Rheumatoid Arthritis

Rheumatoid arthritis is a systemic disease, meaning that it affects the whole body. It is one of the diseases categorised as auto-immune. Auto-immune means that for some reason the immune system has turned on itself and is beginning to attack parts of the body, parts of self. The immune system is made up of lymph nodes or glands such as the tonsils, spleen and thymus; the bone marrow which makes the blood cells, in immunity it is the white blood cells that are important. One group of white blood cells produce antibodies in response to a foreign body. This foreign body is termed an antigen. This is a most important protective mechanism, because it is how bacteria, viruses and toxins are destroyed. It is this mechanism that also causes rejection of a donated organ; which must be supressed with drugs. What causes the body to attack itself, in other words for the antibody to not recognise self as self, but to treat it as foreign is not fully understood but infection may have played a part; or specific foods may trigger the antibody production. The suggestion is that the tissue attacked may have some resemblance to the bacteria or virus and the body simply gets confused. Auto-immune diseases tend to run in families, not necessarily the same disease but one within the group such as: scleroderma, Crohns disease, Graves’ disease, Lupus, Psoriasis, Multiple Sclerosis and others. This means that there must also be a genetic basis to the development of an autoimmune disease,

The parts of the body most commonly attacked in rheumatoid arthritis is the joint lining, particularly the smaller joints of the hand and feet but larger joints can be affected. The biggest symptoms are: pain, stiffness, especially after rest when the joint hasn’t been used. Tiredness is another symptom suggestive of the fact that this is a whole body disease. As with all autoimmune diseases the condition can vary in intensity, both in time and person. One individual may have a slowly developing disease with slight symptoms; another can have a rapid, aggressive disease with many symptoms. In some people the symptoms can wax and wane, so that they can have periods of remission and periods when the symptoms flare up again. Severe rheumatoid arthritis can result in distinctive deformity of the joint resulting in loss of movement; it can also affect the lungs and the kidneys. Early treatment with modern drugs can limit the degree of deformity.

How can Functional Biochemistry help someone with rheumatoid arthritis?
At the very least it can help by making sure that the individual remains as well as possible by making sure that they have all the nutrients that they need. More specifically it can identify any food which is acting as a trigger and also to replace any deficiency of a specific nutrient to boost the immune system to make it work more effectively.

The liver produces enzymes that break down protein this is important because our own cells are constantly being recycled and the old ones have to be broken down. Equally, when our bodies have fought an infection the micro-organism has to be broken down, but research has found that in many autoimmune diseases these protein digesting enzymes have got out of control. In Rheumatoid Arthritis as it is the protein lining of the joint that it is attacked. Most things in the body work by creating a balance between action and inhibition; and just as there are enzymes that attack there are enzymes that block these attackers. The enzyme that blocks attack has zinc as part of its effective armoury, which may suggest that a zinc deficiency is reducing the effectiveness of the inhibitory or blocking enzymes. T cells, one of the group of white blood cells, also have a role in protein destruction, and they too have a mechanism to check their activity, this mechanism is from another group of T cells, called T cell regulators; it has been found that these regulators are less in number in autoimmune disease. Unfortunately most of the research is looking at ways to mimic T Cell regulation, or block the protein destructive chemicals through drugs; rather than encourage the body to create a better balance between attack and inhibition itself, by recognising the nutrients that do this naturally. However, there is evidence that vitamin D is important in the action of the T cells and a deficiency of vitamin D is linked to autoimmune disease.

I never promise to cure anybody of anything. But I do promise to try and find a natural solution that uses the body’s own mechanism to remain well and therefore fight disease.

Why should somebody become so deficient in a nutrient that they become ill; surely so long as we eat well we should get enough?
Evidence suggests otherwise, I’m afraid.   In the section entitled Functional Biochemistry I list a whole host of reasons why not, but it may be useful to repeat them here.

The body is made from the genetic material that we inherited from our biological parents, from what we gained from our mother during pregnancy and after that entirely from the nutrients that we digest, absorb and use from what we eat. Everything in our body is driven by enzymes and the recipe of each of these enzymes is inherited. Sometimes we can inherit enzymes that don’t work as well as they should; and to make them work they use more of a specific nutrient, so that in time we become deficient. Enzymes can also become damaged during our lives by micro-organisms and by the high temperature that may result from an infection. They can be damaged by poisoning with heavy metals and toxic chemicals. The ageing process in itself damages our enzymes. These enzymes are not the enzymes that digest our food in our stomachs and intestines; they are inside every cell, thousands of them driving every aspect of body function. Many diseases result from inherited factors, in our genes; which result in enzyme dysfunction. The dysfunction can be so great that the embryo or foetus cannot survive and dies before birth. Sometimes the baby survives pregnancy but is born with what is called a metabolic disorder and becomes ill very quickly. Doctors and research chemists at Berkley University and the Children’s Hospital Oakley California  are giving mega doses of minerals and vitamins to children who are born with severe metabolic diseases, who would die without intervention, and getting very good results[1].

The amount of a vitamin or minerals that an individual is said to need is called the RDI, Recommended Daily Intake. The RDI has been estimated on the amount required by 98% of the average healthy adult population to remain well; there is no estimation for an already ill person, or for specific illnesses; or for the remaining 2% of the healthy population. In fact this does not determine what health is, but simply the absence of current disease. Doctors rarely test for mineral and vitamin content in the body and if they do they usually test the blood levels which do not tell you what is going on inside each cell and remember the B group vitamins have to be activated, which takes place inside the cell.

There is equally no real evidence as to what the average food of today is yielding in terms of the vitamin and minerals content. Some recent research has found that the soils are becoming deficient in minerals and inevitably so will our food. At the very time when we need more because we are exposed to so many artificial and potentially toxic chemicals in food water and air, 75, 000 man-made chemicals since the 1930’s; which require nutrients to break them down so that they can be excreted. A major source of vitamin D is sunlight; however we are spending less and less time out in the daylight and increasingly we are preventing the  body’s ability to convert sunlight into vitamin D because of the widespread use of sun blocking creams to prevent skin  cancers. I am not advocating that these should not be used but that we allow ourselves 20 minutes a day exposure to the sun prior to the use of protection, this exposure should not be at the hottest times of the day.

I have a book called E for Additives, these are the additives that are recognised by the EU as acceptable to routinely add to food. They are given a number preceded by the letter E to denote the fact that they are recognised by the European Union food legislative body. The book has 204 pages   with roughly 2 additives a page. Some of these are natural ingredients most are not. Many of the colours and preservatives are made from chemicals derived from crude oil, otherwise known as petro-chemicals. Many of these chemicals have no known side effects but many do: gastric irritation, asthma, even liver and kidney damage. Some additives it is suggested interfere with the body’s ability to absorb minerals and vitamins.

Illness has a variety of causes: genetic inheritance, injury, structural damage, nutritional deficiency. But even those caused by damage and injury may have a nutritional basis; in that the structure was not as strong as it could be and that the nutritional status of the body cannot support repair through regeneration of new tissue. This nutritional deficiency may stem from genetic inheritance in that we have inherited an enzyme that requires more of a specific nutrient to make it work. It therefore seems perfectly logical to me that disease frequently suggests that the body is lacking something and the way out of this disease is to find out what and give it that what. It is very likely that due to inherent and environmental factors the individual requires more of a specific nutrient, that the Recommended Daily Intake (RDI taken over the older term RDA) is not sufficient. Zinc is required in 250 known chemical reactions in the human body, and a zinc deficiency will demonstrate itself in a number of symptoms. This could be the explanation for the variety of symptoms that can occur in any one disease. Magnesium is required in 300 known chemical reactions in the body and so a deficiency will also include symptoms that involve more than one system. A deficiency of a nutrient because it is involved with so many reactions will not always cause the same symptom in different people; because one system of one individual may need more of a specific nutrient than another. Sometimes the same symptom can be caused by a deficiency of a different nutrient because the role of the various nutrients overlap; so that sometimes a deficiency will be caused by zinc, sometimes magnesium; sometimes both. I use zinc and magnesium because they have such a major role in the human body but deficiency of different nutrients can also result in symptoms. For example vitamin D deficiency is also implicated in many auto-immune diseases; and it is estimated that vitamin D deficiency has increased as a result of the widespread publicity and use of ultra violet light blockers to prevent skin cancer. We also spend far less time out of doors these days than we did throughout any period of our evolution.

Many find that they benefit from a gluten free diet, suggesting that gluten, a protein found in wheat, barley and rye, may actually be acting as an antigen or trigger. Many suggest avoidance of oats too which do not contain gluten naturally but are frequently processed along with wheat and may become contaminated. The protein of cow and sheep milk has also been found to act as an antigen, so a dairy free diet can also be helpful for some. There are other foods that may also act as an antigen. Aspartame, an artificial sweetener, should be avoided as consumption has been reported to increase flare ups. Currently most low sugar foods and drinks contain aspartame and may cause production of an antigen. There has recently been the introduction of a natural sweetener made from the leaves of the plant Stevia this should be used in preference. Many of the artificial additives can have potentially toxic effects and the diet should be as natural and organic as possible.

There are many who believe that auto-immune conditions arise when the body is too acid. Acidity is created when too much protein, especially animal protein is consumed. Acidity occurs as a result of stress and breakdown of the body’s own protein. And as can be seen from the reference to the enzyme that attacks and increases breakdown of protein this is potentially already happening. It may be helpful, therefore, to try and reduce the acidity through diet and many with rheumatoid arthritis do benefit from specific diets, such as vegan low protein, Mediterranean diet. However, the body will still require sufficient levels of all of the essential amino acids, and of the minerals contained in protein; such as iron in red meat, zinc more widely distributed in animal protein than vegetable protein because the farmers and the vets know about the need for minerals and supply the animal with mineral supplements.

There is evidence to suggest that taking omega 3 fatty acids helps with Rheumatoid Arthritis. We need both omega 6 and 3 fatty acids,  Omega 6 is gained in the diet mostly from LA (linoleic acid) found in many vegetables. Linoleic Acid is converted by the body into GLA (gamma linoleic acid) and AA (arachidonic acid). AA promotes the development of inflammation. Omega 3 found in flax seed as LNA (linolenic acid) is converted into EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). EPA and DHA are found in fish oil and are anti-inflammatory. I have included these long names in brackets because I thought I ought to but in reality only ever refer to them by their abbreviation, after all who can pronounce them. But there will be some who will want to know what the abbreviations stand for. Inflammation is not essentially bad it is necessary for healing; but with an autoimmune disease it is continually destructive. It is estimated that historically we probably had a 1 to 1 ratio of omega 6 to omega 3, but now that that ratio is more likely to be 22 to 1 with our modern diet. This means that we are eating many more foods that encourage inflammation and not nearly enough that discourage. There are some individuals who have inherited a reduced ability, because of poor enzyme function, to convert the omega 3 fatty acids from the inactive dietary form into that which is usable by the body. This will again increases the already biased ration and the risk of inflammatory disease. Taking an omega 3 fatty acid rich in EPA/DHA will offset this difficulty. The omega fatty acids are an inherent part of all cell walls increasing lubrication and preventing dehydration. A dehydrated cell is more prone to damage.

There are some who believe that auto-immune disease has increased as we have become cleaner and free from worms and other parasites. It is thought that these parasites managed to survive along with us because they dampened down our immune system, in doing so reducing the chance of us attacking them and, in doing so, also ourselves.

It may well be that rheumatoid arthritis is caused by a number of different factors effecting people in a variety of ways. This is why a variety of different treatments are found to have a good effect and why it is important to try a number of these treatments until you find what is right for you.

I never suggest that a person does not see their doctor, nor do I interfere with the treatment the doctor is prescribing. This is especially true of a major debilitating disease like rheumatoid arthritis, but it must also be recognised that the drugs used can have important side effects.

References:

  1. Journal of Clinical Nutrition Vol75 No American 4 616-658
  2. PMID: 11600749; A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens.Rheumatology (Oxford). 2001 Oct;40(10):1175-9.
  3. PMID: 12594104; An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis.Ann Rheum Dis. 2003 Mar;62(3):208-14.
  4. PMID: 12548439; Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. 2003 Jan;23(1):27-36. Epub 2002 Sep 06.
  5. PMID: 11890437; Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002 Feb;8(1):71-5.
  6. PMID: 11154796; Antioxidants in vegan diet and rheumatic disorders. Toxicology. 2000 Nov 30;155(1-3):45-53.
  7. PMID: 15513677; Aetiological factors of importance for the development of rheumatoid arthritis. Scand J Rheumatol. 2004;33(5):300-6.
  8. PMID: 11708441; Fish oils are beneficial to patients with established rheumatoid arthritis. J Rheumatol. 2001 Nov;28(11):2563-5.