Healthy Eating for Juvenile Arthritis

By Amy Paturel

Eating a healthy diet is important for any growing child, but children with juvenile arthritis (JA) face an additional challenge: Eating foods that promote growth and development and help quiet inflammation. In the face of the coroavirus pandemic, it's even more important to support your child's health and immune system with a healthy, balanced diet.

Since diet plays a role in inflammatory processes, parents are increasingly turning to popular diets to tame painful arthritis symptoms in their kids. Unfortunately, no special diet can cure arthritis and there’s no evidence that certain foods or nutrients will stave off JA complications or comorbidities. Some of the trendier regimens may even put kids with JA at risk for dietary deficiencies, explains Denise Costanzo, a nurse practitioner in the Pediatric Rheumatology Department at Cleveland Clinic.

The good news? A diet made up largely of whole, unprocessed foods and that limits inflammatory foods can reduce inflammation, while also supporting your child’s bone, joint and tissue health.

What to Eat

These foods promote healthy growth and development and can help dial down inflammation.

• Fiber -Rich Foods. Plenty of research suggests eating a fiber-rich diet protects against inflammation. “So, instead of white rice, white bread and processed snacks, opt for whole grain varieties of these foods,” says Jennifer Hyland, RDN, part of the Pediatric Nutrition Support Team at Cleveland Clinic. Quinoa, sweet potatoes, beans and lentils are good examples. Fiber also helps move food through the digestive tract, which can help growing bodies hold on to important nutrients while filtering out toxins.
• Clean Protein. “Protein is important for growth and development and to navigate the added demands of a long-term illness,” explains Houston, Texas-based rheumatologist, Rajat Bhatt, MD. Not only does protein support the immune system, it’s also a key building block for all muscle and tissue. While plant-based protein such as legumes, beans, peas, lentils, nuts and seeds should top the list, other good protein sources include fatty fish (i.e., salmon) and lean cuts of poultry and grass-fed beef.
• Colorful Fruits and Veggies. In adults, studies show that plant-based diets support health and stave off chronic disease. Folate-rich dark green leafy vegetables are especially important for kids taking methotrexate since the drug can cause deficiencies of this important nutrient. In fact, the darker and more colorful the produce, the more disease-fighting chemicals it contains. Solid examples include beets, berries, tomatoes, cherries, broccoli and kale. “I encourage parents to incorporate colorful vegetables into foods they’re already eating,” says Hyland. Mix them into smoothies, fold them into casseroles and bake them into chips. You can even dice up veggies and puree them into dips and spreads.
• Herbs and Spices. Many herbs and spices boast anti-inflammatory properties, including ginger, turmeric, cinnamon and rosemary, says Hyland. A bonus: Herbs and spices amp up the flavor of food so you may use less sugar and salt.
• Omega-3 -Rich Foods. Omega-3 fatty acids, found in fatty fish, such as salmon, tuna and sardines are heart-healthy and anti-inflammatory. Just watch the amounts, since all types of fish may be tainted with mercury, which can be risky for a developing brain, cautions Bhatt. Plant sources, including walnuts and seeds (such as flax, chia and hemp), contain alpha-linolenic acid (ALA), which is a precursor to omega-3 fatty acids. The body can convert ALAs into omega-3s, but not as efficiently. If your child won’t eat fish, talk to your doctor about omega-3 supplements – and how much may be necessary, if at all, to support his growth and development.
• Calcium and D-Rich Foods. Calcium and vitamin D are critical nutrients for all children. While both nutrients help build strong bones, studies suggest vitamin D has important immune-boosting properties. “A lot of kids with arthritis need to take some combination of calcium and vitamin D,” says Costanzo. This is especially true for children who are taking corticosteroids and medications like methotrexate, which may inhibit calcium absorption.

What to Avoid

Studies consistently show that the typical American diet, which prioritizes processed meats, sugar and chips over blackberries and kale, increases inflammatory processes in the body. Here are some major culprits:

• Sugar. Whether from cookies, cakes and sweets or unsuspecting offenders like enriched “wheat” bread (make sure you opt for 100 percent whole-wheat), ketchup and salad dressing, sugar can increase blood sugar and lead to bacterial overgrowth in the gut. The result? More inflammation.
• Saturated and Trans Fats. You can find these fats in animal products and coconut oil (saturated) and manufactured foods in the form of partially hydrogenated oils (trans). Both types hang out in the body and release inflammatory proteins into the bloodstream. That’s one reason why popular diet plans, including the high-fat Keto diet, can be problematic. Fatty and processed meats and butter are big-time offenders. In some circles, the jury is still out on coconut oil – in part because the plant-based saturated fat is mostly made of medium-chain fatty acids, which the body processes differently. But some major health organizations, like the American Academy of Dietetics and the American Heart Association, advise against it. For now, it’s probably best to err on the safe side: Use it sparingly and make heart-healthy olive oil your go-to instead.
• Artificial Ingredients. If your child’s immune system is already overloaded and confused, you don’t want to give it another unrecognizable substance to digest. Steer clear of partially hydrogenated oils (also code for trans fat), high fructose corn syrup and artificial dyes and sweeteners, suggests Bhatt. Better yet, avoid foods listing more than five or six ingredients.
• Charred Foods. Foods that are grilled, especially fatty cuts of meat and foods that have been charred black, have more pro-inflammatory compounds. So, instead of firing up the barbeque to grill or blacken your favorite foods, turn to your stovetop or oven. Broiling, steaming and baking are all good options.

Bottom Line

“Healthy eating should really be a family affair,” emphasizes Bhatt. “Parents should never single out a child with JA by putting them on a special diet or treating them differently.”

Hyland suggests that the family follows a Mediterranean-style diet, which including olive oil, fish and lean protein, fruits, vegetables and nuts and seeds. “Such diets are naturally rich in important nutrients including vitamin A, B vitamins and omega-3 fatty acids,” she says.

Still, it’s important to recognize that some kids with arthritis may have different dietary needs, depending on which medications they take and if they have any food intolerances or allergies. During flares, some kids may even lose their appetite.

Your best bet? “Work with a dietitian to help ensure your child is meeting requirements for growth and development,” says Costanzo. “And always check with your doctor before embarking on a special dietary plan that cuts out entire food groups.”