Tag Archives: rheumatoid

Paleo Diet: Romance vs Reality?

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Brown cricket isolated on white

One of the current most popular diets is the Paleo diet. I’ve written in my book, The Symbiont Factor, about how there is fossil evidence supporting the Paleo diet as the way ancient humans ate, and have some additional thoughts on this controversial subject. Like many diets, the Paleo diet has evolved as many individuals and organizations promote their own vision of what a Paleo diet would have been or should be. This is normal, but for someone trying to learn how and why to eat a certain way, it can be bewildering! On one extreme is a Paleo vision that seems really more like an Atkins diet with some vegetables, on the other more like a Vegetarian diet with a little seafood added in. So, with that in mind, why would someone choose a Paleo diet? The basic concept is that our species has spent the majority of its evolutionary trajectory consuming a diet that did not include simple carbohydrates, large percentages of grains or any processed foods. This part of Paleo seems to be univerally agreed on as the building blocks of the diet movement-but what about proteins? I’ve read a great deal about our ancestral origins, and I’m going to run it up the flagpole to see who salutes! I grew up spending much of my childhood in the woods hunting or picking food, fishing or catching things to eat along streams and ponds, and catching blue crabs in the Hudson River (and yes they were yummy). I’ve always followed the licensing and bag limit rules, but since being a child I’ve also somewhat kept tally of those times that I could have taken game if I were starving, yet didn’t because it was out of season in some way. Now I know that many people who follow a Paleo diet likely have an image of ancient hominids that is a bit more romantic or idealized than what I’m about to describe, but hang in there and consider it! First, if we had to survive by hunting and fishing, most of us would starve-some quite quickly. Even if there were no rules, as in ancient paleo societies, hunting and fishing as we think of it today would not work well at all. There is too much energy expenditure involved in an individual capturing an animal for meat. Ancient humans worked around this in a few ways: group cooperative hunts, trapping, and alternative sources of protein. Native Americans, for example, let their children hunt small game while the men either raided other camps and tribes or hunted larger prey in groups. This strategy raised the odds that somebody would catch something! There is evidence that ancient Man had similar divisions of labor, with men hunting game while women and children foraged for other sources of nutrition such as tubers, plants, and…insects. Plains Indians of course had different strategies for hunting Bison, including stalking under cover, chasing on horseback (technically not until they had horses after the Spanish brought horses to the Americas) and driving herds toward pit traps, ambushes or ledges. Fishing is a similar example, with fish being far easier to net or trap than to catch! Fossil remains suggest that any civilizations living near the ocean probably subsisted more on shellfish than anything else for protein. This is evidenced by huge fossilized piles of shells that have been discovered. Having moved to Downeast Maine recently, I can attest to the difference in energy expenditure involved. Any game animals I’ve seen are distant and fleeing, yet I can walk down to the shore and pick a bucket of mussels off the rocks in a few minutes, getting enough to feed several people. Ancient man almost certainly spent much time near or in the water foraging for food. Our bodies come equipped with a functional dive reflex that makes short underwater excursions easier than many would believe! With this in mind, where does it leave ancient people that lived further inland? If you were in the wilderness and had to survive, what would be the easiest and safest source of high-quality protein, fats and nutrients? No, it isn’t that deer that you may or may not ever get…it is insects. They are plentiful and nutritious, and rarely fight back much. I know this sounds “gross” and might not fit what most Paleo afficionados would like to think, but consider it for a moment. Other primates eat insects, survival experts have touted them as a food source, and it doesn’t take nearly as much energy to get enough to sustain life. Some modern businesses have emerged to supply a modern version that is more accessible and perhaps more presentable, in forms such as protein powders or flavored varieties. One of the criticisms of Paleo diets is the need for meat, and the environmental cost/footprint to produce meat. Readers of The Symbiont Factor will also know that commercial meat has a huge number of chemicals included, antibiotics and pesticides, hormones and other goodies, which wreak havoc on our microbiome and our health. Organically raised meat is the way to go, and yet from a global perspective, would it even be possible for many more people to raise and eat organically grown meat? Probably not, as the yield per-acre is lower (don’t get me wrong, that’s a good thing compared to feedlot beef, but not necessarily possible on a global scale). While some of us are still hunters and occassionally can stock the freezer with the original organic, free-range meat, there is still a large part of the population that doesn’t hunt for ethical, geographical or practical reasons. In many families it may have been several generations since anybody hunted! Insects can produce more protein and nutrition with less global impact. I’m not ready to give up completely on meat, but when considering a true Paleo diet, an ento-diet (entomology is the study of insects) is worth study. We’ve been a bit spoiled by sanitized, clean, packaged, pretty foods that don’t resemble their original source in any way-and yet, several times each year there are outbreaks and recalls of such foods due to infectious organisms found in them. Is “sanitary” really an illusion after all? Is it even better for us? Again, in The Symbiont Factor, I reviewed something known as the “Hygiene Theory,” which is the observation that the human being requires a certain degree of bacterial and allergen exposure in order to develop a balanced immune system. When all food is sterile and has no contribution to our inner microbiome, and our children grow up in a sterile, Mr. Clean type of household, the risk of autoimmune diseases is far greater. These can be simple allergies or as severe as ALS, MS, Rheumatoid Arthritis and other modern plagues that are largely the result of our attempts to isolate ourselves from the microbial world. Maybe it is time to consider what we would call “alternative” sources of protein, though they were probably a central source of nutrition for much of mankind’s life. I know, it feels like more of a Paleo thing to eat a Bison steak than chili-lime crickets, but…don’t let it bug you!

https://www.entomarket.com/edibleinsects/465?campaign=TSFB Paleo article

https://www.nasw.org/users/mslong/2010/2010_12/Insects.htm

http://www.the-scientist.com/?articles.view/articleNo/34172/title/Why-Insects-Should-Be-in-Your-Diet/

http://www.ncbi.nlm.nih.gov/pubmed/24613098

http://www.ncbi.nlm.nih.gov/pubmed/25315798

http://www.ncbi.nlm.nih.gov/pubmed/24698197

http://www.ncbi.nlm.nih.gov/pubmed/24630913

http://www.ncbi.nlm.nih.gov/pubmed/24560030

http://www.ncbi.nlm.nih.gov/pubmed/12680308

http://www.ncbi.nlm.nih.gov/pubmed/11171955

Why does Rheumatoid Arthritis improve during a woman’s period or when pregnant?

2 Replies

Why does Rheumatoid Arthritis improve during a

woman’s period or when pregnant?

By Richard Matthews DC DACNB

RA Menses MB

By Richard Matthews DC DACNB

This is an article that I wrote for Clint Paddison, to use for his Paddison Program for Rheumatoid Arthritis. Clint successfully healed himself from RA, and took the extraordinary step of teaching other people how to do it!  I’m sharing the article here for my own blog readers.
Rheumatoid Arthritis is a progressive, debilitating autoimmune inflammatory arthritis. The site of actual damage is the synovial membrane of the joint itself, often causing severe angulation deformities of the joint when not controlled. Hands are the most commonly affected area, often in a symmetrical pattern. As it is an inflammatory disorder, the inflammation can also affect the heart, lungs, or other areas of the body. The portions of the immune system that have been identified are the cytokine (inflammatory immune factor) Tumor Necrosis Alpha or TNF-α, Interleukin-6 or IL-6 and Interleukin-17 or IL-17. There are others involved of course but these are the major therapeutic targets for the condition.

hormones-during-pregnancy

It is best to refer to the accompanying drawing to understand the relationship between these factors, as immune function is complex. We have a type of T-cell in our immune system which is called a T-Regulatory cell or Treg. These cells regulate the activity of T-helper cells or Th. The T-helper cells produce cytokines, such as TNF-α, IL-6 and IL-17, which in this case are the prime suspects in this crime!

Our immune system, and the T cells in particular, receive much of their instruction from the microbiome in our gut. Our gut bacteria directly interact with Treg cells, and through that mechanism help to regulate the cytokine system. This interaction has been quite specifically studied down to the genus and species involved.

The species of gut bacteria found to regulate the immune system and reduce inflammation by reducing IL-6, TNF-α and IL-17 include Lactobacillus and Bifidobacterium genus. These organisms have been found to grow well when our gut is reasonably active, a condition that results when we are not in a highly stressed state. They grow well when we have a diet that includes fruits, vegetables and fish. It should not be surprising that this same diet is known to be good for the heart and blood vessels, as atherosclerosis and heart disease are promoted by inflammation.

At least one species, Prevotella copri, is strongly associated with RA. This organism drives the levels of inflammatory IL-17 higher. It thrives in a high-carbohydrate diet, so make sure that your diet includes healthy anti-inflammatory fats and good protein! Also, its growth can be suppressed by seeding and feeding with probiotics, prebiotics, and diet. Another category of organism, segmented filamentous bacteria or SFB, is what initiates the function of the IL-17 cytokine. While getting it started is important, too much SFB can also keep IL-17 levels too high.

Now having identified the immune factors, let’s look at what affects them!
-Progesterone suppresses IL-6 and IL-17
-Estrogen suppresses IL-6 and IL-17
-Microbiome also influences both

Both hormones are elevated around the time of ovulation until the onset of menstruation; essentially during the interval of a woman’s period when she is fertile. Both of these hormones drop off at the onset of menstruation, triggering the sloughing of endometrial lining and blood. Both hormones increase in concentrations during pregnancy, only dropping precipitously at childbirth. It is important to consider that one of the things a woman’s body does in preparation for pregnancy and during pregnancy is to create an increased immune tolerance. If this were not the case, the immune system could treat the developing child as a tumor and attack it, something which actually does happen sometimes and results in miscarriage. It should also be noted that another thing that progesterone does is to reduce inflammation, which is great prior to childbirth, but also may reduce the symptoms of RA during menses or pregnancy—providing a second pathway that explains the relief.

female-cycle

What options does that leave, other than enjoying the brief hormone-induced RA interlude or having another child? Well, progesterone and vitamin D have been used to treat brain inflammation. Certainly a woman should consider using some of the natural and OTC progesterone preparations such as wild yam extract, particularly if evaluation of her existing hormone levels show that there is room for addition of progesterone without levels becoming unnaturally high. Now for the shocker: men also have progesterone, in levels comparable to women during the follicular phase of ovulation. It is converted into testosterone in men, and inhibits the conversion of testosterone into DHT—that nasty little product that causes male pattern baldness and gynecomastia (aka “man-boobs”). Does that mean that men should use low levels of progesterone? Quite possibly! It isn’t the “feminizing hormone” that estrogen is, and its use in men has some precedent already.

Systemic inflammation has the effect of making hormone receptors on the actual cells less functional, so that the hormones do not work as well. Reducing inflammation should therefore also make your existing hormones (progesterone and estrogen in this example) work more effectively. Of course, reducing inflammation helps RA directly as well, since it is an inflammatory condition. Cultivating a diverse and healthy microbiome is at the top of that list, and involves probiotics, prebiotics, diet, lifestyle, stress levels, and avoidance of toxins.

In summary, the sex hormones estrogen and progesterone both inhibit inflammation via inhibition of the IL-6 and IL-17 cytokines. These are the immune molecules that target the actual joint tissue in RA, and they are produced by T-helper cells, which are regulated by T-regulatory cells, which talk to gut bacteria across the intestinal wall to get their instructions. So, healthier gut bacteria means better immune control. Healthier gut bacteria also means better hormone levels and better hormone sensitivity, so it’s a win-win. If getting pregnant is not in your immediate future, and the brief hormone boost afforded by menses is insufficient, supplementation with progesterone may be worth considering in addition to a microbiome-healthy diet with good prebiotics and probiotics. Of course, all of these decisions are best made with the help of some labwork when possible. Identifying your existing microbiome can help to point the direction for improvement whether that means growing more Bifidobacteria or inhibiting the growth of Prevotella copri. In any case, optimize your hormones, and get those symbionts in shape so they can retrain your immune system!
References:
1: Andersson A, Grahnemo L, Engdahl C, Stubelius A, Lagerquist MK, Carlsten H,
Islander U. IL-17-producing γδT cells are regulated by estrogen during
development of experimental arthritis. Clin Immunol. 2015 Sep 28;161(2):324-332.
doi: 10.1016/j.clim.2015.09.014. [Epub ahead of print] PubMed PMID: 26423309.
http://www.ncbi.nlm.nih.gov/pubmed/26423309
2: Kim KW, Kim HR, Kim BM, Cho ML, Lee SH. Th17 Cytokines Regulate
Osteoclastogenesis in Rheumatoid Arthritis. Am J Pathol. 2015 Sep 8. pii:
S0002-9440(15)00445-9. doi: 10.1016/j.ajpath.2015.07.017. [Epub ahead of print]
PubMed PMID: 26362732.
http://www.ncbi.nlm.nih.gov/pubmed/26362732
3: Mortaz E, Adcock IM, Ricciardolo FL, Varahram M, Jamaati H, Velayati AA,
Folkerts G, Garssen J. Anti-Inflammatory Effects of Lactobacillus Rahmnosus and
Bifidobacterium Breve on Cigarette Smoke Activated Human Macrophages. PLoS One.
2015 Aug 28;10(8):e0136455. doi: 10.1371/journal.pone.0136455. eCollection 2015.
PubMed PMID: 26317628; PubMed Central PMCID: PMC4552661.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552661/

4: Gluhovschi C, Gluhovschi G, Petrica L, Velciov S, Gluhovschi A. Pregnancy
Associated with Systemic Lupus Erythematosus: Immune Tolerance in Pregnancy and
Its Deficiency in Systemic Lupus Erythematosus–An Immunological Dilemma. J
Immunol Res. 2015;2015:241547. doi: 10.1155/2015/241547. Epub 2015 May 18.
Review. PubMed PMID: 26090485; PubMed Central PMCID: PMC4451247.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451247/
5: Tang H, Hua F, Wang J, Yousuf S, Atif F, Sayeed I, Stein DG. Progesterone and
vitamin D combination therapy modulates inflammatory response after traumatic
brain injury. Brain Inj. 2015 Jun 17:1-10. [Epub ahead of print] PubMed PMID:
26083048.
http://www.ncbi.nlm.nih.gov/pubmed/26083048

6: Carasi P, Racedo SM, Jacquot C, Romanin DE, Serradell MA, Urdaci MC. Impact of
kefir derived Lactobacillus kefiri on the mucosal immune response and gut
microbiota. J Immunol Res. 2015;2015:361604. doi: 10.1155/2015/361604. Epub 2015
Feb 24. PubMed PMID: 25811034; PubMed Central PMCID: PMC4355334.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355334/

7: Garling RJ, Watts LT, Sprague S, Fletcher L, Jimenez DF, Digicaylioglu M. Does
progesterone show neuroprotective effects on traumatic brain injury through
increasing phosphorylation of Akt in the hippocampus? Neural Regen Res. 2014 Nov
1;9(21):1891-6. doi: 10.4103/1673-5374.145355. PubMed PMID: 25558238; PubMed
Central PMCID: PMC4281427.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281427/
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arthritis. Reumatol Clin. 2015 Mar-Apr;11(2):61-3. doi:
10.1016/j.reuma.2014.11.001. Epub 2014 Dec 30. English, Spanish. PubMed PMID:
25555460.
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9: Furusawa Y, Obata Y, Hase K. Commensal microbiota regulates T cell fate
decision in the gut. Semin Immunopathol. 2015 Jan;37(1):17-25. doi:
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http://www.ncbi.nlm.nih.gov/pubmed/25315350

10: Si D, Li J, Liu J, Wang X, Wei Z, Tian Q, Wang H, Liu G. Progesterone
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13: Shapira I, Sultan K, Lee A, Taioli E. Evolving concepts: how diet and the
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16: Wang HY, Gao WT, He QH, Yang C, Gu W, Yan J, Jiang JX. Endogenous
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17: Ghadimi D, Helwig U, Schrezenmeir J, Heller KJ, de Vrese M. Epigenetic
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18: Campeau JL, Salim SY, Albert EJ, Hotte N, Madsen KL. Intestinal epithelial
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19: Ait-Belgnaoui A, Durand H, Cartier C, Chaumaz G, Eutamene H, Ferrier L,
Houdeau E, Fioramonti J, Bueno L, Theodorou V. Prevention of gut leakiness by a
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20: Ekmekcioglu C. Are proinflammatory cytokines involved in an increased risk
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21: López P, González-Rodríguez I, Gueimonde M, Margolles A, Suárez A. Immune
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22: Reading NC, Kasper DL. The starting lineup: key microbial players in
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23: Meyer J, Döring A, Herder C, Roden M, Koenig W, Thorand B. Dietary patterns,
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24: Weinberg A, Enomoto L, Marcus R, Canniff J. Effect of menstrual cycle
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http://www.ncbi.nlm.nih.gov/pubmed/21429588

25: Srirangan S, Choy EH. The role of interleukin 6 in the pathophysiology of
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26: Yates MA, Li Y, Chlebeck P, Proctor T, Vandenbark AA, Offner H. Progesterone
treatment reduces disease severity and increases IL-10 in experimental autoimmune
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28: Lubberts E. IL-17/Th17 targeting: on the road to prevent chronic destructive
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29: Leite RS, Brown AG, Strauss JF 3rd. Tumor necrosis factor-alpha suppresses
the expression of steroid receptor coactivator-1 and -2: a possible mechanism
contributing to changes in steroid hormone responsiveness. FASEB J. 2004
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30: http://sbi4u3.weebly.com/endocrine-hormones-basic-mechanisms-and-the-menstrual-cycle.html

31: http://www.medicine.mcgill.ca/physio/vlab/other_exps/endo/reprod_horm.htm

32: https://en.wikipedia.org/wiki/Progesterone

33: http://www.hairloss-research.org/UpdateProgesterone5-08.html

In summary, the sex hormones estrogen and progesterone both inhibit inflammation via inhibition of the IL-6 and IL-17 cytokines. These are the immune molecules that target the actual joint tissue in RA, and they are produced by T-helper cells, which are regulated by T-regulatory cells, which talk to gut bacteria across the intestinal wall to get their instructions. So, healthier gut bacteria means better immune control. Healthier gut bacteria also means better hormone levels and better hormone sensitivity, so it’s a win-win. If getting pregnant is not in your immediate future, and the brief hormone boost afforded by menses is insufficient, supplementation with progesterone may be worth considering in addition to a microbiome-healthy diet with good prebiotics and probiotics. Of course, all of these decisions are best made with the help of some labwork when possible. Identifying your existing microbiome can help to point the direction for improvement whether that means growing more Bifidobacteria or inhibiting the growth of Prevotella copri. In any case, optimize your hormones, and get those symbionts in shape so they can retrain your immune system!

References:

1: Andersson A, Grahnemo L, Engdahl C, Stubelius A, Lagerquist MK, Carlsten H,

Islander U. IL-17-producing γδT cells are regulated by estrogen during

development of experimental arthritis. Clin Immunol. 2015 Sep 28;161(2):324-332.

doi: 10.1016/j.clim.2015.09.014. [Epub ahead of print] PubMed PMID: 26423309.

http://www.ncbi.nlm.nih.gov/pubmed/26423309

2: Kim KW, Kim HR, Kim BM, Cho ML, Lee SH. Th17 Cytokines Regulate

Osteoclastogenesis in Rheumatoid Arthritis. Am J Pathol. 2015 Sep 8. pii:

S0002-9440(15)00445-9. doi: 10.1016/j.ajpath.2015.07.017. [Epub ahead of print]

PubMed PMID: 26362732.

http://www.ncbi.nlm.nih.gov/pubmed/26362732

3: Mortaz E, Adcock IM, Ricciardolo FL, Varahram M, Jamaati H, Velayati AA,

Folkerts G, Garssen J. Anti-Inflammatory Effects of Lactobacillus Rahmnosus and

Bifidobacterium Breve on Cigarette Smoke Activated Human Macrophages. PLoS One.

2015 Aug 28;10(8):e0136455. doi: 10.1371/journal.pone.0136455. eCollection 2015.

PubMed PMID: 26317628; PubMed Central PMCID: PMC4552661.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552661/

4: Gluhovschi C, Gluhovschi G, Petrica L, Velciov S, Gluhovschi A. Pregnancy

Associated with Systemic Lupus Erythematosus: Immune Tolerance in Pregnancy and

Its Deficiency in Systemic Lupus Erythematosus–An Immunological Dilemma. J

Immunol Res. 2015;2015:241547. doi: 10.1155/2015/241547. Epub 2015 May 18.

Review. PubMed PMID: 26090485; PubMed Central PMCID: PMC4451247.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451247/

5: Tang H, Hua F, Wang J, Yousuf S, Atif F, Sayeed I, Stein DG. Progesterone and

vitamin D combination therapy modulates inflammatory response after traumatic

brain injury. Brain Inj. 2015 Jun 17:1-10. [Epub ahead of print] PubMed PMID:

26083048.

http://www.ncbi.nlm.nih.gov/pubmed/26083048

6: Carasi P, Racedo SM, Jacquot C, Romanin DE, Serradell MA, Urdaci MC. Impact of

kefir derived Lactobacillus kefiri on the mucosal immune response and gut

microbiota. J Immunol Res. 2015;2015:361604. doi: 10.1155/2015/361604. Epub 2015

Feb 24. PubMed PMID: 25811034; PubMed Central PMCID: PMC4355334.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355334/

7: Garling RJ, Watts LT, Sprague S, Fletcher L, Jimenez DF, Digicaylioglu M. Does

progesterone show neuroprotective effects on traumatic brain injury through

increasing phosphorylation of Akt in the hippocampus? Neural Regen Res. 2014 Nov

1;9(21):1891-6. doi: 10.4103/1673-5374.145355. PubMed PMID: 25558238; PubMed

Central PMCID: PMC4281427.

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