Rheumatoid Arthritis and Integrative Medicine

By Dr. John Gannage, MD

Understanding Inflammation and Autoimmunity

Rheumatoid arthritis is a chronic, progressive disease affecting joints and related tissues. It is an autoimmune disease affecting 3-5% of the population, with 50 % of those affected stopping work within 10 years due to disability. Conventional medical treatments aim to reduce joint destruction, and are well known to have benefits but toxic side effects in some patients. An approach that reduces inflammation through nutrition support is potentially very useful in changing the painful and sometimes debilitating face of this disease.

The risk factors for developing rheumatoid arthritis are genetic, female gender (is there a hormone connection?), and past infection. A holistic approach considers such aspects, with the understanding that genes favouring the possible development of inflammation require an environmental trigger – such as a dietary influence, infection or chemical exposure – in order to become turned on and negatively expressed.

It has also been documented that an abrupt psychological trauma or stressor heralds the onset of the disease. The following aspects are to be considered when using a biological or integrative approach:

1. Identify Food Triggers

The premise is that foods are chemicals, potentially negatively interacting with our genetic makeup to produce an outcome that favours inflammation. The immune system, recognizing a substance as foreign, sends out what are intended to be protective antibodies, which then confuse normal tissue with foreign, and attack the membranes in joints in a way that leads to inflammation – redness, swelling, pain and stiffness. The foods that most commonly are involved in this inflammatory process are: cow’s milk products, caffeinated beverages, corn, the gluten grains including wheat, citrus fruits, shellfish and/or the nightshade vegetables including tomato. A minimum 1-month trial of elimination would be required to evaluate possible food triggers. John Irwin, M.D., in his book “Arthritis Begone!” has an excellent chapter on food elimination. It is a good resource for anyone with any form of arthritis.

2. Address The Gut

I often find, on taking a detailed medical history, that patients with autoimmune disease have symptoms related to digestive function, such as excess bloat, gas, cramping or disturbance of bowel function. There may be a history of excessive prior antibiotic use that disturbs the balance of friendly bacteria in the GI tract. These bacteria are protective and aid digestion, and can be eliminated in an unwanted fashion by antibiotics. Undigested food particles, food sensitivities, and release of biotoxins from harmful gut bacteria can all trigger the unwanted inflammatory response. An approach that emphasizes reinoculation with the normal, healthy bacteria; replacement of digestive enzymes; and repair of the injured intestinal lining may provide assistance to the rheumatoid arthritic patient. Adhering to some form of elimination diet while addressing these issues increases the chance of success.

3. Support Detoxification

The liver has a myriad of functions within the body, including clearance of the excessive amounts of chemical toxins that pollute our environment and enter our tissues. Through the process of “molecular mimicry” described above, where the immune system is confused and mounts a response against our own tissues after exposure to a chemical or infectious agent, the ball gets rolling toward autoimmunity. Immune complexes have formed, as our defense mechanisms kick in, and must be cleared by the liver. If not neutralized, they accumulate in unwanted places where inflammation then ensues. Support for detoxification is a vital part of an integrative approach, and will often address other unwanted symptoms such as brain fog and chronic fatigue. Strategies employed in detoxification include: avoidance of ongoing chemical exposure; restoration of normal gut function, and especially avoidance of constipation; use of liver supportive supplements, in herbal or homeopathic form, under the guidance of a health professional; evaluation of metal toxicity, and approaching its removal carefully; specialized lipid exchange therapy (popular in Europe) and glutathione infusion; consideration of colon irrigation therapy; addressing lymphatic congestion; consideration of hyperthermic detoxification, or sauna therapy. It is important to have a solid base in healthy nutrition practices before pursuing any and all of these strategies, and to work with a trained health professional.

4. Correct Nutrition Imbalances

Once again, a diet high in refined carbohydrates rears it ugly head. Fatty acid metabolism and balance is essential to membrane structure in all tissues and to regulating the output and function of local hormones (termed cytokines) that are involved in inflammation. Refined carbohydrates cause fatty acid imbalance and unwanted high amounts of pro-inflammatory cytokines. Lack of trace minerals is also an issue.

Of particular concern in recent years is the potentially excessive use of omega-3 fatty acids, as contained in fish and flax oil supplements. Important studies have proven the value of these oils in heart, psychiatric and other diseases, but their unmitigated ingestion can result in omega 6 deficiencies and promote what’s become known as “Omega 3 Overdose Syndrome”, according to Patricia Kane, PhD. Finger joint pain, thin skin, heart palpitations, dry eyes and eczema characterize this condition.

Omega 6 and 3’s are both essential fatty acids requiring balance (in a dietary 4:1 omega 6 to 3 ratio according to S. Yehuda and Kane). Toxic chemical accumulations selectively deplete omega 6, and lowered omega 6 leads to abnormal immune response and compromised cell membrane function, such as what occurs in rheumatoid arthritis. To complicate matters further, omega 3 deficiency will cause similar effects, meaning the key is balance.
A cookbook approach unfortunately can’t be recommended for arthritic patients, since individual requirements – based on diet, genetics and toxic exposures – are so highly variable when it comes to essential fatty acid requirements. To illustrate, Joel Kremer, MD, chief of rheumatology at Albany Medical College in New York and a leading researcher on fish oil (an omega 3), says that despite more than a decade of study, researchers still don’t know the optimal dosage, or if a combination of oils might work better than one alone. Meanwhile, Lawrence Leventhal, MD, chief of rheumatology at Graduate Hospital in Philadelphia, says many of his rheumatoid arthritis patients are taking supplemental borage seed oil (an omega 6), with good success in some cases. Another recommended omega 6 is evening primrose oil, which, like borage oil, contains the anti-inflammatory GLA in more concentrated fashion. (A six-month study reported fewer signs of inflammation in rheumatoid arthritis sufferers taking capsules containing GLA than in those taking a placebo.) Perhaps what needs to be considered is the concept of individualizing therapy, based on testing levels and prescribing accordingly. This requires the understanding that, despite the same diagnosis, two patients with rheumatoid arthritis may have completely different fatty acid needs, as appears to be the case. A detailed Red Blood Cell Fatty Acid Analysis can be used to evaluate levels, imbalances and supplement needs. Additionally, Live Blood Microscopy will often show membrane distortions and related “stickiness” i.e. aggregation of the red cells and platelets when such imbalances and chemically related effects exist.

5. Introspectively Manage Stress

As mentioned, an emotional trauma can herald the onset of autoimmune disease. Stress is a contributing factor in ALL modern illness, and through complicated biochemical pathways causes hormone disturbance that leads to inflammation. DHEA is a hormone released by the stress glands i.e. the adrenals, and helps to regulate the immune response, but is depleted with unhealthy ageing and chronic daily stress. A comprehensive integrated approach to rheumatoid arthritis should include management of unhealthy emotions and built up emotional toxicity, where they exist.

To summarize, rheumatoid arthritis is a complicated autoimmune illness that can be literally disabling. A strategy that employs nutrition-based therapies adjunctively, as part of a healthy lifestyle and treatment plan, can be used with success to assist in the anti-inflammatory process.

Disclaimer: The information contained in this article includes the opinions of Dr. Gannage and is for educational purposes only. One should always seek the personalized advice from a qualified practitioner before making the dietary and behaviour changes listed, as the needs and medical status of individuals are highly variable. Dr. Gannage is not responsible for any adverse events that might occur from application of any of the therapies outlined in this article.

Dr. John Gannage, as a licensed physician, practices Integrative and Functional Medicine in Markham, Ontario, serving the Greater Toronto Area and beyond. He earned his Medical Degree from the University of Toronto. He recommends therapeutic lifestyle programs and various detoxification strategies to assist in the management of chronic health problems. His services include nutrition counseling, vitamin infusions and chelation therapy.