Q&A: DIET, ARTHRITIS, & AUTOIMMUNE DISEASES
Dear Dr. Klaper:
“Could what I eat be making my arthritis worse? Is there any kind of diet or supplement that might help my joint pain?”
Yet, it has long been known that many factors can affect arthritis – physical activity, emotions, even the weather. However, prevailing medical thought still holds that food has little or no effect upon joint pain. The diet-arthritis connection is often disdainfully dismissed as “unscientific” or as “magical thinking.” Fortunately for the millions who suffer from arthritic pain, recent medical studies indicate that relief can be as close as their dinner plate.
Numerous articles published in prominent medical journals confirm what I have witnessed for years in my medical practice: many people with rheumatoid arthritis and other forms of inflammatory joint disease really ARE reacting to substances in their food (1). The studies also demonstrate that identification and elimination of the offending foods – a therapy completely free of cost and risk – often provides dramatic improvement, or even complete remission of joint pain and disability.
Why are physicians so reluctant to consider the possible connections between painful joints and what the owner of the joints has been eating for breakfast, lunch and dinner? A major reason is that in medical school, most physicians-to-be learn that fragments of food proteins are simply too large to be absorbed from the intestine into the bloodstream, and thus cannot be involved in inflammatory reactions in distant organs, like the joints.
Consequently, the patient’s diet as a causative factor is usually discounted and instead, powerful (and expensive) anti-inflammatory medications are prescribed as the foundation of therapy. Both physician and patient can then settle for mere suppression of inflammatory symptoms while overlooking a possibly treatable cause that may be as close as the patient’s dinner plate. This “relief” can often inflict severe side effects, such as intestinal bleeding, inflammation of the liver, depression of bone marrow function (where new blood is made) and, of great concern, injury to the wall of the intestine. Why is this important?
IS YOUR GUT LEAKY?
Ignoring the effect of the diet of the patient with inflammatory arthritis is scientifically short-sighted; it is now clear that in most people with these conditions, fragments of protein from foods and from organisms living in the gut certainly DO leak into the bloodstream after most every meal. In reaction to these foreign substances, antibodies in the blood are commonly produced against components of egg protein, chicken protein, milk protein, and wheat protein within hours after eating these foods.
This phenomenon of the “leaky gut” is present in everyone to some degree, but is far more pronounced in those whose intestinal walls are inflamed for any reason, such as in people with chronic parasite infestation, diarrhea of bacterial or viral origin, inflammation of the large intestine (colitis) or small intestine (enteritis or Crohn’s disease,) as well as in many allergic/atopic conditions, like asthma and eczema.
Non-steroidal anti-inflammatory drugs (NSAIDS), including ibuprofen (Advil) and naproxen (Aleve) can injure the intestinal wall directly (more about those later) and, ironically, contribute to the gut inflammation they are taken to treat!
Our food choices can injure our gut lining directly by their physical or chemical properties (fatty, acidic, nutrient poor, etc.) but also indirectly by unbalancing the micro-biome – the trillions of microbes that live in the mucus layer lining our intestine and form part of the functional barrier of our gut.
Fatty foods, especially saturated fats, reduce bacterial populations while high-meat diets spawn bacteria that can tolerate lots of bile in the intestine – and promote DNA damage and cancer growth (2).
People drink chlorinated drinking water, sodas with phosphoric acid, coffee, black and herbal teas and, of course, alcohol in wine, beer and other drinks – all of which kill beneficial bacteria!
Foods are sprayed with pesticides that alter the bacterial balance and most commercial flesh foods contain residues of antibiotics fed to the animals, which then concentrate in their tissues.
And of course, people often go to their doctor with a viral cold and ask for a prescription for antibiotics, “just in case” which inevitably unbalances the micro-biome – NOT a good idea!
All these agents and actions can reduce the numbers of beneficial organisms in the gut lining. This allows more unfriendly, harmful microbes to “set up housekeeping” in the mucus layer – which then proceed to injure the integrity of the intestinal wall. This makes the gut more permeable (“leaky”) to molecules that should never enter the bloodstream – and this is just what happens.
Once in the bloodstream, these small fragments of foreign proteins can lodge in sensitive tissues – like the delicate synovial membranes that line the joints. There, they can incite significant reactions, ranging from subtle but uncomfortable inflammation of connective fibers to hot, painful swelling and distention of the joints, as in acute rheumatoid arthritis.
Chronic inflammation of the joints – or any tissue – over the years can result in tissue scarring, contracture, loss of function and ultimately, destruction of the joint. Many other organs in the body – heart, lung, eye, kidney, muscle – can also suffer damage from repeated inflammation: failing “rheumatoid heart,” fibrous “rheumatoid lung,” bleeding kidneys in lupus nephritis, etc.
Chronic inflammation is energetically expensive and ultimately harmful for the body to sustain – yet, our Standard American Diet(“SAD”) diet filled with daily deluges of meats, dairy products, processed foods, concentrated sugars, preservatives, colorings, flavorings and other chemicals may foster that very process.
So, the various kinds of joint inflammations, including some forms of rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and others, may, indeed, have nutritional components and may greatly improve when offending foods are eliminated from the diet and other measures taken.
Not surprisingly, other inflammatory conditions including asthma, psoriasis, eczema, and related disorders also can involve the so-called “leaky gut syndrome,” and so, too, frequently respond to the same therapies outlined below.
THE MOST LIKELY CULPRITS
Almost any protein or other food substance can set off adverse reactions in the joints; however, in my clinical experience, the foods most likely to trigger joint inflammation are (in order):
1. Milk proteins (especially casein and lactalbumin) in dairy products – including whey, buttermilk solids, skim milk solids, “calcium caseinate,” “sodium caseinate,” all milk-derived cheeses, yogurt, ice cream, chocolate, etc.
2. Chicken protein – including the “light meat” and “dark meat,” as well as egg whites.
3. Wheat protein – including breads, pastas, wheat cereals, etc.
4. Beef and other red meats.
5. Soy protein – including tofu, tempeh, etc. including meat analogues, which often contain soy and wheat proteins.
6. Corn protein.
7. and, to a MUCH lesser extent, “Nightshade” vegetables – tomatoes, (white) potatoes, eggplants, green (bell) peppers. These four plants all contain anmolecule called solanum that, in a small number of people, may cause inflammation in the tissues – hence the shady reputation of these otherwise nutritious foods.
In my experience, less than 10% of people with an autoimmune disease have any problem when they eat any of the above nightshade foods.
I find that after 4 – 6 months, when most or all of the inflammatory symptoms have subsided, the above four can be introduced back into the diet, one at a time, in the manner suggested below, assuming the person desires to eat them.
The following food plan will fully nourish your body while helping to you identify problem foods.
“THE BASELINE SAFETY DIET”
Note: The following has been modified to incorporate the very useful analysis and guidelines of Clint Paddison who has been successful in helping thousands of patients with inflammatory arthritis overcome their painful symptoms.
For 2 days, consume only fresh vegetable juice made of celery and cumber only.
From day 2 – 12, reintroduce foods according to the following “Paddison Program” protocol (link opens in a new tab or window):
During this time of diagnosis through dietary simplicity, it is best to minimize confounding factors by keeping seasonings to a minimum, as some spices like cayenne can incite inflammatory reactions in susceptible people.
A “pinch” (1/8 teaspoon) of iodized salt on the surface of vegetables may be permitted – and will go a long way to make these baseline foods more palatable – but be aware that high-salt diets can turn on genes that promote autoimmune processes in the body (3), so, when it comes to added salt, “less is more.”
Also, as the vital element iodine is washing out from our soils, and thus from our foods. If you are going to be using table salt at all, it is wise to use a pinch of iodized salt on your food. (BTW, “sea salt” does not contain significant iodine – like chlorine and fluorine, its fellow halogens in the periodic table, iodine evaporates with heat – and the hot sun used to dry the sea salt drives the iodine into the air. Iodized sea salts are available.)
After the inflammation has been improved to the maximal extent on this food program, “new” seasonings can be re-introduced, one at a time, as described below. One of the benefits gained through this is increased appreciation for the natural taste of fresh fruits, vegetables and other whole foods.
After following this regimen, many, if not most, people will find their joints much improved or completely free of pain and stiffness, perhaps for the first time in years.
Beneficial fats have a role here:
“Omega-3” fatty acids can exert an anti-inflammatory effect in rheumatoid arthritis and autoimmune diseases. Ample (1 – 2 cup) helpings of dark leafy greens should be consumed daily, as should a small handful of walnuts, either as whole nuts or blended into dressings and sauces.
One to two tablespoons of fresh ground flax, chia, and hemp seeds should be eaten daily sprinkled on cereals salads or soups (4).
DHA/EPA supplements derived from algae (as opposed to fish oil (5) can be purchased online and in natural food stores; 300 mg of algae-derived DHA with approximately 180 mg – 300 mg EPA is appropriate.
GLA (gamma-linolenic acid) is an “omega 6″ fatty acid from which the body makes a potent, natural anti-inflammatory substance, prostaglandin E-1, which complements the omega-3 lipids and can be very useful in inflammatory diseases (6). 300 mg of black current seed oil daily will supply a sufficient amount of GLA to help reduce inflammation.
GUT LINING REPAIR
The “leaky gut” can be made less permeable by:
a) stopping any ongoing injury to the intestinal wall or flora – alcohol, soft drinks, coffee, most teas, chlorinated drinking water, unnecessary antibiotics, etc., as well as,
b) addition of the following supplements for 90 days – all help restore normal tissue integrity and balance of intestinal micro-flora. The supplements below can be ordered online or found at natural food stores:
– L-glutamine: 650 mg. – 1000 mg. twice daily, q to one hour before meals
– Quercetin: 650 mg. – 1000 mg. twice daily, 1/2 to one hour before meals
– Probiotic (non-dairy): 1/2 – 1 teaspoon of powder or 2 tablets 1 hour before meals or 1 hour before bed. (See my article, “Probiotic Principles”.)
Incidentally, the gut is made more leaky by non-steroidal anti-inflammatory drugs, such as ibuprofen, and similar substances. Aspirin is does so to a much lesser degree (7) and nabumetone (Relefen) is reported not to increase intestinal permeability, though I have often been disappointed in nabumetone’s pain-relieving powers. Still, those two agents are worth a try if pain levels are high and the action of an NSAID is sought (8).
Assuming a favorable joint response to the above diet and supplement program, “new” test foods (really, the foods previously eaten) can be added back into the diet as desired, in a controlled manner:
(a) one food at a time,
(b) every 48 (preferably 72) hours (to allow sufficient time for any possible reaction),
(c) while keeping a careful food diary.
Your “food diary” can be a sheet of paper with a vertical line down the middle. Record on the left “Safe Foods,” that do not adversely affect the joints, and in the right column, the “Try Again in 6 – 12 Months Foods,” if they make the joints react in any adverse way.
In this diary, record each new food introduced, the time and date eaten, and very importantly, how the joints feel several hours later, on the following day, and on the day after that.
The joints usually “speak” quite clearly – with pain, redness, warmth, swelling, and/or stiffness – usually within 48 hours of eating an offending food. But, just a subtle increase in stiffness, pain, malaise or any other sign of imbalance should be taken as reason to not eat that food again for 6 to 12 months and then re-introduce it and again observe any adverse reaction.
Over several weeks, adding a new “test” food every 3 days, the diet is reconstructed using only the “Safe Foods” demonstrated not to inflame the joints.
Any (and all) meats, dairy products, and other animal-based foods, as well as any individual grain, legume, fruit or vegetable can be eliminated without fear of deficiency of protein, calcium, or other nutrients.
“Nutritional insurance” during this time can be provided by twice-weekly (NOT daily) high-potency multivitamin and mineral supplements, containing at least 100 mcg. of Vitamin B-12 (methylcobalamin), as well as the U.S. Recommended Daily Allowance amounts of zinc, copper and other trace minerals.
If wheat or other plant protein is found to cause adverse reactions, there are breads, pastas and cereals made of rice, oats, barley, soy, buckwheat, spelt, kamut, and other non-wheat grains, that are widely available at natural food stores.
Test each of these new foods individually, by introducing them separately at 48-hour intervals, to assure that they create no adverse effects in the body.
Complete food programs can be found in Clint Paddison’s excellent program.
Helpful guidance can also be found in, “The Lupus Recovery Diet: A Natural Approach to Autoimmune Disease That Really Works,” by Jill Harrington.
Such simple, but effective food strategies like those above can often produce dramatic improvements – and even complete resolution of inflammatory arthritis and other autoimmune diseases.
Yet, even with the strategies described above, some people experience severe or repeated flare-ups of their inflammatory or autoimmune disease. I feel that if the joints, kidneys or other vital structures are at risk from these destructive inflammatory processes – and the diet and supplement maneuvers described above are not sufficiently effective – then I feel it is appropriate to use potent pharmaceutical agents, such as the new “biological” agents or methotrexate.
However, this is done with the understanding that while the drug is exerting its suppressive effects and giving the person comfort, the dietary and gut-restoration programs presented above are rigorously instituted, so as the medications are gradually tapered off, there is far less chance of precipitating a flare of the inflammation.
No one wants to stay on powerful immune system-depressing medications permanently.
As I have described above, the best chance for eventually getting off those potent, and often toxic drugs lies in Hippocrates’ strategy: “Let food be thy medicine.”
To schedule a private consultation by phone, Skype, FaceTime, or in person, call the TrueNorth Health Center in Santa Rosa, California (about one hour north of San Francisco). The Front Desk at TrueNorth can be reached from 9a – 5p Monday through Saturday, and 12:30p – 4p on Sundays. Phone: 1-707-586-5555.
Yours in health,
Dr. Michael Klaper
AUDIO: Listen to a free 50-minute audio podcast in which I’m interviewed by Clint Paddison about the power of natural healing with a plant-based diet for a broad range of diseases, including Rheumatoid Arthritis.
1) Am J Clin Nutr. 1999 Sep;70(3 Suppl):594S-600S. Rheumatoid arthritis treated with vegetarian diets. Kjeldsen-Kragh J.
Rheumatology 2001;40:1175–1179. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reductionin antibodies to food antigens. I. Hafstro, et.al.
2) “Diet rapidly and reproducibly alters the human gut microbiome.” Nature 505, 559–563 (23 January 2014) doi:10.1038/nature12820
3) “Over-salting ruins the balance of the immune menu.” J Clin Invest. 2015 Oct 20:1-3. doi: 10.1172/JCI84690. (Epub ahead of print) Min B, Fairchild RL. Int J Endocrinol. 2015;2015:312305. doi: 10.1155/2015/312305. Epub 2015 Mar 19. Iodine Supplementation: Usage “with a Grain of Salt”. Prete A, Paragliola RM, Corsello SM.
4) J Clin Biochem Nutr. 2008 Sep; 43(2): 126–128. Published online 2008 Aug 30. doi: 10.3164/jcbn.2008057
PMCID: PMC2533717. Eicosapentaenoic Acid Suppresses the Proliferation of Synoviocytes from Rheumatoid Arthritis, Masahide Hamaguchi.
6) Reed GW, Leung K, Rossetti RG, Vanbuskirk S, Sharp JT; Zurier RB. Treatment of rheumatoid arthritis with marine and botanical oils: an 18-month, randomized, and double-blind trial. Evid Based Complement Alternat Med. 2014;857456.
Remans PH, Sont JK, Wagenaar LW, Wouters-Wesseling W, Zuijderduin WM, et al. “Nutrient supplementation with polyunsaturated fatty acids and micronutrients in rheumatoid arthritis: clinical and biochemical effects.” Eur J Clin Nutr. 2004 Jun;58(6):839-45.
Richardson AJ, Puri BK. The potential role of fatty acids in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2000;63(1/2):79-87.
Simon D, Eng PA, Borelli S, et al. Gamma-linolenic acid levels correlate with clinical efficacy of evening primrose oil in patients with atopic dermatitis. Adv There. 2014;31(2):180-8.
7) Curr Pharm Des. 2015 Sep 15. “Aspirin Induced Adverse Effects On The Small And Large Intestine.” Pavlidis P, Bjarnason I.
8) Gut. 1998 Oct;43(4):506-11. “Intestinal permeability and inflammation in patients on NSAIDs.” Sigthorsson G, Tibble J, Hayllar J, Menzies I, Macpherson A, Moots R, Scott D, Gumpel MJ, Bjarnason I.