You and Food

If you fast inflammatory symptoms seem to subside and quieten.  Clearly, long term fasting has a very specific and undesirable ending.  While fasting and much other research suggests that there is a relationship between our ‘gut microbes’ and our health, we do not support the idea of fasting.  If you want to fast you must speak to your doctor first.

Researchers are beginning to find connections between particular types of bacteria and the several types of arthritis.  For example, a particular bacteria in the gut called Prevotella Copri, is increased in new and untreated Rheumatoid Disease (RD) patients.  Some data shows that while 13% of the general population will have a large amount of these bacteria in their guts, the vast majority of the RD community has excessive amounts.   In other words gut bug imbalance may be a feature of RD.

We have about 1.5 kilos of microbial organisms living in our guts and they seem to play a vital role in our health as our guts house two thirds of the body’s immune cells. It seems that we in the west may not have enough of the right bacteria as compared to people in developing nations where the rates of chronic disease appear to be lower.  One day it might be possible to treat RD by adjusting the micobiome of our bodies.

At Dragon Claw we consider that good nutrition is very important for our members.  In the case rheumatoid disease nutrition is important because:

• We need to eat low inflammatory foods;
• Some of our medications can cause bone demineralisation and vitamin depletion, to name just a few issues;
• Certain pain medications can cause major constipation; and
• You need to look after yourself nutritionally in order to be active.

Alternative therapies, such as turmuric, cumen-phosphatidylcholoine complex, avocado and soybean oil combinations, and many more are available for patients in health food stores and in supermarkets.  Many people assume that because they are natural - they are also safe. This may not be the case.  Get the facts, do some research and inform yourself and you will discover that in some cases, supplements may lead to negative outcomes.  Some seaweeds are actually good for you.

Olive oil anyone?

Consider This

The following have been gleaned from research, conversation and practice.  Just consider these points then do some reading, talk to your doctor or talk to a nutritionist but get started.  Don’t take the following as “gospel” but check things out first by reading.  Good places to start are books by Jack Challem, listed in our reading list at the end of this section.

• Prednisone can cause hypertension.  In order to reduce this possibility, remove salt from your diet.  Do not add salt to anything.
• Prednisone can cause the bone to loose minerals and weaken.  It is important to get additional calcium and to do gentle weight-bearing exercise like walking.
• Other drugs RD people take can reduce vitamins, especially the B group.
• Heating vegetable oils above 100 degrees Celsius can produce a number of unhealthy derivatives such as transfats.  Do not fry, roast or bar-b-cue with oil.  Try it with water or nothing - you might be pleasantly surprised how well things still cook.
• Change the ratio of meat to vegetables and starch.  In other words make meat the smallest portion and trim all fat off the meat.
• Increase your vegetable and fruit intake.  A plate full of vegetables should show lots of colour because of the variety of the vegetables chosen.  The more colour the better the spread of nutrition and goodness.  Fresh is always better than cooked when it comes to vegetables.
• Replace sugar with honey as honey contains many nutritional elements.
• Buy a recipe book dealing with the Mediterranean Diet, considered to be one of the best diets in the world.

Food, diet and nutrition and inflammation are growing areas of research.  The body has a huge capability to heal itself if provided with the right building blocks i.e. good wholesome fresh food.  Read food labels and avoid preservatives.  A useful tool is FoodSwitch, available as a phone app in iTunes and the Google Play Store.  It measures salt and fat from food labels.

Food as Medicine

The following are a series of notes developed from reading books about nutrition, research articles about diet and health and from an excellent website called NutritionFacts.org.  The information below is not intended as scientific fact but as a suggested guide.  While some references appear throughout this section, we strongly urge you to conduct your own research.  For members with moderate to severe rheumatoid disease, it is very important to develop a low inflammatory diet, a diet that limits and does not promote inflammation.  There is increasing evidence that red meat, milk and eggs are highly inflammatory while a plant-based diet is not. 

Listen to this excellent podcast from NutritionFacts.org about Health Joints.

In Your Mouth

Characteristics of an anti-inflammatory diet for those with rheumatoid disease, Lupus and JIA are as follows:

Ideally, a complete plant based vegetarian diet, avoiding all meat and rich in leafy green vegetables.  A plant based diet consists of whole grains, vegetables and fruits, and beans, quinoa, split peas, chickpeas and lentils.  May add fish occasionally if you can’t make the full switch.

• No milk, cheese or other dairy products whatsoever.  Replace dairy with soy milk, rice milk or almond milk. 
• The occasional piece of dark chocolate is fine.
• Uncooked blueberries every day neat or with cereal/desert.
• Unheated extra virgin olive oil on your salads.  Do not use oil for frying or roasting.
• Avoid all deep fried foods and battered foods.
• A little turmeric with black pepper in your cooking is a great idea.
• A table spoon of sesame seeds or oil  in your cooking each day will reduce stiffness over a 30 day period.
• Indian spices (turmeric, ginger and cloves) and chilli appear useful.
• Avoid all corn and corn products.
• Avoid all white foods such as white bread (use whole grain bread), white rice (use brown rice) and highly processed foods (avoid).
• Drink plenty of water and do not consume ‘pop’ and ‘soda’ drinks.

There is a huge area of research, opinion and debate about food intolerances.  A good area to begin your investigations is the Food Intolerance Network and their Failsafe Newsletter.  A list of dietitians and other health professionals is now available here.

On The Skin

Members probably have sensitive, thin or skin that regularly gets rashes.  The drug Prednisone is often to blame as well as age.   Using non-inflammatory skin products may be a useful first step, as follows:

• Replace soap products and shampoos with skin cleaning products that do not contain aluminium, parafum, sodium laureth sulphate or benzene benzonate.
• MSG, yeast extract, disodium guanylate E627 and disodium inosinate E361 (found in potato chips and some liquid stock) can trigger skin rashes.
• Try and avoid all preservatives, an example is preservative E202.  Look at the contents label and if you see lots of numbers, avoid it. Here are some preservatives to avoid:-  Sorbates 200-203; Benzoates 210-213; Sulphites 220-228; Nitrates and nitrites 249-252.
• Always wash fresh fruit and berries before eating.

What To Eat

The follow reference table is simply a ready reckoner or guide based on some available research.  You should consider the following in association with your GP or nutritionist.  If you start using one or more of the foods detailed below, start slowly and build up to the recommended servings, just in case you have a reaction to say, Goji berries because your body is not used to them.

Using Food to Fight Disease: A View Point and Debate  -  Four articles

A point of view not necessarily supported by Dragon Claw.

The Reversal on Fish Oil

Written by: Michael Greger M.D. on March 5th, 2015

With permission: www. nutritionfacts.org  

Are the purported benefits of fish oil supplementation for the prevention and treatment of heart disease just a “fish tale“? Thanks to recommendations from organizations such as the American Heart Association that individuals at high risk for heart disease ask their physicians about fish oil supplementation, fish oil has grown into a multibillion dollar industry. We now consume over 100,000 tons of fish oil every year.

But what does the science say? A systematic review and meta-analysis published in the Journal of the American Medical Association, highlighted in my video Is Fish Oil Just Snake Oil? looked at all the best “randomized clinical trials evaluating the effects of omega-3’s on lifespan, cardiac death, sudden death, heart attack, and stroke.” The studies told the subjects to either eat more oily fish or to take fish oil capsules. What did the study find? Overall, the researchers found no protective benefit for all-cause mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.

What about for those who already had a heart attack and are trying to prevent another? Still no benefit. Where did we even get this idea that omega 3’s were good for the heart? If we look at some of the older studies, the results seemed promising. For example, there was the famous DART trial back in the 80s involving 2,000 men. Those advised to eat fatty fish had a 29% reduction in mortality. Pretty impressive—no wonder it got a lot of attention. But people seemed to have forgotten the sequel, the DART-2 trial. The same group of researchers, and an even bigger study (3,000 men). In DART-2 “those advised to eat oily fish and particularly those supplied with fish oil capsules had a higher risk of cardiac death.”

Put all the studies together, and there’s no justification for the use of omega 3s as a structured intervention in everyday clinical practice or for guidelines supporting more dietary omega-3’s. So what should doctors say when their patients follow the American Heart Association advice to ask them about fish oil supplements? Given this and other negative meta-analyses, “our job as doctors should be to stop highly marketed fish oil supplementation in all of our patients.”

Don’t Forget Fiber

Written by: Michael Greger M.D. on February 19, 2015

With permission: www. nutritionfacts.org

The famous surgeon Denis Burkitt is better known for his discovery of a childhood cancer now known as Burkitt’s lymphoma than for his 1979 international bestseller, Don’t Forget the Fibre in Your Diet.  Anyone asked to list the twenty or more most important advances in health made in the last few decades would be likely to include none of what Dr. Burkitt considered to be among the most significant. What was the number one most important advance in health according to one of the most famous medical figures of the 20th century? The discovery that “Many of the major and commonest diseases in modern Western culture are universally rare in third-world communities, were uncommon even in the United States until after World War l” yet are now common in anyone following the Western lifestyle. So it’s not genetics—they’re lifestyle diseases (See Dr. Burkitt’s F-Word Diet). This means they must potentially be preventable.

Those eating the standard American diet have very high levels of a long list of diseases—such as heart disease and colon cancer—that were similar to the rates of disease in the ruling white class in apartheid Africa. Conversely, the rates in the Bantu population were very low. These native Africans ate the same three sister diets of many Native Americans, a plant-based diet centered around corn, beans, and squash. In fact, it was reported that cancer was so seldom seen in American Indians a century ago they were considered practically immune to cancer—and heart disease. What are “very low” rates? 1300 Bantus were autopsied over five years in a Bantu hospital and less than ten cases of ischemic heart disease, the West’s number one killer.

The Bantu’s rates of heart and intestinal disease is similar to poor Indians, whereas wealthier Indians who ate more animal and refined foods were closer to those in Japan—unless they moved to the U.S. and started living like us. You find similar trends for the other so-called Western diseases, which Burkitt thought were related to the major dietary changes that followed the lndustrial Revolution: a reduction in healthy whole plant foods—the source of starch and fiber–and a great increase in consumption of animal fats, salt, and sugar. His theory was that it was the fiber. He believed all of these major diseases may be caused by a diet deficient in whole plant foods, the only natural source of fiber.

Fiber? In a survey of 2,000 Americans, over 95% of graduate school-educated participants and health care providers weren’t even aware of the daily recommended fiber intake. Doctors don’t even know. How much fiber should we shoot for? The Institute of Medicine recommends 38 grams for men 50 years and younger and 30 grams for men over 50 years. Women 50 years and younger should get 25 and those older than 50 should get 21 grams. But these levels are just the minimum. I recommend we look to our evolutionary past for more clues on fiber intake. See my video Paleolithic Lessons.

One analogy Dr. Burkitt used is this: “If a floor is flooded as a result of a dripping tap, it is of little use to mop up the floor unless the tap is turned off. The water from the tap represents the cause of disease, the flooded floor the diseases filling our hospital beds. Medical students learn far more about methods of floor mopping than about turning off taps, and doctors who are specialists in mops and brushes can earn infinitely more than those dedicated to shutting off taps.” And the drug companies are more than happy to sell us rolls of paper towels, so patients can buy a new roll every day for the rest of their lives. To paraphrase Ogden Nash: modern medicine is making great progress, but just headed in the wrong direction.

How do we know that diet was the critical factor? Because when we place people stricken with these diseases on plant-based diets, their disease can be reversed (Our Number One Killer Can Be Stopped). In fact it was the work of Burkitt and others in Africa that led to the disease reversal work of pioneers like Nathan Pritikin (Engineering a Cure).

The Mediterranean Diet

Written by: Michael Greger M.D. on January, 2017

With permission: www. nutritionfacts.org

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That’s one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn’t eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a “provegetarian” scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a “gentle approach” to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That’s why I prefer the term “whole-food, plant-based diet” since it’s defined by what you eat, not by what you don’t eat. When I taught at Cornell I had “vegan” students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, “this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy.” A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

Olives and Nuts

Written by: Michael Greger M.D. on October, 2016

With permission: www. nutritionfacts.org

Olives and nuts are plant foods, and as such, are packed with antioxidants, raising the antioxidant level of our bloodstream resulting in lower fat oxidation and free radical DNA damage, but what’s happening inside people’s arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating added nuts, added extra virgin olive oil or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. The nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque, rendering them less likely to rupture. You can see these results in my video Which Parts of the Mediterranean Diet Extended Life?

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30 percent. If you look at the baseline adherence to Mediterranean diet principles and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil, wine, fish or cutting back on soda and cookies. Among the individual components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn’t appear to live any longer overall. This is in contrast to other studies that suggested that frequent nut consumption may extend life. For example, the Harvard health professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease and most importantly fewer deaths overall. This was confirmed by all the other big major prospective studies in a recent review.

So what’s going on here with the study showing no longevity benefit from nuts? Did they just not wait long enough? Just because people were randomized to the nut group didn’t mean they actually ate more nuts, and those randomized to the other groups didn’t necessarily stay away.

If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn’t, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called Father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing animal fats; anything to get people to eat less lard and butter.

What is the best kind of nut? The greatest benefits were attributed to walnuts, particularly for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it’s just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet—including walnuts—may be the most critical message for the public.

The Risks and Benefits of Calcium Supplements

Written By Michael Greger M.D. FACLM on March 27th, 2018 (links removed)

There has been an assumption for decades that as a natural element, calcium supplements must intrinsically be safe. But, as I explore in my video Are Calcium Supplements Effective?, calcium supplementation is neither natural nor risk-free. The same could be said, however, for all medications, yet doctors continue to write billions of drug prescriptions every year hoping the benefits outweigh the risks.

So, what about the benefits of calcium supplements versus the risks they pose for heart attacks and strokes? Having a heart attack or stroke can be devastating, but so can a hip fracture. In the months after a hip fracture, risk of dying shoots up, with about one in five women passing away within a year. The odds are even worse for men, with hip fractures having the potential to shorten lifespan by an average of four or five years. Unfortunately, these dismal statistics haven’t been getting much better.

Even if calcium supplements caused a few heart attacks and strokes, it could be argued that if they prevented many more hip fractures, then the risk-benefit ratio might be favorable. But how effective are calcium supplements in preventing hip fractures? We’ve known that milk intake doesn’t appear to help, but maybe that’s because any potential benefit of the calcium in milk may be overshadowed by the increased risk of fracture and death associated with the galactose sugar in milk. (See Is Milk Good for Our Bones? for more on this.) Then what about the calcium in a calcium supplement alone? Calcium intake in general does not seem to be related to hip fracture risk at all. When people have been given calcium supplements, they saw no reduction in hip fracture risk but rather an increased risk was possible. In fact, the randomized controlled trials suggested a 64 percent greater risk of hip fractures with calcium supplementation, compared to a placebo sugar pill.

So where did we get the idea that taking calcium supplements might help our bones? An influential 1992 study found that a combination of vitamin D and calcium supplements could reduce hip fracture rates by 43 percent. However, the subjects in the study were institutionalized women, living in places like nursing homes, who were vitamin D deficient. They weren’t getting sufficient sun exposure. So, if you’re vitamin D deficient and then you take vitamin D and calcium, it’s no surprise your bones get better.

For postmenopausal women living independently in the community, the latest official recommendation for calcium and vitamin D supplementation to prevent osteoporosis is unambiguous: We should not supplement. Why? Because “[i]n the absence of compelling evidence of benefit, taking supplements is not worth any risk, however small.” This is not to say that these supplements don’t play a role in treating osteoporosis or that vitamin D supplements might not be good for other things. But, if you’re just trying to prevent fractures, women living outside of institutions should not take them—and this might even apply to those who live within them.

In a 2012 study, instead of giving nursing home residents vitamin D and calcium supplements, researchers randomized them so one group received sunlight exposure and the other took calcium supplements. Those in the calcium pill group had significantly increased mortality, living shorter lives than those in the sunshine group.

Although calcium supplements don’t appear to prevent hip fractures, they may reduce overall fracture risk by approximately 10 percent. If you’re wondering whether this means it could be worth taking them, here’s how the risk-benefit shakes out: If 1,000 people took calcium supplements for five years, we would expect 14 excess heart attacks—that is, 14 people having heart attacks who would not have had heart attacks if they hadn’t started taking the calcium supplements. They were effectively going to the store and buying something that gave them a heart attack. We also would expect 10 strokes and 13 deaths that otherwise would not have happened. An expected 14 heart attacks, 10 strokes, and 13 deaths compared with preventing only 26 fractures. Of course, it’s no fun falling down and breaking your wrist, but most people would probably look at the risk-benefit analysis and conclude that calcium supplements are doing more harm than good.

Dietary calcium, on the other hand, has not been associated with an elevated risk of heart attacks. Given these findings, individuals should be discouraged from taking calcium supplements and advised to obtain calcium from their diet instead. How much dietary calcium should we shoot for then?

Interestingly, unlike most other nutrients, there’s not an international consensus on how much to take. For example, in the United Kingdom, the recommendation for adults is 700 mg per day. Across the pond in the United States, it’s up to 1,200 mg per day. Whenever I see that kind of huge discrepancy between government panels, I immediately think scientific uncertainty, political maneuverings, or both.

Newer data based on calcium balance studies where researchers made detailed measurements of the calcium going in and out of people suggest that the calcium requirements for men and women are lower than previously estimated. They found that calcium balance was highly resistant to change across a broad range of intakes, meaning our body is not stupid. If we eat less calcium, our body absorbs more and excretes less. And if we eat more calcium, we absorb less and excrete more to stay in balance.

Therefore, current evidence suggests that dietary calcium intake is not something most people need to worry about. This may explain why in most studies, no relationship has been found between calcium intake and bone loss anywhere in the skeleton because the body just seems to take care of it.

Don’t push it too far, though. Once you get down to just a few hundred mg per day, you may get significantly more bone loss. Though there may not be great evidence to support the U.S. recommendations, the United Kingdom may have the right idea shooting for 500 to 1,000 mg per day from dietary sources. This applies unless you’ve had gastric bypass surgery or have another reason for needing supplementation. For most people, though, calcium supplements cannot be considered comparatively safe or effective for preventing bone fractures. 

All of this is not to say that these supplements cannot play any role in treating osteoporosis or that vitamin D supplements might not be good for other things. I do advise vitamin D supplementation for those not getting enough sun.

Other Useful Websites

Food Value: http://nutritiondata.self.com (use the search function on top of the page)

Food Value

Nutrition Information

Food Intolerance

Further Reading

1. Naya Lizardo: Healing Foods
2. Ellen Young: 101 Vegan Recipes For Beginners
3. Jack Challem: Syndrome X, The complete nutritional program to prevent and reverse insulin resistance
4. Jack Challem: The Inflammation Syndrome, Your Nutrition Plan for great health, weight loss and pain-free living
5. Christopher Cannon & Elizabeth Vierck: The Anti-Inflammation Diet
6. Bruce Lourie & Rick Smith: Toxin Toxout, Getting harmful chemicals out of our bodies and our world.
7. J Scher and M Blaser from the University of New York, V Taneja from the Mayo Clinic, Dennis Kasper from Harvard University: published authors dealing with microbial research and the human gut.
8. Giulia Enders, Gut - the inside story of our body's most under-rated organ, Scribe, UK, 2015

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