"Dietary habits should last a lifetime"
Josefine Nelson is a physiotherapist and nutritionist and is studying for a master's degree in immunology and microbiology. Right now she is part of a project investigating the impact of diet on disease activity for people with RA, specifically focusing on antioxidants.
Who are you?
My name is Josefine Nelson and I am a licensed physiotherapist and nutritionist. At my physiotherapy practice, I met many people with arthritis who had a lot of questions about whether diet can affect wellbeing. In my role as a physiotherapist, I could not give any advice and that made me feel slightly restricted. Diet has always been something I am interested in and I thought it would be ideal to investigate it properly, which led me to study to become a nutritionist. I continued my education and I am currently studying for a master's degree in immunology and microbiology at Uppsala University.
Tell us about the literary projects that you have participated in?
During my master's studies, I chose to do literature projects focusing on people with rheumatoid arthritis (RA). The goal was to see if there are any differences between healthy people and people with RA in terms of nutritional status, body composition and intestinal flora.
A general project conclusion is that some biomarkers of nutritional status are lower in RA patients, for example vitamin D, vitamin B6, zinc and folic acid. There was also a high proportion of malnourished RA patients. By using methods measuring the percentage of muscle and fat tissue, it was discovered that in two individuals with the same BMI, patients with RA had more body fat tissue around the abdomen and less muscle mass, mainly on the upper body. No conclusions can be drawn from these studies, but it can be an interesting topic to further explore.
What are you doing right now?
Recently, a study was published on dietary interventions for RA which I co-authored. In that study the results from 27 studies were summarized. We found moderate confidence for the fact that Mediterranean diet, ginger, cinnamon, saffron and the antioxidants quercetin and ubiquinone, as well as probiotics with the bacterium Lactobacillus Casei, seemed to have an effect on disease activity in RA. Cranberry juice, folic acid and alpha-lipoic acid appeared to have moderate confidence in having no effect on disease activity. No conclusion can be drawn from the above as more research is needed to confirm the results. (1)
I am currently working on data from a study called the ADIRA study. ADIRA stands for Anti-inflammatory Diet In Rheumatoid Arthritis and the aim is to investigate whether a diet composed of potentially anti-inflammatory foods can reduce disease activity in patients with RA. (2)
The study was conducted by handing out lunch boxes to two groups of people with rheumatism. The differences between the two groups' foods included protein, fat and fat quality. For example, the study-group received fish three to four times a week, vegetarian meals once or twice a week, potatoes, whole grains, more vegetables, spices and yogurt sauce. They also received low-fat dairy products, pomegranate, blueberries and nuts as well as a juice shot with probiotics.
Eating meat less than three times a week was also recommended as well as more than five servings of fruits, berries and vegetables. Oil was recommended instead of margarine, low-fat dairy products and whole grains were also on the recommended list. These recommendations do not differ much from the so-called Mediterranean diet, with the exception of probiotics.
By using the data from the study we examine the total antioxidant value of the diets. The reason why we are looking at antioxidants is that it is believed that it may have an effect on inflammation and could therefore reduce the disease activity in RA.
What dietary advice can you give today?
There is evidence-based general dietary advice. Specifically for rheumatism there is some support for the Mediterranean diet, which is actually very similar to the general dietary recommendations for us all. Many people have their own idea of what they think is good for them. It is great if you get the feeling that you feel better about something specific, even though there may not be scientific evidence for it. I still want to point out that it is important to think twice before starting experimenting with your diet. You will have to make sure you eat what is needed for you to stay healthy.
I would have liked to create an educational project where one can learn more about what a nutritious diet is. It is good to learn how to interpret the nutrition information on the labels of what you buy, to simply prepare yourself to be able to make healthier decisions. In addition, it is important to learn what is good research that can be trusted. To read a study that seems to have great results when it comes to, for example, turmeric, but when you look deeper into the study, it says that they have injected highly concentrated turmeric into mice. Then you understand that it is inadvisable to take things literally.
If you want to start eating better, what is the first step?
My advice is to start with a small change. If you change a lot at once, it often becomes difficult to get it to last over time. Add more vegetables, fruits and choose more whole grain products. It can be a good idea to choose dairy products with low-fat content, to remove saturated fats. Cut down on red meat, eat more fish and vegetarian food. It should also, of course be pleasurable to eat food and to find alternatives that you think are tasty. It should not be a nuisance to eat something you do not think tastes good, just because it is healthy.
Eat more fruits and vegetables - preferably at least 500 grams a day.
Eat seafood - preferably two to three times a week.
Switch to whole grains in bread, cereals, groats, pasta and rice.
Switch to healthy fats - choose, for example, rapeseed oil or liquid fats.
Switch to low-fat dairy products - preferably unsweetened and fortified with vitamin D.
Eat less red and cured meat - preferably less than 500 grams per week.
Eat less salt - and use salt with iodine.
Eat less sugar - especially in sweet drinks (3)
Try to adopt habits that match your lifestyle and what you're willing to make last a lifetime. That is more important than making a big change that is not sustainable.
References and published articles:
Nelson, J.; Sjöblom, H.; Gjertsson, I.; Ulven, S.M.; Lindqvist, H.M.; Bärebring, L. Do Interventions with Diet or Dietary Supplements Reduce the Disease Activity Score in Rheumatoid Arthritis? A Systematic Review of Randomized Controlled Trials. Nutrients 2020, 12, 2991.
Vadell AKE, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity (2020).