JointHealth™ insight  Published October 2005

This issue of JointHealth™ monthly looks at the research on popular diets.


Fall 2005 Workshops

This Fall, ACE hosted eleven workshops across Canada from Victoria, British Columbia to Halifax, Nova Scotia. The types of workshops included: Plan to Win with Rheumatoid Arthritis, JointHealth™ and Plan to Win with Ankylosing Spondylitis. The last workshop mentioned was new this year to the ACE workshop line-up. This workshop was well received and showed that Canadians want and need information about this type of arthritis. ACE would like to thank everyone who attended a workshop for their participation. We hope they met or exceeded your information and empowerment needs.

ACE hopes to continue providing Canadians with researched-based information on arthritis and osteoporosis in 2006 through its workshop program and through ACE's newsletter, JointHealth™ monthly and interactive web site. If you have a comment you would like to share regarding the workshops or any other ACE activity, or if you have any questions, please write or email ACE at:


De-mystifying popular diets

It is well known that there is a relationship between being overweight and arthritis. For example, a 10kg (22lb) increase in weight almost doubles one's risk of OA. Although weight loss is an important key preventative measure for OA, how the weight is lost is important too.

Today there are many weight-loss diets to choose from. How are we supposed to know which one is right for us? What we do know is:
  • it is important to set realistic goals
  • exercise and diet together can have a positive impact on many types of arthritis
  • it is important to maintain a healthy diet and exercise program after reaching your weight loss goal. In other words, a healthy lifestyle
Healthy lifestyle living includes a nutritious diet and exercise that can lower cardiovascular risk and decrease risk of other chronic diseases that are associated with increased weight or obesity, like osteoarthritis. Health Canada recommends a low-fat diet which is in contrast to many of today's popular diets that promote restricted carbohydrates.

Moderate-fat balanced-nutrient reduction diets: recommended by the Canada Food Guide, Canadian Diabetes Association, Good Eating Guide to name a few.
  • include 20-30% fat, 15-20% protein and 55%-60% carbohydrates
  • on average takes 3-12 months to reduce body weight by 8%
  • weight loss is greater if combined with a limited calorie intake
Canada's Guidelines for Healthy Eating
  1. Enjoy a VARIETY of foods.
  2. Emphasize cereals, breads, other grain products, vegetables and fruit.
  3. Choose lower-fat dairy products, leaner meats and food prepared with little or no fat.
  4. Achieve and maintain a healthy body weight by enjoying regular physical activity and healthy eating.
  5. Limit salt, alcohol and caffeine.
For more information from Health Canada, click here.

The research suggests that the following three popular diets are effective but each one does not work for everyone. The following information is taken from, the Canadian Journal of Diagnosis, October, 2005.

Low-carbohydrate, high-fat diets: examples include Dr. Atkins, Protein Power, and Life without Bread, to name a few. Prior to 2001 there were few, if any, evidence-based studies to support the low carb/high-fat diets. However, since 2001 clinical trials have shown that:
  • this type of diet results in weight-loss
  • lipid profiles improve in most people (lipid profile is a group of blood tests that look at the risk of coronary heart disease)
  • the studies recommend a pre-diet lipid profile and then one every six months to monitor progress in improvement of the profile or not. Your doctor can monitor your progress and help you decide whether this diet is good for you or not
  • the evidence is significant enough that these diets may be a good choice for people interested in weight-loss, in addition to the moderate-fat balanced nutrient-reduction diet
Low-glycemic index diets: these diets are similar to the low-carbohydrate/high-fat diet that focuses on carbohydrates that absorb very slowly. However, this type of diet encourages a low to moderate amount of heart healthy fat. Example: The South Beach Diet. The evidence suggests that:
  • low-glycemic diets are not as drastic and therefore easier to maintain than low-carbohydrates/high-fat diets.
  • eating carbohydrates that are slow absorbing instead of reducing the amount of carbohydrates like in low-carb/high fat diets.
  • carbohydrates that absorb slowly release glucose (sugar) slowly into the bloodstream producing less insulin at one time than fast absorbing carbohydrates
  • less insulin is thought to result in less hunger and less nutrient storage
Low-fat and very low-fat diets: very low fat diets reduces fat intake to less than 10% fat. Low-fat diets reduce fat intake to between 11% and 19%. The evidence suggests that:
  • consuming a low-fat, high carbohydrate diet will promote weight loss and body fat loss in overweight persons
The research shows that the above diets allow people choices in what is a healthy lifestyle diet for them as individuals. The research also shows that these choices of diet and healthy eating also promote the original goal of reducing heart disease.

Remember, it is important to consult your health care professional before beginning any lifestyle change such as diet and exercise. It is also important to remember that a healthy diet and exercise program should be a lifestyle and not just for weight loss.


Exercise for ankylosing Spondylitis

ACE would like to thank the workshop participant at the Plan to Win with Ankylosing Spondylitis (recently held in Toronto) for sharing with the group a website on exercises for ankylosing spondylitis. Sharing information is one of the many benefits that results from the hour long question and answer period at ACE's workshops.

Exercise is an important part of the treatment plan for ankylosing spondylitis (AS). However, it is important to remember that if you have AS your exercises need to be designed for people with AS, and that you know how to perform each one correctly. If you need help, a physiotherapist or exercise therapist can show you how to do the exercises for AS correctly.

For exercises for ankylosing spondylitis (AS), click: Click on, exercise for a virtual and written description of the various exercises for AS. This file is available to download to a PDF, printable form.

If you have something you would like to share with ACE's community, please write or email


Sjögren's syndrome and inflammatory arthritis

Sjögren's syndrome is a type of autoimmune disease that mainly affects the lacrimal (tear-producing) and saliva glands. Sjögren's syndrome can occur by itself (primary Sjögren's) or in combination with other conditions (secondary Sjögren's). The most common combination is with rheumatoid arthritis although it can present itself with other conditions such as lupus, scleroderma and polymyositis, to name a few.

Sjögren's syndrome affects females more than males. About 90% of people that have this syndrome are female. This is not surprising with its association with rheumatoid arthritis, which affects 2 to 3 more females to 1 male.

The signs and symptoms of Sjögren's syndrome are dry eyes and mouth caused by a decrease in the production of tears and saliva as a result of inflammation of the tear and salivary glands. Dry eyes can result in an increase risk of damage to the cornea (clear part of the eye) and a dry mouth can contribute to dental disease. People with Sjögren's syndrome often have a dry, uncomfortable nasal or vaginal mucosa. There are good treatments for the symptoms of dryness A diagnosis can be made by typical signs and symptoms, lab tests or by taking a small piece of tissue from the minor salivary glands in the mouth. Rarely, people with Sjögren's syndrome can develop joint pains, skin rash, or even lung and kidney inflammation.

Although rare, the most dangerous concern with Sjögren's syndrome is an increased risk for cancer of the lymph glands. This type of cancer is about 40 times more common in people with primary Sjögren's syndrome. It is recommended that people with Sjögren's syndrome get regular physical examinations to look for lymph gland enlargement (about every 6 months).

Treatment of Sjögren's syndrome can include artificial tears and saliva, plugging the tear duct (which reduces the loss of tear fluid in the eye), moisture-retaining eyeglasses, vaginal lubricant and drinking lots of fluids. There are some new medications that can increase the tear and saliva production. For people with severe disease or complications, there are immune medications that may be effective.

For more information about Sjögren's syndrome, click here.


Iritis and ankylosing spondylitis

One of the positive things that come out of ACE's workshops is the sharing of information between the speakers and the participants during the question and answer period. This includes what information people want to know about. At ACE's workshop, Plan to Win with Ankylosing Spondylitis, iritis is commonly asked about.

Iritis affects 33-40% of people with ankylosing spondylitis (AS) so it is not surprising there are so many questions about it at ACE's workshops. Iritis can happen once or flare up at times much like other types of inflammatory arthritis. Iritis can also occur with all the seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, reactive arthritis and arthritis associated with colitis).

Ankylosing spondylitis is a chronic inflammatory type of arthritis that affects the spine, hands, feet and the uvea of the eye, thus called uveitis or more commonly iritis. Besides the spine, the eye is more often affected than the other areas. Treatment for AS include the biologic response modifiers etanercept (Enbrel®) or infliximab (Remicade®).

Iritis is an inflammation of the eye that may cause redness in the eye, pain, vision problems and sensitivity to light. Some people report it is like having sand in your eye. It usually occurs in only one eye at a time. A person with any of the above symptoms needs to be treated immediately by an eye doctor (ophthalmologist); iritis can also develop in people with rheumatoid arthritis, lupus and other inflammatory diseases.

Until recently research about medication treatment for AS focused on spinal inflammation and damage. However, recent research about treating iritis suggests that both etanercept (Enbrel®) and infliximab (Remicade®) shows either a decrease in iritis flares or no flares at all while taking these medications. Although more research is needed this is a positive news for people with ankylosing spondylitis.

If you would like to share your experience with iritis, write or email us at


News Release from the Standards for Arthritis Prevention and Care Summit.

To read more about what happened at the Summit, please:
click here (Adobe Acrobat format).

Listening to You

The Invisibility of Chronic Pain like Arthritis

Pain from chronic diseases like arthritis is present in the lives of many Canadians on a daily basis. However, this pain is not always visible to the pubic and is often misunderstood because it is invisible. Although we can see pain in someone's face when they limp or turn their head or we notice deformities of the hands or feet like can happen in rheumatoid arthritis (RA), some people don't limp or have deformities but do have chronic pain and disability. Unfortunately, it is difficult to tell people who have chronic pain from those that do not, especially if one is either sitting or standing.

There is a misconception that arthritis is something older people (65+) experience and not a disease for middle-aged and younger persons, including children. Chronic pain and disability like mobility challenges do not just happen to older people. For some people with inflammatory arthritis, like RA, the disease may or may not be visible but the pain exists. For persons with osteoarthritis it can be visible with movement as the pain comes from joint mobility. However, when standing or seated, it may not show.

Some of ACE's community members with arthritis have expressed their frustration in taking public transit. The main concern was difficulty in getting a seat in the disabled seating area at the front of the bus or having to explain to others why they are seated there. The general rule is those seats are for elderly and disabled persons. Standing and negotiating the stops, starts and turns of a bus and keeping balance can be a real challenge for these people. This includes people with arthritis. One person reported that when she asked a person to move so she could have this seat, they replied she was not disabled but just older than they were. Another person was told they were too young and didn't look disabled so why were they sitting in this area.

Public transportation is an important issue for people with chronic pain, like arthritis. People with arthritis are disabled and have the right to sit in the designated areas of pubic transit system vehicles. You have the right to ask someone who is not disabled to move out of these seats without complaint. You can say, "I need to sit in this area please", or, "I have arthritis (or a disability), and I need to sit here please". If this does not work, try pointing to the signage that says these seats are designated for elderly and disabled persons. The bus driver may assist you as a courtesy.

If the above suggestions do not work, or if you have concerns about taking public transit whether you or a friend or family member has chronic pain, write a letter to the pubic transit company in your area or your Member of Parliament (MP). To find your MP, click here.

You will not only help yourself you will help all persons with chronic pain, like arthritis, in your area.

If you would like to share your experiences, comments or concern please contact us at:

Over the past 12 months, ACE received unrestricted grants-in-aid from: Abbott Laboratories Ltd., Amgen Canada / Wyeth Pharmaceuticals, Bristol-Myers Squibb Canada, GlaxoSmithKline, Hoffman-La Roche Canada Ltd., Merck Frosst Canada, Pfizer Canada and Schering-Plough Canada, UCB Pharma Canada Inc. ACE also receives unsolicited donations from its community members (people with arthritis) across Canada.

ACE thanks these private and public organizations and individuals.