Cases vary widely, but functional medicine would suggest
healing your gut to heal your joints
This 51-year-old lady moved from Argentina to the UK when she was 30. Though thin and sporty as a child, she felt very lethargic in her mid-20s, and was lucky to find a physician who made an instant diagnosis of an underactive thyroid, and she felt much better on thyroxine.
She went to bed at 10, but only fell asleep around 12, waking at 7:30, but not leaving bed until 8:30, due to joint pain and stiffness. She experienced a significant energy dip around 4pm, with improvement in the evening. She had been exposed to severe stress at work, resulting in regular stomach cramps and passing one soft stool every day. Her tummy pain settled when she went on a gluten-free diet. She had a daughter been diagnosed with coeliac disease.
She also suffered with severe left sided migraine, which continued for the whole day. She consumed gluten-free pasta and bread, but also had a bowl of cereal in the morning. She practised yoga once a week, but undertook no other physical activity due to her painful joints.
She had a small goitre (enlarged thyroid gland), symmetrically swollen and tender small joints on both hands. Her inflammation markers were high but her rheumatoid factor and CCP were negative.
The rheumatological diagnosis was obvious – autoimmune arthritis because of her morning stiffness and extensive history of autoimmunity (thyroid, asthma, acne as a teenager.) The endocrinological diagnosis was endemic goitre (because of low iodine in the Argentine district), complicated by autoimmune thyroid disease.
The underlying causes of both conditions were obvious – a western diet and gluten (in wheat, rye, oats and barley) causing gut inflammation resulting in a leaky bowel – the hallmark of autoimmunity. Insufficient vitamin D may have contributed to the immune system’s overreaction.
Specialisation leads to fragmented diagnosis
My friends, I resisted the temptation to specialise early in my medical career. This because I suffer with professional agoraphobia: I find it hard to practise within a small medical area! I have always been interested in working holistically on different issues and finding the links between them.
I found this also cost-effective for my patients. Instead of seeing one doctor for thyroid, another one for the joints and the third one for the heart, they could see one holistic doctor who could deal effectively with all issues, because most of the time there is a common underlying cause for medical symptoms involving multiple body systems.
I believe that medical practice is going to change with the advances in medical knowledge and technology. I think that some specialities may vanish. And this feeling has intensified with the drastic changes brought about by Covid-19.
There are two main types of arthritis – osteoarthritis, a metabolic condition purely related to food that damages the joints, and rheumatoid arthritis, a totally different process where the gut and the immune system are the biggest players.
I can see a small hospital department like Rheumatology one day become much bigger, because dealing both types of arthritis would require the department to deal with two major branches of medicine – metabolic and autoimmune – at the same time.
In this blog, I am going to cover the main types of arthritis, their origin, and how a patient can suffer from both at the same time. We will then explore the genetic issues that make different people prone to one or the other. We will mention minor types of arthritis such as gout, pseudogout, and the relatively bigger group, spondyloarthritis.
Rheumatoid arthritis is an autoimmune condition causing stiffness in the morning and after inactivity. The patient will usually have been diagnosed with other autoimmune conditions. 40% of patients will have other symptoms, mainly fatigue, anorexia and fever. The disease affects the small joints of the hand, particularly those that attach your fingers to your hands, and your toes to your feet. The immune system mistakenly attacks the bodily systems. Unlike osteoarthritis, it affects the lining of joints, causing pain and swelling that can progress to bone erosion and joint deformity.
Who is at risk of rheumatoid arthritis?
Those at risk include smokers and those with periodontal disease who produce anti-CCP. In addition, a study reported that 37% of obese ladies under 55 had rheumatoid arthritis. Others include those on a processed, inflammatory diet. Having one autoimmune condition increases the likelihood of having another. A dysfunctional immune system increases the risk of autoimmunity and therefore rheumatoid arthritis.
You can prevent rheumatoid arthritis by having a healthy diet, and by getting omega 3 fatty acids. NAC increases glutathione production and modulates the immune system. You can take good probiotics to support the immune system. Curcumin and turmeric are powerful anti-inflammatories and immune modulators. The medicinal mushroom also helps to modulate the immune system.
Inflammation is the common factor among various types of arthritis due to the immune system attacking the joints in rheumatoid arthritis, however, the joints are damaged by another process known as oxidative stress in osteoarthritis.
Avoiding a knee replacement
This 72-year-old gentleman of Asian origin had an accident when he was 21, resulting in severe left knee pain. This progressed over the years to severe osteoarthritis, limiting his mobility. He was overweight with a BMI of 29.4. He had also been diagnosed with diabetes and high blood pressure, which was treated with regular medication.
He attended my clinic hoping to lose weight and reduce his medication. Going through his diet, I found he was eating Indian-style curry, high in animal protein, together with polished processed white rice. The meals were cooked in cheap vegetable oil, which can turn into toxic fat.
The patient agreed to replace the rice with beans, to reduce his animal protein intake and to cook his meals in saturated fat, such as coconut or butter. He was also advised to increase his intake of fruit and vegetables to five portions a day and was supported with antioxidant supplements.
He lost weight and his BMI normalised, blood pressure and blood sugar came into the normal range, and he achieved his goal of controlling his conditions with minimal medication within a few months.
At this stage, the patient started to focus more on his left knee pain. He reported that the pain has reduced by almost 50% during this process, and later that he had minimal pain and was able to do unlimited activity.
He had been on the waiting list for a knee replacement for a couple of years. He asked me about this, since his knee pain had significantly resolved. I advised him to approach the orthopaedics team asking for an objective reassessment. Needless to say, his name was taken off the joint replacement list.
Even those with advanced conditions can regain normal life
This ex-cyclist was devastated to be diagnosed with a series of medical conditions in his 70s and to find himself on several pills for diabetes, high blood pressure, high cholesterol and gout. He came to see me with general lethargy and severe arthritis. He had to try and sleep in a reclining chair for severe back pain, but was not sleeping well. He weighed 103 Kg (BMI 31.5), had BP of 160/100, high cholesterol at 6.7 and HA1C (an indicator of diabetes) at a very high 9.2.
After six months on a personalised healthcare plan of a healthy diet, regular exercise and appropriate dietary supplements, he reported that he had lost two stone, his blood pressure normalised at 123/68, his cholesterol dropped to 4.3, his blood sugar normalised and his HA1C came down to 6.8 (normal is 6.5.)
He came off most of his regular medication and went back to enjoying a normal life, including gardening, household work and cycling several miles on regular basis.
This shows that even patients with advanced disease and severe deformity can improve to a great extent and regain a reasonable quality of life.
Osteoarthritis: wear and tear
Osteoarthritis affects middle-aged or older patients, mainly in their hands, lower back, hips and knees. Most patients report that their joint is depreciated with excessive use, so that the condition is referred to as ‘wear and tear’ arthritis. Patients usually present with short-lived morning stiffness and pain in extreme movement, restricting their mobility. Patients also have joint crepitus, palpable bony nodes on their hand joints. Severe disease presents with joint pain at rest, particularly at night, muscle wasting and deformity.
The hallmark of osteoarthritis is oxidative stress, a process that happens in everyone every day. Affected people produce more oxidants (free radicals, the products of normal cellular metabolism) than they can neutralise, resulting in damage to essential cellular components and cell death. The process can be slowed by the body producing fewer oxidants or neutralising more, or by the addition of exogenous antioxidants to neutralise the free radicals.
Oxidative stress can be caused by high blood sugar, because this damages the protein molecules in the blood. You can measure your level of oxidative stress by taking haemoglobin A1C, a test we normally do to assess the blood sugar control in diabetics.
Major sources of free radicals include sugar and refined carbohydrates. Meat produces more oxidants in view of its high iron content. Cheap vegetable oil can become oxidised during cooking. Alcohol is high in calories and can generate high levels of free radicals.
You can increase your antioxidant levels by taking rainbow-coloured vegetables, each colour providing a different variety of antioxidant (vitamins A, C, E and polyphenols), particularly berries, bell peppers, kiwi fruit, citrus, cherries, plums and cranberries, plus alpha lipoic acid, selenium, beta-carotene and lycopene. Nuts, seeds and legumes are rich in vitamin E, magnesium, zinc and copper. Ginger, turmeric, dark chocolate and green tea are also great.
Rheumatoid AND osteoarthritis
I have met many patients who have had the main two types of arthritis at the same time. They usually start by having osteoarthritis, which requires them to take painkillers such as ibuprofen. These medications are grouped together as non-steroidal anti-inflammatory drugs (NSAIDs.) They are known to irritate the gut lining, damaging the tight junctions, leading to leaky bowel syndrome and autoimmunity. This gives the unlucky patient rheumatoid arthritis, in addition to the osteoarthritis they started with!
Traditional medicine provides good interventions to control pain, while functional medicine focuses on finding the underlying cause of the disease, hoping to provide a lasting solution. I think both approaches can help patients have less pain and more quality of life.
Heal your gut to heal your joints
I started doing genetic testing on patients who presented with joint pain, often related to sport. I found that DNA Sport is a great tool in helping people make adjust their training to reduce the risk of injury, improve recovery time, and enhance power and endurance potential.
I have also seen many patients who presented with bone, joint or tendon disease due to calcification of soft tissues. These patients may benefit from vitamin K2, which is necessary for removing calcium from soft tissues such as tendons and muscles.
Helpful here is an anti-inflammatory diet of leafy green and rainbow-coloured vegetables and low sugar fruits, rich in omega 3 (fish oil), nuts, seeds and other healthy fats such as avocado olive and coconut oil, and food that builds bones and cartilage, such as bone broth and cruciferous vegetables.
Gout is a painful form of arthritis, metabolic in origin, common in men and postmenopausal women due to an accumulation of uric acid crystals in joints, commonly at the base of the big toe causing pain and redness. Uric acid is a metabolic product, which, when it is at a high level in the blood, causes hyperuricaemia. It is attributable to a high protein diet, and also to high carbohydrates and particularly high alcohol intake.
The diagnosis is made on the basis of a high uric acid level in blood, uric acid crystals in the joint fluid and the specific radiological appearances. It usually responds to a modification of diet, weight reduction and reduction of alcohol intake.
Pseudo-gout is an inflammation of the joints due to deposits of calcium pyrophosphate dehydrate crystals, resulting in painful swollen joints, most often the knees, wrists and hands. It is more frequent in patients with multiple medical conditions. It is traditionally treated with pain killers (NSAIDs) and steroid injections. The disease responds well to an anti-inflammatory diet rich in omega 3 (fish oil), fruit and vegetable antioxidants, and the right type and intensity of exercise.
If a patient tests negative for rheumatoid factors and CCP antibodies, while having the classic symptoms and signs of rheumatoid arthritis, seronegative rheumatoid arthritis may be the cause.
Seronegative spondyloarthritis can occur in patients who carry the genetic code HLA-B 27, presenting as ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome. This commonly affects the sacroiliac joints in the pelvis together with peripheral arthritis. There may be extra articular manifestations, such as in the eye (iritis.)
As you can see, my friends, arthritis is a complex issue, and we will cover it in more detail in a future posting. The good news is that this gives you the opportunity to ask me any questions you may have. I would welcome all questions, and comments particularly those that reflect a human experience. Thank you!