hello everyone so today I’m going to answer oneof the commonest those issues that I get asked in my clinic physician what is the diet I shouldhave rheumatoid arthritis or with this or any of the other autoimmune cankers I give sothe presentation I have today is actually meant to have a lot of scientific indication behind itso some of it is art Bui but I wanted it to be as thorough as possible so I’m not just giving youinformation which I feel like giving you but most of it is evidence-based medicine so that when youactually follow this diet or decide to take some of these supplements you will be taking based onevidence and science I’m going to now share my screen to pull up the presentation so diet forrheumatoid arthritis I first want to emphasize that there is no magic cure for autoimmunediseases there is no nothing which you know you only abruptly make this and matoi arthritis willdisappear totally however foods and many things you can do to originate your disease betterand besides rheumatoid arthritis some of this advice also applies to ending other autoimmuneconditions which I give especially psoriasis psoriatic arthritis sometimes gut related issueslike ulcerative colitis and likewise to lupus as well ankylosing spondylitis so this is a diet whichyou know precisely I’m going to talk about sign and I’m going to talk about complements so Ijust want to let you know that if you want to reference this article it’s free on the internetit’s published in a peer-reviewed journal it’s called the role of food affecting rheumatoidarthritis sicknes pleasure is a extremely technical article so you may not really enjoy reading itI’m going to try and summarize most of what we know in the talk in the coming few slides food is anemotional topic you’re connected to menu not just to eat but we eat because it connects us to ourheritage to our culture to our mothers so what we did at home but sometimes we’ve also be took a lotof bad dress we start snacking we exerted nutrients “theyre saying” we can’t live without sugar we can’t livewithout chocolate and it’s somehow very important to us to have menus who are not able to be necessarilygood for us so we have to look at where these psychological provokes come from why do you munch why doyou control do you dine when you’re accentuated do you eat when you’re emotionally worried do you chew whenyou’re tired I eat all rubbish when I feel like I deserves it when I felt like I labor very hard orI’m very tired then I decide to eat I’d snack on meat which are not necessarily good so we needto understand that about ourselves and is aware that does food mean to us is it going to be foodis going to be something which is going to nourish you which is when you taken into consideration your form oris it food which is you really use as a tool or a crutch to control your passions so typically whatrheumatologist tell our patients and what are being learn is look there’s very little evidenceof our diets for rheumatoid arthritis and even if there is a diet or you find that you eliminatecertain nutrients and you get better it’s very hard to follow it in the future so don’t bother sothis is what I was taught but with the help of my patients and talking to nutritionist andbreathing I learned that there is evidence to use particular nutritions which could be helpful to patientsso often we just tell cases ok this follow Mediterranean diet needs a lot of vegetables andfollow the minds and the Mediterranean diet yes is one of the most health diets in the world butsome of the foods and the Mediterranean diets like eat or a great deal of flesh for example are no longer able benecessarily good for patients with arthritis or autoimmune malady so first let’s talk aboutsupplements because everyone wants to know how can I help myself how can i boost my immune organisation soyou don’t positioned a improve your immune system there’s no way to lift your immune system if you have anautoimmune disease your immune method is already provoked and once over acting so you wantto have a healthful immune arrangement so let’s talk about some complements which may help first ofall omega-3 this is the most common one and the most sturdy there’s a great deal of ground for omega-3which is observed there foods like salmon fish and flaxseed which your vegetarian flaxseed is a verygood source of omega-3 and the complements Omega three thousand five thousand milligrams a day hasbeen shown in babies studies to be very beneficial for patients with rheumatoid arthritis and alsoyour methotrexate which is a commonly used drug for rheumatoid arthritis in one study if I shownthat methotrexate operates better and combined with omega-3 fatty acids the drawbacks of taking veryhigh quantities or omega-3 as you can get gas gastric problems gas belching but otherwise it’s a safesupplement to take the scientific indicate or the or the you know the references are still in slidebut I’m just going to talk you through now you need to be taking omega-3 and not omega-6 a lotof supplements come as omega 3 6 9 and naturally we imply oh if I make more Omega or more typesof Omega that’s better for me and this is not the case we need to have a right ratio of omega-3to omega-6 in the body if your omega-6 are excessive then sting increases actually so we need to takeonly omega-3 so we have the right ratio in our person and you know if you’re eating specific foodssuch as processed foods and you know cooking the wrong types of oil such as canola lubricants thesekind of petroleums can increase your major sexuality and increase inflammation you protein so first of allif you’re taking a supplement take only omega-3 and forestalled processed foods terribly fatty foods andcooking with the wrong type of petroleums so cooking with the freedom type of petroleums that’s a entire subjectand topic but just briefly when you cook the best types of oil to cook in are coconut oil oliveoil these are quite good to go but if you just wanted to deep fried menus perhaps a seed petroleum likesunflower seed oil is okay but often we’re not squandering canola or vegetable oh it’s true whatabout calcium augments should you be taking calcium adds-on yes calcium supplements reduceyour risk of sure lots of people are worried about calcium adds-on because they’ve read thatthey cause kidney stones and heart attacks and that’s only if you have a diet it is very rich indairy concoctions that you’ve been drinking a great deal of milk yogurt and cheese then you won’t don’t do notneed the calcium complements then you might have too much calcium in your person but the majority of members of us arenot drinking so much milk yogurt and cheese and hence calcium supplementation is important andlater on in this talk I will be talking about perhaps cutting our dairy concoctions for people whohave autoimmune illness so then obviously you need to take that calcium complement the AmericanCollege of Rheumatology specifications are very clear that if you’re taking any steroids you need tobe on both calcium and vitamin D also there been studies which not really show that in rheumatoidarthritis taking overall calcium supplements increase calcification in your veins or leadto heart attacks which has been represented on the internet and in the media so you can take calciumsupplements safely what is the dose you should make you should take about 600 milligrams or 500 milligram calcium one tablets a daytime that should be sufficient and the rest of your calcium can comefrom food now the menu which is most wretched calcium is dairy one glass of milk or yogurt has3 00 milligrams of calcium but if I tell you to avoid a milk or yogurt your calcium can come fromfoods like green leafy vegetables broccoli kale which is which is shown here finish especiallyfish with bones is a rich source and nuts like almonds too are rich in calcium as well so justmatch your nutrition with the augments you make if you are taking a lot of calcium rich foodsyou do not need a supplement but if you’re not drinking milk and yogurt you unquestionably needmore complements vitamin D is one of the most important augments if you can do one thing ortake one supplement it is vitamin d many studies have shown a risk between form 1 diabetes whichis an autoimmune disease and low vitamin D and also this are nice study which came from acrossthe world showed us that patients who have low-grade vitamin T likewise have poorly assured rheumatoidarthritis so vitamin D chiefly comes from sunlight exposure it’s very hard to get onto through foodmaybe a large this large bit of salmon might have thousands of counts of vitamin D but that’sthat’s impossible to get onto truly through your food revelation to the Sun yes it’s a good wayto get vitamin D so Caucasian a light-skinned person needs to spend 15 to 20 minutes in theSun a period to make do to get adequate vitamin D but most people with paint or colored peoplelike myself would need very long exposure to sunlight at least an hour with direct sunlightexposure it doesn’t matter the time of the day but it needs to be direct without discern withoutcloud cover and without small-time so with vitamin D you know most of us are not getting enoughmost of us are insufficient so take a supplement if you’re overweight you need to take a higherdose we need to take at least 5,000 IU per date if you’re a regular course to need to take a thousandto 2,000 IU per daylight but if you’re inadequacy you need to contact your doctor because you need a higherdose of ingredients like fifty thousand once a few weeks to supersede your vitamin T so it’s really importantto have a regular lily-white amendment so to summarize supplements take a calcium supplement if your dietis inadequate about 500 to 600 milligrams today vitamin DS anywhere from thousand to 5,000 IUdaily omega-3 generally people can tolerate between thousand to three thousand milligrams per dayand I just briefly want to mention turmeric the active ingredient is cumin and about a thousand to2, 000 milligrams per day is a safe way of hitting anti-inflammatory properties anti-inflammationit’s an anti-inflammatory or a natural anti between the body and studies have shown that isbeneficial and acts like a drug especially for osteoarthritis what about nutrient what shouldyou eliminate what should you be gobbling so dietary involvements a lot of studies have told a lot ofpapers have been written and said there’s no use the studies are very small and you know then wedon’t have a lot of data on diet problem between good studies is first of all to get patients intothe study to agree to stay on the diet so I agree to have them stick to a nutrition lots of peopledrop they came she tore in something which is not supposed to eat it and then we’re not surethere’s a placebo effect now and funding for these studies is also a problem but there havebeen people who’ve done some some small studies on elimination diets for the purposes of this report by Pam louchewe found that when patients were fasting or in a severely restricted diet their symptoms includesignificantly nonetheless especially when they had milk reintroduced into the diet they had episodesof ache protrude and tender seams for known similarly I am sure when a mispronouncedprofessor jerison frog and police in sweden is a component of the early studies in 1991 showed thatfasting is effective for reducing the symptoms of rheumatoid arthritis however numerous patientsrelapsed as new meat were introduced from the diet so they went on a fast and they didn’t eatanything and then they and this was published in The Lancet which was one of the central journalsso the tendernes and pain returns if a patient goes back to ordinary so you can see how hard it isto be on a fast you can be in a fast indefinitely or it cannot eliminate many forms or each a veryrestricted food indefinitely this is very hot now the same group of people also published in 1999 they did this interesting experiment where they made 51 cases with rheumatoid arthritis andthey parted them into two groups these realize them remaining in two different smudges so a controller groupthey feed whatever normal diet with healthy nutrition of course in normal kinds of exercise and theydid this for several weeks and the group which were interested in which was the venture groupfirst was put on a fast for about three days and they were not allowed to eat anything except teasherbal teas Valley vegetable broth some potatoes parsley and carrot liquid no fruit juices fell outduring this time because there’s a lot of sugar they cherish carrot seed suits and celery juice sothey did this for about two to three days please do not try this without medical supervision youcan become really caloric impaired and these people were under medical supervision and beingmonitored when this was done so after this they were gradually established meat like some vegetablessome some carrots of potatoes etc but they were not allowed to have daily products of glutencontaining foods for about three and a half months and these were these were stopped andthen they were gradually started again and again if the patient had any problems they were withtheir seams they were eliminated okay so what they found is I’m not going to go through allthis that we just did clinically much better leahandgreg is swollen and inflamed joints theyhold well being was much better when they were on this nutrition 12 of the 27 cases had had quitesignificant statistically significant improvements as some components of cases with the normal diet andinterestingly even after one year they continued to do better than the other patients who didnot respond initially we don’t know if this is psychological but the positive impact you’ve keptpersisting even after the diet was discontinued maybe patients had menu allergies maybe patientshad other other issues or perhaps because they were very malnourished the immune organization better alsobe we are very interested in the fecal vegetation what that symbolizes is in the stool and you surpass stoolout the kind of bacteria which you pass out with change when you vary your nutrition drastically orstart eating a lot of healthy meat and so these beings had removal of gluten dairy carbohydrate anda lot of undesirable things such as the lighten and they were almost on a vegetarian nutrition for ayear the fecal botany change over this year that intends their whole intestinal bacteria change its first year and the intestinal bacteria is so important in your immune method so what is therole of the botany in the gut em and and rheumatoid arthritis there’s so many linked with infectionsthat the immune method and these nerve microbiome the very best and the bad bacteria and our bowel aresponsible for both protecting us from illnes but too sometimes when there’s an imbalance weare also responsible for autoimmune cankers so this here you can see here I don’t know ifyou can see my pointer but this here is the intestinal liner and very closely associated withthe intestinal lining is the peyer’s patch which is a collection or cells which are responsible andsort of soda are you part of your immune arrangement and govern your immune responses so the goodbacteria and bad bacteria which are in the gut can vary your immune organisation through the peyer’spatches but also by secrete dangerous chemicals because then their cadres the gap between thecells to widen and noxious elements to enter the bloodstream and also influence the immunesystem and this is called leaky gut so patients like to use the term leaping leaky bowel that meansit’s bacteria sort of damaging the the lining of your nerve and there is gaps between yourselves thishas been well documented and picture and this is not any sort of made-up story so when your bacteriaare in balance you get a leaky intestine and there’s a low gradation info set up because your immunecells which are just behind this barricade triggered so a lot of studies have shown us that patientswith rheumatoid arthritis and other autoimmune illness have an modified intestine bacteria and thismay be a very important factor so how do we get the gut bacteria to be going into a healthy Stateso of course by eating the freedom menus maybe by taking probiotics by evading antibiotics if wetake recited dosages of antibiotics we kill the good bacteria and also your nerve bacteria soantibiotics should be given only when needed and in circumstances in which cases have severeulcerative colitis or Crohn’s they’re using fecal implants but they’re taking the stool fromhealthy beings and putting it into the intestines of the patients who suffer from these diseasesso these are the bacteria bad bacteria trying to set up a colony in your intestine and what whatwill prevent them from setting up a settlement if you gut if the meat which you put into the intoyour into your intestine is healthy then these bad bacteria will release bother so we talkedabout the prebiotic nutrition these are menus which are really good for your intestines surface prebioticsfoods are nutrients which are rich in fiber likewise raw onions raw garlic gobble apples with the skin on itlightly unripe bananas like slightly raw bananas oats blueberries asparagus and artichokes arethe top menus for the prebiotic propria biotic appraise or benefits so there many other things Imentioned the apple with the skin on I mentioned the brown rice lots of different types of beansoranges so mostly a diet genuinely healthy and beans fiber lots of vegetables lots of differenttypes of nutrients ginger as well so trying to add and snack many different types of food and beansand munch across the spectrum different complexions you consider Nature has given us so many different colorsand each green and yellow and orange veggies and fruits and this will really help you chipped mycooking what about fermented meat yogurt is the most common fermented menu we are familiar and Kaffir aswell as a move located fermented meat a imbibe but a great deal of patients with autoimmune illness orrheumatoid arthritis will have menu intolerance is to lactose and too to the Carmel kissing sostudies and missed fairly manifestation to show that eliminating you newborn commodities for the food fromor for patients with autoimmune illnes it give you substantial which are beneficial so as I said before ifyou’re eliminating dairy commodities “youre supposed to” take that calcium add-on now sauerkraut is usedthat’s a kind of fermented vegetable kimchi is a Korean fermented vegetable in India we usea lot of pickled vegetables and we could use this without the chili pulverize which we commonlyuse and also fermented nutrients such as Italy and in the southern part of India are not sure whether otherparts there’s a attire of robbing rice overnight and liquid and this form breaths and eat in themorning as a rice gruel and this was used a lot in the past and it’s unfortunate that parties nowhave gone to start eating food from a container such as cereals which are not as health we should goback to eating foods like this which are more natural and fermented so when menus are fermentedthey likewise had an to a health bowel microbe so this is a study which show that after one year of avegetarian diet but nerve bacteria and rheumatoid arthritis cases improve significantly andthe patient had a much healthier nerve bacteria and the rheumatoid arthritis was also betterbut patients who had a vegan diet did better than patients who’ve had lactose or milk productsalong with vegetarian nutritions I’m not inviting beings to become vegetarian but I’m asking beings toadd a great deal of flowers and a good deal of fiber and be on a plant-based diet so also fasting or beingon a Mediterranean diet likewise achieve changes in intestinal microflora we’re gonna have a lot moreinformation on this because nowadays be able to sequence the gut bacteria through new generationtests and kits and we’ll be able to prescribe considerably better what about gluten these are not a lot ofstudies done on gluten this studies done on on diabetes for example and this studies done onalso showing that there is a link between celiac disease where patients are rarely gluten sensitiveand rheumatoid arthritis and they much of shared antibodies as well but we do see in studies whichhaven’t testified you still further that fasting or going on a gluten-free diet for prolonged periods of timeand eliminating dairy is good for patients with fighters and I’ve already mentioned thisa few terms lactose antipathy and casein and cow’s milk can also be harmful what about fastingthere’s so many benefits from fasting if you want to read more about this you can follow a professorlong ago from Stanford University who else fasting works on your neuro endocrine system from thebrain to the muscles to the liver and system but be queried consider longer only does what’scalled fasting resembling foods that you do diet your food or fast maybe once or twice a week oryou do this a fasting on a daily basis while you fast for 16 hours a need for food for eight hoursand this helps you trimmed bacteria to renovate in a healthy behaviour and there have been benefitsshown for autoimmune cancers as well as for cancer beings experiencing cancer chemo so these areagain studies from Longo showing how it has both autoimmunity and multiple sclerosis sentence whatabout probiotics so in probiotics at least back are the RS taking vessels of healthy bacteriaand hoping to regenerate of that bacteria there’s a good deal of dispute about this because thereare so many millions of bacteria and we don’t really know which are the good ones to put inbut mainly you need to have probiotics which contain lactobacillus or bifida bacteria and ifyou’re go probiotics you need to use between 1 billion to 5 billion those of bacteria per se thestudies haven’t really pictured a good deal of improvement in rheumatoid arthritis cases for probioticsbut I picture working in partnership with a healthful prebiotic food eliminating particular meat and using probiotics youcan have one of those so the take-home messages are although we tell cases that there’s notmuch of a persona there is a role for cyclicals fasting either doing a daily or restraint ourfasting or one day a week you fast or a vegan Mediterranean diets and riddance of daily andPutin that microbiome is fairly very important and my resolution what I tell my patients is snacked alot of plums eat a plant-based diet rich in fiber in veggies stop smoking bypassed processed foodsattitude sugar as well as sugar replaces may be Splenda is okay shunned red flesh especially avoidgluten and dairy fermented meat and probiotics are very helpful vitamin D is essential it shouldbe an a vitamin D augment take calcium if you’re not having dairy produces omega-3 andturmeric included and weight loss exercise and reflection are really important but that’s allthe talk that Phil is probably going to be a full other talk which I’ll is coming to you shortlyso thank you for listening and I see you soon

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