DISCLAIMER
BUS does not officially recommend or endorse any particular dietary, alternative or complementary treatments or exercise regimes.
No claims for health benefits are intended or implied in the contents of the diet, exercise, sleep, supplements, vitamins and minerals sections of the BUS website.
Alternative dietary regimes and strategies should not be used instead of your prescribed medication and your regular eye clinic checks.
Always consult your doctors before starting any new dietary or lifestyle regime.
Diet
Wanting to help yourself
We each arrive at our birdshot diagnosis with our own set of health beliefs and past experiences of healthcare. For many of us, this is the first time we have been faced with taking long-term medications with their accompanying side-effects. Your mind is in a whirl from the shock of diagnosis and discussion of treatments. Importantly, you want to know if there is an alternative, more ‘natural’ way of treating your birdshot and supporting your body throughout your treatment, and so your desperate search for information begins.
Birdshot is an autoimmune, inflammatory disease. There has been a great deal of interest in recent years about the effects of diet on autoimmune and inflammatory diseases. Certain foods are thought to worsen inflammation and other foods are thought to be anti-inflammatory. However, you will soon find in your searches that there is a large amount of contradictory information out there on how to make your diet less inflammatory.
Also, the stark fact is that although much is claimed for the huge numbers of anti-inflammatory and autoimmune dietary and lifestyle diets, regimes and protocols, bear in mind that every person’s body is slightly different. There is no guarantee that any dietary regime will help your birdshot, though making your diet healthier should bring you general health benefits.
The information provided here is offered as a guide to get you started on making dietary changes that may improve your health.
What are the problems?
- It is very difficult to assess the quality and effectiveness of any particular anti-inflammatory or autoimmune dietary regime or protocol
- This is because evidence of benefits from dietary regimes is gathered from many anecdotal reports or from collections of single cases, rather than from controlled studies
- Also, simply because a particular dietary approach may have helped a person with a certain inflammatory or autoimmune condition does not it mean it may help someone with another inflammatory or autoimmune condition, particularly a rare one like birdshot
What to look for
- Look carefully at the qualifications of the diet promoter. What training do they have in nutrition? Some diet promoters have no formal nutrition qualifications. Find advice that comes from nationally accredited and registered diet professionals
- What are you being asked to do? Many alternative dietary and lifestyle regimes are very restrictive, so they are likely to become unsustainable in the long term. Many incorporate ingredients that may be expensive or hard to find in your country. Many are unbalanced in their nutritional composition because they cut out whole food groups
- Diet promoters want to sell their books and other products, and they can be very persuasive sellers. They aim their products at people who are vulnerable, often newly diagnosed with an autoimmune condition, and who are desperately searching for remedies for their health problem
- Be particularly wary of diet promoters who sell their own, usually expensive, brands of foods or supplements. They want your money and will work very hard to obtain your custom. Some may ask you to promote or sell their products to your friends
- Be careful of reviews on popular shopping websites. Check that the reviews actually come from verified purchasers. Consider using one of the many review-checking websites like https://reviewmeta.com
’Further information’ and ‘Websites’ at the end of this Diet section will lead you to more details on foods.
Getting started
- Nearly all dietary regimes and protocols have at their heart two basic principles: remove and replace
-
- remove junk, sugary, fatty, fast and ultra-processed foods from your daily diet – all the foods we already know we should avoid
- replace them with more fresh foods, particularly vegetables, fruits and high fibre versions of food
- Look carefully at everything you eat now
- Read the labels of the foods you buy. If the ingredients listed on the label have long chemical names and aren’t ingredients you might have in your kitchen cupboards, that food counts as ‘ultra-processed.’ Choose a different product that doesn’t contain unfamiliar ingredients
- Do your own cooking whenever possible, so you know what’s in your food and how it’s been cooked. Steam or lightly boil vegetables. Bake or cook potatoes in their skins to help retain their vitamin B6 and C content
- Buy the best ingredients you can afford
- Try to ‘eat a rainbow’ of different-coloured vegetables and fruits each day
Some key points
Sugar
- Sucrose, glucose and fructose are three members of the sugars family. They are found naturally in fruits, vegetables and other foods, but they are also added to many processed foods. A surprising number of these foods are not generally considered to be ‘sweet’ foods. Read the labels
- Sucrose is the scientific name for table sugar, which is produced from sugar beet or sugar cane. Sucrose consists of one molecule of glucose and one molecule of fructose
- Sugar (sucrose) is thought to increase inflammation in the body
- Honey, maple syrup, coconut sugar and many other sweet or sugar substitute products also count as sugar, so don’t swap to those, nor swap to artificial sweeteners
- Many ‘low-fat’ products, including dairy products like low-fat yogurt, contain high levels of sugar added as a preservative
- As well as being better for your general health, removing or reducing your intake of sugary foods and refined carbohydrates, like cakes, pastries, biscuits/cookies and confectionery/candy from your diet, may help you control your weight and also may help reduce your chances of developing type 2 diabetes, especially if you are taking oral steroids like prednisolone/prednisone
Dairy products
- Dairy products have health benefits. They are a source of protein and of several vitamins, including vitamins A, B12, D, E and K, and minerals, including calcium
- Although dairy products that have a high fat content, like full-fat cheese, butter and cream, are probably best consumed only occasionally and in small quantities, deciding to eliminate dairy products from your diet should be done with caution
- You need a source of calcium in your daily diet, particularly for your bone health. This is especially important if you are taking oral steroids like prednisolone/prednisone which can affect your bones
- If you do decide to reduce or eliminate dairy products, ensure you have a good daily intake of calcium by increasing your intake of calcium-rich foods such as
-
- Almonds
- Baked beans
- Chickpeas/garbanzo beans
- Figs
- Green leafy vegetables
- Tinned/canned salmon and sardines (eat the bones)
- Tofu (choose ‘calcium-set’ varieties – read the labels)
- Check that any non-dairy milks you buy are fortified with calcium, and also check their labels for added sugar (sucrose) content – choose products with the least amount of added sugar
Salt
- We all need a small amount of salt (sodium chloride) in our diet to help with many essential body functions. These include fluid balance, transmission of nerve impulses, nutrient absorption and muscle function. However, too much salt is harmful to health
- If you are taking oral steroids like prednisolone/prednisone, try to reduce your salt intake. Salt in foods contributes to the water retention and bloating that can happen with oral steroids
- Tinned/canned and processed foods often contain high amounts of salt to preserve the food. Read the labels and check for sodium content
- Other high-salt foods include soy sauce, stock cubes, cooked meats, pickled or fermented foods like pickled cucumbers, kimchi and sauerkraut, potato crisps/potato chips and other salty snacks
- Try using herbs and spices to flavour your food instead of adding salt
Further information
Audio-visual presentation on birdshot uveitis and nutrition
This presentation was given by Victoria Makepeace-Warne at a London, UK, meeting organised by the Birdshot Uveitis Society in August 2016.
Victoria is a UK qualified and registered nutrition specialist who has birdshot.
(The meeting was held on a Thames sailing barge moored near London City Airport, hence the occasional background noise in the recording).
Websites
www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
https://www.bbcgoodfood.com/howto/guide/why-are-mediterranean-diets-so-healthy
https://patient.info/news-and-features/does-my-diet-really-affect-my-immune-system
Prepared February 2024
Supplements
Important:
- Aim to get your nutrients from your food rather than from supplements
- Just because a supplement is felt to have possible benefits in one particular eye condition, this does not mean it may have possible benefits in birdshot
- Before choosing any herbal/botanical/dietary supplements, check with your healthcare providers that they do not interact with any of your prescribed medicines. ‘Natural’ does not mean ‘safe’
- At the end of the Medicines interactions Q&As you will find links to websites that include information on interactions between herbal/botanical/dietary supplements and prescribed medicines
- Always tell your doctors about all herbal/botanical/dietary supplements you take
Here are some supplements tried by people with birdshot:
Aloe vera juice, biotin (for hair health or hair thinning from taking medication), CoQ10, lutein, omega-3 (consider taking an omega-3 supplement if you are not eating oily fish), probiotics, resveratrol, tart cherry juice, turmeric, zinc.
Prepared February 2024
Vitamins and minerals
Ideally, a balanced diet including fresh ingredients should provide you with the vitamins, minerals and trace elements needed for good health. However, you may have a need for certain vitamins, minerals and supplements, either because of your general health and lifestyle or because of the effects of the medicines you take for your birdshot.
Here are two vitamins and two minerals that may need to be checked by your doctor and supplementation recommended if necessary.
Vitamin D
- Vitamin D helps regulate the amount of calcium and phosphate in the body. Together, these nutrients help to keep bones, teeth and muscles healthy
- Bone health can be adversely affected by taking oral corticosteroids like prednisolone/prednisone. You may already have had calcium and vitamin D tablets prescribed by your eye team if you are taking prednisolone/prednisone – if not, ask about this
- Many people in Northern latitudes have low vitamin D levels because of their lack of sun exposure, and this is not helped by having to use sunscreens to protect your skin from sun damage if you are taking immunosuppressants
- As a useful precaution, ask at your GP practice for your vitamin D levels to be checked, and if supplementation is recommended, get medical advice on the correct dose for you to take
- Caution: check the vitamin D content of any supplements you are already taking, because taking too much vitamin D can cause health problems
Vitamin B12
- If you are taking a stomach-protecting medicine long-term from the group of medicines known as proton pump inhibitors (PPIs), like omeprazole or lansoprazole, this may cause your vitamin B12 levels to drop
- It could be wise to ask for an occasional vitamin B12 blood test to check this, particularly if you are following a vegetarian or vegan diet, or not eating much red meat, fish, milk, cheese or eggs (the main dietary sources of vitamin B12)
- If your vitamin B12 levels are found to be low, check with your doctor on the amount of vitamin B12 you need to take
Calcium
- You may already be taking a calcium and vitamin D supplement if you are on oral corticosteroid treatment (see vitamin D above)
- Calcium and vitamin D are both needed for bone health, so get medical advice and a check on your calcium levels if you are not sure about your calcium intake
- If you have eliminated dairy products from your diet, your daily calcium intake needs attention by including more calcium-rich foods such as:
-
- Almonds
- Baked beans
- Chickpeas/garbanzo beans
- Figs
- Green leafy vegetables
- Tinned/canned salmon and sardines (eat the bones)
- Tofu (choose ‘calcium-set’ varieties – read the labels)
- Check that any non-dairy milks you buy are fortified with calcium, and also check their labels for added sugar content – choose products with the least amount of added sugar (sucrose)
Magnesium
- Like calcium, magnesium is involved in bone health, but blood levels of magnesium are often not routinely measured
- Levels of magnesium can be lowered by several medicines, including stomach-protecting proton pump inhibitors (PPIs) like omeprazole and lansoprazole, oral corticosteroids, the immunosuppressants ciclosporin and tacrolimus, and other medicines such as statins, diuretics (water tablets) and some medicines that lower blood pressure
- If you are taking any of these medicines, it is worth asking for your blood magnesium levels to be checked in case you need to take a magnesium supplement
Prepared February 2024