IT’S NOT OLD AGE, IT’S INFLAMMATION
Researchers at Stanford University have made an explosive discovery that threatens to kick away the central platform of osteoarthritis treatment. Doctors have long assumed that the disease is largely caused by traumatic injury or by mechanical problems of ‘wear and tear’, like a piece of worn-out machinery. But as the Stanford research suggests, the disease, and what appears to be mechanical wear, may in fact be largely driven by low-grade inflammation.
In 2011, associate professor of immunology and rheumatology William Robinson and his colleagues at Stanford carried out studies showing that osteoarthritic joint tissues contain larger than usual numbers of migratory inflammatory cells that secrete certain substances early on in the progression of the disease.
The presence of these substances triggers the ‘complement cascade’, a chain of molecular events that eventually escalates into an attack – mounted by the body’s own defence systems (which are usually only deployed against invading micro-organisms) – against the joint itself.
Doctors have witnessed evidence of inflammation in the cells of osteoarthritis patients (albeit not nearly as much as in rheumatoid arthritis), but the Stanford team’s discovery of a heightened number of inflammatory cells in the early stages of the disease, before it causes symptoms, suggests that inflammation could be its central ‘driver’.
Such findings suggest that osteoarthritis, like rheumatoid arthritis, is in fact an autoimmune condition – whereby the body begins to attack itself. This would explain why osteoarthritis isn’t simply a disease of the elderly but, in many instances, starts in a person’s 40s.
Robinson and his team made use of sophisticated lab techniques to compare levels of proteins present in the joint fluid of osteoarthritis patients with protein levels in the joints of healthy, non-arthritic people. The team discovered an enhanced expression of genes that activate inflammatory proteins, a larger than normal number of proteins that accelerate the complement cascade and a smaller than normal number of proteins that act as a brake.
When the researchers examined how this process could lead to osteoarthritis in the joints of both animals and humans, they discovered a cluster of proteins called the ‘membrane attack complex’ (MAC), the nuclear weaponry of the complement system, which binds to cartilage-producing cells. Ordinarily the MAC reserves its might to punch holes in virus- or bacteria-infected cells, but binding instead to cartilage cells causes them to secrete more complement-cascade proteins, inflammatory chemicals and enzymes than usual.
This process ultimately destroys cartilage, while a breakdown product of this cartilage destruction called ‘fibromodulin’ keeps switching the complement system on, so creating a continuing cycle of destruction.
When the researchers examined the joints of animals that had developed arthritis, they found an association between the level of attack by the complement system and the level of functional impairment – the more active the complement system, the more abnormal the animal’s gait.1
‘This low-grade complement activation,’ said Robinson, ‘contributes to the development of degenerative diseases, including Alzheimer’s disease and macular degeneration. Our results suggest that osteoarthritis can be added to this list.’2
Robinson considers the discovery a paradigm shift in the way medicine sees arthritis. The current medical view is that osteoarthritis is incurable, and the usual recommendations are to lose weight, exercise to increase muscle strength, and take numerous drugs to manage the pain and supposedly the inflammation too. The course of treatment is a tightrope walk between reducing pain and not bringing about a great deal of toxic effects on the heart and liver.
These relatively new findings have huge implications for how medicine deals with osteoarthritis. Rather than treating it as an inevitable part of growing old, the Stanford research suggests that an individual’s lifestyle might be analysed to determine what’s causing the chronic inflammation and what sorts of natural compounds might help lower it to inhibit progression of the cycle.
This represents the first laboratory confirmation of what many practitioners of functional medicine have found to be the case in clinical practice. Dr John Mansfield, author of Arthritis: The Allergy Connection (Chivers Press, 1991), who successfully treated several thousands of arthritis patients in the UK at his clinic in Surrey before recently retiring, believes that most forms of arthritis are ‘environmentally induced’ by an intolerance to food or certain environmental chemicals and that some 90 per cent of patients can be improved or fully cured just by making certain lifestyle changes.
Every ‘itis’ condition you’ve ever heard of – arthritis, bronchitis, gastritis, tonsillitis, neuritis – is an inflammation condition resulting from the body’s natural attempt to induce healing by increasing blood and lymph flow carrying nutrients into a damaged or negatively affected area while also flushing harmful pathogens, irritants and damaged cells away from the site.
Characterized by swelling, heat, redness and pain, inflammation is fundamentally a healing immune system response to injury, toxins, allergy and infection. Initial inflammation conditions are called ‘acute inflammation’ (often frequently accompanied by acute pain), and are usually short-lived.
Chronic conditions such as joint pain are an inflammatory warning sign that something is systemically out of balance – that the body is struggling to maintain health in the face of an overwhelming assault of toxins, stressors and pro-inflammatory foods that are not only inhibiting normal healing, but also contributing to an ever-worsening cycle of pain and general disease, ultimately resulting in serious conditions such as cardiovascular disease and stroke.
An ‘inflammation cascade’ occurs when a tissue injury or pathogen of some sort (a virus, bacteria, parasite, fungal infection or allergens) triggers the creation of cytokines. These small proteins involved in cell signalling stimulate the production of cytotoxic (cell-destroying) chemicals – which is supposed to be part of the ‘seek and destroy’ mission of the immune system, and essential to the healing process.
When cascades get out of hand, the body ends up with an inflammation response that doesn’t stop – as is the case with arthritis.
The connection between food allergies/intolerance and arthritis was suggested over 60 years ago.3 Early evidence was sparse but compelling. Finally, in the 1980s, a major study clearly showed that arthritis patients’ symptoms improved on fasting, but worsened when they began to eat certain foods. The findings were supported by objective evidence from blood analyses.4
Increasingly, clinical ecologists (doctors who believe that food and lifestyle affect health) are concluding that arthritis is caused by food allergies or intolerances of certain environmental chemicals such as tobacco smoke, pesticides, perfume or even hairspray.
Medicine finally gave this theory a grudging nod when a Norwegian study published in The Lancet in the early 1990s revealed that patients with rheumatoid arthritis improved after 1) fasting, then 2) following a gluten-free vegan diet for three and a half months, after which 3) they were put on a lacto-vegetarian diet. The study group showed significant improvements in all areas measured, including number of tender and swollen joints, pain, stiffness, grip strength and even white blood-cell count. These benefits were still present a year after the study ended.5
Although food is the most common culprit, John Mansfield and others find that house dust mites and moulds, smoking and intestinal overgrowth of the yeast bug Candida albican can also bring on arthritic symptoms.
Doctors like Mansfield try to isolate the source of the food or chemical problem through skin prick tests (more useful for inhaled allergens than food ingredients, says Mansfield) and through elimination diets. The treatment is either to eliminate the offender from the diet, or to use a technique called ‘provocation intradermal neutralization’ or else enzyme-potentiated desensitization (EPD), the latter developed by Dr Len McEwen, formerly of the Department of Allergy at St Mary’s Hospital, London. With the provocation neutralization techniques (favoured by Dr Mansfield as they have been subject to many more safety studies), a patient is given (by either injection or drops under the tongue) the dosage of the allergenic substance that ‘turns off’ the symptoms. This is discovered through a series of injections that ‘provoke’ allergenic responses.
It’s been discovered that a small subcutaneous injection (that is, just under the skin) can protect a patient for the next two or three days should he or she eat the particular food to which he or she is intolerant. A cocktail of all the neutralizing doses of the foods to which the patient is sensitive, administered in a single injection about three times a week as a kind of ‘vaccination’, will enable the patient to eat normally. In the case of sublingual drops (that is, drops placed under the tongue), one drop will contain neutralizing doses for lots of different food allergens.
The same principles can be used to ‘neutralize’ reactions to inhaled allergens such as house dust, dust mites, moulds, animal furs and summer pollens. Mansfield reports that relief with inhaled allergen-neutralizing injections often starts within half an hour of the first injection and lasts for several days.
The great advantage of neutralization is that your diet or treatment is completely individualized. After two years of injections, the patient should become desensitized to the food in question and able to eat it without needing any more treatment.
The disadvantage is that, after weeks or months, the neutralizing levels can change, making the body resistant to higher and higher doses. This may make re-testing necessary, adding to the expense.
When the technique of enzyme-potentiated desensitization (EPD) was being developed, Dr McEwen used to scratch a large patch on the arm and place a large number of allergens in a container and strap it onto that area of skin on the arm. Now, EPD practitioners employ a large, intradermal injection of a blockbuster micro-dose of hundreds of allergens mixed with the enzyme glucuronidase (hence the name ‘enzyme-potentiated desensitization’). The injection, which takes several months to work, is given at intervals over months. This therapy does not have the immediate relief of neutralization, but claims good responses over a period of months. The disadvantage with EPD is that we don’t know the long-term effects.
Finding out what in your lifestyle is causing inflammation in your body is a matter of detective work. Consequently, you should carry out this investigation with a qualified and experienced nutritional practitioner, who can help you find the cause and choose from among a plethora of natural treatments that have been shown to work as well as, often even better than, drugs.
As more than 70 per cent of immune-system cells are found in the lining of the digestive tract, we’re now recognizing a direct link between immune-system function and the gut. This means that the body’s immune system is enormously affected by the foods we do or don’t eat, or by the overall state of our digestive system. In recent years it’s been discovered that some foods actually induce an inflammatory response and other foods shut it down.
We also know that inflammatory and autoimmune diseases such as arthritis have radically increased in direct proportion to the development and consumption of highly processed, wheat- and corn-based, sugar- and preservative-filled or genetically modified convenience foods. When the processed foods were introduced some 50 years ago, degenerative diseases such as arthritis, diabetes and cardiovascular disease were certainly not as widespread as they are today; and most processed foods are laden with the most common allergenic ingredients, as we’ll soon discover.
Many integrative and nutritional doctors and naturopaths agree that osteoarthritis is often caused by food allergies or intolerances, and that a majority of arthritis patients are sensitive to foods in the nightshade, or Solanaceae, plant family. This food group includes white potatoes, eggplant (aubergine), sweet and hot peppers such as cayenne and paprika (not the black and white kind sprinkled on food), tomatoes and tobacco. The entire nightshade family contains many of the natural toxic chemicals of belladonna (deadly nightshade).6 In a survey of 763 arthritis sufferers carried out by researchers from Rutgers University and the University of Florida, 73 per cent claimed to have responded positively to a diet eliminating nightshades; 28 per cent of the responses were so marked that ‘immobilized joints became mobile’ again, and “canes, walkers and wheelchairs were discarded’. When the survey was carried out again, this time of 434 responders, 68 reported various degrees of relief from arthritic symptoms; of the 52 per cent who were rigidly on the diet, 94 per cent reported ‘complete or substantial relief’.7
The late Dr Collin H. Dong of San Francisco, himself a victim of arthritis, developed a ‘caveman-type’ diet to deal with his own crippling arthritis. Within a few months he was free of symptoms and able to return to playing golf.
The Dong diet was devised to avoid many of the most common allergens, including artificial ones, as well as meat, fruit (including tomatoes), dairy, vinegar and other acids, all varieties of pepper, hot spices, chocolate, dry-roasted nuts, all alcohol (particularly wine), carbonated soft drinks, and all additives, preservatives and chemicals, especially monosodium glutamate (MSG). Because it avoids meat, the diet is naturally high in fish, and fish oils are now widely recommended as good for arthritis patients.
Suspect an allergy if you have: weight issues (either over- or underweight), swelling of the hands, eyes, ankles or abdomen, excessive sweating, even with no exertion, constant fatigue despite adequate sleep, and a too rapid heart rate, especially after meals.
If you have arthritis, first suspect a food intolerance or allergy to one of the big 15:
Centuries ago physicians had no difficulty linking gout – known as ‘the disease of kings’ or the ‘rich man’s disease’ because most patients developing gout were wealthy and obese – to a high consumption of alcohol, meats, sweets and seafood. These were foodstuffs only the rich could afford to consume, let alone in excess. As it turns out, the old-time belief in a dietary cause for gout was spot on. High consumption of organ meats, shellfish, anchovies, sardines, asparagus and mushrooms all contribute to gout because all these foods are high in purines – chemicals the body converts to uric acid, which builds up in the blood, leading to the formation of crystals in a joint, thereby causing pain and inflammation.
Today, other risk factors for gout include excessive alcohol consumption, especially beer and spirits, as well as certain illnesses and medications. People who suffer from hypertension, diabetes, kidney disease and SLE (lupus) are more vulnerable to gout, as are those who regularly take diuretics, low-dose aspirin (1–2g/day) and drugs commonly prescribed to organ transplant recipients such as cyclosporine.8 An often overlooked cause of gout is lead poisoning,9 caused by the kidneys failing to excrete excess lead effectively.
Carrying too much weight increases the load on joints and seems to be one major factor in the advancement of arthritis. But common targets for osteoarthritis in overweight people include not only the weight-bearing joints of the body, such as the knees, but the finger joints too, suggesting that the link between obesity and osteoarthritis is due to factors other than just biomechanical loading.
Researchers at the Department of Orthopaedic Surgery at Washington University School of Medicine in St Louis, Missouri, believe that fat tissue is a major source of pro-inflammatory mediators such as cytokines, chemokines and adipokines – metabolic factors known to have inflammation-boosting properties that help to ‘orchestrate’ the process of osteoarthritis.10
The obesity connection may have more to do with a patient’s overall diet and lifestyle, and how they contribute to insulin resistance and metabolic imbalances – the so-called ‘metabolic syndrome’, which is connected with atherosclerosis, diabetes and other modern-day degenerative diseases, including Alzheimer’s. The major contributors are too much sugar, processed foods and fried foods, which all release oxidizing free radicals into the system. These, in excess, can damage the tissues around joints.
A poor diet can also cause dysfunction in the mitochondria, the power packs of our body’s cells, which supply the energy needed for cells to do their jobs.11
Today’s processed diets feature too much omega-6 fatty acids, known to lead to inflammation and, in turn, joint destruction, swelling and pain, and too little omega-3 fatty acids.
These fatty acids, stored in our body’s fat cells, are essential because we can’t manufacture them in our body and so must obtain them from our diet. They provide energy, and help to build cell membranes and other important substances in the body such as hormones. Our body requires both saturated fats (the type available from butter and coconut oil) and also unsaturated fats (present in olive and other plant oils and fish oil). Omega-6 fatty acids, available in sunflower and soya oil, are plentiful in most Western diets, because they are present in processed foods, but we’re now beginning to understand that it’s the omega-3 fatty acids that lower inflammation as it occurs with arthritis, and that high levels of omega-6 fatty acids can cause oxidative damage to our cell membranes.
Nevertheless, the American government still recommends high levels of omega-6 fatty acids. The recommendation of the National Institute of Medicine of the US National Academy of Science of a 10 to 1 ratio of omega-6 to omega-3 fatty acids is weighted too much towards omega-6: other countries, including the UK’s Department of Health, suggest a 4:1, 3:1 or even a 1:1 ratio. Such a ratio is thought to be beneficial by reducing the risk of many chronic conditions such as hypertension, cardiovascular disease, diabetes, arthritis and cancer.12
There are two types of fats: saturated fats and unsaturated fats, which differ only in the bond between the atoms, but have vastly different effects on the body.
Saturated fats, made from a bond of a single carbon atom, are mostly from animal foods, but are also found in tropical oils such as palm and coconut oils. The saturated fats in our diets are generally derived from four types: stearic (animal fat and chocolate); lauric (coconut oil); palmitic (palm oil, animal products and dairy); and myristic (coconut oil and dairy).
Unsaturated fats come in two forms: monounsaturated fats (with one double carbon bond between atoms) and polyunsaturated fats (two double bonds). Monounsaturated fats are found in olive and canola oils, cashews, peanuts, macadamia nuts, almonds and avocados. Polyunsaturated fats include omega-3 and omega-6 fatty acids, described separately below:
Omega-3 fatty acids come from fatty fish such as salmon, mackerel, herring, sardines, and also flaxseeds. They comprise alpha-linolenic acid (ALA), found in flaxseed, and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (found in plankton and fatty fish).
Omega-6 fatty acids are found in corn, safflower, sunflower, soya bean and sesame oils. They include linoleic acid (LA) and gamma-linolenic acid (GLA), both of which are converted in the body into prostaglandins, which perform many vital bodily functions. The evidence now suggests that excess omega-6s bring about chronic inflammation in the body, leading to a plethora of diseases, including arthritis, while omega-3 fatty acids lower inflammation.
Trans fats are formed when an oil goes through a process called hydrogenation, which makes it more solid. This type of fat, known as hydrogenated fat, used for frying or as an ingredient in processed foods, has been shown to damage health and contribute to diseases like arthritis.
We live in a world where constant exposure to dangerous chemical agents and pollutants is the norm. Industrial chemicals are not tested for safety before they are put on the market. The US Environmental Protection Agency has required safety testing for only a tiny fraction of the 85,000 industrial chemicals currently on the market in shampoos, hairspray, lotions, sunscreens, laundry detergents, cleaning agents and other chemicals typically found around the house.
And so far only five substances – hexavalent chromium, dioxin, polychlorinated biphenyls, asbestos and chlorofluorocarbons – have been banned, and only then in certain instances and applications. Add radiation, carbon monoxide from road vehicles, particulates from diesel vehicles, the release of volatile organic compounds (VOCs) from synthetics used in furniture, paints and carpeting, and you begin to understand why the human body has become a battle ground of toxicity.
The late Dr Theron Randolph of Chicago, Illinois, who first developed the theory of chemical sensitivity, found that household gas, formaldehyde and the pesticides found in food supplies contributed to many cases of arthritis. Indeed, many of British allergy specialist Dr Mansfield’s patients immediately improved or entirely resolved their symptoms just by switching from gas to electricity for cooking.
People living near airports who are regularly exposed to jet fuels are far more likely to develop arthritis than others, as are people who are sensitive to second-hand smoke, food chemicals, other pollutants in the air, and even hairspray and lipstick. Professor Michael Ehrenfeld from Tel Aviv University has long believed that environmental factors have a large part to play in determining who develops the disease. ‘Most people think arthritis has to do with old age,’ he has said, ‘but this is false.’13
Breast implants and other silicone prostheses have been shown to promote antibodies, or allergic responses, to collagen, which then collect in susceptible tissues,14 and this has been linked with joint swelling. In fact, some women have seen their arthritic symptoms disappear after having their implants removed.
Increased intestinal permeability (so-called ‘leaky gut’) leads to the absorption of incompletely digested proteins through the gut wall, and this has been linked to many diseases, including arthritis and joint problems.15
If you’ve been taking non-steroidal anti-inflammatory drugs (NSAIDs) over the long term, then you almost certainly have a leaky gut, as these drugs are known to cause it. Just two doses of aspirin or indomethacin can increase permeability in the gut wall by lowering levels of the protective fatty acid prostaglandin.16
Long-term NSAID use (typical with osteoarthritis sufferers) leaves the gut very inflamed and highly permeable17 and so perpetuates the problem. Medications can also stimulate an overabundance of harmful bacteria, such as Prevotella copri bacteria, which seem to play a part in triggering arthritis. Research shows that rheumatoid arthritis sufferers have far higher levels of these bacteria in their gut, although whether this is a case of direct cause and effect has yet to be proven.18
An overabundance of unhealthy substances such as breads, refined white sugar and unbalanced omega-6 fatty acids, or a lack of normal healthy foods, such as leafy green vegetables and healthy fats such as omega-3 fatty acids, all can lead to hormonal disturbances, a stressed immune system and chronic inflammation. Often nutritional deficiencies are tied to food allergies. For example, undetected gluten intolerance causes inflammatory damage to the lining of the gut, preventing nutritional absorption of certain foods.
Emotions trigger chemical releases in the body – in fact, the work of the late neuroscientist and pharmacologist Dr Candace Pert (author of Molecules of Emotion, Simon & Schuster, 1999) shows that every single emotion has a unique chemical signature created by peptides – or what she referred to as ‘molecules of emotion’. Unrelieved anxiety and stress, for examples, raise adrenaline and cortisol levels in the body, which can lead to hormonal imbalance and ongoing chronic inflammation. If you’ve had prolonged stress or emotional upsets, consider using some of the ‘mind–body’ approaches offered in Chapter 12.
One interesting hypothesis for the rise of unchecked inflammation is that it results from two factors working together: production of free radicals, combined with a lack of electromagnetic grounding with the Earth.
Processed foods, sugar, pollution and chemical toxins have been proven to stimulate the production in the body of highly damaging free radicals – atoms, molecules and ions that have unpaired electrons and thus a positive charge. These are highly reactive and bond with other substances in the body causing, among other things, oxidative stress and inflammation.
In the old days, dangerous positively charged free radicals in the body were mitigated by regular contact with the Earth, which holds a negative electromagnetic charge. Walking barefoot or in leather-soled shoes permitted an influx of negatively charged electrons into the body, which could resupply the unbalanced positively charged atoms, molecules and ions (free radicals) with a much-needed electron. But with the introduction of rubber-soled shoes and rubber-tyred vehicles, that changed.
Proponents of ‘earthing’ say the process can provide a natural antidote to free-radical activity, because the negatively charged electrons from the Earth are able once again to counteract the positively charged free radicals. To demonstrate the theory, William Amalu, president of the International Academy of Clinical Thermography, used thermographic imaging – by which an infrared camera displays changes in skin surface temperatures – to plot the healing of 20 patients suffering from a range of inflammatory conditions, including muscle strain, carpal tunnel syndrome and inflammatory joint problems.
The patients were earthed with either a conductive electrode patch, applied in Amalu’s office during two to three half-hour treatments a week, or a grounded bed pad in their homes where they slept at night. Some patients experienced improvements after just one week – and the thermographic images supported their claims. In at least 12 cases, an 80 per cent improvement was registered by thermography. Images of all 20 patients can be found in the book Earthing: The Most Important Health Discovery Ever? by Clinton Ober, Stephen T. Sinatra and Martin Zucker.19