The Prednisone Diet

Chapter 1: Food for thought on anti-inflammatory nutrition,
Some special consideration for persons with pemphigus or pemphigoid

By Joan Thompson, PhD, RD, CD
Director of Nutrition Education
Weber State University, Ogden, Utah
PPS Medical Advisor, Nutrition

The effect of food as a medicine has received increased attention in the last decade. Linus Pauling popularized the concept of orthomolecular medicine over fifty years ago.

Orthomolecular medicine addresses the modulation of human biochemistry using nutrients. Research supports the influence that nutrients and food have on the modulation of biochemical pathways and gene expression. From this research, the new discipline of nutrigenomics has begun to grow.

The science of nutrigenomics seeks to provide a molecular understanding for how common dietary chemicals (i.e., nutrition) affect health by altering the expression and/or structure of an individuals genetic makeup.

In the next ten to fifteen years, a standard component of clinical practice will be based on nutrigenomics. The human genome project has allowed the analysis of genetic material, and has already begun to identify several gene expressions that have nutritional ramifications. Using nutrigenomics, practitioners can evaluate the unique genetics of each client and then can begin to make very individualized dietary recommendations that will optimally support that persons health and function.

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Until nutrigenomics is refined and integrated into practice, here are a few concepts that can be applied to patient with inflammatory disease. There are four topics that will be addressed in the following discussion. The first topic will be the awareness of Gut Associated Lymphoid Tissue or GALT. The second topic will be the encouragement to determine personal food sensitivities. The third topic include some suggestions for consuming an anti-inflammatory diet. Finally, nine dietary recommendations for consuming a healthy diet will be presented. In the future, each of the nine dietary recommendations will be discussed in depth, and the application to inflammatory disease will be emphasized.

GALT

About 40% of the human immune system is comprised of GALT as a substance that should not be in the body. Right in the gastrointestinal track, communication is initiated to the rest of the immune system. If there is a food sensitivity that is recognized by GALT, inflammatory messages are sent through the body. In addition, if the individual is also sensitive to the allergens respired, there are additional inflammatory messages sent throughout the body that contribute to total immune system load. Often times the symptomatic manifestation of these inflammatory messages impact the function of mucus membranes and/or result in skin or mucosa manifestations.

A goal for persons who have inflammatory disease would be to minimize inflammatory events by eliminating foods that cause an immune system response. It is key in the management of a pemphigus or pemphigoid patient to be evaluated for food and environmental allergies and minimize their exposures to the allergens. By knowing and controlling these additional inflammatory events, the intensity of the disease manifestations may be reduced.

A few Dietary Anti-inflammatory Strategies

There are several dietary strategies that may be implemented to reduce the inflammatory processes in the body. The first is the aforementioned, and that is to understand the individuals food allergies and refrain from consuming those foods.

Secondly is to manage the fats consumed in the diet. Among the polyunsaturated fats in the diet, there are two popular major categories; omega-three fatty acids (w3FA) and omega-six fatty acids (w6FA). W3FA are found in fish, flaxseed, walnuts, canola, primrose and borage oil. W6FA are found in all plant oils other than olive oil. Patients need to consume enough omega-three fatty acids in the diet to reduce the production of inflammatory prostaglandins and not over-consume omega-six fatty acids.

The three popular omega-three fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic (EPA) acid and docosahexaenioc acid (DHA). ALA comes in very small amounts from plant sources such as canola oil, walnuts, flaxseed, borage and primrose oil. EPA and DHA come from fish such as salmon, tuna, trout and herring.

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Omega-three fatty acids when consumed in the four to six gram per day range has positive effects in persons with inflammatory disease. The adult Dietary Reference Intake (DRI) for ALA is 1.1 to 1.6 grams per day depending on woman or man. Not over-consuming the omega-six fatty acids, will blunt the production of inflammatory chemicals. The most common omega-six fatty acid is linoleic acid, and is present in plant oils like sunflower, safflower, soy, cottonseed oils and most nuts. The adult DRI for linoleic acid is 11 to 17 grams per day, (female, male). This amounts to two to three tablespoons of oil per day.

Thirdly, consume an antioxidant-rich diet. This means that five servings of a fruits and vegetables are consumed each day. Those fruits and vegetables that are packed with antioxidants include citrus fruits, berries, tropical fruits, melons, cabbage-family vegetables such as cabbage, broccoli and cauliflower, the dark-green leafy vegetables and the deep orange vegetables like carrots, winter squash and pumpkin.

The Nine Dietary Recommendations

1. Control total fat intake to meet the acceptable macronutrient density range (AMDR) of 20-35% of Calories provided from fat. Reduce saturated fatty acid and omega 6 fatty acid intakes to less than 10% of Calories, and the intake of cholesterol to less than 300 milligrams daily. Eat foods rich in omega 3 fatty acids such as salmon, tuna, trout, herring, mackerel, walnuts, canola oil, flaxseeds or green leafy vegetables. Use monounsaturated oils such as canola and olive oils as your primary fat. Avoid oils high in omega 6 fats such as safflower, cottonseed, sunflower, corn, soy and vegetable oils. Reduce the intake of trans fats by selecting a trans fat free margarine, avoiding the use of vegetable shortenings and, reducing the intake of prepared snack foods, deep-fat fried foods and convenience foods.

2. Consume adequate amounts of carbohydrate to meet the AMDR of 45-65% of Calories from CHO. Limit intake of simple sugar to less than 10% of total Calories. Consume adequate amounts of fiber (1.4 gm/100 Calories). Every day eat five or more servings of ½ cup of a combination of fruits and vegetables especially dark green and yellow vegetables, and citrus fruits. Also, increase intake of starches and other complex carbohydrates, by eating six or more servings of a combination of breads, cereals and legumes.

3. Maintain protein intake at moderate levels and meet the DRI. Eat more vegetable protein including legumes, nuts, soy and seeds. Avoid eating high-fat animal products.

4. Balance food intake and physical activity to maintain a healthy body weight.

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5. Alcohol consumption is not recommended. For those who drink alcoholic beverages, the equivalent of less than one ounce per day of pure alcohol is suggested. This is equivalent to 2 cans of beer, 2 small glasses of wine or 2 mixed drinks. Pregnant women should avoid all alcoholic beverages.

6. Limit total daily intake of salt (sodium chloride) to 6 grams or less. Sodium chloride is 40% sodium, thus the amount of sodium contained in 6 grams of salt is 2.4 grams or 2,400 milligrams. Thus consume = 2,400 mg sodium per day.

7. Maintain adequate calcium intake, and do not consume phosphorus in excess.

8. Avoid taking dietary supplements in excess of the ULs without purpose or knowledge.

9. Maintain an optimal intake of fluoride, particularly during the years of primary and secondary tooth formation and growth.

As we begin the 21st century clinical nutrition, know that nutrigenomics will more accurately define optimal dietary management for the individual. In the mean time, evaluate your food sensitivities, begin to manage the types of fats you consume, (plenty of w3FA and just enough w6FA) and consume an antioxidant-rich diet by consuming at least five servings a day of fruits and vegetables.

For basic and advanced information on nutrition try these websites:

1. www.nal.usda.gov/fnic/etext/macronut .html

2. www.nutrition.gov/home/index.php3

3. www.health.gov/dietaryguidelines/

4. www.nlm.nih.gov/medlineplus/foodnutri tionandmetabolism .html

5.

Selected books on diet, nutrition and cooking can be found in the PPS Book Cellar.