Introduction to Rheumatoid Arthritis
Rheumatoid arthritis is a debilitating joint-based inflammatory disease that affects people of all ages. It’s the third most common type of arthritis, behind osteoarthritis and gout. Approximately 1.5 million Americans are affected by Rheumatoid arthritis, with 41 out of 100,000 people diagnosed annually. Women are three times more likely to have Rheumatoid arthritis, commonly occurring between the ages of 30 and 60. Men tend to be diagnosed at a later period in their lives. While there is no Rheumatoid arthritis cure or any autoimmune disease cure, there are a host of natural remedies for Rheumatoid arthritis in the functional medicine world. For those with an R.A. diagnosis looking for alternatives to drugs, this article will focus on Rheumatoid arthritis natural treatment (AKA functional, non-drug therapy).
Currently, allopathic (versus functional medicine) treatment for Rheumatoid arthritis begins with non-steroidal anti-inflammatory drugs and advances to (sometimes) gold injections, synthetic corticosteroids, and immunomodulators such as Plaquenil and methotrexate. Eventually, “biological agents” which are “TNF-alpha inhibitors” (infliximab, adalimumab, certolizumab, and golimumab) are often used.
None of these drugs are curative, and their long-term use often causes severe side effects including cancer. Below, I will explain the likely causes of Rheumatoid arthritis and my treatment recommendations including:
- Change what you eat and be cautious with pharmaceuticals.
- Heal the lining of your leaky gut.
- Eat prebiotic foods, take probiotic supplements and clear up possible gut infections.
- Manage stress (cortisol levels).
- Balance hormones.
- Relieve pain.
- Clear up toxins (if needed).
- Supplement appropriately.
- Ask your doctor about LDN.
The Root Cause of Rheumatoid Arthritis
Risk factors traditionally implicated with R.A. include smoking, altered microbiomes, and medications such as non-steroidal anti-inflammatory drugs.
Interestingly enough, each of these things can cause leaky gut; my conclusions will not contradict these conventions.
Leaky gut is the cause of autoimmune disease; including Rheumatoid arthritis. Here are the principal causes of leaky gut and why someone is likely to get R.A.
The food you eat can be the cause of leaky gut, with the standard American diet (S.A.D.) increasingly to blame for this condition. And it’s not just the sugar and processed foods that can harm your gut. It’s the artificial sweeteners, dyes, additives, lectins (mainly found in beans), soda, alcohol and even large amounts of caffeine. It’s GMO foods as well. GMO foods dominate the wheat, soy and corn markets. Increasingly, GMO-gluten used liberally in the food supply is being blamed for non-celiac gluten sensitivity and leaky gut.
Note: Many articles in the reference section show a close connection between the antibodies made in R.A. which result from “bio-mimicry” to gluten.
Dysbiosis of the Gut
When your GI microbiome (bacterial environment) is out of balance, you have gut dysbiosis. This is a prominent feature of leaky gut and has also been studied as a prominent feature in the GI tracts of those with Rheumatoid arthritis. For a more in-depth discussion about this, please see my article on Chron’s Disease.
Painkillers are likely the most common gut irritants that exist. Your gut lining can also be interrupted and the microbiome made toxic by antibiotics and proton pump stomach acid inhibitors such as Prevacid or Nexium. Non-bioidentical hormones such as steroids (prednisone, Medrol) or birth control pills can encourage the growth of excess candida (yeast), which can also damage the gut lining.
There is likely a connection between estrogen and progesterone deficiency and the preponderance of women contracting R.A. Studies reveal that R.A. in women improves when hormones are in balance. Hormonal imbalances can also lead to small intestinal bowel overgrowth, which is a common complication of leaky gut.
Chronic Stress Levels
If you always feel stressed, you have chronically elevated levels of cortisol. High cortisol can cause leaky gut. It slows down both GI motility and the digestive process. Blood flow to the gut decreases causing a higher concentration of toxic metabolites to then chip away at your gut lining.
Direct GI toxins you consume or absorb such as methylmercury in fish, fluoride in water, or air pollution can damage your gut. A newly described direct GI toxin is the ubiquitous household dust mite. Toxic mold is another possible direct gut toxin.
Now, let’s begin the discussion of how we Functional Medicine docs treat Rheumatoid arthritis.
Treat the Underlying Gut Issues
In the first 60 days eliminate everything that might be a “food culprit.” When your symptoms are in remission, you can slowly reintroduce less “offensive” foods. Often, people with leaky gut develop a host of IGG-mediated food sensitivities. This is why it’s better to take anything that could be causing symptoms away initially. I recommend a diet which is a combination of my quasi-paleo anti-inflammatory diet combined with a strict GAPS plus AIP (auto-immune protocol) diet. It restricts gluten, dairy, eggs, corn, sugar, processed foods, citrus, nightshade vegetables (eggplant, tomatoes, peppers, potatoes), legumes and grains, as well as caffeine and alcohol. It also restricts high FODMAP foods and is an “elemental diet plan.”
You will eat mostly vegetables, and meats, using bone broth, water, loose organic tea for beverages and not much else for the first two months. For full details; please refer to the Crohn’s disease articled referenced earlier.
Heal your Gut Lining
Changing your diet is the first step in healing your gut lining. Using the right blend of herbal supplements for leaky gut is also essential; this includes a morning “leaky gut drink,” which includes “GI Rejuv” and collagen powder as well as the essential gut-healer, l-glutamine powder. The next step is re-balancing your microbiome which sometimes means getting rid of “bad bacteria” and yeast.
Re-Balance your Microbiome
Use prebiotic fiber in your diet to start feeding your “good bacteria.” Start with asparagus, Jerusalem artichokes and, during the second month, add naturally fermented foods such as sauerkraut. When you heal your gut lining, typically around month two, add probiotics. Approximately 100 billion probiotic CFU’s per day are necessary. A mixture (in your central probiotic) of Lactobacillus and Bifidobacterium species yields positive results on clinical studies in patients with R.A. The addition of soil-based bacillus species and friendly yeast species are also critical additions for autoimmune disease microbiomes.
Control Stress and Lower Cortisol
Stress is bad for your health. Sustained high cortisol can be the sole reason for having a leaky gut. Adrenal multi-herbal adaptogens, adrenal glandulars, and even the right aromatherapy will bring your cortisol to normal levels. Stress-lowering techniques such as meditation, “vagal breathing,” and yoga in addition to the plethora other methods discussed on this blog will help as well.
Balance your Hormones
The gut “works better” when your hormones are in balance. Women with R.A. will go into and stay in remission faster and longer with balanced hormones.
Adjust your Oral Microbiome
There is a decently strong correlation of periodontal disease, altered oral microbial balance and Rheumatoid arthritis prompting my recommendation for a probiotic-containing non-fluoride toothpaste.
Rheumatoid Arthritis Natural Treatments – How To Relieve Pain and Stiffness
While we’re getting you into remission and anytime after that, we must think about preserving joint structure and mobility and making someone as comfortable as possible. All of my R.A. patients know what they can do immediately for “flares” which usually become quite rare if following my regimen. No matter what regimen you’re following, follow the practices below that are proven to aid in pain relief.
Studies have shown that several inflammatory cytokines including TNF-alpha and IL-6 (and other cytokines) increase pain. In a recent study, levels of inflammatory cytokines were significantly down-regulated with the use of simple cold packs. When compared to more “painful things” such as (brrr!) ice baths and more expensive practices such as cryotherapy, there was no subjective difference in pain relief, either.
Cold therapy also measurably increases the happy neurotransmitter; nor-epinephrine. Nor-epinephrine assists in short-term pain relief, independent of mood.
Lastly, studies show that all types of cold therapy elevate endorphins; your body’s natural pain-reliever. When your body experiences pain or stress, endorphins are mainly released by the brain’s pituitary gland to make you feel better. Cold creates “thermal stress,” currently linked to generating pain-relieving “heat shock proteins” which are generated by heat!
If you don’t have inflamed joints, but you feel stiff, then soak in warm water, have a hot-ish shower, or sit in a hot tub or FIR Sauna.
Heat therapy with or without water eases joint stiffness via “heat shock proteins.” It also increases circulation, and in the case of immersion, the pressure on joints is reduced.
Water temperatures between 92 and 100 degrees Fahrenheit are a good range for most. You can push it to 102 degrees in your whirlpool or your far infrared sauna if you don’t have health issues other than Rheumatoid arthritis.
Exercise and Physical Therapy
Exercise is a good health practice for many reasons. For the R.A. patient, one of the primary goals is to maintain a full range of motion in the joints. For this reason, physical therapy is often a good idea. A heated pool is the ideal exercise venue for many.
Clear out Toxins
If you are “doing everything right” and are not realizing positive results with the steps mentioned above, the first thing to think about is a gut infection and the second thing is toxins. When we think about toxins we think about exposure, including environmental toxins such as mold. We also think about improvement of detoxification (sulfation or methylation) pathways; something your doctor can test. A commonly faulty detoxification (methylation) pathway is the MTHFR pathway.
Supplements as Natural Remedies for Rheumatoid Arthritis
Clinical studies show elevated levels of TNF-alpha and inflammatory interleukins come down with the combination of interventions outlined above. Recall that “conventional medicine” offers R.A. patients “biologics,” which come with a whole host of potentially fatal side effects, including cancer. A new patient, who is a retired Physician with R.A., was put on Humira and soon after; developed melanoma. Her Rheumatologist pooh-poohed the association, so she decided that she had had quite enough of “conventional medicine.” Yes, the biologics often work and please don’t stop anything your doctor is prescribing. None of these drugs, nor what I’m about to share are curative, but if you follow my plan you will have fewer flare-ups compared to documented flare-ups with biologics!
If you implement everything discussed in this article, you will find that your joint pain, stiffness, and swelling will decrease or even disappear. Unfortunately, this is not a cure; but you can get into a nice remission. Make sure your doctor is aware of what you are doing.
Suppress TNF-alpha production
The following integrative products and dietary practices have been studied “in Petri dishes” but have not been tested on humans with any autoimmune diseases. For example, we know that ketosis will inhibit TNF-alpha production. Curcumin, resveratrol, PQQ, melatonin, and vitamin D will also all inhibit TNF-alpha. The production of heat shock proteins by either heat or cold, such as ice packs and baths, FIR saunas, and even cold showers, will suppress TNF-alpha production.
Because the heat and cold practices are great for enhancing mitochondrial function and several of the integratives mentioned above are useful for mitochondrial dysfunction, it’s my practice to recommend these supplements to R.A. patients who all have fatigue as a prominent feature of their illness. And of course, replace and maintain Vitamin D at a level of 75 ng/dL; if your doctor isn’t doing this he/she is “out of date” on the literature.
What about CBD? Or Curcumin?
CBD oil benefits have been studied, but not enough data is available to endorse its use for pain and inflammation wholeheartedly. Yes, it has been studied in Rheumatoid arthritis patients, but the results have been “mixed”; please refer to the linked articles for more information and references. My advice would be to “see if it works” as it is non-toxic, and sure beats taking a non-steroidal drug. Speaking of non-steroidal medications, let me make a shout-out to curcumin, which has been favorably studied to give the same pain relief via the same pathways (COX, LOX-1, LOX-2 inhibition) as non-steroidal anti-inflammatory medications. And does low-dose naltrexone work?
Low-dose naltrexone is a very exciting substance for the treatment of autoimmune disorders; with positive results in studies of R.A. patients regarding inflammation, immune function, and pain. LDN is not a narcotic (it’s a narcotic antagonist) and currently it is only available in 50 mg tablets; so it must be compounded to achieve the correct dose. A patient’s “target dose” is very individual; with some people requiring as little as .75 mg and some needing the maximal “low dosage” of 4.5 mg.
Early suggestions in the non-published literature reveal that liposomal preparations might be better for synovitis than regularly compounded products. This is a prescription-only medication which, at this low dose, has no side effects other than (usually) transient occasional sleep disruption. You can find 50 mg tablets on the internet, but I absolutely wouldn’t recommend using this medication without medical guidance. Note: Companies are marketing the drug for weight loss containing an anti-depressant and intermediate-dose naltrexone; this will not work for autoimmune disease.
My Final Treatment Recommendations
I’m not a fan of biologics or drugs such as Plaquenil or methotrexate for the treatment of Rheumatoid arthritis. The right diet, pre and probiotics, supplements and low-dose naltrexone for immune boosting and natural pain relief are very effective when combined with the other recommendations I have discussed. The last thing I’ll mention is the emergence of peptides as “the next horizon” in regenerative medicine. A peptide called BPC-157 is being used by Physicians in Europe and by professional athletes in the U.S. Since it is not FDA-approved, I cannot recommend it, but I will say that it has been demonstrated in clinical studies to improve the healing of all sorts of tissues. Time will tell if this becomes yet another tool in our treatment arsenal.
Low–dose naltrexone for normalizing immune system function.
The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain
Intestinal dysbiosis and probiotic applications in autoimmune diseases.
The microbiome and autoimmunity: a paradigm from the gut-liver axis.
Molecules 2018, 23(4), 835; doi:10.3390/molecules23040835
Resveratrol as an effective adjuvant therapy in the management of rheumatoid arthritis: a clinical study.
Evaluating the effect of oral N-acetylcysteine as an adjuvant treatment on clinical outcomes of patients with rheumatoid arthritis: a randomized, double blind clinical trial.
Role of Diet in Influencing Rheumatoid Arthritis Disease Activity
How the gut inflames the joints.
Assessment of Vitamin D in Rheumatoid Arthritis and Its Correlation with Disease Activity
Contribution of bacterial pathogens to evoking serological disease markers and aggravating disease activity in rheumatoid arthritis.
Infectious Agents and Inflammation: The Role of Microbiota in Autoimmune Arthritis
The impact of menopause on functional status in women with rheumatoid arthritis.
Long-term efficacy of spa therapy in patients with rheumatoid arthritis.