There's a very interesting study that had been in Florida. The researchers asked for patients who thought that certain foods or food groups would make their arthritis better or worse. And they advertised for these patients to come to the clinical research unit at the University of Florida, and essentially what they did is they locked them up in this unit so they couldn't go out for a pizza at night and have foods that were not on their diet.

 

In some patients specific foods or food groups made worse their rheumatoid arthritis, and some food groups actually improved-their RA.  And then they looked, using either freeze-dried capsules of the food or food group or a placebo freeze-dried capsule with none of the food or food group, and they were able to show that in some patients specific foods or food groups actually exacerbated or made worse their rheumatoid arthritis, and some food or food groups actually improved their RA. And this was both on what's called the joint count where the rheumatologist came, examined the joints to look for pain and swelling, as well as looking at immunologic parameters or looking at blood tests for the immune system. Food can make a difference although the individuality of this is very important to consider.

 

The foods were different. There were some cases where dairy or milk-type products made people worse. There were some nightshades that made some people worse. But the problem was that they couldn't take this and say that was true for every patient with rheumatoid arthritis. It was only true for a subset or a small subgroup of patients.

 

What about somebody trying that, for example, eliminating dairy products to try it out for themselves?  As part of a complete treatment program in rheumatoid arthritis, it is worth thinking about. One needs to obviously discuss this with their rheumatologist or physician because this should not be done instead of standard therapy as  mentioned, that this will probably give them symptomatic relief at best but not slow the radiologic or x-ray progression or destructive changes.

 

And then the other thing that's very important, and that is that the other thing that we see in rheumatoid arthritis is thinning of the bones or osteoporosis, so if a person with rheumatoid arthritis decides to eliminate let's say dairy or any calcium-rich foods and not substitute that with calcium tablets, we may have increased osteoporosis, increased fracture as research has showen. Again, one has to take care of the whole patient.

 

What about somebody eliminating certain foods from their diet to see if that makes a difference?  It's very critical to not avoid certain food groups or any particular food group in growing children, so those per se with juvenile rheumatoid arthritis. So, that becomes a critical issue when you perhaps delete certain foods. Or,for example,the nightshade foods, which include things like potatoes and tomatoes,(let's stop at that as they're many others ) and not name the additional nightshade foods.

 

Think what you're potentially eliminating from a child's diet: it's pizza, it's spaghetti, any type of potato product, and that would be a big cornerstone of what their typical intake might be. Therfore,it can be very critical in terms of being well-meaning to eliminate certain foods but really creating a potential nutritional disaster.

 

The other thing is that we don't think that certain foods actually really cause or are the trigger for rheumatoid arthritis. We're talking about the patients who have rheumatoid arthritis already and the foods either making them worse or exacerbating their disease or making them better or ameliorating their disease.

It's most important to note that the avoidance of certain foods that claim to promote or exacerbate disease symptoms are just that. They're claims, and there's not adequate scientific evidence to support these claims. And that's not to say that an individual might benefit from these dietary alterations, but to broaden that scope and apply it to the general arthritis population is really inappropriate.

 

Avoidance of certain foods that claim to promote or exacerbate disease symptoms are just that. They're claims. Mention of those foods that are commonly indicted, so to speak, for causing these disease exacerbations, and dairy products comes high on the list. And just to give some scope as to how few individuals are actually affected by that, there's only one case report in the literature of a patient with juvenile rheumatoid arthritis that had exacerbation of disease symptoms related to ingestion of milk. Again, to date, there are few scientific rigorous studies that have been conducted to authenticate that certain foods cause or prevent arthritis.

 

It's difficult because we are all exposed to many kinds of foods, especially when we eat prepared foods because we don't know exactly what's in them. What I've told my patients is that if you find a specific food or food group that makes you worse, then eliminating that with discussion with your registered dietitian and physician would be appropriate.

 

Allergies and food sensitivities or intolerances sometimes get pulled together and oftentimes an elimination diet is something that can be implemented in order to pare out what might be causing these allergies or food sensitivities. Now, I wanted to go on to explain exactly what that means -- an elimination diet -- and to underscore the fact that it's important to have a trained healthcare professional -- a physician, a dietitian -- to oversee this elimination diet.
 
To begin, an elimination diet typically takes several months to do appropriately. It's conducted by eliminating or pulling out the diet foods that are thought to cause food allergy or intolerance and then over the course of time once you've seen an outcome in terms of if it improves disease symptoms or whatever, then they would reintroduce that and see if the symptoms return. It's done in a very systematic, scientific way in a fairly controlled manner, and it's important if you want to implement this type of an elimination process to pare out what foods might be giving one problems, to do it in a very specific way and not just by happenstance in order to really be able to determine the outcome and be able to interpret those results.

 

There have been some studies, and they're actually very well-done clinical trials where they've taken patients with rheumatoid arthritis and they've given them omega-3 fatty acid or placebo pills, and they've been able to show that the patients given the omega-3 fatty acids versus the placebo did much better. They actually used the patients as their own controls because what they did is cross them over, meaning that after a certain number of months the patients on omega-3 fatty acid would stop and then get placebo, unknown to either the physician or rheumatologist or the patient, and the patients getting placebo would get omega-3 fatty acid. Omega-3 fatty acid is a fish oil that's rich in tuna fish and mackerel among other fishes and that seems to benefit patients with arthritis including rheumatoid arthritis.
 
The use of fish oil supplements or these omega-3 fatty acids appears to be most potentially useful in the early stages of disease, and it's unknown if it affects disease progression. Some of the pitfalls in prescribing and utilizing fish oils is that there's no universal standardized dose. In most of the clinical trials the dosage has been approximately three grams per day. And fish oil that's sold as a dietary supplement can be packaged in varying dosages, so you may have to take between 10 and 15 capsules a day.

 

There are side effects that have been reported in the use of fish oil, and most commonly are gastrointestinal symptoms such as diarrhea or nausea or abdominal cramping, but usually not so great as to discontinue supplementation in most instances.
 
Dietary supplements, and one being fish oils but there are many others; they're not federally regulated by the government like drugs, and therefore there's no insurance that the levels of active ingredient are what is stated on the ingredient label and the purity, to be free of contaminants. In the case of fish oils, the fish in and of themselves, especially cold-water fish that are high in omega-3s, can have toxins like mercury or dioxins or CBs in the product, and so contamination is a potential concern.

 

None of these supplements are guaranteed, and in a recent independent product review of 20 different fish oils that are currently available, six were found to be inadequate in their levels of omega-3s. And two of these stated, and I thought this was quite interesting, that on the label it stated that the potency of the product had been tested and verified. And also take into account that there are really no long-term safety and efficacy trials that have been conducted on the use of fish oils.

 

It's partly appropriate to go ahead and include fish regularly in your diet. Two to three times a week would be desirable, but the point being with the possible variation in potency of the different supplements of fish oil, it's hard then to improve symptoms through the fish oil when there is this variance. It's a bit questionable and a bit of a dilemma when we talk about the use of any dietary supplements.
 
The studies that I discussed were for signs and symptoms, again meaning swelling of the joints and pain and how patients felt. There were no long-term x-ray studies to show that this was truly slowing the x-ray damage and destructive changes of rheumatoid arthritis. And the fellows in Washington at the FDA are trying to decide whether some of these over-the-counter preparations need to be better regulated so that when one does buy, say, omega-3 fatty acid and you think you're buying three grams of it, you know you're really getting three grams.

 

Just to give you a backdrop as to what's beneficial about these different types of plant oils, flaxseed being one, others being evening primrose, borage oil, even black currant seed oil may have a different type of essential fatty acid, gamolenic acid. And this is thought to be anti-inflammatory, and the studies are more minimal. There're fewer of these studies than clinical trials using fish oil, and dosaging is a bit more questionable as to what should be recommended as dosage. But there is scientific evidence that these plant oils may be beneficial in terms of an anti-inflammatory response.

 

A research scientist said,it's about five or six cans of tuna fish to get three-grams of omega-3 fatty acid. Tuna's not your best bet. It is mackerel, as mentioned, and salmon. Those are the heavy hitters, and then tuna's a little lower on the list. So, it's like those cereal commercials. You've got to really stack it up and eat quite a bit to get just a minimal recommended dose of three grams. We might gain a bit of weight eating five cans of tuna fish a day.  Unfortunately, especially if it's oil-based, which would be more beneficial omega-3 fatty acid-wise, but not in terms of calorie content.

 

What about vegetarian diets? They're typically lower in fat than the American diet in general. Would vegetarian diets be good for people with RA?

This is subject to personal preference and perhaps a bit controversial, but vegetarian diets are typically low in fat. Because they eliminate animal products, and what is the greatest contributor to the diet of saturated or animal fats? And that's meat protein from animals. And so the reduction of that may help to better balance the reduction of N6 types of saturated fatty acids.

 

The increased intake of plants and vegetables and maybe even fish and those types of things may increase not only the omega-3 fatty acid intake but also the antioxidant intake with increased fruits and vegetables and overall may have a beneficial effect for patients with arthritis. And that is more anecdotal.

 There have been some small trials that have shown improvement, but it's unknown the sustained effect of vegetarian diets. And also to say that vegetarian diets are typically lower in calories because it's a lower amount of fat than the typical American diet, and so that again as we have been saying may be beneficial for patients with rheumatoid arthritis.

 

Many patients with RA read about fad diets, either in written or electronic publications such as magazines or Internet, especially chat sites, and they wonder if these fad diets and nutritional supplements that are recommended will really work to improve their disease.

 

What kind of advice should we give to people with arthritis, especially rheumatoid arthritis, regarding these kinds of diets they read in magazines and on the Internet and the supplement information?  If it sounds too good to be true, it's probably not true. 

 

How to go about interpreting nutrition information from all the wide variety of sources that you've mentioned. Lets-just go through what are some of the hallmarks of nutritional fads or quackery, and the first one being if it sounds too good to be true, it's probably not true.

 

The second is that oftentimes this information infers a distrust of current methods of medical practice or it also infers suspicion of the regular food supply, and therefore you need alternatives, and then they list different types of food products.

 

A third one is to take into account that many of the stories or anecdotes that are given are testimonials, and they don't have scientific evidence backing them. And also it's easy to get fake credentialing, to say that you're a nutritionist and hang your shingle in mail-order catalogs, so you can be fooled in terms of fake credentialing as to who may have the authority to lend sound nutritional information.

 

And the other item is that sometimes in these chat rooms or in the lay literature, they refer to studies that are unpublished, and they refer to these results, and they're cited, but they can't be critically examined because they haven't be published. So, that makes for difficulties in terms of being able to tell, and these are all items that should make you suspicious of nutritional information.

 

How do you go about identifying valid nutrition information; results obtained by conducting properly-designed scientific experiments are those that are typically valid. Again,to recognize anecdotal or testimonial evidence. We also realize and recognize that scientists who conduct animal research but don't apply their findings to humans should be a bit suspect in terms of valid results. And those that limit the sample of research participants to very few, which we've mentioned in many of these different types of dietary-related trials, it makes it very difficult to generalize those results to the entire population of patients with arthritis.

 

Most people don't want arthritis. They specifically don't want rheumatoid arthritis, and they would love to find the food or the easy-to-fix cause that would make them all better. People often go to their physicians (some physicians will ignore thsis)with either a printout from the Internet or something in a magazine.
 
And what patients need of the medical community as physicians and rheumatologists to then say, "Let's look at the data or the information behind this and see if it's in what's called a peer-review journal," meaning that some people who really know the field,a nutritionist, would have looked at this information and said, Yes, this is really worth publishing and looking at. Unfortunateliy,doctors get little training at medical school in nutrition,but they are our next best friend.

 

 

Consider this scenerio: You haven't been feeling well for some time,persistent joint pain,flu-like malaise and morning stiffness. You visit your family physician who does a physical exam and orders some lab tests. At a follow-up appointment,your doctor says that you might have RA and an appointment is being set up with a rheumatologist. In the meantime,he says,have the pharmacist fill out this prescription and follow the instructions on the label. You're so stunned by the diagnosis you barely absorb anything the doctor said.

 

You follow instructions blindly,not knowing what to expect and several months later,just as you're beginning to feel a little better,you're totally unprepared when your RA flares up again. Or you throw your pills away and gradually get worse. Or you take the pills when you feel bad and stop when you feel better . Sure,your doctor's confused. Although you're not getting better and he starts adjusting your drug regiman,once again !

 

Here's an alternative: you seize the initiative. You learn everything you can about your condition,become an arthritis self-manager,someone who knows about "risk-to-benefit ratios","optimum blood serum levels" and "indications and contraindications". Now,you know what the medication's supposed to do,when,and why, You know what to do if it doesn't and what side effects to look for,which are serious and which can be easily delt with,either by you or or by a phone call to your doctor or pharmacist.. You will know when drug is working and when it is not,the approximate time to expect before you expect any change in symtoms.

 

You're not buffered by every change in your condition. You're less anxious and far less fearful. You're in control Now,you've made yourself a key player on your health-care team

 

The first thing to understand is that there's no "magic bullet". Currently available medications treat the symptoms and some of the underlying disease mechanisms. There is no "cure" at present. The physician will try to identify which medications respond to you individully and hopefully responds best,and what is the lowest daily dose that will achieve maximum benefit with a minimum risk of side effects.

 

The doctor may have to change your prescription from time to time,perhaps he may have to change it many times,over the course of years. Theirs a certain amount of experimentation that goes on,as the arthritis responds,or doesn't,to one medication or another. That's normal. Not every medication works the same way for everyone.

 

If you're allergic to a specific medication or you're taking medication for another long-term health problem such as heart,dibetes,liver and kidney conditions,make sure your doctor knows. Arthritis medications can interact with medications for other conditions in a number of adverse ways.

 

If you're pregnant,trying to become pregnant,or breastfeeding,inform your doctor,since certain medications can be passed through the placenta or mother's milk.

 

Age is a key factor in medication useage. Generally,if you're over 65,your metabolic rate will be slowing down. Because of natural declines in liver and kidney function,your body won't process and eliminate medication as quickly or efficiently as it once did:not only will you require lower doses ( usually ) of any medication,but any drug you take will have a longer "half-life" in the body,which means the doctor should monitor the effects more closely. Also,seniors are more vulnerable to stomach and digestive tract upset,because of natural thinning of the lining that protects the stomach wall. Many arthritis medications are acidic in nature,so this is an important consideration.

 

For explanation purposes,it's easier to divide arthritis into two categories: inflammatory arthritis ( RA,PsA,lupus,any arthritis with persistent joint inflammation,including short-term problems,such as bursitis and tendenoitis etc. ) and non-inflammatory,or degenerative arthritis,such as osteoarthritis (OA). It's not a clean division,however,because cartilage erosion in OA sometimes causes loose oarticles and debris to irritate the synovial membrane in a joint,causing inflammation,in which case anti-inflmmatory medications may be appropiate. One thing just about every arthritis have in common is pain