Kac Para Yarismasi

Arthritis Diet and Exercises

Food and Inflammation: Extra helpings – Ep 3. Part of the ‘Food as Medicine’ online course series

We’re here to talk about some of the common questions
that we see in practise in regards to diet
and inflammation. Now Steph you see a lot
of patients in regards to inflammatory conditions
and they come to see you for advice around diet, and a lot of the time
they have some common questions don’t they. So we thought we’d talk about
those today, so if you have similar
questions from your patients you can understand
more about how you can answer them within an evidence base. So Steph one of the first
questions that is common in your practise is that a lot
of patients ask around, sorry, a lot of patients ask around
some of the common superfoods that are trending
in the Internet and on the market these days. So think about cacao
and turmeric, green tea and oh,
the list is so long. So if a patient says to you, “should I be eating these every
day and will that cure my inflammation?”
what do you say to them? STEPH COWAN: Well first
and foremost I say absolutely not. I mean superfoods aren’t super
in any way. Absolutely they can be a part
of a balanced healthy diet but just because you’re
having them every day and in every meal doesn’t mean
that they’re going to be able to reduce
your inflammatory markers. And what I would usually say
is “sure if you’re enjoying those foods and you’re
using them in the context of a healthy diet.”
So for example, perhaps you would promote
to your patient that if you liked
chocolate then that’s a great thing to be eating
of a night instead of ice cream. But it doesn’t mean that they
should have be having cacao powder every day, three times a day thinking
that that’s going to be able to reduce their
inflammatory markers. So I think making that message
really clear and overall just promoting
a variety of healthy foods in the diet. And turmeric’s a really good
example of that because people are big
on turmeric at the moment! MELISSA ADAMSKI: So much! It’s coming in everything
isn’t it? STEPH COWAN: Turmeric lattes
everywhere I go. So I think with that, that’s
a beautiful spice, yes, but it’s one of many beautiful
spices that have lots of antioxidants in them
and they’re all good for different reasons. So my answer to someone asking
about turmeric would simply be that well it’s a good spice
but so too is cumin and all of the herbs and spices
that are offered to us and we should be using a range
of them in our cooking and when we’re preparing foods. MELISSA ADAMSKI: That’s exactly
right and I think one of the important points
as well is some of the terminology
that you use around, say turmeric or cacao. You know online there’s a lot
of really strong language around “curing” or it’s
the answer that you’ve been waiting for. So I think as long as we don’t
use those terms it helps us to stay within
the scope of the current evidence-base until
we learn more. STEPH COWAN: Absolutely agree
with that. MELISSA ADAMSKI: Great.
And then another common one that we see in practise
is people coming to see us and they’ve cut out a lot
of food groups that they might say “I’ve cut out gluten, dairy,
red meat and it’s cured me,” or “I feel a whole lot better.” And so how do you react
or respond to patients who have said that? STEPH COWAN: Yeah I get
that extremely common question in my practise — MELISSA ADAMSKI: Especially
with those three — STEPH COWAN: Those three core
food groups. Absolutely. Especially when we’re
talking about inflammation it comes up all the time. And I typically respond
by explaining to the patient that unless they have some kind
of immune-mediated response like perhaps they have
celiac disease in which case absolutely
if they have gluten then they will experience
inflammation in the lining of their intestinal tract,
which can cause damage, or perhaps they have a food
allergy to say a milk protein then absolutely that might
have an impact on their overall health and their inflammatory
markers but otherwise it shouldn’t actually be doing
any damage. In fact, even with intolerances, where for example
the patient might not be absorbing certain
components in their food, like FODMAP might be a common
one you might hear. Even then absolutely
they might get symptoms which might be quite severe
in terms of their everyday functioning of their life
but still there’s no evidence to suggest
that it’s increasing inflammation in any way. MELISSA ADAMSKI: And I think
that’s a challenge for us as healthcare professionals
because on one hand you’ve got a patient that’s
saying they feel a lot better on this kind of diet, and on the other hand you then
got an evidence base that says well they shouldn’t
be feeling better necessarily so we do need to realise that, you know we don’t know
everything about nutrition yet, and inflammation, especially
with it so complex. So we might learn the answers
in the future and your research is certainly looking
to start to uncover those Steph, so we really need to work
with the patient and perhaps say, okay, if there’s you know perhaps
someone who doesn’t like a lot of gluten-containing
foods and so cutting it out they haven’t missed it. Then maybe that’s something
you can say, “well you know you can keep
doing that and we’ll just make sure that your diet
is nutritionally complete with other foods,” but if there’s someone
who’s really struggling because they’ve
always loved their bread, or they’re in a family unit
with young kids and they are struggling
cooking a separate meal for themselves or something
then maybe that’s where you would say something
like “well actually, currently the evidence
isn’t quite strong to suggest that it may be helping you. How about maybe we try
some other strategies?” And overall then in
their lifestyle, it might be less of a stress. STEPH COWAN: Absolutely I think
that’s really really important that it comes
down to the individual, and how they’re coping
with those changes and also whether those changes, as you touched on are
affecting their nutritional adequacy
of their diet. And that might be something
that you talk about with them also.
So using an example, if they have cut gluten out, maybe that has resulted
in them cutting a lot of wholegrains out
of their diet. Perhaps they’re not
getting enough fibre. So I think certainly having
those conversations with them is really important. MELISSA ADAMSKI: Absolutely.
And another question. Well that brings us to another
question around — around weight. So a common question
that you see Steph is: “do you think if I lose weight
that will have an effect on — on my inflammation levels?”
How would you respond to it? STEPH COWAN: Yes, a very
common question and it really comes down
to whether that individual is within
a healthy weight range or they’re not. And also even more than weight
I really think it’s important to dig a bit
deeper because we know when we look at the research
that, yes, overall someone that isn’t
in a healthy weight range, if they lose weight it’s very
likely that their inflammatory markers
like C-reactive protein will come down, but that actually depends
largely on where that fat is distributed. Yes. So you’d be looking at
certainly their weight but you’d also be looking at
is it around their visceral organs, in which case that’s the type
of that we don’t really want. So absolutely if someone
approached me who wasn’t in a healthy weight
range and they wanted advice on whether a weight loss
would help to reduce their inflammatory markers
then I would say “yes, we can absolutely work on that.” I’d probably aim for 10 percent
of their starting body weight in terms of weight loss, but I would also be taking
a simple measure like even waist circumference
so that you can track as well whether they’re
losing fat from around their abdomen and that’s going
to have even more of a benefit than just a general weight loss. MELISSA ADAMSKI: Yeah great. And finally coming to a question
that actually a lot of GP’s or doctors,
nurses, other health professionals
may have is around, a lot of the time we give
information to these professionals about
what they should be telling their patients. But what is more important
than just that is how the patient actually does it.
So it can be, you know easy to say you know
“you need to, I guess, eat more omega-3’s
because it helps with inflammation,” but more importantly how
they then should suggest that patients do that. So if you got any comments
on that Steph. STEPH COWAN: Absolutely, I find
that this is probably the simplest but the biggest
question that you get. So we’re as health professionals
very good at telling people the ‘what’
and maybe even the ‘why’ not so good at telling them ‘how.’. MELISSA ADAMSKI: That’s right. STEPH COWAN: So I think
it’s really important that if you are going to go
away from this course and everything that you’ve
learnt and try to counsel patients on changing
their dietary habits, then you also need to really
have some tricks up your sleeves in terms of practical
recommendations of how they can do that. So an example,
using omega-3 as an example, thinking about well
what types of fish would that actually entail.
Salmon, tuna, sardines and then what are easy
ways that patients could get that into their diet? Could they add some
canned salmon to their sandwiches or to their salads? Could they experiment
with baking a salmon fillet of a night? So definitely having
those practical, how do we put it into —
into your everyday life, recommendations is really
important. MELISSA ADAMSKI: And I know
that some health care professionals might be
watching and thinking “oh, but my consultations
are so crammed as it is,” and we completely
understand that, and that’s maybe where, if you’re the advocate
for good nutrition and for dietary change
and perhaps provide one or two suggestions, but then also suggest a referral
onto a nutrition professional to really
help cement those behaviors with patients can
be a really great multidisciplinary approach
to patient care, can’t it, because it does
take time. STEPH COWAN: 100 percent. MELISSA ADAMSKI: I think to some
of my, you know, behaviours and things, it takes a while to
change something. STEPH COWAN: It
takes a long time. And as we’ve touched
on throughout the course, you know, even it takes a number
of sessions with a nutritionist
or a dietician to make any practical changes. Yes. So it’s very hard to do
that in one short and sweet session if you’ve
only got them for 25 minutes. I definitely think I’m taking
advantage of your allied health and referring one is a
very, very good idea. MELISSA ADAMSKI: Absolutely.
And that’s it from us today, so thank you everyone. STEPH COWAN: Thanks very much.

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