Juvenile Arthritis & Nutrition: Understanding the Facts, Demystifying Trends. Laura Gibofsky, MS, RD, CSP, CDN July 25, 2015

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1 Juvenile Arthritis & Nutrition: Understanding the Facts, Demystifying Trends Laura Gibofsky, MS, RD, CSP, CDN July 25, 2015

2 Overview There are no foods that cause Juvenile Arthritis (JA) or that can cure it In general, people with JA should aim to eat a well balanced diet that includes plenty of fruits, vegetables, and whole grains. It should also include low-fat dairy and lean protein choices, with an emphasis on oily fish

3 Support optimal growth, development and health Establish healthful eating habits that prevent immediate health conditions Promote lifelong behaviors to reduce the risk of chronic diseases DIET

4 JA & Diet Support optimal growth and development Prevent immediate health conditions Reduce the risk of chronic diseases Combat the side effects of medications Achieve or maintain a healthy weight Maintain strong bones and muscles Good nutrition is an important part of an overall treatment plan for the disease

5 Build A Healthy Plate 1. Make half your plate vegetables and fruit 2. Add lean protein 3. Include whole grains 4. Don t forget the dairy 5. Avoid extra fat and other hidden calories

6 1. Eat more fruits & vegetables Provide essential vitamins and minerals, fiber, and other substances that are important for good health Naturally low in fat and calories and are filling

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8 Daily recommendation of vegetables Age (years) Girls Boys cup 1 cup ½ cups 1 ½ cups cups 2 ½ cups ½ cups 3 cups In general, 1 cup of raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens can be considered as 1 cup from the Vegetable Group

9 Daily recommendation of fruit Age (years) Girls Boys cup 1 cup to 1 ½ cups 1 to 1 ½ cups ½ cups 1 ½ cups ½ cups 2 cups In general, 1 cup of fruit or 100% fruit juice, or ½ cup of dried fruit can be considered as 1 cup from the Fruit Group

10 2. Go lean with protein Both animal & plant sources Choose lean or low-fat cuts of meat Avoid processed meats Try grilling, broiling, roasting, or baking

11 Daily recommendation of protein Age (years) Girls Boys ounce equivalents 2 ounce equivalents ounce equivalents 4 ounce equivalents ounce equivalents 5 ounce equivalents ounce equivalents 6 ½ ounce equivalents In general, 1 ounce of meat, poultry or fish, ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds can be considered as 1 ounce equivalent from the Protein Foods Group

12 3. Make half your grains whole Choose 100% whole-grain breads, cereals, crackers, pasta, and brown rice Barley, rolled oats, millet, bulgur, quinoa, oatmeal, buckwheat, wild rice, whole wheat Good source of fiber Look for the word whole at the beginning of the ingredient list

13 TOO MANY CHOICES!! HOW DO I CHOOSE? Look for labels that say "100% whole wheat" or "100% whole grain" The first ingredient listed in the ingredient label should be whole-wheat flour or 100% whole-wheat flour Just because it is brown and has the word "wheat" in the name DOES NOT MAKE IT HEALTHY

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15 Daily recommendation of grains Age (years) Girls Boys ounce equivalents 3 ounce equivalents ounce equivalents 5 ounce equivalents ounce equivalents 6 ounce equivalents ounce equivalents 8 ounce equivalents In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or ½ cup of cooked rice, cooked pasta, or cooked cereal can be considered as 1 ounce equivalent from the Grains Group MAKE HALF YOUR GRAINS WHOLE

16 4. Fill up the bone bank! During childhood, adolescence and early adulthood, calcium is crucial for building the densest bones possible Vitamin D is equally important as it helps absorb calcium in the gut Critical for children taking steroids

17 Calcium Dairy products such as lowfat and non-fat milk, yogurt and cheese Canned sardines and salmon (with bones) Build Strong Bones Vitamin D Fatty varieties of fish such as salmon, mackerel, tuna and sardines Some dairy products are fortified with Vitamin D Fortified Foods- Calcium and vitamin D are sometimes added to certain brands of juices, breakfast foods, soy milk, rice milk, cereals, snacks and breads

18 What if my child can t eat dairy? Lactose intolerance Dairy allergy Non- dairy sources of calcium and Vitamin D No evidence that dairy aggravates the disease Avoidance of dairy products is concerning during bone building years MUST tell your doctor if your child is not taking any dairy products

19 Daily recommendation of dairy Age (years) Girls Boys cups 2 cups ½ cups 2 ½ cups cups 3 cups cups 3 cups In general, 1 cup of milk, yogurt, or soymilk (soy beverage), 1 ½ ounces of natural cheese, or 2 ounces of processed cheese can be considered as 1 cup from the Dairy Group

20 5. Choose Fats Wisely Bad Fats Good Fats Saturated Monounsaturated Trans Polyunsaturated EAT LESS EAT MORE

21 1. Animal products Bad Fats: EAT LESS Fatty cuts of meat Poultry with the skin Dairy products Butter and lard Sauces and gravies made from animal fat 2. Vegetable oils and shortening Coconut oil Palm oil Palm Kernel Oil Margarine Vegetable shortening

22 Unsaturated fat Some studies show association with lower inflammation Limited studies in pediatric population Plant based foods Oils: Olive, canola, corn, soybean, safflower, sunflower, flax Nuts: almonds, peanuts, cashews, hazelnuts, macadamias, pistachios, walnuts, brazil nuts, pine nuts, pecans Olives Avocados Omega-3 Good Fats: EAT MORE Fatty Fish: Halibut, trout, tuna, mackerel, salmon, herring, sardines

23 Practice Portion Control Serving = specific measured amount (1 cup of cereal or 1 cup of milk) When you read nutrition labels, the nutrition content of the food is based on a serving size Portion = amount you choose to eat may be more or less than a serving

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25 Which one has the most calories?

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34 Juvenile Arthritis and Celiac Disease Both are autoimmune diseases No conclusive evidence to suggest direct link More research needed

35 Should my child be on a gluten free diet?

36 Tips for managing nausea Avoid foods with strong odors Avoid greasy and fried foods Eat small meals slowly and more frequently Drink cold fluids slowly or through a straw Try dry, starchy, or salty foods (ex: pretzels, saltines, potatoes) Talk to your doctor

37 A note about supplements Supplements are unregulated, the quality and content may vary widely More studies need to be done to confirm the safety and effectiveness of the supplements ALWAYS CONSULT YOUR DOCTOR

38 Conclusion Encourage healthy eating habits Have regular family meals Serve a variety of foods and snacks Be a role model Avoid battles over food Involve kids in the process

39 Resources

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