Let’s talk about Nutrition and Arthritis – a rheumatolo… — Transcript

I'm a physician. I am board certified in internal medicine and rheumatology. I have a doctorate in immunology. I did a post-doctoral fellowship at Harvard University. When I came here to the United States, I followed that with a transplant immunology fellowship at the University of Pittsburgh, and then I graduated four years, five years later, from the University of Cincinnati, where I did my rheumatology fellowship. Just a few things about me: when I grew up, I grew up in Romania. I was exposed to a culture that I thought was the culture that everybody has, but when I came here to the United States and I started to see patients, I realized that actually a lot of patients will have a very different cultural approach when it comes to nutrition or the things that they do in life. So, seeing patients struggling and myself going through a period of struggle with some symptoms that were not clear to me—some were fatigue, extreme fatigue, and also I was having joint pain—I started to think, what can I do to change the outcome for myself but also for my patients? Some of my patients were feeling great after starting treatment for their arthritis, but some were lacking behind, and I wanted to understand what is the difference, how will I make them feel better, how will I improve their quality of life? So, I started to invest in myself and invest in my knowledge. I pursued a nutrition science course from Stanford, followed by a mindfulness course from the University of Massachusetts, and I started to understand how important it is to implement those in the life of my patients. But besides all these degrees, I want to tell you that I'm a mother of three kids. I'm a wife. I'm a sister. I'm a daughter. And I'm also a patient. So, to begin this lecture, I know that many of you will experience pain. I know that some of you, because of pain, you will feel very frustrated. You will feel very depressed about what's going on. You don't feel like, you know, waking up in the morning. It's hard, but you start feeling stiffness, joint pain. Some patients will have severe back pain, and all of this will have a huge impact on your life. Most of the patients will tell me, I go to see a doctor, another doctor, and another doctor, and all the things that they will offer me is another medication, and that's very frustrating because I've been there. I know how it is. I was researching for my own health, and every single lab that I had was normal. So, I went to see the physician and another physician, of course, and myself being a physician, they did not have an answer for me. And as I said, I started to research myself the things that I thought would help me, and I tried to actually, let's see why is this not working? I tried to actually find, you know, an answer for me. And also, while talking to patients, I had thousands of patients that I treated. I realized that they own their own story. They have a story, and those patients that were feeling actually better had the power to tell me what they were doing differently. And, you know, in time, I started to realize and I started to introduce this idea of food as medicine. You probably know that, you know, what you eat is what you are, but I would like to reinforce that. And, you know, when you look at food, it shouldn't be about just what you eat. It should be about, you know, an experience that you have with your family, an experience that you have with your friends. It should be something that will fulfill you, and you shouldn't be a chore for us. You know, when I talk to people, they all ask me, what is the best diet? And when I hear this term diet, the thing that comes to my mind is a very restrictive plan. And I will tell you that, you know, from patients and from myself, diets are very hard to keep. Diets are not sustainable. Diets are not something that will change your quality of life. When you hear the term diet, you're going to think it's something restrictive that will impact your life negatively. So, I know that probably many of you researched the topics on the internet, and you actually, you know, found tons of resources. People are talking about the benefits of paleo diet, Mediterranean diet, keto diet. You know, you see pyramids, you see food plates, you see blogs, but unfortunately, all of those things, you know, will not bring a lot of clarity or will bring a lot of confusion. Patients will ask me, what is best? Fat, no fat, carbs, no carbs? Which plan is good? The Weight Watchers, the cabbage diet, you know, you name it. They will ask me about all of that. And I think that, you know, the way that you should approach it, you should understand that, you know, your diet is going to impact your whole health. And there is a great connection, actually, between our brain, our gut, and our arthritis. And I start with this diagram. I present this diagram to a lot of patients because they will ask me, so what is the relationship between what I eat and how I feel? And I tell them it's a huge relationship. And, you know, just in a nutshell, I will explain to you, but I think that probably most of you will have an idea what I'm going to talk about. When you start approaching the diet or when you start talking about nutrition, you should know that that will impact our gut microbiome. And in the last 20 years, there was huge research done about the importance of our microbiome. You like it or not, we do live with about 10 trillion bacteria in our gut, and all of these bacteria will influence how you feel, will influence our brain, and there is a huge connection between our brain and our gut and, of course, about arthritis. And there are tons of studies. I have went through a huge amount of them. PubMed is my resource. I start there, and then I deep dive into the content of these researchers. And I realized that, you know, research showed, if you didn't know or if we didn't know, that our lifestyle choices will actually influence our health. So, if you drink a lot, if you sleep less, if you watch TV a lot, and you don't exercise anything or you don't move too much, that will influence your health. Probably we all know that, but the research actually showed that there is a huge connection about these lifestyle changes or this lifestyle approach. And, you know, overweight, obesity, and I'm sure you know obesity is such an epidemic in our days. And, you know, most of the time, we correlate obesity with diabetes or heart diseases, but you have to know that obesity was actually correlated with cancer, obstructive sleep apnea, and with arthritis and psoriasis. People that are overweight or obese, they put a lot of pressure on their joints. They put a lot—they create obesity itself creates a huge amount of inflammation into your body, and that will cause, you know, the downstream will be all of these diseases which are chronic diseases. Obesity also causes depression, and, of course, that's not going to help. Pain, actually. I'm going to give you just a short example, a small example of one of the studies that was published recently in 2019 that show that people that eat ultra-processed food, they're going to change their fat mass in just two weeks. They're going to gain half a kilogram. Just two weeks it took for the weight to change if you eat such things. So, of course, you're going to ask me, where should I start? And I tell that to my patients, and I'm going to tell that to you: you should start in your own pantry. You should go in your pantry, open the doors, and just look what you're going to see. And if you see sugar, you should eliminate sugar for the very first time. You should look there, and you should eliminate everything that contains sugar. As you probably know, sugar is a powerful, very powerful inflammatory food. In this century, we eat probably more sugar than we ate in the whole history of humanity. And the processed food that we have access to is everywhere. You should avoid that. The processed food, you know, all the meats, all the burgers—not only that is going to make you increase weight, but that will translate later on in heart diseases and many times autoimmunity. It does contain a lot of things that you...

transplant immunology fellowship at the university of pittsburgh and then i graduated four years five years later from university of cincinnati where i did my rheumatology fellowship just a few things about me when i grew up i grew up in romania i was exposed to a

culture that i thought that's the the culture that everybody has but when i came here in the united states and i started to see patients i realized that actually a lot of patients will have very different uh cultural approach when it

comes to nutrition or the things that they do in life so seeing patients struggling and myself going through a period of struggle with um some symptoms that were not clear to me some were fatigue extreme fatigue and also i was also having joint pain

i started to think what can i do to change the outcome for myself but also for my patients some of my patients were feeling great after starting treatment for their arthritis but some were lacking behind and i wanted to

understand what is the difference how will i make them feel better how will i improve their quality of life so i started to invest in myself and invest in my knowledge so i pursue a nutrition science course from stanford

followed by a mindfulness course from university of massachusetts and i started to understand how important it is to implement those in the life of my patients but besides all these degrees i want to tell you that i'm a mother of three kids

i'm a wife i'm i'm a sister i'm a daughter and i'm also patient so to begin this lecture i know that many of you will experience pain i know that some of you because of pain you will feel very frustrated you will

feel very depressed about what's going on um you don't feel like you know waking up in the morning it's hard but you start feeling stiffness joint pain some patients will have severe back pain and all of this will have a huge impact

on your life most of the patients will tell me i go to see a doctor another doctor and another doctor and all the things that they will offer me is another medication and that's very frustrating because i've been there i know how it is

i was researching for my own health and every single lab that i had was normal so i went to see the physician and another physician of course and myself being a physician they did not had an answer for

me and as i said i started to research myself um the the things that i thought will help me and i try to actually let's see why is this not working i tried to actually find you know an

answer for me and also while talking to patients i had thousands of patients that i treated i realized that they own their own story they have a story and those patients that were feeling actually better had the power to tell me

what they were doing differently and you know in time i started to realize and i started to introduce this idea of food as medicine you probably know that you know what you eat is what you are but i would like to reinforce that

and you know when you look at food it shouldn't be about just what you eat it should be about you know an experience that you have with your family an experience that you have with your friends it should be something that will fulfill

you and you shouldn't be a chore for us um you know when i talk to people they all ask me what is the best diet and when i hear this term diet the thing that comes to my mind it's a

very restrictive plan and i will tell you that you know from patients and from myself diets are very hard to keep diets are not sustainable diets are not something that will change your quality of life when you hear the term diet you're gonna

think it's something restrictive that will impact your life negatively so i know that probably many of you researched the topics on internet and you actually you know found tons of resources um people are talking about the benefits of

paleo diet mediterranean diet keto diet you know you see pyramids you see food plates you see blogs but unfortunately all of those things um you know will not bring a lot of clarity or will bring a lot of confusion

patients will ask me what is best fat no fat carbs no carbs which plan is good the the weight watchers the cabbage diet you know you name it they will ask me about all of that and i think that you know the way that

you should approach it it should you should understand that you know your diet it's going to impact your whole health and there is a great connection actually between our brain our gut and our arthritis and i start with this

diagram i present this diagram to a lot of patients because they will ask me so what is the relationship between what i eat and how i feel and i tell them it's a huge relationship and you know just in a nutshell i will

explain to you but i think that probably most of you will have an idea what i'm going to talk about when you start approaching the diet or when you start talking about nutrition you should know that that will impact our gut microbiome

and in the last 20 years there was huge research done about the importance of our microbiome you like it or not we do live with about 10 trillion of bacteria in our gut and all of these bacteria will influence

how you feel will influence our brain and there is a huge connection between our brain and our gut and of course about arthritis and there are tons of studies i have went through a huge amount of them pubmed is my resource i start there and

then i deep dive into the content of these researchers and i realized that you know research showed if you didn't know or if we didn't know that our lifestyle choices will actually influence our health so if you drink a lot if you sleep less if you

watch tv a lot and you don't exercise anything or you don't move too much that will influence your health probably we all know that but the research actually showed that there is a huge connection about this lifestyle changes or this lifestyle

approach and you know overweight obesity and i i'm sure you know obesity is such an epidemic in our days and you know we most of the time correlate obesity with diabetes or heart diseases but you have to know that obesity was actually

correlated with cancer obstructive sleep apnea and with arthritis and psoriasis people that are overweight or obese they put a lot of pressure on their joints they put a lot they create obesity itself creates a huge amount of inflammation into your

body and that will cause you know the downstream will be all of these diseases which are chronic diseases obesity also causes depression and uh of course that's not gonna help um pain actually i'm going to give you just a

short example a small example of one of the study that was published recently in 2019 that show that people that eat ultra processed food they're gonna change their fat mass in just two weeks they're gonna gain half kilograms just two weeks it took

for for the weight to change if you eat such things so of course you're gonna ask me where should i start and i tell that to my patients and i'm gonna tell that to you you should start in your own pantry you

should go in your pantry open the doors and just look what you're gonna see and if you see sugar you should eliminate sugar for the very first time you should look there and you should eliminate everything that contains sugar

as you probably know sugar it's a powerful very powerful inflammatory food in this century we eat probably more sugar than we ate in in the whole history of humanity and the processed food that we have access it's everywhere you should avoid that

the processed food um you know all the meats all the burgers not only that is gonna make you increase weight but that will translate later on in heart diseases and many times autoimmunity it does contain a lot of things that you

should avoid like sugars or saturated fats it contains an excessive amount of omega-6 fatty acids excessive salt which will affect your immune system and all of those things not only that they don't make you feel way feel well and you're gonna feel very

fatigued after you eat such food but it will impact your gut microbiome oils you know when you pick up oils you should be extremely careful there are many bad oils the seed oils are extremely powerful creating inflammation into your body

although some seeds oil are good and i'm going to point out later which ones are good most of the oils that we buy like corn oil or um let's say sunflower oil when you fry them all the good things

that were there if they are good things they will transform into trans fats and even if you use them raw you know the fatty acids ratio between the omega 6 and omega 3 is 20 to 1 when it should

be 2 to 1. so just a couple of things that i tell my patients to start avoiding will be the sugar the processed food the trans fats and i will add here excessive alcohol and smoking and why i insist on that especially on

smoking even after you stop smoking 20 years after your risk of developing an inflammatory arthritis including rheumatoid arthritis is still high so what should you eat what are the anti-inflammatory foods and we're gonna dive further into that you probably heard about the leafy

greens things like um spinach kale broccoli asparagus are extremely extremely important to be added to your diet because they do contain a lot of vitamins especially vitamin c that will modulate your immune system vegetables and fruits should be the base

of your plate and you know things like berries all the berries in the world you should incorporate that into your diet they will bring you a lot of antioxidants and they will make you feel better enzymatic fruits are extremely important like papaya or

pineapple or mango those are extremely good for your health and they will decrease your inflammation in terms of legumes legumes are you know the basis of the mediterranean diet you should incorporate beans into your diet and also lentils those are extremely valuable

because they not only bring you a lot of fibers and your bacteria your gut microbacteria will love the fibers but they will also bring you a lot of vitamins and a lot of other micronutrients i mean i don't like the the fact that

people think that meat is you know detrimental to your health in reality is not but the good quality of meat should be incorporated into your plant and i would like to draw attention towards fish you know i tell my patients

at least twice a week they should have fish and they should have wild caught fish when it comes to grains i think i figure out this how to do this presentation to move forward i tell people to incorporate whole

grains and when they ask me what are the whole grains i start by explaining them it's very important to understand that the grain the whole grain has a specific composition it's it's a three layer composition on the outside you have the bran

which is the fiber filled layer and also contains vitamins especially b vitamins which are very important to our health and a lot of minerals like like magnesium or copper on the inside they have the endosperm which is the starchy carbohydrate part

and then the germ which is um the part where the grain grows but when the process of you know refining those grains happens you know that process to make the the you know fluffy flower that we see on the shelves that

stays there for months and months they remove all this layer all the outer layers so what we have or what is remaining is just the refined grain just the endosperm which is the part with the starchy carbohydrates and that is the part that is causing the

problem that is the part that does not contain the fibers so it's so important for you to choose whole grains and to look on the packages about four grains if you are like me um i love nuts if you

don't have any allergies to nuts you should make nuts a big part of your nutrition plan and the reason is that there were very important studies that they show that eating about 30 grams of nuts every day over a period of

five years will decrease your cardiovascular risk with 30 percent 30 percent is huge um in medicine you should use spices a lot of spices for your food because spices will not only bring uh the flavor of your food but will also

help you to you know prevent certain diseases and i'm gonna talk more about those in another lecture because i think it's extremely important to know about the benefits of spices all right the next thing that i would like

you to know and i tell my patients is about fermented foods you know i remember my grandparents or my parents when they were canning and fermenting foods for the winter and i never thought about the benefits of of those foods but it shows and there

are many studies that show that fermented foods not only that they bring um the fibers for our gut but it also boosts the the good microbiota and you know if you come from europe you know that wine it has very beneficial

effects a glass of wine you know not excessive alcohol use will actually has good good benefits for your health and this is my favorite the dark chocolate you probably heard about the the benefits of cocoa and the benefits of dark chocolate if

you are someone like me that crave for something sweet you should take a bite of chocolate you know there are many types of diets and you know we it's going to take us a couple of lectures to go through all of

them but i just wanted to mention the a few of them that they have good benefits for your health and they also have you know i would say long standing results the mediterranean diet the intermittent fasting diet and i'm one of those physicians that

will encourage you to combine those things or the new itis diet and that's a type of diet that was was recently published for patients with rheumatoid arthritis it was basically mostly a plant-based diet with a lot of anti-inflammatory foods and

herbs but how to make those changes how to incorporate those changes because there are a lot of things that i already told you you should consider to you know basically bake those uh foods or grill them or you could

actually steam them i like to be sincere with your grilled vegetables grilled fruits you just sprinkle them with a little bit of salt pepper and a little bit of olive oil you toss them on the grill for five

minutes and that's it so it's very simple to do those you should always consider a salad instead of a starchy meal that will bring you a lot of fibers and not only that but will make you feel fuller the whole day or most of the day

if you like fruits you should eat them fresh there is nothing better than a fresh fruit but if you don't like to eat them fresh you can put them in a smoothie you can combine let's say celery or spinach in that

smoothie you can put chia seed in the smoothie and you know it's going to bring you a lot of value for your nutrition you can do twice a week you can do a smoothie and replace the the eggs and bacon

you know that classical eggs and bacon breakfast here in the united states and that will also bring you a lot of energy hydration and also will bring you the nutrients that you need so i would like to introduce you to

a course that i design and i envisioned starting this course um for a couple of years now um i put together everything but in this course i'm going to talk about everything that i know that is helpful for my patients but it could be helpful

for anybody in the world this is a course that will incorporate nutrition exercise and mindfulness and it's specifically designed for people that suffer i brought you know people to help me i believe in the value of collaboration with um

professionals with people that have expertise and together with me in this course i have brought dr melissa carroll who is a physical therapist a board-certified orthopedic specialist and she's also a pilates instructor melissa is also an echler downloads patient

and if you heard about this you know syndrome or disease you know that being a patient with this disease makes you adapt makes you be makes you understand better what you go through so melisa has designed exercises specifically for patients with

pain caused by arthritis she is an expert and i value her presence in this course tremendously and i also brought elena fredesco who is a psychologist psychotherapist and psychodramatist she is an expert in pain management she knows a lot about mindfulness and

how to implement that to manage your pain and she's going to talk or introduce you to cognitive behavior therapy this course will be designed to be over eight weeks it's gonna be online and it's gonna have live session every

week people that will sign up to this will have lifelong access to all the lecture and just to present you in a nutshell what we will talk about it's going to be the mindset of you know setting up preparing for

a nutrition plan the foundation the science because everything that i recommend is based on science and experience also and then we'll lay out important things that you have to know about nutrition how to plan and how to action how to put

into action those things we're going to teach people how to manage their pain using mindfulness how to sleep better and melissa will teach them how to exercise she's actually going to have some live session to present you how to incorporate your exercise or

exercises into your plan in the last week we will plan how to you know make these changes to be sustainable we will teach you how to plan your days and i will offer you all the resources that i have used to build up this course

i have designed many things from grocery lists to you know plans and you know i hope that this course will bring you will transform you will help you feel better as you deserve to feel i know it's new year

and we said that we're going to have new resolutions but i want to see your transformation i enjoy seeing patients feeling better and i enjoy seeing that they transform they smile they come back to my office or they give

me a call to say that they feel so much better i have many stories that i will share over the course about patients of mind that experience this kind of transformation and i hope that you're gonna wake up and

you're gonna feel better and you can enjoy the things that you like to do in your life to travel to go down and play with your kids or just meet your friends and with that i would like to thank you

for being part of this presentation [Music] you