On Episode 12 of the Arthritis Life Podcast, three nutrition experts help de-mystify the role of diet and nutrition in symptom management for rheumatic, autoimmune diseases such as rheumatoid arthritis.
Cristina Montoya, Registered Dietitian and Kia Peters, Nutrition Student weave together their lived experience as rheumatoid arthritis (RA) patients and nutrition experts in this episode, alongside Jenifer Tharani, a Registered Dietitian Nutritionist who specializes in anti-inflammatory eating.
Episode at a glance:
- What’s the difference between a “nutritionist” and a “Registered Dietitian” and why is it important?
- Nutrition and diet “rabbit holes” that patients often fall down, and mistakes to avoid when seeking support for nutrition.
- Top myths about diet and disease management, including:
- Can nutrition choices cure the disease?
- Are dairy, red meat and nighshades bad for everyone?
- The psychology behind food choices and how food choices give people a sense of control
- The importance of symptom tracking and food journaling
- Kia, Cristina and Cheryl’s lived experiences of trying different approaches to food choices and diet at different stages of their disease management.
Medical disclaimer:
All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Episode Sponsors
Rheum to THRIVE, a community support & education program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. Join the waitlist for the next group, which starts in October 2022!
Rheumatoid Arthritis Roadmap, a self-paced online course Cheryl created that teaches you how to confidently manage your physical, social and emotional life with rheumatoid arthritis.
Speaker bios:
Cristina Montoya is a Colombian mama living in the land of maple syrup, beavers and hockey, Canada. She is a Registered Dietitian (RD), a member in good standing with the College of Dietitians of Ontario, Dietitians of Canada, and the Arthritis Health Professions Association (AHPA). As a patient advocate, Cristina participates in the Durham Region Sjögren’s Syndrome Support Group from the Sjögren’s Society of Canada as well as the Online Consumer Panel from the Arthritis Society.
She is passionate about autoimmune rheumatic diseases, medicinal cannabis science, digestive health, Mediterranean diet and anti-inflammatory way of eating, Hispanic heritage foods, home cooking, gluten-free baking, and living one day at a time.
Jenifer Tharani, MS RD (Registered Dietitian)
Jenifer Tharani has completed master’s in human nutrition from Texas State University, San Marcos TX and training in dietetics from Emory University Hospital, Atlanta, GA. She is a member of College of Dietitians of Ontario and registered with the Commission of Dietetic Registration.
She is multilingual and fluently speaks second languages like Hindi and has worked in different settings which has given her experience treating people of all ages with different conditions. Jenifer believes that eating healthy does not have to be boring, time consuming or expensive. She is extremely passionate about helping you adopt an anti-inflammatory eating pattern without restrictions. She doesn’t believe in diets, instead in making small sustainable lifestyle changes to help you find a balance in your everyday life, including trying to keep your favorite foods in the mix! Jenifer’s mantra is “Give a Man a Fish, and You Feed Him for a Day. Teach a Man to Fish, and You Feed Him for a Lifetime” and so she gives you a nutrition toolbox to help manage your health condition or live a healthy and good quality life, whatever your goal may be.
About Jenifer’s Virtual Nutrition Coaching Services
In today’s technologically driven world, Jenifer provides virtual nutrition coaching to help you take charge of your health from the comfort of your home. In hervirtual nutrition practice, she focuses on helping clients adopt an anti-inflammatory eating pattern to help with weight loss, prevent and manage chronic illness like diabetes and autoimmune conditions like rheumatoid and osteoarthritis, fibromyalgia, lupus, psoriatic arthritis, and IBD.
Kia Peters @livewellwithkia is a Nutrition Student who works with Jenifer, RD to educate other chronic illness warriors about anti-inflammatory nutrition without restriction..
Cheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.
Links to things discussed in this episode:
- Jenifer Tharani, Registered Dietitian, “The Chronic Pain Nutritionist” on @chronicpain.nutritionist on Instagram
- Cristina Montoya, Registered Dietitian, “The Arthritis Dietitian” @arthritisdietitian on Instagram
- Kia Peters, MSc, Nutrition Student: @livewellwithkia on Instagram
- Cristina’s website: The Arthritis Dietitian
- Cristina’s Facebook page
- Free Handout: Cheryl’s Master Checklist for Managing RA
- Cheryl’s Facebook group: Arthritis Life Podcast, Practical Tips & Positive, Realistic Support
Full episode breakdown:
0:2:00 – Introduction: Jennifer, Christina and Kia
0:900 – (Jennifer) The difference between a Nutritionist and Dietitian.
12:00- (Cristina) The role of Registered Dietitian Nutritionists following evidence based practices to protect patient safety.
13:50 – (Cristina) How gut health is affected by Rheumatic Arthritis.
17:45 – (Jennifer) The idea that any diet can solve your problem is a myth, however diet can lessen the severity of flares, help reduce inflammation and improve quality of life.
19:11 – (Jennifer) Autoimmune Protocol Diet – may not be appropriate for all people with inflammation. There is no one size fits all.
19:50: (Cheryl) How the current length of appointments is not long enough to cover the many questions newly diagnosed patients have, and how the uncertainty causes people to adopt black and white thinking.
20:15 – (Kia) Newly diagnosed patients often want a quicker fix than the medications can provide. Focus on “Support” rather than curing, rather than “boosting” your immune system.
23:29 – (Christina) – Food is something we can control; we can’t always control how your body will respond to the disease.
24:41 – (Jennifer) – “Eliminations” can add to more anxiety. The importance of specialist care.
29:27 – (Christina) – Myths around nightshade vegetables and arthritis.
32:20 – (Jennifer) – Myths around dairy and inflammation, and the importance of keeping a symptom journal.
36:10 – (Kia) – Myth: “fun foods don’t fit” on an overall anti-inflammatory eating path. How empowering it is to discover food triggers, and learn how to make trade offs.
38:30 – (Cheryl) – How primal and psychological our relationship with food is, and how food relates to control.
39:24 – (Christina) – Myth: is red meat always bad? Plus, medications and pregnancy can change your disease, which can increase food sensitivities/inflammation triggers.
42:20 – (Jennifer) – How important it is to track symptoms and triggers over time. How weight loss helps with the mechanical stress of osteoarthritis but depending on which foods are eaten you can still get pain / inflammation despite weight loss. Takeaway: trust a professional to help with your nutrition instead of trusting “fad diets” for overall consistency and guidance
45:22 (Jennifer) – Are registered dietitians covered by insurance, depending on the system? In Canada, some are covered, but in the US, most do not cover.
46:30 (Cristina) – Advocating to rheumatologists for more referrals to nutrition care for people with rheumatic disease.
47:22 (Kia) – Doctors don’t undergo nutrition education as part of their care, which might be why they aren’t always referring patients to nutrition and dietitian professionals.
48:30 (Cheryl) – Patients deserve help with all the tools for their toolbox, for everything from exercise to nutrition.
49:00 (Cristina) – Understanding the ability to control how you eat can reduce inflammation but doesn’t cure the underlying disease. Understanding a dietitian can help with your diet and adapts your needs in order to be consistent after the reset phase.
51:00 – (Kia) – How important is is to combine personal experience with expert advice. Final thoughts and advice: try and find support, and know it’s normal and valid to be overwhelmed!
54:18 – (Jennifer) Final thoughts: seek support from valid resources earlier rather than following fads.
54:55- (Cristina final thoughts and advice: “There is no one size fits all, but there is one size that fits you!” Reflections on balancing motherhood with self care. It’s possible to have a mother and have an autoimmune disease!
56:40 – Cheryl’s final thoughts and advice is You are not alone on this journey and you have the ability to choose your support whether it’s informal or formal
Full Episode Transcript:
Cheryl Crow (00:00):
Hi, my name is Cheryl Crow and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years, and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen, life hacks, to how to respond when people say you don’t look sick, stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness, no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there ready to figure out how to manage your arthritis life let’s get started. Hi everybody! Today,
Cheryl Crow (00:51):
I’m so excited to have three different guests to help us understand what role diet and nutrition may be able to play in the management of arthritis and other rheumatic diseases or autoimmune diseases, long name. So I would first love for my guests to each introduce yourself and maybe explain a little bit, what is your relationship to these kinds of diseases and why you pursued your career in nutrition? Let’s start with Jennifer.
Jenifer (01:20):
Hi everyone. So my name is Jennifer. I’m a registered dietician and my graduate research study or thesis was on anti-inflammatory diet and its role in cognition with breast cancer survivors. So I’m really passionate about that, but besides that, my mother has a chronic lower back pain and she has signs and symptoms of fibromyalgia as well. So I only connected the dots after grad school. What role anti-inflammatory eating pattern can have on managing rheumatic and autoimmune conditions. And that’s what inspired me to, you know pursue or start supporting chronic illness warriors with nutrition. Because as a kid, I never understood what my mom was going through. I just only can say like, okay, my mom didn’t want to go out. And my mom said, I can’t sit for a long time. And I used to think as a child, like why mom, my mom can’t do so many things that other people’s mothers are doing. And only to now connect the dots and see that it’s such an invisible illness that your relatives, your family members can’t really understand. And unless you have the conversations with them. So that’s why I’m like super passionate. My mom, I love my mom. And so, you know, I felt like it’s so important for us as dietitians to hug other warriors with managing autoimmune conditions with diet and lifestyle
Cheryl Crow (02:57):
Yeah, that’s wonderful. And you got to see it, you know, through the eyes of your mom initially as a child. And now as an adult, that’s just an amazing story. Thank you. And how about Christina, but what brought you to nutrition?
Cristina (03:10):
Let me tell you what brought me to arthritis, RA twins. So I was diagnosed with rheumatoid arthritis a almost 18 years ago, and that was back home in Columbia. And also I been suffering with Sjogren’s syndrome as a child, as well as fibromyalgia and the list can go on, but those are the main ones. What I’m going to tell you about what brought me to nutrition really was an eating disorder. As a teenager, I suffered from bulimia and surprisingly actually I chosen nutrition because I wanted to be a better bulimic. Can you believe that?
Cheryl Crow (03:55):
Oh wow.
Cristina (03:57):
And if really it’s not a surprise to many who actually joined nutrition to develop some sort of eating disorder because of the pressure, but actually nutrition and the school of nutrition in Columbia. The professors really helped me to heal. I was really amazing. And when actually, while I was diagnosed with rheumatoid arthritis, I, I think I stopped a lot of those harmful behaviors because I wanted to heal. And that’s when I didn’t really see a role then as nutrition and arthritis, to be honest with you, I really didn’t want to think about the condition. And I think that’s what I’ve been kind of on and off when it comes to the nutrition, but it’s still, as, as I said, as I advanced, and I can see more the role of nutrition in so many chronic illnesses and now, autoimmune diseases. So I think there’s in my heart, right, as a patient and as a dietician to be part of these kind of this role. And that’s, that’s what I fit in here.
Cheryl Crow (05:06):
Wow. And that’s incredible that you took kind of a, a negative experience in your life of experience with an eating disorder and then turned it into this positive now of using, using your knowledge to help others with their chronic illness management. That’s really amazing. Thank you. Now let’s hear from Kia.
Kia Peters (05:25):
I guess my story of arthritis and nutrition are one in the same is they kind of come together in a full circle. And so I was first diagnosed with rheumatoid arthritis in June of 2018. And I was right in the middle of my graduate degree and I was in physiology and pharmacology. So, but I was studying the role of niacin and vitamin D for the treatment of diabetes and metabolic syndrome and obesity, because I was always interested in, okay, how could we use nutrients as pharmaceuticals? And that was my interest in kind of the medical sciences field, but then I got really sick with arthritis and I couldn’t walk and everything hurt and all of that. And so I finally was diagnosed and I was started on methotrexate and hydroxychloroquine the main ones, but then I had a really bad reaction to methotrexate and I got really sick.
Kia Peters (06:22):
I lost a lot of weight very, very quickly. And in about two months from starting my treatment, I looked like a skeleton of a person. I was so sick and I was still having joint pain. I hated food. I cause I reacted to everything. I did not like eating. I didn’t enjoy eating. And that’s when I took a medical leave from school to try and heal and get like my treatment plan under control. And then I kind of had to dig down deep and say, what do I really want in life? And I was like, I can’t take the stress of graduate school, so I didn’t want to do a PhD. And so I asked my supervisor, can I just defend my master’s? And she was so, so supportive of me. And definitely she said, you need to put your health first. And we did that.
Kia Peters (07:12):
And then my interest for nutrition was also driven by my first nation first nation community. Because chronic illnesses are very prevalent in first nations community. So I also learned about the role of a dietician through some stuff I was doing with first nations because they had a dietician come in and be a guest speaker. And I was like, I didn’t even know this was a thing. I didn’t know dieticians were really the experts in nutrition. And that’s when I kind of went on my own journey to discover nutrition and diet, the role of dieticians. And I decided to go back to school and become a dietician myself. And I’m in my final year of my undergrad. And then I will have an internship. And it’s just, I found a lot of healing through adopting a anti-inflammatory style of eating and realizing that I could heal my relationship with food after what I went through, being on the methotrexate. And that’s where they all kind of Interline intertwined together. And I just, I don’t want any other warriors or people who got diagnosed to fall down the rabbit hole of nutrition and the experience I had. And so it’s basically, I’m trying to be the person I wish I had when I was first going through my diagnosis. That’s
Cheryl Crow (08:29):
So beautiful. And I’m so sorry. It has such a bad experience at first. I have to share very quick. Mine was similar, but mine, my weight loss, my unintended weight loss was all prior to my diagnosis. So I find out later is something called rheumatoid cachexia, which is like where you rapidly. And I was a college athlete. I was lifting weights like prior to this and I lost so much muscle mass plus I just, I lost my appetite completely. And but anyway, so I can identify with that feeling of going, becoming so de-conditioned and feeling like kind of a walking skeleton and just not knowing if you’re ever going to get relief. So I’m so glad you’re on a really healthy and track now. And this is just so powerful to have speakers here who have lived through it either through your own body or in Jennifer’s case through the eyes of your mother, which is, you know a really intimate experience. So at first I didn’t even prepare this question. So I’m going to put you guys on the spot. One question that I ask is what is the difference between a dietician, a registered dietician and a nutritionist? Are they just the same thing? We just like choose whatever where we like, or how does that work?
Jenifer (09:42):
Basically, anybody can call themselves nutritionists. And I think it’s a little bit different in Canada. I find that there is something called integrative practitioners and some certifications and in the U.S., I see that that’s not as popular because I’ve lived both in both countries and I’ve practiced in both countries, but in the U.S., It’s more like nutrition, nutritionist title is also protected title now. So in the U.S., you like dieticians call themselves registered dietician, nutritionist. And that’s how the whole title is now protected. Unlike Canada it’s the registered dietician is proper becker, but not the nutritionist part. So anybody. So I see so many autoimmune illness warriors call themselves integrative practitioners and nutrition coach and nutritionist, right? So anybody can call themselves through their own experience or to take in like a three month or six month certification, but like Christina, myself, and what Kia is going through.
Jenifer (10:50):
I have a bachelor’s and a master’s degree in nutrition. And then I did a supervised practice training for 1200 hours, just like the doctors would do, right? Like their residency. We have to do our supervised practice training and then sit for a national board exam and then get licensed and registered. So just like a physio-therapist doctor, nurses, occupational therapists like yourself, right? Yeah. But nutritionists, there is no regulatory body like checking on them, but we, we have Dieticians of Canada. Like we are registered through the Dieticians of Canada. So we are, have to abide by all the regulations and rules charging and all of that. And we are the only ones that can do medical nutrition therapy, registered dieticians, but everyone else can just talk about basic healthy nutrition.
Cheryl Crow (11:44):
This is a very common area of concern. And I think that myself also being a licensed health provider, it, there, there is such a difference between being part of a program that’s rigorous and has many hours to it and where you’re continuously having to demonstrate every year that you’re keeping up your continuing education and that there’s a board. So if, if an occupational therapist or a registered dietician, you know, if someone believes that that person isn’t doing a good job, or just being unethical, there’s a board, you can report them to versus a totally unregulated field, like life coaching or nutrition coaching. And it doesn’t mean that you’re never going to find someone wonderful. I mean, it there that, it’s just that there is a higher level of quality control for the regulated professions.
Cristina (12:32):
Yeah. I think it’s important to consider that we are here to protect the public, right? Like how we do have that responsibility, whereas it’s like you said, like when you see others, that perhaps, you know, they’ll think give advice and even promises even cures, right. That they’re going to do as, as a nutritionist. So non-regulated professionals, they can basically say that, but then that becomes very dangerous and harmful for a patient really following that, that path. So I think it’s that registered regulated health professionals whereby by trying to practice much as we can, as an evidence base or on what is available, right? So evidence based practice and always seeking and considerations of public protection and public safety
Cheryl Crow (13:17):
That that’s so beautiful. And that actually leads directly into my next question, which is one of the biggest questions I see on social media and in person over the last 17 years has been, is there just a diet I can go on, that’s going to cure my RA. Can I just go on diet X, Y, and Z, and then never have to worry about rheumatoid arthritis again, who wants to speak about the potential of diets to cure or completely heal that disease.
Cristina (13:49):
I want to share a little bit of history. I don’t know if you are familiar with this. In 1909, there was an article published about diet and rheumatoid arthritis. If you ever, I wrote a blog about it, I kind of went back and reviewed what happened. So this is not new about wanting to know about how diet will cure rheumatoid arthritis specifically. At that time, the theory was that when anyone was in a flare up, they will give them a diet of milk and a pint of whiskey, mmm yummy, to cure out to what that reduce the inflammation. If they wouldn’t be, they didn’t tolerate the milk, they’ll give them fermented or sour milk. And one of the hypotheses back then was that everyone with rheumatoid arthritis will have an outer digestive flora, like a gut flora. So even back then they had that theory that something was really messed up with the, with the gut and the fact that after they, they, after that acute phase, they will set the re-introduce some foods that were like, God, like healthy or digestive.
Cristina (15:09):
I would say like they were tolerated. And so it was like a cooked vegetables and fruits and potatoes. So things that were very soft and then eventually they will re-introduce the rest of the food. So moving forward I 120 years now, now they said there was a rule about the microbiome and in the microbiome. And we’re talking about, about the elimination diets and all that. But I think now, even in 120 years, they still haven’t said, okay, diet can cure arthritis. Like it still hasn’t shown that. But I do find fascinating that nutrition is taking that a spotlight, that it was really denied for people with autoimmune conditions. I think that’s one thing that I really would like to highlight. I wanted to share that piece of history, but I think Jenifer and Kia can talk more about, about the rest.
Jenifer (16:06):
Yeah. So great point. Christina, you’re you’re right on point and it’s so weird, right? Like only now we’re trying to give a lot of importance. To gut microbiome, and actually it was my grad school research. So Kia knows I’m super passionate about that field and the probiotic bacteria and how people are just talking about, oh, I’m just going to pop probiotic, bacteria pills. And, you know, my gut microbiome would be great. And you know, a lot of those things, but to talk about, sure. And not necessarily there’s no research to support that it’s gonna cure it. However there is any like any other chronic illness, you know, when a chronic illness is, I mean, autoimmune conditions are not new, but it’s also hard to do research in this population because everyone’s showing signs and symptoms and medications and everything is so unique.
Jenifer (17:04):
But the same thing with diabetes, right? Like there was a medical news. There came about the time where there was a medical nutrition therapy for diabetes. You don’t cure it completely, but you can reverse diabetes only if it’s type two. And if it’s type one, then you have to it’s genetic, right. So you have to take insulin, but you also have to make sure. So I’m deviating a little bit by giving the example of diabetes, but it’s a very common, you know, people can understand. And every some in someone in their family would have diabetes, right. But it took years to get to the research and understand that, okay, type two diabetes can be managed with diet and lifestyle and the worst, unlike type one. So it’s the same thing with autoimmune conditions. Like it’s not going to be cured with diet and lifestyle.
Jenifer (17:55):
However, the flares, the severity of flares, the quality of life can be improved. The severity of flares can be reduced. And then if you’re putting your body, like if you’re eating more, anti-inflammatory type of eating like I don’t like to call it a diet because it’s not another diet. It’s more like a eating pattern. And so if you’re eating that kind of eating pattern more anti-inflammatory, then you’re, you’re giving your body that chance to stay in that anti-inflammation state. Whereas this pro-inflammatory state, because your body’s already in pro inflammatory state and your medications are doing their job to reduce that inflammation. Right. But with diet, you can support the role of medication and just overall have better quality of life. Instead of having five days of flares, you can have two days of flares and have better quality of life. Right? So their research is there.
Jenifer (18:51):
It’s just, we don’t know specific medical nutrition therapy that, okay, this, if you do this, it’s going to cure. And it’s all up to people to, you know, it’s that consistent action taking versus, oh, I tried this diet like elimination. Autoimmune Protocol is really popular. You know, a lot of people swear by it, but a lot of protein can be pro-inflammatory men versus women. There’s a huge difference on the way we process iron as women and men, you know, they, they don’t lose any iron as women. We lose iron. So for men, if they’re going on Autoimmune Protocol, its eating a lot of red meat, it’s going to be very, very pro-inflammatory for them. So my, my, what I want to say is summary is it needs to be individualized and there’s no one size fits all. Yeah.
Cheryl Crow (19:44):
That, that’s very helpful. And I think that when you’re first starting out, after being diagnosed, like one of my main motivations, similar to what Kia said is creating something that I wish I had when I was newly diagnosed. Right. And so when I think about the mindset of somebody who maybe has not had a lot of experience with the medical system, other than they’re maybe going to their annual physical or going to the doctor when they sprain their ankle. And now all of a sudden you’re getting diagnosed with a complex chronic, lifelong illness. And you have a 40 minute, if you’re lucky appointment, maybe 30 minute to talk about every aspect of that in medications, you know yeah. Lifestyle diet, but also just like, how does this work? Like, do I have to go get, I have to get blood work and I can go on this medicine or that medicine and so long story short, like I think that it, it, there’s a tendency to want to adopt like black or white thinking when you have all this uncertainty and all this overwhelm, you’re like, okay, well is, I just want to figure out how to make this go away.
Cheryl Crow (20:42):
You know? Like it could take it, they make a dietary choice and they get cured, but there’s actually this very, it sounds like from what you’re saying, and from what I’ve read too, it’s like, it’s not this hard line in the sand. Like you either do this diet or not, or you, or you adopt this eating pattern and you’re you get cured or nothing. Like it’s actually it’s trying to get at is like reducing inflammation can greatly improve, improve your quality of life. And that’s done and that’s not the same as a cure, but it’s definitely something in your best interest as a patient.
Kia Peters (21:15):
I really liked just everyone’s points they’re bringing, because that’s the trap I fell down was like, okay, it’s all that all or nothing mindset. It was like, what can I do to cure this? Cause you’re in so much pain and you’re so overwhelmed. You’re thrown all these new medications. You’re told all these things that you just want the quick fix. You’re just like, cause even when my doctor told me, my medications will take three to six months to start working, I was just like, that seems like way too long. Like six months of pain is very long. It feels like years. And so that’s, and then when you find the diets, like this will cure your, or this will take away your inflammation. Like it’s very tempting to fall down that and believe it. And that’s where it’s like, it won’t, there’s nothing that will cure.
Kia Peters (22:03):
And the word I always like to say and try to remind warriors are, is support. There are things you can do to support yourself, but nothing to cure, you can support your wellbeing. You can support your flares. You can support your diet and you can support less severe flares and lower inflammation, but you can’t cure and you can’t heal. The other one I always see is a lot of diets that promise to like boost your immune system or do those. Same thing. You can’t boost your immune system. You can support it. So a healthy eating pattern, not a diet, can support a healthy immune system and a keyword is support. So anytime you see extreme words, cure, heal, boost, that’s kind of a red flag where the person might not necessarily know what they’re talking about or that it’s just, we’re always looking for the keyword of support. We want to support our well-being through our diet and eating patterns. So that’s my little tidbit I wanted to add in there.
Cheryl Crow (23:02):
That’s really, really helpful. And I think there’s so much of a new language. People have to learn when they’re diagnosed that anything we can do to help them kind of sift through all the noise. And of course, yes, some of these people that are the loudest are the hard. They’re the hardest to ignore because they’ll keep saying it and everyone’s comments, oh, you just need to do this. And it’s so tempting to want to believe them
Cristina (23:25):
Really acknowledge what people really feel when they are going through this journey. Because as someone who has been with this probably for 30 years, there’s something about food that we feel that we have some control over. We can control what we eat. We can control what we put in our mouths, right. But we can’t control how these autoimmune diseases are going to treat us from time to time. So I think that’s probably why we feel that we kind of hang on to nutrition and that value of a specific diet is going to cure us because it’s something that we actually can control. We can’t control when a flare is going to hit us. Right. So I think why it really want to acknowledge that that’s, that’s what we go through on and off, on and off. And it’s a journey and it’s still going on because I took up to this point my twin and I it’s been 18 years. Right. And we’re still fighting and we’re still warriors. So I think I really validate, like he has said that it’s about supporting that wellbeing, supporting and adding to that wellness toolkit is one piece of the puzzle. Nutrition is a piece of that big puzzle that is part of managing an autoimmune condition.
Jenifer (24:40):
Yeah so just kind of talking along the lines of, you know, elimination and restriction and like she has said, she also fell into that trap of like, okay, what can I eliminate? What, what is it? And then you look up these Google searches and like, okay, dairy is bad, nightshades are bad, few of them is bad, eliminate everything. And you already are in such a stressful condition because of your autoimmune condition. And on top of that, adding all this stress and anxiety around food, it’s just kind of completely ruins the relationship with food. And that’s the message that I’m always trying to advocate for or share is you don’t have to right off the bat, start eliminating foods. Number one is when you have this diagnosis, you’re going to a doctor, right? For medication you, if you, if your car needs a carwash, you’re going to go to a car wash place.
Jenifer (25:36):
You might do it on your own, but not as best as a carwash place can do for you. If you need some work done by an accountant, you’re gonna go to the accountant. Right? So it’s the same thing, seeking the right support and not falling into the trap of like any like random blog posts that are not per se evidence based. They are more like, based on their experience. See, for me, I have experience, but I also, I’m a qualified nutrition expert. So I read research. I may not have the condition myself, but I can support the person as an expert in the field of nutrition. Like I know medical nutrition therapy for different medical conditions. And I know autoimmune condition warriors. Don’t only have one. I know you have gastroparesis, you know, so there’s like not just like one thing happening, multiple things are happening.
Jenifer (26:31):
And if you try like a cookie-cutter approach, it’s only going to make your relationship food worse, a relationship with food worse, and then it’s going to not eat anything. So getting support with, from a registered dietician who is an expert in the field can really help you take that overwhelm, confusion, you know, overwhelming all the nutrition information because the warriors in our program, they opt to join our program, our nutrition program, because they’re done, you know, they’ve tried everything and it’s just too overwhelming. Even they have bits and pieces of information, but they don’t have like, okay, how do I get from point A to point B and staying stuck at point A is worse than getting support and getting to at least point B and feeling empowered and feeling like you have control over the disease. Like at least the nutrition piece of the disease, not everything else and just overall, you know, the quality of life. But that’s what I always talk about is like get support from the right profession professional versus trying this trial and error, because you will still sit at the same spot by trying doing trial and error because you, no, one’s evaluating no one’s giving you feedback. No, one’s looking at your food and symptom journal to help you that okay. Dairy is okay. You don’t have to eliminate dairy, it’s not your trigger food. Right. So just wanted to add that piece there. That it’s not all about restriction. It’s more about feeling empowered and more efficient.
Cheryl Crow (28:08):
Hi, everybody. I’m interrupting really quickly to let you know that the waitlist is now open for the Rheumatoid Arthritis Roadmap, your guide for a full life with RA. I can’t wait to share more in the coming weeks. I’ve
Cheryl Crow (28:22):
Heard some myths in, in percolating through here. So the myth that you have to eliminate things in order to manage, sounds like that’s a myth that you have to, or every in a one size fits all is a myth. Are there any other myths or a myth that you can boost your immune system? Are there any other myths you’d like to help debunk for the audience?
Cristina (28:42):
I think that started with that because we even started talking about the famous nightshades. I will say that from my history, 18 years, and that’s still consistent almost for 20 years. I was at nightshades, dairy, red meat. Those were like starting, right? And then I will set in 2010 way more. I started using grains, gluten, and the list kind of went on and on. But the one thing that is, is fascinated with the nightshades, it just keeps coming back and forth. And I probably the main theory about the nightshades is that substance it’s called a solanine. That it’s, it’s really to protect the plant, the plants that are basically the eggplants, bell, peppers, tomatoes, and also in certain condiments spices like paprika, chili peppers and all that. So they are found. Solanine is found in those products. And, and so I think the theory comes back with potatoes.
Cristina (29:42):
I think potatoes, there was someone in the 60s and I think a group of children that kind of got poisoned from eating like the green part of potatoes. The potatoes are actually green. So in this part of this, the salad vegetables per se, the solanine that is what they call the kind of the toxin there that is going to cause inflammation. It’s really mainly found in the stems of the green parts of these vegetables. Obviously, you’re not going to eat that. You’re going to eat cooked potatoes. So that’s really not going to trigger the inflammation. And I think we put aside, we really forget about all the extra and beautiful nutrients that are in the nightshades, right? So they’re full of antioxidants and they’re actually part of the rainbow kind of like say, eat the rainbow, right? Eat the rainbow, eat the purples, eat the greens and there, and the reds.
Cristina (30:34):
And I think they’re valuable. It felt amazing. The antioxidants that they have. And even like in cayenne pepper recently, it’s actually in the spotlight and in terms of the anti-inflammatory properties. So say like, I’ll come on, give me a minute. And then as I was reading, I was cooking. Quinoa. Quinoa has that bitter taste. And you know, what? It is the same component that is in nightshade. So how come nobody tells me that they’re in quinoa? Right. So, and that’s why you kind of have to wash and rinse and re-rinse the quinoa in order to get rid of that little bitterness. And it’s the substance that is really found in nightshades as well. So it feels that they, they just kind of pick. And I, it really, really bothers me when they demonize food. Right. And they just pick one and that’s the evil one. You go, Jen, Jenifer.
Jenifer (31:25):
So I just wanted to talk about dairy and yogurt actually, because like I said, it’s my grad school research and it is research studies have shown that it is anti-inflammatory versus pro-inflammatory because it’s the best meat drinks for your probiotic bacteria. And my grad school research was where I put the probiotic strains into frozen yogurt to see how it survives your stomach acidity and goes to the, in this time to flourish there and multiply, right? Because these probiotic bacteria are so fragile that your stomach acidity can’t, they can die. So who is to tell that, oh, you’re taking all these, eating all these probiotic things, or, you know, just random probiotic products that it’s even surviving your stomach acidity. It’s probably dying. Right. So that’s why you will find a lot of probiotic strains in dairy matrix, because it does help protect these probiotic bacteria through the stomach acidity and allows it to go to the end this time.
Jenifer (32:36):
So that’s why like dairy is anti-inflammatory in that sense because you, there is probiotic in it as well as calcium. So calcium is extremely important as well. But the thing is, of course, if it’s your trigger food like today, I was talking to my one-on-one nutrition coaching clients and we, she didn’t consume dairy whatsoever. And then last week we started eating parfait made with yogurt, right. And we started seeing more stiffness. So the thing is we have to really focus on what signs and symptoms you’re having with specific foods. And like Christina said, and like you also said that bell peppers and tomatoes are not okay for you Cheryl, but potatoes are totally okay. So it’s not the whole family, right? It’s, it’s, it’s maybe one of the thing for a lot of people. When you say dairy, they forget about cheese, you know, like cheese is dairy, but cheese can be a huge trigger for inflammation because of its saturated fat content, but it’s just an umbrella, right?
Jenifer (33:41):
So you don’t have to remove the whole dairy food group. You have to test different foods from that food group and see which one is exactly your trigger. And if it’s even consistently your trigger, sometimes it could be something else you had that day. And Kia, can vouch on dairy because now she’s such a lover of dairy and she had eliminated that. So I would love to hear her say something about dairy, but that’s my little, like, myth-busting there about dairy? Like, yeah, dairy is bad. It’s just not good for me. And I get breakouts and this and that, but sure. I get it. I completely understand, like it doesn’t work for some people, but for others, it’s a really good source of nutrients. And we shouldn’t just eliminate it without really kind of doing, keeping the food and symptom journal.
Cheryl Crow (34:31):
That’s that’s so, so helpful. I remember in my own journey realizing that it was that dairy fat, like, like full fat ice cream or full fat creamer versus the lower fat liquid yogurt. So yeah, it’s just so much more complicated than it seems at first. So Kia, did you want to add to it a little bit of your journey?
Kia Peters (34:54):
Yeah. So it’s the same, just like Jennifer is talking with dairy and just like you said, with the high-fat dairy. So I know like I am lactose intolerant, so I do moderate my dairy intake because of that, but I thought dairy was triggering my pain and my inflammation or causing my flare ups, but it’s the same. It’s high fat dairy is what I found through journaling was that it was my trigger. So I I’m fine with yogurt and I’m fine with lower fat frozen yogurt is kind of more for my ice creams. But if I do choose to have cheese or I do choose to have ice cream, I just know that I’m going to not feel so great. And that’s where we say the empowerment is, Okay. I’m choosing to eat this. I expect that when I wake up tomorrow, I’ll be stiff. I’m okay with that.
Kia Peters (35:44):
And then the whole enjoyment of food is okay, because you’re kind of aware of how things will go. And they also know, okay, I’m not going to eat cheese tomorrow. So then my, by the next day, I’m back to normal. So you really have that control and that empowerment over your choices. And that’s, yeah, that was kind of my experience with your- I love ice cream. Like I love, love, love ice cream. And I was always so sad thinking I could never have it. And then it turns out, yeah, I can enjoy frozen yogurt or I can enjoy yogurt and I can enjoy these other things. So I just love having my joy of eating back. So you, you can enjoy. So I guess the myth is that anti-inflammatory diets or elimination diets, I think are boring and restrictive and you can’t ever have like fun foods, but you totally can. And I guess that’s the myth that I overcame myself was that, yeah, you can enjoy fun foods if you want, you can enjoy your favorite foods if you want, and you don’t have to feel guilty about them. And it like Jennifer talked about a lot too once, you know, your unique trigger foods. Yeah. That’s when you, you can just avoid those if they are a huge trigger for you. So I guess, yeah, the myth is fun foods don’t fit. Yes, they do.
Cheryl Crow (36:58):
I love that. And I think you all have done a really good job on your social media accounts. So I’m just definitely going to promote your social media in the comments, but where you show that again, that it’s all about an overall balanced life and a healthy quality of life and not about this. Oh, I must like control my disease at all costs and like do only the right things and only eat the right foods. And again, I guess I’m always searching for the mental health side of things because it’s part of what I find most fascinating in life. And I just loved Jennifer’s point really about how food eating is such a primal thing, right? It’s one of the first things we do when we’re born. We eat from our, we have to, for the first time eat from our mother instead of being inside the womb and getting, you know, on demand nutrition.
Cheryl Crow (37:43):
So like, and I, anyway, in my past, I’ve worked with pediatrics and I’ve seen it with children, especially children with special needs. They have so few things in their environment that they can control. And a lot of people are like, why is my kid so picky about food? Why is my kid? So that’s with food? You’re like, it’s the one thing they, you cannot force someone to chew and swallow food. They have to choose to do that. That’s one of the few things some kids can control in their lives. So it really is a deeply psychological part of this whole journey. And I can, again, I, I identify, I empathize with the warriors who are recently diagnosed and who are just desperate for some sense of control over it. But what I’m hearing from all of you is that there’s a way to give yourself that empowerment and control that doesn’t feel desperate and scary and overwhelming and sad. Oh Christina, you were going to mention your, your journey about red meat, Journeys with Red Meat, title of your memoir. Right? Ha.
Cristina (38:36):
Yeah, red meat. Red meat is a, is also one of the big ones that is still hanging around. But although there’s older people claiming that a carnivore diet can cure rheumatoid arthritis, which is like, okay, wait a minute now. And again, because it becomes like a one, one diet is only comprised of just one food item or one food group really you’re missing out on a lot. I said, you don’t need to acknowledge that. But when it comes to red meat, there was really some research indicating that because of the saturated fat content and just like Kia mentioned, right? Like at that high kind of saturated fats can trigger inflammation, or there’s other type of fat, like arachidonic acid, fatty acids that can also be triggers of inflammation. But my, my, my journey with red meat has been like, a kind of, a little bit, it’s a rocky one.
Cristina (39:26):
So it’s interesting how you had to acknowledge what happens with each individual, because I used to eat red meat. Occasionally. It wasn’t a big part of my diet, but I enjoyed it. But then once I started methotrexate, for some reason that red meat tasted awful, awful, awful. Just doesn’t even taste right. And so that’s how I started that dislike for red meat. I just stopped enjoying it. So even though okay, it’s, it’s, you know, it’s maybe not harmful, but I just didn’t enjoy red meat. I got pregnant, I guess my immune system kind of dropped again. I love red meat again. I love it! So, so even your own inflammatory, like food triggers, they change and they change like the stage of your disease and what what’s happening. Then I resumed methotrexate after pregnancy. And again, it’s just not for me. So I think it still is a process, even, even though you may identify those triggers today, maybe in a couple of years or so, things may change. And that may be those, the triggers may change as well. So I think that just to acknowledge that
Cheryl Crow (40:40):
That’s so great. And that’s, again, I keep thinking of the psychological, it can be really sad when you discover something that maybe works for you and it works for awhile, but then something else changes. And then suddenly that thing that did that worked yesterday didn’t work today. So that’s another thing that a chronic illness teaches you, that you really have to kind of live life moment to moment and not get too attached to the things that worked. Right. Cause then we get really disappointed when they don’t work.
Jenifer (41:06):
Yeah. So, like Christina said, like once you understand the basics and once you know exactly like how to identify those triggers and you’re not doing like a haphazard or trial and error job, when you really understand how to keep that food and symptom journal thoroughly, it’s a lifelong process. Certainly your triggers will change, but then you have that tool in your toolbox and then when life or the phase of your life changes as women, you know, if you get pregnant or if you have a baby or post postnatal prenatal any of those times, or even when you are post-menopausal, you know, things will change. And it’s not the same journey like men and women have like so much going on in their bodies. So it’s, it’s also different. But having like that tool in your toolbox is extremely important. Just wanted to follow up on that.
Jenifer (41:59):
And then the other thing is I find a lot of times people are tying to, you know, like pick up on some fat, you know, and we’ve, I I’ve worked in the weight loss field for a long time as well. And I see that the doctors recommend weight loss for osteoarthritis. And they say like, sure, you know, you lose weight or you will, you will feel better, but it’s only one piece of the puzzle. If someone is eating very, very high pro-inflammatory diet and losing weight and has lost weight, it’s not going to help their osteoarthritis because their inflammation is still there. Right. It’s just like the pressure on the knees has reviews and whatnot, but definitely, you know, they, it, it has to be like a combined approach, but like thinking about, right? Like, okay, celery juice will help or eliminating gluten will help or yeah.
Jenifer (42:54):
Yeah, certainly these things can help, but we are just missing the basics with which if I didn’t go to school for nutrition, like a lot of things like micronutrient absorption in the body, how your gut microbiome is important for vitamin K and you know, like lot of these things and lycopene is only active when you eat a cooked tomato versus raw, like those kinds of things like you don’t like normal population can only Google search and Google search so much. Right? So just missing, like the basics and running after facts, I that’s where, like, I feel like it’s wrong per se. Like if that doesn’t lead to success and, and kind of focusing more on the basics of, okay, what is the basic healthy anti-inflammatory diet? And can I do it on a very consistent daily basis? I think that’s, that’s what the takeaway here is like, okay, the fats are not going to help, but it’s, it’s just, just learning the basics from someone who knows it and who has gone to school is going to help you move in the right direction. Yeah.
Cheryl Crow (44:06):
That’s beautiful. And this actually brings up a couple of questions. I think some of the audience might have, first of all, are registered dieticians, like covered by insurance is that something people can see depending on their plan? I know I’m in the U.S. And you all are in Canada. So I know we have different systems, but my understanding, I know in my plan, I can see our registered dietician.
Jenifer (44:29):
Okay. So yeah, in Canada some of the plans like they do cover registered dietician. And then in the U.S, I know as most of the plans don’t cover, unless you have like some coverage for diabetes or kidney disease, I don’t know how, what insurance you have, but some private insurances may, but see the system in Canada is very much dependent on insurance. Like we, we have this free medical system here. So that’s why, like, the mindset is a little different in Canada versus in the U.S..I find that people in the U.S are so used to spending dollars for their medical needs that seeking a dietician, even paying out of pocket is normal to them. Versus, I find in Canada, it’s a little difficult to convince people that they don’t have coverage that is still worth paying out of pocket for a registered dietician. But it’s just the mindset because we have free medical, but a lot of good insurances like private insurance, I find cover registered dietician up to 80% or sometimes a hundred percent.
Cristina (45:38):
Starting to see a little bit of a shift though. And with rheumatologist and as a patient and as an advocate, even for my own care, I go and talk to my rheumatologist and say, you know what, go check this out. Like, I’ll go check out. Even I have, I suggested Kia as that website. Like I really, I have to, and I say, look at this, it’s it’s happening. We’re changing the rules. So you need to really start involving a nutrition care as part of the whole circle of care, really for our patient, for, for us. So I think it’s a, as a matter of advocating in that area as well,
Cheryl Crow (46:15):
That makes a lot of sense. Kia. I know you had something to cover too.
Kia Peters (46:21):
Yeah. The other thing
Kia Peters (46:22):
That is like surprising too, to consider with rheumatologists and doctors in general, in their training, they don’t get trained on nutrition. That’s the other important piece, I think, to really bring to light. Yes, they might get a small piece of, yes, diet plays a role. These are kind of a few, few basics, but they actually don’t undergo nutrition, education like a dietician does. And so that’s why a lot of times doctors or rheumatologists don’t address nutrition with you. Because they, they don’t know like they are. They can read the evidence and they can do that. But a dietician goes to school for a minimum of five years where they completely focused on diet and nutrition. But where the rheumatologists wouldn’t necessarily. So they might be confused themselves of what diet, because they don’t know what the research is for anti-inflammatory eating styles. And I think they’re just, that’s where the hesitation comes from. And that’s why and because there’s no like medical nutrition therapy to say, this is what works, there’s just that that handoff is, is slow to come. And that’s why, yeah, Jenifer is doing amazing advocacy work in trying to get referrals. And it has proven to be a very difficult task, but with slow, steady pace wins the race. So that’s what we’re going for.
Cheryl Crow (47:36):
I really hope that in the next, you know, 5 to 10 years, there’s a lot more clarity around it because yeah, we deserve patients deserve all the tools in our tool box, the same with, you know, physical therapy, occupational therapy, people just say, okay, well, exercise is good for you actually just go exercise. Well, that’s a lot more complicated than that. There’s different kinds of exercise. There’s cardio, there’s, you know weight lifting. How much, when, how you need someone to help you through that.
Cristina (48:00):
Well, I think I wanted to mention is that you think about when someone is also starting a new therapy of biologic, for instance, right? So your RA or any old, your autoimmune condition that is, or like, it seems like it works like a switch. Like, wow, it works, right? Like you feel so much better. And I think I can translate that into when someone has, let’s say has had like a, we call it kind of the standard American diet processed foods, and that’s what they’re used to having in their diet. And then once they go into these maybe fat diet or they come to this restrictive elimination diets, they feel great because in a way they’re kind of resetting their, their system, right. Like their body, their metabolism. So they think like to respond it’s oh, that cured me. Oh my God. That took away the flare ups.
Cristina (48:50):
Right. But because the process continues. So it’s the same thing it’s going to get to a point of the first biologic stopped working at five years, mark. Right. So then you’re going to need another one, but maybe your body is not going to respond the same way the first time did. So I think I, I’ve been trying to really kind of associate that the, how that responds to the biologics even to, to food or nutrition over time. And I think that that’s when I really valued. Jenifer said that is when we are at experts in nutrition. I think that Jenifer has seen her through her clients and through her mom, I have lived as I had the lived experience for so many years. And I think that’s so valuable. And I, I, and, and that part is when I do see more empowerment with my clients when I see them is because I can relate to them. Right. I can physically relate to them, but I think there’s also value in someone who is not doesn’t have the disease. So perhaps a little bit more of that extra energy that can infuse that to those clients. I think I am so thrilled to really hear about Jenifer and Kia’s work really.
Kia Peters (50:03):
Like what Christina just said about having that lived experience is really important. And I like, that’s why Jenifer and I compliment each other so well in our program because she brings this vast expertise. And then I bring in the experience because she’s always asking me, does this resonate, or would this work for someone? And I, and then I give her feedback and say, yeah, like that would work. Or, you know, when we’re on our flare day, this, we really wouldn’t want to do that. And so it’s this nice balance of just having the lived experience with the, with the, the expertise in our program. And it just really resonates with the warriors in our program. And like, it just, it’s really nice about that. And then my take home is just for warriors is just to stop doing diet alone and, and try and find support. And if you’re overwhelmed, that’s also normal. And those feelings are valid because that’s what I always struggled with. Not feeling validated. And I think with diet and nutrition, yes, it can help. But your feelings of being overwhelmed with diet and nutrition are valid, it’s stressful. And that it’s okay. And that we are listening and we’re willing to talk and support with you because we know how overwhelming it is. Like from my own experience. I know how overwhelming it is. So that’s kind of just my last little piece I wanted to add.
Cheryl Crow (51:20):
That’s that’s beautiful. Jenifer, do you want to go next? Any closing thoughts or messages?
Jenifer (51:26):
Yeah. so again, I would say that, you know definitely seek support. You know, sometimes I find that seeking support is very much later on in the journey and I feel like my message would be instead of spending money on random supplements or just, you know, some kind of fat that you’ve heard, it’s only going to negatively impact your body. Like someone told me in one of my calls that they started this celery juice trend and they, they were diagnosed then with heartburn and acid reflux. And now you’re just adding on another thing and it’s, it’s too much of concentrated concoctions. You know, you don’t need that. So just go back to basics. If you’re not able to figure out, reach out to one of us we are experts in the field of nutrition and we’ll, we’ll really help you sort through it.
Jenifer (52:22):
If we are not a good fit for you. It’s absolutely okay. You know, you can reach out to someone else, but reaching out as the first step and don’t hesitate. Like it’s not that you have to sign up for our nutrition coaching program or our services. We’re also here to listen. Like a lot of times, I just love listening to your stories and, you know, warrior stories because everyone has such unique story. And if I can help them, certainly I will see, you know, this is, this is what I can offer you. It’s up to you. If you want to, you know take that support. But again, reach, reach out. I would say, reach out to us if you have questions, instead of just following some random fat diet, because it’s only going to negatively impact you more because you don’t know, you’ve not gone to school to learn physiology and inside like a lot of things can happen, you know?
Jenifer (53:18):
So that would be just my takeaway that it’s not all or nothing mindset. It is more gray, not black and white and nutrition and diet can be a great tool in the toolbox, along with the holistic lifestyle. You know, like there’s a lot of times when I find like Kia, you know, if she’s flaring or anything like that, we certainly make sure that she prioritizes sleep, good quality sleep, stress management. It’s, it’s a lot of things that go together. And I think working on all these pieces is more important than picking on one thing and doing that for as like a cure,
Cheryl Crow (53:59):
Christina, what are your final words speak now? Or forever hold your peace.
Cristina (54:06):
Yeah. And I’ve been reflecting on that is that there isn’t one size fits all. There’s only one size for you. That’s really what I, I come to and I think I’m loving the conversation just Jenifer said through like social media. I think that I am enjoying more, the platform is having those conversations and understandings, you know, where is this coming from? And I think now I’m kind of showing a new light as a new mom, like my boys on that year and a half. So I think there’s one more thing that you need to find that balance that perhaps. Yeah. So when also we know that hasn’t had perhaps a child or that responsibility can take a break and, and rest and go take a nap. But sometimes when we have an autoimmune condition and a child, that’s not really an option, but it’s also a really kind of acknowledging that they just find things to figure out things, to enjoy with your kid, right. And enjoy with your family. And you’re still going to be able to strive and find a peace of mind and rest that you require. So I think it’s just any still possible to have, I honestly wanted to say it’s possible to be a mama and have an autoimmune disease because that was taken away from me for 10 years. So I really want to say that it is still, it’s still possible to thrive as an autoimmune warrior. I will say then.
Cheryl Crow (55:32):
That’s beautiful. And I’m so glad you were able to experience parenthood and that’s been fun. You and I, again, being twins in terms of having rheumatoid arthritis, the same amount of time, our kids are slightly different ages, but yeah, you’re, you’re, you’re not alone. You know, you can choose to do this journey alone, or you can choose to do it with support. And that can be kind of informal support just through social media and commenting and making connections. And that’s, that’s one level that works for some people, but getting expert guidance is certainly a wonderful tool in your toolbox. So thank you all so, so much and really wonderful learning from you on, I know that the audience will feel the same way.
Cheryl Crow (56:12):
So thank you. Thank you so much for listening to today’s episode. This episode is brought to you by the Rheumatoid Arthritis Roadmap, your guide to a full life with RA. It’s my comprehensive online education and empowerment program. I’m so excited about it and to learn more, go to www.myarthritislife.net. You can also connect with me on my social media accounts on Instagram, Facebook, Twitter, and even TikTok. Check out the links in the show notes.
