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Rheumatoid Arthritis

Recovery from Rheumatoid Arthritis

Frequently Asked Questions

The following questions below are asked regularly. Note that I have leaned heavily on information from an expert in this approach, Robert McFerran (rpmcf@hotmail.com), in listing the answers here.

What foods I can eat on the elimination diet you recommend?

The foods recommended here have been used for years on thousands of patients (with a high success rate) by Dr. John Mansfield and documented in his book ARTHRITIS: THE ALLERGY CONNECTION.

In Robert McFerran's words:

"(cod, trout, mackerel, pears, parsnips, turnips, rutabaga, sweet potatoes, yams, celery, zucchini, carrots and peaches). You may eat them in any combination and in any amount as often as you want throughout the first six days. For best results balance your meals by eating some fish and a generous amount of the steamed vegetables. Use fruit as a dessert to finish your meal."

Food variety is needed during this phase. Don't just eat all pears and think you have done this correctly! If you want to see how to do this, click on the link below.

The elimination diet I used

I haven't improved significantly on Dr. Mansfield's elimination diet? Why?

The answer below comes from Robert McFerran.

"About 15% of people on the elimination diet may not have a noticeable withdrawal or clearing. Usually the reasons fall into one of five categories:

  1. There is a significant chemical exposure or inhaled allergy that is effectively masking symptoms. Common chemical exposures include formaldehyde, various solvents, and chlorine. Dust and/or dust mites from old carpets and bedding are probably the most common and persistent inhaled allergen. Molds can also create a significant problem. A general clean-up of the surrounding environment is always a good idea prior to and following the elimination diet. Changing the bedding (especially the pillowcase) every evening can help reduce dust/dust mite exposure. Showering prior to retiring is a simple way of reducing exposure to pollens and other allergens that get trapped in the hair during the day.

  2. The individual has an extreme metabolism (usually demanding more fat, purine and cholesterol) than provided by the foods in the elimination diet. If they refuse to eat adequate amounts of fish in the elimination diet they will rob themselves of key ingredients to their energy cycle. These individuals usually describe a worsening of symptoms (especially fatigue) followed by a lack of clearing on the diet. These symptoms will resolve as they move to the Metabolic Diet phase of the program.

  3. There is a significant problem with intestinal candidiasis (specifically reacting to the candida albicans microorganism) which is so severe that it's symptoms mask the results of the elimination diet. Usually these folks have withdrawal symptoms followed by only a marginal clearing of symptoms. These symptoms will clear once the candidiasis is properly treated.

  4. The individual is reacting to toxins from other flora or parasites in the intestinal tract. Overabundance of gram negative bacteria or amoebic parasites are the usual culprits.

  5. You are allergic to one of the foods on the elimination diet (very rare).

Any combination of the above can cloud the results of the elimination diet."

I was one of the people in situation 3 above. I had terrible withdrawal, but little clearing of symptoms. An anti fungal was the remedy for this.

What do I do after the first 7 days of the elimination diet?

Elimination of foods is just the first step in this process. Next one should start adding back foods from one of the metabolic diets - more about this at the "How do I know which metabolic diet (agriculturalist, hunter gatherer, mixed) to try?" question below. Add foods one at a time, and look for reactions so that problem foods can be identified. Contrary to traditional medicine, the idea here is to STRENGTHEN one's immune system by transitioning to a whole foods, metabolic diet to accelerate the healing process of one's "leaky gut."

Remember, by this point you have removed the food source of your immune system reactions and have likely experienced some sort of withdrawal symptoms. Think about it - the fact that one can function and improve WITHOUT NSAIDS points toward this. You are now at the beginning of having CONTROL over your RA.

If you don't improve significantly (as was my case), you must look for other sources of immune system reaction as specified in another question ("I haven't improved significantly on Dr. Mansfield's elimination diet? Why?") on this page.

It takes time to start to reverse the RA as this situation did not occur overnight. Remember it took me about 3-4 months to see sustained improvement. See the Timelines page on this site.

In Robert McFerran's words:

"Now that symptoms have cleared new foods can be introduced, one by one, to the base diet of 'safe' foods that you've been eating the past 7 days. The new foods must be in their WHOLE form. When testing allow 4 hours between the introduction of any 'new' foods. Up to 3 foods can be tested each day if there is no reaction. Exactly what foods you should test next will be based on the metabolism that you have inherited.

Keeping a food diary of EXACTLY what you ate and when is critical. While the great majority of 'hyper-acute' responses (or reactions) to foods occur on a timely basis, there are some that are delayed. You'll find yourself referring back to your food diary on a regular basis as you weed out your reactions to foods."

If I were to try anything in your approach, what would it be and how long will it be before I can expect to see results?

Mansfield's elimination diet should be the first thing to try. If done correctly, you should know within 1 week whether food is a factor in your arthritis.

How do I know which metabolic diet (agriculturalist, hunter gatherer, mixed) to try?

The answer below is lengthy, but this is a difficult question that is asked constantly and needs detailed explanation. According to Robert McFerran, who has helped people through this approach for several years, there are several indicators.

"Many folks will get their clearest indication of inherited metabolism during the Elimination Diet phase. Agriculturists find that they feel completely satisfied only eating vegetables and a bit of fruit for breakfast and lunch. Dinner is the only meal where they might feel they need the addition of fish.

Hunter-gatherers on the other hand will feel almost immediately hungry if they don't eat some fish with every meal. They might also find that they need to eat 4-5 meals consisting of the fish, vegetables and a little fruit to sustain them throughout the day. The reason for this phenomenon is that Hunter-gatherers require the purines and fat found in the fish to deliver the energy that they need.

Your eating patterns also give an indication of inherited metabolism. Agriculturists can have a small breakfast and then go without any food until late in the afternoon. Of course they may have several cups of coffee or other caffeinated drinks to help sustain them along the way. In many cases Agriculturists report feeling better with the less they eat.

Hunter-gatherers on the other hand will usually find themselves hungry and in need of food within 2-3 hours after eating breakfast. They might also find themselves in the same situation within 3 hours after lunch and then again just before bedtime. If Hunter-gatherers don't eat breakfast they may find that they can go without food well into the morning hours. If they forgo eating breakfast no insulin is released and blood sugar levels will remain relatively stable.

Your personal reaction to caffeine is another indication of inherited metabolic type. Consider what would happen if you sat down in the mid-morning and had several cups of caffeinated coffee (or other caffeinated beverage) without eating any food. Agriculturists would find that the caffeine energized them and they felt quite well. To EXTREME Agriculturists caffeine is like a magical elixir. Its impact is such that they wonder why everyone doesn't drink it. Hunter-gatherers and individuals with a Mixed metabolism have a different reaction. Two to three cups of caffeinated coffee without food usually leaves them feeling nervous, anxious or jittery.

Caffeine signals the liver to release glycogen which is immediately converted into glucose in the bloodstream. The pancreas then releases insulin so that the glucose in the bloodstream can be utilized by muscles and the brain.

This chain of events assists the Agriculturist metabolism. As you might recall from above the blood sugar levels of the Agriculturist tend to stay elevated. The net effect from consuming a caffeinated drink is the release of a bit more insulin. This extra insulin helps to lower the elevated blood sugar levels making the energy in it available to the brain and muscles.

Hunter-gatherers and Mixed individuals will also find that caffeine gives them a lift. Unfortunately it will be short lived. The release of glycogen from the liver and the subsequent conversion into glucose creates a temporary rise in blood sugar. The pancreas responds by releasing an overly large amount of insulin. This creates the worst possible scenario for these metabolic types with already hypoglycemic (hyper-insulin) tendencies. As their blood sugar levels drop very low they feel hungry, fatigued or jittery.

Of course I routinely see folks that have inherited a Mixed or Hunter-gatherer metabolism that consume caffeinated drinks. The difference here is that they usually drink them shortly before, during or shortly after eating. They simply cannot tolerate several cups without food as can their Agriculturist counterparts.

In many instances a 5 hour glucose tolerance test will reveal your metabolic identity. The test consists of a period of fasting (usually overnight) and then testing for a blood sugar level (or fasting blood sugar level) in the morning. The patient then drinks a sweet, glucose laden, 'test meal'. Glucose readings are then checked at 30 minutes, 1 hour, 1 hours, 2 hours, 3 hours, 4 hours and finally 5 hours after consumption of the test meal.

A sharp rise in glucose levels followed by an abrupt drop indicates hyper-insulinism (better known as hypo-gylcemia). All individuals with this type of blood glucose curve posses a Hunter-gatherer metabolism. Many physicians will suggest that this type of blood sugar curve is abnormal and that the patient has some sort of carbohydrate intolerance. Nothing could be further from the truth. What the 5 hour glucose tolerance reveals is a metabolic identity.

95% of all type II diabetics in America will possess an extreme Agriculturist metabolism. The remaining 5% were previously hypoglycemic (and therefore had inherited a Hunter-gather metabolism). The long term stress of repeated hypoglycemic swings can ultimately results in pancreatic exhaustion and a diabetic blood sugar curve.

Other common blood work values can reveal a bit of a metabolic 'fingerprint' as to what type of metabolism that you've inherited. Cholesterol values give a broad indication of metabolic predisposition. In general Agriculturists tend to have higher total cholesterol and lower HDL cholesterol values than their Hunter-gatherer counterparts.

There is a bit of a paradox with cholesterol values in those that have inherited a Mixed or Hunter-gatherer metabolism. Most individuals with this type of metabolism have a low (less than 165 mg./dl) total cholesterol. Their ratio of total cholesterol/HDL cholesterol is also relatively low. HDL is sometimes referred to as 'good' cholesterol. Physicians now know that high levels of HDL (greater than 50 mg/dl) implies a lower risk of coronary disease. A low cholesterol/HDL ratio is much more indicative of risk factor for coronary disease than simple total cholesterol levels.

Uric acid levels also give some indication of metabolic type. Hunter-gatherers tend to have low uric acid levels where their Agriculturist counterparts test relatively high.

Blood pressure is also a general indicator of inherited metabolism. Many Agriculturists that are eating a diet mismatched to their metabolism will tend to have higher blood pressure values and may actually display chronic hyper-tension. At the same time many Hunter-gatherers will exhibit lower than average blood pressures or hypo-tension. Salt consumption does play a role in all of this. We have seen studies suggesting salt is very bad for us. The more recent wave of research suggests that maybe salt isn't as bad as we thought. Then there are specific studies on folks with chronic fatigue syndrome showing that a high percentage of them get some symptom relief after being put on a high salt diet."

In my case, I had a low uric acid level, low total cholesterol and extreme hunger on the elimination diet (I couldn't imagine doing without the cod I ate every at every meal). I transitioned into the Hunter Gatherer metabolic diet and still eat this way today.

How should I start adding back foods after the elimination diet?

To understand the Robert McFerran's answer below, the following definitions (written by McFerran) are necessary.

"CORE FOODS will be your best foods. Time has made us well adapted to these foods. They have proven themselves to have a low allergenic potential and can be eaten several times a week. They should serve as the bulk (greater than 70%) of your nutritional needs. These should be the first foods you test upon completion of the Elimination Diet phase.

SUPPLEMENTAL FOODS are important since they give nutritional variety to your diet. While these foods tend to work well with your inherited metabolism they also have a higher potential for developing food allergies. Therefore these foods should be regularly enjoyed but not overeaten. You will probably find your best balance if you eat them no more than once a week. These foods should be closely checked for negative reactions after testing your core foods.

AVOID FOODS are those that are metabolically inappropriate for your physiology. While they should generally be avoided they can often be tolerated in small quantities when eaten in conjunction with your Core/Supplemental foods. AVOID FOODS also tend to be best tolerated when eaten with your evening meal. This group of foods are the last that should be tested following the elimination diet as many will generate symptoms.

According to McFerran:

"By day 7 on the elimination diet you should have a clear indication of whether you tend to do better with more protein (fish at every meal suggesting Hunter-gatherer leanings) or just a small bit of fish with dinner (more indicative of an Agriculturist metabolism). You now have about 21 days to re-introduce and test foods for a reaction.

Pick a diet (either the Agriculturist or Hunter-gatherer diet) as your starting point. You may test foods from that metabolic diet in any sequence but you'll get better results if you initially test one of the CORE foods every morning, a SUPPLEMENTAL food for lunch and an AVOID food for dinner (eating too many foods from the AVOID list in back to back fashion will create a metabolic imbalance that can create fatigue and arthritic symptoms making it more difficult to determine food reactions).

Milk and all grains can give a delayed reaction -- therefore these foods must be tested differently. For milk or any grain you must ingest the food at three separate times for 4 consecutive days. During this period you may not test any other 'new' foods. Due to these stipulations it is best to test these foods toward the last part of your testing period.

Don't waste time testing foods that you KNOW you will only eat on rare occasion. At the same time you should make an effort to expand your palette to new foods that you've never eaten before. This will reduce your chance of acquiring new food allergies while you are healing your intestinal tract."

Below are links to the three types of metabolic diets. This is a reflection of the fact that there is no perfect "RA diet" as we inherit different ways of metabolizing foods. These links will show you the exact recommended foods and which category they fall into (Core, Supplemental, Avoid, Eliminate) for each metabolic type.

Agriculturalist Diet
Hunter Gatherer and Mixed Diet

When I add a food, how will I know I have a reaction to it?

In McFerran's words:

"Reactions to foods come in different shapes and sizes. The stronger reactions are easy to spot. Pain and swelling usually flood back within a couple of hours after ingestion. More subtle are reactions that bring on headaches, mental fog, anxiety, intestinal distress, sleepiness or fatigue. Symptoms from hyper-acute reactions can be lessened by taking one tablet of alka-seltzer (the gold box version) in a large glass of water. This can be repeated every 4 hours if needed. You should try to drink plenty of water. It will help speed elimination of the problem food and the 'clearing' of symptoms.

Physicians have used these qualitative symptoms as well as other quantitative measures to determine problem foods. Some early doctors would measure the dilation of the pupils of the eyes prior to and after the introduction of a new food. An easier way for you to detect more subtle food sensitivities is by checking your resting pulse before and after the ingestion of the newly re-introduced food. To do this take your pulse after sitting quietly for about 5 minutes. Do the same at 30 minutes, 1 hour and 2 hours after eating. If your pulse rises or lowers 12 beats or more (from the pre-meal pulse baseline) mark the food in your food diary as questionable and take it out of your diet.

If you are unsure of your response to any food you can re-test it later. Simply pull the food out of your diet for a minimum of 5 days before testing it again. Conversely you should test foods within 20 days of their elimination. It's common to develop a degree of tolerance to an allergic food over time. This increased tolerance will lessen your reaction and with it your ability to perceive it as a problem.

Many individuals that have avoided a known food allergen (say corn) for several months will reintroduce it and find that no effect on their symptoms. They happily begin eating it again on a regular basis. While they don't encounter the 'hyper-acute' reaction that they experienced with the elimination diet, over they next weeks they begin to notice a slow increase in their aches and pains. Panic often sets in as the individual realizes that they feel terrible and they don't know why. The answer is to once again eliminate the food allergen (in this case corn). Withdrawal symptoms will be experienced for a couple of days after eliminating the food followed by a clearing of symptoms and a return to prior well being."

I have osteoarthritis. Will this approach help me?

The method I've followed does help many people with OA. Dr. Mansfield discusses this in his book "Allergies: The Arthritis Connection." A quote from Mansfield (from the book) is below.

"I was so imbued with the idea that this was a purely degenerative condition that I treated people with rheumatoid arthritis or non-specific arthritis for three years or so before a patient with osteoarthritis persuaded me to look at his condition as possibly being connected with allergenic or environmental factors.

After witnessing great benefit in this patient I have treated many hundreds since with results similar to those obtained with other major arthritises.

I now consider that osteoarthritis is not a degenerative disorder in many people and have seen cases where the x-ray appearances of degeneration have markedly improved on follow-up after ecologic treatment....certainly we have seen cases where the x-ray appearances of joint narrowing, and so on, have improved after treatment to the point where the radiologist thought the x-rays had been mixed up with somebody else's."

Below is an excerpt from a series of emails I have recently received which demonstrates positive OA results from this type of approach. From T. F. on 6/19/2001:

"Just a quick note to let you know how things are doing... I did the e diet and noticed substantial withdrawl and, in time, great reduction in my OA pain....So far I have been virtually pain free, unless I slip in my eating, or unless I push my hips too hard. Before the e diet I had begun to find it painful simply to sit for any great period of time. From your site I suspect that it will take some time for my hips to get better to the point that I can exercise hard, etc., there is still stiffness from the loss in joint space.

...LGS (leaky gut syndrome) and OA connection? In my case there is no doubt. I first learned of the food allergy/arthritis connection from your webpage. Saying thank you is not enough. Perhaps all I can do to repay you for taking the time to set up your website is to pass the word to whoever needs it as best I can about my experience with osteoarthritis. And that is something I will certainly do."

From T. F. on 7/16/2001:

"Joseph, one thing. I do believe that OA can come about because of simple joint damage, as well as from the LGS, etc. I have two joints in my fingers that were damaged as the result of sporting activity (judo). These did not respond to diet, but then the occasional pain in these joints really is different than the way the others feel. The other joints hurt much worse, but then that pain did respond to the dietary approach."

Is this approach worth a try if you have osteoarthritis? It sure sounds like it to me.

Questions? Comments? Send me an email


 

 

 

 

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