I wrote this reply yesterday in the discussion on diet, as it seems there are some very hard and fast responses out there which may not encourage people to explore this area in as much detail as they may need to do to improve their health. I also want to say that this is all speculation, but bases on good science and my experience after 21 years of moderate to severe arthritis which necessitated me giving up full time work etc I am not also sure yet about how this diet which I am doing is a recovery program and how soon I will go to more 'summer ' version of this , ie no need for so much sat fat if you live in a hot climate ect when inflammation has subsided. please dont jump to quick knee jerk responses. I havent.
Of course, your sceptism is , and everyone else's a wise and to my mind sound response .I am not writing this because I think it is so easy to get well in a society with a rigid belief in what is normal and safe to eat and do to your body.. There seem to be many, many people in western societies trying to deal with bodies under strain from diseases which have an inflammatory component .I have been reading the biochemists and biologists who look at this in a broad context rather than getting too worried about individual disease pathways ( although they explore these in more detail than my gp or rheumatologists) as they are asking slightly different questions. More exploratory if you will, not how can I suppress this inflammation for this ill person, but questions like what purpose does this inflammation serve the body in an evolutionary context. Its so easy to get brainwashed into thinking your life is the destiny of your genes predisposition to attack your joint tissue and collagen and muddle up your proteins- if that is your genetic inheritance, or genome, maybe that tells us something like, this body has evolved to live with a seasonal diet, high in fats at some times of the year, fallow at others, with exceptionally high omega three from fish so it can withstand the extreme cold and periods without fruit.If evolution is slow, and we have radically altered how we expect our bodies to perform on food they were not designed to eat in such quantities in a few generations, without the exercise and extreme temperature and quiet periods even fasting , then it is not surprising if they start to get a bit muddled in the wiring.
For me the question isn't - how can I suppress these symptoms as safely and economically as possible for the patient, given my resources as a rheumatologist and their resources as a patient in the NHS in the UK, or perhaps on a limited healthcare insurance policy as in the US. That is their job, and I am not dismissing it as a failure . It is a question of where , for me, to put my faith, as have said, if perhaps, the biologic stops working as it has for me.I do not say don't try Humira, or Enbrel if that is a simple next step, but it has to be said that these immune blockers, even with added methotrexate, don't work for everyone and they may not work for ever. I won't harp on about potential side effects, because , when they work, the effects of biologics are amazing, if likely to gradually fade in their effectiveness.
However,when we sign disclaimers we to take them we do that with the adult knowledge that the long term side effects are as yet unknown, they have been used since 1998. They could well be the new aspirin - relatively harmless and I am definitely not intending to do any scaremongering about them. They have brought hope and quality of life to a lot of rheumatologists !! as well as patients with this family of disease. But where do you go when they stop working- and if like me , again with a strong history of moderate to severe arthtritis ?
My answer has been to start with understanding inflammation - not just the very specific pathways of Psa, which I believe has a broader set of issues with it than my rheumatologist will take a medical resposibilty for -as it is - it is just not his/her job to manage the gut issues, the depression, the gum disease , they belong on another specialists desk. And I question this pattern , which is so much part of the way the management of disease is organised.
So no one cures inflammation - that is a biological imperative for life - a major part of how animals function- but we can explore chronic states and look for things in common with unhealthy organisms . I know that as I am well atm, I am more objective about this than I was before, equally I know how much we become identified with our diagnosis as though this somehow helps. I know it did for me anyway at the beginning of my journey 21 years ago- it was like, so this isnt to do with anything Im doing wrong - its a terrible affliction, and it is a huge relief to know you have something in common with others who have experienced such pain, that it isn't you are lazy, lack willpower are going crazy and so on.
the questions I am interested in , which are proving fruitful to me now, post the best part of my life, late twenties, thirties, significant part of my forties dealing with constant inflammation, drug therapies etc, is why did this start , why hasnt my cousin had it so bad - he has managed his on occasional NSAIDS, although he stopped his sport in his twenties, my 71 year old aunt has it too- but she wasn't in such a rush to get running to the rheumatologist as me - , and yes she has very knarled old hands, swollen knees, a wheat belly, but generally is active and just takes the occasional NSAID. Mmmm food for thought for me.
So back to chronic inflammation - and my questions. So I am more looking at how the health of the gut is a vital factor in reducing inflammation and wellbeing and the strategies to manage that. The issue of gut flora and their role is huge, and some ideas of the complexity of looking after the ecosystem in your gut I have gleaned from the site Cooling Inflammation, which is academic and I have found most interesting.
The next thing has been to try and understand the role of different types of food and how it is actually digested - and how it interferes with inflammatory pathways - so all the stuff about how undigested carbohydrate in the gut irritates certain bacteria and this leads to inflammatory responses which can be chronic especially with milk proteins and grain proteins and other tricky plant lectins. as we are advised to eat a high carb low fat diet as a general rule , I have spent considerable time and energy looking at the scientific evidence and the crux points which much of the conventional wisdom is based on. If it aint broke dont fix it of course - but what if it is broke
Many people are experimenting with their diet - looking to feel well and reduce inflammation - and I think there is a lot we dont know about the inflammatory effects of insulin which occurs when you eat any type of starch. There is also the problem of too much fructose - from fruit - again which ties in with the seasonality thing- the idea our bodies may be better when things like plenty of sugary fruit are short lived.
The detail of how different foods are digested as well as how food gives your body hormonal information which affects it is interesting too. I dont think can fasting can be a bad idea- it has been practised for thousands of years for cultural reasons, and maybe millenia when food supplies havent been plentiful and may well have a huge impact on the specific gut bacteria which irritate the gut. Starve a fever and feed a cold. If inflammatory illness - surely a kind of fever - can be helped by starving certain gut flora, then my approach seems to be helping. I wont say cure- you cant cure the body of its dislike of too much of certain things, but it seems happier. And so do I.