Vasculitis, a condition characterized by inflammation of the blood vessels, can manifest with diverse symptoms and varying degrees of severity. While medical treatments are essential, dietary modifications can play a supportive role in managing inflammation and alleviating symptoms. This article explores dietary recommendations for individuals with vasculitis, emphasizing anti-inflammatory foods and strategies to mitigate potential side effects of medications.
Understanding Vasculitis and Inflammation
Vasculitis is a disease caused by inflammation in the blood vessels that restricts blood flow and damages organs in the body. Symptoms of vasculitis can appear suddenly or over time, and may worsen at times and improve at others. There are at least 20 forms of vasculitis affecting the large, medium, and small vessels throughout the body. Doctors and researchers don’t fully understand what causes vasculitis, but it’s believed that certain types may be genetic. Having a close family member with vasculitis could increase the probability of developing the disease.
Inflammation is a complex biological response to injury or infection, involving the release of chemicals that trigger white blood cells to repair damaged tissue. However, chronic inflammation can be detrimental, contributing to various health problems, including the progression of vasculitis. It plays a role in the buildup of plaque in your arteries, increasing your risk of heart disease and stroke.
The Role of Diet in Managing Vasculitis
While there's no specific diet that can cure vasculitis, adopting an anti-inflammatory eating pattern can help manage symptoms and potentially reduce disease flares. There is presently no evidence that a person’s diet affects susceptibility to vasculitis, or that consuming or avoiding certain foods or beverages affects the course of the disease. In general, it's advocated to eat a balanced healthy diet rich in protein and vegetables.
Your rheumatologist or vasculitis specialist may recommend following an anti-inflammatory diet to reduce vasculitis symptoms and prevent further inflammation. The Mediterranean diet is a great place to start when exploring anti-inflammatory diets.
Read also: The Hoxsey Diet
Key Principles of an Anti-Inflammatory Diet
Choosing foods to reduce chronic inflammation is about variety. Specific components in food work together to reduce inflammation. Overall, eat a rainbow of fruits, veggies, whole grains and legumes ― all of which have the anti-inflammatory nutrients your body needs.
- Focus on Whole, Unprocessed Foods: Prioritize fruits, vegetables, whole grains, lean proteins, and healthy fats. These foods are rich in nutrients and antioxidants that combat inflammation.
- Limit Processed Foods: Processed and ultra-processed foods, like deli meats, energy drinks and sweetened cereals, can release inflammatory messengers that raise the risk of chronic inflammation. Minimize your intake of processed foods, sugary drinks, and unhealthy fats, as these can promote inflammation.
- Embrace Variety: Specific components in food work together to reduce inflammation. That's why no specific food makes your diet anti-inflammatory.
Foods to Include in Your Vasculitis Diet
Here are some food groups and specific examples to incorporate into your anti-inflammatory diet:
- Fruits and Vegetables: These contain fiber and antioxidants (a group of nutrients that fight free radicals, which can damage cells). They are also an excellent sources of vitamin C and vitamin A. Fresh or frozen varieties (without sauces) are both preferred. If canned fruits and vegetables are consumed, choose low-salt, low-sugar preparations, and make sure to rinse them off before eating. Intake of dried fruit and fruit juice should be limited due to their high sugar content. Aim to have one serving of fruit OR vegetable OR both per meal. A single serving is equal to ½ cup of cooked vegetables or fruit, or one cup of raw vegetables or fruit.
- Whole Grains: Choose whole grains, such as brown and wild rice, whole wheat bread, whole wheat pasta, rye, oats, quinoa, and barley. They are a low-fat source of fiber and energy. It is recommended to eat at least three servings of whole grains a day
- Lean Proteins: Choose lean proteins such as eggs, skinless poultry, lean ground chicken/turkey, fish, lean meats (beef tenderloin, 90/10 ground beef, veal, lamb, pork tenderloin). As far as cooking preparations: broiling, baking, roasting, poaching, or grilling are better options over frying. Meat, fish, and poultry are also excellent sources of zinc, B vitamins, and iron. The recommendation of protein depends on a variety of factors such as activity level and weight, but on average a sedentary man should eat around 56 grams of protein per day and the average woman should consume around 46 grams of protein per day.
- Beans, Nuts, and Seeds: A good source of plant-based protein as well as high in fiber. They provide vitamin E and selenium. Choose unsalted nuts/seeds and their butters (peanut, almond, cashew, walnut, pumpkin seed, sunflower seed etc.). Dried beans/legumes are preferred. If using canned, choose the low sodium option and make sure to drain and rinse. Soy products like tofu, tempeh, and edamame are also great sources of plant-based protein.
- Dairy Products: These are the richest source of calcium − an essential mineral that builds bone and muscle. They also provide zinc, B vitamins, vitamin D, and selenium. Individuals who avoid dairy may choose from lactose-free milk, soy milk, almond milk and other plant-based dairy products that provide calcium. The goal is to consume three servings of dairy products or dairy substitutes per day.
- Healthy Fats: Good fats come mainly from vegetables, nuts, seeds, and fish. One type of healthy fat is called “monounsaturated fats.” Olive oil, peanut oil, canola oil, avocados, and most nuts, as well as high-oleic safflower and sunflower oils are examples of monounsaturated fats. Try to limit solid fats, such as butter, stick margarine, shortening, and lard as they may contribute to heart disease.
- Omega-3 Fatty Acids: These are important as they may reduce inflammation. Good sources include fatty fish (salmon, mackerel, anchovies, sardines, and herring), avocados, ground flaxseed, chia seeds, hemp hearts, walnuts, pecans, canola oil, walnut oil, and flaxseed oil.
Foods to Limit or Avoid
Start by trimming these foods from your grocery list:
- Fried Foods: such as french fries, chips and donuts.
- Processed Meats: like hot dogs, sausage, bacon and red meat.
- Refined Carbohydrates: such as white bread, rice, pasta and pastries.
- Unhealthy Fats: Shortening, lard and margarine, and foods made with these fats.
- Sugary Drinks: Sugar-sweetened sodas, fruit drinks, sweetened teas and flavored coffees.
Additional Dietary Considerations
- Elimination Diet: We have evaluated the effects of an elimination diet in 5 patients with hypersensitivity vasculitis and a personal or family history of allergy. The presence of autoimmune disorders, infections and neoplastic diseases was excluded on the basis of physical examination, clinical history and laboratory data. Three patients had elevated serum immune complexes and evidence of complement consumption before the oligoantigenic diet. In one patient food allergy was diagnosed on the basis of a positive and concordant challenge test, skin prick test and RAST. The study consisted of a 3 week elimination diet, followed by open and double blind challenge tests with specific foods and additives. Four patients achieved a complete remission and one patient experienced great improvement on the elimination diet. In three cases the vasculitis relapsed following the introduction of food additives; in one case with the addition of potatoes and green vegetables (i.e., beans and green peas) and in the last case with the addition of eggs to the diet. The offending foods and additives were subsequently eliminated from the usual diet and no relapses were observed in 2 years of follow-up.
- Hydration: Adequate hydration is crucial for overall health and can help reduce inflammation. Aim to drink plenty of water throughout the day.
- Alcohol and Caffeine: Limit your intake of alcohol and caffeine, as they can sometimes trigger inflammation or interact with medications.
- Individual Sensitivities: Pay attention to how your body reacts to different foods and adjust your diet accordingly. Some individuals may have specific food sensitivities that exacerbate their vasculitis symptoms.
Nutritional Considerations for Myositis and Swallowing Difficulties
Myositis is the name for a group of rare conditions in which some of the main symptoms are weak, painful, or aching muscles and fatigue after walking or standing. Swallowing difficulty (dysphagia) occur in approximately one-third of people with myositis. Swallowing difficulties may be caused by dry mouth and/or muscle weakness. This can lead to complications, such as aspiration pneumonia (food getting stuck in the lungs), inadequate nutrition, weight loss, and dehydration.
- Addressing Swallowing Difficulties: After consultation with your physician, it may be recommended to go for certain tests to further investigate your swallow. You also might be referred to a speech pathologist, who can provide personalized strategies to help you manage your swallowing difficultiesModifying your diet may also be helpful. Some people with myositis find that dry crumbly foods, such as crackers, dry cereal, chips and muffins are harder to eat. Be sure to speak with your healthcare professional about what works best for you, as what works well for one person, may not work for others.
- Maintaining Diet and Proper Nutrition: Patients with swallowing difficulties may find it challenging to follow a balanced diet and get the proper nutrition. Blend nuts/seeds or tofu into smoothies. Add healthy fats, such as nuts/seeds or avocados into smoothies or shakes. Use full fat-Greek yogurt, avocado or tahini (sesame seed paste) in place of mayonnaise for tuna, egg, chicken, or chickpea salads. Cook vegetables until easily mashed with a fork. To help manage weight loss, it may be recommended to incorporate a high calorie, high protein oral nutritional supplements, such as Boost® or Ensure® or using fortifiers like Carnation® Instant Breakfast in smoothies. If severe weight loss is a concern, your doctor may recommend tube-feeding
Managing Medication Side Effects Through Diet
Many medicines that are taken for myositis, including corticosteroids, nonsteroidal anti-inflammatory agents (NSAIDS), intravenous immunoglobulin (IVIG), and immunosuppressants (methotrexate, azathioprine, and cyclophosphamide), may have undesirable side effects. In some cases, nutritional/dietary measures can help lessen these side effects.
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Here are some nutrition suggestions for patients who take specific medications:
- Corticosteroids: These medication act as powerful anti-inflammatory and immunosuppressive agents but also increase the risk of developing other conditions, such as type 2 diabetes, high blood pressure, heart disease, and obesity.
- Calcium and vitamin D: Corticosteroids can cause or worsen osteoporosis, a disease in which bones become fragile and more likely to break. Consuming adequate calcium daily is important for bone health. Vitamin D helps the body absorb the calcium, so having your blood levels of vitamin D checked and taking a supplement as indicated will be helpful in bone health.
- Sodium: Corticosteroids can elevate blood pressure, so limiting sodium may be important.
- Sugar: Corticosteroids can cause an increase in blood sugars.
- Intravenous immunoglobulin (IVIG): This may have side effects, the most common of which may include headaches, chills, dizziness, fever, nausea and vomiting, increased blood pressure and fatigue. To maintain proper nutrition during treatment, prepare foods that you can tolerate in advance, or, if possible, consider getting help with food shopping and meal preparation. Maintaining adequate hydration is also important during IVIG infusions.
- Immunosuppressants: Sun-sensitivity is associated with these drugs. It is important to have your doctor check your vitamin D levels, regardless of sun exposure, as vitamin D deficiency is very common. In addition, you may need increase your intake of folic acid, which can be found in dark leafy green vegetables, beans, nuts, whole grains, and seafood. Immunosuppressants may cause nausea, fatigue, fever, stomach pain, and associated decreased appetite, try to consume small frequent meals that are easy to digest.
- Anti-inflammatories: Stomach irritation can occur when taking aspirin or NSAIDs (ibuprofen, naproxen, celecoxib). Avoid taking on an empty stomach. When taking NSAIDs, you may need to steer clear of supplements that can act as blood thinners such as vitamin E and fish oils.
The Role of Vitamins, Minerals, and Supplements
While vitamins, minerals and supplements may be helpful for some people with myositis, it is important to consult your physician before starting any supplements as they can interact with medications. Unlike drugs, these products are not regulated by the FDA. There is also a lack of solid evidence/research to conclusively determine the effectiveness of many supplementsIn general, consuming a well-balanced diet is recommended and then using supplements to support getting what your diet may be lacking. Here are some of the supplements that may provide some benefit:
- Creatine: This is studied in muscle diseases, and it is thought to build muscle. This supplement is found naturally in meat and fish, though cooking slightly decreases the level. High doses have been found to harm the kidneys; however, these findings involve the long-term use of creatine in athletes. Consultation is advised if considering creatine supplementation.
- Fish oil: Fish oil may play a role in chronic heart and autoimmune disease by reducing inflammation. Fish oils contain large amounts of Omega-3s, EPA and DHA. Caution should be taken when using fish oils. Speak to your physician if you are taking fish oil and if surgery is planned or if taking blood thinners.
- Calcium and vitamin D: These have bone-building nutrients that may help to prevent or slow down the progress of osteoporosis. In addition to dairy products, calcium can be found in wild salmon and sardines (with bones), enriched/fortified soy milk and nut-based milks, shitake mushrooms, broccoli, kale, and fortified breakfast cereals. The body can only absorb 500 mg to 600 mg of calcium at a time, so it is recommended to take two supplements spread apart, like morning and night. The amount of vitamin D an individual needs per day varies from person to person and should be discussed with the individual’s physician
- Coenzyme Q10(CoQ10): Lower levels of this enzyme have been found in people with muscle diseases, but lack of research makes it difficult to know what the benefits of supplements are for people with myositis.
- Glucosamine: This is thought to play a role in cartilage, ligament, tendon, and muscle repair and used in combination with chondroitin to reduce joint pain in arthritis. However, there is a lack of research and evidence that this can help people with myositis.
Lifestyle Factors to Complement Your Diet
Food isn't the only way to reduce inflammation in the body. Boost the results of what you eat by maintaining a healthy body weight, since weight loss is anti-inflammatory.
Stress is a known cause of inflammation. Incorporating stress-reducing activities into your daily routine can help reduce inflammation that may lead to flares or worsen vasculitis symptoms. Mindfulness meditation has been shown to help reduce stress.
Often described as the “stress hormone,” chronically high cortisol levels can worsen inflammation and impact immune function. Prioritizing stress management is essential for long-term remission. Create a comfortable environment that’s cool but not cold, and choose pillows and mattresses that support your back and neck. If you’re struggling with sleep. Remember to listen to your body and rest when tired.
Read also: Weight Loss with Low-FODMAP
Smoking damages blood vessels, increases inflammation, and exacerbates vasculitis symptoms.
However, it is recommended to avoid high-impact exercises that may inflame joints and stress muscles.
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