Your guide from soup to nuts -- or smoothies, as the case may be.
By Denise Mann
Reviewed By Michael Smith
With arthritis, the simplest tasks can seem Herculean -- especially when they involve preparing and eating meals. You're not alone. Opening a carton of milk, slicing a tomato, or making a sandwich can be overwhelming to the millions of people with arthritis and other diseases and conditions that affect mobility.
So how are you supposed to eat the healthy, balanced diet that your doctors insist is part of your treatment?
"Anyone with osteoarthritis or any kind of limitation that affects their ability to walk, use their hands, or their ability to stand, as well as those with decreased general endurance and weakness that's secondary to another disease, can run into trouble when it comes to preparing and eating meals," says Susan Underwood, RN, RD, manager of nutrition services for the Visiting Nurse Service-Choice of New York. (VNS-Choice), a long-term care program serving the elderly and disabled.
"Someone's ability to cook and prepare meals is compromised if they can't stand or use their hands."
But simple strategies and tasty tips can help make cooking and eating manageable and enjoyable once again.
Counting Your Calories
First things first: "If someone isn't as mobile as they used to be, their total energy decreases so their calorie needs go down. But if they are still eating the same amount as when they were more mobile, it can lead to weight gain," Underwood says.
"Over time, they will gain weight and this will exacerbate problems with mobility." That's why the first step is to talk with a registered dietitian or health care provider who can evaluate calorie needs and discuss how best to meet them, she says. The American Dietetic Association can help you find a dietitian near you.
Harnessing the Power of Protein
Getting adequate amounts of protein is crucial for the elderly and disabled, Underwood says. "As people get older and older, we become concerned about weight loss and we tend to see decreased protein intake," Underwood explains. "When you don't eat enough protein, you don't just lose fat, you lose lean body mass and muscle that your body burns off for energy, then tissue repair," Underwood explains.
So how do you make sure you meet your protein needs?
Tina Freiwald, RD, CDE, at Windber Medical Center in Windber, Penn., suggests the incredible, edible egg. "Eggs get a bad rap, but if you don't have a problem with cholesterol, they are a good source of protein, are soft, so they can chew them as well as cook them very easily," she says.
Tuna and salmon, which are also high in protein, now come in pouches, not just hard-to-open cans, she says. Imitation crabmeat and frozen shrimp are also easy to open and good sources of protein.
You can also get protein and a bonus of calcium from cottage cheese and yogurt -- both of which are easy to chew and open, she suggests. "The less mobility you have, the heavier you [can] get, so calories can still be an issue, and many of these dairy foods come in low-fat varieties, which can be helpful unless you are already not getting enough calories because you are so frail," Freiwald says.
Souping Up Your Diet
"Canned soups can be high in sodium, but dehydrated soups in a cup -- where all you have to do is add water -- are often very health-conscious," says Freiwald.
Look for the words "reduced sodium" when choosing a soup and opt for black beans, lentil, or minestrone. "They are high in fiber, so they help keep your bowels healthy and are also a good source of protein," she says.
Dawn Jackson, RD, a dietitian at Northwestern Memorial Hospital Wellness Institute in Chicago also suggests high-fiber, high-protein canned kidney and garbanzo beans sprinkled on a salad or low-fat refried beans on cracker or tortilla.
"These are easy to prepare, tasty, and nutritious as snacks or meals," she says.
Smoothing Out Your Diet
"Smoothies or shakes are useful if you can't chew," says Windber's Freiwald. "You can make a shake with yogurt, soy milk, and fruit so you get dairy in as well as protein and fruit." Other ways to sneak in fruit include applesauce and canned fruit. "Berries that are frozen are great because you can take them out and set them on counter or nuke them and throw them in yogurt," Freiwald says.
Beefing Up Your B Vitamins
"B vitamins including thiamin, folate, B-6, and B-12 can be hard to get," Northwestern's Jackson says.
"This can be a problem because foods that are rich in these vitamins include green leafy vegetables, fish, poultry, and lean meats that take too much time to prepare, or foods like nuts that are hard to eat if you have trouble chewing," she explains.
For folate, drinking a glass of fortified orange juice "is a down and dirty way to make sure you're getting enough," she says. Tuna or salmon in pouches and/or pre-cooked poultry are also good, user-friendly sources of B vitamins, especially B-6 (not to mention protein!). B-12 comes from eggs and cheese and thiamin is typically found in meat, legumes, grain, yeast, and wheat germ.
"These days, you can buy pre-cooked chicken in a pouch and it's very easy to throw on a bed of pre-cleaned salad greens," she says. A daily multivitamin helps too!
Drinking Your Fill
As people age, fluid intake can become a big problem, largely because we're at an increased risk of dehydration as we get older, Jackson says.
"Some people who have decreased mobility are reluctant to drink adequate amounts because it can be painful to go to the bathroom, but it's important to be conscious of drinking fluid, even if it's cumbersome to go to bathroom," she says.
"Dehydration causes low energy when you are already having energy problems," she says. Aim for as close to eight, 8-ounce glasses of water a day as you can get.
Making Sure You Arent 'D-ficient'
"Getting enough vitamin D can become more difficult if you are homebound or go out less," Jackson says. If you are not in the sun, your body can't make enough vitamin D -- also called the sunshine vitamin.
Egg yolks are a great source. "Try hard-boiling three eggs per week and you can eat them with meals or for a snack," she says. "A cup of milk can be easy when you are not looking to expend a lot of effort, or a cup of yogurt."
The American College of Rheumatology recommends that anyone taking steroids, especially for more than three months, should be taking a minimum of 1,000 to 1,500 milligrams (mg) of calcium and 400 to 800 IU of vitamin D supplements on a daily basis. These medications, which are commonly used to treat many conditions, including arthritis, can make bones weak and susceptible to fracture. Dairy foods, such as milk and yogurt, are often rich in calcium and milk is usually fortified with vitamin D.
Building a Picture-Perfect Plate
Jackson suggests picturing a plate in which half comprises fruit and vegetables, such as the kind that come bagged, cut, and cleaned; a quarter is filled with a protein source, such as a pouch of tuna or salmon or pre-cooked chicken; and the remaining quarter is a whole-grain starch. "Put a sweet potato in the microwave, or add a high-fiber roll or cracker, or boil a bag of brown rice," she says. "This doesn't take a lot of cooking and could be a very good thing."
Variety is the spice of life, and there is no reason that these meals have to be boring. "There are lots of quick things nowadays with so many pre-packaged, convenient foods like pre-cooked chicken strips, tuna in a pouch, imitation crab, and frozen shrimp, that don't take much cooking or standing in the kitchen," she adds.
Being Savvy About Frozen Meals
Choosing frozen meals and adding frozen vegetables to the dish is a good idea, Jackson says.
"These meals have good portion control when it comes to meat and starch and usually we tell people to open a bag of frozen vegetables, add them to the tray, then put it in the microwave," she says. Voila! Dinner is served.
Reading Up on Resources
"If [patients] can't shop, their ability to get food is limited and may have to order meals-on-wheels, prepared foods, or have the home health aide go to the deli every day. Sometimes the choice is not yours and, as a result, the whole food experience may not be as pleasurable as it was before," Underwood says.
But "meals-on-wheels is wonderful," Underwood says of a program in which hot meals are delivered to your door. "If you qualify, it can be paid by insurance, but you can usually pay privately."
Underwood also recommends looking into local churches that might arrange to have meals delivered, or asking a family member to prepare a week's worth of meals to be kept in the freezer and microwaved as needed. Most large communities have an office on aging or similar agency that can help you find out what's available where you live.
Published Aug. 6, 2004.
SOURCES: Susan Underwood, RN, RD, and manager of nutrition services for the Visiting Nurse Service-Choice of New York. (VNS-Choice), Dawn Jackson, RD, Northwestern Memorial Hospital Wellness Institute, Chicago. Tina Freiwald, RD, CDE, Windber Medical Center, Windber, Penn.
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