From:             "Henry Grabowski" 
To:               "Susan Grabowski" 
Subject:          http://www.drmcdougall.com/Newsletter/may_june1.html
Date sent:        Fri, 4 Sep 1998 07:04:20 -0400

McDougall Newsletter  May/June 1998

DIET: THE ONLY REAL HOPE FOR ARTHRITIS

A dentist writes, "In April of 1994 I met you briefly at the
Michigan Dental Association Annual Meeting in Grand Rapids.
During this seminar, I asked you about my 4-year-old son having
juvenile rheumatoid arthritis. Bryan was on 35 mg of prednisone
(a powerful steroid) and 1200 mg of Advil daily. He was in so
much pain he screamed and cried day and night. In one year he
lost weight and did not grow one inch. His blood work reflected a
sed rate of over 40 (This is a measurement of severity of
inflammation and should be below 5). The suggestions you gave me
that day lead me to remove all animal products from his diet, as
well as refined carbohydrates."

"Within six months, we had Bryan off all his medication. He was
free of pain, gaining weight and growing again. His last blood
work was superb with a sed rate of 1 - can you believe it!" 

That’s how bad it can get. But for millions arthritis is much
more subtle. Marvin Burk (Louise’s husband--Louise works in the
McDougall Health Center office) couldn’t hardly get out of the
chair. Then he would walk straddle-legged halfway across the room
until he could loosen up enough to get his joints moving. His
hands were so stiff he could not use his tools and he often
dropped things. He figured a man of 65 shouldn’t be so crippled
and decided he’d do whatever it takes to get well. He changed his
diet 8 years ago with immediate and dramatic results. Now he pops
out of the chair, walks without a bit of stiffness or pain and he
handles his tools with no trouble. Many of us can relate to
Marvin’s troubles.

PEOPLE’S MOST COMMON AFFLICTION

Diseases of the muscles and bones are among the most common of
all human afflictions, affecting all ages, but becoming more
prevalent with years. Government surveys indicate in the United
States approximately 33% of adults currently suffer from
troublesome arthritis with symptoms of swelling, limitation of
motion, or pain. Approximately half of all people over 65 years
report having arthritis. The regions of the body most affected
are the neck, lower back, hip and shoulder.

Arthritis means inflammation of a joint--no more, no less. The
fact that a person has arthritis tells nothing about the cause or
the cure. Joints can be inflamed as a result of an injury, such
as from tripping and spraining an ankle. That’s called traumatic
arthritis. Joints can be infected with bacteria resulting in
suppurative arthritis. Uric acid crystals can accumulate in the
joints causing gouty arthritis. The causes of all three of these
forms of arthritis are known and once the causes are stopped the
joints heal. Unfortunately, most forms of arthritis are said by
doctors to have "no known cause." And whether or not they will
admit it, there is no cure to be found in modern drug therapy
either.

DEGENERATIVE AND INFLAMMATORY

Arthritis of "no known cause" can be divided into two broad
categories: degenerative arthritis and inflammatory arthritis.
Degenerative arthritis most commonly represents a condition known
as osteoarthritis. This is the most common arthritis found in
people living in Western civilizations--seen in x-rays of the
hands of over 70% of people 65 years and older. However, this
same disease is comparatively rare in African and Asian
countries, where people physically labor to survive (Br J
Rheumatol 24:321, 1985). How can that be? Osteoarthritis is said
to be due to wear and tear on the joints, so why is it less
common among hard working people of underdeveloped countries? Nor
does it explain why with light use, the hands of women often
become twisted and deformed with age.

The inflammatory forms of arthritis include juvenile rheumatoid
arthritis, rheumatoid arthritis, psoriatic arthritis, lupus, and
ankylosing spondylitis. These aggressive diseases affect less
than 5% of the people living in the United States today.
Classifying these inflammatory diseases by different names, such
as rheumatoid or lupus provides no further benefits to the
patient, because it does not lead to better understanding of the
cause of the inflammation, or to the successful treatment of the
disease. 

People diagnosed with degenerative arthritis (osteoarthritis)
have inflammation in their joints in addition to the
long-standing damage (degeneration). This inflammation can often
be stopped with a change in diet and the swelling, pain, and
stiffness relieved. What won’t change in either form of arthritis
is the permanent destruction left by years of disease, leaving
deformity, stiffness and pain. To understand how most people with
arthritis can be helped by a healthy diet, I will focus on the
more aggressive inflammatory forms of arthritis.

HOPE FOR ARTHRITIS SUFFERERS

Arthritis is not a genetic disease, nor is it an inevitable part
of growing older--there are causes for these joint afflictions,
and they lie in our environment--our closest contact with our
environment is our food. Some researchers believe rheumatoid
arthritis did not exist anywhere in the world before 1800
(Arthritis Rheum 34:248, 1991). It is well documented that these
forms of arthritis were once rare to nonexistent in rural
populations of Asia and Africa (Chung Hua Nei Ko Tsa Chih 34:79,
1995; Arthritis Rheum 34:248, 1991). As recently as 1957, no case
of rheumatoid arthritis could be found in Africa. That was a time
when people in Africa followed diets based on grains and
vegetables.

These once unknown joint diseases are now becoming common as
people migrate to wealthier nations or move to the big cities in
their native countries. With these changes they abandoned their
traditional diets of grains and vegetables for meat, dairy
products, and highly processed foods (J Rheumatol 19:2, 1992; Ann
Rheum Dis 49:400, 1991). For example, although unknown in Africa
before 1960, African-Americans lead in the incidence of lupus in
the US (J Am Med Women's Assoc 1998;53(1):9-12). The mechanisms
by which an unhealthy diet causes inflammatory arthritis are
complex and poorly understood, but involve our intestine and
immune system.

INTESTINE AND IMMUNE SYSTEM

Increased Intestional Permeability

The intestine forms an effective barrier to separate and exclude
intestinal contents from the interior of the body. Only a single
layer separates the individual from enormous amounts of antigens
(foreign proteins) both of dietary and microbial origin. The
intestinal mucosa absorbs and digests nutrients, turning large
complex molecules into small simple ones. Normally, only the
small molecules are allowed to pass through the intestinal wall,
while the large ones that can act as antigens, causing immune
reactions, have a limited ability to pass through. Infections and
toxins can cause gaps in this barrier and allow large molecules
to pass into the blood. This condition of increased intestional
permeability is referred to as a "leaky gut." Patients with
inflammatory arthritis have been shown to have inflammation of
the intestinal tract resulting in increased permeability
(Baillieres Clin Rheumatol 10:147, 1996). 

The largest amount of lymphoid tissue in the body is associated
with the gut. This tissue protects the body from antigens that do
get through the intestinal barrier. Unfortunately, an unhealthy
diet--too high in fat, cholesterol, and animal protein--can
compromise the capacities of the lymphoid tissue to destroy
invading antigens that make it through the intestional wall.

Fasting is known to decrease intestinal permeability, thus making
the gut "less leaky." This may be one of the reasons fasting has
been shown to dramatically benefit patients with rheumatoid
arthritis (Scand J Rheumatol 1982;11(1):33-38). When patients
return after the fast to a diet with dairy products, the gut
becomes more permeable and the arthritis returns. An unhealthy
diet containing dairy and other animal products causes
inflammation of the intestinal surfaces and thereby increases the
passage of dietary and/or bacterial antigens (Br J Rheumatol
33:638, 1994). A vegan diet (one with no animal products) has
been found to change the fecal microbial flora in rheumatoid
arthritis patients, and these changes in the fecal flora are
associated with improvement in the arthritis activity (Br J
Rheumatol 36:64, 1997). 

In addition to being devoid of animal products, the diet needs to
be very low in fat for maximum benefits. Dietary fat has a toxic
effect on the intestine of experimental animals, causing injury
that increases the permeability of the gut allowing more antigens
to enter the body (Pediatr Res 33:543, 1993). Feeding high
cholesterol diets to young animals also increases their "leaky
gut" (J Pediatr Gastroenterol Nutr 9:98, 1989; Pediatr Res
21:347, 1987). Those vegan diets that have failed to help
arthritis patients have been high in vegetable oils, which are
know to damage intestional integrity.

One dangerous paradox in arthritis treatment is that the drugs
most commonly used to treat arthritis are toxins to this
intestinal barrier. All commonly used nonsteroidal
antiinflammatory drugs (like Advil, Motrin, Naprosyn, etc.),
apart from aspirin and nabumetone (Relafen), are associated with
increased intestinal permeability in man. While reversible in the
short term, it may take months to improve the barrier following
prolonged use. (Baillieres Clin Rheumatol 10:165, 1996).

Foreign Protein in the Body

Through the "leaky gut" pass foreign proteins from foods and
bacteria into the blood stream. The food proteins are recognized
by the body as "not self,"-- as something harmful, just like it
recognizes the proteins of viruses, parasites, and bacteria as
foreign. Then it makes antibodies against these invaders.
Elevated levels of antibodies to gut bacteria and to food have
been found in various forms of inflammatory arthritis (Rheumatol
Int 1997;17(1):11-16; Clin Chim Acta 203:153, 1991). 

Antigen-Antibody Complexes

A "leaky gut" can lead to the formation of large complexes, made
up of antibodies and the foreign protein (antigens) in the blood
(Curr Opin Rheumatol 10:58, 1998; Ann Prog Clin Immunol 4:63,
1980). The healthy body has mechanisms that easily remove these
large complexes from the blood. In some people, however, these
complexes survive--because they are formed too rapidly for
complete removal and/or the removal mechanisms are insufficient
to handle the load. The persistent complexes are then filtered
out by the smallest capillaries of the body which are found in
the joints, skin, and kidneys. Stuck in the capillaries these
complexes cause an inflammatory reaction, like a sliver of wood
stuck in the skin.

Molecular Mimicry

Another fate of the foreign proteins is they can cause the body
to make antibodies that are not solely specific to that foreign
protein, but also interact with similar human proteins. This
mechanism is known as molecular mimicry. The body attacks itself
and the resulting diseases are referred to as autoimmune
diseases. Rheumatoid arthritis, lupus, psoriatic arthritis,
ankylosing spondylitis, and the other inflammatory forms of
arthritis are autoimmune diseases. 

Molecular mimicry in rheumatoid arthritis has been identified
with cow’s milk. One analysis showed that the amino acid residues
141-157 of bovine albumin were essentially the same as the amino
acids found in human collagen in the joints (Clin Chim Acta
203:153, 1991). The antibodies synthesized to attack the foreign
cow’s milk proteins, end up attacking the joint tissues because
of shared sequences of amino acids between the cartilage and the
milk proteins, that the antibody is directed to attack.

The Defense System

A healthy diet allows the defense systems to work to its full
capacity removing antigens that enter the system and removing
immune-complexes from the blood. Components of the rich American
diet are known to impair its function. Vegetable oils, including
those of the omega-3 and omega-6 variety, are particularly strong
suppressors of the immune system. This immune suppressing quality
of oils (for example, fish oil and primrose oil) has been used to
suppress the pain and inflammation of arthritis, but like too
many drug therapies the ultimate outcome may not be best for the
patient. Suppression of the immune system prevents it from doing
its work of removing invading foreign proteins. Low-fat diets
have been shown to retard the development of autoimmune diseases,
similar to lupus and rheumatoid arthritis, in experimental
animals (Ann Rheum Dis 48:765, 1989).


A healthy diet also supplies antioxidants and other
phytochemicals that keep the joints strong and repair damage (Am
J Clin Nutr 53(1 Suppl):362S, 1991). Animal studies have shown
that the foods consumed on the rich American diet fail to provide
adequate antioxidants to destroy the damaging free radicals that
form in the joint tissues (J Orthop Res 8:731, 1990).

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