Thursday, 28 February 2013

Jaw Joint Arthritis and a Soft Food Diet

I wanted to post about arthritis, jaw joints and diet today. Most people think of arthritis affecting knees, fingers and hips but truthfully it can attack any of the 350 or so joints in the body, and for some of us that includes the jaw or temperomandibular joints (TMJ). It's more common in those with the spondylitic forms (ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthropathy) but can occur with other types.  

For me, suddenly getting sore jaw joints was the clincher that something was very wrong and made me push for a proper diagnosis. Jaw arthritis makes life very difficult: it's uncomfortable to eat, speak, lie on your face, open your mouth or even clean your teeth. The pain can radiate up to you temples, down your neck and make your cheeks ache. In short, jaw arthritis is Arthur at his most irritating. 

The difficulties with eating are perhaps the most challenging aspect to handle on a day-in, day-out basis because it tends to mean you need to stick to a soft food diet. For the first few months of my jaw being painful, I lived off a diet of  soup and yoghurt and lost a lot of weight. I was given sip feeds by the doctors to help increase my calorie intake but frankly they are generally disgusting and, more importantly, boring. Through trial and a lot of error I now eat a relatively varied diet and am an expert in soft-food cooking. Here are my top tips for getting a healthy diet if your jaw is affected by arthritis:

- Get a hand blender - you don't need to pulverise everything but it makes for super speedy soups and purées. 

- It can be difficult to get enough protein when chewing hurts. Most meat is off the menu but fish, omelettes ,scrambled eggs, yoghurt (especially low fat greek) and tofu are all excellent alternative protein sources. You can also try adding skimmed milk power or protein powders to oatmeal (porridge) and drinks to fortify them. 

- Grate, mash and puree vegetables to help you still get your five-a-day. Bake fruit like apples, pears and berries or turn tropical fruit into smoothies.

- Small pasta shapes (like soup pasta) are easier to eat or try vermicelli. Rice can be surprisingly chewy so stick to risottos or well-cooked white rice.

- If you find you are losing weight, don't be afraid of boosting the nutrition of your food by adding a little extra cream, olive or rapseeed oil, nut butters and soft cheese. Scoff icecream without guilt - there have to be some perks!

There are some wonderful soft food diet recipes on the lovely Food to Glow blog, and, of course, many of my recipes are jaw friendly so have a browse.

Wednesday, 20 February 2013

Arthritis and Vitamin D

Deficiency of vitamin D is big news in the health community at the moment, with deficiency being linked to a whole host of chronic medical conditions - from multiple sclerosis to heart disease.

So what is it? Vitamin D is synthesised by our bodies when the sun shines on our skin (an argument for a holiday somewhere warm in February if I ever heard one...), it can also be found in a oily fish, egg yolks, cheese and some fortified foods (often soy milk and breakfast cereals). It's been linked to arthritis is several ways:

Vitamin D is used in healthy bone and cartilage formation. Deficiency puts people at increased risk of osteoarthritis, with some studies suggesting that patients with lower vitamin D levels experience more pain and joint space narrowing (a sign of joint damage). However, not all studies have come to the same conclusion. Some research has shown that vitamin D supplements combined with calcium can help slow joint damage. 

Inflammatory arthritis (eg. rheumatoid arthritis, psortiatic arthritis, ankylosing spondylitis)
Lower intakes of vitamin D appear to be related to an increased risk of developing auto-immune, inflammatory arthritis. Vitamin D has been shown to reduce inflammation in lab studies and patients who are deficient appear to greater disease activity than those with normal levels. There haven't been any studies as yet showing that supplements improve symptoms or reduce disease activity.

For all kinds of arthritis, you can get your vitamin D levels checked by your doctor to see if you are deficient. You are more likely to be short of vitamin D if you are older, live in the northern hemisphere (where there is less sun) and take steroids. Vitamin D can be toxic if taken in large quantities, don't take more than 25 micrograms a day without speaking to your doctor first. You can try these recipes too to help boost your intake:
Spinach, Feta and Pea Frittata
Soy and Ginger Salmon
Little Chocolate Cheesecakes

Monday, 11 February 2013

Arthritis Friendly Recipe: Gluten-Free Savoury Pancakes

Tomorrow is Shrove Tuesday here in the UK, more commonly known as pancake day. Growing up this meant rushing home to try and flip and scoff as many pancakes as possible. Some people love lemon and sugar but for some reason I have always liked mine with just a little salt so I'm giving you a savoury pancake recipe today (if you want to try one of my sweet recipes, this one is good). I've also noticed that my gluten-free recipes are amongst the most popular so this recipe use gram or chickpea flour. Both Italy and India have their own versions of these: make them with a little olive oil and rosemary and you have Italian socca. Add a few curry spices and serve them in place of naan or chapati and you have besan cheela. They also make great wraps with a dollop of houmous, some chicken and salad. 

Now for anyone with arthritis making and flipping pancakes is not the easiest of activities but this recipe is a doddle. There is no egg breaking or beating and as long as your pan is good and hot, they slide right out with a spatula - no frying pan heroics required unless you and your arthritis feel like it! 

150g chickpea flour
250ml cold water
A little olive or rapeseed oil for greasing

Makes about 6 - depending on the size of your frying pan

Use a good non-stick frying pan for these and add the oil and wipe it around with kitchen paper before starting.

Tip the flour into a jug and then slowly add the water, stirring as you go until you get a smooth batter. Add any spices or flavourings you like and give another stir. Let the batter rest for 15-20 minutes.

Place the pan on a good high heat and let it get hot for a minute or so. Pour enough batter in to coat the bottom of the pan - it should sizzle as it hits the pan. When bubbles start forming on the surface and the edges are curling slightly, flip the pancake over with a spatula.

Arthritis diet notes:
Chickpea flour is a lovely ingredient. It's gluten free, high in protein and has a lovely nutty taste. There is no direct link between gluten and arthritis (and I've posted on the evidence here) but I know that many of you prefer to eat a gluten-free diet and this makes a change from the usual gluten-free fare.

These pancakes are very low in inflammatory saturated fat compared to the traditional recipe and as you aren't smothering them in golden syrup or chocolate sauce they won't load you full of sugar either. For added arthritis benefits, try them Indian style with a pinch of anti-inflammatory turmeric, ginger and curry powder in the batter and serve alongside a curry.

Monday, 4 February 2013

Arthritis-Friendly Recipe: Bolognese Bake

This is more a way to use up leftovers and make them for further than a recipe, but I thought I'd share it with you as we always really enjoy it as a speedy supper. We don't often have much bolognese sauce leftover but it has been known to happen occasionally - more often than not because I have deliberately cooked extra to freeze for when I'm having an arthritis flare or because I know we will want to eat this delicious bake.

It might seem unconventional to mix rice and bolognese but it really works. Better still as there is no faffing around with pans and hot water if you use ready-cooked rice, this is a really quick dish to make when arthritis makes any complicated cooking unappealing. You can add other things to the bake if you like; a few sundried tomatoes or some cooked aubergine are yummy. I also sometimes even add torn mozzarella for an extra cheesy bake.

Leftover bolognese (see here for my recipe) - about 2 cups worth (or half the quantity made)
Two 250g packets of cooked rice (I like Tilda sundried tomato flavour for this recipe or you could use leftover rice you have cooked yourself)
Handful of grated cheese 

Serves 4

Mix the sauce and rice together. Spoon into an overproof dish and sprinkle the cheese over the top. Bake at 180C/375F for 20 minutes or until bubbling.

Allow to stand for 5 minutes before serving.

Arthritis diet notes:
If you make this with my bolognese sauce, this is a very healthy supper. It's packed with vegetables and the lean mince (or quorn for vegetarians) makes it much lower in saturated fat than some versions. This makes it a better choice for people with arthritis as the links between red meat and rheumatoid arthritis in some studies are mainly thought to be due to the saturated fat and omega 6 fatty acid content of the meat. Rice is a nice change from pasta and a good gluten-free alternative if you have difficulties digesting wheat or are coeliac. 


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