By Dr. Mercola
If you're looking for a way to help fight rheumatoid arthritis (RA) without drugs, then you need look no further than the spice shelf at your local market. New research published in the spring of 2012 showed that curcumin, the active ingredient in the curry spice turmeric, possesses potent anti-inflammatory and anti-arthritic properties.
The clinical study evaluated the safety and effectiveness of curcumin alone, and in combination with an NSAID drug (Voltaren) in patients with active RA... and the results speak for themselves.
A Novel Approach for Treating RA With a 60-90 Percent Likelihood of Improvement
At least 2 million Americans have definite or classical rheumatoid arthritis, a number that has been increasing in recent years. It is a much more devastating illness than previously appreciated. This is NOT the same condition as the far more common and generally less serious osteoarthritis or degenerative joint disease. Although interestingly most of the same treatments discussed below will also work for osteoarthritis.
Most patients with rheumatoid arthritis have a progressive disability, and the natural course of the condition is quite remarkable in that less than 1 percent of people with the disease have a spontaneous remission. Some disability occurs in 50-70 percent of people within five years after onset of the disease, and half will stop working within 10 years. The annual cost of this disease in the U.S. is estimated to be over $1 billion.
Most authorities believe that remissions rarely occur. Some experts feel that the term "remission-inducing" should not be used to describe ANY current rheumatoid arthritis treatment, and a review of contemporary treatment methods shows that medical science has not been able to significantly improve the long-term outcome of this disease.
This devastating prognosis is what makes this novel form of treatment so exciting, as it has a far higher likelihood of succeeding than the conventional approach.
Over the years I have treated over 3,000 patients with rheumatic illnesses, including SLE, scleroderma, polymyositis and dermatomyositis. Approximately 15 percent of these patients were lost to follow-up for whatever reason and have not continued with treatment. The remaining patients appear to have a 60-90 percent likelihood of improvement on this treatment regimen. This level of improvement is quite a stark in contrast to the typical numbers quoted above which are experienced with conventional approaches, and certainly provide a strong motivation to try the protocol I discuss below.
Changes to My Rheumatoid Arthritis Video and Protocol
Many of you may know that I treated many RA patients based on a protocol developed by a maverick but well respected rheumatologist, Dr. Thomas Brown. He died in 1989 shortly after I started using his approach. I first became aware of Doctor Brown's protocol, which focused on the elimination of mycoplasma, in 1989 when I saw him on ABC's 20/20. This was shortly after the introduction of the first edition of his book, The Road Back. Unfortunately, Dr. Brown died from prostate cancer shortly after the 20/20 program and I never had a chance to meet him.
I eventually wound up treating a few thousand RA patients and had quite a following as most got really great results. As I learned more about natural medicine I integrated more of that wisdom into Dr. Brown's original protocol and consolidated that into an article I wrote in 1995 and presented at a conference. Many of the key points are summarized below.
I further revised that paper with the video above but there have been further modifications to the RA protocol since I recorded this video. One of the primary ones is the strong recommendation to use low dose naltrexone as an adjunct to help wean off the nearly universal experience of toxic drugs that most RA patients are put on. Astaxanthin is also a powerful anti-inflammatory antioxidant that could have very powerful benefits in controlling the joint pain. Additionally, I would also strongly encourage working up to 4-6 ounces a day of fermented veggies, which will supply about ten trillion beneficial bacteria, which is about 10% of the population of your gut. Ideally one should consume them regularly if not daily.
The best way to learn how to prepare them properly is to get the GAPS book or listen to my interview with Caroline Barringer
Lastly of course, as the featured study suggests, one can also consider the use of curcumin as discussed below.
Curcumin Works Better Than Drugs
The study revealed that a highly bioavailable form of curcumin was more effective in alleviating RA symptoms, including tenderness and swelling of joints, than the drug. Not only that, those who were taking the curcumin only, actually experienced the most improvement across the board.
Along with relieving the most symptoms, the curcumin group had another benefit – lack of any observed adverse effects. No one in the curcumin group withdrew from the study due to side effects, but 14 percent of those in the NSAID group did so. Researchers noted: i
"Interestingly, the curcumin group showed the highest percentage of improvement... and these scores were significantly better than the patients in the diclofenac sodium [Voltaren] group. More importantly, curcumin treatment was found to be safe and did not relate with any adverse events. Our study provides the first evidence for the safety and superiority of curcumin treatment in patients with active RA."
Several years back, in 2006, another study also found that turmeric supplements, which contain curcuminoids, profoundly lessened joint inflammation and destruction, ii presumably by blocking inflammatory pathways and thereby preventing the increased production of a protein that triggers swelling and pain. Curcumin is most known for its potent anti-inflammatory properties. It has been shown to influence more than 700 genes, and it can inhibit both the excessive activity and the synthesis of cyclooxygenase-2 (COX2) and 5-lipooxygenase (5-LOX), as well as other enzymes that have been implicated in inflammation.
Tips for Increasing Your Absorption of Curcumin
If you want to give curcumin a try for RA, it is widely available in supplement form, but relatively high doses are required to achieve its therapeutic effects, and curcumin is generally not absorbed that well. Typical therapeutic doses are up to three grams of bioavailable curcumin extract, three to four times daily, and this is difficult to achieve using standard curcumin powders.
One alternative is to make a microemulsion by combining a tablespoon of curcumin powder with 1-2 egg yolks and a teaspoon or two of melted coconut oil. Then use a hand blender on high speed to emulsify the powder.
Another strategy you can use to increase absorption is to put one tablespoon of the curcumin powder into a quart of boiling water. It must be boiling when you add the powder, as it will not work as well if you put it in room temperature water and heat the water and curcumin together.
After boiling it for 10 minutes you will have created a 12% solution and you can drink this once it has cooled down. The curcumin will gradually fall out of the solution over time and in about six hours it will be a 6% solution, so it is best to drink the water within four hours. It does have a woody taste, but this is done more for therapeutic benefits than flavor.
One caution: curcumin is a very potent yellow pigment and can permanently discolor surfaces if you aren't careful. You can also use turmeric liberally in your cooking; it has an earthy, peppery flavor. Choose a pure turmeric powder, rather than a curry powder, as at least one study has found that curry powders tend to contain very little curcumin.
We are currently sponsoring some clinical trials with a concentrated highly absorbable form of curcumin that we hope to have available in the next year or so.
Why You Need to be Careful With NSAIDs
One of the primary problems with RA is controlling pain. Effective pain relief is obviously very important, and if this is not achieved, you can go into a depressive cycle that can worsen your immune system function and cause the RA to flare up. But the conventional treatment typically includes using very dangerous drugs like prednisone, methotrexate, and drugs that interfere with tumor necrosis factor, like Enbrel. Many also depend on non-steroidal anti-inflammatories (NSAIDs) like ibuprofen (Motrin) to manage this pain, but the regular, chronic use of these types of medications is associated with close to 100 significant, and very serious, side effects, including: iii
- Cardiovascular problems
- Gastrointestinal harm
- Kidney and/or liver damage
- Hearing Loss
If you are taking an NSAID and you have a history of heart disease, you are at a 10-fold increase in the risk of congestive heart failure (CHF). iv And even if you don't, your risk of CHF will still be increased by 60 percent if you take NSAIDs.
Ulcers are another major risk, and up to 60 percent of regular NSAID users will have gastrointestinal side effects related to these drugs. In fact, regular use of NSAIDs is the second major cause for ulcers. v Given the risks, having a natural alternative to NSAIDs for pain relief is invaluable, especially for a painful condition like RA -- and curcumin is emerging as one of the safest and most effective options out there.
Lifestyle Changes Crucial to Control this Vicious Disease
Improving your diet using my nutritional guidelines is crucial for your success. In addition, there are some general principles that seem to hold true for virtually everyone and these include:
- Eliminating sugar, especially fructose, and most grains. For most people with RA, you'll want to be very careful to limit fructose to just 15 grams per day or less, and this includes fructose from whole fruit.
"Limiting sugar is a critical element of the treatment program. Sugar has multiple significant negative influences on your biochemistry. First and foremost, it increases your insulin levels, which is the root cause of nearly all chronic disease. It can also impair your gut bacteria. In my experience if you are unable to decrease your sugar intake, you are far less likely to improve. One of the first steps you can take is to phase out all soda, and replace it with pure, clean water."
- Eating your food organic, locally grown and as close to raw as possible
- Getting plenty of high-quality animal-based omega-3 fats. Krill oil seems to be particularly helpful here, as it appears to be a more effective anti-inflammatory preparation. It is particularly effective if taken concurrently with 4 mg of astaxanthin, which is a potent antioxidant carotenoid derived from algae
- As astaxanthin offers potent protection against cataracts and age-related macular degeneration, 4 to perhaps 20 mg per day for anyone placed on prednisone
- Incorporating regular exercise into your daily schedule, as described in detail below
Early Emotional Traumas are Pervasive in Those with RA
With the vast majority of the patients I treated, some type of emotional trauma occurred early in their life, before the age their conscious mind was formed, which is typically around the age of 5 or 6. However, a trauma can occur at any age, and has a profoundly negative impact. If that specific emotional insult is not addressed with an effective treatment modality then the underlying emotional trigger will continue to fester, allowing the destructive process to proceed, which can predispose you to severe autoimmune diseases like RA later in life.
In some cases, RA appears to be triggered by an infection, and it is my experience that this infection is usually acquired when you have a stressful event that causes a disruption in your bioelectrical circuits, which then impairs your immune system. This early emotional trauma predisposes you to developing the initial infection, and also contributes to your relative inability to effectively defeat the infection. Therefore, it's very important to have an effective tool to address these underlying emotional traumas.
In my practice, the most common form of treatment used is called the Emotional Freedom Technique (EFT). Although EFT is something that you can learn to do yourself in the comfort of your own home, it is important to consult a well-trained professional to obtain the skills necessary to promote proper healing using this amazing tool.
Vitamin D Deficiency Rampant in Those with RA
The early part of the 21st century brought enormous attention to the importance and value of vitamin D, particularly in the treatment of autoimmune diseases like RA. From my perspective, it is now virtually criminally negligent malpractice to treat a person with RA and not aggressively monitor their vitamin D levels to confirm that they are in a therapeutic range of 65-80 ng/ml.
This is so important that blood tests need to be done every two weeks, so the dose can be adjusted to get within that range. Most normal-weight adults should start at 10,000 units of vitamin D3 per day. If you are in the US, then Lab Corp is the lab of choice for this testing.
Please note that the video above has dated recommendations on vitamin D. It used to be thought that 5,000 IU a day was a good maintenance dose for adults, but according to new research published by GrassrootsHealth from the D*Action study, the average adult needs to take 8,000 IU's of vitamin D per day in order to elevate his or her levels above 40 ng/ml -- the bare minimum requirement necessary for disease prevention. As mentioned, if you have RA you'll want your levels to be higher than this, in the 65-80 ng/ml range, so you'll need to have your blood tested and tweak your dose/sun exposure accordingly.
For more detailed information on how to optimize your vitamin D using the sun, you can review this recent article.
Another newer addition to the protocol is low-dose Naltrexone, which I would encourage anyone with RA to try. It is inexpensive and non-toxic and I have a number of physician reports documenting incredible efficacy in getting people off of all their dangerous arthritis meds. Although this is a drug, and strictly speaking not a natural therapy, it has provided important relief and is FAR safer than the toxic drugs that are typically used by nearly all rheumatologists.
Exercise for Rheumatoid Arthritis
It is very important to exercise and increase muscle tone of your non-weight bearing joints, as disuse results in muscle atrophy and weakness. Additionally, immobility may result in joint contractures and loss of range of motion (ROM). Active ROM exercises are preferred to passive. There is some evidence that passive ROM exercises increase the number of white blood cells (WBCs) in your joints.
If your joints are stiff, you should stretch and apply heat before exercising. If your joints are swollen, application of 10 minutes of ice before exercise would be helpful. The inflamed joint is very vulnerable to damage from improper exercise, so you must be cautious. People with arthritis must strike a delicate balance between rest and activity, and must avoid activities that aggravate joint pain. You should avoid any exercise that strains a significantly unstable joint.
A good rule of thumb is that if the pain lasts longer than one hour after stopping exercise, you should slow down or choose another form of exercise. Assistive devices are also helpful to decrease the pressure on affected joints. Many patients need to be urged to take advantage of these. The Arthritis Foundation has a book, Guide to Independent Living, which instructs patients about how to obtain them.
Of course, it is important to maintain good cardiovascular fitness as well. Walking with appropriate supportive shoes is another important consideration, and if your condition allows, it would be wise to move toward a Peak Fitness program that involves high-intensity burst-type exercises designed for reaching optimal health.
If You Must Use Drugs for Pain Relief...
Ultimately, the goal is to implement the lifestyle changes discussed above as quickly as possible, so you can start to reduce these toxic and dangerous drugs, which do absolutely nothing to treat the cause of the disease. The idea is to be as comfortable and pain free as possible with the least amount of drugs. However, effective pain relief is important, so first try these natural anti-inflammatory alternatives. If you still aren't finding relief, the safest prescription drugs to use for pain are the non-acetylated salicylates such as:
- Sodium salicylate
- Magnesium salicylate (i.e., Salflex, Disalcid, or Trilisate).
They are also much gentler on your stomach than the other NSAIDs and are the drug of choice if you have problems with peptic ulcer disease. Unfortunately, all these benefits are balanced by the fact they may not be as effective as the other agents and are less convenient to take. You need to take 1.5-2 grams twice a day, and tinnitus, or ringing in your ear, is a frequent side effect. You need to be aware of this complication and know that if tinnitus does develop, you need to stop the drugs for a day and restart with a dose that is half a pill per day lower. You can repeat this until you find a dose that relieves your pain and doesn't cause any ringing in your ears.
There is no doubt in my mind that the protocol described above is highly effective for the treatment of autoimmune arthritis like rheumatoid arthritis. I strongly encourage anyone with this disease to adopt the program to help prevent the nearly inevitable poor outcomes that are the result of seeing a conventional rheumatologist. In my experience they have very little to offer except dangerous drugs that only relieve symptoms and do nothing to address the underlying cause of the disease, which continues to ravage the body and cause crippling joint deformities.