Diet and Arthritis (2)

Last week we introduced the topic of arthritis, quoting incredible figures that suggest up to 55% of South Africans will suffer from arthritis of some form or other, rising to 82% in those over the age of 65.  And yet amongst traditional societies the incidence of arthritis is quite rare.  This therefore points to Westernisation in diet and behaviour that causes this high incidence.  Today we are going to look at some interventions to both prevent and perhaps even reverse this trend.

ALSO READ : Turning the Tide – Dealing with the main lifestyle-related conditions in South Africa (Part 13)

The most research has been done in inflammatory joint disease, like rheumatoid arthritis and lupus.  Similar benefits from the interventions offered below have been obtained in other autoimmune diseases such as psoriasis, ulcerative colitis, Crohn’s disease and multiple sclerosis.  I have seen reports of multiple studies done as early as the 1980’s showing sometimes dramatic improvement from simple remedies with rheumatoid arthritis.  See this article referenced last week.

The most rapid benefit accrues from water fasting.  Often within a week the pain and inflammation has substantially subsided.  This effect has been demonstrated in many different studies. (Please note that a water fast lasting longer than 1 week should be medically supervised, by someone who is trained or experienced in this intervention). Of course a prolonged water fast is not sustainable, and should only serve as a re-booting of the system.

Numerous other studies have shown that cutting out all animal proteins in the form of meat (red or white), dairy and eggs can bring equally remarkable results in about half of participants.  Many people find additional benefit in cutting out wheat and even maize, and occasionally even the elimination of brown rice can help.  However the most consistent benefit comes from reducing fat consumption in the form of corn oil, seed oils, even olive oil, and of course animal based fats.  One can often see dramatic drops in inflammatory markers doing blood tests before and after introducing these dietary restrictions.

So what can one eat then?  Obviously the above elimination diet, is not for everyone but can bring dramatic relief to many people suffering from chronic inflammatory pain.

One is encouraged to eat a whole food, plant-based diet rich in all kinds of fruits, berries, vegetables of every colour, cereals if they don’t cause problems, root vegetables, pumpkin and squash, some seeds and tree nuts and plenty of legumes. 

In most of the studies that I have read, those who did best in relieving their symptoms were those who were most strict about sticking to their elimination diet.

But what was most striking in some of the studies, was how quickly the symptoms returned in those who, even for few days, returned to dairy or animal proteins.

What is the basis for the pathophysiology (the underlying causes) of these negative effects of such diets on arthritis?  Last week we spoke about the “leaky gut syndrome” and how that a damaged single cell lining of the intestines allows the entrance of large antigenic protein molecules into the blood stream, which then increases the inflammatory response to these “foreign proteins”.   This may be one of the ways that the body manufactures antibodies against its own structural proteins – the cause of autoimmune disease. Normally proteins are broken down into non-antigenic amino-acids in the small intestine, which have no inflammatory effect in the blood stream.

A damaged gut lining also allows toxins produced by an unfriendly microbiome, as well as ingested environmental toxins, to gain access into the blood stream and wreak havoc upon our normal physiology.  The friendliest health-promoting microbiome is found in people who consume plenty of dietary fibre – found only in plant-based foods.  There is no fibre in animal products, and many processed foods have had much of the natural fibre removed.

Other reasons for inflammatory effects of western diets.

• Fried meats particularly, but in fact any fried foods (rich in fat obviously), as well as prepared frozen meals, can produce inflammation. Cutting back on these foods, so common in so many well-known fast food restaurants can make a big difference.  The types of foods include fried chicken, burgers, fried chips, fried fish, fried sausages and reheated frozen meals.

• Advanced glycation end products (AGEs). This is a toxin produced when foods are heated to high temperatures, such as in grilling, frying or pasteurising. It damages certain proteins in the body. These damaged proteins cause the release of cytokines – that are inflammatory messengers, which can cause inflammation of joints.  The solution is to cut way back on fried or grilled foods, and rather steam or cook foods.

• Sugars and refined carbohydrates increase the production of AGEs. Sugar, of course, is found in cook drinks, fizzy drinks, fast foods, sweets, sweetened yoghurt and ice-cream.  Refined carbohydrates include anything made from cake or white bread flour – cakes, biscuits, buns, white bread, pitta breads, crepes and pancakes, muffins, waffles; white rice, high processed breakfast cereals – which are all loaded with sugar and highly refined grains.

• Dairy products: The protein in milk is predominantly casein.  In some people this may irritate joints.  There are also pro-inflammatory substances in milk that can affect the immune system, and cause nose and throat irritation and inflammation, as well as allergies.

• Alcohol and tobacco both cause inflammation which can aggravate rheumatoid arthritis. Alcohol can also aggravate gout – another very painful inflammatory joint condition.

• Salt and preservatives can increase inflammation – whereas fresh vegetables, especially green and leafy vegetables are like the fire department of the body – putting out fires of inflammation.

• As mentioned before, cutting way back on oil and fat, even plant oils, especially those high in omega 6, have been shown to reduce inflammation. Examples of oils high in omega 6, and low in omega 3 include peanuts, sunflower oil, almonds and cashews.  On the other end of the spectrum foods having a high omega 3 ratio include linseed and chia seeds, green leafy vegetables, canola oil, walnuts, soybeans and macadamia nuts. Avocados and olive oil has a moderate omega 6 to 3 ratio.

Obviously we are not suggesting that everyone needs to have such a restrictive diet, but there are very many health benefits, for everyone, and especially those suffering from arthritic pain – but also any chronic lifestyle disease such as obesity, diabetes, high blood pressure, kidney failure, even cancers.  We can’t abuse our bodies by shovelling in highly processed and altered foods, and not expect to suffer the consequences of such an unnatural diet.

ALSO READ : Turning the Tide – Dealing with the main lifestyle-related conditions in South Africa (Part 12)

Here is a good link, with many references on the above subject of omega 3 vs 6:

Here is a real-life story for those interested:

What does all this information tell us?  There is hope for people suffering from chronic pain related to arthritis – both inflammatory arthritis like rheumatoid arthritis, and also from degenerative arthritis.  Although one cannot reverse the destruction to joints associated with these diseases, it is certainly possible to reduce pain and increase mobility from diet, and from exercise, under the guidance of physiotherapists and occupational therapists.

To a week ahead, with hope for arthritis sufferers.

Dave Glass

Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

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