The mere fact that food allergies, chemical sensitivities and reactions to gut flora are not seen across the board in arthritis has led many to conclude that these phenomenon simply don’t exist. Rheumatologists have been eager to use this faulty logic to ‘toss the baby out with the bath water’. Equally guilty are the doctors that have claimed a cure through the exclusive use of only one modality. They have claimed that antibiotics or dietary manipulation alone were enough to effect a cure or remission. They have witnessed some success but closer scrutiny reveals that these successes have been hit and miss at best. Some individuals have experienced spectacular results while the improvement in others is nil. While all arthritics have a leaky gut, the degree to which they experience reactions to foods, chemicals, or gut flora varies enormously from individual to individual. This is another reason why arthritis has seemed so mysterious and difficult to resolve.

Chapter II

Leaky gut is primarily a ‘design’ problem. Over 4 million years of human evolution has provided us with an intestinal tract that:

• Has a huge surface area - The intestinal tract, while only 20 feet long, has a folding, undulating wall that maximizes surface area. A surface area of over 100 square yards is generated by this design allowing tremendous mechanical, chemical and absorptive efficiency.

• Constantly sloughs off tissue along the innermost wall - The stomach, small intestines and colon regenerate their surface once every 12, 14, and 18 hours respectively. This constant renewal of tissue helps to maintain the high level of functionality required by the intestinal tract. Sloughing also makes it more difficult for disease causing micro-organisms to attach themselves and assists with the efficient processing and excretion of residual wastes.

• Devotes 80% of the body’s total complement of t-cells to constant surveillance along the intestinal tract - The tissues of the intestinal tract are delicate and susceptible to damage. If the intestinal wall is compromised pathogens can enter the body. T-cells provide a much needed defense mechanism. They vigilantly wait, responding quickly and aggressively to inactivate and eliminate these intruders.

• Maintains a symbiotic relationship with over 500 different types of micro-flora - The lower intestinal tract purposely provides a hospitable environment for bacteria, fungi and other micro-flora. Beneficial micro-organisms stabilize the intestinal environment while aiding vitamin synthesis and processing of wastes. This stable mix of intestinal micro-flora plays a crucial role in protecting the gut from pathogens and parasites.

This design wasn’t by chance. Natural selection forged an intestinal tract finely tuned to balance digestion, elimination, defense and stability. This anatomical structure gave our ancestors an advantage critical for survival. However this design would not be without an Achilles heel. The anatomical design of the intestinal tract would demand more cellular regeneration and blood flow when at rest than any other organ system in the body.

We’ve already seen how persistent stress (either physical or psychological) chronically starves the gut of the blood flow needed for cellular repair. A diet mismatched to inherited metabolic needs compromises (among other things) the amino acid synthesis needed to fuel cellular regeneration throughout the body.

What we witness next is what happens when a physiology that has been built for the past hasn’t had time to evolve as rapidly as change in diet and lifestyle. A collision is imminent and the intestinal tract is poised to be the first casualty. What was designed by nature to give our ancestors an advantage has now become a liability.

When viewing the entirety of human history you might be surprised to find that arthritis is a very recent development. Up until approximately 6,500 years ago our ancestors simply did not have arthritis. While there is evidence of trauma induced arthritis, anthropologists agree that the degenerative types of rheumatoid diseases that we see today did not yet exist. Certainly there was no indication of today’s high incidence of arthritic diseases. What changed? Perhaps the answer was change itself.

Prior to that time humans were faced with enormous change but never at a rate proceeding faster than their physiology could adapt. Rheumatoid conditions (including rheumatoid arthritis, osteoarthritis, lupus, ankylosing spondylitis, fibromyalgia, etc.) did not exist in areas where humans were very well ‘adapted’ to their environment. Could the first stumbling block that would lead to leaky gut and arthritis be due to something as seemingly innocuous as changes in diet?

This is a brief introduction describing the three general metabolic subsets. Foods are grouped into three general categories. Information in this introduction needs to be read in advance of reading the specifics for each metabolic diet.

CORE FOODS will be your best foods. Time has made us well adapted to these foods. They have proven themselves to have a low allergenic potential & can be eaten several times a week. They should serve as the bulk (greater than 70%) of your nutritional needs. These should be the first foods you test upon completion of the Elimination Diet phase.

SUPPLEMENTAL FOODS are important since they give nutritional variety to your diet. While these foods tend to work well with your inherited metabolism they also have a higher potential for developing food allergies. Therefore these foods should be regularly enjoyed but not overeaten. You will probably find your best balance if you eat them no more than once a week. These foods should be closely checked for negative reactions after testing your core foods.

AVOID FOODS are those that are metabolically inappropriate for your physiology. While they should generally be avoided they can often be tolerated in small quantities when eaten in conjunction with your Core/Supplemental foods. AVOID FOODS also tend to be best tolerated when eaten with your evening meal. This group of foods are the last that should be tested following the elimination diet as many will generate symptoms.

ELIMINATE FOODS must be completely removed from your diet. People with arthritis tend to be very poorly adapted to these ‘new’ foods. These foods all have a high allergenic potential. Many (especially grains & milk products) can directly damage & increase permeability of the intestinal lining. This intestinal damage also limits the absorption of important vitamins & minerals. Celiac disease is the most obvious example of this phenomenon.

Celiac disease is associated with a specific intolerance to a certain protein (gluten) found in grains. Common symptoms include abdominal bloating, diarrhea, muscle wasting, extreme fatigue, iron & other nutrient deficiencies & in some cases arthritis. Despite intensive study, the mechanisms involved in celiac disease have not been determined. At first it was hypothesized that individuals suffering from celiac simply lacked a digestive enzyme needed to break down gluten. We now know that the mechanisms are far more complex. A new theory suggests that lectins are responsible for at least some of the intestinal damage. Lectins are molecules found in some foods that can have a variety of toxic effects on living tissues. Current research suggests that wheat germ lectin may be the culprit responsible for scarring of tissues along the intestinal tract.

Until recently celiac disease was thought to only effect 1 out of 300 people in the general population. Today’s research shows that there are more undiagnosed than diagnosed cases. The problem is that many of these undiagnosed cases are latent, & do not show the prominent symptoms of more severe disease. Celiac disease exhibits a significantly higher prevalence among patients with autoimmune disease, diabetes, mental/neurological disorders, intestinal cancers & lymphoma. It is becoming obvious that celiac disease is only the tip of the iceberg, representing a very small part of a much larger group of individuals with grain allergy.

We are finding ourselves in a similar situation with milk & milk products. Lactose intolerance is a condition resulting from the inability to digest lactose (milk sugar). The problem is primarily due to a deficiency of the enzyme lactase. Common symptoms of lactose intolerance include bloating, intestinal gas, nausea, diarrhea & cramps. Milk has been shown to damage intestinal cells in a manner similar to celiac disease in many individuals. Likewise, lactose intolerance is only a fragment of a larger population of people with milk allergy.

Celiac disease & lactose intolerance stem simply from being poorly adapted to a food. While we’re not completely sure of the mechanisms at play we do know that the consequences can be quite dire leading to a variety of chronic disease states. How well we will be adapted to any food is based on how many thousands of years that our ancestors ate it. In the case of grains & milk that time has been too short for our physiology to fully adjust.

For best results you should leave grains, milk & milk products out of your diet. You are STRONGLY advised to omit any of the grains or milk that have adverse effects on your specific blood type (see below). ELIMINATE MEANS ELIMINATE! Simply reducing your intake of these foods will do you little good. A single teaspoon of wheat is capable of doing extensive damage to the intestinal tract of celiac patients. This is another reason why a diet composed exclusively of whole foods is a must. Trace amounts of milk, grains (or their excipients) are found in almost all processed foods. If you insist on trying these foods you will need to use a different testing methodology to measure their impact on your arthritis symptoms.

Most foods will deliver an immediate reaction (within 1-4 hours) after ingestion. ELIMINATE FOODS can deliver a delayed reaction as much as four days after eating. The phenomenon of delayed sensitivity is probably due to damage done by that food to the intestinal lining. Let’s use wheat as an example of how to test an ELIMINATE FOOD.

If you intend to test wheat you should eat wheat (shredded wheat cereal is a relatively pure form of wheat) three times a day with your other known ‘safe’ foods for 4 consecutive days. During this period you will not be able to test any other foods. Closely compare your symptoms prior to & after the addition of wheat to your diet. Of course if you experience an immediate reaction to an ELIMINATE FOOD you should consider it a food allergen remove it from your diet.

In the ELIMINATE FOODS section of the various metabolic diets you will be asked to eliminate certain foods based on your individual blood type (O, A, B, or AB). Peter D’Adamo, N.D., a Naturopathic physician, continued in his father’s footsteps by observing the relationship between diet, disease & blood type. He found that certain foods containing lectins react with specific blood types. These lectin/blood reactions trigger inflammation. Here are the foods that I recommend that you totally eliminate from your diet based on blood type.

Type O : Wheat (note that oats & other grains are often contaminated with wheat when processed), Corn, Kidney Beans, Lentils, Cabbage, Brussels Sprouts, Cauliflower, Mustard Greens, Potato

Type A : Milk, Kidney Beans, Lima Beans, Wheat, Tomato

Type B : Corn, Lentils, Peanuts, Sesame Seeds, Buckwheat, Wheat, Tomato, Chicken, Shellfish

Type AB : Kidney Beans, Lima Beans, Seeds, Corn, Buckwheat, Wheat, Tomato

Blood type is not indicative of inherited metabolism. I believe that the effect of certain dietary lectins in creating an immunological response is irrefutable. But that is a completely separate issue from inherited metabolism.

Food allergy reactions have a similar mechanism to what is seen with lectin generated reactions. The only difference is that food allergy reactions give a 'hyper-acute' response after 5 days of avoidance -- while lectins may or may not. I've found for example that potato will not ellicit a food allergy for me (it didn't do it when I ran the elimination diet) -- HOWEVER if I eat potato repetitively it induces inflammation (not in the joint but in the surrounding connective tissues that is quite painful) usually on the 3rd ingestion within 48 hours.

You see, lectins tend to accumulate in certain tissues until their concentration goes up to a 'critical mass' that triggers a localized inflammatory response. This inflammatory response is MUCH different from what I see with common food allergy reactions in that they tend to clear fairly quickly (within 8 hours). Once a lectin generated inflammatory response is triggered it takes days if not weeks to totally resolve.

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