Rheumatic Polymyalgia Diet

Rheumatic Polymyalgia

Polymyalgia rheumatica (PMR) is an uncomfortable condition that causes pain, stiffness and inflammation of the muscles around the shoulders, neck and hips.

The main symptom is morning muscle stiffness, which persists for at least 45 minutes.

Other symptoms may also occur, including:

Fever and sweating
Fatigue
Loss of appetite
Weight loss
Depression.

The diagnosis of polymyalgia rheumatica requires a lot of attention. Due to the similarity of symptoms, cases where it is confused with rheumatoid arthritis are not uncommon.

The suspicion of polymyalgia rheumatica must arise only when pain and stiffness persist over a week.

Drugs and Diet

The treatment of polymyalgia rheumatica is of a pharmacological anti-inflammatory and pain-relieving type.

The most widely used molecule is a corticosteroid called prednisolone, which is used to relieve symptoms; the dose is initially high and is reduced over 1.5-2 years.

Polymyalgia rheumatica may require a specific diet . The nutritional scheme is not aimed at treating the causative agent, but rather at the prevention of pharmacological side effects. Corticosteroids tend to increase the risk of osteoporosis .

For this reason, the diet for polymyalgia rheumatica must possess all the nutritional characteristics typical of the diet against osteoporosis.

OSTEOPOROSIS IN BRIEF

Osteoporosis means a loss of skeletal resistance.

The basis of the osteoporotic condition is the reduction of mass, architecture and bone strength. In practical terms, a demineralization and a loss of hydroxyapatite (calcium + phosphorus) takes place.

The causes are multiple; more often nutritional, metabolic, pharmacological, hormonal and pathological.

Lifestyle Correction

During cortisone therapy, it is necessary to correct some inappropriate factors or "risk" behaviors for osteoporosis; in particular:

Eliminate cigarette smoke
Increase sun exposure
In the event of a sedentary lifestyle, promote physical activity; later we will see how.

We recall that the most important causative agent of osteoporosis is attributable to the lifestyle in developmental age (growth).

It consists in the failure to reach the peak of bone mass (due to nutritional deficiencies, sedentariness, drugs, etc.) and, in adulthood, it cannot be changed.

This means that the diet for polymyalgia rheumatica is a dietary style that aims to reduce the chances of skeletal complications, but is NOT a definitive therapy.

Nutritional Principles

It is possible to try to prevent the onset or aggravation of osteoporosis by applying a series of dietary and lifestyle adjustments.

It is always necessary to delete:

Alcohol abuse
Specific nutritional deficiencies.

The food strategy must guarantee a satisfactory supply of calcium and vitamin D.

On the contrary, it is advisable to limit the intake of some nutrients. If in excess, these could be potentially harmful; in particular, they are more involved:

Excess sodium
The excess of phosphorus
Protein excess
The excess of antinutritional agents.

Football

Calcium and phosphorus are the elements that form hydroxyapatite.

It is assumed that nutritional deficiency or increased excretion of calcium may favor the risk of osteoporosis.

The body absorbs these minerals from food; however, the pharmacological therapy of polymyalgia rheumatica compromises the absorption of dietary calcium.

The nutritional requirement of calcium is not always easy to satisfy with ordinary nutrition. This may increase in growth, in pregnancy, in lactation, in old age and in drug therapy with corticosteroids.

To counter the side effect of polymyalgia rheumatic drugs, people over 60 (especially females) should increase the nutritional intake of calcium. In this case, it is advisable to reach a daily intake equal to or greater than 1, 000mg; better if between 1, 200 and 1, 500mg / day.

In general, this goal can be achieved by drinking a liter of milk / yogurt a day and eating certain foods rich in calcium; among these, above all, mature cheeses and fortified foods.

In the event that it is not possible to comply with these recommendations, it becomes necessary to rely on a nutrition professional for a personalized diet.

Vitamin D

The diet for polymyalgia rheumatica must also be rich in vitamin D (calciferol), a fat-soluble pro-hormonal molecule.

This vitamin is crucial for the functioning of bone metabolism. Without calciferol, regardless of the availability of calcium and phosphorus in foods, the body is unable to effectively prevent the rarefaction of the skeleton.

Ultimately, vitamin D is needed to absorb and metabolize food calcium.

Calciferol is produced independently by the body. This happens thanks to the exposure of the skin to sunlight.

Vitamin D can also be taken with food. The richest foods of calciferol are blue fish and egg yolk.

Furthermore, the food industry offers a wide selection of diet products that are fortified with this vitamin. Most are dairy or surrogate in nature, such as: milk, soy milk, yogurt, soy yogurt, etc.

To have a good nutritional intake of calciferol it is necessary:

Eat 3 servings of bluefish per week (150-250g). The portion and frequency of consumption cannot be unlimited or excessively abundant. Keep in mind that fishery products, especially large ones, may contain discrete levels of mercury (toxic pollutant metal).
Consume 3 whole eggs a week
Consume some fortified products daily.

Especially in people over 60, it is advisable to take a food supplement daily with a dosage of 10-20μg or 400-800 international units (IU) of vitamin D.

Physical exercise

Motor therapy of polymyalgia rheumatica requires an accurate knowledge of subjective needs and physical characteristics. It is strictly necessary to find the right balance between physical exercise (volume, intensity, frequency, etc.) and rest / recovery.

Motor activity usually helps to relieve morning stiffness and to moderate the overall symptoms of polymyalgia rheumatica. Nevertheless, if in excess, it is able to aggravate the perception of pain.

Physiotherapy can be useful in fighting suffering and maintaining joint mobility.

Protocols that allow mechanical stress to be applied to the skeleton help maintain bone density and architecture.

The most tolerated activity on average is walking, slow or fast, on the plain or with gradients. The more adventurous or those who face pain better, engage in alternative activities such as: running, other aerobic sports (swimming, cycling, etc.), exercises with rubber bands (overloads), etc.

Potentially Harmful Molecules

There are dietary components that, by interfering in the absorption and metabolism of calcium and vitamin D, can compromise bone health.

The diet for polymyalgia rheumatica must take this into account and try to prevent such interactions.

At certain concentrations, calcium and phosphorus can conflict with intestinal absorption. The right ratio between the two ions is 3: 1 or 2: 1.

Considering that:

Calcium is generally more deficient in foods than phosphorus
An excess of phosphorus can worsen the intestinal absorption of calcium

it is advisable not to exceed with products very rich in phosphorus, preferring those abundant in calcium (especially at the same meal).

For example, it is better to avoid associating some seeds (pumpkin, sunflower, quinoa, etc.) with milk, aged cheeses and fortified foods. Recall that phosphorus is still abundant even in foods of dairy origin.

Excess sodium food is a potentially harmful factor for calcium metabolism.

It is assumed that the surplus of sodium in food can favor the urinary excretion of calcium, increasing its metabolic demand.

Other sources suggest a similar effect attributable to protein and nitrogen excess. On the other hand, in this case scientific research does not offer repeatable results.

The presence of anti-nutritional molecules is able to bind (chelate) calcium in the intestinal lumen, preventing its absorption. This happens especially in the presence of oxalic acid which, binding to calcium, originates the calcium oxalate. The oxalic acid is contained above all: in rhubarb, in spinach, in beets, in cocoa, in red beet, etc. Although the concentration in foods can be reduced by cooking, it is advisable to avoid the combination of foods with oxalic acid to those rich in calcium.

Another molecule that has a similar effect is phytic acid, typical of legumes and cereal bran. Phytic acid has a chelating effect, which mainly affects zinc and iron, but it is advisable to avoid it also to optimize calcium absorption. It degrades with cooking and can be partially eliminated by soaking legumes or bran (discarding water).

To optimize calcium absorption it is also advisable to avoid the onset of diarrhea. This can have many triggers; it is recommended to pay attention to:

Foods responsible for the typical symptoms of food intolerances (lactose or gluten)
Laxatives: food, drugs and supplements
Fiber excess: food and supplements
Nerve excess: especially stimulating drinks (coffee, fermented tea, chocolate and energy drink) and thermogenic food supplements.

Other

In the symptom reduction of polymyalgia rheumatica, even small precautions such as:

Practice stretching and exercises regularly to improve joint mobility
Practice thermal baths.

Causes, Incidence and Complications

The causes of polymyalgia rheumatica are currently unknown; the most accepted hypothesis is a combination of genetic and environmental factors.

Polymyalgia rheumatica is a fairly common disorder. In subjects over 50 years (most are> 70 years), an incidence of 10 cases per 100, 000 inhabitants is estimated. Instead it is very rare in young people. It especially affects females.

Polymyalgia rheumatica has a very important statistical correlation with Horton's temporal arteritis (giant cells).

The symptoms of the latter pathology, which may occur before, during or after polymyalgia rheumatica, are: