Conquering Arthritis Naturally

Hey everybody, it's Dr. Mark Hyman.

Welcome.

I'm so glad to have my friend and colleague here, Dr. Susan Blum, who's the director of the Blum center for Health in Ryebrook, New York. She's been an extraordinary part of our functional medicine community. Been doing this. I've known her for probably almost a few decades now. And she really focuses on personalized medicine prevention and uses functional medicine to help people get better from all sorts of things. She wrote a great book on autoimmune disease a few years ago and has now written a book called Healing Arthritis, which is really about dealing with this epidemic. She's Advisor on the Dr. Oz Show. She's frequent in the media and she's really committed to actually transforming healthcare. I love that she's got a teaching kitchen in her practice, which is what every doctor should have in their practice, which is teaching kitchen. And I just want to back up on this arthritis thing because it's such a prevalent condition, affects so many people. It limits their activities, it limits their ability to live a full life. It sort of starts a downward slope where people move less and then they move less and then they move less and they age more. And the drugs we use are pretty harmful. We use anti inflammatory drugs, we use drugs that affect the gut, steroids, some of the more powerful drugs. So tell us why in the face of this, why you decide to write a book on arthritis.

Well, first, Marc, let me say thank you for having me. It's great to see you too. And yeah, I think we're about two decades in or something. It's just, it's really been a fun journey to share together. So thank you. And so here's the thing. After these two decades of practicing functional medicine, the amount of people coming into my practice every day with arthritis, I noticed that this is an epidemic that nobody's talking about it. And it seems to me a lot of people come in and I'm sure you've had this experience where they just say they come in for something else and oh yeah, I have arthritis. As if it's just something that it's inevitable and everybody should just accept, right, that this is just, it's inevitable I'm going to be disabled as I get older and I'm just living with it. And so I really felt the need to dedicate a book now to this epidemic. It's happening to younger and younger people. Everyone thinks it's only older folks, but almost 30% of people between 45 and 65 have doctor diagnosed arthritis. Not just Somebody who has joint pain in their house, but they actually were diagnosed by a physician. And so that's a significant number of younger folks. So this is not just something older folks get. And so I really wanted to get the word out that this is not inevitable and that arthritis. The other main thing, as you know and you talk about a lot, is that there's this huge body of literature that's come out talking about the gut arthritis connection. And we're actually learning the actual mechanism for how imbalances in the gut and issues in the gut end up causing inflammation in the joints. And so I really wanted to get this word out that. And this is our mantra, right, is that inflammation in the joints is coming from somewhere else in the body, and that we are one body.

Right.

And that arthritis is a systemic disease. And using functional medicine tools, you can really find the sources of those inflammation, of all the inflammation, and then reduce the pain in the joints.

Amazing. So you're talking about arthritis, but you mean autoimmune arthritis or osteoarthritis. There's so many different kinds, so how can you use that one on arthritis?

Right, I know. And so here's the thing. There are definitely there are a lot of different kinds of arthritis. And so I actually, the book, the whole first section of the book is really dedicated to helping people understand what kind of arthritis they have. So I actually review the two big categories. One is osteoarthritis, and that's the one that's the wear and tear kind of arthritis that everyone thinks they're going to get as they get older and that it's inevitable. But that's called osteoarthritis. And then there's the huge grouping of arthritis conditions that are autoimmune, the inflammatory autoimmune arthritis conditions like rheumatoid arthritis, which is actually the number one most prevalent autoimmune disease is rheumatoid arthritis.

I thought it was Hashimoto's.

No, rheumatoid is. Wow. The statistics on the CDC site that I looked at. So, yeah, rheumatoid arthritis is number one most prevalent. But you have as a whole grouping, you have psoriatic arthritis, you have ankylosing spondylitis, but then you take care of so many autoimmune people, just generally speaking, people with autoimmunity, like lupus or Sjogren's, they'll also often have inflammatory arthritis, like that goes with their whole syndrome. So those are the biggest groupings. But then you also have Gout. Right. So you have to make sure some. Which is also a systemic metabolic disease. And then you also have the things you have to rule out and make sure that people don't have, like Lyme disease, right. And parvovirus. And there are infections that actually can trigger arthritis. But I wrote the book really, to address the chronic arthritis conditions, really looking at osteoarthritis as well as the rheumatoid arthritis and autoimmune arthritis conditions, because what the studies are showing that both of those have common root causes for inflammation. And so you can use one approach to really addressing all the inflammation in the body, looking for the root causes, treating the gut. And as you know, there's a big connection between the gut and rheumatoid and the autoimmune arthritis conditions. But it's really interesting. And is this whole metabolic connection with osteoarthritis that's going on now, Right. And so you have the obese. Well, it's. What do I think about it?

What do you mean by metabolic?

What do I mean? Yeah, yeah, yeah. So what I mean is that there's this understanding now they're looking at the triggers for osteoarthritis, that there's increased amounts of adipokines, right, like leptin, for example, in the joints. In the joints of people with osteoarthritis. And there's this connection between obesity and osteoarthritis.

And so, wait a minute. That big word you said, adipokines, what that means is that's inflammatory molecules that come from fat cells that are in your joints, which is kind of a radical idea. How does belly fat inflammation lead to inflammation inside the joint? It's like, crazy.

It's crazy. And that's the other really important thing to keep in mind. And so we all think about osteoarthritis as weight. Like, lose weight and your joints will feel better. And that's just from the load. The recent research is showing us that it's actually the inflammatory compounds coming out of the fat cells that are ending up in the joints, increasing reactive oxygen species, you know, which is that oxidative stress, which is just free radicals running around in the joints, and that actually causes the damage to the cartilage. And so they're working out, you know, researchers are working out the whole mechanism for sort of the way obesity is connected to the increased risk of osteoarthritis and a trigger for the pathogenesis of it. It's actually really interesting. One of the other Big things when it comes to obese.

Hold on, I want to back up. So it's fascinating because we always thought that osteoarthritis is wear and tear. It's just a mechanical wear and tear. But what you're saying is it's not. It's actually an inflammatory problem. And in obesity, it's not just the weight and the load of the weight on the joints, it's actually the inflammation that comes from the fat that actually causes the problem. That's a major paradigm shift.

I know, and that's what I wanted to tell that story in the book because. Because when you understand it that way, you understand that this is not inevitable from wear and tear of aging and that there is something that you can do about it and that it's more than just, you know, again, this process that is just nothing you can do. And so it also turns out that, well, you. And I'm sure you already know this, is that if you put two people's X rays up on the wall, one person might have pain and the other one won't. So just because there is joint damage doesn't necessarily mean that. That the person is going to. It doesn't necessarily dictate the level of pain. And the level of pain is driven by these inflammatory sort of factors that are coming from somewhere else in the body. And so, you know, because people come in all the time and they're saying, well, I can't. I already have arthritis. There's nothing I can do. And I say, well, actually there is, because there's sort of pain centers and these things called. Another really fascinating thing you're going to love. It's called an acid sensing ion channel, Acid sensing an asic, A S I C. And it actually is the pain sensor that can, that can feel, that can sense subtle changes in the ph in the blood. So when you talk about metabolic acidosis or eating an alkaline diet, a lot of vegetables, that it actually, that's one of the ways that there's pain triggers that are related to that. And so just these really fascinating things that really tell us there is so much you can do and that there is not this inevitability. And. Yeah, and so I knew you would love that. Right. Because so much work on obesity and of course, the work that you talk about a lot about the connection between obesity and the microbiome patterning in people that are obese. And so again, we circle back to the gut, right?

Yeah. Well, tell us now about the gut, because I just had to back up on that because it was a big, big point brushing over.

Well, well it is. And that's why, you know, I remember last time I saw you, I said, I have to tell you about the metabolic stuff, you know, because it so ties into what you're doing and you know, and one of your things you're passionate about as well. And, and it really opened the world to me to. It really opened up that idea that there is so much a person can do and that it really is again, about inflammation and you find and treat the root causes and the person gets better and it's just functional medicine, you know, mantra. Right. And so coming back to the gut piece, I mean, the really interesting stuff that's come out in the research, gut research, is not only that they've been studying rheumatoid arthritis and all the autoimmune arthritis conditions and looking at sort of the pattern of the gut microbiome. And actually researchers are now saying that in a few years they'll be able to look at someone's gut pattern, microbiome pattern and diagnose rheumatoid arthritis based upon specific patterns that they're starting to see in those patients. And so really a lot of sort of great sort of work, especially with rheumatoid arthritis and specific microbiome studies, is.

That more relevant in autoimmune arthritis or in osteoarthritis too?

Yeah. So I think that the research is really much more connected in terms of the mechanism for how you end up with rheumatoid arthritis via the gut, for the autoimmune world, you know, for definitely in the autoimmune arthritis. But again, you know, treating, making sure since the gut is so much the home of where inflammation begins for anybody, you want to make sure that you're addressing that for osteoarthritis people as well. But the mechanism for one of the mechanisms for the gut is that, you know, there's this condition called leaky gut which all your people watching this probably are aware of. And when there's an imbalance in the gut microbiome and you end up with permeability in the wall of the intestine. And what happens is there's certain kinds of bacteria that can leak out of the gut, through the gut and into the body. And it's very specific bacteria that are these gram negative, you know, when you do stool tests and you see like Klebsiella and Citrobacter, these gram negative rods. Well, it turns out that the studies are really Showing that there are pieces of these bacteria, especially these lipopolysaccharides, these lps. There's parts of their cell wall that are very, very triggering to the immune system. And so the researchers have been finding the bacterial cell wall proteins in the joints of people with rheumatoid arthritis. So we're really learning about that.

Stop, stop. So what you just said was that in the joints of people with rheumatoid arthritis, there's parts of the bacteria in the joint that come from your gut. Well, how do they get there?

Through the bloodstream. And they end up there with the immune.

Leaky gut.

Right, right through the leaky gut. And their immune complexes, that the immune system sort of grabs them and they end up making their way into the joints. And really interesting studies in mice and rats. Rats or mice, I don't know. But one of those that have shown that in rodents, but they took healthy rodents and they injected these bacterial cell wall proteins into their blood and the rodents developed arthritis. Wow. So the point is really that we know that there's issues with the gut that are related to arthritis. There's so much interest in this that we're going, I think, look, like all the microbiome research that's happening now, we're going to know a lot more in five years. We'll probably look back and say we didn't know anything then, you know, so.

You were talking about this role of inflammation and you kind of quickly brushed over some things that were the causes. You talked about obesity and you talked about the gut and leaky gut. You talked about Lyme disease, you talked about viruses. But can you kind of give us an overview of like, what are the main causes of arthritis and maybe we should sort of split them out because it might be osteoarthritis and rheumatoid arthritis might be a little different.

Yeah. Well, here's the thing. And so in the book, I really bring everyone together right. Under the same roof. And the Lyme people and the. I give people a clear path to go and get a diagnosis in the book, you know, or at least for anyone with chronic arthritis to really just go through these steps. Number one is always food. Right. So first step of my program, it's a three step program. Number one is food. Number two is heal your gut. Right. And number three is, I call it finish what you started, the six month program. And you're laughing. Okay, you're laughing. But here's the thing. How many patients do you have that you've been Working with for like 10 years, you know, long, long time. And it's very easy for all of us in the functional medicine world to say, here's your 30 day reboot, here's your 21 day reboot. But this is not enough. No, no, no, I'm not saying you're doing this, but I'm saying like it's easy for people to go on the Internet and find.

It's a trick. It's a trick to get people started. I did a 10 day detox, but it's not really 10 days, it's more like 10 years.

There you go. That's the point. And so the first two. So it's always like get a jump start going, work with food in a very sort of aggressive like elimination diet. Clean out things, really clean up, work on the gut. But then, you know, I really wanted to bring my two decades of experience in terms of what's the long term play, like, how do you really help people finish what they started? Because here's the thing, and I don't care what kind of arthritis you have. And this is what, answering the question you asked me. Everybody does food, right? And we'll circle back and talk about what that means. Everybody has to heal the gut because the gut is connected directly to autoimmunity and inflammatory arthritis. It also generates inflammation for osteoarthritis as well, whether directly or whether via the obesity, you know, the whole obesity piece. And so the gut is a source for inflammation. And so that has to be addressed. And then in the finish what you started program, I really talk about stress as well. Stress and trauma. There's so much work that's been done looking at, you know, traumatic events and increased risk for inflammatory diseases and the importance of, and you know, like in terms of, if we, if we all decide that having a healthy gut is going to be central to having a healthy, healthy joints and low inflammation, we have to help people understand how to have a healthy gut over the long run. And so food is the number one most influential thing on the gut and stress.

Like what should we be eating?

Like what we should be eating? All vegetables, you know, so, okay, so.

There'S vegetables, salad every day.

Yeah, yeah, no, I know, I know. Okay, so I'm gonna focus on the things that you and I both, you know, that we both.

There's things you shouldn't eat and there's things you should eat.

There are things you shouldn't eat and there are things you should. And so the kinds of fat that you're eating healthy Fat is really, really important. And I know we're both in agreement about that. So increasing the quality, a lot of it is about helping people understand about quality. It's about the fats you're choosing and eating plenty of healthy fat. I mean all the nuts and seeds and avocado and olive oil. Mediterranean diet is so high in fat. That's one of the reasons why it's been so successful in its own way in every place it's been studied just in terms of the fats and healthy fat. You know, coconut oil is okay, but you know, a lot of healthy fat, which is all the anti inflammatory fat because the fat comes into your body and enters all these pathways that determine, are really important in determining the level of inflammation directly right. In your body. And so the kind of fat quality. So the quality of the fat, the quality of the animal. Right. So you want to eat animals that are fed, grass fed, you want to eat animals. And really the choosing. I'm very not a big dairy proponent. I think dairy is inflammatory for most people. So I advocate, you know, so there's what we advocate long term and then there's what we do in the short run.

What about gluten? Isn't that an issue?

Gluten, yes. So I was going to get to carbs, next piece. So. Absolutely. So it's quality of the carbs you're eating. Limiting carbs, gluten free 100%, especially for the autoimmune people. But at the beginning we take all the. Really help people eliminate sugar, Mark. Because it's not just about saying all grains are bad. It's there's, you know, the standard American diet. Well, and I understand people feel that way, but the standard American diet, at the very least we have to help people get off of processed food and get the sugar out and all that processed stuff. And then I definitely am very restrictive on grains, especially, you know, any gluten grains that are involved.

And so should people with arthritis be off grains?

Well, we might not. I don't take all my patients off of grains. Okay. I do take some people off grains if they have really severe digestive symptoms. And so we do do a much, we personalize the absolute limitation on grains. But I usually restrict people to one serving a day of a gluten free grain at the beginning of the program if they, if, you know, we try that and if they're not getting better, then we'll experiment with taking all the grains away. But I'm not anti grain, you know, all the studies. So in the I reviewed a whole chapter on food. Okay. And so my review of all the literature on arthritis and the studies on arthritis, the studies on gut health, and the best diets for gut health were, hands down, sort of really, the Mediterranean diet kept being the winner. But like, if you think about it, with the Mediterranean diet, it's very focused on healthy fat, a lot of vegetables, and color. You know, this whole idea about polyphenols in the diet, which is all the colors and the colors come in and they help the good bacteria grow. So I'm trying to help people eat for long term good gut health, which I think is.

Yeah. So in terms of colors, there's some colors and foods that people say are bad for arthritis. Tomatoes, peppers, eggplant, potatoes, nightshade, vegetables. What do you think about that?

Yes. And so we always remove those. So. So I'm gonna break the food into. There's two steps to the food. There's the original. I call it the leaky gut diet for arthritis. And that's step one. And that's where we do a full elimination diet. Gluten, dairy, soy, corn, eggs, all clean up the quality. And we take out nightshades. Tomato, potato, eggplant and peppers. At the end of the day, everybody needs to determine for themselves what foods are going to trigger pain. And I have found that some people with arthritis, tomatoes are a huge issue and the rest of them are fine. And for other people, peppers are an issue. And so for some people, none of the nightshades are an issue. So for two months, as part of the whole program, we take out all those foods while we're working on healing the gut. So we limit all the. That's where we do more limiting of the grains. And we really focus on a lot of different vegetables, healthy choices, good quality choices.

For the animal, it's an anti inflammatory diet.

It's an anti inflammatory diet and we all have our versions of it. Some of us like no legumes and some of us like no grains. And that's okay, you know, and we work very one on one with people. And in the book, I sort of give you options for if you have a lot of digestive symptoms, you might want to try eating no legumes at all. You know, some FODMAP kind of, you know, things. And so we try to personalize it somewhat, but that's not necessary for everybody, especially people with osteoarthritis. And so. And so we really. My goal, honestly, there's so much confusion about the food out there that my goal was really, here's just a simple leaky gut diet for arthritis. Do this for a few months, and then when I talk about the step three, finish what you started. That's where I'm talking about. After you reintroduce foods and figure out what your personalized food plan, what you feel best eating. The studies are very clear that a gut healthy what you want to eat for your gut microbiome. And your gut is an ecosystem.

You're not really just feeding yourself. You're feeding your whole body gut flora.

You are feeding your whole gut flora. And the foods that your gut really likes are foods that have a lot of. I keep going back to color. So it's all the colors in all the vegetables. There's a whole group really interesting research.

On Skittles, you mean?

No, no, we're talking about. Right. We're talking about different greens. Okay. So lots of greens and reds and yellows and carotenoids. And there's so much antioxidants. Oh, we didn't have time today even to talk about oxidative stress and the need to increase your antioxidants because people with arthritis have a lot of oxidative stress in their body, which means that they're behind. Right. That means they don't have enough antioxidants to put out all of those free radicals. And so in step one, it's really not just about what we're taking away. It's really about what we know works, what you need to bring in. Yeah. And so it's fascinating about these polyphenols also that they actually they affect the genetic expression of your microbes in your gut. So they influence the expression of those bugs so that they're healthier. So they're actually a prebiotic in their own way.

Amazing.

It's amazing. And so then there's fiber, and you get fiber in vegetables. And if you can tolerate small amounts of grains, you'll get it in the grains as well. And so that's the gut supportive and limiting sugar and then the things we know that aren't good about sugar. And there's so much interesting stuff. It's all in the book. I mean, even like sugar hyperglycemia, sugar coats and causes damage in the joint capsule. It's really crazy. There's so much great stuff.

So refreshing. I mean, to hear that there's hope for people with arthritis, that we now understand some of the mechanisms that you don't have to be on these drugs that actually make your gut even worse. And I've seen amazing Recoveries, Like, I just, you know, when people come in, they like can't walk and their joints hurt and they're in pain all the time and then you change and they're like, it goes away. And it's like sort of frustrating because, you know, when you see a traditional doctor, you don't get that. And they're just giving them more and more medications, more and more disability. And, you know, we're actually wanting to sort of do a program here at Cleveland Clinic where I'm now it's where I'm wearing a tie because you don't wear a tie because they make me wear one in here. But I find that we're really getting a lot of collaboration from the orthopedic surgeons and people who deal with this all the time because they know it's such a crippling condition. And it's great. I can't wait to read your book. And where can people find out about it? Get your book, find out about you.

So I have a whole dedicated website to the book. It's called healingarthritisthebook.com and that's a great way for just go there. You can get bonus material and all sorts of interesting giveaways to just learn more about the book and some videos and all that. And I'm everywhere you can find, find me on Facebook and Twitter and I have a great website called blumhealthmd.com and that's where I have all my sort of online programs and other ways I can support you as you go through the book. And so we're here, you know, I have coaching programs. I'm very, very much interested in helping people, you know, do the program, you know, do it with us. Support, you know, we all need that. And it's a long term, it's a long term process and lifestyle change isn't always easy, as you know.

No, thank you, Susan. Thanks for your dedication to functional medicine. Bringing all this work to everybody. You're one of the functional medicine all stars. I love you. You're awesome. Everybody go get the book. Healing Arthritis. Check it out.

Thank you so much for having me. I really appreciate it, Mark.

Thanks, Susan.