Healio News, February 21, 2024
COMMENT: great article, but it leaves out the microbiome, the source of the inflammation that besets rheumatologic disorders.
“SCOTTSDALE, Ariz. — Incremental changes in diet and exercise habits are the cornerstone of a comprehensive wellness regimen for rheumatology patients, noted a speaker at the Basic and Clinical Immunology for the Busy Clinician symposium.
“We all need to bring the conversation of wellness into our clinic rooms and into our own lives,” Neha S. Shah, MD, clinical assistant professor of medicine in the department of immunology and rheumatology at Stanford University, told attendees. “I have one and only one objective at the end of this, and that is to convince everyone in this room and those who are watching from home to become an integrative rheumatologist.”
According to Shah, the field of integrative medicine in rheumatology experienced a significant leap forward in 2022, when the American College of Rheumatology published a set of guidelines on the topic. With that backdrop, Shah addressed some of the areas where rheumatologists can amplify pharmacotherapeutic interventions by helping patients with sleep, diet, exercise, lifestyle habits and stress management.
Regarding sleep, Shah encouraged attendees to talk to their patients about daily cycles. She suggested that “low angle” sunlight in the morning can help patients wake up, while avoiding the blue light of smart phones and other devices with screens in the evening can help sleep come faster. During the day, caffeine avoidance is recommended, exercise is essential and short naps can help patients recharge, Shah said.
“We should all be sticking with the same rhythm of sleep, going to bed at the same time and waking up at the same time every morning,” she said.
The Mediterranean diet is conditionally recommended as optimal for many patients with rheumatic and autoimmune diseases, according to Shah. Fruits and vegetables are the foundation of this diet, along with whole grains, nuts, seeds and moderate amounts of dairy and fish. Processed sugars and saturated fats should be avoided as much as possible.
“For most of my patients, I encourage them to keep a food journal,” Shah said. “They should pay attention and be observant.”
Importantly, rheumatologists should avoid making wholesale changes to a patient’s diet straight away. “Meet the patient where they are at,” Shah said. “Start with meatless Monday … see if they can cut the meat out of breakfast.”
Shah offered a similar recommendation for exercise. However, while 150 to 300 minutes of moderate exercise, or 75 to 150 minutes per week of vigorous exercise, are recommended, she allowed that many patients are starting from zero.
“The pacing is very important, so that they don’t overdo it one day and then they are laid out the rest of the week,” Shah said.
Stretching and balance are also critical components of an exercise regimen.
“Particularly for our older populations, that last one is very important for preventing falls,” she said.
According to Shah, clinicians should be persistent in encouraging exercise.
“In order to get an actual improvement in RA symptoms, patients have to engage in exercise for a prolonged period of time,” she said.
Cognitive behavioral therapy, meanwhile, is conditionally recommended as a way to minimize stress among rheumatology patients.
“Mental stress actually has an impact on inflammation through a lot of different pathways,” Shah said.
For patients who may be less inclined to engage in tai chi, yoga or other mind-body approaches, Shah recommended time in nature as a great way to reduce stress.
“Exercise is also a wonderful method of stress management,” she said.
For attendees who remained unconvinced that integrative medicine can be beneficial in the rheumatology clinic, Shah offered a simple explanation of why it is both necessary and important.
“Patients demand it,” she said.”
