한 치과의사는 '1994년 4월 저는 잠깐 선생님을 미시간 그랜드 래피드의 치과 연례 회의에서 잠깐 뵈었습니다. 이 세미나 동안 저는 저의 소아 류마티스를 앓고 있는 저의 4살난 아들에 대하여 여쭈어 본적이 있습니다. 브라이언은 강력한 스테로이드제인 프레드니손을 35mg 을 맞고 있었고 애드빌을 매일 1200mg씩 복용하고 있었습니다. 너무나 아파서 밤 낮으로 고통속에 비명을 지르고 했답니다. 일년동안 체중은 충고 키도 자라지 못했습니다. 염증 (Sed rate) 수치는 40 이상 (정상 5이하) 을 가르키고 있는 아주 어려운 상황이었지요. 당신이 저에게 제시한 것은 모든 동물성 음식을 식단에서 제거시키고 마찬가지로 과자 등 정제 탄수화물을 없어버리라는 것 이었습니다. 이렇게 6개월동안 했으며 이제 브라이언은 모든 약을 다 끊은 상태입니다. 통증도 없어지고 또 염증 수치도 1 이하로 내려갔답니다. 믿으실 수 있겠습니까? 

 

마빈 벌크(루이스의 남편-루이스는 맥두걸 건강센터 직원)는 거의 의자에서 나올 수 없는 지경이었습니다. 그는 무척이나 힘들게 관절을 펴서 갈지자로 걸어다녔답니다. 손가락등은 너무나 뻣뻣해서 도구 등을 사용하기도 힘들어 했으며 잡지못해 아래로 떨어뜨리곤 했습니다. 그는 이제 겨우(?) 65세이며 장애가 되기에는 너무 젊습니다. 그래서 그는 뭔가를 해야 한다고 결심을 하고 8년전 식단을 바꾸어 버렸습니다. 바로 극적인 효과가 나타났습니다. 이제 의자를 고통없이 박차고 나와 뻣뻣함이 통증없이 잘 걸어다니고 있습니다. 

 

근육, 뼈 질병들은 나이에 상관없이 모든 사람들에게 가장 흔한 질병입니다. 미정부조사에 의하면 전 인구의 33%가량의 어른들이 붓거나 거동이 불편하거나 또 통증으로 고통받고 있다고 합니다. 65세 넘는 사람들 중 약 50%이상이 관절염 증상을 가지고 있다고 합니다. 가장 영향을 미치는 신체 부위는 목, 등, 엉덩이, 어깨 부분입니다.  

 

관절염은 관절의 염증을 의미합니다. 관절은 넘어지거나 삐거나 해서 부상을 당해서 염증이 생길 수 있습니다. 이것을 외상성 관절염이라고 합니다. 그리고 화농성 관절염을 유발시키는 박테리아에 감염될 수 있습니다. 요산결정체가 관절에 쌓이면 통풍성 관절염이 됩니다. 이 세가지 관절염은 원인이 있습니다. 그래서 원인을 제거하면 치료가 됩니다. 불행이도 다른 대부분의 관절염은 원인을 찾을 수가 없습니다. 측 원인을 찾을 수 없으므로 치료방법도 없습니다

 

원인을 모르는 관절염은 크게 두가지로 나누어 집니다. 즉 퇴행성 관절염과 염증성 관절염. 퇴행성 관절염은 다른 말로 골관절염으로 불립니다. 가장 많이 발견되는 관절염 종류. 65세가 넘는 사람들의 79%에게서 발견됩니다. 그러나 똑 같은 질병이 아프리카나 아시아에 가면 별루 없답니다.

 

어떻게 그렇 수 있을까요? 골관절염은 관절이 닳거나 찟어져서 그렇답니다. 그런데 저개발국가의 사람들에게는 관절염이 적게 발생할까요? 사용하는 정도가 낮은 여성들도 관절은 나이가 들면 관절이 비틀어지고 변형됩니다.

염증성 관절염은 청소년 류마티스관절염, 간경변 관절염, 루푸스, 강직성척추염 등이 있다. 이런 질병을 가진 사람은 전 인구의 약5%정도 됩니다.  퇴행성 관절염 환자들도 관절에 염증이 있지만 식단을 잘 바꾸면 붓기나 통증,뻣뻣함등이 개선되기도 합니다. 그러나 이미 손상된 부분은 회복되지 않습니다.

장은 장의 내용물은 신체의 내부와 분리시키고 제외시키는 효과적인 장애물입니다. 이 단 한 장의 졉이 장기를 엄청난 양의 항원(단백질)- 음식또는 미생물-을 분리시키는 역할을 합니다. 장점막은 영양을 흡수하고 소화시켜 큰 복합분자를 작은 단순분자로 바꾸는 역할을 합니다. 정상적으로 단지 작은 분자들이 장벽을 통과할 수가 있고 큰 분자들은 항원으로 분류가되어 면역반응을 이르키는 원인을 제공합니다. 이 큰 분자들은 제한 통과능력이 있습니다. 장에 염증이 생기면 여기에 틈이 생겨 큰 분자들이 핏속으로 들어가는 불상사가 생깁니다. 이것이 류마티스 환자의 증상을 악화시키는 원인을 제공하는 것입니다

관절염 환자의 희망.

관절염은 유전병도 아니며 늙어서 생기는 병도 아닙니다. 관절에 병이 생기는 것은 원인이 있습니다. 그 원인들은 우리가 사는 환경에 있습니다. 특히 음식이 원인일 수 있습니다. 사실 1800년 이전에는 류마티스에 관한 질병보고가 없었가니 거의 나타나지 않았습니다. 마찬가지로 아시아, 아프리카에서도 보고된 바 없습니다. 최근(1957년까지)도 류마티스가 발병된 적이 없습니다. 그 때까지 아프리카는 주로 곡물과 야채에 의존해서 생활했기 때문입니다.

 

과거에는 전혀 알려지지 않은 류마티스와 같은 질병이 점점 부유한 나라나 큰 도시에서 많이 발병되기 시작합니다. 그이유는 가지들이 먹던 곡물과 야채 등의 전통적인 방식의 음식들에서 고기나 낙농제품, 정제 음식등으로 식단을 바꾸었기 때문이라고학작들은 예측합니다. 건강하지 못한 음식이 염증성 관절염을 유발한다고하는 이론은 거의 이해오디고 있지 않지만, 이것이 장과 면역체계와 관련을 준다고 믿고 잇습니다.

임파조직의 대부분은 소화기관과 관련되어 있습니다. 이 조직은 장벽을 통과하는 항원(알러지를 일으키는 물질)이 문제를 일으키는 것을 예방합니다. 불행이도 건강하지 못한 음식 ( 고지방, 고 콜레스테롤, 동물성 단백질 함량이 높은 식단)은 임파조직이 장벽을 통과한 항원들을 파괴하는 능력을 방해합니다.

 

 단식(FASTING)은 장 투과성을 감소시키는 것으로 알려져 있습니다. 이것이 장을 '덜 새게' 만드는 결과를 만들어서 류마티스 증상을 가지고 있는 환자들에 극적으로 증상을 개선시킨다는 것입니다. 단식 후 유제품 섭취를 시작하면 장은 다시 투과성이 증가되어 류마티스가 돌아오는 것입니다. 건강하지 못한 식단이란 유제품과 다른 동물성 제품들이 자 표면의 염증을 일으켜서 음식과 박테리아의 항원들의 통과를 증가시키게 되어 증상이 악화되는 것입니다. 식물성 식단은 류마티스 환자의 대변의 미생물에 변화를 일으켜서 류마티스 활동에 개선을 가져오기도 합니다 

동물성식단을 제외하는 것도 중요하지만 최대 효과를 얻으려면 지방섭취를 줄여햐 합니다. 동물실험에서 지방은 고 콜레스롤을 투어받으면 장 투과성이 증가되는 것이 확인되었습니다. 식물성 식단을 고수하는 관절염환자들이 증상이 개선되지 않은 이유가 식물성 오일 섭취가 많아서 장이 손상되어 그런 것으로 알려져 있습니다.

 

가장 관절염 치료에 위험한 역설은 관절염을 치료하기 위한 약들이 장벽에는 독으로 작용한다는 것입니다. 아스피린이나 렐라펜 뿐만 아리나 애드립, 모트린 등 비 스테로이드성 항염제들이 이용되는데 이것들이 장 투과성을 높인다는 것입니다. 이렇게 손상된 장들이 회복되는 데 수개월이 걸릴 수 있습니다.

혈관내에서 외부 (음식이나 박테리아)에서 들어온 단백질이 손상된 장벽(Leaky Gut)을 통과하며 혈액으로 들어옵니다. 신체는 이 단백질(항원)을 외부에서 침입한 바이러스, 기생충 단백질로 인정해서 항체를 만들어 냅니다  염증성 관절염에는 이런 항체수준이 증가하게 됩니다.

손상된 장벽(Leaky Gut)이 원인이 되어 투과된 항원(음식과 박테리아 단백질)과 항체의 복합체가 혈액속에 생깁니다. 건강한 사람들에겐 핏속의 이런 커다란 복합체를 쉽게 제거하는 메커니즘을 가지고 있습니다. 일부사람들은 이런한 복합체가 제거 되지 않습니다. 이유는 이러한 복합체가 너무 형성이 빨리되어 완전히 제거되지 않거나 아니면 신체 메커니즘이 제거하려는 복합체가 너무 많아서 제대로 작동하지 않기 때문입니다. 이 복합체는 관절, 피부, 신장 등에서 발견되는 신체의 가장 작은 혈관(모세혈관)을 통해서 제거됩니다. 모세혈관에 있는 이러한 복합체가 연쇄적인 염증을 일으키는 것입니다

 

외부 단백질 (손상된 장벽을 통하여 음식이나 박테리아에서 발견되는 단백질)은 신체가 항체를 생산하게 합니다. 이 항체는 단지 이 외부 단백질을 공격할 뿐만 아니라 비슷한 신체 단백질과 상호작용을 하기도 합니다. 이러한 메카니즘을 molecular mimicry 라고 합니다. 즉 신체가 자기를 공격하는 자가면역질환입니다. 류마티스 관절염, 루푸스, 습진성 관절염, 각직성 척추염 등이 이러한 질병들입니다. Molecular mimicry 현상 ( 신체가 자기를 공격하는 자가면역질환 현상)은 우유(Milk) 단백질에서 에서 확인되었습니다. 쉽게 설명하면 인간의 관절 등에서 발견되는 일련의 아미노산들이 우유단백질의 아미노산들이 배열이 같기 때문에  항체가 우유단백질을 공격하는대신 신체를 공격하게 된다는 것입니다 

 

건강한 식단은 신체방어체계가 외부에서 들어온 항원을 제거하고 혈액에서 생긴 면역복합체를 제거하는 능력을 최대화시킵니다. 많은 음식 중에 특별히 주의할 것은 요리할 때 사용하는 식용유는 면역기능을 억제하는 결과를 초래할 수 있습니다. 면역기능이 억제당하면 외부에서 침입한 단백질을 제거하는 그 기능이 방해를 받게 됩니다. 저 지방 식단은 동물실험에서 자가면역질환(류마티스 및 루푸스)의 진행을 저지하는 것으로 연구결과가 나타났습니다. 건강한 식단은 관절을 강하고 손상된 부분을 치료하는 항산화 물질과 다른 파이토케미컬(미세영양소)를 제공합니다. 

건강한 식단이 많은 염증성 관절염 치료에 대단히 효과적이라는 것을 보여 주고 있습니다

 

• In 1980, Stroud reported on 44 patients with rheumatoid arthritis treated with the elimination of food and chemical avoidance.  They were then challenged with foods. Wheat, corn, and beef  were the greatest offenders (Clin Res 28:791A, 1980).

• In 1981, Parke described a 38-year-old mother with 11-years of progressive erosive seronegative rheumatoid arthritis who recovered from her disease, attaining full mobility, by stopping all dairy products.  She was then hospitalized and challenged with 3 pounds of cheese and seven pints of milk over 3 days.  Within 24 hours there was a pronounced deterioration of the patient's arthritis (BMJ 282:2027, 1981).

• In 1981, Lucas found a fat-free diet produced complete remission in 6 patients with rheumatoid arthritis.  Remission was lost within 24-72 hours of eating a high-fat meal, such as one containing chicken, cheese, safflower oil, beef, or coconut oil.  The authors concluded, "...dietary fats in amounts normally eaten in the American diet cause the inflammatory joint changes seen in rheumatoid arthritis." (Clin Res 29:754, 1981).

• In 1982 Sundqvist studied the influence of fasting with 3 liters of fruit and vegetable juice daily and lactovegetarian diet on intestinal permeability in 5 patients with rheumatoid arthritis. Intestinal permeability decreased after fasting, but increased again during a subsequent lactovegetarian diet regime (dairy products and vegetables). Concomitantly it appeared that disease activity first decreased and then increased again. The authors conclude, "The results indicate that, unlike a lactovegetarian diet, fasting may ameliorate the disease activity and reduce both the intestinal and the non-intestinal permeability in rheumatoid arthritis." (Scand J Rheumatol 11:33, 1982.)

• In 1983, Lithell studied twenty patients with arthritis and various skin diseases on a metabolic ward during a 2-week period of modified fast on vegetarian broth and drinks, followed by a 3-week period of a vegan diet (no animal products). During fasting, joint pains were less intense in many subjects. In some types of skin diseases (pustulosis palmaris et plantaris and atopic eczema) an improvement could be demonstrated during the fast. During the vegan diet, both signs and symptoms returned in most patients, with the exception of some patients with psoriasis who experienced an improvement.  The vegan diet was very high-fat (42% fat).  (Acta Derm Venereol 63:397, 1983).

• In 1984 Kroker described 43 patients from three hospital centers who underwent a 1-week water fast, and overall the group improved significantly during the fast.  In 31 patients evaluated, 25 had "fair" to "excellent" responses and 6 had "poor" responses.  Those with more advanced arthritis had the poor responses. (Clin Ecol 2:137, 1984).

• In 1985,  Ratner removed all dairy products from the diet of patients with seronegative rheumatoid arthritis, 7 out of 15 went into remission when switched to milk-free diets (Isr J Med Sci21:532, 1985)

• In 1986, Panush described a challenge of milk in a 52-year-old white woman with 11 years of active disease with exacerbations allegedly associated with meat, milk, and beans. After fasting (3 days) or taking Vivonex (2 days) there was no morning stiffness or swollen joints.  Challenges with cow's milk (blinded in a capsule) brought all of her pain, swelling and stiffness back  (Arthritis Rheum 29:220, 1986).

• In 1986, Darlington published a 6-week, placebo-controlled, single-blinded study on 48 patients.  Forty-one patients identified foods producing symptoms.  Cereal foods, such as corn and wheat gave symptoms in more than 50% of patients (Lancet1:236, 1986).

• In 1986, Hanglow performed a study of the comparison of the arthritis-inducing properties of cow's milk, egg protein and soy milk in experimental animals.  The 12-week cow's milk feeding regimen produced the highest incidence of significant joint lesions. Egg protein was less arthritis-inducing than cow's milk, and soy milk caused no reaction.  (Int Arch Allergy Appl Immunol80:192, 1986).

• In 1987, Wojtulewski reported on 41 patients with rheumatoid arthritis treated with a 4-week elimination diet.  Twenty-three improved. (Food allergy and intolerance.  London: Bailliere Tindall 723, 1987).

• In 1988, Beri put 14 patients with rheumatoid arthritis on a diet free from pulses, cereals, milk, and non-vegetarian protein foods.  Ten (71%) showed significant clinical improvement. Only three patients (11%) adhered to the diet for a period of 10 months (Ann Rheum Dis 47:69, 1988.)

• In 1988, Hafstrom fasted 14 patients with water only for one week.  During fasting the duration of morning stiffness, and number and size of swollen joints decreased in all 14 patients.  No adverse effects of fasting were seen except transient weakness and lightheadedness.  The authors consider fasting as one possible way to induce rapid improvement in rheumatoid arthritis (Arthritis Rheum 31:585, 1988).

• In 1991 Darlington reported on 100 patients who had undergone dietary manipulation therapy in the past decade, one-third were still well and controlled on diet alone without any medication up to 7 ½ years after starting the diet treatment.  They found most patients reacted to cereals and dairy products (Lancet 338:1209, 1991).

• In 1992, Sheignalet reported on 46 adults with rheumatoid arthritis who eliminated dairy products and cereals.  Thirty-six patients (78%) responded favorably with 17 clearly improved, and 19 in complete remission for one to five years.  Eight of those 19 stopped all medications with no relapse.  Favorable benefits appeared before the end of the third month in 32 of the patients (Lancet 339:68, 1992). 

• In 1992, Shigemasa reported a 16-year-old girl with lupus who changed to a pure vegetarian diet (no animal foods) and stopped her steroids without her doctor's permission.  After starting the diet her antibody titers (a reflection of disease activity) fell to normal and her kidney disease improved (Lancet339:1177, 1992.

• In 1998, Nenonen tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and control groups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to an omnivorous diet aggravated symptoms. The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis (Br J Rheumatol 37:274, 1998).

 

.

류마티스 환자에게 식단의 선택은 대단히 중요합니다, 적절한 음식은 장벽을 튼튼하게 하여 면역시스템이 

 

FOR WHOLE BODY BENEFITS

By no small coincidence the same diet that keeps the joints healthy also keeps the rest of the body sound.  Diane of Walnut Creek wrote to me last year.  "I had what I can only call a miserable life until about five years ago.  Nothing seemed to go right for me.  In late 1991 I was diagnosed with spinal stenosis and degenerative arthritis.  I was declared permanently disabled and left my job as a daily newspaper journalist.  My therapist gave me a wonderful gift--she suggested I try your program.  I shrugged off her suggestion at first.  I swore that I ate well anyway:  only dairy and shellfish and white meats.  Only!  She did not push the point, wisely waiting for me to think about the idea.  I did wait for two years.  Then two years ago she suggested your program again.  I told her I didn't believe it would work, but agreed to try it for two months.  I was overweight, very overweight, by 100 pounds, most of my life--carrrying all that poundage caused a lot of wear on my joints.  That was two years ago, and I'm a lifelong convert."

 

"Of course what you predicted happened:  My migraines went away completely;  I stopped swelling in my joints;  I could sleep easily;  I had no indigestion problems of any kind; and I began to drop weight.  As you probably know, it was a lot easier than I thought it would be.  Before I started the McDougall plan, I was losing weight slowly.  Afterward, the weight loss was dramatic.  After about six months, people started noticing and commenting.  They kept saying things like ‘you look ten years younger,'  or most often,  ‘You look great.  What did you do?'  I no longer take the anti-inflammatory drugs and painkillers that I was taking before the McDougall way.  My knee and low-back are virtually pain-free. Now, what I've found is that nobody believes it can be as simple as eating carefully and exercising.  They all want some magic or some pill."

 

 

A dentist writes, "In April of 1994 I met you briefly at the Michigan Dental Association Annual Meeting in Grand Rapids.  During this seminar, I asked you about my 4-year-old son having juvenile rheumatoid arthritis.  Bryan was on 35 mg of prednisone (a powerful steroid) and 1200 mg of Advil daily.  He was in so much pain he screamed and cried day and night.  In one year he lost weight and did not grow one inch.  His blood work reflected a sed rate of over 40 (This is a measurement of severity of inflammation and should be below 5).  The suggestions you gave me that day lead me to remove all animal products from his diet, as well as refined carbohydrates."

"Within six months, we had Bryan off all his medication.  He was free of pain, gaining weight and growing again.  His last blood work was superb with a sed rate of 1 - can you believe it!" 

 

That's how bad it can get.  But for millions arthritis is much more subtle.  Marvin Burk (Louise's husband--Louise works in the McDougall Health Center office) couldn't hardly get out of the chair.  Then he would walk straddle-legged halfway across the room until he could loosen up enough to get his joints moving.  His hands were so stiff he could not use his tools and he often dropped things.  He figured a man of 65 shouldn't be so crippled and decided he'd do whatever it takes to get well.  He changed his diet 8 years ago with immediate and dramatic results.  Now he pops out of the chair, walks without a bit of stiffness or pain and he handles his tools with no trouble.  Many of us can relate to Marvin's troubles.

PEOPLE'S MOST COMMON AFFLICTION

 

Diseases of the muscles and bones are among the most common of all human afflictions, affecting all ages, but becoming more prevalent with years.  Government surveys indicate in the United States approximately 33% of adults currently suffer from troublesome arthritis with symptoms of swelling, limitation of motion, or pain.  Approximately half of all people over 65 years report having arthritis.  The regions of the body most affected are the neck, lower back, hip and shoulder.

 

Arthritis means inflammation of a joint--no more, no less.  The fact that a person has arthritis tells nothing about the cause or the cure.  Joints can be inflamed as a result of an injury, such as from tripping and spraining an ankle.  That's called traumatic arthritis.  Joints can be infected with bacteria resulting insuppurative arthritis.  Uric acid crystals can accumulate in the joints causing gouty arthritis.  The causes of all three of these forms of arthritis are known and once the causes are stopped the joints heal.  Unfortunately, most forms of arthritis are said by doctors to have "no known cause."  And whether or not they will admit it, there is no cure to be found in modern drug therapy either.

DEGENERATIVE AND INFLAMMATORY (퇴행성과 염증성)

 

Arthritis of "no known cause" can be divided into two broad categories:  degenerative arthritis and inflammatory arthritis.  Degenerative arthritis most commonly represents a condition known as osteoarthritis.  This is the most common arthritis found in people living in Western civilizations--seen in x-rays of the hands of over 70% of people 65 years and older.  However, this same disease is comparatively rare in African and Asian countries, where people physically labor to survive (Br J Rheumatol 24:321, 1985). 

o why is it less common among hard working people of underdeveloped countries?  Nor does it explain why with light use, the hands of women often become twisted and deformed with age.

 

The inflammatory forms of arthritis include juvenile rheumatoid arthritis,  rheumatoid arthritis, psoriatic arthritis, lupus, and ankylosing spondylitis. These aggressive diseases affect less than 5% of the people living in the United States today.  Classifying these inflammatory diseases by different names, such as rheumatoid or lupus provides no further benefits to the patient, because it does not lead to better understanding of the cause of the inflammation, or to the successful treatment of the disease. 

People diagnosed with degenerative arthritis (osteoarthritis) have inflammation in their joints in addition to the long-standing damage (degeneration).  This inflammation can often be stopped with a change in diet and the swelling, pain, and stiffness relieved.  What won't change in either form of arthritis is the permanent destruction left by years of disease, leaving deformity, stiffness and pain.  To understand how most people with arthritis can be helped by a healthy diet, I will focus on the more aggressive inflammatory forms of arthritis.

HOPE FOR ARTHRITIS SUFFERERS

Arthritis is not a genetic disease, nor is it an inevitable part of growing older--there are causes for these joint afflictions, and they lie in our environment--our closest contact with our environment is our food.   Some researchers believe rheumatoid arthritis did not exist anywhere in the world before 1800 (Arthritis Rheum 34:248, 1991).  It is well documented that these forms of arthritis were once rare to nonexistent in rural populations of Asia and Africa (Chung Hua Nei Ko Tsa Chih 34:79, 1995; Arthritis Rheum 34:248, 1991).  As recently as 1957, no case of rheumatoid arthritis could be found in Africa.  That was a time when people in Africa followed diets based on grains and vegetables.

 

These once unknown joint diseases are now becoming common as people migrate to wealthier nations or move to the big cities in their native countries.  With these changes they abandoned their traditional diets of grains and vegetables for meat, dairy products, and highly processed foods (J Rheumatol 19:2, 1992; Ann Rheum Dis 49:400, 1991).  For example, although unknown in Africa before 1960,  African-Americans lead in the incidence of lupus in the US (J Am Med Women's Assoc 1998;53(1):9-12).  The mechanisms by which an unhealthy diet causes inflammatory arthritis are complex and poorly understood, but involve our intestine and immune system.

 

 

INTESTINE AND IMMUNE SYSTEM

Increased Intestional Permeability

The intestine forms an effective barrier to separate and exclude intestinal contents from the interior of the body.  Only a single layer separates the individual from enormous amounts of antigens(foreign proteins) both of dietary and microbial origin.  The intestinal mucosa absorbs and digests nutrients, turning large complex molecules into small simple ones.  Normally, only the small molecules are allowed to pass through the intestinal wall, while the large ones that can act as antigens, causing immune reactions, have a limited ability to pass through.  Infections and toxins can cause gaps in this barrier and allow large molecules to pass into the blood.  This condition of increased intestional permeability is referred to as a "leaky gut."  Patients with inflammatory arthritis have been shown to have inflammation of the intestinal tract resulting in increased permeability (Baillieres Clin Rheumatol 10:147, 1996).

 

The largest amount of lymphoid tissue in the body is associated with the gut.  This tissue protects the body from antigens that do get through the intestinal barrier.  Unfortunately, an unhealthy diet--too high in fat, cholesterol, and animal protein--can compromise the capacities of the lymphoid tissue to destroy invading antigens that make it through the intestional wall.

 

Fasting is known to decrease intestinal permeability, thus making the gut "less leaky."  This may be one of the reasons fasting has been shown to dramatically benefit patients with rheumatoid arthritis (Scand J Rheumatol 1982;11(1):33-38).  When patients return after the fast to a diet with dairy products, the gut becomes more permeable and the arthritis returns.  An unhealthy diet containing dairy and other animal products causes inflammation of the intestinal surfaces and thereby increases the passage of dietary and/or bacterial antigens (Br J Rheumatol 33:638, 1994).  A vegan diet (one with no animal products) has been found to change the fecal microbial flora in rheumatoid arthritis patients, and these changes in the fecal flora are associated with improvement in the arthritis activity (Br J Rheumatol 36:64, 1997). 

 

In addition to being devoid of animal products, the diet needs to be very low in fat for maximum benefits.  Dietary fat has a toxic effect on the intestine of experimental animals, causing injury that increases the permeability of the gut allowing more antigens to enter the body (Pediatr Res 33:543, 1993).  Feeding high cholesterol diets to young animals also increases their "leaky gut" (J Pediatr Gastroenterol Nutr 9:98, 1989; Pediatr Res 21:347, 1987).  Those vegan diets that have failed to help arthritis patients have been high in vegetable oils, which are know to damage intestional integrity.

One dangerous paradox in arthritis treatment is that the drugs most commonly used to treat arthritis are toxins to this intestinal barrier.  All commonly used nonsteroidal antiinflammatory drugs (like Advil, Motrin, Naprosyn, etc.), apart from aspirin and nabumetone (Relafen), are associated with increased intestinal permeability in man. While reversible in the short term, it may take months to improve the barrier following prolonged use. (aillieres Clin Rheumatol 10:165, 1996).

 

 

Foreign Protein in the Body 

Through the "leaky gut" pass foreign proteins from foods and bacteria into the blood stream.  The food proteins are recognized by the body as "not self,"-- as something harmful, just like it recognizes the proteins of viruses, parasites, and bacteria as foreign.  Then it makes antibodies against these invaders.  Elevated levels of antibodies to gut bacteria and to food have been found in various forms of inflammatory arthritis (Rheumatol Int 1997;17(1):11-16; Clin Chim Acta 203:153, 1991).  

 

 

Antigen-Antibody Complexes (항원 항체 복합체)

A "leaky gut" can lead to the formation of  large complexes, made up of antibodies and the foreign protein (antigens) in the blood   (Curr Opin Rheumatol 10:58, 1998; Ann Prog Clin Immunol 4:63, 1980).  The healthy body has mechanisms that easily remove these large complexes from the blood.  In some people, however, these complexes survive--because they are formed too rapidly for complete removal and/or the removal mechanisms are insufficient to handle the load.  The persistent complexes are then filtered out by the smallest capillaries of the body which are found in the joints, skin, and kidneys.  Stuck in the capillaries these complexes cause an inflammatory reaction, like a sliver of wood stuck in the skin.

 

 

Molecular Mimicry

Another fate of the foreign proteins is they can cause the body to make antibodies that are not solely specific to that foreign protein, but also interact with similar human proteins.  This mechanism is known as molecular mimicry.  The body attacks itself and the resulting diseases are referred to as autoimmune diseases. Rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis, and the other inflammatory forms of arthritis are autoimmune diseases. 

Molecular mimicry in rheumatoid arthritis has been identified with cow's milk. One analysis showed that the amino acid residues 141-157 of bovine albumin were essentially the same as the amino acids found in human collagen in the joints (Clin Chim Acta203:153, 1991).  The antibodies synthesized to attack the foreign cow's milk proteins, end up attacking the joint tissues because of shared sequences of amino acids between the cartilage and the milk proteins, that the antibody is directed to attack.

 

 

 

The Defense System

A healthy diet allows the defense systems to work to its full capacity removing antigens that enter the system and removing immune-complexes from the blood.  Components of the rich American diet are known to impair its function.  Vegetable oils, including those of the omega-3 and omega-6 variety, are particularly strong suppressors of the immune system.  This immune suppressing quality of oils (for example, fish oil and primrose oil) has been used to suppress the pain and inflammation of arthritis, but like too many drug therapies the ultimate outcome may not be best for the patient.  Suppression of the immune system prevents it from doing its work of removing invading foreign proteins.  Low-fat diets have been shown to retard the development of autoimmune diseases, similar to lupus and rheumatoid arthritis, in experimental animals (Ann Rheum Dis48:765, 1989). 

A healthy diet also supplies antioxidants and other phytochemicals that keep the joints strong and repair damage (Am J Clin Nutr 53(1 Suppl):362S, 1991).  Animal studies have shown that the foods consumed on the rich American diet fail to provide adequate antioxidants to destroy the damaging free radicals that form in the joint tissues (J Orthop Res 8:731, 1990).

 

 

 

DIETS CAN CURE:  THE RESEARCH

Treatment of arthritis with diet became fashionable in the 1920s and  many studies over the last 20 years have shown a healthy diet, one very different from the typical American diet, can be a very effective treatment of inflammatory arthritis for many people.

 

• In 1979, Skoldstam fasted 16 patients with rheumatoid arthritis for 7-10 days with a fruit-and vegetable juice fast, followed by a lactovegetarian diet for 9 weeks.  One-third of the patients improved during the fast, but all deteriorated when the milk products were reintroduced (a lactovegetarian diet) (Scan J Rheumatol 8:249, 1979). 

• In 1980, Hicklin reported clinical improvement in 24 of 72 rheumatoid patients on an exclusion diet.  Food sensitivities were reported to: grains in 14, milk in 4, nuts in 8, beef in 4, cheese in 7, eggs in 5, and one each to chicken, fish, potato, and liver (Clin Allergy 10:463, 1980).

• In 1980, Stroud reported on 44 patients with rheumatoid arthritis treated with the elimination of food and chemical avoidance.  They were then challenged with foods. Wheat, corn, and beef  were the greatest offenders (Clin Res 28:791A, 1980).

• In 1981, Parke described a 38-year-old mother with 11-years of progressive erosive seronegative rheumatoid arthritis who recovered from her disease, attaining full mobility, by stopping all dairy products.  She was then hospitalized and challenged with 3 pounds of cheese and seven pints of milk over 3 days.  Within 24 hours there was a pronounced deterioration of the patient's arthritis (BMJ 282:2027, 1981).

• In 1981, Lucas found a fat-free diet produced complete remission in 6 patients with rheumatoid arthritis.  Remission was lost within 24-72 hours of eating a high-fat meal, such as one containing chicken, cheese, safflower oil, beef, or coconut oil.  The authors concluded, "...dietary fats in amounts normally eaten in the American diet cause the inflammatory joint changes seen in rheumatoid arthritis." (Clin Res 29:754, 1981).

• In 1982 Sundqvist studied the influence of fasting with 3 liters of fruit and vegetable juice daily and lactovegetarian diet on intestinal permeability in 5 patients with rheumatoid arthritis. Intestinal permeability decreased after fasting, but increased again during a subsequent lactovegetarian diet regime (dairy products and vegetables). Concomitantly it appeared that disease activity first decreased and then increased again. The authors conclude, "The results indicate that, unlike a lactovegetarian diet, fasting may ameliorate the disease activity and reduce both the intestinal and the non-intestinal permeability in rheumatoid arthritis." (Scand J Rheumatol 11:33, 1982.)

• In 1983, Lithell studied twenty patients with arthritis and various skin diseases on a metabolic ward during a 2-week period of modified fast on vegetarian broth and drinks, followed by a 3-week period of a vegan diet (no animal products). During fasting, joint pains were less intense in many subjects. In some types of skin diseases (pustulosis palmaris et plantaris and atopic eczema) an improvement could be demonstrated during the fast. During the vegan diet, both signs and symptoms returned in most patients, with the exception of some patients with psoriasis who experienced an improvement.  The vegan diet was very high-fat (42% fat).  (Acta Derm Venereol 63:397, 1983).

• In 1984 Kroker described 43 patients from three hospital centers who underwent a 1-week water fast, and overall the group improved significantly during the fast.  In 31 patients evaluated, 25 had "fair" to "excellent" responses and 6 had "poor" responses.  Those with more advanced arthritis had the poor responses. (Clin Ecol 2:137, 1984).

• In 1985,  Ratner removed all dairy products from the diet of patients with seronegative rheumatoid arthritis, 7 out of 15 went into remission when switched to milk-free diets (Isr J Med Sci21:532, 1985)

• In 1986, Panush described a challenge of milk in a 52-year-old white woman with 11 years of active disease with exacerbations allegedly associated with meat, milk, and beans. After fasting (3 days) or taking Vivonex (2 days) there was no morning stiffness or swollen joints.  Challenges with cow's milk (blinded in a capsule) brought all of her pain, swelling and stiffness back  (Arthritis Rheum 29:220, 1986).

• In 1986, Darlington published a 6-week, placebo-controlled, single-blinded study on 48 patients.  Forty-one patients identified foods producing symptoms.  Cereal foods, such as corn and wheat gave symptoms in more than 50% of patients (Lancet1:236, 1986).

• In 1986, Hanglow performed a study of the comparison of the arthritis-inducing properties of cow's milk, egg protein and soy milk in experimental animals.  The 12-week cow's milk feeding regimen produced the highest incidence of significant joint lesions. Egg protein was less arthritis-inducing than cow's milk, and soy milk caused no reaction.  (Int Arch Allergy Appl Immunol80:192, 1986).

• In 1987, Wojtulewski reported on 41 patients with rheumatoid arthritis treated with a 4-week elimination diet.  Twenty-three improved. (Food allergy and intolerance.  London: Bailliere Tindall 723, 1987).

• In 1988, Beri put 14 patients with rheumatoid arthritis on a diet free from pulses, cereals, milk, and non-vegetarian protein foods.  Ten (71%) showed significant clinical improvement. Only three patients (11%) adhered to the diet for a period of 10 months (Ann Rheum Dis 47:69, 1988.)

• In 1988, Hafstrom fasted 14 patients with water only for one week.  During fasting the duration of morning stiffness, and number and size of swollen joints decreased in all 14 patients.  No adverse effects of fasting were seen except transient weakness and lightheadedness.  The authors consider fasting as one possible way to induce rapid improvement in rheumatoid arthritis (Arthritis Rheum 31:585, 1988).

• In 1991 Darlington reported on 100 patients who had undergone dietary manipulation therapy in the past decade, one-third were still well and controlled on diet alone without any medication up to 7 ½ years after starting the diet treatment.  They found most patients reacted to cereals and dairy products (Lancet 338:1209, 1991).

• In 1992, Sheignalet reported on 46 adults with rheumatoid arthritis who eliminated dairy products and cereals.  Thirty-six patients (78%) responded favorably with 17 clearly improved, and 19 in complete remission for one to five years.  Eight of those 19 stopped all medications with no relapse.  Favorable benefits appeared before the end of the third month in 32 of the patients (Lancet 339:68, 1992). 

• In 1992, Shigemasa reported a 16-year-old girl with lupus who changed to a pure vegetarian diet (no animal foods) and stopped her steroids without her doctor's permission.  After starting the diet her antibody titers (a reflection of disease activity) fell to normal and her kidney disease improved (Lancet339:1177, 1992.

• In 1998, Nenonen tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and control groups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to an omnivorous diet aggravated symptoms. The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis (Br J Rheumatol 37:274, 1998).

 

IT'S THE WHOLE DIET

The importance of the overall diet cannot be overemphasized.  Proper foods keep the intestinal barriers strong and the immune system in a fighting condition. Those foods are whole starches, vegetable, and fruits.  In addition to being free of animal products, the diet must be low in fat of all kinds--vegetable oil (even olive oil, corn, safflower, and flaxseed oil) and animal fat.  When it comes to blaming individual foods, dairy products seem to be the most troublesome foods, causing the most common and severe reactions.  Many reports indicate grains, such as corn and wheat can also aggravate of symptoms.  The truth seems to be almost any food can cause trouble, but few people react to vegetable foods.

류마티스 환자에게 식단의 선택은 대단히 중요합니다, 적절한 음식은 장벽을 튼튼하게 하여 면역시스템이 

My experience and this research has lead me to prescribe for the past 22 years a starch-based diet with the addition of fruits, and vegetables (low-fat and devoid of all animal products).  If no improvement is seen within 2 weeks, I suggest wheat and corn be eliminated.  The final step is to follow an elimination diet based on the foods least likely to cause problems, such as sweet potatoes and brown rice with the addition of noncitrus fruits, and green and yellow vegetables.  All thoroughly cooked.  Water is the beverage.  If improvement is found (usually within 1 to 2 weeks), then foods are added back one at a time to see if there is an adverse reaction.  (A complete description of this diet can be found in the McDougall Program--12 days to Dynamic Health).  Nonsteroidal antiinflammatory drugs should be stopped, and if necessary, replaced by aspirin or nabumetone (Relafen).  Other medications are reduced and/or discontinued as the symptoms improve.

I have just finished a study on 28 patients with rheumatoid arthritis using the McDougall Diet (with corn and wheat included) and the results were remarkable.  Full publication will appear this fall.

FOR WHOLE BODY BENEFITS

By no small coincidence the same diet that keeps the joints healthy also keeps the rest of the body sound.  Diane of Walnut Creek wrote to me last year.  "I had what I can only call a miserable life until about five years ago.  Nothing seemed to go right for me.  In late 1991 I was diagnosed with spinal stenosis and degenerative arthritis.  I was declared permanently disabled and left my job as a daily newspaper journalist.  My therapist gave me a wonderful gift--she suggested I try your program.  I shrugged off her suggestion at first.  I swore that I ate well anyway:  only dairy and shellfish and white meats.  Only!  She did not push the point, wisely waiting for me to think about the idea.  I did wait for two years.  Then two years ago she suggested your program again.  I told her I didn't believe it would work, but agreed to try it for two months.  I was overweight, very overweight, by 100 pounds, most of my life--carrrying all that poundage caused a lot of wear on my joints.  That was two years ago, and I'm a lifelong convert."

"Of course what you predicted happened:  My migraines went away completely;  I stopped swelling in my joints;  I could sleep easily;  I had no indigestion problems of any kind; and I began to drop weight.  As you probably know, it was a lot easier than I thought it would be.  Before I started the McDougall plan, I was losing weight slowly.  Afterward, the weight loss was dramatic.  After about six months, people started noticing and commenting.  They kept saying things like ‘you look ten years younger,'  or most often,  ‘You look great.  What did you do?'  I no longer take the anti-inflammatory drugs and painkillers that I was taking before the McDougall way.  My knee and low-back are virtually pain-free. Now, what I've found is that nobody believes it can be as simple as eating carefully and exercising.  They all want some magic or some pill."

관절을 건강하게 유지하는 식단은 우리 다른 신체도 건강하게 유지하게 된다고 믿습니다. Walnut Creek의 Diane은  " 5 년 전까지 만해도 비참햇어요.  아무 것도 제대로 된 것 같지 않았습니다. 1991 년 후반에 척추 협착증과 퇴행성 관절염 진단을 받았습니다. 저는 영구적으로 장애가있는 것으로 선언되었습니다. 신문 기자로서 직업도 포기하게 되었습니다. 그러던 중 저를 치료하던 테라피스트가 저에게 맥두걸 플랜을 제안 했습니다.  이 플랜을 시작한 후에  편두통이 완전히 사라졌고. 관절이 부어 오르는 것을 멈추었습니다. 쉽게 잠을 잘 수있었습니다. 나는 어떤 종류의 소화 불량 문제도 없었으며 체중이 떨어지기 시작했습니다.  복용했던 항염증제와 진통제를 복용하지 않고 무릎과 요통에 통증이 거의 없습니다