The Best Diet for Rheumatoid Arthritis

The Best Diet for Rheumatoid Arthritis.jpeg

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn't change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There's also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by "molecular mimicry." The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That's why it's critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there's a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people's gut flora were done using raw vegan diets, figuring that's about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects' gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn't take it and dropped out, perhaps because they were trying to feed people things like "buckwheat-beetroot cutlets" buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn't specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That's why I love doing work--I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There's another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections--another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora--the microbiome. They include:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

The Best Diet for Rheumatoid Arthritis

The Best Diet for Rheumatoid Arthritis.jpeg

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn't change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There's also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by "molecular mimicry." The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That's why it's critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there's a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people's gut flora were done using raw vegan diets, figuring that's about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects' gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn't take it and dropped out, perhaps because they were trying to feed people things like "buckwheat-beetroot cutlets" buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn't specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That's why I love doing work--I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There's another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections--another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora--the microbiome. They include:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

Why Some Like Cilantro and Others Hate It

The Cilantro Gene.jpg

One sign of changing U.S. demographics is that salsa has replaced ketchup as America's #1 table condiment. One of the popular salsa ingredients is cilantro, described as one of the "most polarizing and divisive food ingredients known." Some people love it; some people hate it. What's interesting is that the lovers and the haters appear to experience the taste differently. Individuals who like cilantro may describe it as "fresh, fragrant or citrusy, whereas those who dislike cilantro report that it tastes like soap, mold, dirt, or bugs." I don't know how people know what bugs taste like, but rarely are polarizing opinions about flavors so extreme. Maybe it's genetic.

Different ethnic groups do seem to have different rates of cilantro dislike, with Ashkenazi Jews scoring highest on the cilantro hate-o-meter (see The Cilantro Gene). Another clue came from twin studies, that show that identical twins tend to share cilantro preferences, whereas regular fraternal twins do not have such a strong correlation. Our genetic code is so big, though, containing about three billion letters, that to find some cilantro gene you'd have to analyze the DNA of like 10,000 people, and obviously genetic researchers have better things to do...or maybe not.

Researchers performed a genome-wide association study among 14,000 participants who reported whether cilantro tasted soapy, with replication in a distinct set of 11,000 people who declared whether they liked cilantro or not. And lo and behold they found a spot on chromosome 11 that seemed to be a match. What's there? A gene called OR6A2 that enables us to smell certain chemicals like E-(2)-Decenal, a primary constituent of cilantro and also...the defensive secretions of stink bugs. So maybe cilantro does taste like bugs! But, cilantro lovers may be genetic mutants that have an inability to smell the unpleasant compound.

That may actually be an advantage, though, since cilantro is healthy stuff. In fact, that's the justification to do these kinds of studies: to see why some people don't like the taste of healthy foods.

Are the cilantro haters really missing out on much, though? Mother nature has been described as the "oldest and most comprehensive pharmacy of all time," and cilantro--called coriander around most of the world--is one of nature's oldest herbal prescriptions, credited with anti-microbial, anti-oxidant, anti-diabetic, anti-anxiety, and anti-epilepsy properties. However, these are all from preclinical studies, meaning studies done on cells in a test tube or lab animals. Studies like the "Anti-Despair Activity of Cilantro..." in which researchers placed animals in a "despair apparatus" (you don't want to know).

Finally, though, there was a human study, on the anti-arthritis potential of cilantro. There was an earlier study performed in Germany of a lotion made out of cilantro seeds showing it could decrease the redness of a sunburn, demonstrating it had some anti-inflammatory effects )though not as much as an over-the-counter steroid, hydrocortisone, or prescription strength steroid cream). If the cilantro plant is anti-inflammatory, why nto give it to people with osteoarthritis and see if it helps? Researchers gave about 20 sprigs of cilantro daily for two months, and reported a significant drop in ESR--a nonspecific indicator of inflammation--in the cilantro group. How did the patients do clinically, though? The study didn't say, but it did report a rather remarkable 50% drop in uric acid levels, suggesting that huge amounts of cilantro may be useful for those suffering from gout.


The cilantro lovers/haters factoid reminds me of the video Pretty in Pee-nk about the phenomenon of "beeturia," pink urine after beet consumption seen in some people.

For those that don't mind the taste of bugs, I have some nutritional info in Good Grub: The Healthiest Meat and Bug Appétit: Barriers to Entomophagy.

As an Ashkenazim myself, I'm excited to have narrowly escaped a cilantro-less existence!

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

Why Some Like Cilantro and Others Hate It

The Cilantro Gene.jpg

One sign of changing U.S. demographics is that salsa has replaced ketchup as America's #1 table condiment. One of the popular salsa ingredients is cilantro, described as one of the "most polarizing and divisive food ingredients known." Some people love it; some people hate it. What's interesting is that the lovers and the haters appear to experience the taste differently. Individuals who like cilantro may describe it as "fresh, fragrant or citrusy, whereas those who dislike cilantro report that it tastes like soap, mold, dirt, or bugs." I don't know how people know what bugs taste like, but rarely are polarizing opinions about flavors so extreme. Maybe it's genetic.

Different ethnic groups do seem to have different rates of cilantro dislike, with Ashkenazi Jews scoring highest on the cilantro hate-o-meter (see The Cilantro Gene). Another clue came from twin studies, that show that identical twins tend to share cilantro preferences, whereas regular fraternal twins do not have such a strong correlation. Our genetic code is so big, though, containing about three billion letters, that to find some cilantro gene you'd have to analyze the DNA of like 10,000 people, and obviously genetic researchers have better things to do...or maybe not.

Researchers performed a genome-wide association study among 14,000 participants who reported whether cilantro tasted soapy, with replication in a distinct set of 11,000 people who declared whether they liked cilantro or not. And lo and behold they found a spot on chromosome 11 that seemed to be a match. What's there? A gene called OR6A2 that enables us to smell certain chemicals like E-(2)-Decenal, a primary constituent of cilantro and also...the defensive secretions of stink bugs. So maybe cilantro does taste like bugs! But, cilantro lovers may be genetic mutants that have an inability to smell the unpleasant compound.

That may actually be an advantage, though, since cilantro is healthy stuff. In fact, that's the justification to do these kinds of studies: to see why some people don't like the taste of healthy foods.

Are the cilantro haters really missing out on much, though? Mother nature has been described as the "oldest and most comprehensive pharmacy of all time," and cilantro--called coriander around most of the world--is one of nature's oldest herbal prescriptions, credited with anti-microbial, anti-oxidant, anti-diabetic, anti-anxiety, and anti-epilepsy properties. However, these are all from preclinical studies, meaning studies done on cells in a test tube or lab animals. Studies like the "Anti-Despair Activity of Cilantro..." in which researchers placed animals in a "despair apparatus" (you don't want to know).

Finally, though, there was a human study, on the anti-arthritis potential of cilantro. There was an earlier study performed in Germany of a lotion made out of cilantro seeds showing it could decrease the redness of a sunburn, demonstrating it had some anti-inflammatory effects )though not as much as an over-the-counter steroid, hydrocortisone, or prescription strength steroid cream). If the cilantro plant is anti-inflammatory, why nto give it to people with osteoarthritis and see if it helps? Researchers gave about 20 sprigs of cilantro daily for two months, and reported a significant drop in ESR--a nonspecific indicator of inflammation--in the cilantro group. How did the patients do clinically, though? The study didn't say, but it did report a rather remarkable 50% drop in uric acid levels, suggesting that huge amounts of cilantro may be useful for those suffering from gout.


The cilantro lovers/haters factoid reminds me of the video Pretty in Pee-nk about the phenomenon of "beeturia," pink urine after beet consumption seen in some people.

For those that don't mind the taste of bugs, I have some nutritional info in Good Grub: The Healthiest Meat and Bug Appétit: Barriers to Entomophagy.

As an Ashkenazim myself, I'm excited to have narrowly escaped a cilantro-less existence!

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

Using Cherries to Treat Gout

NF-Mar17 Treating Gout with Cherry Juice.jpeg

Over the last 40 years, the burden of gout, a painful inflammatory arthritis, has risen considerably, now affecting millions of Americans. In fact, gout is now the most common inflammatory arthritis in men and older women.

In my video, Gout Treatment with a Cherry on Top, I profiled new research, suggesting that even as few as a half of a cup of cherries a day may significantly lower the risk of gout attacks. Fresh cherries aren't always in season, though. There are some alternatives. Frozen cherries appeared second-best and cherry juice concentrate is the runner-up. But does concentrated cherry juice actually help prevent attacks of gout?

The first pilot study was a randomized controlled trial cherry juice concentrate with pomegranate juice concentrate as a control for the prevention of attacks in gout sufferers who were having as many as four attacks a month. The cherry group got a tablespoon of cherry juice concentrate twice a day for four months, and the control group got a tablespoon of pomegranate juice concentrate twice a day for four months.

The number of gout flares in the cherry group dropped from an average of five down to two, better than the pomegranate group, which only dropped from about five to four. And about half of those in the cherry group who were on prescription anti-inflammatory drugs were able to stop their medications within two months after starting the cherry juice, as opposed to none of the patients in the pomegranate group.

The second study, highlighted in my video, Treating Gout with Cherry Juice, was a retrospective investigation over a longer term. Twenty-four gout patients went from having about seven attacks a year, down to two. The researchers concluded that cherry juice concentrate is efficacious for the prevention of gout flares. Large, long-term randomized controlled trials are needed to further evaluate the usefulness of cherries and cherry juice concentrate for gout flare prophylaxis.

So, are cherries now ripe for use as a complementary therapeutic in gout? One commentator "is of the opinion that the current state of evidence remains insufficient to formally recommend cherry fruit or cherry products as complementary therapeutic remedy for gout." This commentator is also a paid consultant of nine different drug companies, all of which manufacture gout medications. I understand how the pharmaceutical industry can get nervous seeing studies where half of patients were able to stop taking their gout drugs given the billions of dollars at stake, but what's the downside of eating a half cup of cherries a day, or worst comes to worst a few spoonfuls of cherry juice?

Here are the other videos I've done on the power of cherries to control inflammation:

Tart cherries (the kind people make pies out of, not the sweet kind) may also help with sleep (Tart Cherries for Insomnia).

What do you do with frozen cherries? I just eat them straight--suck on them like popsicles, but they're also an integral part of my Healthy Chocolate Milkshakes.

Another way to help treat gout is to drink lots of water and keep one's urine alkaline by eating lots of dark green leafy vegetables (see Testing Your Diet with Pee & Purple Cabbage).

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Benson Kua / Flickr

Original Link

The #1 Dietary Risk Factor is Not Eating Enough Fruit

NF-Jan28 Inhibiting Platelet Aggregation with Berries.jpeg

The Global Burden of Disease Study published in 2012, is the most comprehensive and systematic analysis of causes of death undertaken to date, involving nearly 500 researchers from more than 300 institutions in 50 countries, and starting with almost 100,000 data sources. What did the researchers find? Here in the U.S., they determined that our biggest killer was our diet. Number 1 on their list of the most important dietary risks was not eating enough fruit, responsible for an estimated 4.9 million deaths a year around the world.

According to the Union of Concerned Scientists: "If Americans ate just one more serving of fruits or vegetables per day, this would save more than 30,000 lives and $5 billion in medical costs each year." One antidote for individuals is easy, painless, and even pleasurable: exploit the multiple nutritional and protective benefits of fruits and vegetables.

One way plants protect us may be their antiplatelet effects. Platelets are what trigger the blood clots that cause heart attacks and most strokes. And beyond their obvious function in blood clotting, platelets are now considered to play a pivotal inflammatory role in the hardening of the arteries in the first place, and in allergies, rheumatoid arthritis, and even cancer.

Normally, under healthy conditions, platelets circulate in a quiescent, inactive state. But once they become activated, they can emerge as culprits in inflammation. Platelets transport a vast amount of inflammatory chemicals, and upon activation they release these chemicals, which can recruit the inflammatory cells that form the pus pockets within our arterial walls that can eventually burst and kill us.

This involvement of platelet activation in atherosclerosis development is well established. We've long recognized the platelets' role in the final stages; however, a growing body of data indicates that platelets may also play an important role in the initiation and propagation of atherosclerosis in the first place. How can we prevent the excessive activation of platelets? It's generally recognized that platelet hyper-reactivity is associated with high levels of cholesterol circulating in the blood; so we can cut down on foods that have trans fats, saturated fats, and dietary cholesterol.

We can also eat more fruits and vegetables. For example, different varieties of strawberries have shown a significant antiplatelet effect in a petri dish and in people. How did researchers figure it out? In my video, Inhibiting Platelet Aggregation with Berries, you can see a platelet in a resting state, packed with little round granule grenades of inflammatory chemicals, which fuse together and are released when the platelet gets activated. Because resting and activated platelets look so different, we can just take blood from people and count how many are resting and how many are activated before and after people eat more than a pint of strawberries every day for a month. From just adding strawberries to people's diets, there's a small but significant drop in the percentage of activated platelets circulating throughout their bodies.

Other berries had a similar effect, even at a more modest two servings a day. Drinking orange or grapefruit juice doesn't seem to help, but purple grape juice successfully reduces platelet activity on the same order that aspirin does.

Studies have shown that daily aspirin can reduce heart attacks and strokes; however, aspirin can also cause severe gastrointestinal disturbances and bleeding problems, and so should not be used for the primary prevention of heart attacks and stroke as the benefits don't clearly outweigh the serious risks. It's nice to have safe, side-effect free alternatives.


One of the ways plants help keep platelets in their place may actually be their aspirin content! See Aspirin Levels in Plant Foods. Why would a plant make a human drug? It's so cool, check out Appropriating Plant Defenses.

Is the Standard American Diet really so bad that we could save 100,000 people by just getting up to minimum fruit and veggie recommendations? Even cynics might be surprised: Nation's Diet in Crisis. Even more plants may cut deaths even more, though. See One in a Thousand: Ending the Heart Disease Epidemic.

For more on lowering cholesterol see my video Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. And it's never too early to start eating healthier. Check out: Heart Disease Starts in Childhood. Heart disease may be a choice. See: Cavities and Coronaries: Our Choice.

Berries are the healthiest fruits, shown to maintain our brain power (How to Slow Brain Aging By Two Years) and improve our immune function (Boosting Natural Killer Cell Activity). That's one of the reasons we want to eat Antioxidant Rich Foods With Every Meal.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Michael Stern / Flickr

Original Link

How to Treat Gout With Diet

NFOct8-Gout treatment with a cherry on top.jpg

The Washington State Fruit Commission, our largest cherry producer, can fund reviews that cherry-pick studies on the anti-inflammatory effects of cherries in a petri dish and animal models. But what we've needed are human studies. For example, if we stuff the human equivalent of up to a thousand cups of cherries down the throats of rats, it appears to have an anti-inflammatory effect, but we could never eat that many. (In fact, if we tried, it could end badly. One poor guy who ate 500 cherries whole--without spitting out the pits--ended up fatally obstructing his colon.)

A decade ago, we didn't have many human studies, but thankfully now we do. A study published in The Journal of Nutrition had men and women eat about 45 cherries a day for a month (I wouldn't mind being part of that study!). The researchers found a 25% drop in C-reactive protein levels (a marker of inflammation), as well as an inflammatory protein with an inelegant acronym RANTES ("Regulated on, Activation, Normal, T cell, Expressed and, Secreted"). Even a month after the study ended there appeared to be residual anti-inflammatory benefit from the cherry fest.

These subjects were all healthy, with low levels of inflammation to begin with, but a follow-up study, highlighted in my video, Gout Treatment with a Cherry on Top, on folks with higher levels found similar results for C-reactive protein and for a number of other markers for chronic inflammatory diseases. Do cherries then help people who actually have a chronic inflammatory disease?

Back in 1950, in an obscure Texas medical journal, "observations made by responsible physicians" suggested that in a dozen patients with gout, eating half a pound of fresh or canned cherries helped prevent flares of gout. But the issue had never seriously been tested, until recently. Gout is an excruciatingly painful inflammatory arthritis caused by the crystallization of uric acid within joints. Based on the National Health and Nutrition Examination Survey 2007-2008, the prevalence of gout in the US is estimated to be 3.9% among US adults, which translates into 8.3 million people.

Hundreds of gout sufferers were studied, and cherry intake was associated with a 35% lower risk of gout attacks, with over half the risk gone at three servings measured over a two day period (about 16 cherries a day). That's the kind of efficacy the researchers saw with a low-purine diet (uric acid is a break-down product of purines). This same research group found that purine intake of animal origin increased the odds for recurrent gout attacks by nearly five-fold. Heavy alcohol consumption isn't a good idea either.

There are some high-purine non-animal foods, like mushrooms and asparagus, but they found no significant link to plant sources of purines. So the researchers recommended eliminating meat and seafood from the diet. This may decrease risk substantially, and adding cherries on top may decrease risk of gout attacks even further. Same thing with the leading drug: allopurinol works, but adding produce appears to work even better.

Often, dietary changes and cherries may be all patients have, as doctors are hesitant to prescribe uric acid-lowering drugs like allopurinol due to rare but serious side-effects.

In addition to fighting inflammation, cherries may also lower uric acid levels. Within five hours of eating a big bowl of cherries, uric acid levels in the blood significantly drop. At the same time, antioxidant levels in the blood go up. So is it just an antioxidant effect? Would other fruit work just as well? No. Researchers tried grapes, strawberries, and kiwi fruit, and none significantly lowered uric acid levels, supporting a specific anti-gout effect of cherries.

There are some new gout drugs out now, costing up to $2,000 per dose and carry a "risk of toxicity that may be avoided by using nonpharmacologic treatments or prevention in the first place." Given the potential harms and high costs, attention ought to be directed to dietary modification, reducing alcohol and meat intake, particularly sardines and organ meats. "If life serves up a bowl of cherries (consumed on a regular basis), the risk of a recurrent gout attack may be meaningfully reduced."

More about the inflammation fighting effects of sweet cherries in my video Anti-inflammatory Life is a Bowl of Cherries.

I've previously mentioned gout and controlling uric acid levels in my videos:

Other foods that may help tamp down inflammation:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Valdemar Fishmen / Flickr

Original Link

The Spice That Helps Ease Rheumatoid Arthritis Pain

NF-Jan22 The Spice that Helps Ease Rheumatoid Arthritis Pain.jpg
Accordingto the World Health Organization, "80% of the Earth's inhabitants rely upon the traditional medicine for their primary health-care needs, in part due to high cost of Western pharmaceuticals. Medicines derived from plants have played a pivotal role in the health care of both ancient and modern cultures." One of the prime sources of plant-derived medicines is spices. Turmeric, for example, has been consumed over the centuries around the world. Turmeric is known by different names in different societies--my favorite of which is probably "zard-choobag."

Turmeric is the dried powdered root stalks of the turmeric plant--a member of the ginger family--from which the orangey-yellow pigment curcumin can be extracted. The spice turmeric is what makes curry powder yellow, and curcumin is what makes turmeric yellow. In the video, Turmeric Curcumin and Rheumatoid Arthritis, you can see the molecular structure of curcumin. I always thought it kind of looked like a crab.

In recent years, more than 5,000 articles have been published in the medical literature about curcumin. Many sport impressive looking diagrams suggesting curcumin can benefit a multitude of conditions via a dizzying array of mechanisms. Curcumin was first isolated more than a century ago, but out of the thousands of experiments, just a handful in the 20th century were clinical studies, involving actual human participants. Most of the 5,000 were just in vitro lab studies, which I've resisted covering until the studies moved out of the petri dish and into the person. But since the turn-of-the-century, more than 50 clinical trials have been done, testing curcumin against a variety of human diseases, with 84 more on the way. One such study got my attention.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that causes progressive destruction of the cartilage and bone of joints. The long-term prognosis of RA is poor, with as much as 80% of patients affected becoming disabled with a reduced life expectancy. There are lots of drugs one can take, but unfortunately they're often associated with severe side effects including blood loss, bone loss and bone marrow suppression, and toxicity to the liver and eyes.

The efficacy of curcumin was first demonstrated over 30 years ago in a double-blind crossover study: curcumin versus phenylbutazone, a powerful anti-inflammatory that is used in race horses. Both groups showed significant improvement in morning stiffness, walking time, and joint swelling, with the complete absence of any side effects from curcumin (which is more than can be said for phenylbutazone, which was pulled from the market three years later after wiping out people's immune systems and their lives).

In the new study, 45 patients diagnosed with rheumatoid arthritis were randomized into three groups: curcumin, the standard of care drug, or both. The primary endpoint was a reduction in disease activity as well as a reduction in joint tenderness and swelling. All three groups got better, but interestingly the curcumin groups showed the highest percentage of improvement, significantly better than those in the drug group. The findings are significant and demonstrate that curcumin alone was not only safe and effective, but surprisingly more effective in alleviating pain compared to the leading drug of choice, all without any adverse side effects. In fact, curcumin appeared protective against drug side effects, given that there were more adverse reactions in the drug group than in the combined drug and curcumin group. In contrast to non-steroidal anti-inflammatory drugs (NSAIDs), curcumin has no gastrointestinal side effects, and may even protect the lining of the stomach.

Hard to appreciate the gorgeous color of fresh turmeric root unless you see it for yourself. You should be able to find it at any large Asian store. I incorporate it into my Natural Nausea Remedy Recipe. The inner color is almost fluorescent!

I'm afraid followers of NutritionFacts.org are going to get sick of turmeric, but there's a load of important new research I felt I needed to cover. So far there's Turmeric Curcumin and Osteoarthritis, Boosting the Bioavailability of Curcumin and Who Shouldn't Consume Curcumin or Turmeric?

I've previously talked about treating autoimmune joint inflammation with diets full of plants in Diet & Rheumatoid Arthritis and Potassium and Autoimmune Disease.

If phenylbutazone sounds vaguely familiar, maybe you read my Q&A Is horse meat safe to eat?

-Michael Greger, M.D

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: David van Horn / Flickr

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