Rheumatoid Arthritis

The Natural Approach
Rheumatoid arthritis is a chronic inflammatory condition that affects the entire body but especially the synovial membranes of the joints. It is a classic example of an "autoimmune disease," a condition in which the body's immune system attacks the body's own tissue. Although rheumatoid arthritis is a systemic disease, it affects primarily the joints. The joints typically affected by rheumatoid arthritis are the hands and feet, wrists, ankles, and knees. Involved joints will characteristically be quite warm, tender, and swollen. The skin over the joint will take on a ruddy purplish hue. As the disease progresses, joint deformities result in the hands and feet. Somewhere between 1% and 3% of the population is affected; female patients outnumber males almost 3:1; and the usual onset is 20 to 40 years, although rheumatoid arthritis may begin at any age.

Diagnostic Summary

  • Fatigue, low grade fever, weakness, joint stiffness, and vague joint pain may proceed the appearance of painful, swollen joints by several weeks.
  • Severe joint pain with much inflammation that begins in small joints, but progressively affects all joints in

the body.

  • X-ray findings usually show soft tissue swelling, erosion of cartilage, and joint space narrowing.
  • Presence of rheumatoid factor in serum.
  • Systemic manifestations are common, including: inflammation of the blood vessels (vasculitis), muscle wasting, skin nodules, inflammation of the heart and lungs, enlargement of the spleen, anemia, and depressed white blood cell counts.


Signs and Symptoms

The onset of rheumatoid arthritis is usually gradual, but occasionally it is quite abrupt. Several joints are usually

involved in the onset, typically in a symmetrical fashion, i.e., both hands, wrists, or ankles. In about one-third

of persons with rheumatoid arthritis, initial involvement is confined to one or a few joints. Most persons with rheumatoid arthritis feel fatigued as a result of the anemia that usually accompanies the disease. Other common findings include carpal tunnel syndrome (tingling and pain in the fingers caused by pressure on the nerve as it enters the hand through the wrist), and Raynaud's phenomenon (a condition where the blood flow through the fingers is severely reduced when they are exposed to cold). In some cases, soft nodules develop beneath the skin over bony surfaces. More serious complications, such as inflammation of the heart and lungs, are usually only seen in more severe cases.



There is abundant evidence that rheumatoid arthritis is an "autoimmune" reaction, where antibodies develop against components of joint tissues. Yet what triggers this autoimmune reaction remains largely unknown. Speculation and investigation has centered around genetic susceptibility, abnormal bowel permeability, and microorganisms,

as well as dietary factors. In short, rheumatoid arthritis is a classic example of a multifactorial disease where there

is an interesting assortment of genetic and environmental factors which contribute to the disease process.


Genetic Factors

A specific genetic marker (histocompatibility antigen HLA-DRw4) is found in 70% of patients with rheumatoid arthritis  compared  to  28% in the general population. This strongly implies that the likelihood of developing rheumatoid arthritis is influenced by genetic factors which govern immune response. Severe rheumatoid arthritis

is also found at four times the average rate in children of parents with rheumatoid arthritis. As strong as these genetic associations are, environmental factors are necessary for the development of the disease. This is perhaps most evident in studies with identical twins. These studies show that it is quite rare for both twins to develop rheumatoid arthritis.


Abnormal Bowel Permeability

An interesting association between rheumatoid arthritis and abnormal bowel function exists that may provide a unified theory as to the cause of rheumatoid arthritis. What is currently known is that individuals with rheumatoid arthritis have increased intestinal permeability. This means that their intestines are too "leaky." Food allergies are thought to contribute greatly to the increased permeability of the gut in rheumatoid arthritis. The release of histamine and other allergic compounds after eating an allergic food greatly increases the "leakiness" of the gut.

The result of a leaky gut is an increased absorption of large dietary and bacterial molecules. Normally these

molecules are prevented from being absorbed because they are too large. In rheumatoid arthritis, however, they

are absorbed into the body. The body's response to these molecules is to form antibodies to bind them. Antibodies are released by our white blood cells to bind to foreign molecules such as those found on bacteria, viruses, and cancer cells, resulting in the formation of an immune complex.

In the case of rheumatoid arthritis, food and bacterial molecules are acting as antigens that are being bound by

the antibodies. The resulting immune complex then triggers the immune system to release compounds to destroy

it. These compounds work great when antibodies bind to bacteria and viruses, but when immune complexes are deposited in joint tissues these compounds actually destroy not only the immune complex, but also surrounding joint tissue.

Another way in which the body may develop antibodies to its own tissue is by developing "cross-reacting" antibodies. The increased gut permeability and altered bacterial flora result in the absorption of antigens that are very similar

to antigens in joint tissues. Antibodies formed to these antigens would "cross-react" with the antigens in the joint tissues. Increasing evidence appears to support this concept as well.

Clinically, physicians use the presence of immune complexes to monitor the patient as the serum and joint fluid

of nearly all individuals with rheumatoid arthritis contain the "rheumatoid factor" (RF). The rheumatoid factor represents the formation of multiple immune complexes. Most of the rheumatoid factor is formed locally in the affected joints by white blood cells. The level of rheumatoid factor can be measured in the blood and usually correlates with the severity of arthritis symptoms. That is, when rheumatoid factor levels are high, severity is high, and when rheumatoid factor levels are low, severity is low.


Standard Medical Therapy

Standard medical therapy is of limited value in most cases of rheumatoid arthritis as it fails to address the complexity of this disease in an appropriate manner. Standard medical treatment of rheumatoid arthritis primarily involves the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Like the use of these drugs

in osteoarthritis, use of these drugs in the treatment of rheumatoid arthritis is a classic example of suppression

of symptoms, but acceleration of factors which promote the disease process. In the case of rheumatoid arthritis, NSAIDs have been shown to greatly increase the already hyperpermeable gastrointestinal tract of rheumatoid arthritis sufferers. The use of NSAIDs in rheumatoid arthritis is also a significant cause of serious gastrointestinal tract reactions including ulcers, hemorrhage, and perforation. Approximately 20,000 hospitalizations and 2,600 deaths occur each year in individuals with rheumatoid arthritis due to NSAIDs.

If NSAIDs are not effective, corticosteroids may be used. However, most experts and medical textbooks clearly state long-term use of corticosteroids in rheumatoid arthritis is not advised due to the side effects. Nonetheless, long-term corticosteroid use is quite common in patients with rheumatoid arthritis. If NSAID and cortisone therapy does not offer benefit, more aggressive and potentially more toxic treatments are used along with continued use

of NSAIDs and corticosteroids. Hydroxychloroquine, gold therapy, penicillamine, azathioprine, methotrexate, and cyclophosphamide are examples of drugs currently in use. Unfortunately, in most cases, the benefit produced by these drugs is greatly outweighed by the significant toxicity they possess. The use of these drugs often requires the use of additional drugs to deal with side effects. It is not uncommon for individuals with rheumatoid arthritis

to be on 12 or more prescription drugs at one time. And finally, joint surgery and replacement are reserved for

the most severe cases.


Side Effects

The side effects of oral corticosteroids are a function of dosage levels and length of time on the medication. Most

of the problems of side effects are not due to taking too much of the drug for a short period of time, but rather

reflect long-term use. The number and severity of side effects is a matter of dosage and length of treatment.

At lower doses (less than 10 mg. per day) the most notable side effects are usually increased appetite, weight gain, retention of salt and water, and increased susceptibility to infection. These side effects are almost always expected  with  corticosteroids.  Common side effects  of  long-term  corticosteroid  use at higher dosage levels include:   depression and other mental/emotional disturbances (up to 57% of patients being treated with high doses of prednisone for long periods of time develop these symptoms); high blood pressure; diabetes; peptic ulcers; acne; excessive facial hair in women; insomnia; muscle cramps and weakness; thinning and weakening

of the skin; osteoporosis; and susceptibility to the formation of blood clots.


The Natural Approach to Rheumatoid Arthritis

Rheumatoid arthritis represents a disease known to have many contributing factors. The natural approach involves reducing as many of these factors as possible; including poor digestion, food allergies, increased gut permeability,  increased circulating immune complexes, and excessive inflammatory processes. Foremost in the natural approach is the use of diet to control inflammation. Diet has been strongly implicated in rheumatoid arthritis for many years, both in regards to cause and cure. Population studies have demonstrated that rheumatoid arthritis is not found in societies that eat a more "primitive" diet and is found at a relatively high rate in societies consuming the so-called "Western" diet. Therefore, a diet rich in whole foods, vegetables, fiber, and low in sugar,

meat, refined carbohydrate, and saturated fat appears to offer some protection against developing rheumatoid

arthritis. In addition, dietary therapy is showing tremendous promise in the treatment of rheumatoid arthritis. The major focus in dietary therapy is eliminating food allergies, modifying the intake of dietary fats and oils, and increasing the intake of antioxidant nutrients.


Food Allergy in Rheumatoid Arthritis

Elimination of allergic foods has been shown to offer significant benefit to some individuals with rheumatoid arthritis. Virtually any food can result in aggravating rheumatoid arthritis, but the most common offending foods are wheat, corn, milk and other dairy products, beef, and nightshade family foods (tomato, potato, eggplants, peppers, tobacco), as well as food additives.

A recent study highlights the effectiveness of eliminating food allergens as part of a healthy diet and life-style program in the treatment of rheumatoid arthritis. In a 13-month study conducted in Norway at the Oslo Rheumatism Hospital, two groups of patients suffering from rheumatoid arthritis were studied to determine the effect of diet on their condition. One group followed a therapeutic diet (the treatment group), the other group (control group) was allowed to eat as they wished. Both groups started the study by visiting a "health farm," or what we in American call a "spa," for four weeks.

The treatment group began their therapeutic diet by fasting for seven to ten days. Dietary intake during the fast consisted of herbal teas, garlic, vegetable broth, decoction of potatoes and parsley, and the following juices: carrots, beets, and celery. Interestingly enough, no fruit juices were allowed. Patients with rheumatoid arthritis have historically benefited from fasting; however, strict water fasting should [never be done as it doesn't support the detoxification mechanism]. Fasting decreases the absorption of allergic food components and reduces the levels of inflammatory mediators as well. A juice fast or a fast similar to the one used in this study is safer than a water fast and may actually yield better results. Short-term fasts of three to five days duration are recommended during acute worsening of rheumatoid arthritis. After the fast the patients reintroduced  a "new" food item every second day. If they noticed an increase in pain, stiffness, or joint swelling within two to 48 hours, this item was omitted from the diet for at least seven days before being reintroduced a second time. If the food caused worsening

of symptoms after the second time, it was omitted permanently from the diet.

The results of the study further supported the positive results noted in other studies, showing short-term fasting followed by a vegetarian diet results in "a substantial reduction in disease activity" in many patients. The results indicated a therapeutic benefit beyond elimination of food allergies alone. The authors suggested that the additional improvements were due to changes in dietary fatty acids. Before discussing the role dietary fats play in rheumatoid arthritis, let's examine the importance of proper digestion.


Digestion and Rheumatoid Arthritis

Proper digestion is a requirement for optimum health, and incomplete or disordered digestion can be a major contributor to the development of many diseases, including rheumatoid arthritis. The problem is not only that ingestion of foods and nutritional substances are of little benefit when breakdown and assimilation are inadequate, but also that incompletely digested food molecules can be inappropriately absorbed into the body. Since many individuals with rheumatoid arthritis are deficient in digestive factors including hydrochloric acid and pancreatic enzymes, incomplete digestion may be a major factor in rheumatoid arthritis. If an individual is experiencing any signs or symptoms of gastric acid insufficiency as listed below, [or if the patient scores high under Hypoacidity on the Health Appraisal Questionnaire] consider adding Metagest to the outlined nutritional protocol.

Common signs and symptoms of low gastric acidity

  • Bloating, belching, burning, and flatulence immediately after meals
  • A sense of "fullness" after eating
  • Indigestion, diarrhea, or constipation
  • Multiple food allergies
  • Nausea after taking supplements
  • Itching around the rectum
  • Weak, peeling, and cracked fingernails
  • Dilated blood vessels in the cheeks and nose
  • Acne
  • Iron deficiency
  • Chronic intestinal parasites or abnormal flora
  • Undigested food in stool
  • Chronic candida infections
  • Upper digestive tract gassiness

Challenge protocol for hydrochloric acid supplements

The challenge protocol for hydrochloric acid supplementation developed by Jonathan Wright, M.D., instructs

patients to:

"Begin by taking one tablet... (600 mg) of hydrochloric acid [Metagest] at your next large meal. If this does not produce a warming sensation or abdominal discomfort, at every meal after that of the same size take one more tablet. Continue to increase the dose until you reach seven tablets or when you feel a warmth in your stomach

or abdominal discomfort, whichever occurs first. A feeling of warmth in the stomach means that you have taken too many tablets for that meal, and you need to take one less tablet for that meal size. It is a good idea to try the larger dose again at another meal to make sure that it was the hydrochloric acid that caused the warmth and not something else.

After you have found the largest dose that you can take at your large meals without feeling any warmth, maintain that dose at all meals of similar size. You will need to take less at smaller meals. When taking a number of tablets

it is best to take them throughout the meal.

As your stomach begins to regain the ability to produce the amount of hydrochloric acid needed to properly digest

your food, you will notice the warm feeling again and will have to cut down the dose level."


Pancreatic Enzymes

The pancreas produces enzymatic secretions required for the digestion and absorption of food. Each day the pancreas secretes about 1.5 quarts of pancreatic juice in the small intestine. Enzymes secreted include lipases which digest fat, proteases which digest proteins, and amylases which digest starch molecules.

Physical symptoms and  laboratory  tests can be used  to assess pancreatic  function. Common  symptoms of pancreatic insufficiency include abdominal bloating and discomfort, gas, indigestion, and the passing of undigested food  in  the stool. [A high  score  under  Small  Intestine  on  the Health Appraisal  Questionnaire  also  indicates pancreatic insufficiency]. For laboratory diagnosis, the comprehensive stool and digestive analysis can be used

to reveal the level of pancreatic enzymes being dumped into the intestines from the pancreas by determining the level of excess fat in the stool, excess nitrogen in the stool, and the presence of any other partially or completely undigested food elements. In addition, the complete stool and digestive analysis will also reveal the health of the bacterial flora which often reflects the degree of pancreatic function.

Pancreatic enzyme products [such as Azeo-Pangen] are prepared from fresh hog pancreas. Pancreatic enzymes are most often employed in the treatment of impaired digestion, food allergies, and autoimmune diseases like rheumatoid arthritis.

Several human studies have shown that when supplemental pancreatic protease or proteolytic enzymes, such

as trypsin and chymotrypsin, are given orally they are absorbed intact into the bloodstream in an enzymatically active form. Even more dramatic is the finding that pancreatic enzymes are not only absorbed intact from the gut, but also transported through the bloodstream, taken up intact by pancreatic secretory cells, and re-secreted into the intestines by the pancreas. The existence of this circulation of proteolytic enzymes is quite similar to the recycling of bile salts by the liver.

Clinical uses of pancreatic enzymes [Azeo-Pangen]

  • Digestive disturbances
  • Pancreatic insufficiency
  • Cystic fibrosis
  • Food allergies
  • Autoimmune disorders: rheumatoid arthritis, Lupus, scleroderma, multiple sclerosis
  • Various cancers
  • Sports injuries
  • Viral infections: herpes zoster (shingles), aids

The Importance of the Proteases

While starch and fat digestion can be carried out satisfactorily without the help of pancreatic enzymes, the proteases are critical to proper protein digestion. Incomplete digestion of proteins creates a number of problems for the body, including the development of allergies and formation of toxic substances produced during putrefaction. Putrefaction refers to the breakdown of protein material by bacteria.

As well as being necessary for protein digestion, the proteases serve several other important functions. For example, the proteases, as well as other digestive secretions, are largely responsible for keeping the small intestine free from parasites (including bacteria, yeast, protozoa, and intestinal worms). A lack of proteases or other digestive secretions greatly increases an individual's risk of having an intestinal infection, including an overgrowth of the yeast Candida albicans.

The proteases are also of benefit in treating food allergies. In order for a food molecule to produce an allergic

response it must be a fairly large molecule. In studies performed in the 1930s and 1940s, pancreatic proteases

were shown to be quite effective in treating food allergies. It appears that many practitioners are not aware of,

or they have forgotten about, these early studies. Typically individuals who do not secrete enough proteases will suffer from multiple food allergies. It appears that many individuals with rheumatoid arthritis may secrete insufficient amounts of proteases.

The proteases are also important in preventing tissue damage during inflammation and the formation of fibrin clots. Proteases cause an increase in the breakdown of fibrin, a process known as fibrinolysis. Fibrin's role in the promotion of inflammation is to form a wall around the area of inflammation which results in the blockage of blood and lymph vessels which leads to swelling. Fibrin can also cause the development of blood clots which can become dislodged and produce strokes or heart attacks. Protease enzymes are often used in the treatment

of thrombophlebitis, a disease in which blood clots develop in veins, which become inflamed, and can dislodge

and cause strokes or heart attacks.

Pancreatic enzymes and protease enzyme preparations have been shown to be useful in the treatment of many acute and chronic inflammatory conditions that are associated with high levels of circulating immune complexes. Diseases  associated  with  high levels of circulating immune complexes include rheumatoid arthritis, lupus erythematosus, periarteritis nodosa, scleroderma, ulcerative colitis, Crohn's disease, and multiple sclerosis. The presence of immune complexes are thought to contribute greatly to the disease process in rheumatoid arthritis. Experimental and clinical studies have shown that protease enzyme preparations are extremely effective in reducing circulating immune complex levels with clinical improvements that correspond with decreases in immune complex levels.


Dietary Fats

Fatty  acids are important mediators of allergy and inflammation through their ability to form inflammatory prostaglandins, thromboxanes, and leukotrienes. Altering dietary oil intake can significantly increase or decrease inflammation depending on the type of oil being increased.

By altering the type of dietary oils consumed and stored in cell membranes, prostaglandin metabolism can be manipulated. Prostaglandin manipulation can be extremely powerful in the treatment of inflammation, allergies, high blood pressure, and many other health conditions. The basic goal in most situations is twofold: (1) reduce the level of arachidonic acid, and (2) increase the level of... EPA [Omega 3 fatty acids]. Vegetarian diets are often beneficial in the treatment of many chronic allergic and inflammatory conditions including rheumatoid arthritis, presumably as a result of decreasing the availability of arachidonic acid for conversion to inflammatory prostaglandins and leukotrienes while simultaneously supplying linoleic and linolenic acids. In addition, many nutrition-oriented physicians recommend GLA, flax seed oil, or fish oil supplements to further modify prostaglandin synthesis.


Omega-3 Fatty Acids

The studies of fish oil supplementation in rheumatoid arthritis have demonstrated far better and more consistent responses than the studies with GLA supplementation. The first double-blind, placebo-controlled study of rheumatoid arthritis patients using 1.8 grams of EPA a day showed less morning stiffness and tender joints. These results led

to considerable scientific interest as well as numerous popular press accounts of the possible benefits of fish oil for allergic and inflammatory condition.

Over a dozen follow-up studies have consistently demonstrated positive benefits. As well as improvements in symptoms (morning stiffness and joint tenderness), fish oil supplementation has produced favorable changes in suppressing the production of inflammatory compounds secreted by white blood cells.

While the results of these studies are impressive, all of these studies were relatively short-term (less than one year).

In order to properly assess the beneficial effect of any treatment of rheumatoid arthritis, it is extremely important

to evaluate patients over an extended period of time (ideally, at least one year) as the condition is associated with ups and downs in symptom severity. Recently, a one-year study of fish oil supplementation in rheumatoid arthritis was completed. The results clearly indicated that supplementation with 2.6 g per day of omega-3 oil (six 1 gram capsules of fish oil per day) resulted in significant clinical benefit and led to significant reductions in the need for drug therapy. The results of this long-term study provide further validation of the short-term studies.


The Importance of Dietary Antioxidants

The  importance of consuming a diet rich in fresh fruits and vegetables cannot be overstated in the dietary treatment of rheumatoid arthritis. These foods are the best sources of dietary antioxidants. While the benefits of vitamin C, beta carotene, vitamin E, selenium, and zinc as antioxidant nutrients are becoming well-recognized and well-accepted, there are still other plant compounds which promote healthy joints. Of particular benefit in rheumatoid arthritis are flavonoids.


The flavonoids are a group of plant pigments largely responsible for the colors of fruits and flowers. However, they serve more than aesthetic functions. In plants, flavonoids serve as protection against environmental stress.

In humans, flavonoids appear to function as "biological response modifiers." Flavonoids appear to modify the body's reaction to other compounds such as allergens, viruses, and carcinogens as evidenced by their anti- inflammatory, anti-allergic, antiviral, and anticancer properties. Flavonoid molecules are quite unique in that they are active against a wide variety of oxidants and free radicals.

Recent research suggests that flavonoids may be useful in the support of many health conditions. In fact, many

of the medicinal actions of foods, juices, herbs, pollens, and propolis are now known to be directly related to their flavonoid content. Over 4,000 flavonoid compounds have been characterized and classified according to chemical structure.

Different foods will provide different flavonoids and different benefits. For example, the flavonoids responsible

for the red to blue colors of blueberries, blackberries, cherries, grapes, hawthorn berries, and many flowers are termed "anthocyanidins" and "proanthocyanidins." These flavonoids are found in the flesh of the fruit as well as the skin and possess very strong "vitamin P" activity. Among their effects is an ability to increase vitamin C levels within our cells, decrease the leakiness and breakage of small blood vessels, protect against free radical damage, and support our joint structures.

These flavonoids have a very beneficial effect on collagen. Collagen is the most abundant protein of the body and  is  responsible  for  maintaining the integrity of "ground substance." Ground substance is responsible for holding together the tissues of the body. Collagen is also found in tendon, ligaments, and cartilage. Collagen

is  destroyed during inflammatory processes that occur in rheumatoid arthritis, gout, and other inflammatory conditions involving bones, joints, cartilage, and other connective tissue. Anthocyanidins and other flavonoids affect collagen metabolism in many ways:

  • They have the unique ability to actually cross-link collagen fibers resulting in reinforcement of the natural cross-linking of collagen that forms the so-called collagen matrix of connective tissue (ground substance, cartilage, tendon, etc.).
  • They prevent free radical damage with their antioxidant and free radical scavenging action.
  • They inhibit destruction to collagen structures by enzymes secreted by our own white blood cells during inflammation.
  • They prevent the release and synthesis of compounds that promote inflammation such as histamine.

These remarkable effects on collagen structures and their potent antioxidant activity make flavonoid components

of berries extremely important in any form of arthritis.


Nutritional Support for Rheumatoid Arthritis

Selenium and vitamin E

Selenium levels are low in patients with rheumatoid arthritis. Low selenium levels may be a significant nutritional factor as selenium plays an important role as an antioxidant and serves as the mineral cofactor in the free radical scavenging enzyme glutathione peroxidase. This enzyme is especially important in reducing the production of inflammatory prostaglandins and leukotrienes.

Clinical studies have not yet clearly demonstrated that selenium supplementation alone improves the signs and symptoms of rheumatoid arthritis, however, one clinical study indicated that selenium combined with vitamin E had a positive effect. Vitamin E is an important antioxidant, working synergistically with selenium.

The selenium content of foods varies widely. The best sources are fish and grains. However, the amount of

selenium in grains and other plant foods is directly related to the amount of selenium available in the soil.


Zinc has antioxidant effects and functions in the antioxidant enzyme superoxide dismutase (copper-zinc SOD). Zinc levels are typically reduced in patients with rheumatoid arthritis, and several studies have used zinc in the treatment of rheumatoid arthritis, with some of the studies demonstrating a slight therapeutic effect. Most of the studies utilized zinc in the form of sulfate. Better results may be produced by using a form of zinc with a higher absorption rate such as zinc picolinate, zinc monomethionine, or zinc citrate. In addition to eating foods rich in zinc, like whole grains, nuts, and seeds, individuals with rheumatoid arthritis should supplement their diet with an additional 30 to 45 mg of zinc daily, preferably by using one of the more absorbable forms of zinc.

Manganese and superoxide dismutase

Manganese functions in a different form of the antioxidant enzyme superoxide dismutase (manganese SOD). Manganese-containing SOD is deficient in patients with rheumatoid arthritis. The injectable form of this enzyme (available in Europe) has been shown to be effective in the treatment of rheumatoid arthritis, however, it is not clear if any orally administered SOD can escape digestion in the intestinal tract and exert a therapeutic effect. In one study, oral SOD was shown not to affect tissue SOD levels.

Perhaps a better and more economical method of raising SOD is to supplement the diet with additional manganese.

Manganese supplementation has been shown to increase SOD activity, indicating increased antioxidant activity.

Although no clinical studies have been conducted to determine the effectiveness of manganese supplementation

in rheumatoid arthritis, it appears to be indicated, based on the low levels seen in patients with rheumatoid arthritis

as well as its biochemical functions. The standard recommendation for patients with rheumatoid arthritis is to supplement their diet with an additional 5 to 15 mg of manganese per day. Good dietary sources include nuts, whole grains, dried fruits, and green leafy vegetables. Meats, dairy products, poultry, and seafood are considered poor sources of manganese.

Vitamin C

Vitamin C functions as an important antioxidant. The white blood cell and plasma concentrations of vitamin C are significantly decreased in rheumatoid arthritis patients. Supplementation with vitamin C increases SOD activity, decreases histamine levels, and provides some anti-inflammatory action. In addition to consuming foods rich in vitamin C, such as broccoli, Brussels sprouts, cabbage, citrus fruits, tomatoes, and berries, it is recommended that patients with rheumatoid arthritis supplement their diet with an additional 1,000 to 3,000 mg of vitamin C daily

in divided doses. [Collagenics Intensive Care contains vitamins E, C, zinc, manganese, glucosamine sulfate, and proanthocyanidins].

Curcumin (Curcuma longa)

Curcumin, [as found in Inflavonoid Intensive Care] the yellow pigment of Curcuma longa (turmeric), appears to

be one of nature's most potent anti-inflammatory agents. Turmeric... is extensively used in foods both for its color and flavor. In addition, it is used in both the Chinese and Indian (Ayurvedic) systems of medicine as an anti-inflammatory agent.

Turmeric and its derivatives have a great deal of pharmacological activity. Although a number of components have exerted activity, curcumin is the most potent compound. Curcumin is a powerful antioxidant and has greater effects in preventing free radical damage compared to vitamin C, vitamin E, and superoxide dismutase. However, the protective effects curcumin has against inflammation and joint damage is only partially explained by its direct antioxidant and free radical scavenging effects. Additional mechanisms include enhancement of the body's natural antioxidant system; increasing the activity of the body's own anti-inflammatory mechanisms; and exerting direct anti-inflammatory action, acting directly on several enzymes and gene loci.

Numerous experimental studies have demonstrated curcumin produces exceptional anti-inflammatory effects. Curcumin is as effective as cortisone or the potent anti-inflammatory drug phenylbutazone in models of acute inflammation. However, while phenylbutazone and cortisone are associated with significant toxicity, curcumin is without side effects.

Curcumin exhibits many direct anti-inflammatory effects including the formation of leukotrienes and other mediators

of inflammation. However, curcumin also appears to exert some indirect effects. In models of chronic inflammation, curcumin is much less active in animals that have had their adrenal glands removed. This observation means that curcumin works to enhance the body's own anti-inflammatory mechanisms. Possible mechanisms of action include:  (1) stimulation of the release of adrenal corticosteroids; (2) "sensitizing" or priming cortisone receptor sites, thereby potentiating cortisone action; and (3) preventing the breakdown of cortisone.

Curcumin has demonstrated some beneficial effects in human studies comparable to standard drugs. In one double-blind clinical trial in patients with rheumatoid arthritis, curcumin at 1,200 mg per day was compared to phenylbutazone at 300 mg per day. The improvements in the duration of morning stiffness, walking time, and joint swelling were comparable in both groups. However, it must be pointed out that while phenylbutazone is associated with significant adverse effects, curcumin has not been shown to produce any side effects at the recommended dosage level.

In another study which used a new human model for evaluating NSAIDs, the postoperative inflammation model, curcumin was again shown to exert comparable anti-inflammatory action to phenylbutazone. It must be pointed out that while curcumin has an anti-inflammatory effect similar to phenylbutazone and various NSAIDs, it does not possess direct analgesic action.

The results of these studies indicate that turmeric or curcumin may provide benefit in the treatment of flare-ups

of inflammation in rheumatoid arthritis. Furthermore, the safety and excellent tolerability of curcumin compared

to standard drug treatment is a major advantage. Toxicity reactions to curcumin have not been reported. Animals fed very high levels of curcumin (3 g/kg body weight) have not exhibited any significant adverse effects. The recommended dosage for curcumin as an anti-inflammatory agent is 400 to 500 mg three times a day. [6-9 tablets

of Inflavonoid Intensive Care].

Ginger (Zingiber officinalis). Ginger [found in Inflavonoid Intensive Care] has been used for thousands of years

in China for medicinal purposes. Chinese records dating from the 4th century B.C. indicate that it was used to treat numerous conditions including "rheumatism." Ginger possesses numerous pharmacological properties. The most relevant in rheumatoid arthritis are its antioxidant effects-inhibition of prostaglandin, thromboxane, and leukotriene synthesis, and anti-inflammatory effects.


Ginger's ability to inhibit the formation of inflammatory mediators along with its strong antioxidant activities and protease component suggest a possible benefit in inflammatory conditions. To test this hypothesis, a preliminary clinical study was conducted on seven patients with rheumatoid arthritis, in whom conventional drugs had provided only temporary or partial relief. All patients were treated with ginger. One patient took 50 grams per day of lightly cooked ginger while the remaining six took either 5 grams of fresh or 0.1 to 1 gram of powdered ginger daily. Despite the difference in dosage, all patients reported substantial improvement, including pain relief, joint mobility, and decrease in swelling and morning stiffness.

In the follow-up to this study, 28 patients with rheumatoid arthritis, 18 with osteoarthritis, and 10 with muscular discomfort who  had been  taking  powdered  ginger for periods  ranging  from three months to 2.5 years were evaluated. Based on clinical observation, it was reported that 75% of the arthritis patients and 100% of the patients with muscular discomfort experienced relief in pain or swelling. The recommended dosage was 500 to

1,000 mg per day, but many patients took three to four times this amount. Patients taking the higher dosages

also reported quicker and better relief.


Physical Therapy

Physical therapy has a major role in the management of patients with rheumatoid arthritis. While not curative, proper physical management can improve patient comfort and preserve joint and muscle function. Heat is typically used to help relieve stiffness and pain, relax muscles, and increase range of motion. Moist heat (e.g., moist packs, hot baths) is more effective than dry heat (e.g., heating pad), and paraffin baths are used if skin irritation from regular water immersion develops. Cold packs are of value during acute flare-ups.

Strengthening and range-of-motion exercises are important for improving and maintaining joint function, as well as general health. Patients with well-developed disease and significant inflammation should begin with progressive, passive range-of-motion and isometric exercises. As inflammation is ameliorated, active range-of-motion and isotonic exercises are more appropriate.


Final Comments

Rheumatoid arthritis is an aggressive disease that needs aggressive treatment. If the patient has been taking corticosteroids or has taken them for more than three months in the past, take a formula containing herbs which support the adrenal glands. If there is significant secondary osteoarthritis, recommend 500 mg of glucosamine sulfate three times daily.

The severity of rheumatoid arthritis varies from one person to the next. In severe cases, NSAIDs and other drugs may be necessary. However, encourage patients not to abandon the natural measures as they will actually enhance the effectiveness of the drugs, meaning lower dosages can be used. When the use of drugs is necessary, be sure to use deglycyrrhizinated licorice to protect against developing peptic ulcers.


Suggested Nutritional Supplementation


Core Nutritional Support Protocol

  • UltraInflamX® Plus 360 - 2 scoops twice daily

Multi-mechanistic support with key nutrients, phytonutrients, and selective kinase response modulators (SKRMs) to address underlying inflammation.

  • Follow either the Modified Elimination Diet or the Anti-Inflammatory Diet
  • LactoFlamXTM - 1 capsule daily

LactoFlamX features L. plantarum 299V - a strain-identified probiotic that has been specifically shown to support the integrity and healthy function of the muscosal lining.

  • EPA-DHA 6:1TM Enteric Coated - 2 softgels three times daily.

EPA-DHA 6:1 Enteric Coated omega 3 fatty acids providing a ratio appropriate for patients with chronic inflammatory conditions.



Iso D TM - 1 tablet three times daily.

Vitamin D3 with Isoflavones.  Iso D3 is designed to support optimal metabolism of vitamin D to its

active form.

If there is a soy sensitivity use:



D 1000TM - 2 microtablets three times daily.

High potency vitamin D3 - the most bioactive form of supplemental vitamin D.


Additional Nutritional Support Considerations


Severe joint damage:

  • Chondro-Relief Intensive Care - 3-6 capsules daily. Comprehensive joint & soft tissue support


Body composition management

  • High BMI - Introduce lower calorie Modified Elimination or Anti-inflammatory Diet
  • Low BMI - Introduce higher calorie Modified Elimination or Anti-inflammatory Diet and measure hsCRP
  • If hsCRP is greater than 1.5mg/l then increase Kaprex® AI to 2 tablets, three times daily


Insulin resistance and dysglycemia

  • MetaglycemXTM - 2 tablets, three times daily


Sex hormone dysregulation

  • EstroFactors® - 3 tablets daily.
  • Meta I3C® - 2 capsules daily.
  • ActiFolate® - 1 tablet, three times daily.


Hepatic detoxification imbalances/Drug or Chemical toxicity

  • AdvaClear® - 2 capsules twice daily.


Gastrointestinal Restoration (4R Program)

  • EndefenTM - 1 tsp, three times daily.
  • UltraFlora I.B.TM - 1-2 capsules daily.
  • Glutagenics® - 2 tsp, three times daily.


TH1 dominance or chronic allergy

  • EstroFactors® or Testralin® - 3 tablets daily.


Impaired biotransformation or hepatic detoxification imbalances

  • AdvaClear® - 2 capsules twice daily.
  • Silymarin 80 - 3 tablets daily.


Oxidative stress

  • Oxygenics® - 2-6 tablets daily.
  • Celapro® - 2 softgels daily.
  • MetaLipoate® 300 - 1 tablet twice daily.


Vitamin A insufficiency

  • Ultra Pure Cod Liver OilTM - 1 tsp, three times daily


Thyroid Support

  • Thyrosol® - 1-3 tablets twice daily


Dietary Suggestions

Anti-Inflammatory Diet (Appendix).

Determine need for hydrochloric acid (Metagest) therapy by a high score on the Health Appraisal Questionnaire. Follow Dr. Wright's recommendation for dosage amount. Determine need for pancreatic enzyme (Azeo-Pangen) therapy by a high score on the Health Appraisal Questionnaire, Small Intestine section. Dosage is 1-3 tablets after meals.


Exercise Considerations

  • Acute: range of motion exercise within limits of pain
  • Stretching, range of motion and gentle resistive exercise
  • Water exercise

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