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Podcast

Mediterranean Diet, Gut Microbiome & More, with Arthritis Dietitian Cristina Montoya

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Summary:

Feeling overwhelmed by all the conflicting info about diet and arthritis? You’re not alone!

In this episode of The Arthritis Life Podcast, Cheryl sits down with Cristina—a registered dietitian and fellow RA warrior—who specializes in arthritis and Sjogren’s Disease. Together, they break down the latest research from the 2024 American College of Rheumatology conference, unpacking the science behind the gut microbiome and the Mediterranean diet. Cristina explains how these can impact inflammatory diseases like RA and Sjogren’s—and why it’s about more than just what’s on your plate.

They also tackle the big questions: Should you go gluten-free? Is the carnivore diet a miracle cure or just another fad? Is it worth having a restrictive diet if I’m stressed about food all the time? Cheryl and Cristina separate fact from fiction, debunking common diet myths so you can make informed choices without the confusion.

But this conversation isn’t just about food—it’s about the bigger picture. Cristina shares her “Five C’s” framework—Commitment, Consistency, Compassion, Courage, and Credibility—helping you stay on track while giving yourself grace. Plus, they dive into the importance of finding the right healthcare team and support system, so you never have to navigate RA alone.

If you’re looking for real talk, expert insights, and actionable tips to feel your best, this episode is a must-listen!

*Content warning: discussion of disordered eating from minute 10:40-14:40

Episode at a glance:

  • Cristina’s Journey: How dietitian Cristina was diagnosed with arthritis and Sjorgen’s Disease
  • Balanced Approach to Arthritis: Combine medication with smart lifestyle changes like diet and exercise for the best results.
  • Gut Microbiome Matters: The health of your gut microbiome plays a key role in managing inflammation and supporting overall health.
  • Cristina’s Five C’s Framework: Commitment, Consistency, Compassion, Courage, & Credibility
  • Build Your Healthcare Dream Team: Collaborate with trusted specialists (rheumatologists, dietitians, occupational therapists) for comprehensive care.
  • Avoid Quick Fixes: Don’t fall for miracle cures; rely on evidence-based practices for long-term success.
  • Specific Aspects of the Mediterranean Diet and Mediterranean Lifestyle: What makes it so helpful for inflammatory arthritis patients?

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, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Cristina Montoya: Cristina Montoya is a dynamic Registered Dietitian who lives with RA and Sjogren’s Disease. She founded Arthritis Dietitian to empower women with rheumatic diseases to embrace a non-restrictive, wellness-focused lifestyle while supporting their gut health. Over the past five years, Cristina has played an important role in developing wellness and nutrition resources for Arthritis Society Canada and the Sjogren’s Society of Canada. Cristina is currently working on developing the Arthritis and Sjogren’s Wellness Hub with nutrition and gut health resources.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty 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.

Episode links:

Full Episode Transcript:

[00:00:00] Cheryl:
I’m so excited today to have my friend, Cristina Montoya, who has lived experience with rheumatoid arthritis and expertise in diet and nutrition for inflammatory arthritis. Thank you so much for being with me. 

[00:00:12] Cristina:
Oh, thank you, Cheryl. I’m so happy to be back to this show. 

[00:00:17] Cheryl:
Yeah, I think this is your third or fourth — third, at least, showing on this podcast, so I’ll make sure to put the links to the previous episodes in the show notes. Can you let everyone know where you live and what is your relationship to arthritis in a nutshell?

[00:00:38] Cristina:
Yeah, quickly, I have lived with rheumatoid arthritis and Sjögren’s disease for more than 20 years. I specialize in anti-inflammatory nutrition and I’m very passionate about helping women — and most recently men — with rheumatic diseases transform their eating habits by really helping them creating arthritis-friendly and gut healthy meals, and promoting overall wellness without the need for restrictive diets. I am from Colombia, but I’ve been living in Canada for 18 years.

[00:01:10] Cheryl:
Yes. And for those who might be newer listeners, I’ve said this before, but I’m very, very picky about who I choose to come on the podcast to talk about the topic of diet and nutrition specifically, because there is a) there’s a lot of misinformation out there; or there’s incomplete information that people, subject matter experts are, for lack of a better word, like, myopically focusing on one part of the research and not looking at the overall breadth and not thinking about the patient’s overall quality of life, and just looking at nutrition in a vacuum. 

So, that’s something that I really love about your perspective, which it makes sense because you are a patient who has a lived experience, that you really are thinking about the big picture holistically of, like, what is the role of — so what is the role of nutrition in our quality of life? I’m already giving it away. But anyway, so I’m happy to have you on. And we are, we refer to each other as RA twins ’cause we were both diagnosed in the same year at around the same age. So, can you tell us a little bit about your diagnosis story or, quote unquote, ‘saga’?

[00:02:13] Cristina:
Okay. Let’s see if I remember, but I was diagnosed with rheumatoid arthritis about like 20 years ago. And with Sjogren’s syndrome, because that’s how it was called back then. Now it’s Sjogren’s disease, thank God. I was in my last year of nutrition in University of Antioquia in Colombia. And at that time, I was, you know, who expects to be in pain all day, all the time, and not being able to reach your professional goals? At that time, I didn’t even have a boyfriend. So, it was all these uncertainties, like, what’s going to happen to my life. And my mom had to literally treat me like a baby. She had to feed me. She had to dress me. She had to take me to the university so I could finish my, take my classes. And I looked back and I said, my mom is my hero because she was always there for me. 

And, I was at the same time diagnosed with Sjögren’s disease, although that one started way earlier when I was eight-years-old, but nobody really knew about it. And that one started with a lot of digestive issues, dry eyes, dry mouth, fatigue. I was the kid that no one picked for playing because I was always tired. So, that was very sad. I couldn’t really have the stamina to keep up with my peers. So, I did grow up with an undiagnosed autoimmune disease. 

So, when I — but one thing that I learned though, is that was 20 years ago, I suffered a lot, a lot of pain. I’m not experiencing that pain right now. So, my takeaway is that even though RA is unpredictable, Sjögren’s disease is unpredictable, even that excruciating pain is temporary in a way that we can learn how to live with it and thrive with those diseases.

[00:04:17] Cheryl:
That’s a beautiful, that’s a beautiful sentiment. And you’ve hit on, when you use the word ‘unpredictable’ or ‘unpredictability’ and ‘uncertainty’. Those are like the toughest parts of it for me, personally. But I think one of the things I’ve heard you referenced before or that we’ve talked about before is the fact that, like, in my journey, I was put immediately on like a biologics plus methotrexate which put my disease into remission for a number of years or near remission for many years after that; whereas you didn’t have that same experience of like what they call early aggressive treatment with Western medicine. What are — what would you want to share with the audience about that?

[00:05:03] Cristina:
Yeah, that’s correct. Actually, the onset of my rheumatoid arthritis was fairly quick. My symptoms started in let’s say, October, and it started with a extremely swollen fingers. They looked like sausages. I wasn’t even able to hold a piece of paper. You probably remember those days. It was extremely painful. And by January, I was diagnosed with rheumatoid arthritis and immediately put under the care of a rheumatologist in Colombia. So, compared to some stories, right, that they take years to get diagnosed, I was, it was very quick. 

And I was put in immediately and I believe in rheumatoid — methotrexate right away. But it still didn’t work. I, unfortunately, that was around 2003. The biologics were not very common in Colombia. Our rheumatologists were hesitant to prescribe it, and they’re also very expensive. So, only when I came to Canada in 2007, by 2008, that’s when I started the biologics. 

But at that time, the rheumatoid arthritis had already caused damage and my joints were irreversibly damaged because once the rheumatoid arthritis attacks your joints, it’s like forever, unfortunately. And so, that’s why I always highlight that each person’s journey and experiences. It’s so unique to the person. And it’s not our fault if certain treatment doesn’t work for you. It’s the disease. It’s not you. It’s the disease.

[00:06:40] Cheryl:
Yeah, that’s so true. And I think a lot of times when people are — in your case, you didn’t have a choice, like, let’s say to try biologics or not at your immediate diagnosis. A lot of people today are given that choice, to maybe be more aggressive or more conservative. And this has come up many times in the podcast in the past, but people tend to really focus on the potential side effects of the medication versus the potential benefits of the medication. And of course there are side effects. But the trade-off is that you are protecting your body from irreversible, not only irreversible joint damage, but the systemic effects, you know, on your other bodily tissues like heart, lungs, and just the inflammation that ravages, you know, your body and makes you not feel good. It’s particularly for fatigue and stuff like that. 

So, I just think that it’s important, like you said, everyone’s journey is different. Some people, someone else who was diagnosed at the same time as you in Columbia who might’ve had a. less aggressive form of RA, because it’s a progressive, it’s a progressive disease, like, by definition. But for some people, that progression is very swift and severe; and other people, it’s slower and more mild. So, some people with your same treatment plan might have done okay, or not had irreversible joint damage until many more years. But you were in the camp of people who unfortunately had that more aggressive form. And that’s not, like you said, it’s not a fault of your own. So, I think that’s really important for people to just think about. 

Like, I’ll say sometimes, people are like, “Oh, you,” like, they use the word ‘achieved’, like,
“You achieved remission.” I’m like, I literally just injected myself once a week. Like, I don’t feel like that’s an achievement that has anything to do with what I did. Like, someone else who did that same injection once a week and that drug, quote unquote, they ‘failed’ that drug, they didn’t — we did the same exact amount of effort and action. So, why is one being seen as, you know, an achievement and one is a failure? That’s silly, right? 

[00:08:37] Cristina:
Yeah, it just, it makes you feel like, “Oh, I’m the winner. I did it and I achieved this.” And now, “Oh, but you’re the loser because you didn’t follow everything. You didn’t do everything perfect just the way I did it.” I think it’s just so it’s so important to just take, take that guilt off the person. It’s just, this is not how it works. And I think for us, we have been navigating this disease for so many years. And I personally have navigated also different healthcare systems where it’s — I know when I was diagnosed in Colombia, we, if we had access to the biologic, we actually had to fight the government to give us the biologic because they wouldn’t fund it. 

In Canada, fortunately, I haven’t had that struggle that I had to fight the insurance to give me the medications. It’s always been consistent. So, I’m very lucky. I’m speaking from my own experience. But I have never had to go through like an insurance company to say, “Look, are you giving me the biologic this month?” Am I having access to it, or have to stop it and try a different job because this insurance company doesn’t have that coverage. I haven’t had that experience in Canada and I’m very, very fortunate to be here and I love Canada. 

[00:09:56] Cheryl:
I love it. I love it so much. That’s so great. Yeah. And that’s, yeah, such a good point, that the navigating the healthcare system, that can be its own episode for sure. But before we get to more of the — I’m excited to hear you share some of the biggest takeaways and ‘Aha!’ moments from the rheumatology conference back in November, but I want to just give you a quick minute to share, what inspired you to become a registered dietitian? And maybe this isn’t what — I just added it, so let me know if this is okay. But like for people who maybe have never seen a dietitian, like, what’s it like to see one? Like what’s an appointment with you? 

[00:10:40] Cristina:
Oh, as a registered dietitian, what inspired me? And what inspired me is because I wanted to be better at improving my eating disorder. I know it’s counter-interactive, but because of my Sjögren’s, my undiagnosed Sjögren’s, I’ll say I struggle with a lot of food imbalances when I was a teenager, and I thought that the one way to control that was through food. That was the only thing I could control, so unfortunately, I developed an eating disorder. When I signed up for, when I applied to study nutrition and diabetics in Colombia, I actually wanted to be better, and how can be better at dieting. And that’s the reason I signed up to be a dietitian. 

And I was actually fortunate to find out that wasn’t the right journey or the right path that was taken, and the professors identified that I had eating disorders, and they actually helped me to get some counseling with a psychologist. And also, seeing that nutrition is not a — it’s not punishment. So, being not well-nourished is not about restriction or about punishing yourself because of things that you can’t control or you don’t understand. And that was, and so that’s what actually when I fell in love with nutrition. And I started focusing more on the social, and social programs that were designed to help people who actually needed food, like people experiencing household insecurity. And so, instead of, so —I went from restricting food to actually finding ways to contribute to feed the people who need it at the most in Columbia. So, that was, that’s how I fell in love with nutrition, in Columbia.

[00:12:46] Cheryl:
Wow. That’s, that’s a really inspiring story. And first of all, thank you for sharing about your disordered eating history, because it is so common for people who have health issues to develop disordered eating, whether it’s, again, like a coping mechanism for symptom control or like in my case, like I had gastroparesis and I started restricting my diet because I could just tell that — like, and it wasn’t, it didn’t fall into the threshold of eating disorder. But I was just trying to figure out, like, why do I feel so bad every time I eat? Like, and what, is there something I can eat that would make me not feel as bad. But it’s, like, for many people, it can be a slippery slope. And you mentioned control. And it’s just so important to recognize that, like, there is so much that feels like out of control. 

Especially when you’re undiagnosed, but even when you are diagnosed, it’s like, of course, you would want to control something that gives you a sense of agency and confidence in your life. And I think, well done to your professors for recommending you see a psychologist. And well done for you, or well done to you for being amenable to their suggestions. I know that eating disorders are one of the most difficult mental health conditions to treat just in terms of it’s very hard, from what I remember learning that at school. I forget, I don’t know what the right way to say it is, but it’s like they’re very intractable at times. Like, it takes many, many, many years to unlearn those restrictive patterns.

[00:14:18] Cristina:
It’s true. It’s like disordered eating, I even, I started experiencing bulimia when I had like all the binges and hiding from people what I was eating, when I had all this binges of food. And then, the way I will do is like I would just go and exercise for like three hours at a time. And, but that slowly started to be coming to anorexia. And I was extremely, like, becoming so weak. And at that point, I hit rock bottom when I had to be hospitalized for extreme weakness and dehydration. And so, that was like a trial at the beginning of my, when I started my nutrition career. And so, that’s when I realized, okay, so I want to live. 

And somehow when I was diagnosed with rheumatoid arthritis, and it helped me — I don’t know, for some reason it really helped me to stop preoccupying myself for how I look or what the mirror is telling me and more about, okay, I need to move. I don’t want to feel pain. So, somehow, maybe it replaced that situation. But it helped me heal that part of me, that it was also hurting me. Now when I think back, it happened that I said, now I have rheumatoid arthritis, I need to eat well if I have to — if I need the energy to go and graduate with my classmates, I don’t want to be left behind. I want to graduate, so I need to eat. That was my thinking.

[00:16:04] Cheryl:
Yeah. And so,were you diagnosed with RA during your school work for being a registered dietitian?

[00:16:12] Cristina:
Yes, that was in my final year.  

[00:16:13] Cheryl:
Okay, I wasn’t sure if it was like a separate program. Okay, yeah, that’s a lot. I was diagnosed right before my senior year of my undergraduate, which was definitely hard, but my master’s was even harder, like, in the terms of that would have been really — anyway, it’s not Suffering Olympics, but it’s just, yeah, that’s I think in my just my little perspective from, I don’t know if this is the same thing you were talking about, but I feel like the worries I used to have aesthetically about my body, like I still occasionally get them, like, especially if you do videos, you’re like, “Oh, my gosh, is that what my mouth looks like when I talk?” Or, like, “Is that what my nose looks like?” Whatever. We all have that. 

But I feel like it, like, I stopped seeing my body as aesthetic, as aesthetically important. And it just completely focused to, like, health. Like, I don’t care how ‘ugly’, quote unquote, I might look, as long as I can, if I can, I’d rather trade looking pretty or looking whatever, looking sexy or something, I’d rather feel healthy than look good. You know what I mean? So, I feel like there’s a utilitarian almost part of you which you’re almost like, okay, looking pretty is like icing on the cake. But first I wanna feel not-in-pain. Does that make sense?

[00:17:27] Cristina:
Yeah. Well, it completely makes sense, especially in Columbia, you have that pressure. Latin America, all the Latin American women have to be gorgeous and have to be, like, well-proportioned, whatever that means. And so, it’s all these pressure on body image that when I was diagnosed with rheumatoid arthritis, that was like just, honestly, I didn’t really care for it. Like, I don’t care if I gained a little bit of weight because I’m expecting that gain, that weight gain, because I was on high doses of prednisone. And so, I needed to really balance all those messages, all those internal messages and say, okay, what is the priority? What is going to really nourish my body? What is going to help me to survive and to thrive? I’m only 21-years-old. I believe I was 21 years old, right? I’m now 43. And I’m very blessed to say, hey, I still have another maybe 20, 30 years ahead of me. And because I took the necessary steps and I committed to the treatment, I committed to changes in my life, that I was able to survive all these 20 years, and I’m hoping to maybe go another 20.

[00:18:37] Cheryl:
Yeah. Yeah, I love that. We were both diagnosed at 21 and we’re both 43 now, which is like another twin thing. So, I love it. Well, and I want to actually, this really dovetails nicely, like, to, I want to use some of our time to separate the fact from fiction when it comes to nutrition for rheumatic disease. And there’s just so much misinformation out there. And we’ve, in previous episodes, also tried to demystify and provide clarity on some of these things. But starting with the 2024 American College of Rheumatology multidisciplinary conference, what are some of the latest kind of evidence-based or emerging evidence areas that you find most exciting or interesting to share with the audience about the role of nutrition in rheumatic disease? 

[00:19:30] Cristina:
I really wanted to share this with you. Well, first, I was very excited to be part of the RA panel of ‘It’s Not Just Joint Pain’, which I had really the privilege to be with you and Eileen, Chronic Eileen, and so many other experts. And I was given that opportunity to speak about a nutrition, the role of nutrition in rheumatic diseases. And that we know that literally, like, that we know that the role of rheumatic diseases, it’s not very clear to be honest. There are some research that has shown that especially for rheumatoid arthritis, like the Mediterranean diet has helped to reduce pain and improve vitality. 

But I was actually — I went back to one session that caught my attention. It was by Dr. Monica Guma, and she talked about food stuffed by inflammation. And the focus actually was on the importance of the gut microbiome and modulated inflammation and rheumatoid arthritis or their potential role. And how she started the presentation, I really like, is because the questions that patients have about diet, they change depending on the stage of their disease. So, a diagnosis, they will come and say and ask the rheumatologist, “Should I consider changing my diet? Or what type of diet do you recommend?” Then you hit the low activity disease, you’re still a little bit, so a little bit of pain there, I’m taking a lot of medications. “So, do you think if I change my diet, I can reduce the number of medications that I’m taking?” And then, once the person reached remission, they said, “Well, I’m feeling great and I just stopped the medication. And what is the diet that’s going to make me feel better?” 

So, I really liked how she started with that because that’s exactly what I get when I work with my, clients. It’s like, “What diet do you recommend for my rheumatoid arthritis?” And I agree with this, that a healthy, balanced diet is essential to improve, and then an improvement of the lifestyle is very helpful with individuals with rheumatoid arthritis. They help them, like, have weight control, right? They help us to improve our cardiovascular parameters or prevent cardiovascular diseases. Because one thing that we’re learning, and it’s this connection with inflammatory arthritis and cardiology, right, or cardiovascular diseases, is that even rheumatoid arthritis is an independent risk factor of developing cardiovascular diseases. 

So, if we go back to the Mediterranean diet and the lifestyle, that is the number one diet that is helping to prevent cardiovascular events, that’s where we can find that connection, that it supports the management of inflammatory arthritis and also the prevention of complications like cardiovascular diseases. I think that makes sense. 

[00:22:47] Cheryl:
Yeah, that does. And I think that’s something, I don’t think I learned that like until maybe 10-years after my diagnosis, that there was this relationship between rheumatoid arthritis and cardiovascular diseases, and heart disease overall, things like having a stroke. Like, when we say cardiovascular events, these are not like events, like little things. Like, these are like strokes, a blood clot, whatever, all just — what’s the thing where the buildup of the plaques in your vessels. I forget what that’s called. Whatever. All the bad stuff. You want to do what you can to avoid that. So, I think that’s such a good point. A lot of people think of maybe there’s some magical relationship in their head between the foods they eat and that those foods are making their joints feel better, but they also are really actually helping your health, your heart health. And in the same way the exercise does, too.

[00:23:45] Cristina:
Exactly. And I think the second one that she pointed out is that, okay, people with rheumatic diseases, they should be informed that consumer-specific foods, it’s unlikely to have huge benefits to their rheumatic disease outcomes. And I know a lot of people don’t want to hear that. And this is, these are the reasons why. Diet-related studies or nutrition-related studies are very, very difficult to conduct and to blind. So, if you think about like a drug, a drug clinical trial that either you get a placebo, you get the drug that they’re studying, but they are giving them a specific dose. It is nearly impossible to do that with nutrition. Because when you go into nutrition studies, they are relying like a 24-hour food recalls to really assess what you ate in the past 24-hours. So, that really relies on memory. It relies on trust that the participant is gonna tell you what they ate. 

Because they said, okay, no, we’re going to have, we’re going to run a study with just, I don’t know, maybe the anti-inflammatory or RA immune protocol, and you need to restrict nightshades for three months, right? So, nightshades including tomatoes, eggplants, potatoes. And you will say, okay, so let’s say you will have, they will have to give you the same food every single day. And are you telling me that you eat the same foods every single day? So, there is a high, like, risk of bias in that situation. Some of the participants, they are very good and they’re trying really their best to follow the guidelines. But sometimes there are, like, cost restrictions and not everybody has the money to maybe buy or eat salmon twice a week. Or maybe the day before, they decided that they went out with their friends and they didn’t eat that salmon during that study, but they’re afraid to tell the researcher because it’s shameful to say, “Oh, I didn’t follow the protocol.” 

And so, these are just examples to tell you how difficult it is to study nutrition because there’s so many confounders. So, they could be that inconsistency. There is, it’s very indirect, that is very difficult to truly measure the effects of the nutrition interventions. And most of these studies really don’t run more than maybe 6-months. Maybe they do a follow up, maybe a year follow up. So, many times your publication has biases because they might be run with a specific interest. Maybe it might be a specific company that wants to promote a specific product. So, it’s really, just keep that in mind when you are reading a nutrition article or research. 

Or many times it will say, “Oh, the such diet, a ketogenic diet showed some results in patients with rheumatoid arthritis.” When you look down at the methodology, they say, well, it only affected maybe two or three people showed positive results, then on top of that, you want to be ethical when you’re running nutrition or diet-related studies, all the patients are on their medications. The researchers are never going to tell these patients, you have to stop the medication so then we can see the outcomes of this trial. That would be unethical.

[00:27:37] Cheryl:
Right.

[00:27:38] Cristina:
Oh, sorry. I just kind of went there.

[00:27:40] Cheryl:
Oh, no. And this has to go with, this is really not even only specific to diet, but diets just — and nutrition — is like a magnified example of just the overall some issues in health literacy when it comes to patients trying to do their best to do, quote unquote, ‘do your own research’. And, that’s really important. Like, no one would say you should never research your own disease, but you need to understand how to make sense of scientific journal articles and avoid pitfalls, things like cherry picking data. Just cause there is a piece of evidence in one journal article does not mean that is conclusive. 

There was just a, just to use a different example from nutrition, I follow this OBGYN, who’s called Dr. Jen Gunter. And she’s really great at like busting myths about, she wrote a book called ‘The Menopause Manifesto’. And she posted an example where a first author on an article — it’s about menopause and hormones. And this is another really tricky area like autoimmunity where there’s so many variables that are hard to control for. And this first author on one of these studies, which showed there was some relationship between testosterone and improving symptoms in people with menopause, that was never replicated. 

But the influencer who doesn’t have any scientific training and understanding of this to look at the breadth of research, she was like, “Well, you guys should tell your doctors that you need testosterone therapy. ‘Cause here’s an article,” she’s doing, in her mind, she’s looking at evidence. But the lady who wrote the article, it’s like, evidence is not just about cherry picking one study. There were like nine other studies that could not replicate my finding. So, sometimes the findings are due to chance. They’re just – or there’s some underlying variable that was influencing the results that you just don’t know till later. So, everything is complicated, in one conclusion.

[00:29:39] Cristina:
Yeah, and I think that’s what it’s — I always talk to, and when I get a client and they want to change their diet, and it’s like, I want to ask them, like, are you being seen by a rheumatologist? First of all, are you getting treatment for rheumatoid arthritis; and second of all, I just don’t want to give you like ‘The 10 Most Anti-Inflammatory Foods’. And we have to look at what is your lifestyle, what is in your life, what’s going on. And I’ll give you an example. So, like I said, I promote my business for women, but somehow I’m getting more men. And the reason I started to take a more kind of male clients is because the shame that sometimes they experience, and they said they are afraid of saying, “I’m in pain,” or, “I can’t provide for my family.” So, anyway, so I was really — I was seeing this specific client that wanted to lose weight, was very committed to make the changes and they wanted to just do the diet. But you know what we went through actually, we went through a journey of seeing what was the lifestyle. So, one of the things was, “No, I only drink a cup of coffee in the morning, and maybe a granola bar for lunch. And then, I have a huge dinner when I come home, and an hour later I go to bed.” So, do you see anything wrong in that scenario? What do you see in that scenario?

[00:31:01] Cheryl:
I remember learning, you did talk about this at the conference at the ‘It’s Not Just Joint Pain’ talk about if you have a huge amount to eat before you go to sleep, that is not helpful for your sleep quality. And overall for your blood sugar, that’s not good to just eat one huge meal, right? Or you can tell them more than me.

[00:31:22] Cristina:
And that’s the thing. It’s like, and it was not just about, you know, that he did just one large meal, but it was just the choices throughout the day that they could be — that yes, there are foods that had now had the evidence that can be pro-inflammatory, right? Like a highly processed foods, and a high refined sugars, saturated fats. And when I started maybe highlighting those areas that were concerned, and that can actually be specific, there was a high intake of sodium, even over like 5,000 milligrams of sodium a day, which the guidelines, it’s less than 2,000 milligrams. The same thing for saturated fats, it was like 300% over what the requirements were. And also, a high intake of carbohydrates and simple carbohydrates. 

So, that’s when a registered dietitian really comes in and starts to dissect your lifestyle and your eating habits and really start targeting, okay, what is it that is going to make the most, like, an impact in your lifestyle? Because chances are, it’s almost like going to the gym in January. Do you see the gym in January? Completely full. So, when someone, when you go in February, March, number starts to dwindle, So, the same thing happens when you’re trying to make a dietary change overnight. Because we eat every single day, so you want to make sure that the changes that you make, they’re very gradual and they become so, like, common sense that over the course of like the weeks, he said, “Oh, no, I’m not just having a cup of coffee. I’m actually having a bowl of oatmeal with nuts and black and blueberries and I’m actually feeling better. I’m having more energy, and I don’t think I can have that only cup of coffee.” Do you want to get to that stage where you just feel that you want to do it, not just because you have to do it, but because I have to follow this meal plan. We know, dietitians know, that whenever we give a meal plan to a person, they never follow it. 

[00:33:34] Cheryl:
It’s the same with the — it’s the same with a home exercise program for PT, especially if the caveat there is, at least what I was taught in as an occupational therapist, is that if you just hand them a sheet of paper without talking about it or customizing it to them, obviously it’s not relevant, right? But if you can work collaboratively together with the client or the patient, I’m sure you do that as a dietician too, like, what feels doable to you versus ‘Oh, here’s this prescription’ approach. Like, there really is no one-size-fits-all. It’s going to be like an iterative process and your dietician is, like a registered dietician, is like an important team member if you want to pursue the, you know, improving your quality of life with rheumatic disease through nutrition, it’s much harder to do it on your own, you know?

[00:34:26] Cristina:
That’s the thing. So, almost sometimes we come and I see clients where they want that permission because they have, they’re so overwhelmed with all the information online. And from credible sources, right? So, you have this doctor who wrote ‘The Plant Paradox’ and it has a protocol and eat lots of plants, and some people just they’ve got to eat all these plants and they feel guilty. But, “I used to enjoy, like, a steak of my husband’s birthday or a little bit of cake of my with my birthday and my kid’s birthday. And, but if I eat it, I feel so guilty that I didn’t follow that protocol. I’m being bad. And that’s why things are not working.” 

And my approach is always about really compassion. And I say like, wait a minute. You are already having a very hard time to adjust and to live with an chronic disease that is incurable and unpredictable. So, give yourself a little bit of, you know, a break. And enjoy too, right, like that’s meaningful to you to have a little bit piece of steak, it’s okay. When everything else is going well, you’re adding more plants into your diet, you’re being more consistent with your meals, you’re getting yourself more hydrated, you’re starting to move. It’s just not about the specific food, it’s about the change in your overall lifestyle. 

And I think this is what I really wanted to highlight, something that I shared in one of my webinars. So, as you mentioned earlier, actually, I realized by doing this is that I’ve been contributing through the Arthritis Society Canada Knowledge Program. If you just go on to their website on arthritis.ca, and I’ve been contributing to their program in terms of anti-inflammatory recipes, articles, webinars for the past five years. And I feel very honored because then they trust mt opinion, they trust my knowledge. And because I don’t give any promises to patients because I haven’t seen that cure. I’m very responsible to what I say to my clients and I’m very honest. 

[00:36:52] Cheryl:
Me too. Yeah. Yeah. 

[00:36:55] Cristina:
So, this is what I wanted to share with you, because sometimes when you look at people who think about the Mediterranean diet and say, “Oh, my God, you’re talking about the Mediterranean diet again, and I don’t want to eat hummus every day.” And it’s like, okay. Because when you think about the Mediterranean diet, you’re thinking that you’re eating like, I don’t know, not how they eat in Italy. But the Mediterranean diet covers so many different cuisines, right? It covers from all the Mediterranean places, from it goes from Portugal, Spain, even all the way to Turkey. So, it’s just a variety of foods. But the main goal of the Mediterranean diet that I support is that it’s a plant-focused, a dietary pattern. And we know that includes all whole grains, and nuts, and seeds, fruits, and vegetables, and lean proteins. 

But the one thing that we tend to not focus is that the Mediterranean diet is also that lifestyle. So, the diet emphasizes on the physical activity, socialization, and even cooking with your family, cooking with others. It’s just a celebration of food; it’s a celebration of your culture and life and family. And on top of that, of course, it is rich in antioxidants and anti-inflammatory compounds and can be adapted to various cultures. So, in my case, I’m Colombian and I hated olive oil. I honestly hated it. I didn’t like it at all. It took me many years to finally embrace the flavor of olive oil. And it’s okay, right? It’s okay. So, I started eating palm oil. Then I said, now, I love olive oil. If I’m eating arepa, you know, like that corn kind of bread that we eat in Colombia. And instead of butter, I use olive oil and I love it. So, it takes time to adapt.

[00:38:56] Cheryl:
Yeah. I just had someone in one of my Rheum to THRIVE support groups who was saying it was really a grieving process for her of trying, like, she felt that, or she assumed that she was going to have to stop eating all of her favorite foods. And she’s Mexican. And she’s like, “I can’t find any overlap between the foods I eat and Mediterranean, except for corn as a plant, technically,” I’m laughing, but it’s just like, you’ve got tomatoes, you’ve got red meat, all this stuff. And I think it’s, I think that’s really important. Sorry, overall, what you’re saying about the Mediterranean, what is it about the Mediterranean, quote unquote, ‘diet’? Is it really the Mediterranean diet or is it the Mediterranean lifestyle, like you mentioned? Is it that they’re walking more? Is it that your food is fresh and less processed? What is the context of you sitting down mindfully eating with your family? Is it stress management? Is that all contributing? And stopping — it’s important, I think, at least in my experience to not look at food as the same as like medicine where it’s just what’s inside that pill, but it’s what’s the overall context that you’re eating that food in, how do you feel about it, to me is huge. So, anyway, I’m just preaching. You’re preaching to the choir here. I think it’s such a beautiful point.

[00:40:16] Cristina:
Nobody’s — I think I like the fact of how you summarized and making sense, right, from that the patient perspective. Like, what can you see? And when you look into more, let’s say, let’s go into more like a chemical, what is the importance of the Mediterranean diet in gut diversity? And so, I don’t know, like, about that, but we learned about that connection with modulating the gut microbiome to improve or to reduce inflammation. So, the Mediterranean diet, because it’s so rich in fresh fruits and vegetables, it’s rich in polyphenols in plants — like flavonoids, they have antioxidant, anti-inflammatory properties — and they actually affect the gut microbiota in immune system. 

They reduce inflammation and they also promote, like, beneficial bacteria. These flavonoids and also fibers and prebiotics, when they go to the gut, there’s this little, little bug that they love that fiber and they produce that short-chain fatty acid that they’re the main source of fuel for the gut barrier, to maintain a gut barrier. No, I’m not going to say that ‘leaky gut’, no, like everybody experiences a little bit of leaky gut at some point in their daily life. But it’s just the importance of maintaining that gut and cell function, immune cell function within the gut because it holds up to 70% of the immune cells. 

So, you see when you started to analyze and see what are the benefits of the Mediterranean diet and you bring it down to your gut, literally, do you start seeing why more consciously as to why I should really eat that? If we are modulating information from the gut, it is possible that I’m also helping to enhance or perhaps enhance the effect of the medications that I’m taking. Also, the Mediterranean diet is full with antioxidant foods like vitamin C, vitamin E, and Omega 3’s, right, that we know that’s a very important nutrient to reduce inflammation. And it really promotes what we have seen from the gut health perspective, that we eat more than 30 plants a week, and plants counted as anything from nuts, and seeds, whole grains, fruits and vegetables; that all counts as plants. So, this is why it all goes back, any anti-inflammatory eating pattern, it stems from the Mediterranean diet.

[00:43:07] Cheryl:
I really love how you’re breaking it down. ‘Cause I think, yeah, when I have seen educational blurbs about the Mediterranean diet, it’s often just like, here’s — what you mentioned — here’s a list: You should eat olive oil, you should eat lean meats, you should eat these, hummus, like you mentioned. And it doesn’t go to that next level of what is it that those foods are doing. And I think if you understand the why of it, then you’re more likely to buy in to making a change towards that eating pattern is going to work. 

And also, again, maybe just reiterating the role of the overall lifestyle, and the behaviors around eating that I know I am the first to admit that in American culture, we’re kind of known for eating on the go and grabbing something, eating it in the car, and not having a real like sense of I’m nourishing. I’m having a nourishing experience with when I’m eating. 

So, anyway, I find that really just helpful to understand what’s maybe going on. And I think, do you think that there’s going to be — this is totally off the cuff question. But in the next — I feel like this is just a premonition based on evidence I’ve seen, but I’m not as deeply into it as you are — but in the next five to 10 years, there’s going to be like a massive increase in the understanding of the role of the gut microbiome in autoimmune diseases in general?

[00:44:35] Cristina:
I would say, like, a massive — I think they’re still very confused and they don’t truly understand the results, but what I do see is that that is being acknowledged and it’s being studied. So, for that, and this is so important to know, because even if the person feels and follows the, let’s say, quote unquote, ‘perfect Mediterranean diet and lifestyle’, and, or two people, let’s say you and I start eating the same Mediterranean diet, but our gut microbiota is completely different, right. So, those foods are going to react also differently to what we eat. 

So, what they say is that, with Dr. Guma, she said that this diet, specifically the Mediterranean diet, will increase the pool of anti-inflammatory metabolites compared to the Western diet. So, the one that you were just describing, right? The things that are on the go, fast foods, and so on. But the question she asked, so why don’t we simply change the diet, and they will get better, if we know that these foods have anti-inflammatory metabolites? 

So, then she describes so well, unfortunately the gut microbiome doesn’t only depend on diet. The diet is only one piece of that puzzle that shape the gut microbiome. So, there are other factors that we have in that we cannot change; which is age, genetics, past medical history, perhaps infection, environment, drugs or antibiotics, right? Those are things that we can’t change. So, until we understand how we, with how the microbiome really — it really depends on so many factors. That’s it, I think, that’s the key. I think that’s what he’s trying to understand. And some, so yeah, I think that was very powerful.

[00:46:42] Cheryl:
Yeah, I love that. And I think, I know we’ve mentioned this before, but like for me, I have another confounding variable or a condition like gastroparesis or decreased GI motility. That means that certain things that are recommended in the Mediterranean diet, my body doesn’t respond well to. And especially insoluble fiber in the form of like beans, like legumes, I do not do well with them currently in my diet. My body might change in the future, but so things have to be, again, we can say it a million times till we’re blue in the face, but I think if there’s no one size fits all, really. But I love thinking about the — I actually had never really thought of the gut microbiome as being so influenced by things outside of the foods that you’re eating. And I actually realized, we didn’t even define what is the gut microbiome. Can you tell people who they might not have heard of this before? Sorry. I try to always define our terms.

[00:47:39] Cristina:
Yeah. Just the latest terms. So, the gut microbiome is, like, comprised of all the trillions of bacteria in microorganisms, really, it’s not just bacteria but yeast. And they’re mostly located, like, found in the gut, but also the skin. Like, the skin also has their own, like, microbiome. But in terms of all the research that is being done here, especially in dermatology and the gut, they call it the gut-joint-axis related research. It is focused on all the bugs that we have in the gut, in the large intestine. That’s what it refers to.

[00:48:25] Cheryl:
Yeah, that’s so helpful. Sorry. Yeah, I’m gonna also link in the show notes to, I had a dentist who goes as, like, she’s an integrative dentist which I had never even heard of that being a field before. But she talked about your oral microbiome and that was something, yeah, and I’m sure for you, even more important when you have Sjogren’s as well, understanding what’s going on in your mouth. But people with RA themselves, we are much more likely to have dental disease, gum disease, and stuff like that. And just, there is a whole set of bacteria living in your mouth, which like freaks me out as I think about it, but.

[00:49:03] Cristina:
No, and it’s so great that you bring this up because that’s really how the, aside from the skin, right, like as kind of the first barrier of protection, but like the mouth is really the door to everything. When you’re eating your food that we have, like, this pool of bacteria also both harmful and beneficial, you’re eating your food, like, you’re bringing all that down. And like you mentioned, if you don’t consider a past medical history, if somebody’s not maybe is taking medications to reduce the gastric acid. 

Then, and then you are consuming those bacteria that the gastric acid is supposed to kill, then you’re actually generating maybe, or you’re creating another problem. So, be really conscious of what we’re eating and how we’re feeding that microbiota from our mouths all the way to our gut. It’s very important. For Sjögren’s disease specifically, there a specific bacteria that causes cavities and the cavities are like just around, just below the gum line, which is very specific. So, our cavities — and it’s the strangest thing when I get cavities. It’s like in the gum line. They’re not really on the surface. They’re right in there.

[00:50:28] Cheryl:
Oh, wow.

[00:50:29] Cristina:
And they’re very, very painful to treat because it’s like how — and then you don’t have enough saliva to really sustain and to continuously repair it to wash off that bacteria. So, that’s why Sjögren’s disease is like so important to maintain that oral care. It’s just paramount if you don’t want to lose your teeth or if you don’t want to, yeah, if you want to improve your quality of life. But another thing that I really wanted to share with you when it comes to these gut and joint axis, where they do most of the research is with patients who are actually diagnosed with ankylosing spondylitis. Those with spondyloarthritis — did I say it right? 

[00:51:22] Cheryl:
It’s spondyloarthritis. 

[00:51:224] Cristina:
Spondyloarthritis. So, those patients are actually, up to 20% of them can develop inflammatory bowel disease or some intestinal disease. So, when it comes to researching really the connection between the gut and joint, they take the pool of patients with spondyloarthritis. Because they were just so close, right? The spine, so close to the gut. So, they have actually seen that they’re, the gut microbiome, could be modified in so many ways. They have seen that many autoimmune diseases, in these biopsies, so there’s this alteration of the microbiota, right? We have more kind of harmful bacteria and less beneficial bacteria, and they have seen that in individuals who have not been diagnosed yet. When they’re diagnosed, they say, “Oh, there’s got these biopsies here.” When they start methotrexate, they start to balance the gut diversity. 

[00:52:32] Cheryl:
Whoa. 

[00:52:34] Cristina:
So, that was just, it’s so interesting. So, there is this article where they say that they showed that methotrexate, it’s an anti-inflammatory drug designed to target human cells. They actually can modify of the activity of certain gut bacteria. In sulfosalazine, which was initially developed like to treat rheumatoid arthritis, I think it’s just now more used in spondyloarthritis. But they see that they promote the microbiome butyrate production. What that means is that, like I mentioned before, when we also increase the amount of fiber that we take, that also is going to lead to more production of short-chain fatty acids, which is going to help to maintain that gut barrier. But you can also see that from certain medications like methotrexate and sulfosalazine, that helps with that gut to improve the biodiversity, which is really interesting. I was just fascinated by it.

[00:53:35] Cheryl:
Oh, my gosh. That’s why I have a gut feeling — pun intended — now that there’s going to be a lot more, if nothing else, just correlational evidence, but hopefully there’ll be more causal evidence of, like, what can we, you know, what are the — but even more tailored or targeted nutrition choices we can make that really have that good influence on the gut microbiome and our overall disease. Those of you who are watching this on video, you’ll have the benefit of seeing Teddy be really cute right now in life, in my office daybed, which is part of my rest and sleep intervention for my, quality of life with rheumatoid arthritis. Is there any other, anything else you wanted to share about, you know, nutrition facts, myths that you want to bust, anything else? I know I want to just be respectful of your time as well, but.

[00:54:28] Cristina:
No, I appreciate it. I think I wanna go back to some of these myths, and I was sharing with you earlier, that I started posting more in Spanish because I identified that there is also a huge gap in knowledge and information in. And I feel like 2025 is the era of misinformation. Even in Canada, the, medical association, Canadian Medical Association found that up to 30% of individuals in Canada are avoiding or stopping treatment because of misinformation, and that’s huge. It’s like a 1 in 3 people are doing this. And so, obviously now, we are not really — we are also a huge target, right? That to get all the — because there’s no cure, then we’re so hopeful that they want protocol that a diet is going to cure us. 

So, I want to highlight a few of them. So, some people say, “Oh, a carnivore diet cures our immune diseases.” Okay. So, when we just talked about the benefits of having more diversity and plants to improve our gut microbiome and potentially reduce inflammation. So, we just go for a carnivore diet. You are removing grains, legumes, nuts, and seeds and so many others that really contradicts the benefits of a plant-based diet. You’re also, in the long run, we’re going to have a higher intake of saturated fats, which is, there is strong evidence suggesting that it does increase inflammation and also increases the risk of cardiovascular disease.

[00:56:11] Cheryl:
Oh, and can I say the word I remembered? Atherosclerosis. That’s where you get the plaques and it occurs when fat cholesterol and other substances build up in the walls of the arteries forming plaque. That’s the one I was trying to remember. Sorry.

[00:56:25] Cristina:
And actually, that’s very fitting because that’s what the carnivore diet is going to lead to if you consume all these extra saturated fats, right? 

[00:56:32] Cheryl:
That’s what made me think of it. I was like, oh, yeah, I remember the word. 

[00:56:37] Cristina:
The other one is a gluten-free diets for all, right? And it’s very clear that a gluten-free diet, it is the only treatment for individuals with celiac disease. That’s very clear. But then, we need to really assess them for such thing that is a non-celiac gluten/wheat sensitivity that we have, but we are still struggling to diagnose that, right? And there are people who do respond to maybe a low-gluten diet or a gluten-free diet. But before going into that, please make sure that you get that — at least rule out the celiac disease because that’s another autoimmune disease and then we know, we are known to collect autoimmune diseases. So, before you do that, make sure that you get that ruled out. 

There was something very interesting though when I was preparing for a webinar that I did for the Arthritis Society of Canada on Gluten and Arthritis. There was a review of case reports from Spain that suggested that individuals with fibromyalgia and spondyloarthritis who have experienced fatigue, oral candidiasis, or oral yeast, GI or gastrointestinal symptoms, iron deficiency, anemia, and in relative with celiac disease actually benefit from a gluten-free diet, which I thought that was quite interesting. But it was like a summary when they had all these conditions. They said, well, okay, maybe a gluten-free diet will work for you. And it’s also, the literature also tells that Sjögren’s disease have a higher prevalence of non-celiac gluten/wheat sensitivity and also Celiac disease compared to the general population, and even compared to other individuals with other rheumatic diseases. And that’s why it’s so important to have to register a dietitian to break that down for you and then you just don’t go in a rabbit hole.

[00:58:34] Cheryl:
Yeah. I really agree with that. And I think there’s also a difference between a dietary change that you might just, through your own trial and error, discover. Like, “Oh, when I eat,” as people tell me sometimes, “When I eat gluten, I feel joint pain or swelling afterwards.” That’s helpful information for your body and even if you don’t actually have, it’s not really doing a bunch of horrible things to you on like the cellular level or to your disease to eat gluten. If you feel better when you don’t, there’s no reason not to, but there are many people who don’t have that experience. Like, I personally, I went gluten-free to help with my GI motility, and I was hopeful it would also help with my RA. It had, like, literally no effect. 

And so, just, like, know that it’s not — it’s weird that people focus, in my opinion, the evidence is so much smaller than people’s focus on gluten. And I think my assessment is that it’s just because, again, we’re driven towards finding something we can control. If it works for you, it’s great. But if not, then you don’t need to. There’s nothing inherently ‘unhealthy’, quote unquote, or ‘inflammatory’, quote unquote, about gluten. That’s across the board for everyone. It’s just individual bodies respond differently. That’s my opinion.

[00:59:50] Cristina:
Oh, and have you heard how people say, “Oh, but I traveled to Europe and Italy and I ate, like, I ate gluten there and it didn’t affect me.” And so, it’s about, so some of the dietitians started talking about these gluten kind of dilemma in some of the patients. And I said, well, okay. So, in Canada, like Canada is like one of the major producers of wheat in the world. And, but one thing that’s interesting is there are two types of gluten. So, we have the soft gluten. So, there’s like the wheat that contains maybe less gluten. And then, we have the hard gluten, which is kind of preferred for pastas and all that. Apparently in Europe, they tend to use more soft gluten. It doesn’t mean that it doesn’t have gluten; it’s still there. But isn’t it when you go to Italy, you just go to relax, to take your mind off work, and then you — but they’re like, “No, it’s the food,” and it’s like, no, maybe you’re just in a different state of mind that is helping just to reduce inflammation overall from what you’re doing, right? So, it’s just that correlation that we’re talking about. “Oh, no, it’s the gluten.” It’s like, no, it’s everything else.

[01:00:59] Cheryl:
It reminds me of also like, I was talking to Dr. Yu about this once and I was like, it’s mind boggling to me sometimes how there are so many different diets that work for different individuals and they seem opposites in my head. Like, vegan for one and carnivore for the other. And then, he said, “Well, interestingly, there is a similarity between those.” And I was like, really? Because this was like five years ago or four years ago. And he’s like, well, they both, it’s what are they both cutting out? Like, they’re both cutting out highly processed foods and they’re more both more straight up whole foods in a way. If you consider meat, this is like a whole food. And I was like, oh, that’s so interesting. 

Sometimes it’s not what it is that you are eating. It’s what you’re not. You’re avoiding the pro-anti — or pro-carnivore is not recommended for RA, or for just overall heart health, or just anyone, unless you just — yeah, but it’s just interesting. Like, when you’re trying to detective, do that detective work to figure out what, why does this make sense? It’s not just what you are eating. It’s what you’re not. So, sorry. So, you have carnivore, the myths about carnivore, myths about gluten.

[01:02:04] Cristina:
I want to share this one because I just couldn’t tape my mouth. One of my clients wanted to work with a dietitian and she asked for a referral to a doctor because I want to see a dietitian because I’m having a lot of gastrointestinal issues, diabetes, and the doctor told her, “A dietitian is only for fat people.” And it, literally, that’s how she was told. 

[01:02:25] Cheryl:
Oh, my gosh. I’ve never heard that. 

[01:02:28] Cristina:
Yeah, I was, I couldn’t believe it. And then, so I remember saying, “Hey. Well, Sjögren’s, for instance, and compared to other rheumatic diseases, can actually affect your entire gastrointestinal tract from gum to bum.” That’s how I say it. And so, a dietician can help provide guidance on diet modifications to ease that discomfort related to dry mouth, chewing and swallowing difficulties. It helps to help you with a heartburn, gastroparesis, right, the chronic constipation or diarrhea, and also develop strategies to prevent unexplained weight loss that actually happens in children. So, there’s a lot of weight loss and nutritional deficiencies. And so, that’s why it’s such a huge advocate for individuals with Sjögren’s because it really goes beyond the dryness. And this is how I told her to respond to that doctor. I said, no, a dietitian is more than the weight loss. And initially I said I didn’t want to work with weight loss and obesity because it’s almost like a stigma that is attached to dietitians that it only works for people for weight loss.

[01:03:39] Cheryl:
That’s so important. It’s almost like it almost reminds me of, like, a misconception I had which is I actually thought, before I went to mental health therapy, that therapists are only for people with, like, extreme, extremely — what would you call them — like, very severe mental illnesses, versus I didn’t think I could just get help with anxiety. In my head, I’m like, but it’s not like I’m leaving the house, it’s not like I have severe OCD or something. And it’s like, sometimes it’s hard to remind yourself that these resources are for anyone who’s struggling, and it’s up to the provider, like, whether it’s a mental health provider, they’re not allowed to like charge insurance for just like seeing people who don’t have any sort of issues at all. But there’s a huge spectrum. Anyway, but this is this has been so, so helpful. And I have a couple rapid fire questions. I’m not going to ask all of them. Do you have time for a few? 

[01:03:39] Cristina:
Yeah, I have it. 

[01:03:40] Cheryl:
Okay. Okay, perfect. So, I think this is so chock full of helpful information. So, I really, really appreciate it. What are your just overall — whether it’s about nutrition or just basics — what is your best advice or words of wisdom to somebody who might be newly diagnosed with either rheumatoid arthritis or Sjögren’s disease, like, today?

[01:05:04] Cristina:
I acknowledge that being diagnosed with a rheumatic disease is incredibly challenging and life changing. However, compared to 20 years ago, there is now greater awareness, more advanced therapies, and stronger support systems available. So, it is very, it’s essential to remain vigilant and avoid individuals who promise miracle cures. I think that’s what it is, that we need to really go and hold on to what is the evidence holding to support systems. I just said the support groups that you run, which is amazing because you know that you are providing evidence-based information. And then, because that’s your motto, that’s what patients are expecting from your support group. 

[01:05:58] Cheryl:
Right, right.

[01:06:00] Cristina:
So, this is what I see. Don’t let — because some kind of cure, someone promising a cure, is gonna get you to damage your joints, your organs. It’s not worth it, because then it will be very difficult to correct that.

[01:06:17] Cheryl:
Yeah. And one thing we’ve all talked about before is like it and the importance of a both/and versus an either or when it comes to Western medicine and complementary or lifestyle interventions. It’s most people who have rheumatoid arthritis statistically require both. With the vast, vast majority, whether you look at the studies that say 80%, whether you look at the studies that say 90%, 95%, there’s different studies depending on how they define things, but the majority of people with rheumatoid arthritis require medication to sustain remission. That’s just a fact. So, having a both/and mindset of, “Okay, I can take medication AND let’s maximize my diet,” see whether maybe a realistic goal instead of being like a medication-free remission, could be reducing medications or going from two to one that’s something that a lot is more achievable than saying, “I’m just going to only control this with nutrition and lifestyle.” 

And that’s just, you know, and I’m saying I have — I actually have a vested interest in people doing the non-medicinal things because I’m not a doctor. I don’t have any skin in the game in terms of me. And I’m saying this as somebody who it would be a better business thing for me to say, “All you have to do is take Rheum to THRIVE and I’m going to teach you all the stuff so you can get off of all those scary medicines.” Yeah, but like, and you’re the same as a dietitian, you’d be like, “Oh, you just need to do diet. And I’m going to teach you that.” And that’s an easier selling proposition, but we’re like ethically bound to saying ‘No’, not just as providers, but as patients, you know? 

[01:07:47] Cristina:
And we know it doesn’t work. Like, why am I going to — I don’t have the face to tell you, “Yes, you have to follow this diet and you’ll be cured.” I can’t say it. My heart doesn’t allow me to do that. Otherwise, I’ll be rich. I think I’ll have been rich by now, but I just can’t, Cheryl.

[01:08:03] Cheryl:
I can’t. I don’t want to put anyone on blast, but I do get so many inquiries of people trying to get on to the podcast to share their miracle thing. And I’m like, you obviously haven’t listened to like a single episode. But anyway, do you have a favorite quote or inspirational saying for tough days? 

[01:08:21] Cristina:
Well, I’ll tell you when it comes to mental health — and I spend a lot of time, so I have my little mental health kind of journal. And whenever I have a quote, then I put it. So, I just opened it a random one, and I found a really cool and a really interesting one. So, it’s, “Replace self-criticism with self-awareness and great commitment. Could I give up my addiction to suffering?”

[01:08:44] Cheryl:
Oh, that’s thought provoking.

[01:08:50] Cristina:
Yeah. It’s, is it that we have that sensation that, okay, I just, I’m in pain. I want to be in pain. Or maybe because I’m in pain, I have everybody’s attention. Or maybe I’m, I don’t know. There was just something about that that really got me.

[01:09:07] Cheryl:
That’s awesome. Thank you for sharing. Do you have a favorite arthritis gadget or tool in your toolbox, physical or metaphorical?

[01:09:15] Cristina:
Oh, it really depends on what is going on. Like, right now, I’m relying on my resting splints and everything has been a lot of pain with my wrist. And also, a reminder to use my finger — 

[01:09:30] Cheryl:
Silver rings splints?

[01:09:32] Cristina:
Ring splints, and all the plastic, whatever. I think it’s a reminder that sometimes I feel comfortable that living like this, but it’s that I have to remind myself that I need to also make sure that my joints remain functional. So, I can survive, you know, work.

[01:09:53] Cheryl:
Yeah, and if you’re wondering how do you even know, like, which kind of splint might be right for you, then you can ask your doctor for a referral to a certified hand therapist, which is usually an occupational therapist, sometimes a physical therapist with advanced training in the hand. And they could fit you for them and recommend what might work best for your body. So, that’s so it’s helpful. Do you have a favorite book or movie or show you’ve consumed recently?

[01:10:20] Cristina:
Oh, I was so happy to finally see adapted my favorite book into a mini-series on Netflix, ‘100 Years of Solitude’. It was by Gabrielle Garcia Marquez. It was so beautiful to see. It was completely shot in Colombia with all Colombian actors and Spanish, all the fabrics, everything was made in Colombia. And that’s what the author wanted, Gabriel Garcia Marquez, he said that, “I don’t want my book to be made into a movie,” and he didn’t want it, but somehow the sons managed to say, “Well, it has to be in Spanish, it has to be in Colombia, and it has to be with Colombian actors.” And I think they did a beautiful, beautiful job doing that. And so, I’m very happy. I was very happy to see that.

[01:11:13] Cheryl:
That’s awesome. Okay. I’m going to check that out. And last question, what does it mean to you to live a good life and thrive with autoimmune disease or RA?

[01:11:24] Cristina:
You know, I thought about that and I came out with five C’s. So, I have Commitment, Consistency, Compassion, Courage, and Credibility. Probably doesn’t fit in there, but the way I like them are, like, that is a commitment. It’s because when you are diagnosed, you truly need to be committed to life changes. So, be it a lifestyle, be it a treatment, but you need to be committed to that, to make that conscious decision that’s going to make me feel better. 

Consistent, because you need that consistency. If you stop your treatment, you’re gonna feel pain. That’s about it. If you make a lifestyle change, if you want to make changes to your diet, you need to be consistent in those habits to really see positive outcomes. 

Compassion is because we live with an unpredictable disease. And the only certain thing about living with autoimmune diseases is the uncertainty. That’s the only thing that is certain. So, when the treatment fails you, maybe that lifestyle that you maybe embarked on or changed is not working, take your time and treat yourself with compassion because it’s not your fault. 

But then, you also need to have courage because it’s so unpredictable and many times you’re going to feel that the treatment fails you and you kind of go back to ground zero; you don’t want to do anything. And it’s actually harder when you have felt maybe well for two or three years and then all of a sudden, a flare hits you. The treatment is not working for you. And you’re just feeling all these things; anger and disappointment. It takes a lot of courage to say, “Okay, I’m going to recommit, I’m going to try this treatment, and I’m going to give myself another chance.” 

And when it comes to credibility is that you want to go back for reliable sources and reliable information. You’ll want to collaborate with your team, starting with your rheumatologist, and then build that dream team that is going to help you. The occupational therapist, physiotherapist, registered dietitian, mental health therapist; it’s built according to your needs. So, those are my five C’s. Commitment, Consistency, Compassion, Courage, and Credibility.

[01:14:02] Cheryl:
I love that so much. I’m like a sucker for like an acronym or an alliteration. And I’m, my name is Cheryl Crow. C.C. is my initials. So, I’m like, I love it. Keep going. Let’s do the 10 C’s. No, that’s so great. Thank you. That’s so thoughtful. You know, I know we have so much more to talk about. We’ll probably, we were just talking about maybe doing a panel discussion at a different date, a panel episode on maybe obesity. ‘Cause there’s a lot of, just like nutrition, there’s a lot of myths versus fact for, that. But for today, if people are looking to find you online, where should they go? 

[01:14:41] Cristina:
So, yeah, you can go to my website, arthritisdietitian.com. You can find me on Instagram at @ArthritisDietitian, pretty much everywhere as Arthritis Dietitian. If you’re looking for connecting with me in Spanish, I’m doing that more in on TikTok at @ArthritisDietitian as well. But you also can find out any of my collaborations with Arthritis Society Canada at arthritis.ca. And I also love some work for the Children’s Society of Canada, and that’s where you can find me.

[01:15:15] Cheryl:
Well, and I should say, because I am — really have interesting spelling techniques, that dietician is spelled, ‘Arthritis Dietitian’, we know how to spell ‘Arthritis’, but D-I-E-T-I-T-I-A-N. I usually put a C there. Don’t put a C there. There’s no C in dietitian. So. 

[01:15:33] Cristina:
At least from Canada and England. 

[01:15:36] Cheryl:
Okay. I get confused. Okay. Maybe that’s why I get confused. But thank you so much. This has really been helpful. I always learn something or many somethings when I talk to you. And I hope everyone follows Cristina. Get on her email newsletter list. I always read what she’s sending, tons of helpful stuff. And we’ll say bye-bye for now. Thank you so much for taking the time to chat with me today. We’ll talk to you later. Bye!

[01:16:04] Cristina:
Bye-bye.

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