Nutrition and Vasculitis
By Aimee Shea, MPH, RD, CSO, LDN, Outpatient Oncology Dietitian, NC Cancer Hospital
Most people diagnosed with vasculitis will likely agree – nutrition is complicated. Both the symptoms and the treatment of this disease can significantly influence nutritional status. While at the same time, what you do (or don’t) eat can impact the disease process and possibly even make it easier to manage. This article will provide suggestions for maximizing your nutrition while dealing with vasculitis.
First, let’s examine how vasculitis itself can affect nutrition. Common systemic symptoms of this disease include poor appetite, weight loss, and fatigue, while organ-specific symptoms may include mouth sores, diarrhea, and kidney problems. If poor appetite or unplanned weight loss is a concern, try to eat every 2 hours, even if just a few bites. You should also focus on high calorie, high protein foods, like nuts and nut butters, beans, granola or protein bars, dried fruit, milk, yogurt, cheese, ice cream, poultry, meat, fish, eggs, and healthy fats (like canola or olive oils, spreads made from those oils, mayonnaise, salad dressings, or avocado). Also, try to choose beverages with calories, i.e. milk, juices, sports drinks, smoothies. Lastly, keep in mind that light physical activity can help stimulate appetite. If fatigue is a problem, remember that skipping meals won’t help matters – still try to eat regularly throughout the day. Also, sometimes fatigue may be a sign of dehydration, so be sure to get in 8 to 10 cups of non-caffeinated fluids every day. In addition, light exercise can help improve fatigue.
For some people, organ-specific side effects are more of a concern. If mouth sores are an issue, there are foods you can choose and avoid to help. Choose soft, bland foods, like yogurt, pudding, applesauce, ice cream, canned fruit, mashed potatoes, macaroni and cheese or buttered pasta, creamy soups, and milkshakes or smoothies. Be sure to avoid citrus foods (orange, grapefruit, lemon, lime); tomato products; vinegar-based foods; coarse, rough, dry goods (like granola or cereal); irritating or “hot” spices; and anything containing alcohol, including most commercial mouthwashes. Lastly, make your own mouth rinse: 4 cups water, 1 tsp salt, and 1 tsp baking soda – swish and spit often throughout the day. Likewise, specific foods can help you manage diarrhea. Choose bananas, applesauce, white rice, white bread/toast, plain white noodles, oatmeal, canned fruit, potatoes without the skin, and yogurt. These foods may make diarrhea worse: whole grains breads, cereal, or bran foods; raw vegetables; the skin on fruit; dried fruit; the skin on potatoes; fatty, greasy, fried foods; spicy foods; and very rich, sweet desserts. Of course, some of these foods are quite healthy – once diarrhea has resolved, be sure to include them regularly. Another organ-specific side effect is kidney disease. A detailed discussion of the nutritional management of kidney disease is beyond the scope of this article, but if it’s a concern for you, ask your physician for a referral to a registered dietitian who specializes in kidney issues. Also, here’s a great resource to get you started: www.davita.com.
Unfortunately, many of the drugs used to treat vasculitis can also significantly impact your nutrition. Cytotoxic or immunosuppressive therapies (like Cytoxan, Imuran, Methotrexate, or CellCept) can lead to nausea/vomiting, poor appetite, and increased risk of infection. Biologic or “targeted” therapies (like Rituxan or Remicade) can also cause nausea/vomiting. To help manage nausea/vomiting, try to keep something on your stomach – eat every 2 hours. Take liquids between meals, instead of during. Stick with bland, dry foods that are cool or room temperature, and avoid fatty, greasy, fried foods; spicy foods; or very sweet foods. Also, try ginger foods (ale, tea, candies, cookies), since ginger has natural anti-nausea properties. If you are told that your white blood cells are low and you’re at an increased risk for infection, make sure to avoid raw meats, poultry, fish (including sushi); raw eggs or anything containing raw eggs (i.e. don’t sample the cookie dough); unpasteurized cheeses, milk, or juice; or unwashed produce.
Corticosteroids (like Prednisone) are another common treatment for vasculitis; these drugs can cause bone loss/osteoporosis, high blood pressure, high cholesterol, high blood sugar or diabetes, and increased appetite and weight gain. To help prevent bone loss, make sure to get adequate amounts of calcium (1000-1500 mg) and vitamin D (400-1000 IU) per day – check with your doctor or dietitian for specifics. Good food sources of calcium include milk, yogurt, cheese, salmon, collard greens, almonds, and sesame seeds. Good sources of vitamin D include salmon, tuna, milk, eggs (and of course, sunshine!). Also, don’t forget that weight-bearing exercise, like walking or jogging, is very important for bone health. To manage both high blood pressure and high cholesterol, it is important to maintain a healthy weight, get at least 30 minutes of activity per day, and take alcohol in moderation. Cutting back on sodium (salt) intake will also help with high blood pressure. The DASH diet has proven to be very effective for managing blood pressure – for more info, check out dashdiet.org. To manage high cholesterol, cut back on saturated and trans fats and increase your intake of soluble fiber. For more details on how to do this, click here. To manage high blood sugar, it’s also very important to maintain a healthy weight and get 30 minutes of exercise daily. Other helpful strategies include focusing on whole grains and complex carbohydrates over processed foods made with refined flours, eating at regular times and intervals, and spreading your carbohydrate intake evenly throughout the day. For more specifics, click here. Lastly, if weight gain is a concern, try to focus on lower calorie foods, like fruits, veggies, whole grains, beans, and fat free or low fat dairy products. And of course, don’t forget the importance of exercise!
So you’re probably wondering, “But can nutrition actually impact vasculitis itself?” Unfortunately, there is limited evidence-based data specifically on vasculitis and nutrition. However, since vasculitis is an inflammatory condition, choosing “anti-inflammatory” foods and avoiding “pro-inflammatory” foods should help control this disease. Anti-inflammatory foods include fruits, vegetables, whole grains, beans and legumes, nuts and seeds, healthy fats (like olive and canola oils, nuts and seeds, avocado, fish and seafood), and herbs and spices. Pro-inflammatory foods include sugary foods (like soda, cakes, cookies, candy), processed foods, foods made from refined white flours, red meats, processed meats (like bacon, sausage, hot dogs, deli meats), and high fat animal products (like full fat dairy products and fatty or fried meats or poultry). For more ideas on how to include anti-inflammatory foods daily, check out The New American Plate Cookbook, published by the American Institute for Cancer Research. And lastly, at the risk of sounding like a broken record, including at least 30 minutes of exercise daily is critical for overall health, not to mention fighting inflammation.
As you can see, there are many ways vasculitis impacts nutrition and vice versa. Hopefully, you now have a better understanding of which foods can help you manage this disease and live a long and healthy life!