Joint Pain & Fatigue

The causes of joint pain

When patients seek advice from their rheumatologists regarding dietary modifications, they are told that there is limited scientific proof regarding the effectiveness of a dietary approach. However current data has rather conclusive answers to the question about recommended nutrition for RA patients. Contrarily, the EULAR (European League Against Rheumatism) recommendations for treatment of early RA considered that none of the existing studies has unequivocally proved an advantageous influence of specific diets on the course of the disease, but agreed that a vegetarian diet has positive influence on pain and disease activity indicators.

It was also shown that fasting for 7–10 days induces anti-inflammatory effects. Diet and intestinal microbiota are modifying factors that may influence intestinal barrier strength, functional integrity and permeability regulation. Intestinal microbiota may play a crucial role in RA pathogenesis, but up to now, no solid data have clarified a mechanistic relationship between gut microbiota and the development of RA. Gut microbiota regulate the T cell mediated immunity and seem to have a role in RA development, while gut dysbiosis contributes to the occurrence or development of a range of rheumatic diseases.

In this reasoning, we can assume that diet can not only exert anti-inflammatory effects, but has also an influence on the gut bacteria and hence disease activity. Systemic inflammation can be triggered by food. Proteins or proteinderived compounds that occur in food may modulate the immune response of the body. The immune system takes food proteins or derived compounds as immunogens that generate food specific IgG antibodies, which are combined with food particles and then induce inflammatory response, presented as symptoms or diseases. Continuous and repeated consumption of the same foods that trigger IgG-mediated hypersensitivity reactions may thus promote and maintain silent inflammation. IgG-mediated food hypersensitivity can therefore be a trigger factor for the development of diseases where inflammatory pathways are involved, such as rheumatic diseases.

The scientific approach to joint pain and IgG

In a survey, 300 subjects with rheumatoid arthritis (RA) were asked about consumption of 20 foods that make their RA symptoms better, worse, or unchanged. Almost a quarter of respondents stated that foods do affect their symptoms, being blueberries and spinach most often reported to improve RA symptoms. Soda with sugar and desserts were most often reported to worsen RA symptoms. Another survey found that rheumatic disease was affected by diet among 60% of respondents, whereby a positive effect was attributed to groats and oily fish (39% and 32% of the respondents, respectively). To investigate the immunological link between gut immunity and rheumatoid arthritis (RA), antibodies (IgG, IgA, and IgM) to dietary antigens (cow’s milk (alpha-lactalbumin, beta-lactoglobulin, casein), cereals, hen’s egg, cod fish and pork meat) were measured in the serum and jejunal fluid of 14 RA patients and 20 healthy subjects.

The results showed that jejunal IgA, IgG, and IgM activities to nearly all food antigens were highly or moderately increased in RA patients when compared with healthy individuals. Gliadin- and casein-specific IgG antibodies in the jejunum of RA patients were 12 times higher, and a 4-8 fold increase was measured for other food or food constituents, compared to healthy persons. Five RA patients were then treated with sulfasalazine (an anti-inflammatory drug used for patients with Crohn’s disease, ulcerative colitis and RA) for 16 weeks. The increased food antibody level strongly decreased in two patients, suggesting that sulfasalazine had an immunosuppressive effect on intestinal immune responses.

This points towards a connection between mucosal immune activation and the pathogenesis of RA, at least in some patients. Their food related problems probably reflect the additive effect of multiple hypersensitivity reactions that are mediated by immune complexes, which then predispose the joints for autoimmune tissue destructive reactions.

The diagnosis of fatigue

The distinguishing factor between normal fatigue and a diagnosable condition like “Chronic Fatigue Syndrome” (CFS) is not necessarily the chronicity of symptoms but the timing. Sufferers of CFS will experience ‘post-exertional malaise’ (PEM); severe energy depletion that occurs after exertion such as exercise or general physical movements. While some will feel energised after a run, PEM makes it difficult to carry out many daily functions and a spiral of low energy ensues. There are no specific blood markers for CFS so diagnosis is made based on a scale of criteria, including PEM severity. Women are diagnosed 4 times more often than men.

The causes of fatigue

Chronic Fatigue Syndrome (CFS) has been linked with various infectious triggers but an actual cause is still not known. Recent evidence suggests a link with the gut microbiome, as many patients appear to have markers for leaky gut and imbalances in certain microbial species. This provides another pathway for IgG food allergies, since the proteins are then able to slip between the intestinal barrier to activate the inflammatory immune response. This is potentially why up to 76% of patients reported an improvement in fatigue on a strict ImuPro diet.

The scientific approach to fatigue and IgG

Identifying leaky gut is important for chronic fatigue sufferers as this allows the passage of both food proteins and bacterial endotoxins into the blood stream. Removal of IgG triggers and correction of the gut microbiota are likely to be helpful, particularly if there is a history of repeated antibiotic use. A few years ago, ImuPro undertook a clinical observation study, to collect evidence on the efficacy of ImuPro Complete in patients with very different conditions that may indicate food hypersensitivities, including, psoriasis, neurodermatitis, headaches/migraines, overweight/obesity, fatigue, rheumatic diseases or gastroenterological complaints.

A total of 938 patients participated in this trial; 600 and 746 patients indicated that they suffered from fatigue and exhaustion, respectively. The following improvements were noted after elimination of IgG-reactive food for a period of at least 8 weeks:
Fatigue: improvement in 71 – 76% of patients (depending on compliance)
Exhaustion: improvement in 69 – 74% of patients (depending on compliance)