Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (124 page)

Since then, other studies have been done on the relationship between food sensitivities and arthritis. In a study of 43 people with arthritis of the hands, a water fast of three days brought improvement in tenderness, swelling, strength of grip, pain, joint circumference, function, and SED rate (a simple blood test that determines
a breakdown of tissue somewhere in the body). When some of these people were tested with single foods, symptoms recurred in 22 out of 27 people. In other studies, the foods most likely to provoke symptoms after an elimination diet were, in order of most to least, corn, wheat, bacon or pork, oranges, milk, oats, rye, eggs, beef, coffee, malt, cheese, grapefruit, tomato, peanuts, sugar, butter, lamb, lemon, and soy. Cereals were the most common food, with wheat and corn causing problems in more than 50 percent of the people.

In another study, it was found that 44 out of 93 people with rheumatoid arthritis had elevated levels of IgG to gliadin. Among these 44 people, 86 percent had positive RA factors. In yet another study, 15 out of 24 people had raised levels of IgA, rheumatoid factor, and wheat protein IgG with a biopsy of the jejunum. Six of the wheat-positive people and one of the wheat-negative people had damage to the brush borders of their intestines. The researchers felt that the intestines play an important role in the progression of rheumatoid arthritis. Increased intestinal permeability allows more food particles to cross the intestinal mucosa, which triggers a greater sensitivity response.

Hvatut and colleagues measured IgG, IgA, and IgM antibodies in serum and intestinal fluid in 17 people with rheumatoid arthritis and 20 healthy controls. They concluded that measuring food antibodies in intestinal fluid gives a more “striking” result between rheumatoid arthritis, food sensitivities, and the immune activation of the mucosal lining (MALT).

Kallikorm and Uibo reported that of 74 people admitted to the hospital with arthritic diseases, 12 percent had elevated antigliaden antibodies, indicating gluten intolerance; 1 person had celiac disease. Because people with one autoimmune disease are more susceptible to other autoimmune diseases, it’s good to screen for celiac and gluten intolerance.

The concept of food sensitivity and increased intestinal permeability is gaining acceptance as more physicians see the clinical changes in their patients when they use this approach. Testing for food and environmental sensitivities, parasites, toxic metals, candidiasis, and intestinal permeability and performing a comprehensive digestive stool analysis (CDSA) often provide an understanding of an underlying cause of the disease.

Candidiasis frequently plays a role in “fungal” arthritis and is a possible aggravator in rheumatoid arthritis. While common in people who are on immunosuppressant
drugs, it is beginning to be seen in people who have normal immune health. It has been found in the synovial fluid of knee joints, yet how often do physicians actually test synovial fluid for infection? Fungus in people with arthritis can be the result of using antibiotics, oral contraceptives, or steroid medications; increased use of alcohol or sugar; or a stressed immune system. Treatment of candidiasis in the digestive system has improved rheumatoid symptoms in many cases.

In many types of arthritis, known microbes trigger a molecular mimicry that then activates the disease. Rheumatoid arthritis is associated with Proteus mirabilis infection; ankylosing spondylitis is associated with Klebsiella sp.; reactive arthritis is triggered by a GI infection of salmonella, yersinia, campylobacter, and in the urinary tract chlamydia.

Infection can trigger arthritis and joint inflammation. Why they move to the joints or cause joint pain is unknown at this time. But the phenomenon is well documented. If candida, Lyme disease, chlamydia, klebsiella, salmonella, or another infection is present, your physician can recommend a variety of therapeutics, including both natural and pharmaceutical remedies.

There is documentation in the literature about arthritis and deficiencies of nearly every known nutrient. When the needed nutrients are supplied, the body can begin to balance itself. Though many nutritional and herbal products help arthritis sufferers, no one thing works for everyone, so persist until you find the therapies that work best for you. Give each one at least a three-month trial before giving up on it. I remember Abram Hoffer, M.D., speaking about a patient at a conference many years ago. He had recommended the man take 1,000 mg of vitamin C daily for his arthritis. The man took the vitamin C faithfully each day without any improvement. After a whole year, he suddenly became pain-free.

People with arthritis are often too acidic. To buffer this acidity, the body pulls alkaline minerals out of the bones. These minerals are sometimes deposited in joints throughout the body. (See
Chapter 17
for more on pH balance.)

Exercise and stretching are useful for all types of arthritic conditions. Yoga has been found to help with range of motion, pain, stiffness, and joint tenderness. Walking, swimming, physical therapy, and massage therapy may all play a role in reduction of symptoms. Movement is not optional. Even small amounts can give great relief.

Osteoarthritis is the most common type of arthritis and the one we associate with aging, although nutritionally oriented physicians believe it has more to do with poor dietary habits and biochemical imbalances than age. Pain is usually the first symptom. The main characteristics are stiffness, aches, and painful joints that creak and crack. Stiffness may be worse in the morning and after exercise. Osteoarthritis begins gradually and usually affects one or a few joints, most commonly in the knee, hip, fingers, ankles, and feet. As joints enlarge, cartilage degenerates. Eventually, hardening leads to bone spurs. You lose flexibility, strength, and the ability to grasp, accompanied by pain. Risk of osteoarthritis, especially arthritis in the knee, increases if you are overweight; losing weight helps. Acid-alkaline balance is also important in treating this illness.

Rheumatoid arthritis is characterized by inflammation of joints, most often in the hands, feet, wrists, elbows, and ankles, with symmetrical involvement. It can start in virtually any joint. The onset may be sudden, with pain in multiple joints; or it may come on gradually, with more and more joints becoming involved. Joints become swollen, feel tender, and can degenerate and become misshapen. Joints are often stiffest in the mornings and also feel worse after movement. RA is most common in women and in people who smoke. In a blood test, the rheumatoid factor (RF) will be elevated in most cases of rheumatoid arthritis. While it may get better or worse, once established RA is nearly always present to some extent. Treatment is aimed at lowering inflammation and TNF-alpha.

Many drugs are being used to treat rheumatoid arthritis, and all have complicating side effects. Natural therapies are an adjunct or replacement for medical intervention. For example, fish oils and curcumin lower TNF-alpha.

Rheumatoid arthritis has a genetic component, often running in families. It is believed to be triggered by a bacterial infection (Proteus mirabilis), having the “right” genetics (HLA-DR1/4), and autoimmunity caused by a molecular mimicry. When genes meet the environment, the illness is triggered. The gene marker HLA-DR1/4 is present in 50 to 75 percent of people with rheumatoid arthritis.

There are many microbes that have been associated with rheumatoid arthritis. Here are some of the many microbes that have been indicated in RA: proteus mirabilis, Epstein-Barr virus, mycobacteria, mycoplasma, chlamydia, yersinia, salmonella, shigella, campylobacter, staphylococcus, streptococcus, candida, clostridium, borrelia, leptospira, erysiplotrix, klebsiella, and oral bacteria.

Proteus mirabilis is a bacterium commonly found in the urinary tract and can be found in urine. It causes no problems in most people, but in people who have the HLA-DR1/4 genotype, it acts as a genetic mimic that cross-reacts with collagen XI and hyaline cartilage, breaking down the cartilage. Proteus mirabilis antibodies in people with RA have been found in people in 14 countries. Proteus mirabilis has not been found to have an association with any other disease. I was able to find 44 studies on PubMed regarding the role of Proteus mirabilis, and the mechanisms are beginning to be very well understood. It’s postulated that incidence of RA is higher in smokers because smoking puts people more at risk of developing urinary tract infections. In one study, a decrease in antibodies to Proteus mirabilis was observed in subjects on a vegetarian diet. Proteus infections can be treated with either natural or pharmaceutical therapy.

Proteus mirabilis is also found in biofilms. Although there are no studies yet on the relationship of this particular bacteria, biofilms, and arthritis, I look forward to seeing those in the future.

Waldemar Rastawicki and colleagues in Poland studied 92 patients with RA. They were tested for bacterial genes in synovial fluid and blood. While bacterial genes weren’t discovered, antigens to pathogenic bacteria were found: salmonella (8.6 percent), yersinia (20.7 percent), and enterobacterial common antigen (34.9 percent).

A 1973 study by Mardh and colleagues reported mycobacteria in synovial fluid. Just recently, a friend with chronic knee issues had her synovial fluid tested and discovered that she had Lyme disease.

Vegetarian, vegan, and raw-food diets have been shown in numerous studies to be successful at reducing the symptoms of rheumatoid arthritis. Vegetable-based diets help balance pH levels. They also provide an abundance of antioxidants, natural
anti-inflammatory factors, vitamins, minerals, and phytonutrients. This diet also tends to be more hypoallergenic. Add fish oil to increase the benefits. Short-term fasting prior to beginning the vegetarian diet has also been shown to provide long-term benefits. Please work with a good nutritionist.

It’s hard to generalize or predict which of these factors will be found in each person, but usually one or more is present. Each of them needs to be investigated. Leaky gut is probably not a primary cause of rheumatoid arthritis, but long-term use of medications used for the arthritis often makes it a factor.

Psoriatic arthritis affects 30 percent of people with psoriasis (the incidence used to be 3 to 7 percent), about 1.4 million Americans. People with severe psoriasis are more likely to develop psoriatic arthritis. In addition to the usual symptoms of psoriasis, they also have joint pain, tenderness, or swelling in the fingers, toes, or spine. Other symptoms include reduced range of motion, morning stiffness, redness and pain of the eye that is similar to conjunctivitis, and nail changes with pitting or lifting of the nail. Psoriatic arthritis is rarely found in people who do not also have psoriasis. Psoriatic arthritis is associated with bone erosion and deformities that affect half of the people with this disease. Skin and joint symptoms may flare up or improve simultaneously. Psoriatic arthritis closely resembles rheumatoid arthritis, although people with psoriatic arthritis usually have a negative rheumatoid factor. This disease can be mild, but it can also be severely deforming and disabling.

Like other types of autoimmune disease, psoriatic arthritis has genetic, environmental, and immunologic origins. The gene marker HLA-B27 is present in most people with this disease.

Inflammation of psoriatic arthritis is involved with arachidonic acid pathways and TNF-alpha. New drug therapies, such as injectable infliximab and etanercept, aim at lower TNF-alpha levels. A healthful diet plus essential fatty acids help reduce and prevent further inflammation. Evening primrose, borage, and fish oils; turmeric; curcumin; bromelain; and quercetin all work on these pathways.

Li and Wang used traditional Chinese medicine (TCM) and integrative medicine in working with 47 people with psoriatic arthritis. Seventeen people were given TCM only. Thirty were given a combination of TCM and integrative medicine. Dosages of medications were reduced as symptoms were relieved, cured, or improved. They conclude that TCM and integrative medicine are effective for people with psoriatic arthritis with fewer negative effects than current medical treatment.

Ankylosing spondylitis is characterized by a progressive fusion of joints in and around the spine. Caucasian men constitute 90 percent of those with the illness, and it typically becomes evident between the ages of 10 and 30. It starts off as a low backache, which is often worse in the mornings. Symptoms get progressively worse and spread from the lower back to the midback and up to the neck. The spine gradually becomes fused. Later, shoulders, hips, and knees may be affected. Symptoms flare and subside.

The role of dysbiosis in ankylosing spondylitis is the most researched and best understood of all the arthritic diseases. Most researchers believe that AS is triggered by an inherited gene and interactions with the environment. Much research has been done on the role of infection as a primary trigger of AS. The gene implicated is HLA-B27, although others may still be found. HLA-B27 is present in 96 percent of people with ankylosing spondylitis. This marker is also present in 8 percent of the general population. Research shows 70 to 80 percent of people with ankylosing spondylitis have klebsiella bacteria in their stools. Yersinia, shigella, and salmonella bacteria are also associated with this process and may contribute to the disease in people who are not infected with klebsiella. These bacteria may not normally cause disease, but in people with the HLA-B27 gene marker, antibodies produced to kill the bacteria cross-react, causing pain and inflammation. This concept of autoimmune disease may explain why some people get certain illnesses and others don’t. It’s the presence not only of a specific gene but also of a microbe or other environmental trigger that activates the disease process.