Rheumatoid arthritis and fasting

Many moons ago (it seems) Bloggeier sent me a pdf of a paper in which a group of researchers made a serious attempt to look at the roll of food allergies in rheumatoid arthritis. They went deeper than simple food challenges, antibody counts and skin prick allergy testing. They looked in to the small intestine, I won't go in to how, and found that people with rheumatoid arthritis have food allergies. Lots of food allergies. Never mind the levels of antibody in the blood, local reaction in the gut picked up far more allergies than it seems fair for anyone to have. Food seems to be important in RA.

I've had this paper lying around for ages but pretty well ignored it due to its vegan/vegetarian stance. I really shouldn't let my biases stop me thinking about interesting stuff. Before I get on to the main jist of this post I'd just like to point out that this group also looked at antibody counts against Proteus mirabilis during their intervention diet and the antibody counts dropped in some subjects. This is important if you have followed Ebringer's work on bacterial mimicry as a trigger for auto immune diseases. There is a protein sequence on the surface of P. mirabilis that is remarkably similar to certain sequences on the HLA molecules associated with RA in humans. The diet changes, used over a year, ONLY helped those people in whom the antibody titre to P. mirabilis dropped. Look at it this way, you could eat a totally allergy free diet, say a cocktail of amino acids and glucose, and P. mirabilis could assemble those amino acids in to an allergenic protein.... Neat hey? RA is associated with antibodies to P. mirabilis and this holds true in various countries around Europe. I'll come back to this later.

Back to the study. They starved their subjects for the first 7 days. As far as I can see they used a water fast. It produced dramatic improvement.

The same group looked at ketosis without calorie deficit and it didn't work, though I don't know what components were used in the less than 40g of carbs per day which were allowed. This may be important, especially if gluten was included in the carbs. In a separate study they looked at various cells in the immune system after a 7 day fast and found that CD4+ lymphocytes, the ones I chatted about here, went sleepeebyes after a fast.

What's happening during a fast? Well, you're not getting any food! So for food allergens it's an absolute, total and complete elimination diet. Then your GUT BACTERIA aren't getting any food either. In fact, your gut bacterial count is likely top drop like a stone when you fast. If you are remotely lucky your P. mirabilis count will also drop and your CD4+ cells might start ignoring both proteus and your HLA DR1 and DR4 molecules.

So fasting is good news. Personally I've only ever played with fasting for 48 hours, in a spirit of companionship with a friend who was fasting for non specific arthritis. We both did 48 hours and, because we were both already in full ketosis, it was easy. That included cooking carbs for my children over that 48 hours. I don't know how easy it would be to extend this to 7 days, and my willpower might be markedly influenced by the size of the RA gorilla sitting on my shoulders. It worked for the non specific arthritis BTW (which has never been worked up and could be rheumatoid).

But no one can fast for ever and expect to stay healthy.

Assuming the improvement occurred, as it really should, anecdote and Kjeldsen-Kragh's work supported, how should you break the fast?

I'd suggest with a single food substance of absolutely no allergenic potential and of no use to P. mirabilis. Beef dripping comes to mind. I discussed long chain fatty acids and starving your gut bacteria in the fiaf posts. The colon, home to P. mirabilis, is anaerobic. Nothing can be done here with a fatty acid. Fatty acids only do oxidation, never fermentation. Aesthetically I guess clarified butter might taste better but watch the casein and lactose. Next would be to add some protein. Not much, say 40 grams as a maximum. You want it all absorbed and none to get through to the colon. Egg yolks first, whole eggs next. If you are still ok you are set up. You can live on eggs and clarified butter. How big is the gorilla?

After that it's a matter of introductions and seeing what happens. In general animal protein won't make it to the colon, cereal protein will always and pulse protein is not worth the risk.

Unless you want to stay in frank raging ketosis some carbs are going to be needed. That's a tricky one. Obviously any fiber will feed colonic bacteria. No fiber. Simple sugars with absorption slowed by a high fat meal might do the job. Optimal icecream comes to mind. A peeled potato might do a reasonable job too, as chips if you like.

It feels a bit odd sitting here musing about a disease as nasty as RA when I don't have it. Having read a little about RA, it seems that musing without the disease is infinitely preferable to musing with the disease.

Peter