Weight Loss Strategies to Help Ease Osteoarthritis Pain
WebMD Feature
By Denise Mann
Reviewed By Brunilda Nazario, MD
It makes perfect sense if you think about it: carting around extra weight in your middle, for example, places a burden on your knees and hips. And study after study shows that this extra stress can put you at risk for developing osteoarthritis (OA), the wear-and-tear form of the disease. Being overweight or obese will also amplify your pain and make it harder for you to remain active and independent if you've already got OA.
With obesity rates soaring, it's no wonder that 27 million Americans now have OA, according to the Arthritis Foundation. But modest weight loss -- dropping just 10 to 15 pounds -- can make a huge difference in your knee and hip OA pain, and may even postpone or prevent joint replacement surgery.
As of now, there are no medications that can help modify or stop the OA disease process once it has started, so weight loss and exercise have become increasingly important.
"Being overweight puts too much pressure on the joint, and stresses the tendons and a number of other structures around the joint like your muscle," explains Emilio B. Gonzalez, MD, chief of rheumatology at University of Texas Medical Branch in Galveston. "Overweight people usually develop accelerated osteoarthritis in their weight-bearing joints like hips and knees, so one of the treatment strategies is to lose weight."
Weight Loss and OA: Any loss Will Do
"Any weight loss can make a difference in pain control and delaying the progression of the condition," Gonzalez says. "In some cases, we can prevent the need for surgery, but this depends on how advanced the OA is."
Many orthopaedic surgeons won't even do the surgeries if you are overweight, so there is really no way to feel better without first slimming down, he says. Being overweight increases the risk of any surgery, including joint replacement.
His prescription? "Lose weight if you can, and exercise a little bit," he suggests. "The best exercise is aquatic because your body floats and there is no extra pressure placed on the joints and muscles."
Walking can also aid weight loss efforts. "The best surface to walk on is grass or a softer surface because pounding on concrete can increase tendon damage," Gonzalez says.
"If you achieve significant weight loss, you will get symptomatic relief," says Michael Parks, MD, an assistant attending orthopaedic surgeon at the Hospital for Special Surgery in New York City."There is no hard and fast number," Parks says. "It varies from patient to patient."
"If you decrease your body size, the load on your knees will go down," agrees Laura Thorp, PhD, an OA researcher at Rush University Medical center in Chicago. Higher than normal knee loads are characteristic of knee OA and progression, she explains. A study in Arthritis & Rheumatism showed that losing just 1 pound resulted in a fourfold reduction in knee joint load among overweight and obese people with knee osteoarthritis.
Weight Loss and OA: What Are You Waiting For?
But if losing weight were really so easy, wouldn't more people do it?
Yes, says David Felson, MD, a professor of medicine and public health at Boston University School of Medicine. "If we could only get people to adhere to weight loss and exercise regimens, we could forestall and even prevent the need for total knee replacement," he says. "Weight loss and exercise are the initial therapies for OA and the thing we speak to everyone about."
The trick is to set people up to succeed, not fail, he says.
"I usually tell my OA patients to lose 10 to 15 pounds," Felson says. "I do not want to create an impossible goal because unless they have bariatric surgery, losing 50 pounds is probably not reasonable."
"I say, 'look, let's keep this reasonable: how can we help you lose 10 to 15 pounds?'"
Being more active is just one part of the equation, he says. "I may recommend a nutritionist to help with diet, and then I will review their favorite foods and their calories and healthier substitutes with them."
Choosing whole-grain over white-bread products is a good place to start. Whole-grain products such as oatmeal and whole-wheat bread and pasta are better sources of fiber than their refined counterparts (white bread and white pasta). The more fiber a food has, the more full you feel, and the less likely you are to overeat.
Wednesday, April 20, 2011
Tuesday, April 19, 2011
Treating Rheumatoid Arthritis: The Role of Biologics
4 Inflammation-Fighting Foods for Rheumatoid Arthritis
WebMD Medical Reference
Reviewed By Brunilda Nazario, MD
The centuries-old Mediterranean diet may be as good for the joints as it is for the heart.
Rheumatoid arthritis (RA) sufferers know all too well the inflammation and pain that comes with the disease. Although there's no "RA diet" that can treat the condition, some foods may help you lower inflammation in your body. And because they're good for you, these foods -- including fruits and vegetables, whole grains, olive oil, and fish – may help you feel better overall.
An Age-Old RA diet
People with RA have immune systems that attack the lining of their joints. This assault causes chronic inflammation, stiffness, and pain. Research shows the Mediterranean diet's healthful components can help lower inflammation, benefiting people with the disease.
A British study looked at the impact of foods from the Mediterranean diet in women with RA. Researchers split 130 women into two groups. One group took a cooking class on Mediterranean-style eating. The other group received only written information and made no dietary changes.
Women who attended the class ate more foods that were rich in antioxidants and other anti-inflammatory substances, including fruits, vegetables, and monounsaturated fats (the kind found in olive oil). Over the next six months, they had less joint pain and morning stiffness and better overall health compared to the other group.
How can you add these foods to your plate? Here are four foods to try.
Inflammation Fighter: Fish
People with RA have higher levels of substances called cytokines that ramp up inflammation in the body. Polyunsaturated fats – especially omega-3 fatty acids – help suppress cytokines and other inflammatory chemicals.
These good fats also help decrease LDL "bad" cholesterol and triglyceride levels when used to replace saturated and trans fats in the diet. High levels of LDL cholesterol and triglycerides (fats in the blood) promote inflammation, which is thought to play a critical role in heart disease. That's important for people with RA, who have a significantly higher risk of heart disease.
All fish have some omega-3s. But salmon, herring, sardines, and anchovies are chock full of them. Salmon provides the most, with up to 2 grams of omega-3 fatty acids per 3-ounce serving. Go lightly with the heat; overcooking can destroy more than half of the omega-3s. Bake or grill fish instead of frying it to preserve healthful fat.
The American Heart Association recommends eating fish twice a week. Fish high in omega-3s are powerful anti-inflammatory foods that offer a multitude of health benefits.
Don't like fish? Other foods rich in omega-3 fatty acids include walnuts, canola oil, and soybeans. Or ask your doctor about omega-3 supplements derived from plants.
Foods for RA: Colorful Produce
Nutritionists often advise people to add color to their diet. Why? The substances that give fruits and vegetables their color – flavonoids and carotenoids – are also potent antioxidants. Antioxidants are an important component of an inflammation-fighting diet. Vitamin C is another antioxidant found in many fruits and vegetables.
Fruits and veggies high in these antioxidants include blueberries, blackberries, squash, sweet potatoes, carrots, tomatoes, peppers, oranges, broccoli, and melons.
Choosing colorful foods – with red, orange, yellow, blue, green, and purple hues – will ensure you eat a variety of fruits and vegetables and help you have a balanced diet.
Anti-Inflammation Diet: Whole Grains
A study published in The American Journal of Clinical Nutrition found that people who ate more whole grains such as oatmeal, brown rice, and barley lowered their levels of C-reactive protein (CRP), a marker of inflammation in the body. In people with RA, CRP levels may go up during a flare, and CRP is sometimes measured to track disease activity or to see how well a person is responding to treatment.
Whole-wheat pasta and breads -- hallmarks of the Mediterranean Diet -- also contain selenium, an inflammation-fighting antioxidant. Some people with rheumatoid arthritis have lower levels of selenium levels in their blood.
Another advantage of eating whole grains instead of refined carbohydrates – such as white bread and white rice – is that whole grains may help you manage your weight better. Staying at a normal weight – or losing weight if you need to – will take pressure off painful joints.
Foods for RA: Olive Oil
The olive symbolizes peace in Greek mythology. And its oil seems to have a calming effect on inflammation, as well.
A study published in The American Journal of Clinical Nutrition found that people who ate the lowest amount of extra-virgin olive oil were more likely to develop RA, compared to people who ate the highest amounts. Studies show that a compound in olive oil stops the production of the chemicals that induce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen work to lower inflammation by reducing the production of these same chemicals. Another study found that olive oil was similar to ibuprofen at reducing inflammation.
When it comes to fighting inflammation, opt for extra-virgin olive oil. Extra-virgin olive oil comes from the first pressing of the olive and contains the highest content of health-promoting nutrients.
In addition to being a crucial component of an anti-inflammation diet, healthful olive oil makes a tasty substitute for saturated and trans fats. Saturated fats are found in foods such as whole milk, butter, ice cream, and fatty red meat. Trans fats are found in many processed baked goods.
WebMD Medical Reference
Reviewed By Brunilda Nazario, MD
The centuries-old Mediterranean diet may be as good for the joints as it is for the heart.
Rheumatoid arthritis (RA) sufferers know all too well the inflammation and pain that comes with the disease. Although there's no "RA diet" that can treat the condition, some foods may help you lower inflammation in your body. And because they're good for you, these foods -- including fruits and vegetables, whole grains, olive oil, and fish – may help you feel better overall.
An Age-Old RA diet
People with RA have immune systems that attack the lining of their joints. This assault causes chronic inflammation, stiffness, and pain. Research shows the Mediterranean diet's healthful components can help lower inflammation, benefiting people with the disease.
A British study looked at the impact of foods from the Mediterranean diet in women with RA. Researchers split 130 women into two groups. One group took a cooking class on Mediterranean-style eating. The other group received only written information and made no dietary changes.
Women who attended the class ate more foods that were rich in antioxidants and other anti-inflammatory substances, including fruits, vegetables, and monounsaturated fats (the kind found in olive oil). Over the next six months, they had less joint pain and morning stiffness and better overall health compared to the other group.
How can you add these foods to your plate? Here are four foods to try.
Inflammation Fighter: Fish
People with RA have higher levels of substances called cytokines that ramp up inflammation in the body. Polyunsaturated fats – especially omega-3 fatty acids – help suppress cytokines and other inflammatory chemicals.
These good fats also help decrease LDL "bad" cholesterol and triglyceride levels when used to replace saturated and trans fats in the diet. High levels of LDL cholesterol and triglycerides (fats in the blood) promote inflammation, which is thought to play a critical role in heart disease. That's important for people with RA, who have a significantly higher risk of heart disease.
All fish have some omega-3s. But salmon, herring, sardines, and anchovies are chock full of them. Salmon provides the most, with up to 2 grams of omega-3 fatty acids per 3-ounce serving. Go lightly with the heat; overcooking can destroy more than half of the omega-3s. Bake or grill fish instead of frying it to preserve healthful fat.
The American Heart Association recommends eating fish twice a week. Fish high in omega-3s are powerful anti-inflammatory foods that offer a multitude of health benefits.
Don't like fish? Other foods rich in omega-3 fatty acids include walnuts, canola oil, and soybeans. Or ask your doctor about omega-3 supplements derived from plants.
Foods for RA: Colorful Produce
Nutritionists often advise people to add color to their diet. Why? The substances that give fruits and vegetables their color – flavonoids and carotenoids – are also potent antioxidants. Antioxidants are an important component of an inflammation-fighting diet. Vitamin C is another antioxidant found in many fruits and vegetables.
Fruits and veggies high in these antioxidants include blueberries, blackberries, squash, sweet potatoes, carrots, tomatoes, peppers, oranges, broccoli, and melons.
Choosing colorful foods – with red, orange, yellow, blue, green, and purple hues – will ensure you eat a variety of fruits and vegetables and help you have a balanced diet.
Anti-Inflammation Diet: Whole Grains
A study published in The American Journal of Clinical Nutrition found that people who ate more whole grains such as oatmeal, brown rice, and barley lowered their levels of C-reactive protein (CRP), a marker of inflammation in the body. In people with RA, CRP levels may go up during a flare, and CRP is sometimes measured to track disease activity or to see how well a person is responding to treatment.
Whole-wheat pasta and breads -- hallmarks of the Mediterranean Diet -- also contain selenium, an inflammation-fighting antioxidant. Some people with rheumatoid arthritis have lower levels of selenium levels in their blood.
Another advantage of eating whole grains instead of refined carbohydrates – such as white bread and white rice – is that whole grains may help you manage your weight better. Staying at a normal weight – or losing weight if you need to – will take pressure off painful joints.
Foods for RA: Olive Oil
The olive symbolizes peace in Greek mythology. And its oil seems to have a calming effect on inflammation, as well.
A study published in The American Journal of Clinical Nutrition found that people who ate the lowest amount of extra-virgin olive oil were more likely to develop RA, compared to people who ate the highest amounts. Studies show that a compound in olive oil stops the production of the chemicals that induce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen work to lower inflammation by reducing the production of these same chemicals. Another study found that olive oil was similar to ibuprofen at reducing inflammation.
When it comes to fighting inflammation, opt for extra-virgin olive oil. Extra-virgin olive oil comes from the first pressing of the olive and contains the highest content of health-promoting nutrients.
In addition to being a crucial component of an anti-inflammation diet, healthful olive oil makes a tasty substitute for saturated and trans fats. Saturated fats are found in foods such as whole milk, butter, ice cream, and fatty red meat. Trans fats are found in many processed baked goods.
Tuesday, April 5, 2011
'Added Sugar' May Add to Weight Gain in U.S.
Study Sees Link Between Weight Gain and Eating Foods With Sugar Added to Ingredients
By Brenda Goodman
WebMD Health NewsReviewed by Laura J. Martin, MD March 24, 2011 -- Researchers taking nutritional snapshots of the population around a major metropolitan area for more than 30 years say they’ve noticed something interesting: as consumption of added sugars has increased, so too, have body weights.
Researchers parsing the myriad reasons for America’s collective growing girth have looked at the contributions of total calories and fat, experts say, but less is known about what role added sugars might play.
Added sugars are sugars in foods that aren’t naturally occurring. They’re mixed in as sugar or syrups during processing or preparation.
The sugar in fruit, fructose, for example, wouldn’t count as an added sugar. But the high-fructose corn syrup that’s added to some kinds of fruit cocktail would fall into that category. So would sugars added to sweeten yogurt, soft drinks, and processed snacks and desserts like cookies, cakes, and pies.
“We’re looking at trends,” says study researcher Lyn M. Steffen, PhD, MPH, an epidemiologist at the University of Minnesota School of Public Health. “We looked at them in women and men, and in both men and women, added sugar intake increased since 1980.”
“At the same time, BMI [body mass index] has also increased,” Steffen tells WebMD. Though the study isn’t designed to prove that one is causing the other, the closely parallel trends over 27 years of data collection may point to the need for closer investigation. “It looks suspicious,” she says.
The study was presented at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions.
Industry Perspective
An industry group that represents sugar producers says the evidence of a connection is lacking.
“A single study, performed by AHA [American Heart Association] or any other group, is inconclusive and needs further investigation,” says Andrew Briscoe, president and CEO of the Sugar Association. “When a major review occurs, the results always come back the same -- there is no scientific evidence to support a need to set an intake level for sugar.”
“It is necessary for consumers to understand the importance of practicing moderate consumption of all foods and beverages while maintaining a healthy lifestyle” Briscoe says. “Focusing on any one food takes away from the most important and more tangible goal of caloric balance.”
Looking at Added Sugars
Every five years since 1980, researchers have surveyed about 5,000 people around the Minneapolis-St. Paul, Minn. area, asking questions about what they ate within the last 24 hours. They also collected information about body weight, age, socioeconomic status, and lifestyle.
Researchers ran the answers through a software program that has compiled nutritional analysis information on hundreds of thousands of food products. By doing that, they were able to tell how much sugar people ate was added or naturally occurring.
Over 27 years since 1980, consumption of added sugars increased for all ages and both sexes.
In the latest survey, which was conducted from 2007 to 2009, for example, men were getting about 15% of their total daily calories from added sugars, nearly 40% more than was reported in the study’s first survey, which ran from 1980 to 1982.
Among women, added sugar intake rose from about 10% to about 13% over that same time period.
When researchers organized their results by age, they saw that younger adults reported eating more sugar than older adults.
At the same time, BMIs climbed along with sugar consumption.
There was one bright spot, however: in the 2000 to 2002 survey, added sugar consumption appeared to level off in both men and women and actually decreased a bit over the next seven to nine years. The BMIs of women also went down.
“I think women do pay more attention to their diet, and I think women are also paying attention to the messages of overweight and obesity,” Steffen says.
Watching Extra Sugar
The American Heart Association recommends eating no more than 5% of total calories from sugar. In a 2,000-calorie a day diet, for example, that’s about 100 calories of extra sugar, or about 24 grams, which is how sugar is listed on nutrition labels.
“It’s difficult because the label lists total sugars. The label doesn’t list added sugar,” says Rachel K. Johnson, RD, PhD, a professor of nutrition at the University of Vermont who has studied added sugars, but was not involved in the current research.
“So a good rule of thumb is, if there’s no milk or dairy products, which would have the sugar lactose, or no fruit, which would have the sugar fructose, the total sugars is a good indication of the amount of added sugars,” says. “If you have something like a flavored yogurt or a cereal with dried fruit in it, it’s a little more difficult.”
One way to figure out how much sugar has been added, she suggests, with a product like yogurt is to try to find a plain product to compare.
“Take a plain, unsweetened yogurt, if you can find one of the same brand, and compare the amount of sugars in that and compare the amount in the sweetened yogurt you’re looking at and the difference will tell you what’s been added,” she says.
By Brenda Goodman
WebMD Health NewsReviewed by Laura J. Martin, MD March 24, 2011 -- Researchers taking nutritional snapshots of the population around a major metropolitan area for more than 30 years say they’ve noticed something interesting: as consumption of added sugars has increased, so too, have body weights.
Researchers parsing the myriad reasons for America’s collective growing girth have looked at the contributions of total calories and fat, experts say, but less is known about what role added sugars might play.
Added sugars are sugars in foods that aren’t naturally occurring. They’re mixed in as sugar or syrups during processing or preparation.
The sugar in fruit, fructose, for example, wouldn’t count as an added sugar. But the high-fructose corn syrup that’s added to some kinds of fruit cocktail would fall into that category. So would sugars added to sweeten yogurt, soft drinks, and processed snacks and desserts like cookies, cakes, and pies.
“We’re looking at trends,” says study researcher Lyn M. Steffen, PhD, MPH, an epidemiologist at the University of Minnesota School of Public Health. “We looked at them in women and men, and in both men and women, added sugar intake increased since 1980.”
“At the same time, BMI [body mass index] has also increased,” Steffen tells WebMD. Though the study isn’t designed to prove that one is causing the other, the closely parallel trends over 27 years of data collection may point to the need for closer investigation. “It looks suspicious,” she says.
The study was presented at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions.
Industry Perspective
An industry group that represents sugar producers says the evidence of a connection is lacking.
“A single study, performed by AHA [American Heart Association] or any other group, is inconclusive and needs further investigation,” says Andrew Briscoe, president and CEO of the Sugar Association. “When a major review occurs, the results always come back the same -- there is no scientific evidence to support a need to set an intake level for sugar.”
“It is necessary for consumers to understand the importance of practicing moderate consumption of all foods and beverages while maintaining a healthy lifestyle” Briscoe says. “Focusing on any one food takes away from the most important and more tangible goal of caloric balance.”
Looking at Added Sugars
Every five years since 1980, researchers have surveyed about 5,000 people around the Minneapolis-St. Paul, Minn. area, asking questions about what they ate within the last 24 hours. They also collected information about body weight, age, socioeconomic status, and lifestyle.
Researchers ran the answers through a software program that has compiled nutritional analysis information on hundreds of thousands of food products. By doing that, they were able to tell how much sugar people ate was added or naturally occurring.
Over 27 years since 1980, consumption of added sugars increased for all ages and both sexes.
In the latest survey, which was conducted from 2007 to 2009, for example, men were getting about 15% of their total daily calories from added sugars, nearly 40% more than was reported in the study’s first survey, which ran from 1980 to 1982.
Among women, added sugar intake rose from about 10% to about 13% over that same time period.
When researchers organized their results by age, they saw that younger adults reported eating more sugar than older adults.
At the same time, BMIs climbed along with sugar consumption.
There was one bright spot, however: in the 2000 to 2002 survey, added sugar consumption appeared to level off in both men and women and actually decreased a bit over the next seven to nine years. The BMIs of women also went down.
“I think women do pay more attention to their diet, and I think women are also paying attention to the messages of overweight and obesity,” Steffen says.
Watching Extra Sugar
The American Heart Association recommends eating no more than 5% of total calories from sugar. In a 2,000-calorie a day diet, for example, that’s about 100 calories of extra sugar, or about 24 grams, which is how sugar is listed on nutrition labels.
“It’s difficult because the label lists total sugars. The label doesn’t list added sugar,” says Rachel K. Johnson, RD, PhD, a professor of nutrition at the University of Vermont who has studied added sugars, but was not involved in the current research.
“So a good rule of thumb is, if there’s no milk or dairy products, which would have the sugar lactose, or no fruit, which would have the sugar fructose, the total sugars is a good indication of the amount of added sugars,” says. “If you have something like a flavored yogurt or a cereal with dried fruit in it, it’s a little more difficult.”
One way to figure out how much sugar has been added, she suggests, with a product like yogurt is to try to find a plain product to compare.
“Take a plain, unsweetened yogurt, if you can find one of the same brand, and compare the amount of sugars in that and compare the amount in the sweetened yogurt you’re looking at and the difference will tell you what’s been added,” she says.
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