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  • Scott Adams
    Scott Adams

    Arthritis and Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Arthritis may be an allergic response to materials in the food supply. Diet revision may be helpful in reducing the activity of inflammatory arthritis and in some instances may halt the progression of the disease. There are many patterns of arthritis. A group of related joint and connective disorders have been called rheumatic diseases. All these diseases are immune-mediated, and all are expressions of inflammation in connective tissues. Inflammation damages joints and surrounding tissues resulting in loss of function and deformities. Variations in the patterns of these diseases reflect the many possibilities for immune damage to disturb and distort structure and function. Severity ranges from mildly painful, chronic activity to drastic, disabling disease. Rheumatoid arthritis, often severe and disabling, is the dominant rheumatic disease that can attack all joints in the body.

    Rheumatoid arthritis is often considered to be an autoimmune disease. Our idea is that no disease is just internally generated and must involve outside contributions. Arthritis is often associated with inflammatory bowel disease. The mechanisms of food allergy link abnormal Gastrointestinal Tract (GIT) function with immune attacks on connective tissue. In all arthritic patients, normal GIT function should be rigorously sought by adaptive dietary adjustments.

    Simple allergic arthritis is a definite entity that is often not recognized as a food allergy. Typically, a dramatic, acute, and painful swelling develops in one or more joints asymmetrically. Eating a food, either an unusual food eaten for the first time or sometimes a regular food eaten in excess usually brings on the joint inflammation. This presentation is similar to and often confused with gout. Any food can cause allergic arthritis. Staple foods such as milk, eggs, and wheat (rye, oats, barley), coffee, beef, pork, and food additives are the most common food triggers. Carinini and Brostroff reviewed the concepts of and evidence for food-induced arthritis. They stated:

    Despite an increasing interest in food allergy and the conviction of innumerable patients with joint disease that certain foods exacerbate their symptoms, relatively little scientific attention has been paid to this relationship. Abnormalities of the gastrointestinal tract are commonly found in rheumatic disease...Support for an intestinal origin of antigens comes from studies of patients whose joint symptoms have improved on the avoidance of certain foods antigens, and become worse on consuming them. These have included patients with both intermittent symptoms, palindromic rheumatism and more chronic disease.

    In another study, 33 of 45 patients with rheumatoid arthritis improved significantly on a hypoallergenic diet. The authors concluded: Increasing numbers of scientific studies suggest that dietary manipulation may help at least some rheumatoid patients and perhaps the greatest need now is for more careful and well-designed research so that preconceptions may be put aside and role of diet, as a specific or even a nonspecific adjunctive therapy, may be determined.

    Unfortunately, dairy products, wheat and its close relatives, oats, barley, and rye, have proved to be a major problem in the diets of our patients. There are many possible reasons for cereal grains to become pathogenic. Hypersensitivity mechanisms triggered by grain proteins, collectively called Gluten, are the likely cause of the illnesses related to intake of cereal grains. Gluten is a mixture of individual proteins classified in two groups, the Prolamines and the Glutelins. The prolamine fraction of gluten concerns us the most when grain intolerance is suspected. The prolamine, Gliadin, seems to be a problem in celiac disease; gliadin antibodies are commonly found in the immune complexes associated with this disease. Recently marketed grains, spelt and kamut, are wheat variants (despite claims to the contrary) and are likely to cause problems similar to other wheat varieties.

    A wheat gluten mechanism has been studied in rheumatoid arthritis patients. The clinical observation is that wheat ingestion is followed within hours by increased joint swelling and pain. Little and his colleagues studied the mechanism, as it developed sequentially following gluten ingestion. Dr. Parke and colleagues concurred with this explanation of the gut-arthritis link in their report of three patients with celiac disease and rheumatoid arthritis. The mechanism involves several stages:

    • GIT must be permeable to antigenic proteins or peptide fragments, derived from digested gluten.
    • The food antigens appear in the blood stream and are bound by a specific antibody (probably of IgA or IgG, not IgE class), forming an antigen-antibody complex, a circulating immune complex (CIC).
    • The antigen-antibody complex then activates the rest of the immune response, beginning with the release of mediators - serotonin is released from the blood platelets.
    • Serotonin release causes symptoms as it circulates in the blood stream and enhances the deposition of CICs in joint tissues.

    Once in the joint, the immune complexes activate complement, which in turn damages cells and activates inflammation. More inflammation results in more pain, swelling, stiffness, and loss of mobility.

    Arthritis is usually treated with salicylates or related anti-inflammatory drugs generally referred to as NSAIDs. These drugs alleviate the terrible pain of active arthritis but do not favorably affect the outcome of the disease. All anti-arthritic medication can produce asthma or chronic rhinitis and a variety of allergic skin rashes. Gastrointestinal surface irritation, bleeding, and ulceration are routine problems of anti-arthritic medication.

    The first attack of joint swelling and pain should be treated as an urgent problem to be solved. Inflammation may damage joints. Often NSAIDs and physiotherapy are the only treatments prescribed and inflammation is given every opportunity to ravage tissues. We have seen countless patients, just treated with NSAIDs, who progressed rapidly to a severe disabling disease, often with poor pain control. In unlucky patients, severe deformities of joints accumulate in the first few months of a severe attack. There is a trend to recommend more aggressive treatments, using drugs that impair the immune response. The best drug is prednisone, but it is seldom used because it has long-term side effects which scare both physicians and patients. Prednisone is often a magic drug that relieves terrible pain and suffering often in the first 48 hours of therapy. Beyond prednisone, there is a grab bag of immune suppressant drugs to treat arthritis-chloroquine, penicillamine, gold and methotrexate have emerged as the favored drug therapies. All these drugs have impressive side effects and great potential for toxicity.

    Our preference is to try to stop the inflammatory activity as soon as possible with diet revision. All inflammation is likened to a fire. You get out the fire-extinguishers and go to work. No matter what pattern the immune attack assumes, our standard defense can be tried first. The Core Program method of diet revision is used. Food is replaced with an elemental nutrient formula, ENFood, for a clearing period of 10 to 20 days. Prednisone and/or NSAIDs are drug options during the clearing period and then the dosage is reduced after pain and swelling have subsided. Improvement is followed by slow food reintroduction (see Core Program). Each returning food is carefully screened for arthritis- triggering effects. You hope that food allergy caused the problem and that food control can be successful controlling the disease in the long- term. Nothing is lost by taking this approach and complete control of the disease can sometimes be obtained. If strict food control proves to be inadequate, then other drug treatments can be instituted.

    End Notes/Sources:

    • Carinini C, Brostroff J. Gut and joint disease. Annals of Allergy 1985;55:624-625.
    • Darlington et al. Lancet Feb 1 1986;236-238.
    • Keiffer M et al. Wheat gliadin fractions and other cereal antigens reactive with antibodies in the sera of of celiac patients. Clin Exp Immunol 1982;50:651-60.
    • Little C, Stewart AG, Fennesy MR. Platelet serotonin release in rheumatoid arthritis: a study in food intolerant patients. Lancet 1983;297-9.
    • Parke AI et al. Celiac disease and rheumatoid arthritis.
    • Annals of Rheum Dis 1984;43:378-380.
    • Voorneveld CR, Rubin LA Disease-modifying antirheumatic drugs: early use is better. Medicine North Amer. Oct 1991 3177-3184.

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    I was diagnosed with suspected rheumatoid arthritis nearly 2 years ago. I was prescribed Plaquenil for the pain and swelling. The Plaquenil worked but I started to experience side effects after 5 months. It was due to a posting like this that I saw the connection to RA and eating gluten free.

     

    My father has celiac disease so I started eating gluten free within a week. I bought an excellent book called Dangerous Grains and got in contact with the author who incidentally, is a friend of my fathers. The RA went into remission though it took 6 - 9 months for my joints and swelling to return to normal.

     

    Any ingestion of gluten including gluten free oats (Bobs Red Mill) induces arthritic pain. Large amounts such as what I ingested before the small bowel biopsy also cause problems with what I call a mind/body connection, something like brain fog.

     

    I just did a 4 day gluten challenge before a colonoscopy and small bowel biopsy which showed I don't have celiac disease. The arthritis hit me like a wall and 3 1/2 weeks later, I am still limping, having joint problems but I can already feel myself getting better.

     

    The gastroenterologist said that I have a manifestation similar to celiac disease which just does not affect my small intestine. I have seen it called "gluten sydrome" in a book I read recently by Scott Adams and Ron Hoggan. I look at the arthritis as being equivalent to problems that gluten causes such as gluten ataxia which can occur without damage to the small intestine.

     

    I just consider myself so lucky to have seen information on line and whenever I can, I try to pass the information on.

    I have been struggling with gluten & dairy intolerance symptoms for almost a year now. I have had joint pain (rheumatoid arthritis, I suppose) in my hands for almost 5 years, but never knew what it might be from. I've been mostly gluten/dairy free for about 9 months now. For a while I started feeling better, but recently took a turn for the worst again. I feel as though my body is not digesting properly, and I feel tired with headaches all of the time on top of rheumatoid arthritis.

     

    Could I have something else besides celiac/gluten intolerance? I tested negative for the celiac blood test. Not sure what to do now : / Please help!!!

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    Did this regime help you? I have severe RA and now after being on Enbrel and Methotrexate for over a year am looking for another answer besides these toxic drugs. Also, I have had severe cramping the past 4 months and am trying an experiment today. Please let me know how it helped you.

    I am celiac and lactose intolerant. PLEASE do NOT take these dangerous meds. No one knows the long term effects. Look up the story of Jordan Rubin. He is totally healed from Chron's Disease by eating raw whole foods and enzymes. Talk to health food store owners, etc. Do your own research and save your life and so many others.

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    Good article, where can I get information on the core plan in your article, as I have celiac disease and chronic arthritis?

    Try reading "Wheat Belly", written by a doctor. I have arthritis and suffer from constant joint inflammation. I'm also addicted to wheat products and sugar. I've been noticing that when I eat certain foods, my inflammation flares up badly. I am going to go wheat-free and see how I feel. Good luck to you.

     

    PS - my physical therapist recommended this book - said it's terrific. He suffered from terrible arthritis, and his wife had debilitating knee pain most of her life. Her pain is barely there now, as is his, because they have been wheat-free for several years. I am very curious about this and want to learn.

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    Try reading "Wheat Belly", written by a doctor. I have arthritis and suffer from constant joint inflammation. I'm also addicted to wheat products and sugar. I've been noticing that when I eat certain foods, my inflammation flares up badly. I am going to go wheat-free and see how I feel. Good luck to you.

     

    PS - my physical therapist recommended this book - said it's terrific. He suffered from terrible arthritis, and his wife had debilitating knee pain most of her life. Her pain is barely there now, as is his, because they have been wheat-free for several years. I am very curious about this and want to learn.

    I just want to say that it isn't enough just to be wheat-free Marybeth, you must be gluten-free i.e. no wheat, rye, barley or oats, and on top of that keep all other carbohydrates to a minimum, including potatoes, rice, quinoa, buckwheat etc. Though they are gluten-free there is evidence that simply high carb foods are inflammatory. Obviously that includes all sorts of sugars, including honey and maple syrup, which I should have mentioned too. Do it properly and you will reap the benefits.

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    I think I have celiac and I am ANGRY my doctors have not mentioned this to me I have a GP doctor I have IBS and I have have several test I have RA and I have terrible stomach pain. I am not to the point where I can not eat at all. Anything I eat make me hurt I end up in a ball in pain. I have diarrhea or I am constipated and I was in tears when I read you wrote the book cereal kills. I LIVE off of cereal I love it and for some reason I do not hurt after I eat it well lets say it doesn't seem like it the pain comes later so it must take awhile to effect me. I am in tears reading an writing this I NEED help I am losing weight I am so depressed I need someone to diagnose me so I can get my life back.

    I so understand you! I too went through this... I was diagnosed with mesenteric panniculitis, osteoarthritis, and celiac disease. I have eliminated most nightshades from my diet, and all wheat and gluten containing products. No bread. No pizza. No cookies (I used to be a cookie monster! No pastries!). I discovered Rudi's gluten-free bread, and gluten free peanut butter. I discovered CHEX cereal, which is gluten-free (gluten-free). I discovered the Schar products which are delicious. I discovered Glutino's chocolate cookies which are just like Oreos! And I added a lot of Mediterranean foods to my diet (lentils, garbanzo beans, rice, hummus). I discovered Heartland pasta, which is delicious and gluten-free. I started to eat more fruit and green veggies. I limited the soda and eliminated the wine. Limited the fatty cheeses and switched to gluten-free cheese (do your research!) And I am 90% better! You ought to try! Snack foods like Cheetos, Frito Lays, Tostitos, and Hershey bars are gluten-free. Do not eat gluten! I no longer curl up in a ball. Change your diet, and you will see!! Good luck to you.

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    My husband was on gluten and the blood test was negative yet WE went gluten free and 4 days later the 25 lbs. of water he was carrying left. It is a digestive problem and that is why it rarely shows up in the blood. As its not a blood problem.

    I would like to know more about what Theresa Schaefer commented on. You said your husband went gluten free and in 4 days lost 25 lbs of water? What? Tell me more. I was thinking I had gout at one time and the doctors thought gouty arthritis. Then they said they thought something more was going on and that was the end of that. Anyway, now my ankles swell up as big as softballs & my feet are as big as mens rubber boots.I feel like my skin is going to tear & the pain is ridiculous.Tried water pills and all I did was pee. The only thing that makes them go down is sleep & then it starts all over again from sitting all day.

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    I think I have celiac and I am ANGRY my doctors have not mentioned this to me I have a GP doctor I have IBS and I have have several test I have RA and I have terrible stomach pain. I am not to the point where I can not eat at all. Anything I eat make me hurt I end up in a ball in pain. I have diarrhea or I am constipated and I was in tears when I read you wrote the book cereal kills. I LIVE off of cereal I love it and for some reason I do not hurt after I eat it well lets say it doesn't seem like it the pain comes later so it must take awhile to effect me. I am in tears reading an writing this I NEED help I am losing weight I am so depressed I need someone to diagnose me so I can get my life back.

    Liz, this is in case no-one has replied. From all that I have read people usually crave those foods that are making them ill. Organic foods are expensive but it is usually what is done to the food and the chemical used in the processing that make us ill. Raw Garlic, Raw Ginger, Ceylon Cinnamon, Extra Virgin Olive Oil, Extra Virgin Raw Coconut Oil, and local Raw Honey and Black Strap Molasses (not sulphur treated) are all ingredients that should help your tummy to heal. Coconut oil has amazing health properties and cooking with it will not produce trans fats. Your body will be deprived of the essential nutrients it needs. You could also add a little rock salt, turmeric and some cayenne pepper for seasoning. The foods above are filled with nutrients. If you use sugar make it raw sugar. The white sugar and salt that are available in supermarkets are chemically treated and have their nutrients removed. Your body is telling you that the food you are eating is harming you. Many do not get this warning (no tummy troubles) and so continue to eat the contaminated foods in our supermarkets only to learn that they have a chronic life threatening illness. The pain you have experienced is your body attempting to warn you and keep you safe from further harm. If possible use only natural treatments if you require medication as the side effects from prescription and over the counter medications will add to your toxin overload.

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    Great article, thank you. I have RH and suspect that I have celiac as well. It's been 7 years now....the doctors keep telling me to take the medication, but I prefer organic / bio-dynamic foods, so went off the medication and most of the symptoms went away, but some still lingered. All this time I have been asking if there is a link between food and RH, but felt like I was being laughed at by the Medical Professionals! I recently watched a documentary about how the pharmaceutical companies pay the doctors to recommend there products! The rich get richer!.....The doctors said to me that once I have been on the methotrexate and prednisone and folic acid for a few months, I would have other symptoms starting to show, that would need treating with stronger drugs to counteract those reactions and so the cycle would continue. They said that these drugs would probably take 10 years off my life, but that was a price I should pay for a better quality of life! Obviously I didn't agree, now that I have read your article I will get tested and try being totally gluten free and see what happens with the last of the symptoms. Thank you. There is one more thing I would like to comment about and that is that my son has a mild case of asthma / eczema, so we watch what ingredients are in the foods we buy, numbers, colors and preservatives all make his face go red, immediately, so we avoid these foods. My comment is if you actually research what the additives are you will find that a lot of the additives are banned in most countries, yet will still use them. Just one example is the number 133 brilliant blue, it causes adverse reactions, hyperactivity, asthma, aspirin intolerant people should avoid use, suspected carcinogen, skin rashes and chromosomal damage! How do the owners of these companies sleep at night!

    133 is mainly used in children's lollies! The rich get richer and we pay them....then suffer the consequences, then go to the doctor for help and get prescribed medication.....and so the cycle continues!

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    I would say you should try giving up the nightshades and see if it applies to you.

    I am ANA and rheumatoid factor negative but positive for the anti-CCP test and have elevated C Reactive Protein for at least 5 yrs. In 2002, I was positive for celiac on blood test and got rid of 30 yrs of irritable bowel when I gave up gluten.

    I also have received considerable relief from joint and muscle pain and stiffness by giving up gluten. If I get contaminated or cheat I really pay for it.

    Recently I thought about nightshades and decided to try giving them up. Within a few days my joints were feeling looser and moved more freely. I tried eating tomato sauce again and before too many hours my fingers felt fat and achey. Tonight I ate potato salad which I have missed and my feet are feeling swollen and itching. I used to eat nightshades every day in some form, but when I am off them for a week or so I really start to feel like my old self. There is RA in both of my parents families.

    My daughter who is also celiac, has ulcerative colitis and throat burning has given up the nightshades and she has gotten rid of most of that reflux-like feeling of inflammation in her throat.

    My daughter has been diagnosed with ulcerative colitis as well and also has GERD, she has never been told she has celiac, however, they tell her that she cannot eat fiber. So, if you have celiac with ulcerative colitis - what kind of a diet would you eat. She also has a lot of knee pain.

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    At age 45, I was healthy, slightly above average in weight and in fair health. I had just entered nursing school and found that I could not lift my arm. Strange! Weeks later, I could not walk as the pain was so acute on both feet. I was soon diagnosed with R/A and my Rheumatologist placed me on a daily regimen of Methotrexate and Folic Acid (Folic Acid protects the liver and should always be taken with Methotrexate). The medication allowed me my mobility again, but did not eliminate much of the pain and swelling. Sadly, I was forced to leave nursing school.

     

    Last year in 2010 (three years later), I began changing my diet. I eliminated beef, pork, most nightshades, and most processed foods. This reduced the pain and swelling further. Then I began aerobic exercising 2-4 times a week, working up to 45 minutes per session while greatly increasing my water intake. This reduced things further. In October, 2010, I additionally began a gluten-free diet. Since November, 2010, (seven months now) I have been off of the Methotrexate all together, and drug free. Traditionally, this would signify only a temporary period of remission in R/A, however; with what we now know about maintaining a TOTAL health program, I think the odds of sustaining a remission period for a decade or more are greatly increased, and may even significantly reduce the long term effects and outcome of disease progression, both for celiac and R/A.

     

    My recommendation for others would be to incorporate a total health program of:

    1. daily AEROBIC exercise, increasing time length as able.

    2. water (four to six 8 oz bottles per day),

    3. reduce beef, pork, dairy, eggs, and nightshades

    4. go gluten-free

    5. get 8-9 hours of sleep per day if possible.

    6. recommend having several positive, social external interests and goals to help motivate oneself, help others, and add meaning/purpose/joy to living.

     

    Having now graduated at age 50 with a bachelor's in business, my new goals are to continue on towards a graduate degree and on a person health note....reduce my sugar intake to possibly eliminate the occasional slight remaining swelling and minor discomfort. What a phenomenal relief from being formerly unable to walk under excruciating pain!

    Thanks for all your recommendations and your encouragement. You really gave a complete program on what a person suffering from autoimmune diseases must follow. I loved point 5. as I myself have experienced how important an uninterrupted sleep is, specially if done in the first night hours and in complete darkness

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    I just want to say that it isn't enough just to be wheat-free Marybeth, you must be gluten-free i.e. no wheat, rye, barley or oats, and on top of that keep all other carbohydrates to a minimum, including potatoes, rice, quinoa, buckwheat etc. Though they are gluten-free there is evidence that simply high carb foods are inflammatory. Obviously that includes all sorts of sugars, including honey and maple syrup, which I should have mentioned too. Do it properly and you will reap the benefits.

    Afifah I fully agree. After a while one recognises the paste like quality of the food as poison. Even sweet potatoes, tapioca and chestnuts are problematic. For years I tried to fool myself that wheat re-placer was ok, but it isn't. One has to change one's diet to a much simpler paleo style. We recently found cheesecake sans sugar made with an almond base, cream cheese and gelatin and topped with fresh or frozen berries delicious as a healthy birthday treat. It has a lovely rich quality. Giving up baked goods is a big one. Also I agree regarding sugar, honey etc.

    When giving up sugars there will be dizzy periods where one will feel panicked and needing to eat sugar. My advice is to try exercise and then to eat a small amount of white rice with one's food. Cutting out all carbs can be very stressful. Also I have discovered Tai Chi as a way to relieve the joint pain.

    specifically the flicking swinging chi exercises.

    The other thing I like to mention is something I'm suffering right now which is a painful flareup from literally a lick of gluten paste in the form of caramel sauce. I have been strictly gluten free for about six months and that tiniest lick was like dynamite. That's why I am here I suppose. I had the works: five days of complete shut down of the bowel. Pain in the gut, hives all over, and now the arthritic elbows, knees, fingers and toes and excruciating wrists. The caramel didn't even taste that nice even if it had been made by a famous chef, (groan).

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    Every day I had stabbing pain in my toe knuckles to the point I couldn't sleep. For about 3 years it got steadily worse. Cortazone injection helped a lot but was not recommended as a long term solution. I am 53 and walk 10 km/day. Xrays showed arthritis had set in. Other joints were also starting to become painful. I had no stomach issues when ingesting gluten. I was desperate, so I tried gluten free diet for 21 days. The pain got worse on the the 3rd day. By the fifth day the pain dramatically declined to nil. After 21 days I tried a beer and bread to ensure this was not wishful thinking and the pain returned and was as intense as before about 6-7 hours after eating gluten products. I did another 2 weeks of no gluten and returned to pain free days. Not only did the pain disappear, movement in my joint improved and I could actually crack my toe knuckle again after not being able to for several years. To confirm the result as I was still in disbelief that the pain could be so significantly reduced, I went back on gluten and then off two more times with exactly the same results. I am not suggesting it will work for everyone however in my case, there is a definite direct correlation between joint pain, resulting inflammation and ingestion of gluten. Avoidance of gluten must be absolutely 100% for this to work. If you endure daily chronic joint pain, Its worth trying.

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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