Rheumatoid Arthritis: It's the food!

I had an email query about Rheumatoid Arthritis, so off to PubMed I went.

From http://www.webmd.com/rheumatoid-arthritis/ss/slideshow-ra-overview

I found Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis.

"Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food."
This suggests that rheumatoid arthritis (RA) is an ongoing process, triggered by something that's consumed.

"After an initial 7-10 day subtotal fast, they were put on an individually adjusted gluten-free vegan diet for 3.5 months. The food was then gradually changed to a lactovegetarian diet for the remainder of the study."
Are you thinking what I'm thinking? I'm thinking Gliadorphin-7, as per Wheat, Constipation, Ischaemic Heart Disease, Type 1 Diabetes, Schizophrenia and Autism.

This suggests that RA is caused by peptide chains passing through loose "tight junctions" in the gut, triggering an (inappropriate) autoimmune response. For ways to improve gut integrity, see Cow's milk, Schizophrenia and Autism.

BCM-7 can be avoided by drinking A2 milk. Most cheeses are made from A1 milk, so should be avoided. Swiss cheeses like Gruyère and Emmental are probably made from A2 milk, so suck 'em and see.

To reduce inflammation in joints, consuming oily fish may help, as an adjunct to prescribed anti-inflammatory medications.

Continued on Fibromyalgia: It's the food, again! (probably).

Things that make you go "Struth!"

I was wading through my Facebook News Feed when I spotted THIS. That article led me to New approach to coeliac testing identifies more Australians at risk, which in turn led me to A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways (provisional pdf), where I saw: "HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts."
HLA-DQ2.5, DQ8 & DQ2.2 are the alleles for Coeliac/Celiac Disease (CD).

Image from http://www.clker.com/clipart-tango-face-surprise.html

"Transglutaminase (TG)-2 IgA and composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 4.6% and 5.6%, respectively, of the community women and 6.9% and 6.9%, respectively, of the community men, but in the screen-positive group, only 71% and 75%, respectively, of women and 65% and 63%, respectively, of men possessed HLADQ2.5, DQ8, or DQ2.2."
There were abnormalities in ~5% of Australian women & ~7% of Australian men, even in those who didn't carry CD alleles.

"...but based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2 in all TG2 IgA or TG2/DGP IgA/IgG screen-positive subjects, CD affected 1.3% or 1.9%, respectively, of females and 1.3% or 1.2%, respectively, of men."
~1.6% of Australian women & ~1.3% of Australian men have CD.

From the discussion: "The concept of a ‘celiac iceberg’ has been important in drawing attention to a large, unrecognized group of patients with CD who do report symptoms considered ‘typical’ of CD [29]. Investigators have proposed expansion of the ‘iceberg’ to encompass patients who are genetically susceptible to CD, but show only raised IEL counts or an isolated abnormal CDspecific serology and normal intestinal histology [30-32]. Consequently, there is considerable uncertainty regarding the true extent of gluten-mediated disease in the community.

Random thoughts: About 1 in 20 Australian women & about 1 in 15 Australian men have some kind of a gut problem (IBS?) due to gliadin, even in those who don't carry CD alleles. The following made me smile.
"Making a diagnosis based on a blood test alone or commencing a gluten-free diet without a confirmatory bowel biopsy is inappropriate and can impose an unnecessary and lifelong treatment."
'Cos life without wheat, rye, barley & oats is such an imposition (undue burden) and everyone just loves to be given a bowel biopsy. <- sarcasm alert.

From Ancestry of Australian population: "More than 92 percent of all Australians descend from Europeans. Anglo-Celtic Australians (English, Scottish, Welsh, Cornish or Irish ancestral origin) make up 74 percent of the Australian population."
Most Australians have genes that originate from Britain & Europe. Uh-oh!

Why do only a small percentage of people carrying the CD allele go on to develop CD? I believe that it's down to luck. During digestion, gliadins are snipped into fragments & amino acids by the peptidase enzymes pepsin, trypsin & chymotrypsin. Gliadin fragments that contain the wrong triplet of amino acids and that manage to slip through excessively-loose tight junctions may trigger CD. Once the "damage is done", it only takes a tiny amount of gliadin to provoke an immune response.

False dichotomies: moderation.

Feel like you're walking a tightrope? I sang this at Open Mic night on Wednesday, including the orchestration!


There's another internet "punch-up" over moderation in what people eat. Apparently, there are only two options:-

Everything in moderation,

Image from http://www.deltadentalarblog.com/2013/07/ditch-the-junk-help-your-kids-eat-better/

or Nothing in moderation.

As always, it's a case of "It all depends". If, when you're at home, you keep raiding the chocolates from the box or sweets/candies from the tin and you don't want to, don't have them in the house. However, if when you're not at home, someone offers you a chocolate or a small sweet/candy, unless you're so desperate that you'll steal some more or go to a shop and buy some more, eat the chocolate or small sweet/candy. Five grams of sugar won't harm you, even if you're diabetic.

If you have Coeliac Disease and mustn't eat any significant gluten, moderation isn't an option. Ditto, if you have impaired gut integrity and you feel better avoiding gluten. If consuming stuff doesn't cause you medical problems or make you desperate to consume even more, moderation is fine.

EDIT: Sometimes, I ramble in a way that makes it hard for people to understand what I'm talking about. I've emphasised the word "Apparently", as this post is about a perceived false dichotomy (perceived by the "Nothing in moderation" group).

Diet, Nutrition & Fitness: Whatever the question, the right answer is "It all depends".

The carbohydrate pendulum keeps on swinging! Bloggers keep on fighting!

Carbohydrates are good. No, they're bad. Wait, they're good again. Nope, bad again. Good again. Aargh!

See also http://wholehealthsource.blogspot.co.uk/2012/09/more-thoughts-on-macronutrient-trends.html
 
So, are carbohydrates good or bad? See the title. Gluten? See the title.

As Everyone is Different, whether "X" is good, bad or indifferent all depends on genes (including gender), the expression of those genes, environment (i.e. birth weight, exposure to pollutants in the womb & after birth), general diet (i.e. nutrients, anutrients & anti-nutrients), lifestyle (i.e. sunlight exposure, stress, sleep etc) and type, level & volume of activity.

The proteins are the problem: Safe proteins for people with compromised gut integrity.

First, Matt Lalonde Ph.D's video "The Science Behind the Paleolithic Diet."

The title of this post comes from Matt Lalonde. As mentioned in Keep 'em tight., about 10% of healthy blood donors have antibodies in their blood to something that shouldn't be in their blood - gliadin. How do gliadin fragments get into the blood? Compromised gut integrity (a.k.a. Leaky gut).

It's possible to repair compromised gut integrity, as mentioned in the above post. In the meantime, it's advisable to avoid "problem proteins" and eat only "safe proteins". Which proteins are the problem?

1) Prolamines: Prolamines are a group of plant storage proteins having a high proline content and found in the seeds of cereal grains: wheat (gliadin), barley (hordein), rye (secalin), corn (zein), sorghum (kafirin) and as a minor protein, avenin in oats.

2) Casein: Of the six major protein types in cow's milk, four are casein proteins and the other two are whey proteins. The caseins usually make up about 80% of the protein in cow's milk. Cheese is ~100% caseins. As Matt said, caseins are also high in proline. Whey is rapidly digested (which is why it's used by bodybuilders post-workout) so it's pretty safe.

3) Anything that makes you feel ill: As everyone is different, this could be anything (peanuts, eggs, shellfish, tomatoes etc). If "X" makes you feel ill, stop eating "X" until your gut is working 100% correctly. There's a possibility that your gut will never work 100% correctly. Which proteins are safe?

Rice, quinoa & amaranth contain generally safe proteins. Properly-cooked legumes (peas, beans & lentils) contain generally safe proteins. Seeds contain generally safe proteins, but most types are very high in omega-6 fats (except for chia & linseeds). Tubers, root veggies & buckwheat contain pretty safe proteins. Meats & fish contain pretty safe proteins.

Pigging-out on safe proteins, (resulting in significant amounts of incompletely-digested proteins reaching the lower intestine) is asking for trouble. Ditto for eating excessive amounts of fruit with or shortly after eating safe proteins, as this increases the speed of peristalsis, which increases the amount of incompletely-digested proteins reaching the lower intestine.

That's all for now. If anything else comes to mind (or if you come up with a bright idea), I'll add it.