats, oils, and grains, often contain additives that promote inflammation.
- Refined carbohydrates: such as white bread or white rice
- Sugary drinks
- Processed meats: such as salami or hotdogs
- Margarine
- Foods with added sugar
- Alcohol
When shopping for processed foods like cereals, prepackaged meals, and condiments, carefully read food labels.
Gluten and Sugar
Some individuals may be intolerant to gluten, the protein in wheat, barley, and rye. Excessive sugar intake is also inflammatory and may cause weight gain.
Processed Foods
Processed foods may increase inflammation and lead to weight gain, putting more pressure on muscles and joints affected by PMR, worsening pain.
Sample Meal Plan for PMR
This meal plan provides options for each meal and snacks, focusing on anti-inflammatory foods and essential nutrients.
Breakfast:
- A bowl of fortified cereal with dairy or plant-based milk, flaxseeds, and blueberries.
- Eggs and salmon on wholemeal bread.
Lunch:
- A turkey breast sandwich on wholemeal bread (use home-cooked turkey instead of packaged slices).
- A tuna salad.
Dinner:
- Baked cod with steamed vegetables.
- Chicken and steamed vegetables with brown rice.
Snacks:
- A mix of walnuts and almonds.
- Fresh fruit.
Additional Lifestyle Considerations
Physical Activity
Regular physical activity is crucial for managing PMR symptoms and preventing medication side effects. While strenuous activities should be avoided, light exercise can improve symptoms and overall well-being.
Recommended Activities:
- Daily walks
- Bike rides
- Swimming
- Gardening
- Household chores
Cardio exercise helps maintain a healthy weight, reducing stress on affected bones and joints, and promotes heart health. Lifting light weights can also reduce the risk of osteoporosis by building bone density. Consult your doctor before starting any new workout routines.
Self-Care Strategies
Healthcare professionals may suggest nonsteroidal anti-inflammatory medicines you get without a prescription to ease symptoms of polymyalgia rheumatica.
Diagnosis and Treatment
Diagnosis
A physical exam and lab tests can help your healthcare professional find the cause of your pain and stiffness. The exam may include checking your joints and nervous system, called a neurological exam. During the exam, your healthcare professional might gently move your head and limbs to check their range of motion.
Your diagnosis might change during treatment. Blood tests. Besides checking your complete blood counts, your healthcare professional looks at two lab tests for signs of irritation and swelling, called inflammation. These tests are erythrocyte sedimentation rate, also called sed rate, and C-reactive protein. Not everyone with the condition has high levels of these proteins in their blood, but most do. Imaging tests. An ultrasound can tell whether you have inflammation of the joints and soft tissues and can help in the diagnosis of polymyalgia rheumatica. Some people have an MRI or a PET scan to look for other causes of joint pain. Watching for giant cell arteritisYour healthcare professional watches you for symptoms that can mean the onset of giant cell arteritis. New headaches or headaches that don't go away. Jaw pain or tenderness. Blurred or double vision or vision loss. Tender scalp. To confirm a diagnosis of giant cell arteritis, you may have an ultrasound or a biopsy of an artery in one of your temples. A biopsy involves removing a small sample of the artery for study under a microscope. The biopsy is done with a numbing medicine in the area where the artery is removed.
Treatment
Treatment most often involves medicines to help ease your symptoms. Corticosteroids. A low dose of a corticosteroid you take by mouth, such as prednisone, most often treats polymyalgia rheumatica. You may feel rapid relief from pain and stiffness in 1 to 3 days. After 2 to 4 weeks of treatment, your healthcare professional might start to lower your dosage slowly. This depends on your symptoms and the results of blood tests. Because corticosteroids have side effects, the goal is to have you take the lowest dose that keeps symptoms from coming back. Many people with polymyalgia rheumatica need to have the corticosteroid treatment for 1 to 2 years or more. You have follow-up visits with your healthcare team often. This is to see how the treatment is working and to watch for side effects. Long-term use of corticosteroids can result in serious side effects. These may include weight gain, bone thinning, high blood pressure, diabetes and cloudy areas on your eyes that can lead to vision loss, called cataracts. Your healthcare team watches for side effects. You might need to change your dose or take medicines to manage corticosteroid treatment side effects. Calcium and vitamin D. You may take daily doses of calcium and vitamin D supplements to help prevent bone loss from corticosteroid treatment. Methotrexate (Trexall). Guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using methotrexate with corticosteroids in some people. This is to lower the dose of corticosteroids or for relapses. You take methotrexate by mouth to lower your immune system response. You may take it early in your treatment. Or you may take it later if symptoms return or corticosteroids don't work well enough. Sarilumab (Kevzara). Food and Drug Administration has approved this medicine for people whose symptoms return. This medicine works by blocking a substance in the body that causes inflammation. You take this medicine as a shot every two weeks. It may relieve symptoms with a lower dose of corticosteroids. Physical therapyMost people who take corticosteroids for polymyalgia rheumatica return to the level of activity they were at before they got the condition. But if you've had to limit your activity for a time, physical therapy may help. Talk with your healthcare team about whether physical therapy is a good choice for you.
Tips for Adopting a Healthy Diet
- Take it one day at a time. Changing habits takes a long time. Start by trying to make one small change. For example, you could start by drinking an extra glass of water every day next week. Or replace your go-to processed snack with baby carrots or fresh fruit.
- Recruit help. Meal planning and cooking with your family or a friend will make you more likely to follow through and help you feel less isolated in your efforts.
- Plan and prepare. It’ll be easier to stick to your new diet if your kitchen is stocked with all the right food. Set aside a couple hours to plan out your meals for the next week. Make a shopping list and do any prep work now, like dicing vegetables, to make it easier to prepare healthy meals during the week.
- Experiment with flavor. Convinced you don’t like something? Try cooking it and seasoning it in new ways. For example, if salmon isn’t your favorite fish, try spreading a thin layer of honey and mustard over it before baking. Salmon is a good source of omega-3, and the honey-mustard topping can help mask the distinct flavor of the fish.
- Consider an elimination diet of one or more of the common allergies and intolerances, such as nuts, soy, gluten, dairy, eggs, or shellfish, to see if your symptoms improve.
- Offer nonfood rewards.
tags: #polymyalgia #rheumatica #diet