What is Scleroderma?

The foods we eat affect our health in many ways, for better or for worse: fruits and vegetables are beneficial foods that provide our bodies with energy and essential nutrients, whereas processed "junk foods'' such as cookies, potato chips, and sugary sodas are essentially devoid of nutrients and potentially harmful to our bodies in large amounts. This holds true regardless of age or current health. However, when one is facing a potentially debilitating chronic disease such as scleroderma, in which fatigue, digestive difficulties, and nutrient deficiencies are commonplace, a high-quality, nutritious diet must take center stage to enhance quality of life and successful management of symptoms. While there is no one "diet for scleroderma" per se, as there is much variability in symptoms and severity from person to person, establishing a balanced diet with special emphasis on foods that fight inflammation and provide energy, protein, vitamins, and minerals is paramount.

Systemic sclerosis is a condition in which the immune system over-stimulates the collagen producing cells of the body causing inflammation and an excessive buildup of collagen, leading to hardened skin and fibrosis of internal organs such as the lungs, digestive tract, and blood vessels. While there are no specific foods or nutrients capable of reducing collagen production, the foods you eat can have a positive impact on your disease condition by fighting fatigue, inflammation, and digestive dysfunction. 

Even if you try your best to eat a healthy diet, people who suffer from scleroderma are at increased risk of malnutrition.  Malnutrition in scleroderma is either caused by inadequate intake of nutritious foods or from poor absorption of nutrients from the gastrointestinal (GI) tract.  Someone who eats less due to difficulty chewing, swallowing, and/or preparing his or her own food may suffer from inadequate nutrient intake, thereby causing excessive weight loss and malnutrition.  However, someone suffering from extensive GI involvement may be eating enough food, but is unable to absorb the nutrients properly, resulting in specific vitamin or mineral deficiencies, with or without obvious symptoms.  Therefore, it is important for everyone with scleroderma to have their nutritional status monitored regularly and to eat healthy foods throughout the day from all the different food groups.  Substantial weight loss over a period of 3-6 months can be an indication of inadequate nutrient and calorie intake. Measuring your weight at home at regular intervals can be a simple step towards monitoring your risk of malnutrition.

Symptoms of malnutrition

• reduction of 10% or more of body weight in less than three months
• muscular waste and fatigue
• extreme or sudden weariness
• infection risk increases (weakened immunity)
• hair loss, nail brittleness, and wound healing delays
• rough, flaky, and too dry skin

It may be hard to tell if the foregoing symptoms are connected to scleroderma or starvation. Malnutrition can cause new or worsening symptoms (such extreme exhaustion or weight loss).

Tests for diagnosis of malnutrition

• Protein malnutrition can be diagnosed by measuring total protein, serum albumin, and serum prealbumin; 
• Vitamin/mineral deficiencies can be detected by measuring serum iron, ferritin, total iron binding capacity, zinc, and B-12; and 
• Small bowel bacterial overgrowth can be diagnosed by measuring serum folate, carotene, and/or vitamin D.

These tips may help if you're not eating enough because of problems with chewing or swallowing:

• Juice or puree fresh produce in a blender.
• Incorporate soft, moist protein sources at meals and snacks including cottage cheese, scrambled eggs, yogurt, fish, chicken with gravy, ground meats, macaroni and cheese, and lasagna; 
• Prepare homemade smoothies out of fruit, yogurt, 2% milk, Carnation Instant Breakfast, and/or whey protein powder.

Some things to think about if you've lost a lot of weight and need to get back on track nutritionally are:

• In order to exclude gastroparesis and small bowel bacterial overgrowth, you should see a doctor.
• Olive, canola, and peanut oils; nuts, seeds, and nut butters; avocado; fatty fish; and oil-based salad dressings are all excellent sources of healthy fats to incorporate into your diet.
• Fruit, yogurt, 2% milk, 1-2 Tbsp peanut butter, 1-3 tsp canola oil, Carnation Instant Breakfast, and/or whey protein powder can be blended together to form a healthy and filling smoothie.
• Consider eating 1-3 times daily in between meals a high-protein liquid nutrition supplement (like Ensure Plus or Boost Plus); Boost Breeze is a high-protein juice substitute that can be used as necessary.
• to maximize calorie and nutrient intake, eat every 2 hours.

General dietary recommendations:

• Eat several small meals throughout the day, spaced out by three to four hours. If you've been losing weight rapidly or find that you can only eat a little at a time, eating every two hours can help you get the most out of the nutrients you take in.
• Pick foods that are fresh, whole, and minimally processed, with no added sugar, salt, or hydrogenated oils. To be safe, you should not use anything with what might be described as "chemical" sounding ingredient names. As a rule of thumb, the fewer ingredients there are, the better.
• Basil, rosemary, oregano, cinnamon, ginger, paprika, cayenne, turmeric, and curry powder are all great examples of antioxidant- and inflammation-fighting herbs and spices to use liberally when cooking.
• Reduce your consumption of sugary drinks and processed foods. (Unless it causes gastrointestinal irritation, the natural sugar present in fruit, milk, and yogurt poses no threat.) Look out for sneaky phrases like brown rice syrup, honey, agave nectar, molasses, corn syrup, corn syrup molasses, sucrose, and evaporated cane juice that all point to the presence of additional sugar.
• An over-the-counter multivitamin/mineral supplement with 15 mg zinc, 10-18 mg iron, vitamins A, D, E, and K, folate, and B-12 is a good idea. Additional supplements may be needed if particular nutritional deficits have been discovered. Bloating and distention may be alleviated by taking a probiotic supplement like Align or Culturelle.
• Get your fluids from a filtered supply that hasn't come into contact with any plastic containers. Drink solely from glass or stainless steel containers and filter your water at home. Aim for half your body weight in ounces of water every day. (thus, 75 ounces for a 150-pound individual)

Guidelines for Low FODMAP foods:

Foods high in fermentable oligosaccharides, disaccharides, and monosaccharides (FODMAPs) should be eliminated from the diet one item at a time if they cause digestive distress. Adopting a low FODMAP diet may be helpful if eliminating wheat and/or dairy products does not alleviate symptoms.

FODMAP is an abbreviation for:

• Fermentable
• Oligosaccharides (fructans and galactans)
• Disaccharides (lactose)
• Monosaccharides (excess fructose in a food)
• And
• Polyols (sugar alcohols like sorbitol, maltitol, mannitol, xylitol and isomalt)

Carbohydrates and sugars contained in many meals, known collectively as FODMAPs, are poorly absorbed and processed by the body. Stomach cramps, farts, bloating, diarrhea, and even constipation can all arise from the fermentation of these substances by intestinal bacteria. Aggravating gastrointestinal symptoms are often relieved when foods high in FODMAPs are eliminated from the diet.

List of FODMAP foods:

Concerns related to scleroderma and how to address them

• If you suffer from acid reflux or heartburn, try eating smaller, more frequent meals, staying away from food for at least two to three hours before bed, and avoiding foods like citrus fruits, tomatoes, fried foods, coffee, garlic, onions, peppermint, beans, broccoli, raw peppers, and onions, and spicy foods as well as carbonated drinks and alcohol. The decrease of abdominal fat may also alleviate symptoms. Sleeping with your head and body elevated, as with a sleep wedge or by raising the head of the bed, can help prevent stomach acid from flowing back up into your airway while you sleep.
• Decreased gastrointestinal motility and constipation can be treated by increasing fluid intake, eating a high-fiber diet consisting solely of whole grains, fruits, and vegetables, taking a daily probiotic supplement, and/or eating yogurt with active cultures on a regular basis.
• Eat fatty fish, ground flaxseeds, and walnuts for omega-3 fatty acids; consume vitamin E-rich foods like nuts, seeds, and extra-virgin olive oil; take a 1000 IU Vitamin D3 (cholecalciferol) tablet with your heaviest meal to reduce inflammation (to allow for better absorption).
• In order to combat fatigue, it is recommended that you consume a diet high in complex carbohydrates and protein, and that you drink enough water and engage in moderate activity for 30-60 minutes every day. Get between 7 and 9 hours of sleep nightly. Talk to your doctor about taking an iron supplement if your iron levels are low; this is common among those who suffer from chronic illness. To improve iron absorption, take your pill with a glass of vitamin C-rich fruit juice.
• Exercise can help improve blood flow in places where it's poor; eating protein-rich animal foods (such beef and pig) that are also high in zinc and iron can speed the healing of finger ulcers.
• Eat vitamin E-rich foods including nuts, seeds, wheat germ, and canola, olive, and peanut oils; take a 5 mg (5000 mcg) biotin supplement, which may benefit skin and nails, if you suffer from tight, thickened skin.