About the Author

Photograph by Louise Rose Photography

Emily Johnson launched the Instagram page @arthritisfoodie in September 2018 after struggling with seronegative arthritis for five years. The page has since gained more than 10k followers, with people looking to Emily for inspiration on living healthily with arthritis. Emily also works in marketing and is a social media influencer.

To the other two people who make our three musketeers:

my mum and sister.

BEAT ARTHRITIS NATURALLY

Supercharge your health with 65 recipes and lifestyle tips from Arthritis Foodie

Emily Johnson

www.yellowkitebooks.co.uk

The information in this book is not intended to replace or conflict with the advice given to you by your GP or other health professional. All matters regarding your health should be discussed with your GP or other health professional. The author and publisher disclaim any liability directly or indirectly from the use of the material in this book by any person.

First published in Great Britain in 2021 by Yellow Kite

An Imprint of Hodder & Stoughton

An Hachette UK company

Copyright © Emily Johnson 2021

Logo by Kate Larsen Design & Illustration

The right of Emily Johnson to be identified as the Author of the Work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition being imposed on the subsequent purchaser.

A CIP catalogue record for this title is available from the British Library

eBook ISBN 978 1 529 34770 8

Yellow Kite

Hodder & Stoughton Ltd

Carmelite House

50 Victoria Embankment

London EC4Y 0DZ

www.yellowkitebooks.co.uk

Contents

About the Author

Foreword

Introduction

1. All About Arthritis

2. Anti-Inflammatory Essentials

3. Avoiding Inflammation

4. Putting A Plan In Place

5. Your 65 Tried-and-True Recipes

• Breakfast

• Small Plates

• Large Plates

• Desserts, Snacks and Treats

• Drinks, Juices and Smoothies

• Sauces, Sides and Dips

6. Pain Management

7. Make a Move

8. Rest and Sleep

9. Be Kind to Your Mind

A Final Word

Worth a Read

Additional Resources

Acknowledgements

References

Conversion Chart

Index

Foreword

Emily Johnson is the founder of Arthritis Foodie, the international health and lifestyle blog dedicated to living well with arthritis. Bringing together numerous health practitioners, including me, Beat Arthritis Naturally provides you with vital information you need to know about your arthritis, helping you to make the lifestyle changes required to manage life with your condition, and improve and possibly beat the pain and symptoms.

As a rheumatologist, I see all types of patients with rheumatic diseases at varying stages, including autoimmune diseases and chronic inflammatory conditions. The manifestation of arthritis is a spectrum, and every individual may experience the condition differently. One common thread is that it can feel that the arthritis is happening to you, and that you have no control. But this is not the case. With the tools in this book, you have the means to make a difference to your mental and physical wellbeing – no matter how big or how small.

With lifestyle changes and lifestyle medicine, there is the potential to reduce your symptoms alongside your medication. One patient who had rheumatoid arthritis completely cut their dairy intake and saw an improvement while on medication, before trying a wholefood plant-based diet that led to them stopping medication completely. And a psoriatic arthritis patient saw their psoriasis and arthritic symptoms improve on a wholefood plant-based diet. These are just two examples, and while not everyone may want to go fully plant based (fatty fish, for instance, has vital anti-inflammatory properties), cutting down on highly inflammatory processed foods will help.

Food is not the only anti-inflammatory component in this book; nutrition, sleep, exercise and emotional wellbeing all play a role too. And in order to decrease inflammation we need to work on these factors, which are the foundations of Beat Arthritis Naturally and intertwined in Arthritis Foodie, by Emily.

Bringing this book into the world is the realisation of Emily’s purpose behind Arthritis Foodie: to help people living with arthritis to feel better – with their arthritis and about having their arthritis. The book joins together Emily’s personal experience of arthritis, scientific research and expert advice to fulfil her mission for the world to beat arthritis naturally.

Dr Micah Yu

Integrative rheumatologist at Dr Lifestyle,

Orange County, California

Introduction

You, your body and your life are at the mercy of your arthritis, and it has the control. But starting from today, it is time for you to take that control back. Rather than, ‘I suffer with arthritis’, say, ‘I live with arthritis’. Say it out loud: I live with arthritis. It is a part of your life; you live with it and you can learn to live alongside it – you can beat arthritis by taking control. You can live with arthritis, talk about it and feel better in your body and mind by understanding it, and doing something about it. You are at step one already, reading this book. You are willing to transform your life by living with your arthritis in a new way.

There are, in fact, 100 types of arthritis and musculoskeletal conditions, affecting an estimated 350 million people globally. And many of those who are living with a form of arthritis are under 35 years old. Yet when you say the word ‘arthritis’, more often than not, people conjure up the stereotype of somebody elderly.

Arthritis can happen to anyone at any age, whether they are a 4-year-old, a teenager, a young adult or a grandparent. If you are not elderly when you notice the first signs or symptoms of arthritis, it can be hard to recognise – even for your GP – because of a widespread lack of awareness and understanding of the condition. And it is not just creaky joints either, with symptoms such as joint pain and swelling, stiffness, difficulty or restriction of movement, fatigue and poor sleep.

Living with pain is not easy. There are good days and bad days, but every day the arthritis is there. Currently, there is no cure for arthritis, and it can leave you feeling helpless, depressed and far from in control of your own body. The intention of this book is to enable you to take action. It’s your chance to control your attitude towards your body and how you treat it – because who is living inside of it? Nobody but you. You are the one to make it a better place to live in, and to live with your arthritis.

Think about it this way. If you have to live with someone every day, 365 days, 24 hours, 1,440 minutes and 86,400 seconds of the day, actively and angrily wishing that person would leave is fine up to a point, but mentally exhausting if you do it every day. Isn’t it easier to be friends with them than to make them an enemy? Isn’t it easier to try to understand them than to ignore them? Isn’t it better to make life with them the best it can possibly be? Making peace with your condition and learning everything you can to live better with it – beating it naturally – is about taking control of your body and your mindset. Your arthritis is not about to miraculously disappear – there is no magic potion, superfood smoothie or overnight therapy – but with the many strands of health and lifestyle improvements and advice in these pages, it can get quieter.

Will Lifestyle and Food Cure My Arthritis?

The short and truthful answer is no – not on their own. There is no evidence that they will cure the disease; so far, they have not cured mine – but what they have done is help me to manage my symptoms and live more healthily and happily alongside it.

As ‘Plant Power Doctor’ Dr Gemma Newman says:

Arthritis has a common denominator, inflammation, so taking the time to naturally reduce your inflammatory markers is a way to relieve your symptoms and manage your condition. Eating anti-inflammatory foods, with a healthful plant-based diet, can be done alongside any treatment you may be receiving from your rheumatologist and should not be thought of as a replacement, but rather an augmentation of medical therapy from which to reduce need for medications if possible.

Exercise is anti-inflammatory, and it too is essential – even when you have an active disease, as you will see in Chapter 7. Add a lack of movement to poor diet and you have a recipe for being overweight, resulting in more inflammation and even less enthusiasm for physical activity. A decline in mental health can also often be a symptom of living with a chronic condition (who wouldn’t struggle mentally when waking up in pain every day?) and new research has discovered a direct connection between depression and inflammation (see Chapter 9). The pain of the condition (see Chapter 6), plus the snooze-inducing-medication, general fatigue and lack of sleep really are exhausting (see Chapter 8). And food influences mood too, as both your brain and immune health are derived from your gut. It’s evident that we must be mindful of what we eat (see Chapter 2–5) and how we look after ourselves in the long term.

Who has contributed to this book?

The book draws content from leading researchers, doctors and experts, and has had direct support in certain areas from the following contributors:

Dr Micah Yu, Integrative Rheumatologist at Dr Lifestyle, Orange County, California

Victoria Jain, ‘The Autoimmunity Nutritionist’, Pilates instructor, BSc in biochemistry with immunology

Professor Paul Emery OBE, Versus Arthritis, Professor of Rheumatology and Director of the NIHR Leeds Biomedical Research Centre

Dr Lauren Freid, Rheumatologist Clinical Instructor of Medicine, UCLA

Steve Haines, chiropractor and author

Zoe McKenzie, ‘Actively Autoimmune’, physiotherapist, personal trainer, gym and Pilates instructor

Dr Jenna Macciochi, immunologist, author of Immunity, lecturer at University of Sussex

Dr Gemma Newman, ‘Plant Power Doctor’, author and GP

Dr Rupy Aujla, ‘The Doctor’s Kitchen’, author and GP

Raj Vara, pharmacist for over 40 years, superintendent pharmacist at Husbands Pharmacy, one of the oldest in London

What About Scientific Research?

Where there is research available, I have deciphered it and worked it into something more digestible. Despite a large proportion of this leaning towards RA, OA, PsA, AIDs (autoimmune diseases) and chronic inflammation, I have tried to achieve a balanced view on the condition and how we can all live better alongside it. For references, please see p. 269.

Will I Need to Remove Any Food Categories From My Diet?

With food, there is no one-size-fits-all, and where some people may find they react negatively to a particular substance, others may not. Rheumatologist Lauren Freid encourages patients to become interested in diet and to be as informed as they can be about anti-inflammatory and pro-inflammatory foods (more on these later) – she also advocates for a wholefood, plant-predominant diet, with an avoidance of processed foods.

It’s also important to remember, though, that food is the foundation for many social interactions, which support emotional and mental wellbeing. It is essential to learn how to eat for your body and your arthritis, so that you can continue to enjoy food and allow it to bring you together with others. Celebrity personal trainer Nicola Addison explains that an 80/20 rule is a helpful approach, meaning that we make healthy choices 80 per cent of the time (accepting that we cannot always be perfect) regarding exercise, sleep, managing stress and alcohol intake.

So, never feel guilty for wanting to enjoy a moment with family or friends, at Christmas or on social occasions. Tracking if or when you notice changes is important, to be able to be mindful of the effects in the future (more on this in Chapter 4), but I must emphasise that this is personal. You know your body better than anyone else.

Should I Consult My GP or Specialist Before Implementing Changes?

Beat Arthritis Naturally is simply about taking back control of your health through natural means, but if you have any concerns about the contents of this book and you are unsure as to how it may impact any underlying health conditions that you have, please consult your medical professional – either your GP or specialist (a rheumatologist, for example). This book is by no means a replacement for your current therapy, so please do not stop taking your prescribed medications unless advised to do so by your medical specialist.

With the support of expert advice from leading researchers, doctors, rheumatologists, immunologists, nutritionists, physiotherapists, pharmacists and other health experts, Beat Arthritis Naturally will give you the confidence you need to live a healthier and happier life. This book is your time to listen, learn and absorb a new approach to managing and living with arthritis – find all the time you need to take it in.

This is not a book you read once, then leave on the shelf.

This is not a book you use as a doorstop or decoration.

This is not a book you forget about.

Beat Arthritis Naturally is the book you read over and over again. It’s the book that gets a little messy with every recipe you make; the book you dip into before bed to remind yourself of an exercise sequence, pain relief or sleep remedy. It is your map, your manual and your motivation. Turn down the page corners, sticky-note your favourite parts, scribble and highlight the sentences you will return to. Love – and learn from – this book: it will be with you on your journey to living better with arthritis, every step of the way.

1
All About Arthritis

‘Anything that’s human is mentionable, and anything that is mentionable can be more manageable.’

Fred McFeely Rogers, American TV host and producer

How did I end up here, writing this book for you? Perhaps it would be a good starting point for you to know a bit about Arthritis Foodie.

Your genetics hold the bullets in the gun, but your environment pulls the trigger. My environment was a friend’s barbeque, summer 2013. I was run-down, having taught in Italy as a tutor for six weeks without a break, and my immune system was crying out for rest, vitamins, hydration and good gut bugs. Instead, what I gave it was exhaustion, dehydration in the form of alcohol and food poisoning. While I am not completely certain that I can pinpoint the demise of my immune system to this particular day, it had previously had one blip when I was 4 years old and I was hospitalised for a week with swollen knees. That was definitely the start of living with arthritis.

Eating and drinking whatever I pleased from that barbeque buffet – including processed meats and starchy white bread – I bit into food poisoning that lasted over a fortnight. Shortly after, my ring finger on my right hand swelled up like a balloon on the verge of popping (which I now know was dactylitis – see p. 18). As I returned to university for my final year, more than one finger began to swell and my thumbs too. My skin was so painful to touch and I could not sleep (or talk) for sneezing. These symptoms remained for months, becoming progressively worse, but I explained them away as ‘a bit of hay fever’, ‘a cold’ or ‘freshers’ flu’.

But I was in a state of chronic inflammation and – although I didn’t know it at the time – it was an autoimmune disease. The thing with autoimmune diseases is that they are not easily explained with a quick diagnosis, speedy recovery, easy medicinal solution and voila! You are better. Rather, they are drawn-out processes, affecting mind and body, as you are dragged through consultation rooms, hospital corridors and departments, prescribed a myriad painkillers and medications, probed, poked and prodded like a pincushion. Sitting in hospital waiting rooms becomes normality. And since starting the Arthritis Foodie community and speaking with so many of you, it is clear to me that there is rarely a fast diagnosis or a treatment that works straight away.

Eventually, I was sent to a rheumatologist who, at the time, proposed that the pain was ‘all in my head’, which I now understand to be a form of medical gaslighting: a healthcare professional downplays or denies the symptoms you know you are experiencing, and instead tries to convince you that they are caused by something else, or that you are imagining them. Over the course of two years, my diagnosis went from fibromyalgia to reactive arthritis, before finally – and permanently – landing on ‘seronegative arthritis’, described as being in between rheumatoid arthritis and psoriatic arthritis. I tried all kinds of medications – steroid injections, naproxen, sulfasalazine – all with little to no effect. By Christmas 2015, after four months of gradually increasing the dosage, I was taking 20mg of methotrexate (an immunosuppressant drug) weekly, 5mg of folic acid five times a week (to help protect the healthy cells in my body) and having biweekly blood tests to monitor my liver function.

But my arthritis was not me; it was separate from me. It felt like a squatter was living in my home, causing damp and cracks in the walls, spoiling what I thought my life should ‘look like’ and ‘be like’ as a young person. So, I hid it. I painted over the damp and plastered over the cracks. I hid it from everyone and even tried to hide it from myself. Desperate to be ‘normal’ – and by ‘normal’, I mean my normal and living like I would have done before my arthritis – I pushed myself and my body to its limits, even when I knew I would suffer for it. And believe me, I always suffered for trying to keep up, frequently ill with flu-like symptoms. Regularly, I would still go into work when I should have been in bed because I was so worried about losing my job, or being judged, or being seen as incapable compared to my picture-of-health colleagues.

When taking methotrexate, your alcohol consumption is limited to the national guideline recommendations of 14 units spread out during the week, but at 22, I felt the unspoken social pressure to ‘join in’. I became accustomed to pouring drinks away or ‘losing them’. I confided in a friend about my condition and he would discreetly drink them for me. It was amusing to see him become more inebriated than he had intended to be, until I started to get some of the blame for his hangovers. Now I no longer feel the pressure to drink, so I don’t, and I am happy to say why, but it has taken time to get here. Never apologise to people, society or the world for doing what is right for you.

The swelling in my hands began to reduce and the pain subsided too, but when you have arthritis, you cannot ever sit back, relax and think that it has gone. You know that’s not possible, so the thought of it lingers in the back of your mind. Still there underneath the wallpaper. Will it worsen in my hands again? What if it flares up somewhere else? My knee again, or my feet? What if I can’t walk? During a period of remission, all of these thoughts whisper in the background, but despite them, you make the most out of feeling your ‘normal’, because you do not know how long it will last.

Despite the improvement, I was still fatigued and I did feel poorly regularly. My lifestyle, eating habits and job did not help. My mum would always say to me, ‘Emily, please stop burning the candle at both ends’. Working or socialising in the evenings, often until late, I grabbed sandwiches or foods requiring minimal preparation, like pasta or fish fingers. My diet included processed or preserved foods, refined carbohydrates, sugar-filled sauces and cakes, and I pushed the boundaries on caffeine and alcohol. We only get one body to take care of, so we must do all that we can to do that well, but at this point in time I was not taking much care of mine at all. And I had zero awareness of what my body needed in terms of rest, exercise or mental wellbeing either.

During Christmas 2017, I had a nasty flu, and could not remember being so poorly since the arthritis first began in 2013. Hot and cold sweats, sleepless nights, headaches, blocked sinuses, fatigue, my entire body aching, coughing and sneezing, and – a strange signal for me – white spots on my tongue. My body was having a complete meltdown. My heart sank. My symptoms lasted for more than three weeks. I felt powerless. Then, just as I started to feel better, I looked down and saw the start of a lump in my right ankle, and that all-too-familiar stiff, fluid-like feeling.

My rheumatologist’s solution, as an interim measure while waiting for an available appointment, was to have a steroid injection in my gluteus maximus muscle, aka derrière, and to increase my methotrexate dosage, with a review after three months. I thought, Great, the medication will sort it out, it’s out of my control. I began wearing ankle supports, icing or heating my ankle at night and taking strong painkillers. That steroid injection kept my pain at bay for a few months, but the next one had no effect, and the increase in methotrexate did not help either.

Still, I would tell myself: Nobody can tell I am in pain. Nobody knows the extent of my pain. Nobody wants or needs to know. Nobody my age has arthritis. Nobody sees my arthritis. Nobody sees my pain. Just keep going . . .

But it got worse. Out with my mum and sister, I was in so much agony that I had to sit on benches outside while they shopped. Similarly, on holiday with my friends, the pain was so sickening and unbearable one day that I had to sit on a chair in the supermarket while they grabbed our groceries. Most days, I would try so hard to hide it, and it was an exhausting mental burden. I do not do this now.

Joint swelling in arthritis can mirror from one side of the body to the other. By the summer of 2018, I had swelling in both of my ankles and in my leg above my right ankle. When I was away with friends, I woke up with another new flare one morning. My right arm, elbow and shoulder felt peculiar and painful. I tried to stretch my arm, but physically couldn’t. My elbow was so swollen it had literally bent my arm. I played it down and said I had just slept funny on it, but this became a real breaking point for me.

Completely disengaged from my body, I had given over control of it to the methotrexate. But it was time to take it back. I started to think about how I treated my own body. Could I help it – and the arthritis – through lifestyle changes? I bought a few arthritis food-based books that were extremely outdated, a range of healthy recipe books and logged on to social media, eager to find someone talking about living with arthritis and natural ways to beat it. But I just could not find what I was picturing. Where was the account dedicated to food and arthritis? A community, with people like me, where I could learn how to manage my symptoms naturally?

And then it clicked.

If it did not exist, if nobody else was doing it, then I would. And maybe I could help anyone else who was looking for it too . . . And that is how Arthritis Foodie began.

What is Arthritis? A Comprehensive Look

Living with arthritis can feel isolating, and the Arthritis Foodie community’s mission is to make sure people do not feel alone. Because you aren’t.

As mentioned earlier, arthritis and other joint-related conditions affect millions of people around the world and can happen to anyone at any age. For starters, here is a short list of celebrities who are living with a form of the condition:

Lady Gaga (fibromyalgia)

Andy Murray (osteoarthritis)

Robbie Williams (arthritis – back)

Kim Kardashian (psoriatic arthritis)

Tiger Woods (osteoarthritis)

Kristy McPherson (juvenile arthritis)

Jo Whiley (rheumatoid arthritis)

Tatum O’Neal (rheumatoid arthritis)

Paddy McGuinness (rheumatoid arthritis)

Laura Wright (juvenile arthritis)

Liam Gallagher (arthritis – hips)

Worldwide, musculoskeletal disorders, which include all forms of arthritis, are ranked as the second-most common cause of disability. Arthritis exists in all races, age groups and sexes. As I’ve said, arthritis does not always equal old, and if we can continue to debunk this myth, it may enable those of us who have it to live more openly with our condition. The ramifications of this could be a reduction in the mental burden of the condition, which would, in turn, ease the physical one. I hope.

Types of arthritis

There are various conditions linked to joint pain and swelling, with osteoarthritis (OA) and rheumatoid arthritis (RA) known as the two most common types. Many are autoimmune diseases (AIDs), which are chronic inflammatory disorders caused by abnormal immune-system function that may be initiated by environmental factors, viruses, toxic chemicals or genetic factors. This immune-system abnormality is described as your body ‘attacking itself’: your immune system fails to recognise your body’s own cells as ‘self’, or belonging to you, viewing them instead as a disease to be combatted – or mistaking friend for foe.

Studies have shown that around a third of all AIDs are genetically predisposed, while the remainder are due to environmental triggers, as well as diet, disturbances to the gut and digestive systems and other lifestyle factors. It’s that gun, bullets and trigger analogy again. Whether immunity-based or not, arthritis is a chronic and painful condition without a cure. So the more we can understand it – and learn to manage a life with it – the lighter the affliction may feel.

ARTHRITIS AT A GLANCE

The following are the main types of arthritis:

Osteoarthritis (OA)

Rheumatoid arthritis (RA) [AID]

Psoriatic arthritis (PsA) [AID]

Juvenile idiopathic arthritis (JIA) [AID]

Reactive arthritis (ReA) [AID]

Ankylosing spondylitis (AS) [AID]

Gout

Typical symptoms include:

Joint pain, swelling and stiffness

Difficultly and restriction in movement

Fatigue and sleep disturbance

Decline in mental wellbeing

Muscle wasting

Osteoarthritis

OA is the most prevalent joint disease worldwide. It is a wear-and-tear condition in which physical deterioration in the cartilage and bones leads to pain, loss of joint function and disability. The knee is the most common site in the body for OA, followed by the hips, hands and wrists.

The onset of this condition is twofold: primary OA is associated with ageing (but is not caused by it), whereas secondary OA frequently appears earlier in life and is typically instigated by injury, a stressful job, diabetes or obesity. It is generally not included among inflammatory diseases, but increasingly evidence indicates that inflammation does play a central role in its development, induced by pro-inflammatory cytokines. Cytokines are a bit like WiFi – signalling molecules that enable communication between the cells of the immune system and other non-immune cells. We will come across these again throughout the book.

Rheumatoid arthritis (RA)

RA is the most prevalent inflammatory arthritis, associated with high levels of oxidative stress. Females are affected three times more than males. It is an autoimmune condition and characteristically it occurs in the same joints on both sides of the body, but there may also be inflammation of skin, eyes, heart or lungs. The exact origins of RA are believed to be multifaceted, and studies suggest that both environmental and genetic factors are at play, also noting the release of pro-inflammatory cytokines, as described above.

There are two forms: seropositive and seronegative (the one I have). Those with seropositive test positive in their bloodwork for the rheumatoid factor (RF) and/or anti-CCP (an antibody present in most RA patients), whereas those with the seronegative form test negatively for both. Other blood-monitoring terms that you may have come across are the C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR), associated with acute and chronic inflammation, including infection, cancer and AIDs. Now that you know what these are, you may feel more comfortable discussing your levels of them with your rheumatologist, as I like to.

Psoriatic arthritis (PsA)

Closely related to RA, this is a type of spondyloarthritis (SpA), describing a group of inflammatory rheumatic diseases induced by a complex mixture of genetic, immunological and environmental factors. Unlike RA, however, PsA is experienced asymmetrically, is usually seronegative and affects tendons. PsA may also involve the skin condition psoriasis. Dactylitis is also a distinguishing feature of PsA, which is characterised by sausage-shaped swelling of the toes or fingers (a clear signal in my early experience).

Juvenile idiopathic arthritis (JIA)

In the UK alone, about 15,000 children are living with JIA. It is the most commonly diagnosed rheumatic condition in children, but JIA is not a disease – it is a collective term, with a set of diagnostics that includes symptoms of arthritis forming before a child’s 16th birthday, lasting for at least six weeks and with an unknown origin. The word ‘idiopathic’ relates to any disease or condition that develops unexpectedly and has an undetermined cause.

JIA conditions seem to be the childhood equivalent of those observed in adults, and at least one third of children with JIA will continue to have an active form of arthritis in adulthood. My suspicion is that my ‘idiopathic’ swollen knees that lasted a week when I was a child were the early signs of inflammatory arthritis.

Reactive arthritis (ReA)

ReA is inflammation in one or multiple joints caused by an infection within the body. The infection may derive from the gut, urinary tract or reproductive organs. Reiter’s syndrome – a triad of arthritis, urethritis and conjunctivitis – is a common example of ReA. ReA symptoms usually develop around one to three weeks after exposure to the cause of the infection. Bacteria and bugs that are often responsible for causing ReA are chlamydia, yersinia, salmonella, shigella and campylobacter.

ReA can also be associated with auto-inflammatory or immunologic disorders such as Crohn’s disease, ulcerative colitis, rheumatic conditions and hereditary auto-inflammatory disorders. For most people, ReA disappears completely within six months, but in 10 to 20 per cent of cases, the symptoms last for longer. In some situations, people may go on to develop an ongoing type of arthritis that requires long-term treatment.

Ankylosing spondylitis (AS)

AS is an AID and seronegative inflammatory condition that largely affects the spine and pelvis. The average age of onset for AS is 24, and it is generally associated with an inflammation of the spinal joints and surrounding structures, resulting in pain, stiffness and limitation of movement. Pain and stiffness of the limb-based joints, including the hips and shoulders, are also present in around a third of patients with AS. Treatment usually involves physiotherapy and anti- inflammatory drugs.

Gout

Gout (also known as monosodium urate crystal deposition disease) is a type of inflammatory arthritis, and a hereditary metabolic disorder. An abnormal build-up of monosodium urate crystals in and around the joints features in episodes of acute arthritis, caused by having too much of the chemical uric acid in the bloodstream. The most prevalent cause of inflammatory arthritis in men aged over 50, gout affects 1–2 per cent of adult men in the Western world, and is far more common in males than females. It was first identified as early as 2640 BC, by the ancient Egyptians.

In gout, the uric-acid crystals can also deposit in tendons, kidneys and other tissues, as well as the joints, causing inflammation and damage.

FIBROMYALGIA AND LUPUS

Fibromyalgia and lupus are two widespread conditions which, while not technically counted as arthritis, are commonly associated with it.

Fibromyalgia

Fibromyalgia is a chronic-pain-syndrome with an unknown cause. It involves a wide spectrum of symptoms such as allodynia (pain from stimuli that do not normally cause pain, such as lightly touching your skin), debilitating fatigue, joint stiffness and migraines. Fibromyalgia is also accompanied by sleep disturbances, cognitive dysfunction, anxiety or depressive episodes.

There are still many physicians who refuse to believe that fibromyalgia exists, assuming that a patient’s pain is ‘all in their head’. Although it is not classified as an AID, it can often manifest with one – such as RA, for example. A multidisciplinary approach to treatment involving both pharmacological and non-pharmacological interventions is advised.

Lupus

Lupus is an AID that is roughly around nine times more common in women than men. There are two main types of lupus: discoid lupus and systemic lupus ery-thematosus (SLE). Discoid lupus only affects the skin, causing rashes in widespread or small areas of the body, whereas SLE lupus – like RA – can affect many different parts of the body, and most people will have one or a few of the possible symptoms (such as joint pain, skin rashes, fatigue, fever, weight loss, swelling of the lymph glands) and these will ebb and flow. More common in younger people, the precise cause is not yet known, but it is evident that both genetic predisposition and environmental triggers are factors.

Current therapies for arthritis

Mainstream treatments consist of medication, physiotherapy and surgery, depending on the type of arthritis that you have and its severity.

Medicinal therapies

There are numerous medicinal treatments given, dependent upon your arthritis severity, but typically a patient will begin on one, before trying the next (the try, test and trial period is 12 weeks to see if it helps). You may be prescribed one or a combination of drugs, and this can be temporary, for short-term relief, or ongoing, for long-term management of your condition.

Disease-modifying anti-rheumatic drugs (DMARDs) are usually the first stop and include:

sulfasalazine

hydroxychloroquine

methotrexate

leflunomide

Biological treatments such as etanercept and infliximab are frequently taken in combination with a DMARD, such as methotrexate. These tend to be used only if DMARDs alone have not been effective.

JAK inhibitors, including tofacitinib and baricitinib, were introduced in 2012 for those with severe RA who have not found DMARDs or biologics effective.

Non-steroidal anti-inflammatory drugs (NSAIDs) can help to relieve pain while also reducing inflammation, but it is worth noting that long-term use may accelerate OA:

ibuprofen

naproxen

diclofenac

celecoxib

etoricoxib

Steroids – usually (but not always) in the form of an injection, either directly into a painful joint or into a muscle to help multiple joints. They are generally given to provide short-term pain relief while waiting for other medication or struggling mid-flare.

Painkillers – although they do not treat the inflammation in your joints, these may be helpful in relieving pain and include paracetamol, codeine or co-codamol.

Capsaicin cream – a topical pain reliever that works by blocking the nerves that send pain messages in the treated area (more on this in Chapter 6).

Physiotherapy

One of the pillars of mainstream therapy for arthritis, physiotherapy is looked at in much more detail on pp. 185–188 (along with chiropractic and osteopathy, as well as rehabilitative care, such as occupational therapy and podiatry).

Surgery

If a joint has been severely altered by arthritis, surgery may improve mobility and quality of life. Generally, it is only needed in a small number of patients where other treatments have not been effective or more support is required. Types of surgery include:

joint replacement – such as for the hip, knee or shoulder joints

joint fusing – where a joint replacement is not suitable, a surgeon may suggest an operation to fuse a joint in a permanent position

osteotomy – in those with osteoarthritis in the knees who are not suitable for knee-replacement surgery this can help to realign the knee and readjust the weight upon it

finger, hand and wrist surgery – such as carpal-tunnel release

arthroscopy – a procedure to remove inflamed joint tissue

The Foundations of Beating Arthritis Naturally

Because there are various types of arthritis, and taking into account age, environment and genetics, the condition manifests differently from one person to the next. But, as previously mentioned, several lifestyle factors – including diet, exercise, sleep and emotional wellbeing – can have an impact.

According to professor of rheumatology Paul Emery:

‘. . . exercise, sleeping well, eating healthily – for example, the Mediterranean Diet (MD), all of which help in managing chronic autoimmune/arthritic/inflammatory conditions, alongside medication. The MD has even been useful in showing that it reduces pain mediators, but nobody has shown whether or not it can prevent arthritis, as yet. There is evidence to say that the bowel is abnormal in patients with arthritis. The argument is whether or not you can change it, and if you stop your intervention whether or not it [the bowel] just returns to the way it was before, but if you maintain on the right diet there is no reason why the improvement couldn’t be maintained.’

And Dr Lauren Freid comments: ‘If you’re taking a medicine with the purpose of fighting inflammation and reducing pain, why wouldn’t you also take the lifestyle approaches to achieve the same effect? Medicine will only go so far if lifestyle continues to drive inflammation that will counteract its effects.’

It may feel overwhelming at first, but this book is your starting point. It is your set of stepping stones, and every chapter is a step in the right direction. In the words of writer and illustrator Charlie Mackesy, ‘One of our greatest freedoms is how we react to things’. In other words, managing how you feel and think about having arthritis, as well as how you react to it, are key to being able to advance changes in both your body and your mind. The tools in this book will facilitate this holistic approach.

Befriend your gut

The gut is the main protagonist in this story. Pretty much everything we ever feel is associated with our gut microbiome – in fact, the gut houses almost 70 per cent of our entire immune system, and produces hormones that influence anything from appetite to mood. So we should be feeding and fuelling our gut bugs properly.

What exactly is the gut microbiome, you might ask? Well, it is an immense ecosystem of organisms and microbes such as bacteria, yeasts, fungi and viruses that live in our digestive systems. And what is the difference between the gut microbiome and the gut microbiota? Often used interchangeably, microbiota is the actual bugs (microorganism), whereas microbiome refers to the bugs and their genes (there’s actually a staggering 22 million bacterial genes in the gut microbiome).

Collectively, the gut microbiome is heavier than the average brain, weighing up to 2 kilograms, and it is increasingly becoming established as an organ in its own right, research showing that we are likely to be around 50:50 human and microbes. Each gut contains about 100 trillion vital bacteria that break down food and toxins, make vitamins and influence our immune system. The immune system, much like the gut microbiome, is not one place or one thing, but a collection of things in a number of places. As articulated by immunologist Dr Jenna Macciochi, immunity is a fusion of leukocytes (white blood cells), lymphatic organs, cytokines (signalling molecules) and their combined mixture of biological functions.

Not only is the gut heavier than the average brain, it actually contains a very thin layer of brain. BBC’s Dr Michael Mosley writes in astonishment that this layer of brain (called the enteric system) is made up of the same cells (neurons) that are found in the brain and there are over 100 million of them in the gut – the same number you would find in the brain of a cat. (Yes! I managed to get a cat into this book, and yes, I will look at Molly, my cat, a little differently now.)

With the gut being a pivotal part of our health and wellbeing, it is not, then, a wild revelation that an unhappy gut equals an afflicted body and mind. Research is uncovering connections between gut health and disease manifestation, both mental and physical. Depression often accompanies many of these diseases, including arthritis, psoriasis, multiple sclerosis (MS), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), autism, Alzheimer’s and many more.

Many doctors feel that their training is sorely lacking when it comes to nutrition. If my doctor had been sufficiently trained in gut health and nutrition, could this have led to a quicker diagnosis or a more suitable treatment? Non-profit organisation Culinary Medicine UK (CMUK), led by Dr Rupy Aujla, has taken its lead from the Goldring Centre for Culinary Medicine (GCCM) in the USA, and developed a programme to teach doctors and medical students in the UK the foundations of nutrition – from the practical aspects of cooking, to the science of food and its application in clinical practice.

Whether your doctor has grasped the importance of nutrition or not, ensuring that your gut is happy is essential, so this includes feeding your gut microbiota with the ultimate diet, including the phytochemicals (see Chapter 2) that are being studied by scientists as additional therapies for obesity and inflammatory diseases. Good nutrition can provide and preserve good health; conversely, poor nutrition can increase the risk of developing chronic degenerative diseases. Our eating habits influence all aspects of our biology, from our metabolisms to our immune systems to our guts. But the response that we receive from diet is individual and depends on everything from genetics to our guts, sex and immune systems.

As mentioned, a good place to start is the MD, typically consisting of a high intake of vegetables, fruits, nuts, legumes and extra virgin olive oil, with moderate intakes of fish, poultry meat and dairy products, less red meat and a moderate amount of red wine. It has been shown to preserve human health in a myriad of ways, from protecting against cancer and cardiovascular disease to preventing alterations in gut microbiota composition and the subsequent inflammation, exerting long term anti-inflammatory effects. The MD is definitely a foundation for the recipe ideas in this book.

But let’s get back to arthritis again because, funnily enough, scientists suspected an interaction between the gut and arthritis decades before the more recent exploration and interest in the gut microbiome. In fact, Professor Emery notes that the UK’s largest arthritis charity, Versus Arthritis, has been researching this connection, with microbiologists posing the question: ‘ Do gut bacteria play a role in rheumatoid arthritis?’ An animal study demonstrated the role of the gut microbiome in modulating arthritis progression and multiple studies have demonstrated dysbiosis (impaired and imbalanced gut) in RA patients. And some researchers have suggested that genetic factors alone do not appear to be sufficient to develop the disease, stating that an environmental trigger, such as variations in our microbiome, is likely to be required to initiate inflammatory arthritis in individuals with a genetic predisposition.

Immunologist Dan Littman of New York University has taken it one step further and speculated that RA in humans might also be due to specific gut microbes through a study involving a group of 114 residents within the New York City area – some healthy, others living with treated RA, some PsA and others with new and recently diagnosed RA, who were not yet receiving treatment. In the newly diagnosed, a bacterium named Prevotella copri was present in 75 per cent of patients’ intestines, whereas it only appeared in 37 per cent of those living with either RA or PsA and just 21 per cent of healthy individuals.

Undeniably, more research is needed to explore the association between diet and the gut microbiome and how this can influence RA pathogenesis, or even other forms of inflammatory, immune-related chronic diseases. As diet can influence the gut microbiome, perhaps diseases can be manipulated through diet and alteration of gut bacteria, but research is still in its infancy. Who knows, in 20 years’ time, I could be revisiting this book with some amendments . . . But, in the meantime, we know that there’s plenty we can be doing.

Be mindful of your body

The gut has plenty to answer for. It is our second brain, after all. But there’s lots that goes on outside of it when you are burdened with a chronic disease paired with chronic inflammation. Anything from stress to a poor night’s sleep, to a nutrition-less meal, to sitting down all day can lead to an excess of inflammation. Being aware and present around how your body is feeling, both mentally and physically – taking the steps to understand your pain, your body and your brain a little better – is also an underpinning principle and foundation of this book.

Your arthritis, body, and genetics belong to you – your experience of this condition may look entirely different to mine, or you may have found some strands of my story in yours. Either way, I hope that you are now beginning to feel emboldened as you begin to learn more about managing your arthritis using the tools in this book as part of a holistic approach.