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Strong Intestinal Health Relieves Rheumatoid Arthritis
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 1991;338:1209.

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 1983;12(2):161­5.

4 Wolfe MM, Soll AH. The physiology of gastric acid secretion. N Engl J Med 1988;319(26):1707­15.

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 1991;47(3):534­48.

10 Seignalet J. Diet, fasting and rheumatoid arthritis. Letter. Lancet 1992;339:68­9.

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).





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