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Strong Intestinal Health Relieves
by Melvyn R. Werbach, M.D.
Rheumatoid arthritis is a painful degenerative disease that affects
joints and other tissues. A chronic inflammatory process, it causes affected joint linings
to overgrow and the joints themselves to erode. Usually its course is progressive, with
periodic exacerbations and remissions. After 10 years, slightly less than half of those
afflicted with this disease can continue to work. After 20 years, there is a one in three
chance they will be unable to work and perhaps be wheelchair-bound.
The exact cause of rheumatoid arthritis is unknown. However, astute clinicians have long
been aware that, for some patients, removing certain common foods such as dairy, wheat,
corn, yeast, eggs and beef can bring blessed relief, while their return can cause a
flare-up. This clinical impression has prompted a number of research studies, with
impressive results. We now know that improvement following an elimination diet appears to
be frequent and long-lasting. For example, of 100 patients who were treated over the span
of a decade by eliminating the foods to which they reacted, one-third were still well and
needed no other treatments for their illness after as much as 71/2
years of follow-up.1
Improvement following the elimination of reactive foods is not limited to pain relief.
Fasting, the ultimate food elimination diet, is associated with reduced joint inflammation
as well as with improvement in laboratory markers of inflammation.2,3
Reduced stomach acid affects perhaps 10 to 20 percent of people with rheumatoid arthritis4
and appears to be partly responsible for their high prevalence of food sensitivities.
These levels are not low just during fasting; they also are low during digestion, when
they should be increasing.5
Specifically, if gastric acid is low, it may inhibit protein digestion. When the digestion
of food proteins is inadequate, the gut lining absorbs more partially broken-down products
(peptides and polypeptides). While amino acids, the fully broken-down products of protein
digestion, are invisible to the immune system, partially broken-down protein products
alert the immune system to the presence of perceived foreign invaders. The resulting
immune response, while probably not the initial cause of the rheumatoid arthritis, may
cause a flare-up.6
The lining of the small intestines blocks absorption of substances that aggravate the
immune system. However, rheumatoid arthritis is one of the conditions in which this
barrier becomes "leaky" and thus fails to sufficiently protect the body against
increased absorption of these partially broken-down products of protein digestion. For
people suffering from rheumatoid arthritis, even the mere presence of these products
further reduces the barrier function of the gut lining. One study, for example, found that
a period of fasting strengthened the barrier, while the reintroduction of a
lactovegetarian diet weakened it.7
Although the mechanism by which food-derived substances could promote rheumatoid joint
changes is poorly understood, we do know that food-generated inflammation is associated
with serotonin release from blood platelets.8 A powerful chemical mediator,
serotonin ultimately controls the discharge of neurons that transmit pain signals.9
Rheumatoid arthritis is a disease of modern civilization.10 Its responsiveness
to food eliminations suggests that it may have developed because of changes in our
ancestral diet to which we may not have fully adapted. For example, in prehistoric times,
cereals and dairy products were not eaten, and food was cooked only briefly.10
Moreover, the widespread use of nonsteroidal anti-inflammatory drugs may contribute to the
problem, as there is evidence that their use increases the leakiness of the gut lining.11
In my view, everybody with rheumatoid arthritis should try a food elimination diet,
preferably under the supervision of a licensed health practitioner. As previously
mentioned, totally eliminating common foods for a few weeks may be effective, or an
"elemental diet" consisting of a hypoallergenic and nutritious liquid drink can
be substituted for regular foods. If remission is achieved, then individual foods can be
added back slowly to determine if any of them exacerbate the arthritis. Please do not try
this diet, however, unless you are sure you will receive adequate nutrition while on it.
1 Darlington LG, Ramsey NW. Diets for rheumatoid arthritis. Letter. Lancet
2 Uden AM, et al. Neutrophil functions and clinical performance after total fasting in
patients with rheumatoid arthritis. Ann Rheum Dis 1983;42(1):4551.
3 Skoldstam L, et al. Specific plasma proteins as indices of inflammation during a
modified fast in patients with rheumatoid arthritis. Scand J Rheumatol
4 Wolfe MM, Soll AH. The physiology of gastric acid secretion. N Engl J Med
5 de Witte TJ, et al. Hypochlorhydria and hypergastrinaemia in rheumatoid arthritis. Ann
Rheum Dis 1979;38(1):147.
6 Walker WA. Role of the mucosal barrier in antigen handling by the gut. In: Brostoff J,
Challacombe SJ, editors. Food allergy and intolerance. London: Baillière Tindall;
1987. p 20922.
7 Sundquist T, et al. Influence of fasting on intestinal permeability and disease activity
in patients with rheumatoid arthritis. Scand J Rheumatol 1982;11(1):338.
8 Little CH, et al. Platelet serotonin release in rheumatoid arthritis: a study in
food-intolerant patients. Lancet 1983;2:297.
9 Rang HP, et al. Chemical activation of nociceptive peripheral neurones. Br Med Bull
10 Seignalet J. Diet, fasting and rheumatoid arthritis. Letter. Lancet
11 Bjarnason I, et al. Intestinal permeability and inflammation in rheumatoid arthritis:
effects of non-steroidal anti-inflammatory drugs. Lancet 1984;2:11814.
Melvyn R. Werbach, M.D., is a faculty member at
the UCLA School of Medicine and the author of Nutritional Influences on Illness
(Third Line Press, 1993).