Yes, it matters what we eat!

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 indexFor 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  All sorts of nutritional information is included, including the estimated glycemic load:


So What?

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.

RA is a Risk Factor for Osteoporosis

Osteoporosis is silent. People’s bones can gradually become weaker and weaker with no outward hints that there is a problem — until suddenly bones break.  Spontaneous compression fractures of the spine can be quite painful and lead to deformity, chronic pain, and premature death.  Broken hips are another risk factor for early death — approximately 20% of people with a broken hip die within one year of the fracture.

In an ideal world, osteoporosis would not occur.  In theory, osteoporosis is entirely preventable.  Since we don’t live in an ideal world, it is crucial that osteoporosis be identified early and treated aggressively.

DEXA is the gold-standard in osteoporosis testing.  DEXA scanners (Dual-Energy X-ray Absorptiometry) (also called DXA) use two separate very low-radiation x-ray beams – about 1/10th the radiation of standard x-rays — to image the hips and spine to measure bone mineral density.  As we would expect from the “dual energy” portion of the name, these two x-ray beams have different energy levels.  Bone mineral density is calculated by measuring the difference between what is absorbed from the first beam and the second.

Test results will provide a variety of numbers.

  • Bone Mineral Density
  • T-Score
  • Z-Score

Bone Mineral Density (BMD) is a raw number indicating the average concentration of minerals in your bones. The higher the number, the higher the bone mineral density and the stronger the bones.  Lower numbers indicate weaker bones.

T-score and Z-score are based on statistics.  Compiling the results from many people has allowed scientists to determine what is normal bone mineral density, and what constitutes strong or weak bones.  Graphing the data forms a picture shaped somewhat like a bell.

A brief aside about statistics:  in statistics, the mean is the average — it tells us what is normal. The standard deviation tells us how far away something is from what is normal. 68% of all data will only deviate slightly from the average (will be within one standard deviation of the mean) — this makes sense because obviously most things should be close to what is normal. On a bell curve (pictured below), the mean does not deviate at all from what is normal, thus the center of the curve deviates zero (labeled 0), and most of the data clusters close to the middle — one standard deviation is labeled +1 (above zero) and -1 (below zero).  95% of the data will be within two standard deviations of the mean (labeled +2 and -2), and 99.7% of the data will be within three standard deviations of the mean. It is very rare for something to deviate significantly from what is normal.

T-score and Z-score numbers indicate standard deviations from the mean on a bell curve.  A T-score compares your BMD with healthy young adults who have good bone mineral density.  A Z-score compares your BMD with others of your age and ethnicity.  Doctors are most concerned with the T-score.


A bone mineral density scan T-score that is more than one standard deviation below the mean is bad. Between one and 2.4 standard deviations below normal is osteopenia, while a T-score of 2.5 or more standard deviations below the mean is osteoporosis.

Who should get a bone density scan? The general rule is women at age 65 or men at age 70.  Before age 65, the test is only considered if you have risk factors, and if treatment would occur based on test results.  If you wouldn’t be treated, there’s no point in having the test done.  Bone density scans are rarely done on premenopausal women; until menopause, high estrogen levels seem to provide protection against broken bones even in people with low bone mineral density.  The question is, what are the risk factors?

Rheumatoid arthritis is just one of many risk factors for development of osteoporosis.  Other risk factors include:

  • history of taking 5mg or more of corticosteroids for more than three months
  • taking methotrexate (other meds, too)
  • family history of osteoporosis
  • history of an immediate family member with a fragility fracture
  • history of bone fracture as an adult
  • loss of height
  • weight of less than 127 pounds
  • being a smoker
  • menopause
  • eating a diet low in calcium
  • avoiding sunlight (indicative of low vitamin D production)

Given these risk factors, it is no surprise than rheumatologists refer patients for bone density scans.

Everything published about DEXA says that it is painless.  This information is obviously prepared by people who have never had the test.  Although it is technically true that the x-rays themselves do not inflict pain, before the scan is taken you’re strapped to a table in an uncomfortable position and required to stay tied down for the duration of the 15-20 minutes of the test. Although the average person might not be physically injured by the scan, it is inaccurate to say that the test is painless.  More accurately, the test is uncomfortable, but not unbearable.

After the test is complete, the referring doctor will receive a report showing your Bone Mineral Density, your T-score, and your Z-score.  Your report might also include use of the World Health Organization’s Fracture Risk Assessment Tool (FRAX) . This attempts to calculate a person’s probability of fracture within the next ten years with the goal of frightening patients into taking osteoporosis seriously.  A 28% risk of fracture within ten years is about 2.8% per year.  2.8 doesn’t sound nearly as scary as 28%, though, thus the use of ten-year risk estimates.  If you click on the link, select “calculation tool” and then select your continent/country and complete the questionnaire.  The calculation can be made either with or without results of a bone density scan.

Keeping Busy Despite RA

RA meds work!  True, they don’t cure the disease, but they’re designed to slow down progression and make it possible to have a life.  I’d have to say that my life is a testament to how well my meds are working.

rheumatoid arthritis best blogs badgeA big thank-you to Health Line for honoring my blog while I was busy proving that RA meds can be effective, and congratulations to my fellow-bloggers also named.

 Before diagnosis, I remember having to limit myself to three errands a day. Two was even better.  Best was to stay home and not do anything.  Everything hurt, and I was just too exhausted to do anything.  Nothing could be done before 8 a.m., and I had to be back home by noon because my energy for the day was gone by then.

In contrast, now I’m able to go out and do things  — many things.  For example, between them, my two boys have had ten baseball games and two track meets in the past week.  After schoolwork in the mornings, we leave the house around 1:30 (way past noon), drop one son off for practice, drop the other off for his practice, stop at the store if needed, go home and make/pack dinner, then go back to pick up boys from afternoon practice (or watch & cheer if it’s a game/meet day). On baseball game days (most days, it seems), drive to evening games, some of which are an hour away, and cheer some more.  Thanks to RA meds, I can do more than three things in one day, and can be gone from the house past noon.  Honestly, my entire family’s life would be very different without biologics, because that’s what it took to get me to this point.

That doesn’t mean that I’m pain-free, or that there aren’t rough days, but things are manageable.

High school basketball begins in early November, as do practices and tournaments for my younger son’s select basketball team. Middle school basketball begins the first week in February, so the select team ends their season (thankfully we stop – some teams go year-round).  Then high school basketball ends a week later.  High schoolers have a week off before baseball turnouts, then games start the first week of March. Youth league baseball practices also start practicing in mid-February, so kids are doing both basketball and baseball.  Basketball season is over at the end of March, then track begins in April (right after school), as do youth baseball games (in the evenings and on weekends). The high school baseball season ends the first week of May, then American Legion teams start the next day. Unless the high school team makes playoffs, in which case kids are playing on two teams. Track ends the first week of June, but high school’s summer basketball program starts, so we’re still juggling three teams.  Baseball runs into July, but this year the coaches are trying to ensure that people have a break, so we’ll get most of a month off between the end of summer ball and the start of fall ball.  Fall baseball practices for both boys begin in August, with games running through October.  Then it starts all over again.


Sports weren’t like this when I was a kid (back when dinosaurs roamed the earth). Sports had distinct seasons, and coaches didn’t make kids feel like they couldn’t make the regular season team if they didn’t also participate in extended stuff.  The best I can do is juggle, try to teach about having some balance, and support my kids in pursuing their dreams.

But I can!  The way I felt before starting on a biologic, there is no way my sons would be able to play sports because I wouldn’t be able to transport them.  I can only imagine what family life must have been like for RA patients before biologics came out.

Plus, we still have cows, horses, alpacas, and ducks to feed.  Meals need to be cooked, laundry needs to be washed, and it’s nice to vacuum the floor every now and again.

My two sports-minded sons aren’t the only kids in this family.

  • My oldest just completed his junior year of college. He is currently in Greece.  A group of students have spent the past year studying Greek history (3 history credits), as well as physical setting of the Bible (3 Biblical Literature credits), and are now travelling in Greece to see the places they’ve been learning about.  Once he returns, he has an internship set up (same place he worked last summer).
  • My older daughter is a college sophomore, and is taking time for some real-world experience before finishing her degree.  She is fundraising, and leaves soon for a six-month trip that begins with 12-weeks of training, followed by hands-on medical missions work.  They’ll start out at a clinic in Kolkata, then head either to southeast Asia, Africa, or Nepal (depending on needs at the time).  In addition to earning money for her trip, she’s doing all the pre-trip things one needs to do like get travel vaccines, find a good-quality backpack she can live out of while she’s gone, learn about the places she’ll be going, renew her passport, apply for visas…
  • My younger daughter is nearly done with her high school work and took two dual-credit courses this year.  She just registered for classes at her first-choice college, so is doing all the college prep activities that 18 year olds do.

Life is busy!  I am so thankful that I have been able to keep up with my kids’ activities!