Nutrition. Vitamins. You.
Written by Dr.Claire Arcidiacono, ND For further questions or concerns email me at [email protected]† Last week we began our conversation on the topic of strokes or CVA and even talked about TIAs. As I said last time this will be a 3 part blog. We will …
Written by: Dr.Claire Arcidiacono, ND For further questions or concerns email me at [email protected] No conversation involving joints and joint health could possibly be complete without talking about healing after having a joint repair surgery. To start with what types of surgeries are done to repair …
Written by Dr. Claire Arcidiacono, ND
For further questions or concerns email me at [email protected]
Last week we started off our discussion of arthritis with osteoarthritis (OA). This week we will be looking at rheumatoid arthritis (RA). When most people think of RA they think of joint pain and while that is true RA is much more than just a joint disease. RA is an autoimmune disorder which involves the immune system attacking the joints. This inflammatory response affects both the cartilage and the underlying bone. However, unlike in OA where other parts of the body are relatively unaffected in RA multiple systems are affected by the disease. In RA for example the skin, eyes, lungs, heart, nerves and even the blood vessels can all be affected. † (1)
The first signs of RA involve the joints. Typically, the affected joints will be swollen, warm and in the morning, they will be very stiff and need to be “warmed up” as people say. Interestingly this is different from the joint pain we see in OA where there is no difference in the morning meaning that there is no morning inflammation or morning joint pain that just needs to be “warmed up”. As the autoimmune disease progresses in its severity the underlying tendons can become affected, and this leads to the structural changes typically seen in RA. I would like to point out that in addition to the structural changes seen in the fingers there can often be similar structural changes in the toes. This is important since it can affect mobility in the long run. (2) Please see the attached pictures. † (3) (4)
Fingers
Toes
As I said earlier due to the fact that RA is an autoimmune illness other parts of the body are affected and will show signs of the illness. As I discuss each individual aspect of the disease, I will go over how the systems are affected. To start with the very beginning the skin can develop something called a rheumatoid nodule. These typically occur over areas such as the elbow, heels, and the knuckles. † (5) Please see picture (6)
Additionally, vasculitis, which is inflamed blood vessels, can also occur in the skin. Other symptoms of RA that can occur in the skin include but are not limited to the following: Pyoderma gangrenosum, sweets syndrome, Erythema nodosum and even atrophy of the skin of the fingers. † (7)
RA can also affect the lungs and cause signs of respiratory illness. In fact, having symptoms of lung disease when you have RA is so common it even has a name – Rheumatoid lung disease or lung fibrosis. As I said this is a well-known complication of RA. Caplan syndrome is a diagnosis that describes lung nodules that occur when RA is present. † (8)
In addition to symptoms of lung disease individuals with RA often experience comorbidity of the heart and blood vessels. For example, these can include an increased risk of atherosclerosis, MI, and stroke. Other possible complications can include pericarditis, endocarditis, valvulitis and fibrosis. † (9)
Anemia as well as a decrease in white blood cells can also occur. When the inflammation is not well controlled, we can also see an increase in platelet count. † (10)
RA can also affect the kidneys and cause symptoms of kidney disease. It can affect the liver as well and cause symptoms of liver disease. In the long run it can even cause vision changes as it affects our eyes. Over time as the autoimmune aspects of RA starts to affect the nerves, we can start to see signs of neuropathy. † (11)
GENERAL SYMPTOMS
The general symptoms of RA include fatigue, low grade fever, malaise, morning stiffness, and periodontal disease. † (12)
COMMON RISK FACTORS
There are some very common risk factors for RA. For those with RA in their family tree the risk of developing RA increases 3 to 5X that of someone without a family history. In fact is estimated that genetics account for 40-65% of sero-positive RA and 20% of sero-negative RA. (13) Smoking has been found to increase the risk of RA 3X compared to nonsmokers! †(14)
Studies have found that having vitamin D levels that are lower than optimum can increase the risk of developing RA. † (15)
Anything that increases inflammation can also increase the risk of RA. This can include the standard American diet, stress and even other autoimmune disorders. As I mentioned in my article series on digestion having leaky gut is a risk factor for all autoimmune disorders including RA. Studies also show a link between RA and gluten sensitivities. † (16)
As I mentioned previously RA is diagnosed with blood work as well as certain imaging tests. Blood work can also be used to monitor the effectiveness of treatments. In addition to any treatments recommend by your doctor the following may be helpful:
WHAT CAN BE HELPFUL?
1. Lifestyle changes such as stop smoking! †
2. Making dietary changes – A Mediterranean diet has been found to be anti-inflammatory in studies! (17) I would also suggest increasing anti-inflammatory foods – such as leafy greens, broccoli, cauliflower, cabbage, brussels sprouts, kale, berries of all types, cherries, oily fish, avocados, olive oil and nuts. † (18)
3. Working on the inflammation part of RA sometimes requires supplements in addition to diet! †
–> Turmeric has been found to lower inflammation and help with the morning stiffness as well as the inflammation seen in RA. (19) Please see Invite’s Biocurcumin, Turmeric with ginger and Curcumin blend! †
–> Boswellia has been found to reduce inflammatory parameters in studies. (20) Please see Invite’s Biocurcumin!†
–> Ginger has been found to reduce inflammatory factors hs-CRP and IL-1β or in other words it helps to reduce the inflammation seen in RA. (21) Please see Invite’s Turmeric with ginger. †
–> Omega 3’s may have an effect on disease activity especially the swollen and crooked joints. (22) Please see Invite’s Fish oil, Krill oil, and Inflammune.†
–> D3 is important to supplement when you are low. † (23)
4. If the leaky gut is causing the inflammation, it’s important to heal the gut! Please refer to my series on GI health. †
START Dr.Claire’s series on GI Health here–>THE BASICS OF DIGESTIVE HEALTH, PART 1>>READ NOW!
5. We also want to work on protecting the joints! †
–> Collagen has been found to lower joint inflammation and joint pain. (24) While more studies on collagen are important to do at this time current studies show that collagen may help to promote the growth of cartilage damaged by OA or RA. (25) Please see Invite’s Collagen Hx, Collagex HA, Collagen tablets and Cartilage Hx!†
–> Hyaluronic acid has been found in studies to help promote cartilage repair as well as reduce inflammation. (26) Please see Invite’s Hylauronic Acid with Devil’s Claw†
6. Lastly let’s protect some of the other organs affected by RA! †
–> For lung health there are a number of products that can help! NAC has been found to improve respiratory function. (27) Black seed is also amazing for lung health and respiratory function. (28) Please see Invite’s NAC and Black seed with Rosemary†
–> Coq10 is amazing for heart health! Please see all Invite’s Coq10 products! †
–>Resveratrol is amazing for so many different areas. It helps the lungs, heart and is just an amazing antioxidant! (29) Please see Invite’s Resveratrol 100mg Hx and our new Resvertrol Max formula†
–> Bilberry has been found in studies to help with vision and eye heath. (30) For this and other amazing eye nutrients please see our Macula Hx and Macula Advanced Hx†
For further questions or concerns email me at [email protected]
REFERENCES
1. “Handout on Health: Rheumatoid Arthritis”. National Institute of Arthritis and Musculoskeletal and Skin Diseases. August 2014. Archived from the original on June 30, 2015. Retrieved July 2, 2015.
2. Majithia V, Geraci SA (November 2007). “Rheumatoid arthritis: diagnosis and management”. The American Journal of Medicine. 120 (11): 936–939. doi:10.1016/j.amjmed.2007.04.005. PMID 17976416.
3. https://www.orthobullets.com/basic-science/9085/rheumatoid-arthritis
4. https://www.thehealthsite.com/diseases-conditions/how-rheumatoid-arthritis-affects-the-foot-and-ankle-b1016-440550/
5. Turesson C (May 2013). “Extra-articular rheumatoid arthritis”. Current Opinion in Rheumatology. 25 (3): 360–366. doi:10.1097/bor.0b013e32835f693f. PMID 23425964. S2CID 21462453.
6. https://www.pcds.org.uk/clinical-guidance/rheumatoid-nodules
7. Genta MS, Genta RM, Gabay C (October 2006). “Systemic rheumatoid vasculitis: a review”. Seminars in Arthritis and Rheumatism. 36 (2): 88–98. doi:10.1016/j.semarthrit.2006.04.006. PMID 17023257.
8. arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern”. Chest. 136 (5): 1397–1405. doi:10.1378/chest.09-0444. PMC 2818853. PMID 19892679.
9. 9). “Evaluating cardiovascular risk in rheumatoid arthritis”. Journal of Musculoskeletal Medicine. 26 (8): 481–494. Archived from the original on 2012-07-23.
10. Gibbs JE, Ray DW (February 2013). “The role of the circadian clock in rheumatoid arthritis”. Arthritis Res Ther. 15 (1): 205. doi:10.1186/ar4146. PMC 3672712. PMID 23427807.
11. de Groot K (August 2007). “[Renal manifestations in rheumatic diseases]”. Der Internist. 48 (8): 779–785. doi:10.1007/s00108-007-1887-9. PMID 17571244. S2CID 28781598.
12. “Handout on Health: Rheumatoid Arthritis”. National Institute of Arthritis and Musculoskeletal and Skin Diseases. August 2014. Archived from the original on June 30, 2015. Retrieved July 2, 2015.
13. Smolen JS, Aletaha D, McInnes IB (October 2016). “Rheumatoid arthritis” (PDF). Lancet. 388 (10055): 2023–2038. doi:10.1016/S0140-6736(16)30173-8. PMID 27156434. S2CID 37973054.
14. Sugiyama D, Nishimura K, Tamaki K, Tsuji G, Nakazawa T, Morinobu A, Kumagai S (January 2010). “Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies” (PDF). Annals of the Rheumatic Diseases. 69 (1): 70–81. doi:10.1136/ard.2008.096487. PMID 19174392. S2CID 11303269. Archived from the original (PDF) on 2021-03-01. Retrieved 2018-04-20.(subscription required)
15. https://www.keckmedicine.org/blog/could-more-vitamin-d-help-relieve-your-rheumatoid-arthritis/#:~:text=Studies%20also%20have%20found%20that,in%20the%20hands%20and%20feet.
16. https://pubmed.ncbi.nlm.nih.gov/33677948/
17. https://www.eatingwell.com/article/2061785/anti-inflammatory-mediterranean-diet-plan/#:~:text=In%20fact%2C%20research%20has%20identified,oil)%20in%20the%20diet%20every
18. https://www.healthline.com/nutrition/13-anti-inflammatory-foods
19. https://pubmed.ncbi.nlm.nih.gov/33914984/
20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477955/
21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137811/
22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362115/
23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539179/
24. https://www.versusarthritis.org/about-arthritis/complementary-and-alternative-treatments/types-of-complementary-treatments/collagen/#:~:text=Four%20trials%20tested%20collagen%20against,the%20trials%20against%20a%20placebo.
25. https://blog.designsforhealth.com/node/1375
26. https://www.arthritis-health.com/treatment/injections/what-hyaluronic-acid#:~:text=Hyaluronic%20acid%20helps%20in%20the,by%20injury%20or%20tissue%20degeneration.
27. https://www.lifeextension.com/magazine/2020/ss/protect-your-respiratory-system#:~:text=NAC%20(N%2Dacetyl%2DL,%2C%20MD%2C%20in%20May%202022.
28. https://www.webmd.com/vitamins/ai/ingredientmono-901/black-seed#:~:text=Taking%20black%20seed%20oil%20by,low%20lung%20function%20before%20treatment.
29. https://www.webmd.com/diet/health-benefits-resveratrol#:~:text=Resveratrol%20has%20antioxidant%20and%20anti,for%20arthritis%2C%20and%20skin%20inflammation.
30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146147/
Written by: Dr. Claire Arcidiacono, ND For further questions or concerns email me at [email protected]† Joints are a part of our body that get used constantly, as a result of this, many things can go wrong with their health. To determine exactly what is going …
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Hosted by Amanda Williams, MPH
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InViteⓇ Health Podcast Intro: Welcome to the InViteⓇ Health Podcast, where our degreed healthcare professionals are excited to offer you the most important health and wellness information you need to make informed choices about your health. You can learn more about the products discussed in each of these episodes and all that InViteⓇ Health has to offer at www.invitehealth.com/podcast. First time customers can use promo code PODCAST at checkout for an additional 15% off your first purchase. Let’s get started!
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Amanda Williams, MPH:
[00:00:40] Teas have been widely consumed throughout the world, and we’ve all heard about the many potential health benefits that go along with tea. So today I want to zero in on tea and inflammation in the setting of arthritis. I’m Amanda Williams, M.D., M.P.H., and let’s get right to it. Let’s talk about the amazing amount of clinical research that is out there that is assessing the impact of the power nutrient, that power catechin coming from green tea, the EGCG and how beneficial that can be when it comes to targeting inflammation that’s directly associated with arthritis, so whether we’re looking at osteoarthritis or we are looking at rheumatoid arthritis.† [00:01:22]
[00:01:22] There was a very extensive research study that was published in the Life Science Journal back in 2010 that looked at the power of that polyphenol, that EGCG when it came to inflammation and arthritis. So being that we know that many Americans suffer from arthritic joints and arthritic conditions, this is an area that oftentimes people are looking for alternatives as opposed to using an NSAID on a daily basis, the non-steroidal anti-inflammatory drugs, because the long-term use of those in not so great, depending upon which one that you’re taking, can impact negatively different things, like acetaminophen, for example. The extended use of acetaminophen, definitely not a good thing for your liver. And then when you look at the other NSAIDs, such as ibuprofen, for example, then we have to start having concerns with the long-lasting negative impact on the kidneys.† [00:02:16]
[00:02:16] So that’s why I want to talk about green tea in this setting today and looking at the many benefits of how it is that green tea is really kind of guiding us through this inflammaging highway. So we… I talk oftentimes about inflammaging, which is accelerated aging brought on because of chronic inflammation. So understanding how the antioxidants that are contained within green tea can really target the inflammatory pathways in a much broader degree than we ever recognized previously. And one of the things that we now know from scientific research is that not only can that green tea help with the regulation of expression of different cytokines and chemokines and the reactive oxygen species and targeting, you know, COX-1 and COX-2 pathways. But we also now know that it targets something known as HMBG1, which is high mobility group box one. Why does that matter? Well, because when we understand the impact of HMGB1 in the body, then you can start to tie that in with the excessive amount of inflammation that can occur within the joints. So HMGB1 turns on the release of chemical signals in the body, which we call cytokines, and those cytokines generate up inflammation. So if we have this release of inflammatory cytokines, then over the course of time, so we’re talking chronic inflammation. In the acute setting, that’s one thing. You know, you stub your toe, you sprain your ankle. Acute inflammation is one thing, but we’re talking in the setting of chronic inflammation. Then we know we’ve got a big problem. So elevated HMGB1 levels have been found to be associated with many different chronic inflammatory conditions, so when we’re thinking about things such as arthritis. But we can also, you know, put into the mix different respiratory chronic conditions such as asthma, COPD, for example, we can look at inflammatory bowel disease, we can look at diabetes, for example, and many different conditions, even within the cardiovascular system, where you can see this elevation of HMGB1, which is a big problem.† [00:04:48]
[00:04:49] So what do we know now from the scientific studies is that the EGCG, the epigallocatechin gallate that’s coming from the green tea, this has been studied and shown to have this ability to inhibit that HMGB1, which is really incredibly powerful. So the first study that came out that really zeroed in on EGCG’s ability to do this was back in 2011, and that was in the Journal of Biochemical Pharmacology. So understanding that if we have a nutrient that’s coming from nature, so this power catechin, that EGCG. And this can actually work in a way to, in a sense, turn off that switch for inflammation, then we can start to see how it is that when you’re in a setting such as arthritis, why green tea can potentiate all of these powerful benefits. So I pulled a few different studies just to reinforce this, because it’s not like this was just a finding that they stumbled upon and then they let it go. No. They continue to look at this and said, “Wow, EGCG, you can actually down regulate the activation of this power signal, this HMGB1, which triggers this flood of cytokines to be released, which is significantly driving up inflammation.”† [00:06:04]
[00:06:06] So in the Life Science Journal, they go into many of the different components of green tea and how when you look at the scope of conditions to which green tea has been shown to be incredibly beneficial to you, when you think about green tea and cardiovascular disease and how green tea has been shown even at UCLA, University of California, Los Angeles to actually be able to lower the risk of stroke. And this was through a meta analysis that they did, and this was just through people who consumed a lot of tea. So drinking tea. So we’re not even talking about the power amount of EGCG that you get if you utilize Green Tea HxⓇ, for example. And they found that when people consumed three or more cups of tea per day, that they had a 20% lower risk of a stroke. And that’s just from, you know, something that they’re drinking every single day. Certainly, when you look at cognitive studies and what occurs within the brain, the aging brain and oxidative stress and how detrimental that can be to our cognition, this is another area of research where green tea is really shown to be incredibly beneficial when it comes to its immunomodulatory benefits. This is where you know, things like rheumatoid arthritis, looking at some of the issues that are arise with ulcerative colitis and Crohn’s disease, for example. So there’s just a vast amount of research out there that really zeroes in on just how powerful the use of EGCG can be when it comes to its vast, vast benefits.† [00:07:45]
[00:07:46] And of course, there’s a ton of studies looking at EGCG when it comes to cancer studies and cancer research. So when it’s cardiovascular, cancer, metabolic conditions such as diabetes, whether we’re looking at inflammation, we certainly can see how it is that the EGCG, potentially it’s this really powerful, powerful benefit. So in the Journal of Toxicology and Applied Pharmacology in 2017, they were looking at the anti-inflammatory activities of the green tea catechins when it came to these different signaling pathways in rheumatoid arthritis. So how do they set this up? While you have to test this in patients who have been diagnosed with rheumatoid arthritis, which is an autoimmune condition, and finding how the EGCG was incredibly effective in terms of inhibiting these downstream inflammatory signals. So we kind of go back to that high mobility group box one and you can see how that green tea really does pack a heck of a punch.† [00:08:49]
[00:08:50] In the Arthritis Research Therapeutics Journal in 2010, they also were looking at the progress of research, and so we’re talking over 10 years ago where they were looking at the progression of the scientific research that was coming out showing how the EGCG, the epigallocatechin gallate from the green tea, how this was creating an environment that was actually lowering inflammation in even the most severe cases of rheumatoid arthritis. Now, as I mentioned, you can also throw osteoarthritis into this mix, which is what most people have. Most people don’t have RA. Most people have osteoarthritis, and it’s key to be able to differentiate between the two. But the important takeaway from from that is to also recognize that whether we’re dealing with rheumatoid arthritis or we’re dealing with osteoarthritis, we’re dealing with significant amounts of inflammation. And so looking at the studies in patients who have RA is one thing, but they’ve also been able to show in patients that have your typical run-of-the-mill arthritis that the green tea and those powerful catechins do a wonderful job at being able to downregulate all of that inflammation.† [00:10:05]
[00:10:06] So, so much science out there. You can see the different pathways, whether we’re dealing with the same pathways that you’re non-steroidal anti-inflammatory drugs are targeting or, you know, even if we’re looking at some of the prescribed pain medications, the pathways to which those are working, the COX-1, COX-2 pathways, and obviously the more we can lessen our inflammation burden in the body, the more resolution we get to any type of a chronic condition. So addressing chronic inflammation is certainly important, and we understand the true benefit of getting green tea on board when it comes to partnering up in the, in the body and helping our body with managing that inflammation and a much more efficient way.† [00:10:53]
[00:10:53] I want to thank you so much for tuning in to the InViteⓇ Health Podcast. Remember, you can find all of our episodes for free wherever you listen to podcasts or by visiting invitehealth.com/podcast. Now do make sure that you subscribe and you leave us a review. You can follow us on Facebook, Twitter and Instagram, and we will see you next time for another episode of the InViteⓇ Health Podcast.† [00:10:53]
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