Friday, 10 August 2012

Diet, Arthritis and Medications - How They Effect Your Nutritional Health

I had an interesting conversation the other day with a specialist nurse about how drugs can impact on the nutritional status of people with arthritis. Now we're both biased, but we both agreed that it is something not often discussed in the rheumatologist's office. However, the arthritis medications can have a big impact on your nutrient intake, metabolism and absorption.

Side-effects - arthritis medications can sometimes make it hard to eat a balanced diet. For example, non-steroidal anti-inflammatories like ibuprofen can cause heartburn, stomach pain and nausea putting you off your food. Methotrexate is renowned for making people feel sick and can also cause ulcers or a sore mouth which may make eating 'normal' food difficult. Some drugs also alter the way things taste or leave a funny taste in the mouth. Finally, the tiredness the drugs cause may make it hard to face shopping or cooking

These side-effects are part of the reason that people with arthritis, especially those with inflammatory or auto-immune arthritis (rheumatoid, psoriatic, enteropathic, ankylosing spondylitis etc) are often found to  have nutritional deficiencies. The most common ones found in studies are low levels of selenium, vitamin C, iron, folic acid, calcium, vitamin D and vitamin B12 (follow the links to read about why these are important for people with arthritis). We're also more likely to eat more fat and sugar than those without arthritis, possibly because we rely on prepared or convenience foods.

Drug-nutrient interactions - some drugs either lower absorption or deplete micro-nutrients in the body. Methotrexate blocks the metabolism of folic acid so patients are usually given supplements and these help reduce the drug's side effects (although these are normally taken on a different day to the methotrexate to ensure the don't reduce the drugs effectiveness). Sulfasalazine also depletes folic acid although slightly differently, by reducing absorption so again, supplements are important.  Steroids reduced calcium absorption in the intestine which can damage bone strength. Making sure you get extra calcium whilst on long term steroids is important and sometimes a supplement (with vitamin D) is necessary.

 However, it is worth remembering that arthritis itself can cause  deficiencies and malnutrition and the medications help combat the risk in different ways. For example, inflammation can cause a loss of lean body mass known as 'cachexia' which is a serious condition and far harder to treat than folic acid deficiency. Medications like methotrexate can help prevent this as well as treating the underlying arthritis.

Ultimately, watching out for side-effects and knowing about drug-nutrient interactions can help protect you from any deficiencies. Talk to your doctor, nurse or dietician if you are on medications and suffering from side-effects. They will be able to check out any possible deficiencies and help you manage the side-effects or nutrient interactions. All the recipes on this site are also designed to help get people with arthritis get enough of the nutrients they need whilst being easy to cook with arthritis and delicious, so do have a browse.


  1. This post is very educational. I will send to several friends ... then print for reference. You should write a book Kate!

    A bit ago I commented on a reader's comment. You know what? My goodness ... there is sooo much to remember. One has to go to medical school to know what's what at any given time. For me to keep going to doctors is ridic. I cannot do it.

    Because I never wanted to become hooked on pain killers .... my daily medications are Motrin. Usually 200 mg. every 35-40 minutes. A lot I know. But .... what else is there? Not much.

    Been reading your posts for awhile. I like them. You are amazing when it comes to research! Wow ... I couldn't do that. Ha.

    Going to try making the cumin carrot dip. Sounds delicious. I love most all Indian flavored foods. Very healthy stuff.

    Thanks for helping all of us "Arthur's." It is definitely a huge endeavor.


  2. Thank you Marcee - really kind comment. Glad you are enjoying the blog and do keep popping by - I'll read all the stuff so you don't have to! The carrot cumin dip is seriously yummy. I'm going to be making it to for a BBQ this weekend.



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