THE theme of World Arthritis Day, is ‘It’s in your hands, take action’, and I thought I’d ring the changes a bit this year and take a look at Rheumatoid Arthritis (RA).
While not as common as osteoarthritis, RA affects up to three people in every 100. It can develop at any age and in fact there is a form called Juvenile RA.
But it more usually affects people between the ages of 30 and 50, three quarters of whom will be women.
The body attacks itself
Quite unlike osteoarthritis, which is known as a ‘wear and tear’ condition, RA is an autoimmune disorder, meaning that the body’s immune system gets out of balance and starts attacking itself. Tissues around the joints are broken down in an inflammatory process, causing swelling and erosion of the bones and joints (and sometimes other parts of the body) that can, if unchecked, create permanent damage. Early diagnosis is therefore key.
Many reasons why
RA may be triggered by a viral or bacterial infection that stimulates the immune response, but it’s deemed multifactorial. There may be a genetic component, lifestyle and nutritional issues, or food allergies that lead to abnormal bowel permeability (where toxins from the gut get into the bloodstream). But the exact mechanisms have been poorly understood—perhaps until now.
Studies are ongoing into the role played by the balance of bacteria in the gut (the microbiome). The cells of the immune system are largely located in the wall of the intestine, and are controlled by the bacteria residing there. ‘Bad’ bacteria may cause the immune system to become too aggressive, and the result is inflammatory allergic reactions which can lead to the body mistakenly attacking its own healthy cells.
Last year, scientists in the US found that people with RA have large amounts of a particular bacterium, prevotella, which is rarely found in healthy individuals. Dr Veena Taneja of the Mayo Clinic conducted ground breaking research by putting a certain ‘good’ bacterium into mice with RA, and found a significant decrease in both frequency and severity of symptoms. ‘These are exciting discoveries,’ she said, ‘that we may be able to use to personalise treatment for patients.’
Cut out processed food
That may be some time off at the moment, but it makes sense for RA patients to do all they can to repopulate the gut with good bacteria (which also push out the bad). Firstly, you need to cut out the foods that feed the bad bacteria, namely processed foods, processed meats, trans/hydrogenated fats, emulsifiers, sweeteners, sugar and refined (white) grains, and carbonated drinks. It would also be very useful to ask your GP about allergy testing—a significant proportion of sufferers have allergies or intolerances, especially to wheat and dairy.
Take a good probiotic
Secondly, you can take a good probiotic (to boost the good bacteria), but bear in mind that only a small proportion of the bacteria will reach the gut alive, so you need to eat your probiotics. That means fermented and cultured foods such as live yoghurt, kefir, kimchi and sauerkraut, apple cider vinegar, tempeh and miso, sourdough bread and aged cheeses. You also need to eat a wide variety of fibre-rich foods that are prebiotic (they feed the good bacteria). Particularly powerful prebiotic foods contain inulin and oligofructose, and they include onions, leeks and garlic, asparagus, Jerusalem artichoke, oats, barley, beans and lentils, chicory root (‘coffee’), and bananas. Inulin is also available as a supplement, or there is the more expensive but comprehensive supplement Prebiotin.
Another, related branch of research is focusing on the role of serotonin in RA. This is the brain chemical that governs things like mood, appetite and sleep, but also it seems controls the inflammatory response that governs all autoimmune disorders. French scientists have discovered that an unusual proportion of people with RA have a deficiency, and the thing is that 90% of serotonin is made, with the help of the good bacteria, in the gut.
Serotonin is produced when we eat foods containing the protein tryptophan – fish, meat, poultry, eggs, dairy, nuts and seeds, quinoa, oats, buckwheat, tempeh, dark chocolate – through the intervention of something called 5-hydroxytryptophan (5-HTP). When researchers injected RA-induced mice cells with 5-HTP, they produced far less inflammatory immune cells and more serotonin. It’s possible to take a 5-HTP supplement, but you must consult your GP first as is can interact quite seriously with other medications.
Go for a plant based diet
As for more mainstream and established methods of controlling frequency and severity of RA symptoms: multiple studies have shown that a plant based diet plus fish is optimal. Vegetables and fruit, nuts and seeds, beans and wholegrains all carry nutrients including fibre, vitamin K, and cell-protective antioxidants like vitamin C, quercetin (red onions, apples) and bromelain (pineapple) that are highly beneficial and proven to reduce inflammatory markers on a cellular level and significantly ease symptoms.
As do olives, olive oil and especially the omega-3 fats in oily fish and the spices ginger (inhibits the manufacture of inflammatory compounds) and turmeric. When researchers gave pre-symptomatic mice concentrated curcumin, the active ingredient in turmeric, it completely halted the development of RA.
Oily fish is also the best source of vitamin D, and we know that the higher the blood levels of vitamin D the lower the frequency and severity of symptoms. Just this June, a study showed that the more oily fish the patients consumed the more their symptoms decreased. Animal products, on the other hand, contain the pro-inflammatory arachidonic type of fatty acid, so go easy.
Evening primrose oil carries highly beneficial oils called GLAs, and compounds in green tea block the inflammatory effects of RA, and can even help repair the tissues involved. Supplementation with green-lipped mussel extract has been shown to improve symptoms in an impressive 75% of sufferers.
Vitamin D3, vitamin C, a good probiotic such as BioKult, an inulin supplement or Prebiotin, curcumin, ginger, pure fish oils/omega 3 (if you cannot regularly eat oily fish), quercetin, green tea extract, Evening primrose oil, bromelain, green-lipped mussel extract.