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What Causes Rheumatoid Arthritis? Possible Microbial Causes

From the Book: Arthritis – How you can benefit from Diet, Vitamins, Minerals, Herbs, Exercise, and Other Natural Methods by Michael T. Murray N.D. published 1994.

Many suggest that microorganisms are responsible for rheumatoid arthritis. A variety of microorganisms (for example, Epstein-Barr vims, rubella virus, amoebic organisms, and mycoplasma among a few) have been suggested as causative factors in the development of rheumatoid arthritis despite the fact that no microbial agent has been consistently isolated in rheumatoid arthritis patients. The actress/comedian Lucille Ball developed crippling Rheumatoid Arthritis after being sick with pneumonia at the age of 19. After a year, she managed to CURE herself. Read her book “Love Lucy”.

Hydroxychloroquine

A drug originally used in the treatment of malaria, hydroxychloroquine (Plaquenil) is also used

in the treatment of rheumatoid arthritis. Researchers think it works by inhibiting the immune system. Since rheumatoid arthritis is an autoimmune disease, the drug effectively cripples the immune system from damaging the joint tissues. Hydroxychloroquine must be used for at least six months to determine if it is going to be of value in the treatment of rheumatoid arthritis. Since hydroxychloroquine is associated with a high rate of side effects, use is often discontinued before this time period, however natural hydroxychloroquine (made from grapefruit peel) does not. Mild adverse effects include skin rashes, loss of hair, headache, blurring of vision, ringing in the ears, loss of appetite, nausea, vomiting, stomach cramps, and diarrhea. Severe side effects include emotional or psychotic mental changes; seizures; excessive muscle weakness; damage to the eyes, with significant impairment of vision; anemia; decreased white blood cell counts; and frequent infections.

Gold Salts

Injection of gold salts aids about half the rheumatoid arthritis patients who receive them, but nearly

one-third of these patients experience severe side effects. Oral gold salts are slightly less toxic than injections, but the treatment still causes skin rashes; painful mouth ulcers; bone marrow suppression; and, in some cases, even more serious side effects, such as kidney damage. Like hydroxychloroquine, a trial of six months is required to determine the benefit of therapy with gold salts.

Flaxseed Oil: The Best Choice

Black currant, borage, flaxseed and evening primrose oils contain gamma-linolenic acid (GLA), an omega-6 oil. These oils are often recommended by nutritional-oriented physicians for the treatment of inflammatory conditions, such as rheumatoid arthritis and eczema. GLA is a precursor to series 1 DHGLA and prostaglandins. Unlike the pro-inflammatory series 2 prostaglandins, which are derived from arachidonic acid, series 1 prostaglandins exert anti-inflammatory effects. In addition, other derivatives of DHGLA actually block the formation of damaging leukotrienes. These biochemical effects have provided the rationale behind supplementing the diet with black currant, borage, or evening primrose oil.

In my opinion, the best choice for an oil supplement in the treatment of rheumatoid arthritis is flaxseed oil— especially when cost is taken into consideration. The recommended daily dosage of either EPA (1 .8 grams) or GLA supplements (5 grams) costs $50 to $100 per month. Taking less than the recommended dosage is not likely to produce benefit. In contrast, flaxseed oil is fairly inexpensive. A 12-ounce bottle of flaxseed oil costs less than $12. At a daily dose of 1 tablespoon, this 12-ounce bottle would last more than a month. This daily dose of a high-quality flaxseed oil provides about 6 grams of alpha-linolenic acid and 2 grams of linoleic acid.

Homemade salad dressings are the perfect opportunity to use flaxseed oil. In The Healing Power of Foods Cookbook (Prima Publishing, Rocklin, CA, 1993), I give several recipes for salad dressings. In this book, see Chapter 7 for a recipe for Herb Dressing.

Selenium and Vitamin E

Patients with rheumatoid arthritis have low selenium levels. Selenium plays an important role as an antioxidant and serves as the mineral cofactor in the free radicalscavenging enzyme glutathione peroxidase. This enzyme is especially important in reducing the production of inflammatory prostaglandins and leukotrienes. In addition, selenium has a synergistic effect with other antioxidant mechanisms.

Because free radicals, oxidants, prostaglandins, and leukotrienes cause much of the tissue damage associated with rheumatoid arthritis, a deficiency of selenium results in even more significant damage. 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.

Because patients with rheumatoid arthritis have an increased demand for selenium and vitamin E, supplementing the daily diet with 50 to 200 micrograms of selenium and 200 to 400 international units (IU) of vitamin E appears to be appropriate. Most quality multiple-vitamin, multiplemineral formulas provide the recommended amounts of vitamin E and 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

Zinc has antioxidant effects, and it functions in the antioxidant enzyme copper-zinc superoxide dismutase (copperzinc SOD). Zinc levels are typically reduced in patients with rheumatoid arthritis. Several studies have used zinc in the treatment of rheumatoid arthritis; some have demonstrated a slight therapeutic effect. 44-46 Most of the studies utilized zinc in the form of sulfate. Better results maybe 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— foods such as whole grains, nuts, and seeds— individuals with rheumatoid arthritis should supplement their diet with an additional 30 to 45 milligrams of zinc daily— preferably, one of the more absorbable forms of zinc. Most quality multiple-vitamin, multiplemineral formulas provide this amount of zinc.

Manganese and Superoxide Dismutase

You have already read about the antioxidant enzyme copperzinc superoxide dismutase (copper-zinc SODj. Manganese functions in a different form of SOD, manganese SOD. Patients with rheumatoid arthritis are deficient in manganese SOD. The injectable form of this enzyme (available in Europe) has been shown to be effective in the treatment of rheumatoid arthritis. 48 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 had no effect on tissue SOD levels.

Perhaps a better and more economical method of raising SOD is simply 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 the treatment of rheumatoid arthritis, supplementation seems indicated because patients with rheumatoid arthritis have low levels of manganese. The standard recommendation for patients with rheumatoid arthritis is daily supplementation with 5 to 15 milligrams of manganese. Dietary sources of manganese include nuts, whole grains, dried fruits, and green leafy vegetables. Meats, daily products, poultry, and seafood are poor sources of manganese.

Vitamin C

Vitamin C functions as an important antioxidant. Concentrations of vitamin C in white blood cells and plasma 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—foods such as broccoli, Brussels sprouts, cabbage, citrus fruits, tomatoes, and berries— patients with rheumatoid arthritis should supplement the diet with an additional 1,000 to 3,000 milligrams of vitamin C daily, in divided dosages.

Pantothenic Acid

Compared to normal controls, the level of pantothenic acid in whole blood is low in patients with rheumatoid arthritis. In addition, disease activity is inversely correlated with pantothenic acid levels: The lower the level of pantothenic acid, the more severe the arthritis symptoms. Correction of low pantothenic acid levels brings about some alleviation of symptoms.

In one double-blind study, subjective improvement was noted in patients receiving 2 grams of calcium pantothenate daily. Patients noted improvements in duration of morning stiffness, degree of disability, and severity of pain. Dietary sources of pantothenic acid are whole grains and legumes. But, to reach the daily dose of 2 grams used in the clinical study, supplementation is required.

Iron

Anemia is quite common in patients with rheumatoid arthritis. Most common iron supplements, however, may actually do more harm than good. There are two forms of dietary iron, heme iron and nonheme iron. Heme iron may be useful to some patients with rheumatoid arthritis. Nonheme iron may actually increase inflammation.

Heme iron is iron bound to hemoglobin and myoglobin. Nonheme iron includes the iron found in plant foods and iron salts such as ferrous fumarate, ferrous gluconate, and ferrous sulfate. Dietary sources of heme iron are animal meats, egg yolks, fish, and shellfish. Liver is regarded as the best dietary source of heme iron.

Heme iron is the most efficiently absorbed form of iron. About 25% of heme iron can be absorbed. Nonheme iron is poorly absorbed; its approximate absorption rate is 5%. However, it is not the relatively high absorption rate of heme iron that makes it beneficial to individuals with rheumatoid arthritis. Heme iron is comparatively beneficial because unbound iron (nonheme iron) can actually generate free radicals and pro-oxidants. Also, in most chronic diseases involving anemia, the anemia is simply unresponsive to nonheme iron. In contrast, heme iron supplementation is usually quite effective in treating anemia, as it is in treating the anemia that may accompany rheumatoid arthritis.

The best iron supplement rheumatoid arthritis patients with iron-deficiency anemia can use is one made from liver extracts. In my opinion, the best liver product available is Liquid Liver Extract from Enzymatic Therapy. This extract is produced from a specific fraction of beef liver obtained from animals raised in South America, where ranchers use no chemical sprays, pesticides, or antibiotics in their livestock feed. The fats and cholesterol of the liver are removed via a special cold process, and then the extract is placed into gelatin capsules in free form (this ensures optimum utilization by the body). Liquid Liver Extract is far superior to liver and desiccated liver tablets.

Note: There is Liquid Multi-Vitamins on the market. NOW Brand is what the Amish use because it meets their religious requirements. You will need to add copper tablets 2mg.

Plant-Based Medicines for Rheumatoid Arthritis

Many plants possess significant anti-inflammatory action and are appropriate in the treatment of rheumatoid arthritis. The plants discussed in this section are some of the more effective. Also discussed are plants that can enhance the function or secretion of the body's own cortisone and those that can prevent or reverse some of the negative effects of orally administered cortisone. The herbal medicines are presented in order according to my ranking of their importance in treating rheumatoid arthritis.

Curcumin (Turmeric)

Curcumin, the yellow pigment of turmeric {Curcuma longa), appears to be one of nature's most potent anti-inflammatory agents. Turmeric is the major ingredient of curry powder and is also used in prepared mustard. It is used extensively in foods for both its color and flavor. In addition, turmeric is used in the Chinese and Indian (Ayurvedic) systems of medicine as an anti-inflammatory agent.

Turmeric and its derivatives can produce a great deal of pharmacological activity. Curcumin is a powerful antioxidant, and its ability to prevent free radical damage is greater than that of vitamin C, vitamin E, or SOD. However, the protection curcumin provides against inflammation and joint damage is only partially explained by its direct antioxidant effect and scavenging of free radicals. Additional effects include enhancement of the body's natural antioxidant system and the body's anti inflammatory mechanisms.

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

Among the many direct anti-inflammatory effects of curcumin is the formation of leukotrienes and other mediators of inflammation. As for its indirect effects, models of chronic inflammation show that curcumin is much less active in animals that have had their adrenal glands removed. This means that curcumin works to enhance the body's antiinflammatory mechanisms. Possible mechanisms of action include (1) stimulating the release of adrenal corticosteroids; (2) "sensitizing, " or priming, cortisone receptor sites, thereby facilitating cortisone action; and (3) preventing cortisone breakdown.

In comparisons with standard drugs, curcumin has demonstrated some beneficial effects in human studies. In one double-blind clinical trial involving patients with rheumatoid arthritis, the effects of curcumin (1,200 milligrams per day) were compared to those of phenylbutazone (300 milligrams per day). The improvements in the duration of morning stiffness, walking time, and joint swelling were comparable in both groups. However, phenylbutazone is associated with significant adverse effects; at the recommended dosage curcumin has not been shown to produce any side effects.

Another study used a new human model, the postoperative inflammation model, for evaluating NSAIDs. Again, curcumin exerted anti-inflammatory action comparable to that of phenylbutazone.

Note that, though curcumin has an anti-inflammatory effect similar to that of phenylbutazone and various NSAIDs, it does not possess direct analgesic action.

The studies cited indicate that curcumin can provide benefit in the treatment of the flare-ups of inflammation caused by rheumatoid arthritis. Furthermore, compared to standard drug treatment, curcumin is safer and better tolerated. No toxicity reactions to curcumin have been reported. Animals fed very high levels of curcumin (3 grams per kilogram of body weight) have not exhibited any significant adverse effects.

The recommended dosage of curcumin as an antiinflammatory is 400 to 600 milligrams, three times a day. To achieve a similar amount of curcumin using turmeric would require a dosage of 8,000 to 60,000 milligrams. Because the absorption of orally administered curcumin is in question, curcumin is often formulated in conjunction with bromelain to possibly enhance absorption. In addition, bromelain has anti-inflammatory effects of its own (see the next section). If you use a curcumin-bromelain combination, take it on an empty stomach, 20 minutes before meals or between meals.

Providing curcumin in a lipid base—such as lecithin, fish oils, or essential fatty acids—may also increase absorption. If you use this form, take it with meals.

Bromelain (Pineapple)

Bromelain refers to a mixture of enzymes found in pineapple. Bromelain was introduced as a medicinal agent in 1957, and since that time over two hundred scientific papers about its therapeutic applications have appeared in medical literature." These studies report that bromelain exerts a wide variety of beneficial effects, including reduction of inflammation in cases of rheumatoid arthritis. Figure 6.9 lists the conditions that bromelain can be effective in treating.

Several mechanisms may account for bromelain's antiinflammatory effects, including the inhibition of pro-inflammatory compounds. Bromelain can prevent swelling by activating compounds that break down fibrin. (Fibrin was discussed early in this chapter, in the section about the importance of proteases.) Also, bromelain blocks the production of kinins. Kinins are compounds produced during inflammation. They increase swelling as well as cause pain.

The standard dosage of bromelain is based on its mcu (milk clotting unit) activity. The most beneficial range of activity appears to be 1,800 to 2,000 mcu. The dosage that can effect this level is 400 to 600 milligrams, three times daily, on an empty stomach. Although most studies have utilized commercially prepared bromelain, it is conceivable that drinking fresh pineapple juice could exert similar, if not superior, benefits. One of the best fresh juices to consume if you have rheumatoid arthritis is pineapple ginger. Simply juice one-half of a pineapple along with a 'A-inch slice of fresh ginger. For additional fresh juice recommendations for rheumatoid arthritis, consult The Complete Book ofJuicing (Michael T. Murray, Prima Publishing, Rocklin, CA, 1992).

Ginger

Although ginger (Zingiber officinale) is native to southern Asia, it is now extensively cultivated in the tropics (for example, India, China, Jamaica, Haiti, and Nigeria). Jamaica is a major exporter of the crop. Jamaica exports ginger to all parts of the world—more than 2 million pounds annually. The knotted and branched underground stem, or rhizome (commonly called the root), is the portion of ginger used for culinary1 and medicinal purposes. Ginger has been used as a medicine for thousands of years in China. Chinese records dating from the fourth century b.c indicate that it was used to treat numerous conditions, including rheumatism.

Ginger causes numerous pharmacological activities. The most relevant in terms of rheumatoid arthritis are its antioxidant effects; its ability to inhibit synthesis of prostaglandin, thromboxane, and leukotrienes; and its anti-inflammatory effects. In the treatment of rheumatoid arthritis, fresh ginger mav be more effective in treating inflammation than dried preparations, because fresh ginger contains a protease that may cause actions similar to those of bromelain. A preliminary clinical study involved seven patients with rheumatoid arthritis. For all seven, 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; 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.

A follow-up study evaluated 28 patients with rheumatoid arthritis, 18 with osteoarthritis, and 10 with muscular discomfort. All had been taking powdered ginger for periods ranging from 3 months to 2 ½ years. Based on clinical observations, 75% of the arthritis patients and 100% of the patients with muscular discomfort experienced relief from pain or swelling. The recommended dosage was 500 to 1, 000 milligrams per day, but many patients took three to four times that amount. Patients taking the higher dosages reported quicker relief and better results.

Many questions remain concerning the best form of ginger and the proper dosage. Most scientific studies have utilized 1 gram of dry powdered ginger root. This amount is a relatively small dose of ginger compared to the average dailv dose of 8 to 10 grams consumed in India. Although most scientific studies have used powdered ginger root, fresh (or possibly freeze-dried) ginger root at an equivalent dosage may yield even better results because it contains higher levels of gingerol as well as the active protease. In light of all this information, what is a practical dosage of ginger for those with rheumatoid arthritis. A daily dosage of 2 to 4 grams of dry powdered ginger may be effective. This amount would be equivalent to approximately 20 grams of fresh ginger root— that's roughly a 1/2-inch slice. These amounts of ginger can easily be incorporated into the diet, especially if you have a juicer. At this dosage, ginger does not appear to have any side effects.

Physical Therapy

Physical therapy has a major role in the management of patients with rheumatoid arthritis. Though 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 (for example, moist packs, hot baths) is more effective than dry heat (such as that from a heating pad). Paraffin baths can be 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 for 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. Here is a hierarchy of the key natural measures to employ In addition to rheumatoid arthritis, these same measures apply to other autoimmune diseases that can lead to arthritis— diseases such as ankylosing spondylitis, systemic lupus, and scleroderma.

1. The first step is therapeutic fasting or an elimination diet followed by careful reintroduction of foods. Note any symptom-producing foods and avoid them in the future.

2. Eliminate all animal products from the diet, with the exception of cold-water fish. Follow the dietary recommendations given in this chapter as well as the guidelines presented in Chapter 7.

3. Drink 16 to 24 ounces of fresh fruit and vegetable juice each day. This will provide a large intake of antioxidants. Grind and consume a ¼ to ½ inch slice of fresh ginger in the juice each day. Or, take powdered ginger capsules.

4. Take 1 to 2 tablespoons of flaxseed oil each day.

5. Determine if you need hydrochloric acid supplementation.

6. Take a 10X USP pancreatic enzyme product at a dosage of 500 to 1,000 milligrams, three times a day, 10 to 20 minutes before meals.

7. Take a high-potency multiple-vitamin, multiple-mineral supplement that provides the recommended levels of vitamin E, selenium, zinc, and manganese. Also take an additional 1,000 to 3,000 milligrams of vitamin C daily, in divided dosages.

8. On a regular basis use the physical therapy treatments discussed in this chapter.

9. Take a high-quality thymus preparation at the appropriate dosage.

10. Take a curcumin-bromelain formula at a dosage of 400 to 600 milligrams, three times daily, between meals.

The severity of rheumatoid arthritis varies from one person to the next. In mild to moderate rheumatoid arthritis, the 12 measures listed previously are extremely effective on their own. In severe cases, NSAIDs and other drugs may be necessary. However, do not abandon the natural measures; they will enhance the effectiveness of the drugs, meaning you can use lower dosages of the drugs. When the use of drugs is necessary, be sure to use DGL (see Chapter 2) to prevent or protect against. peptic ulcers.