Rheumatoid Arthritis

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Natural Medicine

Rheumatoid arthritis (RA) is a disease with many contributing causes, from genetics to diet. A natural medical approach to treating RA addresses known contributing factors by taking a holistic, comprehensive approach.

Genetics of RA
As many as 70% of people who suffer from rheumatoid arthritis have a genetic marker called HLA-DR4. Not everyone who has the marker gets the disease, but there is a tendency for those with the marker to develop rheumatoid arthritis sometime during their lifetime. Following the nutritional guidelines described below may help to prevent symptoms.

Diet and RA
There is a history of clinical observation of the connection between diet and the symptoms and the severity of rheumatoid arthritis. Recently, there is mounting research evidence to confirm the relationship between intestinal health and inflammatory disease.

The modern Western diet, which tends to be high in pro-inflammatory foods such as sugar, refined carbohydrates, saturated animal fats, processed foods, and hydrogenated oils, may contribute to the expression of RA in people who are genetically inclined to the disease.

While there is some evidence that food allergies play a role in the overall severity of RA symptoms, it is unclear whether food allergies are the cause or the result of an overactive intestinal immune system.

In order for RA patients to understand the connection between diet and symptoms, naturopathic physicians may encourage a 3 to 5 day juice fast. Usually, there is a reduction in pain, swelling, and other symptoms during this time. This brief fast can help give patients more control over the management of their symptoms. Fasting can also be a beneficial tool during acute flare-ups.

Following a period of fasting, an elimination/challenge trial diet (as outlined below) followed by a vegetarian/fish based diet may be tried. Regardless of the severity of RA symptoms, incorporating a healthful, nourishing diet can support the return to pain free movement.

Here are a few ways to decrease the gastrointestinal inflammation contribution to the RA problem. They focus on ruling out food sensitivities and normalizing intestinal bacteria and flora.

Rule Out Food Sensitivities
In some cases, the only obstacle to relief of symptoms. There are a couple of different ways to detect food sensitivities that negatively impact health. These include blood allergy testing and the elimination/challenge trial.

1. Blood Allergy Testing
   Most diagnostic medical laboratories can analyze blood samples to detect an immune response to specific food substances. These can be very helpful. However, this type of testing is most accurate when there is a severe allergic interaction with a food such as hives or throat swelling (i.e., an IgE mediated response). This type of response is a true allergic reaction and the foods generally associated with it are peanuts, strawberries, and shellfish. These are dangerous responses and require immediate medical intervention when they occur. Blood testing is less reliable when low-grade food intolerances or sensitivities are involved.

2. The Elimination/Challenge Trial
   A less invasive and more accurate way to determine the impact of food on symptoms is the "elimination/challenge" trial. This naturopathic procedure can accurately diagnose food-related symptoms and is the standard for identifying food sensitivities. While this procedure is more time consuming than a laboratory test, the results can be more reliable.

   There are two ways to approach an elimination/challenge. The first and more difficult but more effective route is outlined as option #1 below. It involves eliminating all of the foods that usually cause problems and then slowly, over time, adding them back into the diet one-by-one. It provides clear insight into which foods impact health in which ways.

   The second option is used by patients who already have a good idea which foods are problematic for them. The suspected food group is eliminated until symptoms clear and then added back into the diet to determine the response or return of symptoms.

   Symptoms associated with food challenges may not be the same as before the elimination process. For example, some patients experience chronic sinus pain prior to embarking on the elimination/challenge and upon challenging the food, experience stomach pain. This does not indicate that the food group being challenged has not contributed to sinus pain, rather that the immune system may react a bit differently when re-introduced to the offending food.

   Symptoms that may occur on a food challenge include the following:

   • Anxiety
   • Depression
   • Excitability (feeling "hyper" or "buzzed)
   • Facial flushing and reddening of the ears
   • Fatigue
   • Headache (may be brief or prolonged)
   • Insomnia
   • Irritability
   • Muscle twitching or aching
   • Nausea
   • Sharp abdominal pain
   • Skin rash or itching
   • Sleepiness
   • Sore throat
   • Stomach ache
   • Stuffy, itchy, or runny nose and eyes
   • Tightness in the chest

Option #1 - Elimination
Eliminate all suspect foods:

• Wheat products (e.g., pasta, breads, processed foods, faux meat)
• Dairy products (e.g., milk, cheese, yogurt, cream)
• Corn products (e.g., tortilla, chips, polenta, cornstarch/thickeners)
• Peanuts (e.g., peanut butter, peanut oil)
• Soy products (e.g., tofu, tempeh, soy milk, soy protein powder, soy oil)
• Glutinous grains (e.g., rye, barley, oats, spelt, kamut, seitan, hops)
• Beef (this is usually a problem with the additives)
• Chocolate
• Sugar, nutrasweet/aspartame
• Food coloring/dye
• Pesticides and chemical spoilage retardants (e.g., sulfites)

Maintain a diet based on:

• Fresh fruits
• Vegetables
• Potatoes
• Yams
• Animal protein (e.g., fish, poultry, lamb)
• Non-glutinous grains (e.g., millet, buckwheat, rice, amaranth)

Whenever possible, choose organic foods. Avoid sulfite-containing foods, including canned vegetables and fruits, wine, and canned tuna (albacore).

Read labels. Know that "vegetable protein" is either wheat or soy; thickening agents and stabilizers are either wheat or corn; and food starch is usually wheat or corn. It is easier to avoid processed food while on the diet than to determine which additives are in prepared foods.

After 2 to 6 weeks of maintaining a strict elimination diet, patients often experience fewer symptoms.

Challenge
Begin your challenge with the food group you feel is the least likely culprit. Eat several servings from that food group throughout the day. For example, if you are challenging dairy, have milk with breakfast; include cheese, cream, and yogurt in your lunch and dinner menus; drink milk at meals; and snack on dairy items. Only challenge for one day, then wait at least 48 hours. Do not continue to add that food group to your diet. Return to eating only elimination diet foods.

If symptoms do not return after 48 hours, go on to the next suspected food group. In most cases, symptoms return within 48 hours; rarely do they appear several days or weeks later. If, however, you want to wait more than 48 hours, feel free to do so as this increases the accuracy of the diagnosis. Continue this process until the problematic food group is determined. A week between food group challenges is optimal. Only challenge one food group at a time.

Option #2
Maintain your regular diet, eliminating only the food group that you believe is causing symptoms. Eliminate all items in that food group for at least 1 month. If your symptoms disappear before the one month deadline, continue to abstain from that food group for an additional week. If, for example, relief occus after just a few days of avoidance, continue to avoid that food group for another week before challenging. When you challenge, follow the guidelines stated above: eat several servings of the suspect food group during a 24-hour period, then return to the elimination diet and wait.

Normalize Intestinal Bacteria/Flora
There is a single layer of cells between the gastrointestinal bloodstream and the digestive waste products in the intestines. When the intestines are inhabited with normal, healthy bacterial flora, this close proximity is not a problem. The powerful digestive immune system is designed for constant vigilance, quick analysis of the resident and transient inhabitants, and swift action when a threat to the body is detected. The more waste that accumulates from a poor diet, low-grade inflammation, and/or abnormal or pathogenic bacteria (significant in patients with RA), the bigger the challenge to determine what is helpful or harmful.

The result of waste accumulating in the intestines is an increase in immune complexing and autoimmune reactivity throughout the body and, especially when there is a genetic predisposition, in joint tissue.

Natural therapeutic methods directly address these causative factors with dietary guidelines, proteolytic enzymes to break down immune complexes, and suppositories to normalize intestinal bacterial flora.

Diet Recommendations
Reducing the amount of pro-inflammatory, arachidonic acid-containing foods (animal products) and replacing them with foods high in EPA (eicosapentanoic acid, a beneficial fatty acid and omega 3 oil found in deep ocean fish) decreases inflammatory reactivity in tissues and is essential in inflammatory conditions such as rheumatoid arthritis.

Maintain a vegetarian/fish diet based on fresh vegetables and fruits; whole grains; broiled, baked, or steamed cold water fish (salmon, herring, mackerel, sardines); flax seed oil, or other EFA (essential fatty acids) found in fish oil, olive oil, and nuts.

Drink plenty of fresh water. Choose organic foods when possible. Avoid processed food, "fast food," "junk food," fried food, dairy products, animal fat, red meat, poultry, hydrogenated oils and margarine, sugar, white flour products (e.g., pasta, bread, crackers, cookies, ), alcohol, and caffeine.

Read labels to make sure that there are no hidden ingredients in what you are eating. Take extra fiber by adding 1 tablespoon psyllium seed husk fiber, 5-8 tablespoons flax seed meal, and/or oat bran to your daily diet.

Proteolytic enzymes or Wobenzyme
Take proteolytic enzymes (400 mg Bromelain) or Wobenzyme (5 tablets, 3 to 4 times a day between meals). This is the single most potent supplement you can take for the treatment of RA. It breaks down immune complexes in the blood and at the joint tissue; breaks down inflammatory products like fibrin; and helps to relieve pain. Occasionally, loose stool results from the above dose. This is not harmful and can be avoided by changing the dose to 3 tablets, 5 times a day between meals.

Other benefits of proteolytic enzymes and Wobenzyme include:

• They are anti-inflammatory and have the ability to break down circulating immune complexes. This action reduces inflammation in soft and connective tissue such as internal organs, eyes, skin, muscles, tendons, fascia, joint capsules, and blood vessels.

• They are anti-fibrotic, meaning that they break down hard, fibrotic tissue, and in so doing, help prevent atherosclerosis, hypertension and other cardiovascular diseases, blood clots, uterine fibroids and other fibromas, fibrocystic breast disease and other fibrous degeneration.

• They are blood-thinning. Like aspirin, proteolytic enzymes lower blood viscosity. Unlike aspirin, enzymes do not carry a risk of hemorrhage (the blood becoming too thin) and do not cause gastrointestinal bleeding. The mechanisms by which the thinning occurs involves the breaking down and cleaning up of waste products, cellular debris, circulating immune complexes, and white blood cells. By cleaning up the blood, more white blood cells are made available to protect the body.

Other Nutritional Supplements
The following nutrients have been shown to be deficient in many patients with rheumatoid arthritis and should be supplemented:

• Zinc: 30mg daily
• Selenium: 200mcg daily
• Manganese:15mg daily
• Vitamin C: 1000mg 3 times a day with meals
• Pantothenic acid: 500mg 4 times a day with meals
• Vitamin E: 400 - 800IU daily

Homeopathic Medicine
A trained homeopathic practitioner is required to diagnose and prescribe treatment for chronic symptoms. For acute, short-term symptomatic relief the following remedies have shown success with some of the symptoms associated with RA:

• Rhux Tox (for joint stiffness and pain that is worse in the morning; associated with a sense of restlessness and irritability)
• Calcerea fluorica (for rheumatoid nodules)

Standard dosage for acute symptom relief is 12c -30c, 3 to 5 pellets every 4 hours until symptoms resolve. If you have chosen the right remedy, you should experience a shift in your discomfort shortly after the first of second dose.

Warning: most homeopathic remedies are delivered in a pellet that has a lactose sugar base. If you are intolerant to lactose, be advised that a homeopathic liquid may be a better choice.

Physical Medicine
The goal of physical medicine in the treatment of rheumatoid arthritis is to increase blood flow to the joint and surrounding muscles and ligaments. This nourishes the tissues and removes waste products that may have accumulated as the result of the inflammation.

Patients should consult a physical therapist, chiropractor, osteopath, or naturopath to develop an exercise program that includes stretching.

Hot and cold hydrotherapy increases circulation to the joint and surrounding tissues. Alternate ice water and hot water bottle or hot compress (3 minutes hot, 30 seconds cold), and always finish with cold to flush the tissues. Get regular therapeutic massage to increase circulation.

Rheumatoid Arthritis, Natural Medicine reprinted with permission from podiatrychannel.com
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