Danny looked distressed. “There’s no way I’m going to give up gluten. How can I? I’m Italian. I live on pizza and pasta.” He sat slumped in his chair. His dark-brown eyes looked up at me, waiting for my response.

Danny, a forty-two-year-old man of Italian descent and father of two children, came to my office for a consultation in the late 1990s. He requested help for his rheumatoid arthritis, a potentially crippling autoimmune disease. He had been prescribed several aggressive drugs for pain relief and for immune suppression. The side effects had become intolerable. Like many of my patients, he contacted me as a last resort.

Arthritis is a general term that refers to inflammation in the joints. Rheumatoid arthritis (RA) is a specific kind of arthritis, a chronic, inflammatory autoimmune disease that affects approximately 1.5 million Americans, the majority being women. Unlike osteoarthritis, a degenerative arthritis related to wear and tear, RA involves auto-antibodies that attack the joints, leading to pain, deformity, and loss of function.

Autoimmune disease happens when certain organs or structures in the body are mistakenly attacked by one’s own immune system. Each type of tissue in our bodies has specific proteins that act like name tags that reveal its identity. If your antibodies are attacking a foreign substance that has an identifying protein configuration similar to an organ or structure in your body, then the antibodies can potentially cross-react with that tissue—like soldiers mistakenly firing at their own men. The subsequent auto-attack can eventually leave the tissue severely damaged.

In RA, the antibodies specifically attack the synovium, the membrane that lines the interior of the joint capsule. The inflammation causes thickening of the synovium, which can eventually lead to destruction of the cartilage and bone within the joint. The inflammatory process can lead to stretching and weakening of the tendons and ligaments that hold the joint together, causing the joint to lose its shape and alignment. The joints most commonly affected are in the fingers and wrists and less commonly the knees and feet.

Although I had treated many women with rheumatoid arthritis over the years, Danny was the first male I had ever treated for this condition.

Autoimmune disease is far more prevalent in women than in men. There are many theories that attempt to explain this phenomenon. One credible theory relates to the role of estrogens and the effects of the many toxic chemicals in the environment that mimic estrogen, causing the immune system to become hyper-reactive.

When women are estrogen-dominant they are at an increased risk of developing autoimmune disease. Estrogen dominance does not necessarily mean that the woman makes too much estrogen. It usually means that the ratio between estrogen and progesterone is out of balance, as occurs in women as they approach menopause. Another common cause of estrogen dominance is the heavy body burden of estrogen-mimicking chemicals, which do not show up on standard blood tests.

Estrogen dominance, along with a genetic susceptibility, can predispose women to have an over-reactive immune system. To develop into an autoimmune disease, a trigger is needed that sets off the autoimmunity. The trigger could be a viral infection, intestinal parasites, heavy metals in the body, exposure to toxic chemicals, food allergies and sensitivities, and mycotoxins produced by mold spores.

During our initial consultation, I discovered that Danny had been a schoolteacher, now on disability. His grandmother had RA and his mother had autoimmune thyroiditis, giving the impression that there might have been a genetic predisposition to autoimmune disease. Danny mentioned that his grandmother had died from a bleeding ulcer, the result of using anti-inflammatory pain medications several times a day over many months.

Danny had been taking Methotrexate and high doses of Prednisone for two years to suppress his immune system. The manifold drug side effects he struggled with included mood swings, flu-like symptoms with body aches, mouth ulcers, chronic nausea, hair thinning, headaches, fatigue, and “brain fog.”

Danny’s mainstream doctor had spoken to him about a relatively new class of drugs on the market called TNF-alpha inhibitors, sold under the brand names of Humira, Enbrel, and Remicade. His doctor said that if he took this class of drug he would be able to stop his Methotrexate and Prednisone. This idea was tempting to Danny.

Danny wanted my advice about the possibility of taking one of these new drugs so that he could get off the Methotrexate and the Prednisone. I openly expressed my concern about this plan. These powerful drugs so effectively suppress the immune response that patients are at an increased risk of dying from an overwhelming infection, given that the immune system is unable to respond appropriately when under attack by invading pathogens.

On exam, I noted that the joints in both of Danny’s hands looked swollen and red, and the base of his fingers deviated laterally, creating an obvious deformity that made it difficult for Danny to write and use the computer or hold a glass in his hand.

I suggested that instead of taking the risky drug his doctor proposed, we search for the culprit causing Danny’s autoimmune disease.

In many cases the culprit is never found, in which case I advise the patient to follow a general protocol to reduce the symptoms. The protocol includes an anti-inflammatory diet. (Please refer to the blog posts on cancer to read about the anti-cancer diet, which is almost identical to an anti-inflammatory diet. Here is the link to Part I of the three-part series https://www.musingsmemoirandmedicine.com/2016/03/cancer-treatment-a-different-approach/).

In addition, anti-inflammatory supplements can be helpful, along with acupuncture, herbs, and customized physical therapy such as swimming in warm water.

Danny reluctantly agreed to a six-week trial of the dietary protocol. I emphasized that the experiment would only work if he followed the diet 100% so that the resulting data would be accurate.

Danny asked if his joints would return to normal if we were successful in reducing his pain and inflammation without drugs. Sadly, I had to confess that I had never seen advanced rheumatoid arthritic joints return to normal, given the extensive destruction of the joint structure by the antibodies. Perhaps stem cell therapy might one day hold some promise in restoring the deformed joints.

We waited to begin the anti-inflammatory supplements and the other healing modalities until we could see more clearly the role of diet alone. At the end of the six-week trial, Danny said he was able to stop all his medications and felt much better with very little pain in his joints. With just diet alone he noted significant improvement.

Danny was both thrilled and depressed. He said that there was no way he could spend the rest of his life not eating pizza and pasta and enchiladas. On top of that, his wife and children protested loudly at having to eat such a strange diet. He said that he would try the other things I had mentioned in the protocol, but would not continue the anti-inflammatory diet. I wished him all the best.

A year went by with no word from Danny. Then one day he called to ask for an appointment. He said that he was fed up with the drugs and ready to make a commitment to doing whatever it took to become free of pain and free of his medications.

Although his hands remain deformed, he is now without pain and without any medications. After only a few weeks of following the diet to the letter, he noticed a big reduction in the pain and swelling. He swims in a heated pool, gets regular exercise, spends about 20 minutes outside in the sun every day, takes his anti-inflammatory supplements, and gets acupuncture once a week. When his joint pain flares up in spite of following his program, he inhales vaporized medical marijuana which lessens his discomfort.

Inflammation in the joints can be caused by other conditions besides autoimmune disease associated with RA, and wear and tear associated with osteoarthritis.

Non specific inflammation in one or more joints is commonly caused by food allergies. If you have pain in your joints for no apparent reason, try doing a partial fast to see if your joint pain improves. Try making fresh vegetable juice and drinking it several times a day as your only source of food for three to four days. On the first two days, clean out your intestines with bentonite clay and psyllium husks, following the directions on the bottle. The clay will bind any food residues in the intestinal tract that might still be bio-active and affect the immune system.

If your pain is alleviated while on the vegetable juice fast, this suggests that one or more foods are causing the inflammation in your joints. In order to determine which foods are the culprit, reintroduce one food group at a time back into your diet. The most common culprits are wheat, dairy, soy, corn, and meat. But any food could be the culprit.

One of my patients did the above experiment and discovered her long-time pain at the base of her left thumb was indeed related to food. Through extensive trial and error, she discovered that when she ate chicken at a restaurant, she had a flare-up of the pain at the base of her thumb, but when she ate chicken from the local farmer’s market, there was no pain. We surmised that she was reacting to something the factory-farm raised chickens were given in their feed, like antibiotics, arsenic, and growth hormones.

When you are not able to remove the source of the inflammation in your joints, here are some common anti-inflammatory supplements that can make a difference:

1. Bio-available curcumin, formulated with black pepper to enhance absorption. Curcumin is the chemical in turmeric that can reduce pain and swelling by blocking inflammatory cytokines and enzymes. A small 2012 study using a curcumin product showed a greater reduction in joint pain and swelling in patients with active arthritis compared to one of the prescription anti-inflammatory medications.

2. Omega 3 fish oil. Some of the purest sources are Carlson’s and Nordic Natural.

3. GLA is an omega-6 fatty acid that the body converts into anti-inflammatory chemicals. In one trial, 56 patients with active RA showed significant improvement in joint pain, stiffness, and grip strength after six months and progressive improvement in control of disease activity at one year. A smaller study found that a combination of GLA and fish oil significantly reduced the need for conventional pain relievers.

4. Boswellia, a resin from which Frankincense is derived. The active components have anti-inflammatory and analgesic (pain-relieving) properties. Boswellia may also help prevent loss of cartilage and inhibit the autoimmune process. In a 2008 study, the active ingredient, also known as Loxin 5, significantly improved arthritis pain and function within seven days.

5. Ginger root has many health benefits, one of which is reduction of inflammation.

6. SAMe acts as an analgesic (pain reliever) and has anti-inflammatory properties. Several studies have shown it to be as effective in reducing inflammation as NSAID (e.g., Ibuprofen) without the side effects.

7. Serrapeptase, a proteolytic enzyme used to digest the proteins of inflammation. Serrapeptase is produced by a bacteria that was first isolated in the intestines of the silkworm. The enzyme digests the silk in the cocoon, allowing the transformed moth to emerge. The enzyme should be taken at least an hour away from food so that it won’t be used up digesting the proteins in the food. Drink plenty of water and stay upright for 20 minutes after swallowing the capsules to ensure that they pass all the way through the esophagus to the stomach.

If you suffer from chronic pain, it’s worth the effort to determine the underlying causes so they can be addressed. If the causes are not evident, then explore non-pharmaceutical remedies to see if they can help alleviate your pain. Long term use of prescription pain medications comes at a high price to your health. High doses of Tylenol can cause liver damage; NSAID’s (such as Ibuprofren, Aleve, Celebrex) can cause kidney and stomach damage, and narcotics can cause serious addiction problems and the need for escalating doses to achieve pain relief.

A daily Mindfulness Meditation practice can help reduce the perception of pain and can also help alleviate the emotional component of pain which adds to the suffering. Spending time in nature can have a similar effect.

Some of you have tried every possible route available to you to alleviate your intractable pain. It’s certainly understandable your need to resort to extreme measures to get some relief.

Here’s to freedom from pain! And if that’s not possible, here’s to learning how to manage the pain—without the suffering.