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Chapter 2 Know your enemy (understanding arthritis and its causes)

The costly epidemic of arthritis

‘People ignore arthritis both as public and personal health problems because it doesn’t kill you.’ So said Chad Helmick, a medical epidemiologist at the Center for Disease Control and Prevention in the United States. He continued: ‘But what they don’t realize is that as Americans work and live longer, arthritis can affect their quality of life and eventually lead to disability.’ According to the FDA Consumer (May–June 2000), who quoted Dr Helmick, the current annual cost of arthritis to the U.S. economy is nearly $65 billion – a sum large enough to have about the same impact as a moderate recession.

Arthritis can strike at any age, and the number of arthritis sufferers increases each year. During a person’s lifetime, arthritis is more likely to restrict activity than cancer, diabetes or heart disease. World-wide, arthritis inflicts a terrible cost. In the United States alone, currently about 42 million people are afflicted by chronic forms of arthritis: according to the Center for Disease Control, that number will rise to 60 million by 2020. More than 11 million of those people will be crippled badly enough to be classified as disabled. And the U.S. is not an exceptional case – the social and economic impact of arthritis in the United States is mirrored throughout the Western world.

Why should more people suffer from arthritis today than in the past? And why do various forms of arthritis appear to be increasing at a greater rate in Westernized countries than in the rest of the world? Many experts believe the answer must be related to our lifestyle and diet.

When you consider the vast amount of money spent on medication to treat the symptoms of arthritis, and on surgical repair of crippled hips and knees, you get some idea just how much could be saved if people would eat and live according to the simple rules suggested here.

Arthritis comes in many forms

The word ‘arthritis’ refers to any process that causes inflammation of joints and surrounding tissues. Depending on which expert you believe, there are between one and two hundred different conditions that can be classified as ‘arthritis’. Some of these are common (osteoarthritis, rheumatoid arthritis and gout), while others are relatively rare (ankylosing spondylitis and systemic lupus erythematosis are examples). In Eat to Beat Arthritis we focus on those types of arthritis that affect the most people, although the anti-inflammation diet described here will help almost everyone.

Two key words need explanation: ‘inflammation’ and ‘joint’.

Inflammation is a natural process in which the body’s immune system reacts to infection, injury or any abnormal form of irritation. The area of inflammation becomes red, swollen and abnormally warm. When inflammation takes place around a site of infection or injury its role is to kill any invading organisms and speed up the removal of debris from dead bacteria (or viruses) and tissue. In other words, inflammation is a healthy part of the normal healing process. Unfortunately, there are times when the immune system mistakes the body’s own normal tissues for the ‘enemy’, and attacks them. This is known as an auto-immune reaction. The immune system may also attack parts of the body where concentrations of abnormal substances occur – such as joints in which bony nodules form after injury; or in places where abnormal deposits of uric acid form, as is the case in gout.

Inflammation is the real culprit in arthritis, so the diet described in this book is designed to help control inflammation. Even if you are on medication for your condition, changing the way you eat will help break the painful bonds of inflamed joints and tissues.

A joint is a place, or ‘join’, in the body where bones meet. Some joints are stationary, or fused, and have no motion; the joints between bone in the skull are examples. Other joints may allow a limited degree of motion, such as those in the fingers and toes, while others allow extensive motion. Hip joints are a good example of a place where there can be considerable movement at the place where bones meet.

As a general rule joints are formed from fibrous tissue, a pad of cartilage at the end of each bone within the joint, a thin lining of synovial membrane (which secretes a thin lubricating fluid into the joint to aid its motion) and, sometimes, a ligament, or strong band of fibrous tissue binding the bones together. Ligaments are also found supporting other parts of the body, including some internal organs.

OSTEOARTHRITIS

Almost everyone suffers from some degree of osteoarthritis. The older you get the more likely it is that injury or constant use has damaged one or more of your joints, and osteoarthritis has set in. Many athletes suffer this form of arthritis at a fairly early age owing to injury to cartilage and the bones within much-used joints, such as the knee. In less athletic people the pain experienced in knees, hands and hips by the time they reach retirement age is as a result of simple wear and tear on the internal structure of joints. In both cases, cartilage can wear so thin the ends of bones become exposed within joints. This causes pain and inflammation. To make matters worse, bony nodules may collect in osteoarthritic joints, adding to the pain and inflammation. And as anyone who suffers from pain knows, it can be mentally exhausting as well as physically debilitating.

Medical treatment for osteoarthritis usually involves analgesics (painkillers) and – in some cases – drugs that support the body’s attempts to rebuild damaged cartilage. Most of these drugs not only effectively reduce pain, they also reduce inflammation. The problem is that many analgesics (including aspirin and ibuprofen) cause stomach irritation that can lead to bleeding, and they do nothing to help rebuild worn tissue. During the past decade research has shown that there are natural compounds that support the rebuilding of damaged cartilage: glucosamine holds the greatest promise at present. You can learn more about this healing compound here.

RHEUMATOID ARTHRITIS

The stiffness, pain, swelling and loss of function associated with rheumatoid arthritis results from inflammation of the lining that secretes lubricating fluid into joints. The disease can affect other parts of the body, but treatment is most often sought for the condition when it involves joints. In most cases this form of arthritis affects the same joint on both sides of the body: both knees, or both hips, or the knuckles of both forefingers. In severe cases deformity and loss of function result.

The medications used to treat rheumatoid and osteoarthritis are similar, and are selected to block pain and reduce inflammation. However, there is strong evidence that certain foods, such as oily fish, and food supplements, such as fish oil, help reduce the causes of the inflammation without endangering the delicate lining of the stomach.

More information about rheumatoid arthritis can be found here.

GOUT

Gout is frequently lampooned as a rich man’s illness, associated with too much fine wine and fatty food. In fact it strikes people from all walks of life: beggar and king. It can be very painful, and it is common to hear sufferers describe how they cannot bear to have even the weight of a bed-sheet rest on an affected toe. (Big toes are frequent victims of this illness.) Mercifully, gout is far less common than either osteoarthritis or rheumatoid arthritis.

Gout is caused when too much uric acid collects in the blood. Uric acid is a by-product of normal metabolism, and it is usually collected and discarded from the body by the kidneys in urine. However, when the kidneys are not functioning normally, or when the diet contains an excess of certain foods, blood levels can rise to the point where the excess uric acid crystallizes in joints, the kidneys, or even the soft tissue of the ear. These stone-like residues cause pain, damage surrounding tissues, and trigger the biological processes that lead to inflammation.

There are medications to help gout suffers, but diet is a vital part of controlling the build-up of uric acid in the blood, and reducing or eliminating inflammation.

For more about gout, see here.