Nutrition Essentials | Can Certain Foods Ease Joint Pain? with Elaine Husni, MD, MPH

Podcast Transcript

John Horton:

Welcome to another episode of Nutrition Essentials, a spinoff of our long-running Health Essentials Podcast. I'm John Horton, your co-host, with registered dietitian Julia Zumpano. How's it going today, Julia?

Julia Zumpano:

It's going great, John. I'm so excited about today's topic. We're going to talk about how what we eat affects our joints.

John Horton:

Julia, given the hundreds of millions of people around the world who are living with arthritis, you can see where any possible connection between diet and joint pain feels like a really big deal.

Julia Zumpano:

Absolutely. And we're going to talk about what you put in your mouth and how it affects your symptoms. So we brought in Dr. Elaine Husni. She's the Vice Chair of Rheumatology, and she's the Director of the Cleveland Clinic Arthritis and Musculoskeletal Center.

John Horton:

Well, Julia, let's get to it because I know nobody wants to be living with achy joints.

John Horton:

Welcome to the podcast, Dr. Husni. I can't tell you how happy we are to have a little bit of time to spend with you today.

Dr. Elaine Husni:

Thank you.

Julia Zumpano:

So great to have you, Dr. Husni. Thanks again for joining us.

Dr. Elaine Husni:

Glad to be here.

John Horton:

So Dr. Husni, we've done a lot of these Nutrition Essentials episodes by now, and we always have this pre-recording chat ahead of time to kind of pick the brains of our guests and explore how the topic interconnects with diet. And I don't know if we've ever had another doctor ask more nutrition questions to Julia than we had during our meeting, which kind of signaled what a big deal this is. So let's just kind of start with how often you get questions from patients about links between food, arthritis and whatever joint pain they're feeling.

Dr. Elaine Husni:

Yeah, that's interesting. I'm sorry if I asked you too many questions, Julia.

Julia Zumpano:

No, I loved it. That made me happy. I love it.

Dr. Elaine Husni:

There's not a week that goes by in my clinics that I don't get at least one question about diet, "What I should eat" — nutrition, how does it affect arthritis.

John Horton:

Well, and that really does just go to show just, like I said, how big a deal it is, and people are kind of looking for solutions. And kind of, as we talked about when we met earlier, there's no one simple answer. And some of that is because of just the complexities of arthritis and joint pain. So if you kind of walk us through a little bit of background there on how everything we're talking about, all this arthritis, it's not all the same.

Dr. Elaine Husni:

Right. So “arthritis” is a really general term, as you know. It just basically means pain and swelling in a joint. But we know that there's many reasons for pain and swelling in a joint. It could be something as common as osteoarthritis, where it's more of a wear and tear, the cartilage gets worn down after a while, usually happens in older patients or anybody that has an overuse injury, or a competitive athlete can develop early osteoarthritis. And then, there's inflammatory arthritis, which is more in the category of rheumatoid arthritis and psoriatic arthritis. So no matter where or why you have it, it does end up having pain and swelling in a joint, but they are two sorts of very different types of arthritis.

John Horton:

Well, and I know you had mentioned that there's 50 different types of arthritis when you start getting all the little classifications. It's just crazy what a diverse thing we're talking about.

Dr. Elaine Husni:

It is, isn't it? It's kind of crazy to think about because everybody thinks their one arthritis is the only arthritis. But as a rheumatologist, we care for people with all different types of arthritis.

John Horton:

And when we talk about diet with arthritis, I think everybody wants to make that direct connection. And I know we had that when we were talking ahead of time. You want to be able to go: A leads to B. And it sounds like it's not quite that simple, right?

Dr. Elaine Husni:

Yes. This is why I really want somebody like Julia on our home team here, sitting in rheumatology with us, because I get so many inquiries that it's really hard, as you say, to kind of have one size fits all, right?

Dr. Elaine Husni:

So it's the different types of arthritis. It's also what they're asking about. Is it a specific gluten-free diet? Are they just asking about what to eat, what's nutrient-dense? And then, the most common thing is they feel like the one thing they ate that morning makes their joint pain a couple hours later worse. And so I think we have really little data to support that there's this immediate connection, but I'd love to hear from Julia. Really, what we think of is sort of a diet over time — or maybe we don't even want to use the “diet” — but having a healthy nutrition over time will definitely help with symptoms of arthritis.

Julia Zumpano:

I couldn't agree more, Dr. Husni. I would love to join your team. I would love to be a part of your team and continue to educate your patients on how to relieve their symptoms.

Julia Zumpano:

So now on that note, we know that diet does not cure any disease and nor does diet cause any disease to happen, right? So when it comes to arthritis, we look at symptoms and how can we reduce symptoms. And we do know that certain types of eating habits and lifestyle can cause symptoms to worsen, and we know certain ones can help symptoms get some relief, and that's what we really want to focus on. That's what I focus on with my patients, is looking at the overall lifestyle, looking at the style of eating, and I try to shave out some of those foods that could be more triggers, and I try to include more of the foods that could help suppress some of the symptoms and the inflammation.

Dr. Elaine Husni:

Love that. Love that. Yes. I think that it's really helpful in real time to work with a nutritionist so that these sorts of myths can be more easily conquered rather than in our small visit that we get once every three months, where it's really difficult, right? So nutrition advice is better, I think, over time. So I had mentioned the gluten-free diet. And of course, if you have celiac disease, you need to be gluten-free. But many of my patients have not been diagnosed with celiac, but really believe that restricting their diet in certain ways equates to much better joint pain and they think that there's a trigger. So how do I manage that?

Julia Zumpano:

Great question. And that comes up often. So I like to zoom out a little bit. So I think we can get hyper-focused on one food or one nutrient, like gluten or dairy or whatever the one food might be. So I like to look at the diet as a whole because one thing can't cause or resolve problems, right? So when we zoom out and we look at the diet and we, let's just say, look at gluten, most of the foods that the standard American diet consumes in forms of gluten are highly processed. So we're looking at processed breads and bakery items and processed noodles and pastas and buns — any of those white bread refined products. And those products, specifically, if they have a lot of added sugars, added artificial sweeteners or regular preservatives, those can cause more inflammation because they're highly processed foods. And I think that's more of where the problem lies, is the amount of processed foods and refined grains that we're consuming.

Julia Zumpano:

Refined grains are those processed forms of grains. We know whole grains, such as 100% whole wheat or oat or rye or barley or millet or brown rice or wild rice, those have so many great nutrients and are really not processed at all. They come in their whole form, and you prepare them, and you normally would never have any issue with that. But the issue really lies from the processed foods that we consume. And as I mentioned, most of those processed foods most likely will contain some gluten. So I think that's where some of that association comes in.

John Horton:

Julia, I know when we were talking ahead of time, too, you had an analogy you used — the overflowing cup analogy — to kind of break some of this down. So can you kind of share that with our listeners?

Julia Zumpano:

Yes. So when you think about inflammation, let's say, or just joint pain or whatever you're experiencing, your cup is full. You're experiencing that fullness of the severity of your symptoms. So your cup may be full of a lot of pro-inflammatory, or trigger lifestyle or dietary means.

John Horton:

Because of everything that you're doing day after day after day...

Julia Zumpano:

Right. Exactly.

John Horton:

You're [inaudible]. OK.

Julia Zumpano:

Exactly. Your life of just your normal routine of the foods you consume, the lifestyle you have, maybe stress, inactivity, not enough sleep, poor nutrition, all of that fills your cup. So these symptoms are very present.

Julia Zumpano:

So when you have something on top of a full cup and you overflow it with something like gluten or any food that you construe as a trigger, that's the overflowing cup analogy, right?

Julia Zumpano:

So what I like to do is, let's empty that cup as much as we can. So let's take out the inflammatory reactions that we can, such as nutrition, sleeping adequately, exercise, reducing stress, et cetera, and let's reduce how much load we can put. And then, when you do have maybe an insulting ingredient or food that will not overflow your cup, it won't create such a reaction. So if we keep a half full, or as low as we can to keep that cup as empty as we can, we won't necessarily be as reactive to certain triggers.

John Horton:

Yeah. It seems like it's a statement on our overall diets for a lot of people.

Julia Zumpano:

Right. So it's the holistic approach, right? So when you've had a weekend of eating out and drinking alcohol and all these things, and then all of a sudden, Sunday morning, you wake up and you had, let's say, a bagel and you're like, "Oh, it was that gluten," well, let's zoom out, right? Let's look at what else we had, right?

Julia Zumpano:

So maybe you followed a gluten-free diet, but it was still refined grains. It was still processed foods. Maybe you're still consuming high amounts of sugar, alcohol. All these things are not beneficial from an inflammatory standpoint and a symptom management standpoint. So I want to make sure people aren't hyper-focused on one thing, and looking at the whole diet. And that's where a dietitian can really help because now, there could be certain triggers per se.

Julia Zumpano:

And generally, I may recommend an elimination diet, so a short period of time. Again, very short, two weeks of eliminating certain potential triggers and then adding them back in slowly to see the reaction. And now, if you are reactive to one of these food triggers, that doesn't mean you have to avoid it forever. We have to maybe limit it until the inflammation is more manageable, and then we could build and slowly add that back in.

John Horton:

Dr. Husni, I mean, this sounds like … this is a lot of what you hear from your patients. They come in and they're like, "Hey, this bagel did it to me." So how do you then, kind of guide them through that to go, "It might not be that. It's probably a much bigger picture"?

Dr. Elaine Husni:

Yeah, I really like Julia's analogy. I think increasing that reserve so that they're just not always just their head above water. They have a little more reserve and they can manage things in their life a little better. I also love the idea of a more composite look at your lifestyle. So not just a specific diet, but keeping your movement, reducing your stress, and really, having more of that umbrella lifestyle attitude really helps because one of the things I worry most about is when they come in and they have one type of food they don't want or one type of diet, is that it affects their relationship with food. And I feel bad because I know that there's not scientific evidence to show that and I don't want their relationship with food to skyrocket into something that would be negative down the road.

Julia Zumpano:

Yeah, I can't agree more, and I think that's where education comes in. I mean, that's a big piece of what I do day by day with clients and patients is I'm explaining to them that what my goal is, is to expand the amount of foods that they're able to eat, to give them the most possible nutrition from their food, right? Food is medicine. I do believe that truly, wholeheartedly. Now, it's not the only form of medicine, but it is a form of medicine, right? We can heal our bodies with overall lifestyle, good nutrition, and maybe some medications are in there, whatever other means you need, physical therapy, all those other things can really be very, very helpful, but I'm not in the sense of restriction. I'm more educating, educating on what foods are going to be more helpful, what foods may potentially be harmful, and how to help people really just empty some of that cup so they can have some of those other foods that they really do enjoy that may not be as ideal, but that won't overflow their cup.

Dr. Elaine Husni:

Yeah. I also think that it's so hard for a patient that is suffering with pain and swollen joints. And then they hear something on the TV or a friend at church or somebody who says, "Oh my gosh, chia seeds are good," which we all know is good. But then, I love your idea of expanding that horizon and really not, kind of, having that relationship that just one food is going to fix everything.

Julia Zumpano:

Right. We know.

Dr. Elaine Husni:

Right. So one of the issues I have is, really how do we talk to our patients maybe — what is a good thing to have for breakfast? How do we expand that palate? How do we start that conversation so it's not so scary to have another appointment with a nutritionist?

Julia Zumpano:

Sure. I love that. So what I like to focus on for breakfast would be a higher-protein breakfast for many reasons. First of all, it's going to help keep you more full. It's going to help meet protein needs. It's also going to help better with blood sugar management and decreasing spikes in insulin, which we know can sometimes lead to more inflammation, in some cases. So a perfect breakfast would be some eggs or egg whites with some veggies. A veggie omelet, I think, would be a great breakfast, with a cup of berries. I think that would be a phenomenal breakfast. If you can't take the time to make the eggs, I love oatmeal. I think oatmeal with some chopped nuts and some berries on top. Again, those chia or flax seeds would be great.

Julia Zumpano:

And then a third option would be some Greek yogurt. I love Greek yogurt with, again, some berries and some fruits. Any kind of fruit and any kind of added fat to that. So my go-to is nuts or seeds on top. And you could even do that with a slice of whole-grain toast with some avocado on it.

Julia Zumpano:

So there's so many great options, but really focusing on whatever breakfast you have that you're containing some protein there.

Dr. Elaine Husni:

Yeah. I love to hear that variety that you have. And I think some people can get stuck because they know what they know to buy and they don't know how to expand that palate. So I think working with a nutritionist can be really helpful. I mean, many of my patients feel like, "Oh my gosh. Another visit." And then they're going to tell me, "I can't eat this and I can't eat that." But I love how you are really presenting it as more like, "I'm trying to expand your overall diet, not restrict."

Julia Zumpano:

I think I can speak for all dietitians, I mean, we're really here to help you create a diet that's perfect for you. No one wants to be told not to eat something. I learned very young as a dietitian that as soon as you tell someone they can't eat something, they're done. You could see it in their face. They're like, "I'm not listening to anything you're saying. You've already made me mad." So no one wants to hear that. So I learned pretty early that if I can just educate and provide more that they can have, and then educate why maybe Greek yogurt with berries is a better choice than a chocolate croissant, I can maybe win them over with why it's better, right? And just saying, "This chocolate croissant doesn't need to always go away.” We can have it occasionally on special occasions. Enjoy it when you have it. But for a regular routine basis, a day-to-day basis, this is what was going to serve you better. So it's never an all-or-nothing approach.

John Horton:

And Julie, I know you mentioned oatmeal a little bit ago when you're going through those ideal breakfast things. So I'll make sure, too … I know we talked about processed foods earlier versus whole foods. Oatmeal is one of those things where I know people think that they're eating really well when you get that little packet out with the brown sugar and all that stuff in it and you dump it in there and you heat it up. You want to be careful when you're even making those choices just to make sure you're getting as natural a product as possible.

Julia Zumpano:

John, I love that you brought that up because I tend to hesitate saying oatmeal because of that exact reason. Yes, those packets are loaded with so much sugar, and that's the first thing I ask when the people are like, "I have oatmeal for breakfast." I'm like, "OK, is it a packet or are you cooking it fresh?"

John Horton:

All oatmeal is not equal.

Julia Zumpano:

Right, right. So we want to be able to buy the old-fashioned oats or even the quick oats or steel-cut oats all are phenomenal options. They all take a little different timing for cooking, but the real oats, and then cook them yourself and then season and flavor on your own.

John Horton:

And there's so much you can add like that.

Julia Zumpano:

So much.

John Horton:

Like you said, putting in the fruits and maybe even a little drizzle of maple syrup or something like that where you're not getting all the garbage.

Julia Zumpano:

Wonderful. Honey, cinnamon, vanilla. You can chop so much different fruits in there. You can add nuts in there. Another thing that I often recommend in a bind is that if you really do like oatmeal, whether you like it hot or cold, if you like it hot, a crockpot. So cooking a crockpot of oatmeal in the beginning of the week and then having it ready there to eat. I used to do that when my kids were young, I would put apples and cinnamon and it would cook overnight and it would smell amazing in the morning. So that's another great option.

Julia Zumpano:

Or if you like it more cold, overnight oats is great. So you just have to make it the night before. It's extremely simple. You just use a liquid, like a nut milk, an almond milk, or actual cow's milk, or Greek yogurt as a liquid, and then the oats, and you store it in a glass container overnight, and it kind of just absorbs that liquid. Now, you can eat it cold or you can throw it in the microwave, too, but those are two great ways to save time and have it quick and easy, ready to go.

Dr. Elaine Husni:

Yeah. I do think that time is always against us, whether you're raising kids, trying to get to work on time, and really that's when I believe the poor food choices kind of sneak in. And so I find myself, if I prepare the night before, I definitely have healthier choices. And if I wait till the morning and inadvertently something comes up, I don't know, the garbage truck comes and I forgot to put something out and then it just takes away my 10, 15 minutes that I need. Things like that. So I do love that idea of expanding the palate and then maybe preparing ahead of time because I feel that's when I make some poor choices is when I'm kind of rushed.

Julia Zumpano:

Yes. I talk about planning all the time. Planning ahead is the number one thing that will keep you on track with your nutrition and health goals. I mean, I can't say it enough. Having enough groceries in your house to be able to grab good things, be able to set aside time to prepare for meals, to plan ahead. I'm like you. Mornings are a disaster. I get distracted. I run late. The kids need this. Whatever it is. So the night before is key. Even pack my kids' lunches the night before. Although they may be a little fresher in the morning, typically, I'm scrambling because I'm making their breakfast and then also their lunch. So usually, it's just whatever you know about yourself to be able to minimize any excuse of just grabbing something quick and easy and planning ahead.

Dr. Elaine Husni:

I do want to maybe spend a couple more minutes a little bit more granular. Some of the things that we have in our literature for rheumatoid arthritis, let's say, one of our typical inflammatory arthritis … is the Mediterranean diet. So there's been some large studies that show that the Mediterranean diet can have a much more nutrient-dense or anti-inflammatory effect than other diets. And I'd love to hear what is it about the Mediterranean diet? How do we try to incorporate that for our patients with inflammatory arthritis?

John Horton:

Oh, this is right up Julia's alley.

Julia Zumpano:

Yeah.

John Horton:

We can sit back now.

Julia Zumpano:

In so many ways. So first of all, I was born in the Mediterranean, so I was raised on this diet, so very dear to my heart. And I work in preventive cardiology, so it's the number one dietary recommendation we make is some form of the Mediterranean diet.

Julia Zumpano:

Now, I know culturally, it may not align perfectly with your eating habits, but really, when you just look at foods alone, it can really fit into any type of cultural cuisine. The foundation is produce. It's fruits and vegetables and plant-based foods. So no matter what your produce is in your cultural repertoire, just fill it up, right? You want to fill your plate and your day with as many plant-based foods as you can. So we're thinking fruits, vegetables, whole grains, beans and legumes, lentils, nuts and seeds. So extra virgin olive oil, that is the foundation. So those are the main key points.

Julia Zumpano:

And one thing to note about that is these are naturally extremely nutrient-dense. So you're going to meet so much of your nutrient needs from this plant-based category and all these plant-based rich foods. You'll get polyphenols, which have been shown to help with inflammation. You'll get tons of antioxidants, which again protect ourselves from damage and oxidative stress. So that is one of the key components is that it's so nutrient-rich in these anti-inflammatory properties that are found in these plant-based foods.

Dr. Elaine Husni:

Great. That was really helpful.

Julia Zumpano:

Then, your go-to your protein sources from a Mediterranean standpoint are mainly fish. Again, depending on where you live, this may be more or less accessible to you, but fatty or oily fish, like salmon, herring, tuna, mackerel, sardines, those are excellent. They're high in omega-3 fatty acids. So if you can, consume fish on a regular basis.

Julia Zumpano:

Poultry is the other main source of protein, and then you have some eggs and some dairy. And most of the dairy on a Mediterranean diet is Greek yogurt or very mild, light cheeses. More of a dusting, not a foundation of the meal.

Julia Zumpano:

And then lastly, they do limit things like red meat. Not avoid, just limit. Limiting the amount of red meat you're consuming and limiting in the amount of baked goods, desserts, processed foods, right? So most of the baked dessert-type foods are things like yogurt or fruit-based. They still include the foundational pieces of the Mediterranean diet.

Dr. Elaine Husni:

So would you say a limit would be once a week or once a month or what?

Julia Zumpano:

Yes. Yeah. I think it depends. For me personally, when I look at my patients, I look at their cardiovascular disease risk, and then I may give them more of a specific number. But as a general rule, I'd say one to two times per week is considered safe. And just keeping in mind, though, that red meat should be ideally fresh, not processed. So we're avoiding processed red meat. So that's things like salami and pepperoni and hot dogs and bacon and sausages. Those processed foods are the ones we really want to avoid. But if you're getting a nice piece of lean pork, like a pork tenderloin or a beef sirloin or lean ground beef, those can safely be included once or twice a week. And we do consider red meat being beef, pork, veal, and lamb so keep that in mind.

Dr. Elaine Husni:

All right. I do want to switch gears a little bit to osteoarthritis, which is also a very, very common arthritis that we see, but it's more localized. When I say localized inflammation rather than systemic. And so many of the studies show that what helps in osteoarthritis is probably more of the eating healthy and keeping your weight, or even reducing your weight to a more normal BMI to help with those osteoarthritic joints. And so many of that happens when we don't reach for that chocolate croissant, but how do we think about diets that kind of keep us full and so we're just, I don't know, less tempted to take snacks. I mean, we can't eat almonds all day.

Julia Zumpano:

No. No, no, no.

Dr. Elaine Husni:

What are some of the options for osteoarthritis where we're really just trying to keep ourselves full and not take in too over the amount of the calories that we are supposed to?

Julia Zumpano:

Yes, great question. And I am so glad you brought that up because definitely, a moderate amount of weight loss can make a big impact, and we're looking even 5-10% of-

Dr. Elaine Husni:

…for sure.

Julia Zumpano:

…yeah, your body weight. It's such a small amount, such an attainable amount for most people.

Dr. Elaine Husni:

So how do we do that?

Julia Zumpano:

Most people, that is very reachable, and that's always what I start with with my patients, regardless of their weight. I really start small and attainable because that's reachable for them. So what I would say from a weight management standpoint would be starting to increase your non-starchy vegetables for a couple reasons.

Julia Zumpano:

Non-starchy vegetables are extremely low in calories, very high in nutrients. They have a little bit of protein, they have fiber and they tend to be more filling. So that, I would say the one thing that I have noticed across the board, seeing patients, is that 99% of people are not eating enough vegetables. So that would be an area I think everyone and anyone could increase. That's easy. And then-

Dr. Elaine Husni:

…what's an example of a non-starchy vegetable?

Julia Zumpano:

Yeah, great question. Leafy greens.

Dr. Elaine Husni:

OK.

Julia Zumpano:

Tomatoes, cucumbers, peppers, onions, asparagus, broccoli, cauliflower, eggplant, squash, zucchini. Yeah, so many. The only starchy vegetables — it's almost easier to name the ones that are starchy — the only starchy vegetables that I really count as starches or carbohydrates would be potatoes, peas and corn. The rest of them are non-starchy. So really, the sky's the limit. So as much as you possibly can get of those non-starchy vegetables. And the general rule of thumb is filling 50% of your plate with non-starchy vegetables.

Dr. Elaine Husni:

How about cooked versus not cooked?

Julia Zumpano:

Either one. Unlimited amounts. I never even limit non-starchy vegetables. Whether they're cooked or raw, you can eat as many as you want. They're unlimited. Any weight loss plan I give, it always has unlimited non-starchy vegetables. They're highly encouraged.

Dr. Elaine Husni:

Sounds good.

Julia Zumpano:

So that would be my number one step.

Julia Zumpano:

My number two step is making sure you're getting enough protein because I think, oftentimes, people are assuming they're getting enough protein, but they're not. And if you're not meeting your protein means, it's just going to leave you hungry all the time and searching. So I think that's extremely important if you can focus on those two things. And then again, meeting with a dietitian is going to help immensely.

Dr. Elaine Husni:

And what are some of your favorite lean proteins?

Julia Zumpano:

Lean protein, yes. So skinless poultry, fish, lean red meat, dairy like cottage cheese, Greek yogurt, eggs, legumes, beans, and nuts and seeds.

Dr. Elaine Husni:

OK, sounds good.

Julia Zumpano:

So tons of variety there.

Dr. Elaine Husni:

Yeah.

Julia Zumpano:

If you look at veggies and all that protein sources, you're full. You don't have to count calories. You don't have to measure. You don't have to weigh. It's just a matter of just really filling your plate with those foods.

John Horton:

Dr. Husni, I was going to say, while we're on the topic of weight loss, I know, kind of one of the other things that comes with that is getting enough exercise. And I'd imagine when you're talking to patients that are having achy joints and their arthritis is flaring up, that sometimes that's maybe the last thing they want to do. Can you kind of talk about how important it is to keep going, keep moving, make sure you get that activity in if you do have arthritis, just to keep those joints going and to help with weight and just everything that it can do to benefit you?

Dr. Elaine Husni:

Yeah, that's a common myth I have is that if my joints hurt, I don't want to move it because it's just going to make the arthritis worse, right? And so we hear that a lot. But we know that studies show that the joint is actually a whole unit. It's not just the cartilage and the bones, it's the ligaments. It's the muscles. It's the joint capsule. It's the whole sort of musculoskeletal system, and they work in harmony. And one of the best ways to help correct that, or to at least make your joint work longer into your lifespan without arthritis, is really to keep it moving. So patients that really have a hard time with that, sometimes they have to start with what we call “non-land-based therapy.” So it might have to start with water therapy because water therapy allows you to have the buoyancy of the water and still do all the range of motion exercises that is just too hard to do on land therapy. So sometimes, they start with water therapy and then they go on to land therapy.

Dr. Elaine Husni:

Other things that we tell our patients is people love to do yoga, but it hurts when they try a downward dog. And then we said, "You know what? There's chair yoga," where literally just like it sounds, you're sitting in a chair, but yet you can from head to toe be able to move all of your joints easily without having all that pressure that you can get with regular yoga. So you might have to start with chair yoga and then advance yourself into other forms of yoga.

Dr. Elaine Husni:

So the key is to keep moving, to kind of bust that myth that staying still or being a couch potato sometimes helps the joint. Not really. We really want you to keep moving, but we want you to do it intelligently, so we want to give you ways. Just like you are teaching me ways to change our diet and add more to our palate, we have different ways to get you moving as well.

Julia Zumpano:

Dr. Husni, an important note: Most people think, "Well, if I'm just doing chair yoga or swimming, I'm not burning that many calories and it's painful," or "It's not as comfortable." I think something important to note is that any movement is good movement. Any movement is better than being stagnant, and I tell my patients that all the time. Anything that you can do to move more that doesn't hurt, that is not causing excruciating pain, is wonderful. I recommend stationery bikes a lot. I do recommend some of those very gentle stretching. Any form of movement is getting us closer to our end goal. And as we continue to work on diet and lose a little bit of weight, that movement will be even easier. So it ties in together so beautifully.

Dr. Elaine Husni:

I know. Every time I say a word like “exercise,” what do people think? They think of that person that is doing a spinning class. So exercise just comes in all different flavors, and you have to give your body a break. One day, you may be able to do the spinning exercises, but right now, we try to tailor the movement and the exercise to what you can do now. Sometimes, you could be in an arthritis flare, so you can do even less, and then that arthritis flare will get better and then you can do more. There's also a concomitant sort of pain syndrome that can sometimes develop with our patients where they've had a lot of arthritis and flares, and all of a sudden they sort of get into this vicious cycle of having what we call “pain sensitization,” and they get almost like a total body pain.

Dr. Elaine Husni:

And we have to make sure that they understand the difference that if you have total body pain, it's really different than having an arthritis flare, and that you might need treatment for the chronic pain before you can really start to get moving for your regular joints as well.

Dr. Elaine Husni:

So there's all these different nuances that we touch on in a visit. And sometimes, it's hard to hear, and sometimes, you can't get it all in one visit, so having multiple visits and then reaching out to people like you as a dietitian, and then also people like physical therapists for movement, is also very helpful to us.

John Horton:

So Dr. Husni, those are some great tips with exercise, and I know we're kind of winding down here a little bit. So just for people who are listening, just to kind of go over some real actionable steps if they're dealing with arthritis pain or joint pain and they want to tackle it, it sounds like there are a couple main things they need to do. So just maybe a couple top things, if somebody's going to do it, what would you recommend?

Dr. Elaine Husni:

So I think the most important thing is actually to get diagnosed properly because arthritis is such a general term, and sometimes you can talk about wrist pain with your friend next door or you could talk about wrist pain with your coworker and it's from totally two different things, right? So somebody may have gout. Somebody may have osteoarthritis, some patient may have psoriatic arthritis. And because the treatments are so different, I think getting diagnosed properly is probably the first step they could do instead of assuming that their joint pain is from this or this, right? So that's what I would definitely sort of recommend first is to touch base with your primary care doctor or maybe a referral to rheumatology as needed to make sure that your joint pain is correctly diagnosed.

Dr. Elaine Husni:

And remember, if you have osteoarthritis, it doesn't mean you can't have rheumatoid arthritis, right? So some people can have two different types. If you have gout, it doesn't mean you can't have another type of arthritis. So I think that is all very helpful to know what you have. That's number one.

Dr. Elaine Husni:

And then, based on what you have, to really understand the sort of normal trajectory of that arthritis so that you can be prepared, then you can … then visit with many of these, what I call my colleagues, like Julia or a physical therapist, where then we can work together based on the type of arthritis you have. Otherwise, you're sitting there, "Oh, I generally have arthritis everywhere." That's so hard to take care of.

Dr. Elaine Husni:

So I think getting diagnosed and then making up your team, I think is really important, and you can talk to your primary care or your rheumatologist about making that team.

Dr. Elaine Husni:

So Julia may be really important for the next six months, and then maybe the therapist will become really important. And so I think being able to pivot and to just be agile is really great for care and to really accept that multidisciplinary team. And I'm sure it's helpful to you, Julia, when you have that team.

Julia Zumpano:

Yeah, I couldn't agree more. I definitely think we need a multidisciplinary team. And I would say, just to piggyback off what you're saying, from your own personal symptom management standpoint, if nutrition seems overwhelming to you, I would just utilize the sources you have and try, if you can, to connect with a registered dietitian. That would be a wonderful first step, even if it's just a couple initial visits.

Julia Zumpano:

If you don't have that as a resource, I would make sure you're getting your nutrition information from credible sources. So there's so much out there that's conflicting, confusing, trendy, very restrictive, and that is exactly the opposite of what we want to be taking in because it creates more stress around the situation. The Cleveland Clinic has phenomenal resources. They have a health library. They have a Health Essentials newsletter. So anything you could do from any type of health organization, hospital system that you can gain your information from.

Dr. Elaine Husni:

Yes, I love that. I think that's so true. It's hard to filter what's coming at you because everything seems so glossy and shiny and real, but like you said, getting it from a true source. I don't know if I should ask this, but do you have an app that you recommend? Because there are definitely patients that ask me about that, and I know it's hard that we can't really endorse anything, or maybe an overall website. But the Cleveland Clinic, I know, has a lot of essential health.

Julia Zumpano:

Cleveland Clinic has a great multitude of resources on their Health Library or their Health Essentials. The Cleveland Clinic Diet app®, I have to say, I helped create it. It's phenomenal. It's excellent. It's very disease-based-focused, so it will give you a lot of that clinical data. It will give you an update of nutrition information. Things specific to your condition, it will feed you information on. So I think the Cleveland Clinic Diet app is great.

Julia Zumpano:

There are a lot of other apps out there, too, that are excellent. I think the Yuka™ app people have had a lot of success with. Just even the National Institute of Health websites. Any of these governmental organizational websites, too, can provide good information. I think there's a lot of great information there, just making sure you're choosing the science-backed data versus just websites that you're not familiar with or they don't have any science backing on the claims that they're making.

Dr. Elaine Husni:

Very helpful. Thank you.

John Horton:

Just to kind of sum everything up then, when you're looking at joint pain and diet, it sounds like there isn't one food you're going to get that's going to solve the problem. There's no magic thing you're going to find at the market. But instead, you really need to look at kind of a broad-based approach, where you're looking at your entire diet and just eating more fresh produce, more whole grains, things like that. And if you do that, hopefully, we can empty that cup a little bit, as you were talking about, and make everything better moving forward.

Julia Zumpano:

Exactly. Exactly. It's not the one thing that's in your grocery cart. It's the entirety of your grocery cart that makes the difference.

John Horton:

Well, I would say our grocery cart is full with information after this whole discussion. So Dr. Husni, I just want to say thank you so much for coming in today and really kind of tackling this topic.

Julia Zumpano:

Thank you so much, Dr. Husni.

Dr. Elaine Husni:

This was great. Thank you.

John Horton:

Julia, after talking with Dr. Husni, she makes it sound so simple, as far as addressing some symptoms of arthritis, just by doing a few maybe easy things in your life.

Julia Zumpano:

I agree. I mean, it all almost always comes down to the same basic categories of what we need to do to stay healthy. We look at diet and nutrition and the importance of eating whole foods and movement and exercise and getting holistic care, so really having a robust interdisciplinary team. So I think it's so important to start with whatever is attainable to you, what's reachable to you, and utilize all the resources that you have around you.

John Horton:

Yeah, it's amazing because I know, as we've done this podcast, it seems like it always comes down to just eating your fruits and vegetables and those whole grains and staying away from all those processed foods. And really, it does a lot just to make you move better and feel better.

Julia Zumpano:

Yeah. Just taking one step back to really take a look at the diet versus focusing on overly restricting or taking out a single food or nutrient, it's really looking at the diet as a whole and minimizing those processed foods that we know don't serve us very well.

John Horton:

I know everybody wants that one food that's going to do it, but it's just not there.

Julia Zumpano:

Doesn't exist, unfortunately. But the good news is, there are a lot of foods that do support health.

John Horton:

And I guess that's even better for us in the long run.

Julia Zumpano:

Right.

John Horton:

Well, if you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 4:

Thank you for listening to Nutrition Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.