Those individuals facing the health-related challenges associated with rheumatoid arthritis (RA) and fibromyalgia have much to be thankful for--research is clearly demonstrating that they can reduce their level of pain and suffering and enhance their quality of life by simply adding readily accessible, interesting, colorful and even flavorful foods into their diet. Specifically, research scientists are stating that those individuals that incorporate high levels of antioxidant, fiber and essential fatty acid-rich foods into their diets on a regular basis will experience a substantial improvement in quality of life and a reduction in the painful physical and psychological symptoms commonly associated with RA and fibromyalgia.

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Rheumatoid disorders such as rheumatoid arthritis and fibromyalgia are accompanied by painful and sometimes debilitating symptoms. Fibromyalgia affects approximately 2% of the US population and is seven times more likely to affect a woman than a man. Symptoms associated with fibromyalgia include pain and stiffness in the neck, shoulders, upper and lower back, and hip areas. It is often accompanied by sleep disturbances and psychological distress. There is no known cause for this disorder, but factors such as psychological stress, nutritional imbalance, immune and endocrine dysfunction, and biochemical abnormalities in the central nervous system may contribute to the underlying cause.

Patients with fibromyalgia may also suffer from rheumatoid arthritis. Rheumatoid arthritis (RA) is a chronic condition causing pain, stiffness, swelling and loss of function in joints, and inflammation in body organs. RA affects more than 2 million Americans, 75% of whom are women. The age of onset typically falls 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 that is recognized by the American College of Rheumatology.

Reducing the Inflammatory Response and Improving Immune Function with Food
While the medical community at large feels that there is no "cure" for rheumatoid conditions, we do have the ability to remove key factors associated with the disorders and consequently, remove important barriers imposed by these conditions that make living difficult. 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. There are, however, 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 (which is an omega 3 fatty acid) derived from fish oil is proven to inhibit cytokine formation, significantly decrease pro-inflammatory adhesion molecules and enzymes that degrade joint tissue and cause more inflammation and pain.(1)

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 (which will be 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.(2-6)

The Living Food Diet
In a study by Hanninen et al.,(6) fibromyalgic patients who were put on a strict vegan diet of raw fruits, vegetables, roots, nuts, and berries (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 antioxidant levels were markedly increased in subjects put on the diet as compared with subjects on an omnivorous diet. These included carotenoids and polyphenolic compounds, lycopene and lutein, vitamin C, and vitamin E. Quercetin, myricetin, and kaempherol levels were much higher in test subjects due to a 3-fold 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.(6)

Inflammation is thought to involve free radical generation as either a cause or an outcome of a given disease state. Antioxidants found in plants are proposed to scavenge free radicals and may therefore reduce inflammatory responses due to free radicals in the body. In nature, plants are exposed to a heavy load of oxidizing UV light from the sun that 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. A plant diet rich in these antioxidants may prevent as well as decrease the symptoms of disease states.(6)

The Living Food diet is very 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.(6)

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.(7) 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.(6)

Increasing Serum Antioxidant Levels May Not be the Answer
Scientists mistakenly believed that the reason these diets are working to reduce inflammation and reduce autoimmune reactions is solely because the diets are rich in antioxidants and consuming these foods would thus increase antioxidant levels in the body which are predictably low in patients challenged by RA and fibromyalgia.(8-10)

However, we are now learning that those patients who consume antioxidant-rich foods do not typically increase their serum levels of antioxidants.(11) However, their symptoms do improve dramatically. In addition to the fact that antioxidant-rich foods possess anti-inflammatory properties,(12-14) there are other factors, such as fiber and essential fatty acids, found in whole, unadulterated foods (that happen to be rich in antioxidants) that 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(11) while, again, those individuals who are 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, making it even more critical that those individuals that have a documented antioxidant deficiency (always associated with compromised immune function) focus on eating whole foods, rich in antioxidants. The reason being that antioxidant-rich whole foods contain 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 demonstrate significant clinical benefit.(15)

Final Thought
The bottom line is that patients with rheumatoid disorders benefit most from consuming whole foods (rather than antioxidant supplements) that are recognized for reducing rheumatoid symptoms. These foods include fish, * fresh vegetables and fruits (non-GMO-see the last two issues for a discussion on GMO foods), raw nuts and seeds. As one gradually increases the consumption of these foods, a natural progression towards the limited intake of arachadonic acid-rich foods (such as pork, beef, cured meat and sausage) will likely ensue.

* The only fish I recommend is Wild Alaskan Sockeye Salmon offered by Vital Choice (www.vitalchoice.com) as this is the only source of cold water fish that I am aware of that, according to the company, is free from harmful levels of methyl mercury and PCBs that are known to bioaccumulate in other species. This salmon is wild, not farmed, and is grown free of antibiotics, pesticides, synthetic coloring agents, growth hormones and GMOs.

© COPYRIGHT 2006 Dr. Gina L. Nick

References

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