Q&A: Diet, Arthritis, and Autoimmune Diseases

Dr. Michael Klaper answers questions on a wide variety of health and nutrition-related subjects. To submit a question or topic for possible inclusion here, send e-mail to: answers@DoctorKlaper.com

Question for 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?”

Answer:

Ask these two questions to most physicians in practice today and the likely answer you’ll receive is, “The cause of arthritis and autoimmune diseases is unknown, and nothing that you eat or any supplement that you take will make any difference at all.”

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. 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 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 then settle for mere suppression of inflammatory symptoms instead of effective treatment. This “relief” often inflicts severe side effects, like intestinal bleeding, inflammation of the liver, and/or depression of bone marrow function, where new blood is made.

IS YOUR GUT LEAKY?

Ignoring the diet of the arthritis patient is scientifically short-sighted; it is now clear that in most people, fragments of protein from foods certainly do leak into the bloodstream after most every meal. In reaction to these foreign substances, antibodies in the blood are commonly detected against fragments 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, colitis or enteritis (Crohn’s disease) or other form of inflammatory bowel disease, or unrecognized gluten sensitivity. Increased intestinal permeability is a common co-condition in many allergic conditions, like asthma, urticaria (hives) and eczema, and likely plays a causative role in keeping the conditions active.

We can also damage our gut integrity by ingesting substances that either damage the gut lining directly – like alcohol and non-steroidal anti-inflammatories such as ibuprofen or naproxen, or by reducing our population of healthful gut bacteria (our microbiome) by ingesting unnecessary antibiotics, chlorinated drinking water, and alcohol. Of course, eating refined sugars in baked goods, candies, fruit juices and soft drinks promotes the growth of pathogenic bacteria and yeast which further injure the gut.

Once in the bloodstream, these fragments of irritating, foreign proteins can lodge in sensitive tissues – like the delicate synovial membranes lining the joints, or trigger the formation of antibodies by our immune cells, inciting autoimmune diseases. In the joint membranes, they can incite severe inflammatory reactions, ranging from subtle swelling of connective fibers to hot, painful distention of the entire joint, as in severe rheumatoid arthritis.

Chronic inflammation of the joints 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.)

We now know that various kinds of joint inflammations, including some forms of rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and others, may have nutritional components and may improve when offending foods are eliminated from the diet. Other inflammatory conditions including asthma, psoriasis, eczema, and related disorders, also can involve the so-called “leaky gut syndrome,” and can 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 bovine-derived meats.

5. Soy protein – including tofu, tempeh, etc.

6. Corn protein.

7. “Nightshade” vegetables – tomatoes, potatoes, eggplants, green (bell) peppers

Since many foods can trigger joint inflammation, the following method can help you identify problem foods.

THE BASELINE SAFETY DIET

For 7 to 14 days, the diet should consist (in unlimited amounts) of only the following five simple foods, least likely to incite inflammatory reactions in the body:

Chart for Baseline Safety Diet
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.

One of the benefits gained through this is increased appreciation for the natural taste of fresh fruits, vegetables and other whole foods. A pinch of iodized salt or a spray of rice vinegar on the surface of vegetables is permitted, but beyond those, each seasoning and spice (re-)introduced should be re-tested individually.

After following this regimen for five to fourteen days, 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.

Two maneuvers will increase the natural anti-inflammatory effect of the above dietary therapy and often provide even faster relief:

1. A brief period (24 to 72-hours) consuming only pure water or vegetable broth (with 4 – 6 sixteen ounce glass of water or broth consumed every 24 hours) allows potentially inflammatory proteins to be cleared from the bloodstream and reduced in the joint membranes, and is quite effective in “cooling off” inflamed joints. Marked improvement of arthritic joints is often observed within 48 hours; however, such a “washout period” is not absolutely necessary.

2. Algae-derived DHA is an omega-3 fatty acid with anti-inflammatory properties. 300 – 600 mg (1 or 2 vegi caps) taken daily as one institutes the Baseline Safety Diet” can help act as a “fire extinguisher” for inflamed tissues. Abundant amounts of dark, leafy greens will also contribute to positive omega-3 balance.

Once out of the initial stages of the Baseline Safety Diet (5 – 14 days) and improvement in the joints is seen, foods with omega-3 fats, including walnuts, freshly ground flaxseeds, chia seeds, and hempseeds (on fruits or in salads) can be added, one at a time, every 3-4 days, to see if they cause any adverse reactions in the joints.

GUT LINING REPAIR

The “leaky gut” can be made less permeable by addition of the following supplements, available at any natural food store, for 6 weeks – all help restore normal tissue integrity and rebalance intestinal microflora:

1. Glutamine – 500 – 1000 mg. twice daily, with breakfast and dinner.

2. Quercetin 500 – 1000 mg twice daily, with breakfast and dinner.

3. SAM-E (S-adenosyl-methionine) 500 mg twice daily, with breakfast and dinner.

4. Vitamin D3 (plant derived) – 2000 IU, with breakfast.

5. Vitamin B12 (liquid or sublingual tablet) 1000 mcg three times per week, PLUS – A non-dairy probiotic, like PB8 or Nature’s Way Optima: 1 capsule an hour before bed.

Assuming a favorable joint response to the above, “new” 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 48-72 hours (to allow sufficient time for any possible reaction),
(c) while keeping a careful food diary.

In this diary, record each new food introduced, the time and date eaten, and very importantly, how the joints feel several hours later, and on the following day. The joints usually “speak” quite clearly – with pain, redness, warmth, swelling, and/or stiffness – usually within 48 hours of eating an offending food. On a separate sheet with a vertical line down the center – the “Score Sheet” – record on the left “Safe Foods,” that do not adversely affect the joints, and in the right column, “Problem Foods,” that make the joints react in any way.

Over several weeks, 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.

Some types of fats can make inflammatory arthritis flare, especially saturated animal fats and hydrogenated vegetable oils. The person with arthritis must be guard against “fast foods” and processed foods re-entering the diet as they are notorious for making autoimmune diseases worse. It pays for her or him to become a skillful reader of labels to detect offending substances hidden in packaged foods, like processed oils and ingredients your grandmother would not have recognized.

A whole-food, plant-based diet does not have to be boring. Delicious recipes can be found in the Health Supporting Cookbook by Alan Goldhamer, D.C., and Bravo! by Chef Ramses Bravo (links open in new tab or window) .

If wheat or other plant protein is found to cause adverse reactions, there are breads, pastas and cereals made of rice, (gluten-free) oats, buckwheat, kamut, and other non-wheat grains, also widely available at natural food stores. Test each of these new foods individually, by introducing them separately at 48-72 hour intervals, to assure that they create no adverse effects in the body.

If desired, foods that triggered joint inflammation at one time can be tested again 6 – 12 months later to see if they still cause adverse reactions. The body can be quite forgiving if given a rest from repeated exposure to offending proteins. Such simple, but effective food strategies can produce dramatic improvements and, often, complete resolution of arthritis and other autoimmune diseases like lupus, ankylosing spondylitis, etc.

REFERENCES

Kjeldsen-Kragh, J., et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991; 338:899-902.

Parke, A. Rheumatoid arthritis and food: a case study. Br. Med. J. 1981; 282:2027-29.

Phinney, S., et al. Reduced arachidonate in serum phospholipids and cholesteryl esters associated with vegetarian diets in humans. Am. J. Clin. Nutr. 1990; 51:385-95.

Walker, W. Uptake and transport of macromolecules by the intestine. Possible role in clinical disorders. 1974. Gastroenterology, 67, 531.

Peterson, R. (1963) Antibodies to cow’s milk proteins – their presence and significance. Pediatrics, 31, 209.

Paganelli, R. Detection of specific antigen within circulating immune complexes: validation of the assay and its application to food antigen-antibody complexes formed in healthy and food-allergic subjects. Clin. Exp. Immunol. (1981) 46, 44-53.

Inman, R. Antigens, the Gastrointestinal Tract, and Arthritis. Rheumatic Disease Clinics of North America, Vol. 17, No. 2, May, 1991.

Mielants, H., et al. Intestinal Mucosal Permeability in Inflammatory Rheumatic Diseases. II. Role of Disease. J. Rheumatol., 1991;18:394-400.

Morrow, W. Systemic lupus erythematosus: 25 years of treatment related to immunopathology. The Lancet, 2:206, 1983.

Solomon, L. Rheumatic disorders in the South African Negro. Part I. Rheumatoid arthritis and ankylosing spondylitis. S. Afr. Med. J. 49:1292, 1975.

Lithell, H. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Effects on clinical condition and serum levels of neutrophil-derived granule proteins. Acta Derm Venereol (Stockh) 63:397, 1983.

Kremer, J. Effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. The Lancet, January 26, 1985, Pp. 79-81.

Darlington, L. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. The Lancet, February 1, 1986, Pp. 80-83.

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• To learn more about this subject, see Dr. Klaper’s free video, “Curing Leaky Gut Syndrome.”