In past issues of Townsend Letter (October 2006; November 2006), I introduced a condition I've named Sickness Syndrome (I also refer to it as "Inflamed Brain"), which causes depression, anxiety, and sleep disorders. Sickness Syndrome is the result of an increase in inflammatory cytokine levels in the periphery,1 sometimes caused by infection (the type of cytokines depend upon the type of infection), which then leads to local production of inflammatory cytokines in the brain.

Research has shown that cortisol is the main brake in the production of inflammatory cytokines, both at the periphery and in the brain. However, while its production is enhanced by cytokines, its negative feedback on cytokines production and action is operational only if there is no cortisol resistance2,3 occurring when chronic stress inhibits cortisol's effectiveness in regulating levels of inflammatory cytokines in the body.4

Infection, Fibromyalgia Syndrome, and Sickness Syndrome
Cortisol resistance has also been documented in Fibromyalgia Syndrome (FMS) patients who are also more likely to suffer from a compromised stress response system.5,6 Interestingly enough, research shows that in approximately 50% of patients who have FMS (a condition that affects approximately two percent of the US population and is seven times more likely to affect women than men), their FMS symptoms began after a specific event, most often some form of physical or emotional trauma. This greatly increased their chance of experiencing a defect in the hypothalamic pituitary adrenal axis, while reducing their ability to tolerate stress in a healthy way, ultimately leading to the expression of Sickness Syndrome or an Inflamed Brain.7

This is further supported by statistics demonstrating that approximately 30% of FMS patients have major mood disorders,8 key indicators of Sickness Syndrome. Moreover, if FMS patients were then infected with Lyme disease, their system would have limited mechanisms in place to regulate the number of inflammatory cytokines produced due to the infection. Consequently, the patient would likely experience an Inflamed Brain or Sickness Syndrome symptoms such as anxiety, depression, and sleep disorders, with antidepressant medications such as fluoxetine considered standard treatment for FMS-caused depression. 9

Regardless of whether Lyme infection caused the FMS (increased inflammatory cytokines from infection leading to symptoms of FMS and an Inflamed Brain) or FMS has caused one to be more susceptible to Sickness Syndrome/Inflamed Brain if infected with Lyme, the naturopathic approach would be to treat the cause of the depression, in this case, cortisol resistance. The treatment needs to focus on normalizing adrenal gland activity and supporting healthy cortisol levels and receptor sensitivity in an effort to normalize its negative feedback on inflammatory cytokines production and action.

This can be done through the clinical use of herbal medicines and nutraceuticals such as Holy Basil, adrenal gland extract, vitamin C, DHEA, pregnenolone, and ashwaghanda to repair adrenal gland activity and normalize the hypothalamic pituitary adrenal axis, along with incorporating whole foods in the diet.

Fibromyalgia Symptoms and Treatment Options
Rheumatoid disorders such as FMS are accompanied by painful and sometimes debilitating symptoms, which can include pain and stiffness in the neck, shoulders, upper and lower back, and hip areas as well as sleep disturbances and psychological distress. There is no known cause for this disorder, although psychological stress, nutritional imbalance, immune and endocrine dysfunction, and biochemical abnormalities in the central nervous system may all been implicated in its onset.

Patients with FMS may also suffer from rheumatoid arthritis (RA). RA is a chronic condition causing pain, stiffness, swelling and loss of function in joints, and inflammation in body organs. RA affects more than two million Americans, 75% of whom are women, with the age of onset typically falling between 20 and 45 years. Diagnostic criteria used to confirm the condition include prolonged morning stiffness in the joints, characteristic nodules under the skin, joint erosions apparent on X-rays, and presence of rheumatoid factor in the blood. There is no cure for this condition--or more accurately, there is no cure recognized by the American College of Rheumatology and the medical community-at-large.

However, we do have the ability to remove key factors associated with the rheumatoid disorders and consequently eliminate important barriers imposed by these conditions that make living unpleasant. Because inflammation is a major factor of rheumatoid symptomology, researchers have studied ways in which diet may mitigate inflammation by reducing the intake of arachadonic acid, a polyunsaturated fatty acid (PUFA), and increasing the intake of eicosapentaenoic acid (EPA), fiber, and antioxidants present in whole foods.

We know that metabolites of arachadonic acid mediate PUFA signals associated with the autoimmune reactions seen in rheumatoid disorders. Specifically, leukotrienes, lipoxines, hydroxyl fatty acids, and prostaglandins, which are derived from PUFAs, increase the activity and formation of pro-inflammatory adhesion molecules, cytokines, chemokines, and colony-stimulating factors. Obviously removing dietary sources of arachadonic acid (for example, beef, lamb, pork, and chicken) will reduce these pro-inflammatory factors, which, incidentally, also contribute to Inflamed Brain.

There are also foods that one can eat to also help reduce the production and stimulation of these factors. Double-blind, placebo-controlled clinical research trials demonstrate that an increased intake of EPA (good sources are cold water fish and algae) and antioxidant-rich foods consistently improve the laboratory and clinical findings associated with rheumatoid disorders. In particular, EPA (an omega 3 fatty acid) derived from fish oil is proven to inhibit cytokine formation and significantly decrease pro-inflammatory adhesion molecules and enzymes that degrade joint tissue and cause more inflammation and pain.10

By removing dietary sources of arachadonic acid and incorporating high levels of antioxidant, fiber, and essential fatty acid-rich foods in their diets on a regular basis, FMS patients can reduce the painful physical and psychological symptoms associated with the disease while enhancing their quality of life.

Treating Rheumatoid Disorders with Clinically Proven Whole Food Diets
Specific diets that are high in antioxidants, EFAs, and fiber, such as the Mediterranean diet (rich in fish, olive oil, vegetables, wine, nuts, and seeds and low in meat and dairy) and the Living Food Diet (described in detail below) are recognized for their ability to reduce inflammatory activity, increase physical function, and significantly improve vitality in those individuals challenged by rheumatoid disorders.11-15

The Living Food Diet
In nature, plants are exposed to a heavy load of oxidizing ultraviolet (UV) light from the sun, which generates free radicals in plant tissues. Additionally, reactive oxygen is generated in chloroplasts during photosynthesis, and respiring plant mitochondria generate free radicals just as animal cells do. This may be why plants have a large array of antioxidant chemicals and enzymes, the benefits of which can be conferred to humans upon consumption of them.

Since inflammation is thought to involve free radical generation as either a cause or an outcome of a given disease state, it's been theorized that antioxidants found in plants scavenge free radicals, thereby reducing inflammatory responses due to the presence of free radicals in the body. A plant diet rich in these antioxidants, such as those found in the Living Food Diet, may decrease and possibly even eliminate the symptoms of disease states.15

In a study by Hanninen et al.,15 fibromyalgic patients who were put on a strict vegan diet of raw fruits, vegetables, roots, nuts, and berries (the Living Food diet) reported substantial reduction in joint stiffness and pain as well as improved self-experiences of health. Rheumatoid arthritic patients put on the diet also reported similar positive responses, which were supported by objective measures.

Blood and urine analysis showed a marked increase in antioxidant levels (including carotenoids and polyphenolic compounds, lycopene and lutein, vitamin C, and vitamin E) in subjects put on the Living Food Diet as compared with subjects on an omnivorous diet. Quercetin, myricetin, and kaempherol levels were much higher in test subjects due to a threefold greater berry intake relative to omnivorous controls. The Living Food diet decreased fecal urease and beta-glucuronidase activity, the hydrolysis products of which (urea and glucuronides, respectively) can be reabsorbed in the gut, increasing chemical loading and the potential for inflammation.15

The Living Food diet is low in sodium and cholesterol and high in fiber. Its lipid content is almost exclusively unsaturated fat, including omega-3 fatty acids. The high fiber content speeds and promotes gut function, lessening the time available for absorption of harmful substances. In combination with the fatty acids, dietary fiber dramatically shifts gut flora toward beneficial lactobacilli, on the order of a power of magnitude with the Living Food diet. In an omnivorous diet, gut bacteria convert aromatic amino acids from protein into toxic phenols that act as free radicals. The Living Food diet was shown to reduce phenol and paracresol levels in the blood and urine of study subjects, and the alleviation of the free radical load may contribute to the reduction in rheumatoid symptoms. Furthermore, in study subjects, a greater change in gut microflora with the Living Food diet corresponded to greater improvement in rheumatoid symptoms.15

Another theory suggests that microbial membrane fragments may pass through the gut wall and lead to antibody formation by the host organism, an intriguing idea.16 The glycopolysaccharides of certain gut flora may be quite similar to the glycopolysaccharides found in joint tissues, and the inflammation in rheumatism may be an autoimmune response stimulated by the foreign antigen particles. Thus, the beneficial effects of the Living Food diet may represent a shift toward gut flora that are less autoimmunoreactive.

Although the Living Food diet is extreme, it is known that vegetarians in general have significantly lower oxidized LDL cholesterol, an increased antioxidant status, and a higher ratio of vitamin E to cholesterol. Epidemiologically, populations that eat mostly vegetarian diets have lower incidences of constipation, diverticular disease, gallstones, and appendicitis.15

Increasing Serum Antioxidant Levels May Not Be the Answer
Scientist initially believed that the reason these diets reduced inflammation and autoimmune reactions was solely because they are rich in antioxidants. Therefore, consuming these foods would thus increase antioxidant levels that are predictably low in patients challenged by FMS.17-19

However, we are now learning that although those patients consuming antioxidant-rich foods do not typically increase their serum levels of antioxidants,20 their symptoms do improve dramatically. In addition to the anti-inflammatory properties possessed by antioxidants-rich foods,21-23 other factors, such as fiber and essential fatty acids found in whole, unadulterated foods (that happen to be rich in antioxidants), function together to bring the body back to a state of health.

Interestingly, when healthy individuals consume antioxidants, their serum levels of antioxidants do increase significantly,20 while, again, those individuals deficient in serum levels of antioxidants (such as those experiencing rheumatoid disorders) who consume antioxidants fail to increase their serum levels of antioxidants. One reason for this dissimilarity is that healthy individuals have the ability to efficiently absorb the antioxidants they are ingesting while unhealthy individuals may not. Therefore, it is even more critical that those individuals with a documented antioxidant deficiency (always associated with compromised immune function) focus on eating antioxidant-rich whole foods, since the whole foods also supply factors that help to repair absorptive capabilities while supplying the body with antioxidants.

In fact, the majority of controlled studies investigating the therapeutic use of antioxidant supplementation (both isolated and combined) have not been shown to significantly improve rheumatoid-related symptoms, while consuming whole foods rich in antioxidants consistently demonstrated significant clinical benefit. 24

Final Thought
The bottom line is that patients with rheumatoid disorders like FMS benefit most from consuming whole foods (rather than antioxidant supplements) that are recognized for reducing rheumatoid symptoms, such as fish, fresh vegetables and fruits, and raw nuts and seeds. As patients gradually increase the consumption of these foods, they will likely experience a natural progression towards the limited intake of arachadonic acid-rich foods (such as pork, beef, cured meat, and sausage).

Additionally, it is important to remember that FMS patients are likely to have reduced function of their hypothalamic pituitary adrenal axis and a compromised ability to tolerate stress. They may also experience Sickness Syndrome (Inflamed Brain). If these patients contract an infection such as Lyme disease, their risk of having excessive production of inflammatory brain cytokines grows significantly, leading to depression, anxiety, and sleep disorders, which further compromise their ability to tolerate stress in a healthy way. Taking a total approach (ingestion of whole foods as explained above, supplemented by specific herbal medicines and nutraceuticals) will help alleviate the symptoms and improve patients' overall quality of life.

© COPYRIGHT 2006 Dr. Gina L. Nick

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