In general I don’t like to use supplements, I prefer instead to rely on my whole food plant-based diet, exercise, and a decent amount of sleep. However, here are a few supplements which need to be considered if you are trying to halt or reverse your rheumatoid arthritis. These may all be needed for overall health too but I believe these four are specifically beneficial for rheumatoid arthritis and leaky gut too. I’ll describe them below and I’ll explain why I think they’re important.
Recently I’ve been reading in more depth about a range of problems associated with vitamin B12 deficiency, some of which directly exacerbate RA and some which have an indirect effect on RA in terms of overall health. Increasing B12 levels can improve fatigue (a common problem with arthritis), it can also improve the production of red blood cells which allows more haemoglobin to circulate improving oxygen diffusion and absorption. B12 can also decrease certain types of nerve pain which is a definite factor in arthritic joint pain, I know this from experience.
Elevated homocysteine levels are associated with heart disease and endothelial damage and it seems it can cause direct damage to other tissues and to joints. Homosystine promotes the release of inflammatory cytokines and increases tissue damage through oxidative stress, both of these will increase arthritic symptoms. Also, B12 levels are inversely associated with various inflammatory markers including CRP. There are many more negative health effects of low vitamin B12 and there are some therapeutic effects from taking higher doses of B12 such as a reduction in homosystine, a general analgesic effect, and a reduction in lower back pain for example.
Vitamin B12 is essential for everyone whether on a standard UK (SUK) diet or a Standard American Diet (SAD) or a whole food plant-based diet. These days it’s difficult to guarantee that sufficient B12 will be obtained from the food we eat regardless of our diet. I think it’s a good idea for everyone to have their B12 tested periodically, perhaps once a year, particularly if you’re suffering from a chronic disease such as rheumatoid arthritis.
Our B12 reserves can last a long time, in fact many years, but if they become depleted the consequences are extremely serious including permanent brain and nerve damage, and also growth and development problems in children etc. No matter what your diet, there is the potential for B12 deficiency.
There are many types of B12 supplements including methylcobalamin and cyanocobalamin; methylcobalamin is more absorbable but is less stable as a supplement, cyanocobalamin is more stable but less absorbable. I choose to take both as a supplement to be on the safe side; I take 1000 µg of methylcobalamin as a capsule and 1000 µg of cyanocobalamin as a lozenge under the tongue. Taking these once a week would be fine for most people but for the time being, I’m choosing to take these every day in order to guarantee absorption and to reach a higher than average blood level. Blood tests for B12 can be inaccurate so I prefer to be on the safe side and since B12 is water-soluble, it’s almost impossible to overdose.
From the studies I’ve read (and from other sources) it’s clear that low vitamin D levels are associated with rheumatoid arthritis. It’s not so clear whether rheumatoid arthritis causes low vitamin D or whether low vitamin D contributes to rheumatoid arthritis. Either way low vitamin D levels need to be corrected to help reduce pain and to help prevent osteoporosis.
Vitamin D is important for bone and muscle strength, immune function, the prevention of viral infections, and reducing the risk of heart disease and cancer.
For rheumatoid arthritis sufferers like me, the main reason for maintaining an adequate level of vitamin D is to help prevent osteoporosis, to help strengthen my bones and muscles, and in relation to this – to help with the absorption of calcium and other minerals. Vitamin D affects overall health in so many different ways, many more than I’ve mentioned here, so as a rheumatoid arthritis sufferer it’s important that my vitamin D level isn’t allowed to drop via association with my disease. Also, for all of us with rheumatoid arthritis or other inflammatory diseases, it’s important to maintain and improve our overall health as this undoubtedly helps with our specific disease.
Ideally we should get our vitamin D from sunshine :-) Depending upon where we live, our skin colour, and our clothing; the amount of sunshine exposure that we need will vary. Here in the UK, in the summer, I can manage with about thirty minutes a day, however, in the autumn, winter, and spring it’s still quite cold here and often raining and cloudy, so for about six months of the year I find it very difficult to get enough sunshine to meet my needs. I therefore take a supplement of around 4000 units per day during this period. Here are a couple of videos by Dr Michael Gregor giving an expert view of vitamin D requirements; How Much Vitamin D Should I Take? and The Optimal Dose of Vitamin D Based on Natural Levels.
A very likely cause of rheumatoid arthritis in many people including myself, is intestinal permeability or leaky gut. This is where the gut’s villi and/or tight junctions become damaged and allow undigested food proteins and other foreign particles or pathogens to leak through the gut into the bloodstream. These foreign particles or pathogens then create an immune response which produces inflammation and generates free radicals. This is bad enough, but certain proteins or protein fragments can resemble some of the body’s own tissues such as joint cartilage or pancreatic tissues and when this happens the immune defence response can switch to an attack on these tissues.
If you have rheumatoid arthritis and you find that eliminating certain foods improve your symptoms, particularly if you find that this is the case with many different foods, then you should probably look into the possibility that you have a leaky gut. Many people improve their arthritis by avoiding certain foods or food groups, in some cases this seems to be a real intolerance or poisoning like effect, for example avoiding dairy products can have an immediate beneficial effect on arthritis symptoms, in many cases leading to full remission or effective cure of the disease. On the other hand avoidance of certain foods or food groups just improves symptoms for some people and often the number of food sensitivities increases over time.
Healing leaky gut (and developing and supporting beneficial gut bacteria) is therefore a priority for anyone with rheumatoid arthritis who has symptoms of leaky gut. I personally believe that in many cases leaky gut is the original and only cause of a person’s rheumatoid arthritis and many other chronic inflammatory diseases. If you’re lucky and this is the cause in your case, then you have an amazing opportunity to reverse your disease.
There are many ways to heal and support your gut and develop a wide variety and quantity of beneficial bacteria and certain beneficial yeasts. From my own experience and research, the most important thing is to adopt a whole food plant-based diet with minimal added oil, salt, and sugar. This immediately removes so many of the most common inflammation and insensitivity causing foods such as milk, cheese, eggs, processed meats, AGE and acrylamide forming meats which are commonly burned on barbecues and grills.
Then there are specific steps you can take to try to heal a leaky gut, one of these is to take a zinc carnosine supplement. Zinc carnosine can reduce gut permeability and it can also inhibit the inflammatory response to H pylori – another suspected cause or contributor to rheumatoid arthritis. Zinc carnosine can also enhance tight junction formation and stabilisation.
Zinc itself is an essential nutrient of course and is important for wound healing, cardiovascular protection, anti-ageing, fighting viral infections, skin health and mental health and the list goes on… The combination of zinc-carnosine is used in Japan to treat stomach ulcers and was also found to be gut protective in patients taking indomethacin. I’m taking zinc carnosine regularly at the moment to protect my gut villi and to reduce my tight junctions’ permeability. As I mentioned earlier, generally speaking I don’t like to take supplements and prefer to rely on whole foods to improve my health, however zinc carnosine is one of the more promising supplements that I’ve taken in the last thirty-five years or so.
EPA and DHA
To improve rheumatoid arthritis and health in general it’s important to have a good ratio of omega-3 to omega-6 essential fatty acids, somewhere between 1:1 and 1:4. Omega-6 essential fatty acids are generally pro-inflammatory (apart from GLA) and omega-3 essential fatty acids are generally anti-inflammatory. To obtain enough ALA and/or EPA/DHA in the diet each day should be the goal. Whether this is obtained initially from walnuts, flax seeds, hemp seeds, chia seeds or leafy greens (ALA) which is then converted in the body (with the help of a couple of enzymes) into EPA and then DHA, or obtained directly from an algae-based supplement (or worst case fish or fish oil). Personally I use an algae-based supplement plus ALA rich plant foods, I don’t recommend using fish oil for omega-3 because fish is highly contaminated with mercury and other toxins, and also fish oil becomes rancid very quickly.
While omega-3 essential fatty acids are extremely important for brain health and for reducing or preventing cognitive decline (amongst other things), they are specifically important for rheumatoid arthritis sufferers since they moderate inflammation directly. They can also reduce auto-antibodies which could help to reduce the effect of food intolerances caused by a leaky gut. Omega-3 essential fatty acids (EPA and DHA) can also reduce inflammatory cytokines such as IL-6.
I optimise my intake of omega-3 essential fatty acids to help improve my rheumatoid arthritis of course, but I’m also keen to look after my arterial health and the health of my brain :-) There are lots of studies regarding omega-3 and rheumatoid arthritis, here’s an example: Omega-3 fatty acids in rheumatoid arthritis. The problem is that there are many contradictory studies, some show benefits and some don’t, I believe this is because most of them use fish oil as a source for omega-3’s and since fish oil is generally rancid and full of toxins I think this is why the results are so mixed. However, there is no doubt at all that ALA and subsequently EPA and DHA are extremely beneficial for overall health and are essential for brain health and arterial endothelial health. Anything that improves overall health is beneficial for rheumatoid arthritis sufferers particularly if it improves circulation or reduces inflammation.
Supplements for Rheumatoid Arthritis – Summary
After decades of research and experimentation with supplements of all kinds for rheumatoid arthritis and general health, I found that the majority are not useful. Most of the time the anti-inflammatory claims made for many supplements didn’t translate into an improvement in my symptoms, neither did claims made for the pain relieving benefits. Also, with few exceptions, I don’t believe that there’s any merit in trying to use supplements to improve overall health. Overall health (and rheumatoid arthritis relief or remission) is best achieved by dietary and other lifestyle changes i.e. adopting a whole food plant-based diet with regular exercise, some sunshine and good quality sleep.
For me, the four supplements I discussed above are really the only ones that need to be carefully considered in relation to rheumatoid arthritis and overall health. There are a few others that seem to have specific benefits in certain areas and at certain times, however the four nutrients above are so important for health at all stages of life that everyone should make sure that their intake is adequate, especially rheumatoid arthritis sufferers.
If you already eat, or if you switch to a whole food plant-based diet, then you may only need to take a B12 supplement to meet your needs. However; vitamin D, zinc carnosine and EPA/DHA supplementation may be beneficial and necessary in many cases for rheumatoid arthritis sufferers. These are the four nutrients that I supplement myself and that I believe are necessary in my circumstances, I use my whole food plant-based diet to obtain the other 95% of my nutrient needs.
“Jigsaw puzzle” image (modified) is public domain