The science is clear. It matters what we eat. Research that is especially pertinent to people with any type of autoimmune arthritis is the apparent link between diet and inflammation. Barry Sears, PhD, calls RA (and other types of autoimmune arthritis) “screaming inflammation.” He also claims that it’s possible to stop the screaming. Unfortunately, he doesn’t go so far as to claim a cure.
Between mtx, ssz, and a biologic, my RA symptoms seem to be mostly under control. It’s taken a while, but I’ve discovered that when I make different nutritional choices, I can drop the “mostly” from my “mostly under control” statement.
In pursuit of better health, I’ve been changing the way I eat. Honestly, it’s a struggle. Food choices are habits, and like any other habit, it’s hard to break. Add to that the fact that I have a family. If we go three days without any grain products, they all start begging me to bake bread!
I am discovering that I must plan. Without menus planned in advance, I wander around the kitchen and grab easy foods, then get hungry and snack between meals, and it’s a terrible cycle that perpetuates itself and makes me feel awful. Planning makes a world of difference.
But what to plan? Unless my goal is to join the circus as the fat lady who can’t walk, planning to eat cinnamon rolls is a bad idea. Although many diets count carbohydrates, newer research also considers the glycemic load of carbohydrate-containing foods. It’s not just the number of carbohydrates, but the amount of insulin your body needs to produce to metabolize the glucose from those carbs. The goal is a slow, steady release of glucose, not a dump-it-all-at-once release which then leads to a crash. Have you ever eaten a sugary snack, then needed a nap? That’s due to the snack having a high glycemic load. The Insulin-Resistance Diet, The Anti-Inflammation Zone, and Grain Brain are unanimous in recommending that people control their glucose levels. Meal plans need to consider glycemic load.
This is incredibly important for anyone with RA, because it turns out that not only does dumping glucose into the bloodstream leads to a release of insulin, this release of insulin stimulates the body to make arachidonic acid, which is a building block of inflammatory proteins. Dumping glucose increases inflammation.
Glycemic Index and Glycemic Load
Controlling the release of glucose into the bloodstream is important. The rate at which that release occurs is quantified by a number called the glycemic index. For fats and proteins, the glycemic index is zero (fats and proteins don’t lead to a significant release of glucose into the bloodstream). For carbohydrates, the glycemic index tells how fast the food’s glucose will be released. High-numbered foods release faster than low-numbered foods.
Many people consider not just the raw index, but also the amount of the food eaten. Obviously a whole pineapple will release more glucose than a modest-size bowl. The load is easily calculated by multiplying the GI by the number of carbs in the food to be eaten, then dividing by 100 (to make the number sound smaller). Even easier, google “glycemic load of ___.” I like the website http://nutritiondata.self.com. All sorts of nutritional information is included, including the estimated glycemic load:
The goal for most women should be a glycemic load of no more than 15 at every meal. Most men, being larger, can aim for 20. And, before you ask, no, we don’t get to save up from one meal to pig out at another! The goal is steady levels of glucose in the bloodstream.
So is a glycemic load of 15/20 (women/men) a target or a limit? It’s an upper limit, but very low can be bad for two reasons. First, the brain needs glucose to function. Second, low blood sugar can make you feel hungry (maybe it’s the brain saying, “Hey! I need some glucose!”), so although it’s important not to ingest too much in the way of a glucose source, it’s also important to get enough. The glycemic load should probably be at least 8-10 per meal (5ish for a snack). While it’s important to not eat too much, it’s also important to eat enough.
If I serve cinnamon rolls for breakfast, a 2-roll serving contains 516 calories, 81 g of carb, and has a glycemic load of 57. This means, basically, that if I eat half of one cinnamon roll it uses up the entire allowed glycemic load – and I still need protein and a nap. In contrast, a breakfast containing a fried egg with hashed browns and bacon contains 495 calories, 27g of carb, and has a glycemic load of 12. It’s delicious and filling, and will last me until lunch time. Basically, we should be getting our carbs from fruits and vegetables, not from grains.
By keeping an eye on the glycemic load of the foods to be eaten (as well as balancing proteins and carbs) I’m discovering that it’s easy to get enough food and never feel hungry. I’m feeling better, and as a bonus, my extra weight is slowly coming off. What we eat has a huge impact on how we feel.