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Arthritis: are food allergies an answer?

For years the idea that food allergies play a role in arthritis had been dismissed as nonsense by much of the medical establishment. But not so today. The reason for the change of heart is straightforward: slowly, scientific evidence is implicating food allergies in a variety of health problems.

Last October, a team of British doctors, writing in the British medical journal The Lancet, reported a link between food allergies and migraine headaches in children. More than 90 percent of the 88 children in their study improved once the foods they were allergic to were eliminated from their diets.

"Most people have just one picture in their mids of food allergies. Namely, the person eats a forbidden food and within seconds is either covered with hives or is having trouble breathing. That happens, and it can be a life-threatening situation, but most food allergies are far less dramatic," explained Alan S. Levin, M.D., adjunct associate professor of immunology and dermatology at the University of California Medical Center in San Francisco (UCSF).

Levin and others working on the puzzle of food allergies and arthritis say the typical story is usually not all that different from Dorothy Calwell's. "As far as I knew I didn't have any allergies. What I did have was arthritis and a terrible skin rash which covered my face and kept creeping into my eyes," she explained.

Like millions of other arthritis sufferers the Ventura, California, woman was taking one of the non-steroidal anti-inflammatory drugs (NSAIDs). "I couldn't make a fist and needed a cane to walk. Often I didn't do anything more than take my Motrin [a NSAID], sit in the jacuzzi and go to bed," Calwell said. But increasing doses of Motrin didn't seem to be doing the job, and her skin rash (dermatitis) was once again inching toward her eyes. "My doctor suggested I try another course of Prednisone. I went ahead with it but I wasn't happy about it," she added.

Calwell's concern about Prednisone is shared by doctors. Corticosteroids are not only potent immunosuppressive drugs, but they can lead to a variety of other problems, as well. "Anyone who knows anything about them would prefer not to take them if they had a choice," she added. Fortunately for Calwell there was a choice.

Breaking with tradition, Calwell sought out not another rheumatologist (arthritis specialist) but instead an allergist/nutritionist. Now arthritis- and dermatitis-free for nearly 16 months, Calwell and her husband were finally able to take the trip to Australia they had been planning for years. "My family doctor says Ihm in better shape than I have been in in years. My husband says it's a miracle. I'm just thankful that I can do all the things I couldn't for so long," she said.

A growing number of allergists are seeking to unlock the riddle of delayed food allergies. What they mean by an "allergic reaction" to food is diferent from what most people think of when they hear the word allergy. There are no hives and often the reaction doesn't occur until hours or days after the offending food or foods have been eaten.

Actor James Coburn first sought treatment after he had completed a movie in Mexico. His arthritis was so bad during the filming that he could hardly move. They were lifting him on and off horses using a crane. Coburn was dramatically improved by eliminating the offending foods from his diet. He remarked during a December 1981 appearance on the "Merv Griffin Show" that the diet had saved his life.

How common, then, are such delayed food allergies? UCSF's Levin explained that although no one really knows for sure, he believes they are far more common than many of his colleagues might imagine. "This is, relatively speaking, a new area in medicine. Many doctors were never taught anything about this type of allergic reaction occurring in association with eating foods," he said.

Such statements are backed up by a Michigan allergist who chaired a committee formed by the American College of Allergists to look into the association between arthritis and food allergies. "I don't think there's any doubt that in many cases arthritis symptoms are linked to these delayed food allergies. A number of studies have shown that. And, while we don't yet have precise figures on how common the problem is, I think it's reasonable to estimate that somewhere in the neighborhood of 60 to 80 percent of arthritis sufferers would benefit from dietary manipulations," explained James C. Breneman, M.D.

Although interested in the association between delayed food allergies and arthritis, those who make their livings treating arthritis sufferers are somewhat skeptical of the numbers being tossed about. "I think there are probably some small number of patients who are helped by altering their diets, but I don't think the number is anywhere near the 60 to 80 percent figure being discussed. That's ridiculous," said Frederic C. McDuffie, M.D., senior vice president for medical affairs at the Arthritis Foundation.

Physicians such as Levin are undaunted by comments like those of McDuffie. "I think," he said, "we recognize that what we're saying goes against much of what rheumatologists have been saying for years. Nevertheless, the evidence is there that this is very much a real phenomenon."

Levin and others explain that the key to the link between allergies and arthritis is something called immune complexes. These complexes are formed when protein-building blocks in food, called macromolecules, make their way from the intestine into the blood stream. In the person with food allergies, these antigens combine with antibodies against the offending food to form immune complexes. "When they deposit in joint spaces they produce inflammation, and that is what causes the pain, swelling and stiffness," Levin said. He went on to explain that in his view food allergies don't cause arthritis, but rather that they exacerbate the problem.

But understanding how food allergies contribute to arthritis symptoms isn't the whole story. Patients need to find out what foods they are allergic to if they are to control the problem. One doctor explained that he prefers finding the specific foods a person is allergic to rather than just trying one of the many so-called arthritis diets: "The problem with those is that they may or may not work. Certain foods or groups of foods, like the nightshades [including potatoes and tomatoes] are frequent offenders. Pork and some wheat products may also be culprits, but if you develop a diet plan rather than identifying the specific foods, you can totally miss what might be a given patient's problem food(s)."

However, deciding to identify specific foods and actually doing it are often totally different things. Breneman said testing for delayed food allergies can be quite complicated. "Most of our attention," he explained, "is focused on tests which measure immune complexes in the blood and a new patch test which can spot delayed food allergies."

Breneman and Levin reject the controversial cytotoxic test, which looks at white blood cells' response to specific antigens. They say that the mainstays remain elimination diets and the newer patch tests and blood tests for immune complexes. "We start out," Levin said, "by eliminating foods from the diet and then slowly add them back and observe the patient's response." Ironically, the offending food is often one which the patient craves.

"It's hard for people to understand at first why they should crave something which is in fact making them sick. But the key is that the biochemistry of food allergy is very similar to the biochemistry of heroin addition," Levin explained. As a result, when patients are first taken off the allergy-producing foods they often go through withdrawal.

Improving the lot of those with arthritis is, of course, the goal of all those who treat arthritis sufferers. Richard S. Panush, M.D., associate professor of medicine and chief of clinical immunology at the University of Florida in Gainesville, is one rheumatologist who believes there may indeed be something to the allergy-arthritis connection. "This has been a slow area to develop for a variety of reasons. However, we and others are very interested in it. We've already done one study on the role of diet in alleviating arthritis symptoms. What we found was that a very small number of patients seemed to benefit from the dietary manipulations. And we are in the process of doing more work on this," Panush explained.

One reason Panush and others may not be seeing the same dramatic results some claim they are is that the former have studied so-called arthritis diets. "The problem with those is that they are essentially a hitor-miss thing. If the diet happens to eliminate the food you're allergic to you get better, but if the food that triggers your allergic response isn't on the list, you stay the same," said one M.D. And that, some say, is one reason that diet therapy for arthritis is viewed so skeptically by the medical profession.

However, a number of foods do seem to crop up time and time again in arthritis sufferers with food allergies. Pork, wheat products, the socalled nightshades, milk and eggs are among the most prominent. "We found," Breneman said, "that pork was a very common offender." Others have found alcoholic beverages to be a common trigger.

Better defining the triggers and testing for them ahead of time is something that will require more research and will require more funding. Panush believes more money needs to be spent on such studies so that it can be determined once and for all how significant a problem food allergies are in causing arthritis symptoms. "I think," he explained, "that those of us involved in this field have to do morethan just keep an open mind. I think we need to do more research on this."

Although the Arthritis Foundation is keeping an open mind, its current position is that dietary manipulations have no proven efficacy in treating arthritis sufferers. But it is behind federal legislation that seeks to establish a separate division within the National Institutes of Health (NIH), one devoted exclusively to arthritis and related disorders. This legislation should produce more funding for arthritis-related research, as well.

Senator Orrin Hatch (R-Utah) is now spearheading the drive to get the bill, originally introduced by Senator Barry Goldwater (R-Arizona) and Senator alan Cranston (D-California), through Congress. Hatch explained that the magnitude of the arthritis problem means that it needs its own institute within the NIH. "There are approximately 36 million people in the United States who have one of the more than 100 diseases which are lumped under the broad heading of arthritis and related disorders. That translates into," Hatch said, "one in seven people. It's a leading cause of disability and industrial absenteeism."

McDuffie and the Arthritis Foundation believe the federal government is hampering the battle against arthritis by underfunding research. The Arthritis Foundation estimates about $44.8 million is spent annually on arthritis research. That translates into $1.24 per arthritis sufferer. Cancer, on the other hand, has a budget of about $935.3 million, which translates into $187.06 per cancer patient.

The legislation currently winding its way through congressional corridors would establish a separate institute within the NIH called the Institute of Arthritis, Musculoskeletal and Skin Diseases. "Right now arthritis falls under the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases," Hatch said. NIH director James B. Wyngaarden, M.D., and the Reagan administration oppose the bill, a position supported by the American Medical Association.

The Arthritis foundation's McDuffie explained that past history shows such proposals are usually opposed. "Part of the problem is a resistance to change. But the key issues in the view of the bill's opponents seem to be afear that this enlarges the bureaucracy, making administering the NIH an even more difficult task than it now is. And there is concern that if arthritis gets its own institute, eventually every disease will receive its own separate institute as well," he said.

Regardless of whether the bill establishing a separate arthritis institute makes it through the series of obstacles facing it, such researchers as Levin and others vow they will continue to do the research necessary to unravel the link between food allergies and arthritis. "The thing to keep in mind is that many of the therapies now being used to treat arthritis have potentially serious side effects associated with them," says Levin. "Excluding offending foods from one's diet may be a bit inconvenient at first, but provided adjustments are made to assure adequate nutrition, there are no serious problems associated with giving it a try."
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Author:Vinocur, B.A.
Publication:Saturday Evening Post
Date:Apr 1, 1984
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