We devised this method of behavior modification more than 10 years ago. This diet is not aimed at losing or gaining weight. It excludes foods that are harmful to your health and aggravate chronic pain (i.e., Five C’s: cookies, cakes, chocolate, cocktails and candy. Other foods to avoid are internal organ meats such as Liver, sausage, and hot dogs). It also emphasizes the intake of foods that help the inhibitory nerve cells that suppress the pain input (4 F’s: Fresh fruit, fresh vegetables, fish, and fowl).
By doing so, the patient’s weight normalizes itself automatically: overweight or underweight extremes normalize close to the patients ideal weight.
The four F’s:
1. Fresh Fruit - not canned.
2. Fresh vegetables - Olive oil is the best cooking oil.
3. Fish - baked or broiled. Use fresh lemon juice for flavor. Avoid the use of margarine.
4. Fowl - skinned! Not fried - baked, roasted or grilled is fine. When you are in a hurry, try wrapping a boneless breast with vegetables (i.e., onions and bell peppers) in aluminum foil and baking - it is quick and easy.
Avoid the five C’s: cookies, cake, chocolate, cocktails, and candy.
Foods to be avoided
Crystalline sugar
Cakes
Soft drinks with sugar
Sweet-rolls
Pies
Lard
Bologna
Crisco and other shortenings (replace with olive oil)
Salami
Potato chips
Hot dogs
Dips
Sherbert
Cake mixes
Ice cream
Alcohol
Enriched white flour (bleached flour)
Nondairy cram substitutes
Syrups
Margarine
Mayonnaise
Donuts
White bread
Butter
All fried foods
Bacon and any pork
Canned fruits packed in syrup
Candies
Foods allowed rarely or sparingly
No Coffee (may be replaced with ice tea)
Lamb
Tea
Pulp of potato (may fry in olive oil)
Foods that are allowed
Diet drinks - no caffeine, sugar, and low to no sodium
Nuts - raw and unsalted
Skim cheese
Honey - natural
Apples
Oatmeal (plain and unflavored)
All fresh fruits
Low-fat cottage cheese
Unsweetened orange juice
Low-fat plain yogurt - flavored has sugar - add your own fresh fruit
Natural fresh - squeezed orange juice and grapefruit juice
Sweet potato with skin
Apple juice - no added sugar, natural
Eggs - no more than two / week
All fresh vegetables
Sardines
Veal
All fish
Chicken and other fowl - skinned
Cereals - whole grain, low sugar
Lobster (no butter)
Shrimp
Lean roast beef (in moderation)
Fruits - dried
Raisins
Crab
Skim milk
Drink 6-8 glasses of water per day
Tuna (water-packed)
—
Labels - read them! Be aware of the word "carbohydrates." Frequently it is a euphemism for sugar. Be aware if the ratio of fat to calories. Avoid high fat to calories ratios. Also, high cholesterol and preservatives/chemicals (or flavorings) should be avoided. An ingredients list that is very long and has many unrecognizable (unpronounceable) words should also be avoided. Remember very low to no added salt.
Food preparation - Avoid adding fats (oil, margarine, etc.) and salt during and after preparation. Try to prepare in ways that do not require oil/fat - such as steam, back, broil, roast. Definitely do not fry!!! (Olive oil is okay).
Salad Bars - The tendency to eat free food results in excessive calories! Therefore, it is for this reason that salad bars can be deceptive. They seem to be more of a high calorie/fat, all you can eat buffet. When confronted with one, stick to the fresh fruits and vegetables - avoid the desserts (i.e., puddings, cakes, etc.).
Diet fads
"Cheese is rich in cholesterol". There are two types of cheese: sharp cheese rich in tyrosine is harmful to RSD patients; mild cheese (e.g., mozarella, ricotta, muester) contains only 25-30 mg cholesterol per serving (in contrast to liver, 375 mg, and kielbasa, 400 mg).
"Shell fish has too much cholesterol." Shellfish contains HDL cholesterol, which is preventive against any form of vascular disease.
"Don’t eat food before going to sleep." Wrong: Don’t consume red meat, coffee, or chocolate. Eating fruits and dairy products before bedtime is quite helpful in chronic pain (such as RSD/CRPS).
Coffee
Coffee should be avoided altogether in patients suffering from RSD/CRPS; to consider coffee as a simple conveyor of caffeine is naive.
1. Coffee has an acid-based oil that is an irritant to gastric mucosa. It stimulates the secretion of gastric acidity. Secondarily, the high gastric acidity results in secretion of adrenalin. The secretion of adrenalin stimulates insulin secretion with resultant secondary relative hypoglycemia. The end result is tension, a mild rise in blood pressure, and 2-3 hours later craving sweets because of the relative hypoglycemia. Obviously none of the above is helpful in RSD/CRPS. The rise in plasma epinephrine will undo whatever good medications are doing to counteract the hyperactive dopaminergic system in RSD/CRPS.
2. Coffee is more harmful than caffeinated soft drinks or tea.
3. Mild tea does not cause reactive hypoglycemia and a rise in blood pressure.
4. Tea, if prepared in mild form (not too strong), contains less caffeine. It has no acid-based oil as does coffee. It contains tannin. Tannin or tannic acid curbs thirst and results in less demand for further consumption of tea or coffee.
5. Coffee and tea both temporarily raise the body temperature. A few minutes after drinking coffee, the stimulation of the dopaminergic system causes colder extremities and a simultaneous rise in systemic temperature. Tea has a much milder effect in this regard. The cold extremities aggravate RSD/CRPS.
6. Iced tea seems to be the mildest and safest of caffeinated drinks.
7. A patient with high fever is harmed by coffee and helped by tea and lemon juice. As is the case with home-made chicken soup being helpful to the sick (in contrast with factory-made red meat type of soup) for unknown reasons, mild tea has a healing effect and coffee has an aggravating effect in patients suffering from stress and fever, including stress of complex chronic pain.
Herbal tea
Just because tea is less harmful than coffee does not imply that herbal tea is good or healthy for anyone. Herbal teas are a variety of different dried vegetable leaves. Some of the herbs contain toxic substances that are harmful to anyone- including RSD/CRPS patients. Because of the variety in strength and quality of chemicals in herbs, the use of herbal teas should be avoided. Some of them contain such high doses of tannins (e.g., sassafras tea) that can be carcinogenic. Catnip, juniper, nutmeg, and hydrangea may be hallucinogenic. Chamomile and marigold may be fatally allergenic. Senna leaves, aloe leaves, and duck roots can be strongly cathartic. Mistletoe leaves and horsetail grass may cause fatal toxicity. So why bother with such chemicals?
PMR..what can help and what should be avoided
by Polymyalgia Rheumatica on Tuesday, March 8, 2011 at 12:56am
Nutritional therapy offers an important adjunct approach to polymyalgia rheumatica. Even though there is a lack of serious nutritional research into polymyalgia rheumatica, the inflammatory cascade that underlies the disease is well understood. By using proven anti-inflammatory supplements, it may be possible to reduce dosages of strong prescription drugs and reduce symptoms. In addition, the inflammation associated with the disease causes impairment of the adrenal hormone system, causing a deficiency in vital hormones that need to be replaced.
Steroid-Sparing Drugs
In treating polymyalgia rheumatica and giant cell arteritis, one major goal of therapy is to reduce the dosage of steroid to help reduce side effects (Hellmich B et al 2005). Because of the risk of blindness and other consequences of arterial inflammation (such as thrombosis and aneurysms), high doses of corticosteroids are used when giant cell arteritis is suspected. Although these high doses bring with them the additional risk of significant side effects, most clinicians feel that the risk associated with giant cell arteritis justifies this approach (Chang RW et al 1983; Weyand CM et al 2004).
Methotrexate. Methotrexate is a folate antagonist with anti-inflammatory, immunosuppressive, and antiproliferative actions (Majumdar S et al 2001). Studies of methotrexate in addition to prednisone have been contradictory. Some studies suggest that methotrexate decreases the total steroid dose needed by patients (Ferraccioli GF et al 2000; Caporali R et al 2004).
Methotrexate increases homocysteine levels (Aksu K et al 2001), so people taking methotrexate should consider supplements with vitamins B6, B12, and folate to lower homocysteine (Sunder-Plassmann G et al 2000; Guthikonda S et al 2006).
Pentoxifylline. Pentoxifylline (PTX) is an anti-inflammatory drug that has been used for more than 20 years (Pollice PF et al 2001; Abdel-Salam OM et al 2003) and is well tolerated (Lin SL et al 2005). PTX suppresses inflammation by decreasing synthesis and secretion of cytokines, including interleukin-1, IL-6, interleukin-8, and TNF-alpha (Mandell GL 1995; Graninger W et al 1995; Dorazil-Dudzik M et al 2004; Neuner P et al 1994; Pollice PF et al 2001). While no published studies of PTX in patients with polymyalgia rheumatica or giant cell arteritis exist, it is possible that PTX will be a treatment for polymyalgia rheumatica in the future. Research shows that a combination of fish oil (omega-3 fatty acids), alpha-linolenic acid, and PTX can reduce synthesis of IL-6 (McCarty MF 1999).
Nutritional Therapy
Unfortunately, data are scant regarding the effect of many dietary supplements in polymyalgia rheumatica, perhaps because few research dollars are being directed at natural remedies for this condition. Because of the significant side effects associated with drugs prescribed for polymyalgia rheumatica, however, Life Extension recommends that patients do everything possible to reduce their use of these drugs, including pursuing natural remedies that have been proven to reduce inflammatory cytokine levels.
Fish oils. The inclusion of omega-3 fish oils in the diet has been shown to help with autoimmune and inflammatory diseases (Kelley DS 2001; Simopoulos SP 1999, 2002) by suppressing synthesis of TNF-alpha (Endres S et al 1989). Vitamin E and fish oil work together to decrease pro-inflammatory cytokines, including IL-6 and TNF-alpha, in mice (Venkatraman JT et al 1999a,b). Omega-3 fish oils have been useful in patients with a variety of inflammatory diseases, including rheumatoid arthritis and atherosclerosis (Simopoulos SP 1999). Studies in humans with rheumatoid arthritis suggest that fish oil and vitamin E decrease inflammation in humans (Tidow-Kebritchi S et al 2001). Moreover, fish oil supplementation has shown anti-inflammatory effects, including decreased use of anti-inflammatory drugs, for patients with a variety of other chronic inflammatory diseases (Simopoulos SP 2002).
Vitamins C and E. Vitamin E is an antioxidant with anti-inflammatory actions. The alpha-tocopherol form of vitamin E can decrease inflammation that contributes to atherosclerosis (Singh U et al 2005). Alpha-tocopherol supplementation has been shown to decrease C-reactive protein levels (Singh U et al 2005). Vitamin C is an antioxidant (Das 1989) that also has anti-inflammatory properties and blocks NF-kappa B activation by TNF (Bowie AG et al 2000).
Methylsulfonylmethane. Sulfur is a mineral found in several amino acids, the building blocks of all the proteins in the body. Methylsulfonylmethane (MSM) is a natural metabolite of dimethyl sulfoxide (Richmond VL 1986). MSM is used as a dietary supplement by many people and is naturally found in fruits, vegetables, grains, and animals (cow’s milk is a rich source) (Parcell S 2002; Richmond VL 1986). MSM has been studied in patients with a variety of conditions, including arthritis, allergies, and fibromyalgia, among others. MSM appears to have little or no toxicity (Horvath K et al 2002).
Studies have shown that MSM can decrease pain and increase mobility in patients with osteoarthritis (Kim LS et al 2006).
Curcumin and ginger. Curcumin has been shown to reduce NF-kappa B in a wide variety of settings, including autoimmune diseases and cancer. It is a well-known antioxidant and anti-inflammatory (Yadav VS et al 2005). Ginger has also been documented to reduce multiple inflammatory chemicals, including NF-kappa B and many others, and to be effective against a variety of inflammatory diseases, including autoimmune diseases that are characterized by an elevation of NF-kappa B (Aggarwal BB et al 2004).
Life Extension Foundation Recommendations
Patients who are diagnosed with polymyalgia rheumatica will likely be prescribed corticosteroids. Life Extension advises patients to take the following supplements to help prevent steroid-induced osteoporosis:
¦Calcium—at least 1200 milligrams (mg) daily, along with essential cofactors, such as boron, zinc, and magnesium
¦Vitamin D—up to 2000 international units (IU) daily
¦Vitamin K—10 mg daily
In addition, the following nutrients that help protect against inflammatory events in the body or reduce the dosage requirements of NSAIDs and corticosteroids may provide some relief:
¦Omega-3 fatty acids—1000 mg docosahexaenoic acid and 1400 mg eicosapentaenoic acid daily
¦DHEA—15 to 75 mg daily to start, followed by blood testing in three to six weeks to ensure adequate levels of this vital hormone
¦Arginine—1800 mg daily
¦Glutamine—1000 to 2500 mg daily
¦NAC—500 to 1500 mg daily
¦Vitamin E—400 IU daily (with 200 mg gamma tocopherol)
¦Vitamin C—1 to 3 grams (g) daily with food
¦MSM—1000 mg daily
¦Curcumin—900 to 1800 mg daily
¦Ginger extract—500 to 1000 mg daily
¦Topical analgesic cream—Apply to sore muscles as needed
Polymyalgia Rheumatica Safety Caveats
An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:
Calcium
¦Do not take calcium if you have hypercalcemia.
¦Do not take calcium if you form calcium-containing kidney stones.
¦Ingesting calcium without food can increase the risk of kidney stones in women and possibly men.
¦Calcium can cause gastrointestinal symptoms such as constipation, bloating, gas, and flatulence.
¦Large doses of calcium carbonate (12 grams or more daily or 5 grams or more of elemental calcium daily) can cause milk-alkali syndrome, nephrocalcinosis, or renal insufficiency.
Curcumin
¦Do not take curcumin if you have a bile duct obstruction or a history of gallstones. Taking curcumin can stimulate bile production.
¦Consult your doctor before taking curcumin if you have gastroesophageal reflux disease (GERD) or a history of peptic ulcer disease.
¦Consult your doctor before taking curcumin if you take warfarin or antiplatelet drugs. Curcumin can have antithrombotic activity.
¦Always take curcumin with food. Curcumin may cause gastric irritation, ulceration, gastritis, and peptic ulcer disease if taken on an empty stomach.
¦Curcumin can cause gastrointestinal symptoms such as nausea and diarrhea.
DHEA
¦Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
¦DHEA can cause androgenic effects in woman such as acne, deepening of the voice, facial hair growth and hair loss.
EPA/DHA
¦Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding.
¦Discontinue using EPA/DHA 2 weeks before any surgical procedure.
Ginger
¦Do not take ginger if you have a bile duct obstruction or gallstones. Ginger may stimulate bile production.
¦High doses of ginger (6 grams or more) can cause damage to the stomach lining and ulcers.
¦Ginger can cause anllergic skin reactions.
¦Consult your doctor before taking ginger if you take blood thinners such as warfarin (Coumadin). Ginger can increase the risk of bleeding.
L-Arginine
¦Do not take L-arginine if you have the rare genetic disorder argininemia.
¦Consult your doctor before taking L-arginine if you have cancer. L-arginine can stimulate growth hormone.
¦Consult your doctor before taking L-arginine if you have kidney failure or liver failure.
¦Consult your doctor before taking L-arginine if you have herpes simplex. L-arginine may increase the possibility of recurrence.
L-Glutamine
¦Consult your doctor before taking L-glutamine if you have kidney failure or liver failure.
¦L-glutamine can cause gastrointestinal symptoms such as nausea and diarrhea.
MSM
¦MSM can cause headache or gastrointestinal symptoms such as nausea and diarrhea.
NAC
¦NAC clearance is reduced in people who have chronic liver disease.
¦Do not take NAC if you have a history of kidney stones (particularly cystine stones).
¦NAC can produce a false-positive result in the nitroprusside test for ketone bodies used to detect diabetes.
¦Consult your doctor before taking NAC if you have a history of peptic ulcer disease. Mucolytic agents may disrupt the gastric mucosal barrier.
¦NAC can cause headache (especially when used along with nitrates) and gastrointestinal symptoms such as nausea and diarrhea.
Vitamin C
¦Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
¦Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.
Vitamin D
¦Do not take vitamin D if you have hypercalcemia.
¦Consult your doctor before taking vitamin D if you are taking digoxin or any cardiac glycoside.
¦Only take large doses of vitamin D (2000 international units or 50 micrograms or more daily) if prescribed by your doctor.
¦See your doctor frequently if you take vitamin D and thiazides or if you take large doses of vitamin D. You may develop hypercalcemia.
¦Chronic large doses (95 micrograms or 3800 international units or more daily) of vitamin D can cause hypercalcemia.
Vitamin E
¦Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
¦Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
¦Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
¦Discontinue using vitamin E 1 month before any surgical procedure.
Vitamin K
¦Do not take vitamin K if you are taking warfarin sodium unless, the vitamin K is specifically prescribed by your physician.
Recently, noninvasive imaging techniques, especially magnetic resonance imaging, have been used to determine the true degree of aortitis in patients with giant cell arteritis (Narvaez J et al 2005). Because of its significant consequences, patients with polymyalgia rheumatica should be carefully monitored for signs or symptoms of giant cell arteritis.
This info is made by a fellow PMR Sufferer.
Regarding supplements, I take 8000 mg fish oil, which gives me 4800 mg omega 3. I use Carlson brand, but my vitamin isle guy at Mom's Organic Market told me that Costco fish oil is very good -- you just have to take more -- read the label and do the math to get close to 5000 mg omega 3's. I also take n acetyl cysteine, curcumin, alpha lipoic acid, co enzyme q 10, B complex, vitamin e, multi minerals, vitamin d, msm, vitamin k, and acai capsules that I ended up with from an internet scam. I also try to eat lots of fiber. Hard to always be good, but at higher pred I was eating lots of fruit so I wouldn't pack on the pounds. Veggies and lots of fresh garlic also. With this regimen, I have been able to go from 40 mg. pred to 4 in 5 1/2 months and I feel very good. (At this time, I'm tapering by 1/2 mg. per week, cautiously. My cholestrol was recently checked and I have dropped 30 points in a year on this new regimen. Most of my info comes from the life extension foundation. They have a section for PMR. The other very helpful thing I did was go to an accupuncturist for my frozen shoulders. He got me full range of motion in 2 weeks and concurrently did physical therapy to rebuild lost muscle in my arms. Drink lots of water too.
I am having headaches not at the temple but over the eyes and top which is unusual. I’m on 10mg of Predisolone. Poor sleep and shoulder pain
Classification Criteria vs. Diagnosis Criteria
Books on PMR/GCA and Prednisone 
