Q: My mother is 49 years old and has been suffering from rheumatoid arthritis (RA) for years. Later it affected her lungs, which is considered rare. One of her lungs is completely damaged. She was prescribed steroids, which have a lot of side effects. After 4 years of the disease, she has become very lean, no muscles at all besides she also has breathing problem. She also has diabetes. Her blood vessels have shrunk and there is less blood flow. What type of diet should she take in order to increase the blood content and to regenerate the muscles? She is only 30 kg now.

A:The case of your mother is no doubt one of the rarest and needs to be handled with utmost care and patience. Because of arthritis a very high protein diet is not advisable and because of diabetes very high carbohydrate diet can also not be advised. Avoid meat and also lower the intake of dairy products (however one glass of toned milk or curd should be essentially included in her daily diet). Eat a variety of foods. Choose a diet with plenty of grain products and vegetables & fruits so that you get sufficient calories and fibre to keep your blood sugar under control. Also try to include cold water fatty fish (like salmon) in your diet at least twice a week. However, the preparation should not be done in too much oil. Grilled or poached fish is more preferable. Choose a diet low in fat, saturated fat, cholesterol and sugar. Caffeine intake through tea and coffee should be cut down too. Also ensure an intake of at least 10 glasses of pure water everyday. To increase the haemoglobin, she must take some iron rich foods like brewers yeast, blackstrap molasses, iron-fortified breakfast cereals, wheat germ, soybean, lentils, turnip greens, baked-potato skin and spinach. To ensure maximum absorption of iron from foods, citrus fruits like guava, orange and plums should be taken in ample amounts. Patients with RA are considered to be at nutritional risk for many reasons. One cause of poor nutritional status in this patient population is thought to be the result of the weight loss. The effects of arthritis medications that are frequently taken long-term may also compound some nutritional problems. One example of this is observed in patients receiving methotrexate, where patients are frequently identified with folic acid deficiency. Additionally, prolonged dosing of other RA medications may be associated with conditions such as gastritis or peptic ulcer, frequently reducing a persons desire to eat which you may have seen in your mother also. The most commonly observed vitamin and mineral deficiencies in patients with RA, are folic acid, vitamin C, vitamin D, vitamin B6, vitamin B12, vitamin E, folic acid, calcium, magnesium, zinc and selenium. Although, food is always the preferred source for vitamins and minerals, it may be essential to use supplementation to assist in counter balancing the outlined deficiencies and improving nutritional status for patients with RA. Increased intake of antioxidants such as selenium and vitamin E may decrease free-radical damage to joint linings, which diminish swelling and pain. Supplementation of calcium and vitamin D is also recommended to decrease the risk of osteoporosis that results from nutritional loss of these supplements, from menopause and from concurrent steroid therapy.