• micaela panzavolta

Arthritis


I know a thing or two about arthritis, I have been diagnosed with it at 27, exactly 20 years ago. I have been on heavy medications for many years: some powerful anti-inflammatory drugs and some other to protect my stomach from the effects of the aggressive painkillers.

The cocktail did provide some relief in the beginning, but in the long-term, didn't influence the severity of the disease and contributed to making me very ill. As I’m writing, I have been symptoms and medications free for 7 years after adopting a diet and a lifestyle that sent my arthritis in remission.

In aid of World Arthritis Week [9-16 October], I want to share some of what I have learnt from my 20-year journey and study of naturopathic nutrition. There are 2 types of arthritis: osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the type of arthritis associated with wear and tear of cartilage within joints. It is more commonly (but not exclusively) linked to the ageing process. Differently from Rheumatoid arthritis, osteoarthritis doesn’t continue to get steadily worse over time. The risk of developing it depends on age, joint injury or abnormality, genetic factors, obesity or damage from a different kind of joint disease, for example, rheumatoid arthritis

Rheumatoid arthritis is an autoimmune problem with a genetic component and can be triggered by infections, environmental or lifestyle factors. About 80% of sufferers are women. The body develops antibodies against its own tissue, and it attacks the cartilage and connective tissue. Over time, joints become inflamed and enlarged. The key to keeping this type of arthritis under control is to slow down an over-active immune system. This can be done with disease-modifying drugs and diet + lifestyle. What I have learnt over the years is how powerful the diet+ lifestyle weapon is.

There are a number of factors that are important in managing arthritis

How good your digestion and detoxification are Blood sugar balance Inflammation/Levels of essential fats Allergies

Supplements Lifestyle: stress management, sleep and level of activity

The key to improving the symptoms of arthritis is to work on the underlying causes rather than just treating the symptoms.


Digestion + detoxification The scene for inflammation – even if that inflammation is elsewhere in the body, e.g. the joints – is often set in the digestive tract. If the gut environment is disturbed (a disruption in the normal balance of bacteria), you can develop intestinal inflammation leading to intestinal permeability  (aka ‘leaky gut’). What happens with permeable gut is that partially digested food proteins that should remain in the intestinal lumen, get into the bloodstream, along with other toxins and microbes, putting greater pressure on the body’s detoxification processes. Once the liver starts to become overtaxed, any dietary or environmental toxins may cause further inflammation. A programme that works on creating a good gut environment is ideal. Probiotics and prebiotics can be very helpful, as can food intolerance testing or an elimination diet (see below).

Blood sugar balance There is a big link between inflammation and how well your body responds to insulin, the hormone produced in the pancreas to control blood sugar levels. If your body has a reduced sensitivity to insulin (or you are diabetic), sugar (glucose) or insulin stay in the blood, and too much of either is toxic, triggering inflammatory reactions. Learning to balance your blood sugar levels plays a key role in managing the symptoms of arthritis. This is achieved through eating adequate amounts of protein at every meal and snack, increasing the number of non-starchy vegetables, and considering the quality and the quantity of the starchy carbohydrates you eat. All my nutrition plans are based on a blood sugar balancing diet, also known as low glycaemic load (low GL) diet. A low GL diet is easy to follow, focuses on real foods (not weird things you can only buy at health food shops), keeps you feeling full, and helps you manage your cravings.


Inflammation/levels of essential fatty acids In pretty much every circumstance, joint problems are linked to inflammation and sometimes also to problems with the immune system (autoimmunity). The body produces chemical agents in the body to either switch on or off inflammation. Yes, we need both, inflammation is a normal healthy process in the body needed to fight microbes or to heal a wound. The problem is when inflammation gets out of control. In this case, diet becomes our first ally.

Prostaglandins are one of the main chemicals in this process, and these are the easiest to manipulate with diet. There are 3 different types. 1 and 3 are anti-inflammatory and 2 is pro-inflammatory (causes inflammation and promotes pain). Omega-6 fats can convert into either type 1 or type 2 prostaglandins. Eating a diet high in omega-6 polyunsaturated animal fats (found in meats and dairy produce) has the body producing more of these less desirable type 2 prostaglandins. Sugar and insulin can also redirect the conversion of plant omega-6 fats down the pro-inflammatory pathway.   Omega-3 fats, on the other hand, can only go down the route towards the anti-inflammatory type 3 prostaglandin. Omega-3 polyunsaturated fats are found in foods like walnuts, flaxseeds, hemp, chia seeds, and oily fish. Monounsaturated fats, e.g. avocado and olive oil, are neutral and not involved in inflammatory processes.

Reducing animal proteins and dairy products can bring symptomatic relief. There’s another group of chemicals called ‘free radicals’. These are highly reactive oxygen molecules that rely on other molecules in the body to stabilise them.   You might have heard of free radicals in skincare commercials. They are linked to accelerated ageing, cancer and other diseases. What helps keep these unstable molecules in check are antioxidants (again, something often talked about in skincare).    Antioxidants are found in large amounts in brightly coloured fruit and vegetables. The different colours tend to indicate the type of antioxidants produced – all are good. What we know about antioxidants is that they have a synergistic effect – eating a variety of different ones (by eating a large range of different coloured fruit and veg) has a greater effect that eating the same volume of the same type. Bottom line? Eat a LOT of vegetables and low sugar fruits like berries (which have some of the highest antioxidant levels of all fruit).

Allergies Many people with inflammatory conditions have allergies or intolerances, some of which may be due to leaky gut, where food proteins are able to get through the gut lining, triggering an allergic response. Common offenders are dairy products, yeast, wheat and gluten, other grains, eggs, beef, chilli, coffee and peanuts. If you have rheumatoid arthritis you might find that nightshade foods like potatoes, peppers, tomatoes, and aubergines, play a role in flare-ups.

Remove Gluten Dairy products nightshade food (with rheumatoid arthritis)

Reduce Animal protein

Increase Vegetables of all kinds (eat a rainbow) Sources of vegetable protein Oily fish Nuts Seeds Olive oil

Specific foods to increase Celery Chilli Garlic Ginger Pineapple Red peppers Shiitake mushroom Sweet potato Turmeric


Supplements

As well as having a healthy, balanced diet, getting additional nutrients from food supplements may help if you have arthritis. Their effectiveness depends on the individual but several studies have shown they do have some effects on inflammation. Here's a selection of the most used (but there are many more)

Glucosamine sulfate helps keep the cartilage in joints healthy and may have an anti-inflammatory effect. Natural glucosamine levels drop as people age.

Vitamin D3. Vitamin D is very important for people with joint pain. Research shows that people with low levels of vitamin D may have more joint pain.

Ginger. Ginger has been shown to have anti-inflammatory properties similar to ibuprofen and COX-2 inhibitors. In a 2012 study, a specialized ginger extract reduced inflammatory reactions in RA as effectively as steroids did.

Turmeric. Curcumin is the chemical in turmeric that can reduce joint pain and swelling by blocking inflammatory cytokines and enzymes.

Boswellia. The active components (Boswellic acids) have anti-inflammatory and analgesic (pain-relieving) properties. It also may help prevent cartilage loss and inhibit the autoimmune process.

Omega-3. Omega-3s block inflammatory cytokines and prostaglandins, and are converted by the body into powerful anti-inflammatory chemicals called resolvins. EPA and DHA (Omega3 fatty acids) have been extensively studied for RA and dozens of other inflammatory conditions. A 2010 meta-analysis found that fish oil significantly decreased joint tenderness and stiffness in RA patients and reduced or eliminated NSAID use.

Green tea. Green tea contains compounds that have powerful antioxidant and anti-inflammatory properties that may be helpful in combating join pain.

Devil's claw. Cat’s claw is an anti-inflammatory that inhibits tumor necrosis factor (TNF), a target of powerful RA drugs. It also contains compounds that may benefit the immune system.

It’s important to note, however, that supplements can have side effects, and some may interfere with medications. It’s critical to discuss any supplements with your doctor to learn whether they are safe for you, and the correct dose for you.

Stress and lifestyle Food is important but following the perfect diet will not help if you are stressed, sleep deprived and completely inactive. So here's my number one tip.


1. Stay Active Although arthritis can cause pain and limited range of motion, remaining active is very important for controlling symptoms. Researches show that joint pain associated with arthritis tends to be worse after periods of inactivity (which is why sleeping causes morning stiffness). The best exercises are those that are low-impact such as cycling, walking, water aerobics and yoga. When symptoms become very bad, extra rest is helpful — however, stretching can still help manage inflammation.

2. Manage Stress and Get Enough Sleep This is paramount. I know it’s easier said than done but consider for a moment this fact: numerous studies have shown that sleep deprivation and circadian disruption leads to an increase in the production of inflammatory molecules around the body and dysregulation of the immune system.

Circadian rhythms influence sleep-wake cycles, hormone release, eating habits and digestion, body temperature, and other important bodily functions and are disrupted by insomnia, night shifts, stress, overexertion


Getting enough sleep and limiting stress allow the healing process to start and continue. This is why taking care of your sleep and emotions is especially important during flare-ups. Remember: fatigue and stressful episodes tend to make inflammation worse. Practising guided meditation (I cannot recommend the app ‘Calm’ enough) yoga or stretching, deep breathing, guided imagery, and visualisation help your muscles relax, balance hormones, decrease cortisol and strengthen your immune system.


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