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Ask The Sage

I have a rare autoimmune/muscle inflammatory disease called dermatomyositis. I have two questions related to this: 1. Are there foods that naturally help with inflammation due to autoimmune issues? and 2. What types of food would you recommend to people who take prednisone long-term (which causes an insatiable appetite and uncontrollable weight gain)?

July 17, 2012
I'm sure you know this, but as for other folks out there, I'll explain your condition briefly. Dermatomyositis is a muscle disease that can be genetic or caused from a viral infection (some studies have suggested) resulting in extreme weakness, especially in the arms and legs, rash, shortness of breath, inflammation (and thusly pain), and difficulty swallowing.

So, the first there here to be concerned with is - do you have difficulty swallowing? Does this affect your diet? If so, well maybe pureeing whatever you planned to eat for dinner and eating like an elderly person for a night might be a good idea. At least you are getting the nutrition you need. Also, specialists called speech pathologists can help figure out where you are in the swallowing problem stages and help you reach a more concrete solution. If not - ignore this.

So, on to your questions!

(1) Firstly, a low sodium- mediterranean style diet has mixed studies that prove any association between the consumption of foods within those eating patterns and inflammation. This means a diet with whole grains, fruits, vegetables, unsaturated fats, fish and legumes. There is a compound in most of these foods called polyamines, which have been seen to suppress inflammation through decreased cytokine activity (cytokines are compounds that cause inflammation). Also, fish consumption (because of the Omega 3 levels) has been seen to support low-grade inflammation and generally reduced inflammation altogether, especially in women and nonsmokers. Because I would recommend a strict adhesion to a diet that incorporates these food/food groups (with the consultation of a physician and/or outpatient dietician, of course), let's review:

- eat plenty of fruits and vegetables

- eat more fish, nuts, and ground flax seeds (both have Omega 3)

- eat plenty of whole grains such as brown rice, bulgur wheat, and quinoa

- eat only lean protein sources such as chicken or eliminate altogether

- eat low-fat dairy, or cut out altogether (there is plenty of calcium in heart greens)

- avoid refined and processed foods

- alcohol in moderation, eliminate if you can

- add certain spices that promote anti-inflammatory activity, especially ginger, turmeric, & curry

(2) So, because steroids are common medications for people with inflammation, this is also a common concern. Before we go forward, some questions to ask yourself… Are you eating the diet above? Are you inflamed and thusly think you are heavier than you are? Are you watching your portions?

After considering those things, because steroids cause water and sodium retention, a low-salt diet is key. Your doctor may prescribe diuretics to reduce the water retention, which have a whole other gamut of dietary considerations. Also, potassium and calcium is released in large amounts due to steroid intake, so consuming more foods with these vitamins is essential (I can answer this in another question if you need, let me know). Calcium and Vitamin D supplements are recommended to reduce the risk of osteoporosis common in those taking steroids, not to mention the increased risk in women alone. Getting your calcium levels checked is ESSENTIAL because steroids may not only increase excretion but reduce absorption of this mineral.

It is important to KNOW how much you should eat. View to see what your personal plate looks like… just enter in some simple non-personal information. Basically, half of your plate should be fruits and veggies, with the other half being designated for protein (including yogurt and low-fat dairy, if not eliminated) and whole grains. Whole grains and fiber are a great way to make yourself feel fuller faster. Fiber is not only found in bread, but whole fruits and vegetables (not purees or juices). This satiety factor is important to reduce further weight gain.

Consumption of protein IS IMPORTANT because steroids put your body in a semi-wasting state (which is why they work) and protein helps prevent the wasting from taking place (but still allows the medication to work). Low fat protein foods include beans, legumes, and lean meat (if you need further information on this, ask and you shall receive).

Specific recommendations for those taking steroids include vitamin A supplements, restriction of grapefruit and grapefruit juice, and reduce caffeine (including coffee, tea, chocolate, and soda [even diet]). Because steroids may also put you at risk for diabetes, increased blood pressure, headache, and psychological disorders, it is important to speak with a physician IMMEDIATELY if any of these occur or rear their ugly heads.

So that's that. I know it's a lot, but I hope I answered your question(s) in detail. Good luck and happy eating!

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