Did you know that as a person with rheumatoid arthritis (RA), you are considered to be at nutritional risk?
When you live with a chronic illness, you will gradually build up a diverse healthcare team—including a dietitian or nutritionist. This team can help you stay as healthy as possible and avoid malnutrition.
RA, nutrition, and deficiencies
There are a number of reasons why you may experience poor nutrition. One factor is that chronic inflammation involves the production of certain proteins called cytokines. Two such cytokines, the tumor necrosis factor and interleukin-1, are known to increase your resting rate of metabolism and protein breakdown.
The medications we take can also impact nutrition. Many of these meds have gastrointestinal side effects, such as acid reflux and nausea, which can make it hard to eat and may result in vitamin deficiencies. The medication themselves can also cause deficiencies. Methotrexate, for instance, can cause folic acid deficiency. It is also quite common for people with RA to have deficiencies in vitamin D and selenium, a mineral often found in shellfish and whole grains.
A dietitian can take a look at your diet and make suggestions on changes that can give you a more balanced nutrition, as well as recommend supplements. Remember to inform your doctors of the supplements you take, as some may interact with medication.
If you want to lose weight, or wish to explore how your diet may impact RA symptoms, a dietitian can also be very helpful.
Dietitian versus nutritionist
There are two types of professionals who work with people to change their eating habits: dietitians and nutritionists. An interesting fact is that all registered dietitians are nutritionists. However, not all nutritionists are registered dietitians.
The title of Registered Dietitian Nutritionist (RDN) or Registered Dietitian (RD) is given only to people who have completed the requirements for these professional designations purpose of dictation. Nutritionists, on the other hand, don’t need any formal designation or certification. That’s not to say that anyone can do it — both professions receive extensive training in nutrition, and many states require state certification.
Look for the RDN or RD letters to ensure that the person you’ll be working with has proper certification. If you’re working with a nutritionist, asking about their qualifications, schooling, and training can ensure that you are paying for services of someone who is qualified for the work.
Working with a dietitian
The first time you see a dietitian or nutritionist, they’ll ask questions about what you eat and how you eat. They’ll also ask about your medical conditions, food allergies and sensitivities to get a more complete sense of your health.
They may have given you a food diary to complete in advance of the visit. Take that seriously — it forms the basis of your work together. I have done a couple of these food diaries and it helped to start the process. It’s not just about writing down what you eat — and how much of it is crap (or is that just me?) — but in that it makes you aware of what you eat. The simple act of writing it down is enough to make you go for the carrots instead of the chips.
It’s also quite likely that the dietitian will ask what brings you to their office. Having some clarity on that before the appointment will help focus your work together. After sharing your goal, the two of you will review your food diary, and the dietitian will make recommendations based on what it is you would like to accomplish.
You may choose to continue to work with the dietitian over a series of appointments to get support that can help you attain your goal. Some dietitians and nutritionist will also come to your house and go shopping with you. If that sounds like the kind of support you’d like, ask the dietitian about the variety of services.
Paying for dietician services
Some insurance plans cover dietitians and nutritionists, others do not, so check your plan carefully. If you’re on Medicare, you will need a referral from your doctor in order to get Medical Nutrition Therapy covered. Your insurance plan may also require a referral, but you should otherwise be able to arrange appointments yourself.
If you don’t have coverage, you may want to talk to an RDN about booking some highly targeted counselling. The fee may seem expensive. However, when you look at the big picture, getting expert advice on diet and nutrition, and how you can be healthier, is an investment in your future.
Have you ever consulted a dietitian or nutritionist?
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Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.