RHEUMATOID ARTHRITIS
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RHEUMATOID ARTHRITIS is really a type of arthritis. Like osteoarthritis it causes inflammation of the joints. Indeed, the word arthritis is derived from the Greek word for joint (it actually means inflammation of the joint). Rheumatoid arthritis, unlike osteoarthritis, is a more systemic illness. It begins with an inflammation of the synovial membrane--the source of the fluid that lubricates the bone joints. Rheumatoid arthritis is a chronic inflammatory disease that affects particularly the hands, feet, wrists, ankles, and knees, but it can also affect other organs. It usually begins between the ages of twenty and forty, but it can manifest at any age. It's an unpredictable disease: Up to 20 percent of those affected find that it disappears on its own and never comes back. Others suffer some degree of disability for the rest of their lives. In the past, conventional medicine has concentrated largely on relieving the symptoms with ever larger and stronger antiinflammatory drugs. But many of these drugs cause serious side effects--in some cases worse than the condition itself.
Though the cause of rheumatoid arthritis has yet to be precisely identified, there's evidence that it's related to a failure of the autoimmune system, or, more precisely, a case of an immune system that's fighting the body it's supposed to protect. The immune system breaks down the components of joint tissue, causing joint pain, redness, stiffness, and swelling. What stimulates the immune system to do this? There's increasing evidence that individuals with rheumatoid arthritis have intestines that are more permeable to certain antigens, allowing these antigens to invade the body, stimulating the symptoms.
If you suffer from rheumatoid arthritis, you probably have seen or should see a rheumatologist. Different people will respond to different therapies. It's important to find someone who will not simply rely on relieving your symptoms with drugs but who will be open to finding the cause of your particular symptoms. I don't mean to imply that I'm against drug therapy for treating RA, but I have seen excellent results in my patients from the use of nutritional therapy combined with physical therapy and/or acupuncture.
While a nutritional approach used to be controversial--the Arthritis Foundation still insists that there is no connection between diet and arthritis--now there's overwhelming evidence pointing to diet as a major factor contributing to the development of symptoms.
Why would diet have an effect on what is essentially an autoimmune disease? Because food makes the greatest demand on the immune system. Foods contain countless allergens that the body is constantly trying to fight or adapt to. Some of these allergens are natural; others come from additives. In any event, finding the foods that stimulate symptoms is one of the first steps that I encourage RA patients to take.
There are many food allergies that can aggravate RA symptoms. Among the most common foods are wheat, corn, milk and other dairy products, and beef. If you had allergies as a child, if there's a history of allergies in your family, if you developed sensitivities in recent years, food allergies could be stimulating your RA symptoms. In order to discover exactly what foods are affecting you, the best approach is an allergy-elimination diet. (I should mention that these reactions may not be true allergies; in some cases they're simply food reactions. For more information on this, see Food Allergy. However, for this discussion, I'I1 refer to both as food allergies.)
You may have heard about osteoarthritis and the nightshade family of foods. The connection between rheumatoid arthritis and these foods was originally made by Childers, a horticulturist, who found that eliminating foods of the nightshade family cured his arthritis. While his theory--that long-term consumption of the alkaloids in potatoes, tomatoes, eggplant, peppers, paprika, cayenne, and tobacco inhibit collagen and cartilage repair--has never been proven, it is true that some patients find relief from their symptoms when they eliminate these foods. It is well worth eliminating them entirely from your diet for a month to see if you find any symptomatic relief. Obviously, if you do, discontinue them permanently. If not, reintroduce them gradually.
It's interesting to note that people who eat a more "primitive" diet--one containing fewer refined foods and foods with additives--than ours are generally free from rheumatoid arthritis. This gives even greater weight to the advice that I routinely give all my patients: Modify your diet to reduce sugar, saturated fat, meats, and refined carbohydrates. Increase the amounts of fresh fruits and vegetables, whole grains, and unrefined carbohydrates. Some patients have found that becoming a vegetarian significantly reduced their symptoms. One study tested a one-week fast followed by a year of a lactovegetarian diet in a controlled test group. The group on the vegetarian diet found significant improvement in joint tenderness, swollen joints, pain, duration of morning stiffness, grip strength, and white blood count, among others. The control group found that only their pain improved significantly. The benefits for the vegetarian group were still present after a year.
I've had good results in reducing inflammation with patients when they significantly lower the fat in their diet. This reaction was discovered quite by accident by researchers at Wayne State University in Detroit who were working with obese women, two of whom suffered from rheumatoid arthritis. While on the low-fat diet, both women experienced a complete remission of their symptoms. They stayed on the diet for up to fourteen months without symptoms, but when they ate any fatty foods, their pain and stiffness returned within a day or two. I suggest that you eliminate as many fats as possible (with the exception of fish oil) including animal and vegetable fats.
Some of my patients have found relief with an occasional fast of no more than four days. No one knows exactly why fasting helps. Obviously fasting eliminates the source of any food allergies, but also there seems to be some connection with fasting and the suppression of the immune system that fights rheumatoid arthritis symptoms. I tell my patients to go on a vegetable juice fast for three or four days if their symptoms are severe, making sure that the vegetable juices contain no nightshade. Check with your doctor to determine whether fasting would be appropriate for you.
Many studies have shown fish oil to be effective in fighting inflammatory diseases, and my patients have found it helped their symptoms.
You may have heard about the use of evening primrose oil to help RA patients. I haven't seen dramatic results among my patients, but as some doctors swear by it, and there is research evidence that it can alleviate symptoms, I usually recommend it along with the fish oil. Remember, it has been shown that it can take up to three months for the evening primrose oil to have an effect, so be patient.
Selenium has also gotten attention lately as a supplement that can give relief. Many RA patients have lowered levels of selenium, a known anti-inflammatory agent. In one study, fifteen women with rheumatoid arthritis of less than five years' duration received either selenium or a placebo daily for three months. The patients treated with selenium found that pain and joint tenderness were improved. The patients receiving the placebo found no change. The improvements in the group treated with selenium disappeared three months after the study ended.
Vitamin C also is frequently below normal in RA patients. There's some speculation that the increased aspirin consumption of RA patients may interfere with the absorption of vitamin C: Average doses of aspirin can triple the amount of vitamin C excreted by the body; therefore, a supplement can help.
Because of its anti-inflammatory properties, I also recommend vitamin E supplements.
It seems that the B vitamins, particularly vitamin B1 and vitamin B12, can enhance the effect of nonsteroidal anti-inflammatory drugs, thereby reducing the amount of drugs needed to reduce pain. In one study, the effect was seen in as little as seven days, allowing some patients to reduce the amount of pain medication needed by as much as 90 percent.
If you rely on regular doses of NSAIDs to relieve pain, you should try B1 and B12 supplementation to see if allows you to reduce your drug intake.
There's long been a connection between copper and reduction of arthritic pain. Perhaps you've seen or heard of people wearing copper bracelets for this purpose. Copper is an effective anti-inflammatory agent that may be more potent than aspirin. It is known to reduce morning stiffness and help joint mobility, sometimes reducing the need for other drugs. Studies have suggested that rheumatoid arthritis patients are marginally deficient in copper, and supplementation may help relieve symptoms. The best form of Copper for this purpose is oral copper salicylate.
Zinc and boron also seem to help reduce swelling in the joints, as well as morning stiffness.
I recently read a very interesting study that tested the use of ginger. Although it was a small sampling--only seven patients--there were dramatic results. It seems that for all the patients who consumed 5 g. of fresh, or 0.5 to 1 g. of powdered, ginger daily, symptoms were greatly reduced. It can take up to three months for results, but I suggest that my patients include ginger in their diet. Ginger capsules are available at health food stores and of course fresh ginger can be had at many supermarkets.
Many of my rheumatoid arthritis patients are dismayed when I suggest that they begin an exercise program. The idea of exercise can seem overwhelming when your joints are painful, but lack of exercise can cause the muscles around a joint to begin to deteriorate, causing more pain. Any exercise that you feel comfortable doing is fine. Some people find swimming or pool exercises to be the least traumatic and best tolerated. Others find that yoga is both soothing and energizing.
One of the basics of my treatment of rheumatoid arthritis is acupuncture. There is a long tradition of using acupuncture for inflammatory diseases; it seems not only to reduce pain and swelling but also to contribute to an enhanced sense of well-being. Many of my patients have found it gave them great relief. I suggest that you find a qualified practitioner and begin with two sessions a week for a month to see if it helps.
Finally, all rheumatoid arthritis sufferers must recognize that stress plays an important part in their disease. Of course you cannot eliminate stress from your life, but you can modify your reaction to stress through exercise and stress-reducing techniques.
NATURAL PRESCRIPTION FOR RHEUMATOID ARTHRITIS
- Unless noted otherwise, it can take up to three months for this program to have an effect.
- Investigate the possibility of food allergies and/or food sensitivities (see Food Allergy, page 146) and undertake an allergy-elimination diet. Among the most common foods that cause sensitivities in people with rheumatoid arthritis are wheat, corn, milk and other dairy products, and beef.
- Avoid foods from the nightshade family (potatoes, tomatoes; eggplant, peppers, paprika, cayenne, and tobacco) for a month to see if you find any symptomatic relief.
- Modify your diet to reduce sugar and other refined carbohydrates, and saturated fat, including red meats. Increase the amounts of fresh fruits and vegetables and whole grains, In general, a more "primitive" diet seems to be beneficial.
- Eliminate as many fats as possible (with the exception of fish oil, see below) including animal and vegetable fats,
- If your symptoms are very bad, I suggest you try a vegetable Juice fast for three or four days, making sure that: the vegetable Juices contain no nightshade. Check with your doctor about this.
- Adopt a regular exercise program as tolerated. Swimming, pool exercises, or yoga are good choices.
- Develop a program of stress reduction.
IN ADDITION TO YOUR DAILY SUPPLEMENTS, TAKE:
- Fish oil: Take 1,000 mg, three times a day. In addition, increase your consumption of fish,
- Boron: 2 mg.
- Evening primrose oil: 1,000 mg. three times a day.
- Selenium: 100 mcg. daily,
- Vitamin C: 2,000 mg. daily.
- Vitamin E: 400 I.U. daily.
- Zinc: 22.5 mg.
- If you take NSAIDs for pain relief: vitamin B~: 100 mg.; vitamin B~2, 1,000 mcg. in tablets dissolved under the tongue. (These supplements may allow you to reduce your drug dose.)
- Copper salicylate: 2 mg. one time a day with meals, and zinc: 50 mg. two times a day with meals. Discontinue after six weeks if no improvement.
- Ginger (powdered form is available at health food stores): 500 mg. three times daily.
IN ADDITION: Acupuncture can be extremely helpful. Find a qualified practitioner and begin with two or three sessions per week.
Sea cucumber is another remedy that seems very promising, although the clinical trials are preliminary. No one seems to know precisely why sea cucumber works. Sea cucumbers are actually animals that live on the Great Barrier Reef in Australia. The substance they produce is available at health food stores in pill form. Some patients have had dramatic results taking these pills, and I think it's worth a try. Take one 500-mg. capsule twice a day.
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