Tag Archives: rheumatoid arthritis

Arthritis | The Paleo Diet
It’s often times a diagnosis of cancer, diabetes, multiple sclerosis (MS), or another disease which proves to be the pivot point for individuals to make significant changes to their eating and exercise habits. Whether the change stems from obvious reasons, like losing weight because obesity has been the causal agent for developing type 2 diabetes, or per the advice of their physicians to cut out gluten and dairy following an autoimmune diagnosis, these steps are reactive versus proactive.

If we were to exercise daily and eat foods that set us up for health, rather than sickness in the first place, would we be able to determine our destiny? Clearly, we can take preventative measures to lower our risk for obesity and type 2 diabetes by leading an active lifestyle, veering away from the typical, highly refined Standard American Diet (SAD), and implementing a Paleo diet.

But what about minimizing our risk for autoimmune diseases like rheumatoid arthritis (RA) with diet? Science suggests it’s looking quite promising.

Two studies presented at the American College of Rheumatology Annual Meeting in San Francisco show diet can significantly lower our chance for developing RA.1 RA is an autoimmune disease where the body’s immune system mistakenly attacks the joints, creating inflammation that causes the tissue lining of the joints to thicken, resulting in swelling and pain in and around the joint.2

For those following a Paleo regime, inflammation is hardly a foreign term, and you’re familiar with the notion that avoiding certain foods can help offset symptoms dramatically.3 But how does this scientifically factor into RA treatment or minimize risk altogether?

In the first study, researchers found “typical Western diets high in red meat, processed meat, refined grains, fried food, high-fat dairy, and sweets can increase a person’s risk of developing RA in comparison to Prudent diets (a diet low in total fat, saturated fat, trans fat, cholesterol and sodium which aid in lowering cholesterol and triglyceride blood levels and blood pressure)4 made mostly of fruit, vegetables, legumes, whole grains, poultry and fish.”

The second study found that “following the Dietary Guidelines for Americans can also lower one’s chances of developing the disease because they provide authoritative advice about consuming fewer calories, making informed food choices, and being physically active to attain and maintain a healthy weight, reduce risk of chronic disease, and promote overall health.”

How was this measured? By using the Alternate Healthy Eating Index, created to measure how well participants followed the Dietary Guidelines for Americans, researchers observed associations of the subjects’ diets and their likelihood of developing RA. The researchers noted those who best adhered to the Dietary Guidelines for Americans had a 33% reduced risk of developing RA when compared to those who did not follow the guidelines as closely. And, just as in the first study, the researchers noted that body mass index may be a modest intermediate factor linking diet and risk of RA.

A few questions arise. If the sole means of data collection was to review and analyze what the participants reported to eat, how accurate can the findings really be? Were findings measured upon accountability and how can we be sure participants didn’t take the liberty of “cleaning up” their food log entries, energy levels, or sleep patterns?

A colleague of mine joked in reference to a new client who’d touted the benefits of a new fad diet, “any eating plan is going to ‘work’ in comparison to what one did before, because before, they didn’t have one!”

Researchers state “the single-nutrient approach may be inadequate for taking into account complicated interactions among nutrients, and high levels of inter-correlation makes it difficult to examine their separate effects.” So grouping all foods into  one lump category (recall the list: “diets high in red meat, processed meat, refined grains, fried food, high-fat dairy, and sweets”) doesn’t differentiate between high quality, grass fed meats, from the corn-fed beef. Nor does the “diet made mostly of fruit, vegetables, legumes, whole grains, poultry and fish” distinguish the effects of antinutrients contained in legumes and grains,5 or the glycemic load of eating too much fruit.6

While I do agree that a healthy diet may prevent RA development, it’s a matter of deciphering what actually comprises a healthy diet. And from everything I’ve read and seen over the past decade, I certainly don’t need further convincing that a real Paleo diet can be the remedy to addressing a diagnosis of RA. By eating a diet rich in alkaline, anti-inflammatory foods, the body is armed with its best defenses and most equipped to stay diseases free for a healthy, long life!

References

1. “Diet May Determine Your Risk for Rheumatoid Arthritis.” ScienceDaily. ScienceDaily, n.d. Web. 16 Nov. 2015

2. “What Is Rheumatoid Arthritis?” What Is Rheumatoid Arthritis? Arthritis Foundation, n.d. Web. 16 Nov. 2015

3. Wahls, Terry L., and Eve Adamson. The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine. N.p.: n.p., n.d. Print

4. “What Is the Prudent Diet?” LIVESTRONG.COM. LIVESTRONG.COM, 30 June 2015. Web. 16 Nov. 2015

5. Stephenson, Nell. “Antinutrients, the Antithesis of True Paleo | The Paleo Diet.” The Paleo Diet. The Paleo Diet, 10 Mar. 2015. Web. 16 Nov. 2015

6. “Glycemic Index and Glycemic Load | The Paleo Diet | Dr. Loren Cordain.” The Paleo Diet. N.p., n.d. Web. 16 Nov. 2015

Wheat | The Paleo Diet

Click Here to Start The Wheat Series from the Beginning!

It’s one of the most commonly used analogies in existence and it’s about a game that few want to play. A revolver is loaded with a single bullet. The hapless players take turns putting the gun to their heads and pulling the trigger. The analogy is often used to make a point about the high stakes of luck. Eventually someone gets a loaded chamber and pays the ultimate price.

There is a second side to the analogy, however that is frequently overlooked. Regardless of whether you have extremely good or bad luck, you first have to willingly pull the trigger.

We’ve known for a while that most chronic diseases such as cancer, autoimmune disease, and heart disease have a genetic component.1 – 10 Genetics are the loaded bullet that we sadly have no control over.

For celiac disease, the “bullet” is a genetic variant in HLA-DQ.11, 12 However, a large number of people with the variant never express the disease. Further, those who do develop the condition usually resolve it by removing gluten from their diet.13, 14 In other words, the bullet might be in the chamber, but often the gun is never fired.

Environmental factors ultimately pull the trigger.

In the first four parts of this series we talked about how wheat (and to a degree other gluten-containing grains such as rye and barley) is highly effective at dysregulating the immune system of our guts. In fact, it’s the only food we know of that affects all three pathways of dysregulation:

  1. Opening up the tight junctions of our gut (Part 2)
  2. Excess and chronic bacterial stress (Part 3)
  3. Harmful dietary antigens (Part 4)

In this final part, we’ll talk about how the resulting chronic inflammation leads to a pathological state that essentially “pulls the trigger” on disease. But just as importantly, we’ll discuss how there has to be a bullet in the chamber first. The genetic susceptibility has to be there.

It’s Not So Easy to Pull the Trigger

Our genetics have not changed in the last 100 years. Yet, chronic disease such as autoimmune conditions and cancer have risen dramatically. Faster than rate of population growth.

In other words, going with our analogy, the number of bullets hasn’t changed, but for some reason the trigger is getting pulled a lot more often. Which is surprising considering no one wants to pull it.

Imagine for a minute what it takes for a person to get to the point where they will voluntarily put a gun to their heads. None of us handed a revolver and told we have a five in six chance would exclaim “sure, those sound like good odds.”

From what little we understand, Russian Roulette players essentially have to build up to it, engaging in other risky behavior, and slowly desensitizing themselves. As it turns out, a lot of behavior altering substances help too.15

Likewise, our bodies have a lot of defenses to avoid ever pulling the trigger on disease, even when the bullet is there.

So, while we hopefully made the case in the previous four parts that wheat is not good for us, one piece of bread isn’t going to give you cancer. Despite all the dysregulation of our immune system caused by wheat, it still takes a lot to build up to the point of disease.16, 17

Building Up to It…

In fact, as we discussed in Part 1, all the inflammatory processes activated by wheat are both normal and necessary processes designed to deal with regular bacterial stress. Mice breed without these inflammatory responses suffer severe tissue damage and wasting disease.18, 19

Even the temporary shift in the balance between two critical immune cells – Tregs and TH17 cells – is a natural response to this inflammation. Let’s explore these two cells a little more.

In a healthy state, Tregs dominate. Their role is to suppress the immune system20 – 24 preventing it from damaging our own bodies. People unfortunate enough to have dysfunctioning Tregs suffer severe autoimmune diseas.25

TH17, on the other hand, have a murkier and less benign role. Only discovered in 2006, they solved an important puzzle for researchers. Scientists knew that T cells were involved in many conditions but none of the known T cells at the time fully explained disease development.26

With the discovery of TH17, they had their answer.26, 27

Proving to be highly inflammatory cells, TH17 effectively explained the damage in a multitude of chronic diseases16, 28 – 31 such as asthma,32 heart disease,33, 34 and most autoimmune conditions30, 35 including celiac disease,36, 37 type I diabetes,38, 39 Crohn’s disease,40, 41 rheumatoid arthritis,31, 42 and multiple sclerosis.43

A question remained, however: Why would our bodies produce such a self-destructive cell?

The reason lies in their role. It was believed that TH17 cells evolved to deal with harmful bacterial infections and effectively handling the invasion means doing some damage to our own bodies.19, 44, 45

This damage seems to be acceptable to our bodies and even part of a healthy immune response as long as one essential condition is met – the shift towards TH17 dominance is short-lived and ends. Once an infection is dealt with and the resulting inflammation quiets down, TH17 cells die off and Tregs return to dominating our immune system.24, 46

So what happens if the inflammation doesn’t end?

According to one emerging theory, the result is an out-of-control pathogenic form of the TH17 cell.10, 23, 24 In other words, if normal bacterial stress causes a little risky behavior by inciting beneficial TH17, chronic inflammation causes the buildup that leads to the pathogenic TH17 putting the gun to our heads and pulling the trigger.

Chronic Inflammation – Putting the Gun to our Heads

The diagram below shows the different responses between normal and chronic inflammation.30

Chronic Inflammation | The Paleo Diet

Kamada, N., et al., Role of the gut microbiota in immunity and inflammatory disease. Nat Rev Immunol, 2013. 13(5): p. 321-35.

Let’s explore this destructive shift a little more closely. Bear with me – this gets technical.

Under normal inflammation, the number of Treg cells increase alongside the TH17 cells allowing Tregs to continue controlling TH17’s destructive potential and maintain some balance.30, 47

But in chronic inflammation, a dramatic shift occurs. More and more innate immune cells such as dendritic cells and CD14+ macrophages (explained in Part 3) are activated or recruited to the digestive immune system.17, 28, 48, 49

Over time, these cells change the chemical milieu of the gut to one that is high inflammatory. Il-23 is released which both promotes the destructive form of TH17 and inhibits Tregs.27, 47, 50, 51 Newly recruited CD14+ macrophages also suppress Tregs.52

In fact, it gets worse. The chronic inflammation causes Tregs to “flip” and start behaving like TH17 contributing to the inflammation instead of preventing it.47, 52, 53

The result is that chronic inflammation breaks the Treg/ TH17 balance. Treg lose their ability to control the immune system and TH17, now uninhibited, take on a more destructive form traveling from the gut45 throughout the body pulling the trigger:30

Gut Microbiota | The Paleo Diet

Kamada, N., et al., Role of the gut microbiota in immunity and inflammatory disease. Nat Rev Immunol, 2013. 13(5): p. 321-35.

This is the point where you may want to remind me that this is the fifth part in a series about wheat. Where does wheat come into all of this?

Wheat, as we’ve shown in the previous parts, creates the chronic inflammation that sets off this cascade. In fact, in one study of mice, that tested many dietary antigens, wheat was the only one that could activate inflammatory TH17 cells.54

Put simply, wheat sets in motion the build-up that causes our bodies to ultimately put the gun to our heads and pull the trigger.

Why Aren’t More Guns Going Off?

The very sobering thought is that the chronic inflammation, which wheat is so effective at creating (in fact it took three parts to explain all the ways wheat can cause it,) appears to be common to everyone.17, 20, 55

So why aren’t we all sick?

This is where we need to flip things around and remember there are two parts to the Russian Roulette analogy. Wheat causes our immune system to put the gun to our heads and pull the trigger, but there still needs to be a bullet in the chamber. The genetic susceptibility has to be there.

Sure enough, a genetic susceptibility to chronic inflammation has been identified in many conditions. Often taking the form of a hyper-sensitivity to inflammation or a failure of the Treg system to suppress it.

CD14+ macrophages appear to be particularly potent in rheumatoid arthritis.56 Celiacs are hyper-sensitive to Il-15 – one of the key proteins used by wheat to produce inflammation.3 Much higher levels of inflammatory CD14+ macrophages exist in the guts of people with Irritable Bowel Disease (IBD).57 IBD sufferers also appear to be more responsive to IL-23.29 In type II diabetes, the immune cells that destroy the pancreas exist in healthy and afflicted subjects, but Treg cells appear to be less functional in diabetics.1, 2

Making a further case for the importance of genetics, people with one of these conditions are often more susceptible to the others.58-63

Still, There Are a Lot of Bullets…

The need for a “genetic bullet” in order for a disease to materialize has led many to breathe a sigh of relief. An example is the recent Washington Post article “For many, gluten isn’t the villain it gets cracked up to be.”

But the fact is that there are many chronic disease and they are all on the rise. A lot more guns are actually going off now.

Recent research is showing more and more that inappropriate chronic inflammation is at the heart of almost every “disease of civilization” including cancer,64, 65 metabolic disorders,66, 67 Alzheimer’s disease,68 most autoimmune conditions,30, 35 and heart disease where aberrant macrophages (immune cells) form the atherosclerotic plaques.69, 70

That amounts to a whole lot of genetic bullets.

While the research is still small, several of these conditions including celiac’s disease, diabetes, and     IBD are improved when wheat is removed from the diet.13, 14, 71 – 73

So feel free to do as the Washington Post article says, eat your bread, and trust your luck that the chamber is empty. But with that many potential bullets in the revolver and chronic inflammation – so effectively produced by wheat – ready to pull the trigger, I’m personally going to avoid putting the gun to my head.

References

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Rheumatoid Arthritis

Congratulations to the winner of The Real Paleo Diet Cookbook Giveaway, Karla! Thanks for sharing your inspired journey with us!

“I began the Paleo Diet with my daughter January 8, 2013 and within 2 weeks I had more energy, my mind felt clearer, I no longer had constant sinus drainage and nasal stuffiness, my digestive problems resolved and I didn’t feel bloated. I then segued to the autoimmune protocol due to having Rheumatoid Arthritis and my SED rate dropped dramatically (per lab tests) to the point where I went off Methotrexate (which wasn’t working anyway) and didn’t have to go on Humira. I virtually eliminated my R.A. joint pain and swelling.

My daughter who was 17 at time experienced loss of belly fat, more energy and though she had been on Solodyn for her acne for years, never really eliminating it, she experienced a dramatic reduction of her acne for the first time. But the most amazing change she experienced was no longer having exercise induced asthma, which was huge since she is a competition dancer and had to use an inhaler 30 minutes prior to dancing but still had the fear of experiencing an attack. The Paleo Diet gave her freedom and gave me a life back.”

Karla

Osteoarthritis | The Paleo Diet

Dear Prof. Cordain,

I am an orthopaedic surgeon specializing in hip and knee arthroplasty for the treatment of symptomatic osteoarthritis. I am currently coming to the end of a clinical fellowship in Toronto and will be returning to the UK to take up a post as a consultant (attending) in a NHS hospital and I would be grateful if you could give me any information on the use of Paleo diet and evolutionary fitness principles in the treatment of my patients.

I first read about the Paleo diet on Art de Vaney’s website, then read Rob Wolff’s The Paleo Solution and am now reading through your book The Paleo Diet. I already give many of the patients I see dietary advice because very often they are overweight (in fact, more often than not) and have radiographically mild disease but considerable pain. It is an observation many surgeons have made anecdotally that patients who are of normal weight and are active seem to be able to tolerate far more severe disease (in terms of joint destruction observable on X-radiographs) than those who are overweight and sedentary.

Many patients can be educated that weight loss may improve their symptoms and are willing to try but conventional diets are difficult to follow, so I advise them to follow Paleo principles because I think it is a much easier diet to follow consistently. However, I wonder if there is anything specific I should be advising that may help their symptoms. Also, exercise is important for joint function, symptom control and general health, but of course it is very difficult to exercise when one has a painful joint. Do you have any advice that I can pass on to them, or do you know of anyone doing clinical work in this field who I could get in contact with?

Many thanks for your time in reading this.

Kind regards,

— Julian Gilbody MSc, FRCS (Tr & Orth)
Lower limb arthroplasty fellow, Toronto Western Hospital

Dr. Cordain’s Response:

Hi Julian,

Thanks for your support of the Paleo diet. I believe that arthritis, particularly RA (rheumatoid arthritis) is driven by inflammation emanating from the gut. See our group’s paper “Modulation of immune function by dietary lectins in rheumatoid arthritis.” Hence, inflammation of the gut and inflammation of the joints (particularly in RA) appear to be linked by a number of dietary mechanisms we have proposed in this paper. Clearly arthritis can result from purely mechanical factors independent of the gut immune response. Nevertheless, arthritis of mechanical origin is also driven via systemic inflammation, and any environmental factor (pharmaceutical, dietary or otherwise) that reduces inflammation will also tend to reduce symptoms of arthritis (mechanical or otherwise). This therapeutic response in all arthritis patients who adopt the Paleo Diet may help to explain your anecdotal observations why contemporary Paleo diets are therapeutic for your arthritis patients. Keep up the good work, and keep me posted on any case studies you may encounter.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

Curing Rheumatoid Arthritis With The Paleo Diet | The Paleo Diet

Below is a recent success story from a Paleo Diet fan:

Dr. Cordain,

Thank you for answering questions I’ve had for the past 15 years about why this diet makes my RA better.  I just wish you could get the point across to all the rheumatologists out there!

I have had RA for 35 years….  first onset 1978 at age 37, finally diagnosed as adult onset Still’s Disease in 1983.  My rheumatologist had me on just about every high powered RA drug available for the next 20 years.  I was truly blessed by having side-effects to most of them and that kept me from taking them long enough to really shatter my health.

About 1997 or ’98 I decided I really needed to lose weight.  I felt I was already doing about all I could for the RA with medication and just getting rid of the excess pounds would at least make me feel better about myself.

I chose my own modified version of the Atkins diet.   I didn’t want to do ketosis so left meat and fat levels at the same moderate amounts I’d been eating and just left out all the starches (grains & white potatoes), sugars and fruit juices, legumes and milk products he recommended.  I did lose weight, but in the process noticed my RA was much better except when we would eat out or celebrate a birthday and I momentarily fell off the diet.

I asked my rheumatologist why this diet affected me like that but he had no answers.  At least he said, “If it works, go for it.”  So I have been on-again/ off-again with this diet since that time.  Anytime my RA flares, the diet works much better even than any of the new biologic drugs (such as Humira, Enbrel, etc).

Through the years I have read everything that has come my way looking for the reason this diet has this effect on me.  In the past year I began to notice more and more references to the Paleo Diet and decided it sounded like the diet I’ve been using.  I looked it up on your website and bought your Paleo Answer book and  IT IS THE SAME !  And then I found your research articles  Modulation of immune function by dietary lectins in rheumatoid arthritis and Cereal Grains: Humanity’s Double-Edged Sword in particular.

THANK YOU!  THANK YOU!  for making them available on your website!  I printed those and gave them to my rheumatologist in July.  I will be interested in hearing his opinion at my next visit.  If this information had been available  when I first came down with RA, I can only imagine the pain and suffering I would have been spared (plus 2 artificial knees, 2 artificial hips, and reconstructive surgery on both wrists).

If I had known about lectins, saponins, etc. 15 years ago, perhaps I would have also avoided the on-again/off-again use of the  diet.  Or maybe this on-again/off-again pattern was the necessary proof that it really is the diet that is working!  (I’m thinking the healing of my body, because of the diet, is what allowed me to drift off the diet for extended periods of time.)  One thing I have found is that when initially beginning the Paleo Diet, depending on the degree of pain and inflammation, it may take 4 to 6 weeks for the symptoms to really clear.  And it is most important to not forget about the legumes and milk products…..  I was concentrating on starches and sugars and I had a tendency to forget them for a while until I read your research.

I am trying to spread the word about this diet to my many friends and acquaintances with RA as well as those with other medical conditions.  Sad to say, many of them feel they must rely only on what their doctor recommends…. after all the doctor is the “expert”.

What can be done (what can I do) to re-educate these “experts”?  Will you be having any seminars in the Austin, TX area in the near future that I can recommend to my doctors?  What can I tell them to spark their interest?  Do you have any new research coming up on this topic?

Dr. Cordain, thank you again for your research and for making it available.  I will be “on-again” forever thanks to you.

Sincerely,

Linda

Rheumatoid Arthritis and The Paleo Diet | The Paleo Diet

Hello,

The article, “Modulation of immune function by dietary lectins in rheumatoid arthritis” is of interest to me, but is 10 years old. Can you suggest any more recent scientifically valid articles on the same topic?

Many thanks,

Allena

Maelán Fontes’ Response:

Hi Allena,

To my knowledge, there are no reviews or studies addressing the role of a paleolithic diet and it’s implications in rheumatoid arthritis, except from that of Dr. Cordain. In his MS (Multiple Sclerosis) DVD Dr. Cordain thoroughly explains the dietary mechanisms of autoimmunity in MS, which are almost the same for all autoimmune diseases–including RA. Those are: increased intestinal permeability, increased passage of luminal antigens into peripheral circulation, molecular mimicry and genetic susceptibility (genes encoding for the HLA system), among other factors.

In recent years, new substances have been discovered which might be responsible for increased intestinal permeability, namely saponins (found in legumes), potatoes, soya, quinoa, amaranth, alfalfa sprouts or tomatoes. If you’ve seen Dr. Cordain’s scientific paper entitled “Modulation of immune function by dietary lectins in rheumatoid arthritis”, I am sure you are aware of the role lectins play in autoimmunity.

Adjuvants are used by immunologists in order to boost the immune system and induce immunization. It turns out that certain foods have bioactive compounds that have adjuvant-like activity, this is the case for tomatoes or quillaja (a foaming agent used in beers and soft drinks).

Gliadin is a prolamine found in wheat which has been shown to increase intestinal permeability and hence the risk of suffering an autoimmune disease.

On the other hand, several clinical trials have been conducted with promising results. However, they have used a gluten-free diet or vegan diet instead of a whole paleolithic diet, which we think is the superior diet.

In vegan diets, authors often claim that the effects might be due to the lack of meat, but we think the positive effect relies on the lack of diary proteins and gluten. Meat has historically been seen as the “bad guy” in inflammation, but the data to support that notion is not sufficient to support this view.

Below are some references that could be useful.

Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study. Elkan AC, Sjöberg B, Kolsrud B, Ringertz B, Hafström I, Frostegård J. Arthritis Res Ther. 2008;10(2):R34. Epub 2008 Mar 18.

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. Hafström I, Ringertz B, Spångberg A, von Zweigbergk L, Brannemark S, Nylander I, Rönnelid J, Laasonen L, Klareskog L. Rheumatology (Oxford). 2001 Oct;40(10):1175-9.

I hope this helps.
Maelán Fontes MS Ph.D. candidate in Medical Sciences at Lund University, Sweden

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