Friday Favorites: Fasting for Rheumatoid Arthritis and Autoimmune Diseases

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Fasting is put to the test for a number of diseases. Does it help? Watch the video to find out, and then check the doctor’s note below for other videos on the topic.

Alan Goldhamer is the founder of the TrueNorth Health Center in Santa Rosa, California, which has fasted 10,000 people for conditions ranging from diabetes and cardiovascular disease to autoimmune diseases. He noted that conditions that seem to be tied to dietary excess tend to respond predictably to the use of fasting followed by a health-promoting diet, which he describes as a low-salt, all-plant, high-fiber, low-fat, low-protein, and low-sugar diet.

This approach offers people an option to eliminate the cause of lifestyle diseases, often to the point where the medication is no longer needed, in contrast to conventional medicine, which is more about the suppression of the symptoms associated with the disease rather than removing the underlying root cause.

Goldhamer put it this way: If you treat high blood pressure or type 2 diabetes or autoimmune disease medically, they’ll tell you, “You’ll be on these medications the rest of your life.” That’s them in effect promising you, if you follow their advice to the letter, “you will be sick the rest of your life.”

Preliminary data suggests fasting may benefit metabolic diseases, pain syndromes, high blood pressure, chronic inflammatory diseases, allergic diseases, and psychosomatic disorders, but the highest level of evidence we have for the benefits of fasting are in regard to rheumatic diseases: autoimmune inflammatory joint diseases, like rheumatoid arthritis.

Nearly a century ago, it was written that “diet treatment is not generally recognized by the medical profession…as one of the weapons with which to attack [such diseases].” This attitude persisted until relatively recently, but a systematic review of controlled trials has since “shown a statistically and clinically significant beneficial long-term effect.”

Rheumatoid arthritis has a well-known genetic component, but the concordance rate, the chance that a pair of identical twins both get it when one has it is probably under 30 percent, despite having the same genes––leaving 70 percent to be explained by nongenetic factors.

Even if we don’t know exactly what those factors are, “fasting [has been compared] to rebooting the hard drive in a computer. Sometimes, the [drive] gets corrupted and you don’t know exactly where the problem is. But if you just turn it off and reboot it,…that corruption [may get] cleared out.”

The evidence base started with case reports, fasting followed by a plant-based diet, remarkable reports of years of pain and stiffness… gone within a week, and, more importantly, stayed gone on the healthier diet. One after another like that, but case reports are just glorified anecdotes. There have been studies going back decades suggesting fasting may represent the most rapid, available way to induce relief of arthritic pain and swelling for patients who have rheumatoid arthritis. But the studies often failed to have control for the placebo effect, which is especially important when it comes to relying on self-reported subjective symptoms, such as pain and general well-being. But there are objective measures, lab tests of inflammation that don’t appear to be affected by placebos, and that’s what you can see in controlled trials, starting immediately and remaining down for at least a year.

Ten different measures of inflammation significantly decreased after the fasting and subsequent meat- and egg-free diet, whereas none of the parameters budged in those disease victims that continued to eat their regular diets. And this squelching of inflammation translated into a significant reduction in pain, morning stiffness, loss of grip strength, and number of tender and swollen joints.

Even a year after the trial was over, those who benefited from the diet continued to benefit in terms of pain, stiffness, and tender and swollen joints, presumably because they stuck with it. There is little doubt that while fasting both inflammation and pain are relieved. But if you go back to the same diet you were on before, the inflammation returns—unless, evidently, the fasting period is followed by a vegetarian diet. Why might that be? It could be due to changes in the microbiome; the improvement in symptoms coincided with a significant alteration of the intestinal flora, which may somehow be beneficial––perhaps by strengthening the gut barrier. We know fasting can decrease the leakiness of the gut in rheumatoid arthritis patients, but we don’t yet know what role, if any, this plays in the disease process.

It could be as simple as eicosanoids, the mediators of inflammation that are formed from arachidonic acid. Arachidonic acid is a long-chain inflammatory omega-6 fatty acid found in animal fats. The biggest contributors are chicken and eggs, which together contribute nearly half of American intake. That’s been suggested as an explanation of why those eating more plant-based appear to have better mental health; they’re not suffering the “cascade of neuroinflammation” caused by arachidonic acid; why removing eggs, chicken and other meat was shown in a randomized controlled trial to improve mood, suggesting the arachidonic acid might be negatively impacting mood states, and may help explain the impact of more plant-based diets on inflammatory diseases like rheumatoid arthritis.

So, that may help explain why maintaining a plant-based diet appears to be necessary “after the fast to prevent the recurrence of symptoms and inflammatory activity,” or, as one popular press article put it, fasting may just be a tool to get you to radically kickstart a change in the way you eat.

The strongest evidence of the benefits of fasting surrounds the treatment of an autoimmune joint disease known as rheumatoid arthritis, as I detailed in my last video. There was a German study suggesting benefits for osteoarthritis as well, with reported improvements in pain and joint function. But we’d really need randomized controlled studies to know for sure. The researchers despair that they only had 30 patients, but that’s 30 times more than many reports on fasting in the medical literature, which may detail only single cases.

For example, a woman with a rare autoimmune disease known as mixed connective-tissue disease, which can cause all sorts of painful and distressing symptoms, treated with steroids in an attempt to suppress her immune system; but 21 days later, off her medications, her symptoms improved with fasting and, more importantly, seemed to stay away. So, does fasting work for mixed connective-tissue disease? Well, all we can say is that hey, at least it worked at least once.

A similar success story was reported with fibromyalgia: a woman with pain throughout her body, couldn’t sustain activity, on lots of drugs, but ended up symptom-free 24 days later, and remained that way at least a month later. But when a modified fasting regimen was tried on dozens of individuals, the benefits seen at two weeks largely disappeared by week 12.

What about lupus? A 45-year-old woman remaining in pain despite her immunosuppressive drugs, but pain-free by day four of fasting, and remained symptom-free for one year, before wiping them out again with a second fast. Now, note this wasn’t just fasting, but fasting followed by a plant-based diet in an attempt to solidify the gains. And a strictly plant-based diet—zero animal protein—alone has been shown to control symptoms in at least some cases.

The same with sacroiliitis, a common manifestation of ankylosing spondylitis, an autoimmune arthritis that primarily affects the spine, causing back pain that can last for years. They tried all sorts of conventional therapies and drugs, but the pain still didn’t go away. So, they tried recommending the complete avoidance of animal foods, and saw distinct persistent improvement within days—until he ate meat again. But back on plant-based nutrition, he was off most of his drugs, almost completely free of symptoms. So at least in this case, inflammatory pain refractory to other treatment was abolished by eating healthier; so, hey, at least it’s worth a try.

Autoimmune glomerulonephritis, where your body attacks your own kidneys, is a common manifestation of lupus. In a case series of 29 patients who were fasted for 60 hours and then just put on fruits and vegetables until they got better, described such remarkable recoveries that fasting, in their opinion, “should be an essential part of treatment.”

What about multiple sclerosis, an autoimmune nerve disease?  Sufferers were randomized to a “fasting mimicking diet,” meaning a modified fast that started out with an 800-calorie-a-day diet of fruit, rice, or potatoes, and then they spent a week sipping a few hundred calories of flaxseed oil and vegetable broth before transitioning to a plant-based Mediterranean diet. Over the next three months, they experienced a significant improvement in overall quality of life. They also tried a ketogenic diet, but that failed to offer clinically or statistically significant overall benefit.

And finally, chronic urticaria (hives), where you get a rash of itchy weals and welts, started to improve on day three of the fast, and completely disappeared by day 11. This is consistent with studies out of Germany and Japan that evidently showed around a 75 percent effectiveness for such patients with what looks like some sort of tea-with-sugar diet. It’s certainly worth giving fasting therapy a try, but of course fasting should only be done under trained medical supervision. Otherwise, you’d never know if you have some hidden underlying kidney issue that could land you in a coma and then in the morgue. You have to have your kidney function and electrolytes monitored to make sure your body is up for the challenge.

“Despite the [potential benefits,] water-only fasting is…not a cure or treatment in the traditional sense; it is simply intended to promote the body’s self-healing mechanisms.” Since, by definition, fasting is unsustainable, “in order to maintain the results obtained by water-only fasting, it is necessary to adhere to a health-promoting lifestyle that includes a [healthy] diet of minimally processed plant foods, …sleep, and …exercise.”

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• Gustafson C. Alan Goldhamer, dc: Water Fasting-The Clinical Effectiveness of Rebooting Your Body. Integr Med (Encinitas). 2014;13(3):52-7.
• Goldhamer A, Helms S, Salloum TK. Chapter 37 fasting. In: Pizzorno J, Murray M, eds. Textbook of Natural Medicine. 4th ed. Churchill Livingstone; 2013.
• Wilhelmi De Toledo F, Buchinger A, Burggrabe H, et al. Fasting therapy - An expert panel update of the 2002 consensus guidelines. Forsch Komplementarmed. 2013;20(6):434-43.
• Hare DC. A Therapeutic Trial of a Raw Vegetable Diet in Chronic Rheumatic Conditions: President’s Address. Proceedings of the Royal Society of Medicine. 1936;30(1):1-10.
• Müller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001;30(1):1-10.
• Kjeldsen-Kragh J. Rheumatoid arthritis treated with vegetarian diets. Am J Clin Nutr. 1999;70(3):594s-600s.
• Fuhrman J, Sarter B, Calabro DJ. Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune disease. Altern Ther Health Med. 2002;8(4):112, 110-1.
• Palmblad J, Hafström I, Ringertz B. Antirheumatic effects of fasting. Rheum Dis Clin North Am. 1991;17(2):351-62.
• Porter DR, Capell HA. The 'natural' history of active rheumatoid arthritis over 3-6 months--an analysis of patients enrolled into trials of potential disease-modifying anti-rheumatic drugs, and treated with placebo. Br J Rheumatol. 1993;32(6):463-6.
• Kjeldsen-Kragh J, Borchgrevink CF, Laerum E, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. The Lancet. 1991;338(8772):899-902.
• Kjeldsen-Kragh J, Mellbye OJ, Haugen M, et al. Changes in Laboratory Variables in Rheumatoid Arthritis Patients During a Trial of Fasting and One-year Vegetarian Diet. Scand J Rheumatol. 1995;24(2):85-93.
• Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Førre Ø. Vegetarian diet for patients with rheumatoid arthritis - Status: Two years after introduction of the diet. Clin Rheumatol. 1994;13(3):475-82.
• Longo VD, Mattson MP. Fasting: Molecular Mechanisms and Clinical Applications. Cell Metab. 2014;19(2):181-92.
• Peltonen R, Kjeldsen-kragh J, Haugen M, et al. Changes of faecal flora in rheumatoid arthritis during fasting and one-year vegetarian diet. Br J Rheumatol. 1994;33(7):638-43.
• Sundqvist T, Lindström F, Magnusson K-E, Sköldstam L, Stjernström I, Tagesson C. Influence of Fasting on Intestinal Permeability and Disease Activity in Patients with Rheumatoid Arthritis. Scand J Rheumatol. 1982;11(1):33-8.
• Wang D, DuBois RN. Urinary PGE-M: A Promising Cancer Biomarker. Cancer Prev Res. 2013;6(6):507-10.
• Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc 2010 Oct;110(10):1477-84.
• Beezhold BL, Johnston CS, Daigle DR. Vegetarian diets are associated with healthy mood states: a cross-sectional study in seventh day adventist adults. Nutr J. 2010;9:26.
• Beezhold BL, Johnston CS. Restriction of meat, fish, and poultry in omnivores improves mood: A pilot randomized controlled trial. Nutr Journal. 2012;11:9.
• Marcus B. How the Terrible, Insufferable Six-Day Water Fast Made Me a New Man. GQ. November 2013.
• Schmidt S, Stange R, Lischka E, et al. Unkontrollierte klinische Studie zur Wirksamkeit ambulanten Heilfastens bei Patienten mit Arthrose. Forschende Komplementärmedizin / J Complement Med Res. 2010;17(2):87-94.
• Michalsen A, Li C, Kaiser K, et al. In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy. Evid Based Complement Alternat Med. 2013;2013:908610.
• Shigemasa C, Tanaka T, Mashiba H. Effect of vegetarian diet on systemic lupus erythematosus. The Lancet. 1992;339(8802):1177.
• Huber R, Herdrich A, Rostock M, Vogel T. Klinische Remission einer HLA-B27-positiven Sakroiliitis unter veganer Kost. Forsch Komplementärmed Klass Naturheilkd. 2001;8:228-31.
• Brod J, Pavkova L, Fencl V, Hejl Z, Kratkova E. Influence of fasting on the immunological reactions and course of acute glomerulonephritis. Lancet. 1958;1(7024):760-3.
• Choi IY, Piccio L, Childress P, et al. A Diet Mimicking Fasting Promotes Regeneration and Reduces Autoimmunity and Multiple Sclerosis Symptoms. Cell Reports. 2016;15(10):2136-46.
• Okamoto O, Murakami I, Itami S, Takayasu S. Fasting Diet Therapy for Chronic Urticaria: Report of a Case. J Dermatol. 1992;19(7):428-31.
• Norbury FB. Contraindications to Long-Term Fasting. JAMA. 1964;188(1).
• Sievers ML, Hendrikx ME. Letter: Therapeutic starvation. Br Med J. 1974;3(5929):524-5.
• Myers T, Goldhamer A. Clinical fasting. Sonoma Medicine (Summer 2017):25-8.

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