( By Dr. Krishna Murari Modi )

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3-Arthritis: The Great Crippler (contd)

These are "miracle" drugs, but most dangerous of them all. When first introduced in 1950 they were thought to be the greatest boon of all time for patients with rheumatoid arthritis. When the people were first given this drug their symptoms disappeared overnight. The patients who were confined to chair or bed suddenly were up and about. Their limbs moved and spirits soared. To millions of people with arthritis around the world, cortisone held out great promise that at last an effective remedy for the disease had been found. Unfortunately, in the next few years the drug showed that it was a much dangerous as wonderful. It soon became evident that the remedy was worse than the disease.

Doctors found that patients got side effects which were serious. They developed stomach ulcers, loss of muscle tone and became moon faced. Hair grew on the faces of women taking them. Bones became less dense and fragile (osteoporosis). There was difficulty for a wound to get healed. It also led to cataract, high blood pressure, greater appetite, emotional depression, even psychosis.

The other drugs which produce a welcome relief from pain and inflammation and also terrible side effects are prednisolone, decadron, hydrocartisone etc. These drugs even suppress the immune system of the body. The body becomes less capable of fighting infection. An immune system is essential for our survival.

Overenthusiastic and new doctors tend to overprescribe cortisone. This drug when essential should be taken in minimum doses. Switch on to some milder drug or reduce the doses. It must not be stopped immediately, but doses reduced gradually and then stopped. After taking steroids for sometime, the adrenal gland shuts down. If you stop suddenly the body will not be able to reduce the dose and space it.

A random injection of cortisone directly into a painful joint does not produce dreadful side effects. Because of its very brief stay in the body the drug not have much chance to do a lot of damage. Keep in mind, applying ice often produces the same relief.

Sometimes gold is given orally or by injection in arthritis. Unlike steroids or aspirin the beneficial effect does not appear for weeks even for months. Injections are painful and can have serious side effects. Most common is soreness in the mouth, skin rashes or even a plastic anaemia and kidney damage.

Like gold it takes several months to work. The side effects of penicillamine are explosive vomiting, loss of taste, sore mucous membrane, excretion of protein in urine, bone marrow problem in some cases a serious disease like myasthenia gravis.

This is the drug actually used to treat malaria, but in can also be used to treat chronic active rheumatoid arthritis. Taken over a long period it can produce some unwanted symptoms like skin rashes, hair loss or even retinopathy which may result in blindness. Arthritis is a disease which will last for a lifetime. All the medicines used are merely pain relieving and inflammation reducing drugs to be used for years if not life long. The innocent looking tablets are not innocent at all. They give relief in symptoms but do damage to the body. Doctors always balance the two, if disease is too severe and symptoms must be relieved the drug is given inspite of the fact that they know that the drug does harm to the body and many a time the harm is greater than the benefit derived. With the above knowledge of drugs and their side effects we know that it is better to avoid drugs or take them in minimum doses and for the shortest duration to avoid the dreaded side effects.

The most important thing of all is that the treatment must do no harm. So it becomes more important to know what we should do to avoid medicine and what are the alternative methods to get relief or cure. The cure is accomplished by the healing power inherent in the body, itself. One of the most important things to help the body to help itself is food. Wrong food can produce disease and the right food can cure it. Make food, your medicine, Hypocrates said.

During the World Wars I and II acute gouty arthritis was less common in Europe. When dietary proteins again became plentiful the disease returned. In Japan gouty arthritis was rare but now it is competing with Europe, with an increase in the consumption of proteins. Arthritis seems to be more common among people who consume a rich diet.

Most doctors honestly and firmly believe that what you eat absolutely has no effect on arthritis. Yet people who switch on to a milder vegetarian diet are known to find relief. Some doctors have come forward with explanations how certain specific diets may really help almost every one with arthritis.

Amazing effect of low fat diet
Two doctors at Wayne State University in Detroit Michigan made a remarkable discovery while working with obese patients on low fat diet. Two of the group had active rheumatoid arthritis. After just five days on special diet their symptoms of arthritis disappeared and did not return as long as they remained on diet.

"Now I do not believe this diet affects the basic underlying rheumatoid diseases", says Dr. Lawrence Power, co-developer of the diet. However, the body needs fat to produce the intermediary products like prostaglandius that fuel inflammation. You take away the fuel and you take away the inflammation.

Dr. Power and his colleague Dr. Charles P.Lucas have had encouraging results with this diet. It all began with one patient who had arthritis for a long time. Her condition which was critical mostly in hands, cleared up on this diet. After a while she returned to her work routine. The symptoms reappeared, when her diet included fat. Later Dr. Power and Dr. Lucas borrowed 6 patients from a rheumatologist and got the same astonishing result. They are confident that ninety per cent of the patients on special diet will improve.

Nathan Pritikin, the inventor of a diet for the obese watched the improvement in many patients having rheumatoid arthritis, some of them had severe pain in fingers and their arthritis had lasted sometimes for 35 years. He was surprised at the recovery made by an 81-year-old lady with severe deformities in her fingers. Her arthritis in the knee was also bad and she could not walk. After one year of this diet at the age of 85 ? years she entered Senior Olympics and won two gold medals.

Unlike Dr. Power, Pritikin believes that his diet strikes at the disease itself and not just the inflammation. He claims that "the disease is not the misery. Fat and salt are the primary causes with fat the major factor. On a low fat diet, the blood has substantially better circulation. Fat coats the red blood cells so that they cannot get through the small blood vessels. This limited circulation lowers oxygen levels and indirectly destroys certain cells of immune system, and powerful enzymes then leak into the joint. The result is rheumatoid arthritis". Salt, Pritikin explains causes the tissues to become flooded with water which also lessens circulation".

Pritikin says it works on 90 per cent of the people who have arthritis in their hands, fingers and wrists and 50 per cent of all people who have arthritis in their knees and hips. "May be we get it too late after serious joint damage has already occurred," he said. You will know fairly soon if the diet is working. Most people begin to improve in one or two weeks and feel better in two to six weeks.

"It is not a matter of being overweight, but eating too much fat", he warns. Dr. Power also agrees that we love food which is moist, rich and buttery "but we never meant to eat fat the way we do- we were meant to eat it as it is found naturally in whole food". Look at this way. You would have to eat a lot of corn to get one table spoon of corn oil. It is important to adjust your thought about food so that when you are hungry you want an apple instead of a samosa.

Thus if you follow Dr. Power’s line of reasoning you would stop eating fried foods, butter, cheese, whole milk, red meat, pork, most nuts and seeds, cakes and pastries etc. Instead you will prefer cereals, grains, skimmed milk, fruits, salads, vegetables and fish. You will sense the intensity of your arthritic pain going down. It would have nourished you well, aided digestion, unclogged the arteries and slimmed the body. Surely there is no harm trying it.

Allergy and Arthritis
Food allergy plays a great role in rheumatoid arthritis. 80% of people with rheumatoid arthritis are allergic to certain foods. Dr. Marshal Mandell, Connecticut, allergist admits: "Allergic reactions aggravate and perpetuate the swelling, redness, pain and limitation of movement. I am convinced that allergic reactions are the underlying cause of many cases of this form of arthritis. Allergy also plays a role in childhood arthritis and osteoarthritis." Dr. Mandell along with Dr. Anthony Conte, completed a study on 40 patients with arthritis that revealed their arthritis symptoms along with other important chronic ailments were caused by reaction to food frequently eaten or exposure to something in the environment they are allergic to.

"We investigated the relationship between arthritis and allergy in 40 volunteers with arthritis by means of double blind study, where neither the patient nor the doctor knew which substances were being tested on whom. We tested the volunteers for allergies with specially prepared solution of food, house dust, molds, tobacco smoke and petrochemicals. Eighty six percent had symptoms of arthritis – their usually chronic joint and muscle complaints provoked by these allergens (substances that cause allergic reactions), the method of testing we employed was one that actually reproduced the volunteers familiar symptoms. Most had no idea that allergies might be a very important factor in their illness", Dr. Mandell explained.

He adds: "The body’s response to an allergen is complex and can involve arthritis, nervous system disorders, respiratory ailments, gastrointestinal and urinary tract disorders even eye problems. My clinical experience indicates that at least 70 per cent of the general population (about 150 million people) in U.S.A. suffer from some form of internal allergy that is unsuspected, unrecognised, undiagnosed and therefore uncorrectly treated. Each human being has a biologic uniqueness which is going to determine which substances will or will not cause health problems in a particular person. Much depends upon the duration or amount of exposure to allergen, exposure to indoor and outdoor pollution, chemical additives, a personal nutritional state and so on. Some people will react to only one or two substances, others will respond to more than a dozen and some individuals may be allergic to almost every food they eat".

According to Dr. Mandell arthritis could be related to allergy if there is strong family history of allergy, a personal history of allergy or if arthritis improves during fast or illness when you lose appetite. You should also suspect as a culprit if the arthritis gets worse on a certain day of the week, during a particular season, at a particular location, during home activity, after certain meals, after taking an alcoholic beverage or after an obvious chemical exposure.

If you think your arthritis is related to allergy, keep a careful record of your personal observations, noting when the arthritis got worse or what food and other substances you have been exposed to that could have provoked the attack. These observations provide valuable clues to determine the particular offending substance.

Armed with this information you can set about eliminating these problems substances from your life. Unfortunately some of the foods most likely to cause a problem are old favourites that will be missed. "But you do not have to avoid these foods for ever", says Dr. Mandell. After the arthritis is under control, you will be able to eat many of these food items again without any problem, perhaps once every five or seven days.

After staying on your own individualised allergy – arthritis – diet with great success, you may have a flare up. Why? Dr. Mandell suggests that perhaps the diet relied too heavily on a certain food creating a new allergic sensitivity because of an overexposure to a trouble maker. Should this happen do not feel that the entire effort has been wasted. Instead calmly determine which foods might be causing the problem and eliminate them.

Dr. Mandell is not alone in his conviction that there is connection between allergy and arthritis. In England, 20 out of 22 patients with rheumatoid arthritis who followed allergy free diet found improvement in less than 3 weeks. Of the group 7 were sensitive to grain, 8 to nuts and seeds, 7 to cheese, 5 to eggs, 4 each to milk and beef and one each to chicken, fish, potato, onion and liver.

Dr. James Braly, Head of Optimum Health Laboratories in Encino has developed an allergy free diet that has helped several arthritic patients. Dr. Braly used to new and controversial method to find out a patient’s allergy. He has helped several athletes and actor James Coburn of his severe arthritic pain. He calls this test as "cytotoxic food allergy test". A blood sample is centrifused to remove the plasma and white cells. Next, tiny groups of these cells are mingled with individual food concentrates. In theory, if a person is allergic to certain food, this white blood cells should change shape or even rupture after several hours contact with that food sample concentrate.

In "Muscle and Fitness" magazine, he adds" "Within a few weeks of eliminating allergic foods from your diet you notice some drastic changes in your physical and psychological well being. One immediate result is a marked weight loss. Some patients lose upto 10 to 15 lbs. in two to three weeks. This is primarily water that is flushed from the system once the allergy induced inflammation has abated.

He recommends that " a person with arthritis should stop alcohol, stop caffeine, stop tobacco, stop refined sugar, and excess fat, stop food allergens and learn to deal more effectively with mental stress. Moreover I find that exercise is extremely important in treating arthritis. Certain foods called night shades (solonaceae) of a family of foods has been linked with arthritis and rheumatic pain. Norman F. Childers, a retired professor of Horticulture feels that the members of this family commonly used in daily food are tomato, white potato, egg plant, tobacco and all pepper except black (a different family).

The allergic problem that results from eating these foods is a toxic problem, a kind of slow poisoning since 5 to 10 per cent of people are sensitive to these foods. He discovered the relationship between night shades and joint pain on his own, after he stopped eating tomatoes for a time and noticed improvement in his pain and aches in his joints and neck pain. Although he is not a doctor he plunged into medical research by launching a nationwide survey involving thousands of volunteers. Eventually he published a book called A Diet To All Arthritics. The diet is not as easy to follow as it looks because traces of these forbidden fruits are found in many processed foods.

It must be followed for 3 months and often six to nine months before results are observed. If you want to try a diet to relieve your arthritis where do you begin? First make some careful choices. Say, if you have allergies you may try Dr. Mandell’s approach. If you are eating too many fatty foods try Pritikin’s diet and if you can get through a day without tomatoes and potatoes try Mr. Childer’s approach.

There are many health farms spread all over the world. More people are getting attracted to them for an alternative method after prolonged medication. Having known the limitations of medication and its severe side effects or developed allergy to these medicines they seek new options. Some of these health farms are old , new ones are coming up in larger numbers. How do reputed, well established health farms treat their arthritis patients? The stress is on diet but other physical treatments like water treatment, exercise and relaxation are also added to the routine.

Vita Nora an extremely well located health farm in Sweden, has a 3-storeyed villa on the steep slope of Kulla hill overlooking the sea, a narrow strip of sea which separates Sweden from Denmark. It accommodates only 50 patients. The dining table is huge and placed in a room with a breathtaking view of the sea. Salads of different types, buttermilk, cottage cheese, baked and boiled potatoes, vegetable soup and protein-rich assortments made from soyabean.

Their arthritis patients are given raw foods which includes fruits, salads, sprouted beans, nuts. A small portion of cooked food would include boiled or baked potatoes and vegetables soup with a small quantity of butter milk, curd from skimmed milk. Butter and ghee are drastically cut down. Generally, non-vegetarian foods are avoided. Even a small portion of fish or meat is given with a lot of boiled vegetables and salads. At their farm they grow fruits using organic manure and using minimum insecticides. Today, "to grow more food" we are using much larger quantities of fertilizers and deadly insecticides. A small quantity of these chemicals often enter the food grains, which is not healthy for our bodies.

The world famous Bircher-Benner Clinic, in Switzerland, excludes all cooked food during the first phase of treatment for the first one or two weeks. The diet is chiefly of raw nuts, sprouted grains, fruits, salads and small quantity of milk. After the second week foods are added like soups, boiled vegetables, potato boiled or roasted and whole wheat bread. Then comes milk, butter milk, curd and small amounts of cheese. Refined food like sugar, white flour are avoided as also overcooked, canned or frozen foods. The food should be easy to digest and provide nutrients for the repair.

The patients are not allowed to smoke, imbibe alcohol or coffee. In general they avoid all animal foods like meat, fish, eggs, milk, butter and cheese. In chronic cases needing a more vigorous treatment, they are advised to undertake a small fast. The fast is normally short and is followed by a special cleansing diet. If need be, these fasts can be repeated. In a few healthy people they can be prolonged for a week or ten days.

I have been treating patients of arthritis in our Health Farm at Gorakhpur and also at the clinic in Bombay. In gorakhpur we keep indoor patients. It is much easier to regulate the diet in a health farm and also carry it through as group therapy. At gorakhpur, we generally give one seasonal fruit (say of 250 gms) for breakfast. At 12 noon the patients get a whole wheat chapati, 2 green vegetables, salads and a small quantity of curd. In the afternoon one glass of carrot or sweetlime juice. The food at lunch is similar to that given for dinner. Nuts, resins or whole pulse sprouts can be added at breakfast. The patients also get water treatment, are advised to do walking and exercises as much as their health permits. Many mild cases respond to this treatment. Sugar, white flour, tobacco, alcohol and coffee are completely avoided.

In a few obstinate cases fasting is prescribed. These are short fasts which last 3, 5 or 7 days. Gradually they are brought to normal diet. I have observed that a patient who had taken steroids for a prolonged period was difficult to treat. Steroids are known to suppress the immune system of the body. Health farming depends more in activating the immune system.

In a majority of cases cutting down sugar to one teaspoonful a day and adding a lot of salads and fruits is good enough. In early cases two months are enough. In chronic cases the diet should continue for a longer period, may be 6 months or one year. Little milk or curd can be added to make the food more palatable and nutritious. Cut down on alcohol, cigarettes and coffee as much as you can.

Patients with higher ESR, Uric Acid or blood sugar levels take longer to respond. When a patient is put on the prescribed eliminative diet the elevated ESR, uric acid and blood sugar level tend to fall. If these tests are repeated after one or two months a marked difference can be noted. Diet is important, though medical science cannot still conclusively decide what role it plays in arthritis. It is a little tricky and needs to be adjusted individually. Some foods to which patients are allergic should be eliminated. A careful study of a person’s response to a particular diet will need to be studied before discovering the optimum diet for an individual.

Water Treatment
Water forms the major portion of the body, with each of the hundred trillion cells filled and bathed with it. It is the basis of our blood and our tears. Humanity has recognised some what mystical qualities in water and they realise that it does more than simply quench thirst.

Doctors and health professionals abroad recommend water therapy. It is economical, effective, has no hidden side effects and it works.Hydrotherapy, apart from its pain relieving quality, can also prevent deformity and improve joint function. However this treatment does not work like a miracle drug. Two hot water treatments and you are cured is really not true. Hydrotherapy needs some time and committed effort. The experience is pleasant and rewarding and, actually, you will look forward for each treatment.

Hydrotherapy is being used in a big way. In hospitals abroad they use a contraption known as Hubbard Fank, shaped like the figure eight, with pulleys straps and levers that lower the patient in and out of water. The treatment is simple and can be done in comfort at home. There is no need to buy special equipment. All you need is two buckets, two basins, or a bath tub.

Fill up the bath tub with hot water. With a special thermometer measure the water temperature. Keep the water temperature a little higher than the body temperature say between 100-102F. It should never be higher than 104F. Otherwise the body will not be able to throw out enough of its own heat. This can give rise to hyperthermia – a kind of under water heat prostration.

It would be nice to fill the tub each day with some marvellous elixir like that from a mineral spring or a hot spring spread all over India like the one in Vajreshwari near Bombay, or Sohna (Gurgaon) near Delhi. But most of us cannot afford to get this spring water. Instead use just whatever comes out of the tap.Once in the bath tub plan to stay there for 20-30 minutes.

When the body is submerged in water, it loses weight as much water as it displaces. If you displace 45 litres, the weight is around 40 kgs. Like astronauts circling the globe you will be relatively free from gravity. The limbs can float, the joints can be moved more freely than while lying in bed. It will be a nice feeling to know that the old joints can still work. It will heighten you spirits. A rheumatologist advised his patients. "Exercise your lower back, knees, hips, ankle and wrists. There may not be enough space in your bath tub to move your shoulders or elbows".

At the spa in Baden Baden, West Germany, they have tiny jets of carbon dioxide that shoots into the tub through tiny pin holes. The carbon dioxide gathered gives a special tingling sensation to the body. There is no need to go to Baden Baden. Any health club can provide these facilities in a tub fitted with a whirlpool.

The exercise in the bathtub will pay rich dividends. You will feel that your joints are opening up, the pain is reducing and the muscles getting toned up. The flexibility will increase almost every day. You will be able to perform these motions once you thought impossible. You will feel a lot better in a week to 10 days.

You can try these in a swimming pool too. With hydro-gymnastics, you can work your entire body. It will gain a large range of health benefits like preventing muscle wasting. It will tone up muscle strength, balance and co-ordination. You can swim if you know swimming, wear a swim belt if you like. You need a willing partner to support your back and hips so that you can make circles with the legs and arms or to hold you by shoulders so that you can do spine stretches. The idea behind moving around and having fun is fruitful. But do not overdo, ask your doctor if you are in doubt.

Baggie Therapy for pain
The new and latest breakthrough is by doctors at the German town Philadelphia, Pennsylvania, who have found that the arthritis pain can be killed with a baggie full of ice. For those who do not help through the usual heat treatment this might be the answer.

At this clinic, 24 patients applied this treatment to sore knees, three times a day for 4 weeks and all agreed they had experienced improvement. They had no pain. The movement was free and there was muscle strength. Those who undertook this treatment could stand up faster, sleep better and best of all could cut down their doses of medicine to half.

This is the treatment, in a nutshell. Using 2 large baggies, you fill each of them with six cubes of ice and half a litre of water. Put one on top of the sore knee and one below. Wrap it with a towel and keep it for 20 minutes. Do it three times a day at evenly spaced intervals. You may feel uncomfortable for a little while. This feeling lasts for 5 minutes then anaesthetic effects set in. At the end of the treatment you feel great. The German town patient, used baggies only on one knee even if they had arthritis in both the knees. Even though it was applied to only one knee, patients said it made both knees feel better. Peter D.Utsinger, who headed the research team says this unexpected benefit may not be just the power of suggestion, but something purely physical. This is why one of several effects produced by the cold therapy is an upsurge in the body’s level of endorphines. These are the natural chemicals that circulate in the body and actually numb pain. It is quite possible that endorphines relieve pain in both legs and convincingly anywhere else in the body.

Exercise is one of the most important therapies. It helps to regain flexibility and strength. Exercising, with the onset of arthritis, can be really painful. Should one exercise if there is pain? Pain in the nature’s way of telling us to stop doing something harmful. Sure the old saying is generally true, but not absolutely true in the case of arthritis. The arthritic joints you must keep moving, preferably through the full range, to prevent them from freezing up and to prevent muscles from wasting. Many a time these motions hurt but most doctors will agree that you must move the arthritic joint. Push it just a little past the point of discomfort during the work out. If the pain persists over two hours after you have finished the exercise it will mean you have pushed a little too hard. Reduce the pressure when you do it the next time. You will be surprised as the days and weeks pass by. Keep on exercising, the range of your joint movements will go on increasing slowly but surely.

The movement and pain are inversely related. As you increase the movement, the pain keeps on reducing. The cartilage in the joints does not have its own blood supply and for it there is only one way to get the nourishment and that is through synorial fluid and the only way synorial fluid can enter the joint is by doing exercises. Without movement the synovial membrane gradually adheres to the joint cartilage, eventually it obscures the synovial fluid reaching the joints. The cartilage cannot survive without nutrition for long and it degenerates.

Exercises are not only good for you, but they are (or soon will be) a source of real fun. There are a lot of items to choose from yoga, dancing, stretching, sports or just plain movements. This will depend more on your personality than the type of arthritis you are suffering from. The aim is to improve flexibility, increase the strength of the muscles surrounding the joint, so that you do not need the external support and you increase your endurance.

A word of caution. Do not use painkillers when you are exercising. They too easily mask the pain, so that you unwittingly damage the joint by pushing it too fast or too hard.