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. 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 pieces 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 and in many allergic conditions, like asthma and eczema.
Once in the bloodstream, these ragged chunks of irritating, foreign proteins can lodge in sensitive tissues – like the delicate synovial membranes lining the joints. There, they can incite severe inflammatory reactions, ranging from subtle swelling of connective fibers to hot, painful distention of the joints, as in 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.)
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
“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:
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. Each seasoning and spice should eventually be re-tested individually. 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 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 (a 6-ounce glass of water or broth hourly) allows all potentially inflammatory proteins to be cleared from the bloodstream, and is thus extremely 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. Flaxseed oil, hemp seed oil, or evening primrose oil, available in the refrigerator case at the natural food store, are rich in linolenic acid (an “omega 3″ fatty acid), from which the body makes a potent, natural anti-inflammatory substance, prostaglandin E-1. Two teaspoons of flaxseed oil or hemp seed oil, or one teaspoon of evening primrose oil, consumed daily, combined with the “Baseline Safety Diet” foods above, often act as a “fire extinguisher” for inflamed tissues.
Flaxseed oil or hemp seed oil can be drizzled over a baked potato (instead of melted butter), brushed onto corn on the cob or onto bread, mixed with salad dressing, or taken “straight” from a spoon – but don’t cook with it, as it is quite fragile and breaks down at high temperatures. (Flaxseed oil also comes in capsules, for those who prefer not to ingest it in liquid form.) All delicate “medicinal” oils should be taken together with 200-400 I.U. of Vitamin E to prevent oxidation in the body.
Other oils with natural anti-inflammatory properties include soybean, pumpkin, and walnut, and may be used sparingly, e.g. 1 – 3 ounces tofu, a daily handful of raw walnuts or pumpkin seeds, etc.
GUT LINING REPAIR
The “leaky gut” can be made less permeable by addition of the following supplements for 60 days – all help restore normal tissue integrity and balance of intestinal microflora:
Glutamine – 250-500 mg. 3x/day
Acidophilus (non-dairy) – 1/2 teaspoon of powder or 2 tablets between meals
Incidentally, the gut is made more leaky by non-steroidal anti-inflammatory drugs, such as ibuprofen, aspirin, and similar substances.
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 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. “Nutritional insurance” during this time can be provided by daily high-potency multivitamin and mineral supplements, containing at least 2 mcg. of Vitamin B-12, 500-1000 mg. each of calcium and magnesium, and U. S. Recommended Daily Allowance amounts of zinc, copper and other trace minerals.
Some types of fats can make inflammatory arthritis flare, especially saturated animal fats and hydrogenated vegetable oils. The person with arthritis must be aware as “fast foods” and processed foods are added back into the diet, and it pays for her or him to become a skillful reader of labels to detect offending substances hidden in packaged foods.
Meals that are gentle on the joints do not have to be boring to the tongue. Non-dairy versions of sour cream, cheeses, yogurts, and “cream cheese” spreads, as well as soy milks, rice milks and almond milks are found in the refrigerator case of most natural food stores, while the freezer cases now offer delicious non-dairy “ice creams.” (Most current brands of soy-based “cheeses” contain casein or caseinates, proteins derived from cow’s milk.) Be sure to read labels!
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, also 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.
If desired, foods that triggered joint inflammation at one time can be tested again several 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 or, often, complete resolution of arthritis and other autoimmune diseases like lupus, ankylosing spondylitis, etc.
Yours in health,
Dr. Michael Klaper
NEW: See a 2.5 minute introductory video and rent or buy a video of the January 2015 “Healthy YOU” webinar about Leaky Gut.
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.