Popular Diets and Juvenile Arthritis
What you should know before putting your child with JA on a popular diet.
By Amy Paturel
When your child has arthritis pain and inflammation, it’s natural to want to try different ways to relieve symptoms. As such, many parents turn to diet changes for help. But while healthy eating is key in helping children manage their disease, it’s not a cure.
Studies have demonstrated the benefits of anti-inflammatory and plant-based eating plans on pain, stiffness and inflammation. But the research applies to adults, and oftentimes, the number of study participants is small. It’s also important to remember that a growing child requires a different balance of nutrients for healthy development. So, before you put your child on one of these headline-grabbing diets, here are some things you should know.
What it is: The Paleo plan champions natural foods. Vegetables, low-sugar fruits, grass-fed meats and wild-caught fish are staples. The diet nixes processed foods, trans-fats, sugar, grains and dairy products, and promotes healthy fats from nuts, seeds and avocados. A more restrictive version, called the Paleo Autoimmune Protocol, prohibits alcohol, eggs, fruit juices, sweeteners (artificial and natural), nightshade vegetables (i.e., tomatoes, eggplants and green peppers), nuts, seeds, including cocoa and coffee, and many popular spices.
Is it backed by science? No. The diet evolved from anthropology not biology. The idea is to mimic the diet that ancient hunter-gatherers are thought to have followed. But no one really knows what Paleolithic people ate, and there isn’t a standardized definition of a Paleo diet.
What are the pitfalls for kids: The diet doesn’t have a good balance of nutrients to optimize kids’ health. They may miss out on important nutrients in dairy products (like milk, cheese and yogurt) and whole grains. “Without dairy in the diet, people may have trouble getting the calcium and vitamin D they need to protect their bones and stave off osteoporosis, particularly since many arthritis medications leach calcium from the bone,” says Sonya Angelone, RDN, spokesperson for the Academy of Nutrition and Dietetics. This diet also limits carbohydrates, which are also important for growing children, Angelone explains. Without carbohydrates, the body burns fat and protein for energy and that can affect your child’s development. Protein is required for muscle and bone building, and fat is required for brain development. If you ditch dairy, find alternatives that are calcium and Vitamin D-rich as well as Paleo-friendly. These include kale, almonds, plant-based milks as well as sesame and chia seeds. Fish, like salmon, sardines and tuna are great sources of Vitamin D, too. If your child is gluten intolerant or sensitive, some grains may trigger inflammation. Check with a dietitian for nutritional gluten-free alternatives.
What it is: The Mediterranean diet emphasizes fruits, vegetables, whole grains, heart-healthy olive oil, nuts, seeds and lean protein (including fatty fish and beans). In addition to a plethora of fruits and vegetables, the diet typically consists of 3-4 ounces of fish (preferably wild-caught) at least twice per week, 1 cup of beans twice a week along with daily doses of nuts (1.5 ounces), olive oil (2-3 tablespoons) and whole grains (6 ounces).
Is it backed by science? Yes. “While there’s no direct link to arthritis, there are clearly anti-inflammatory benefits with this diet,” says Alicia Romano, a registered dietitian at Tufts University Medical Center in Boston. Fruits, veggies and whole grains are good sources of antioxidants and fiber. Olive oil boasts anti-inflammatory properties. And fatty fish, including salmon, sardines and mackerel, are rich in omega-3 fatty acids.
What are the pitfalls for kids: Some Mediterranean staples aren’t especially kid-friendly (omega-3-rich sardines are a prime example). Plus, access to fish may be limited depending where you live and your budget. The upshot: Substitutions, including chia, flax and hemp seeds, omega-3-enriched eggs and some nuts (including walnuts), can help supply some omega-3s. Strawberry and lemon-flavored fish-oil supplements, containing both DHA and EPA, are another option. If you’re interested in taking the supplement route, take to your child’s doctor about recommendations and amounts.
Vegetarian and Vegan
What it is: A vegetarian diet is free of all meat, including fish and poultry. A vegan diet is free of all animal products, including meat, fish, poultry, eggs and dairy.
Is it backed by science? Yes, but studies are small and produce mixed results. In adults, research suggests going vegetarian or vegan may help reduce inflammatory markers in the bloodstream.
What are the pitfalls for kids: Meat and egg yolks have B vitamins, dairy has vitamin D and calcium and fatty fish boast heart and brain-healthy omega-3 fatty acids. Each of these nutrients play important roles in protecting bone, heart and brain health, among other health perks. So, if you’re set on putting your child on a vegan or vegetarian diet, talk to your doctor first. Also, seek guidance from a registered dietician to ensure that your child gets these important nutrients from other sources.
What it is: Elimination diets avoid a specific food or group of foods, such as milk, meat, gluten-rich fiber and processed foods, that may be inflammatory for some people. Patients avoid these foods for a specific period and then gradually reintroduce them back into their diet one at a time. Since researchers still aren’t clear which foods trigger a flare, the goal of an elimination diet is to determine which foods cause a negative reaction among arthritis patients.
Is it backed by science? It’s hard to say. Most elimination diet research focuses on dairy or gluten – and even those studies produce mixed results with some studies showing dairy is pro-inflammatory and others suggesting it’s anti-inflammatory. “It’s highly variable depending on the individual,” says Angelone. But there’s no doubt that dairy products, such as milk, can help meet growing kids’ nutritional needs. The same issue applies to gluten. There’s no need to strip gluten from your child’s diet unless he/she has a gluten sensitivity or has been diagnosed with celiac disease.
What are the pitfalls for kids: Elimination diets are a big shift from the standard American diet, so there’s a lot of prep work involved. “Eliminating foods eliminates nutrients and that’s especially concerning for kids since they’re already self-limiting certain foods,” says Angelone, emphasizing that elimination diets may set children up for developmental delays.
Instead of focusing on what to nix from your child’s diet, consider what you should include (fruits, vegetables, nuts, seeds and legumes). Fill his/her plate with a rainbow of foods from all the food groups and select powerhouses that have been proven to boost immunity and promote bone, eye and heart health. They may not cure arthritis or silence pain, but they’ll significantly improve your child’s wellbeing.
Most importantly, work with your child’s doctor or a registered dietitian before trying a specific diet to help manage your child’s arthritis symptoms. “When we’re adults we can self-modify and make more liberal changes, but with children we really have to worry about hitting developmental milestones,” says Romano.
What it is: A gluten-free diet is a type of elimination diet that is free of gluten, a protein found in wheat, rye, barley and a few other grains, such as farro, kamut and spelt. The diet was designed for people who have celiac disease because their natural defense systems react to gluten by attacking the small intestine and compromising nutrient absorption.
Is it backed by science? Yes – and no. There’s some evidence to suggest that people with RA, but not celiac disease, experience improved symptoms when going gluten-free – but other studies show no difference in disease activity or pain among patients with juvenile idiopathic arthritis. Plus, avoiding gluten isn’t for everyone, especially children. In some cases, it may even cause nutrient deficiencies and exacerbate other ailments.
What are the pitfalls for kids: Gluten-free diets often fall short on B vitamins (thiamin, riboflavin, niacin and folate), fiber and iron. Equally important, studies show families have trouble following a gluten-free diet, not to mention sticking to one can be costly. But it can be an option if parents go about it properly, says Jennifer Hyland, RDN, part of the Pediatric Nutrition Support Team at Cleveland Clinic. “If you do opt to go gluten-free, choose less-processed, natural food sources and eat a variety of foods, such as quinoa, rice, beans, legume-based pasta and potatoes.” Each of these foods supply some of the nutrients in their gluten-containing counterparts and they’re also anti-inflammatory. Before you dive into a gluten-free diet, speak with your doctor and dietitian to find appropriate gluten-free alternatives to meet your growing child’s nutrient needs.
What it is: The keto diet restricts carbohydrates in favor of fat and protein. In fact, the plan requires dieters to get 70-80 percent of calories from fat, 15 to 25 percent from protein and less than 10 percent from carbohydrates. Butter, coconut oil, meat and full-fat dairy are fair game, but most fruits, beverages, grains and starchy vegetables are out.
Is it backed by science? The keto diet forces the body to burn fat instead of carbohydrates, a process called ketosis. Instead of energy from carbohydrates, the body runs on a build-up of acids in the blood called ketones. While the diet was designed to control seizures among children with epilepsy, there’s no evidence to suggest a keto diet has any benefits for children with arthritis.
What are the pitfalls for kids: “The keto diet adds pro-inflammatory foods, such as butter and meat, and restricts anti-inflammatory foods, such as fruits, starchy vegetables and whole grains,” says Hyland. Kids need carbohydrate-rich foods to grow. It’s also lacking in critical nutrients found in fruits, vegetables and whole grains. To make matters worse, it’s constipating and could overtax your child’s liver and kidneys (due to increased acid in the blood).
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