The Pain of Rheumatoid Arthritis: Nature's Intended Overreaction
Robert Kachko, ND, LAc
May is National Arthritis Month
Friday, May 8, 2015
by: Robert Kachko, ND, LAc

Section: Healthy Aging

About Dr. Robert Kachko

Robert Kachko, ND, LAc is a Naturopathic Doctor and Licensed Acupuncturist at InnerSource Health in New York City. He proudly serves on the Board of Directors of the American Association of Naturopathic Physicians (AANP) and takes an active role in the New York Association of Naturopathic Physicians (NYANP). He graduated Summa Cum Laude with a Doctoral Degree in Naturopathic Medicine and a Masters Degree in Acupuncture from the University of Bridgeport College of Naturopathic Medicine and Acupuncture Institute. He has completed an additional 2 year course of study in Classical Homeopathy at the New England School of Homeopathy. He completed his pre-medical studies with a Bachelor's Degree with honors at the University of Wisconsin, Madison.

Dr. Kachko believes in the importance of expanding access to Naturopathic Medicine and Acupuncture for all patients. At the College of Naturopathic Medicine, he was founding President of the expanded local chapter of the Naturopathic Medical Student Association (NMSA) and received the prestigious award for Outstanding Service to the Profession.

To learn more about Dr. Kachko, please visit him on Facebook and
Imagine for a moment that your home is on fire, and your local fire department arrives in heroic fashion to save the day. Yet, instead of coming through as saviors, they merely “fix” the problem by cutting the power to your fire alarm. No more obnoxious noise, no more problem right? The obvious problem, though, is that the fire proceeds to wreak havoc on all of the possessions you hold dear. While the hyperbole of this anecdote flies in the face of everything we find to be logical when it comes to fire safety, the analogy is far from exaggerated in relation to how medicine often addresses chronic pain.   
The sad truth is that our understanding of pain has not evolved appreciably in the last 60 or 70 years, and much of the time doctors are grabbing at medical straws in trying to ease the discomfort of those in their care. While this is an uncomfortable truth for a doctor to admit, it’s a daily reality for the many thousands of Americans who deal with chronic pain. Much of the reason for our stunted understanding is that our approach is grounded in the idea that the pain itself is the problem, which leads us to ignore the fact that pain is just an internal alarm informing us that something has gone awry. The pain of Rheumatoid Arthritis is just like that blaring alarm in response to our imaginary fire, and we must learn to put the fire out by discovering its true cause. Otherwise, it will continue to burn to drastic proportions. 
Nature or Nurture?
Arthritis, Autoimmune disease, and the combination of the two which we call Rheumatoid Arthritis (RA) is increasing in incidence in industrialized countries. While there are many potential reasons for this which are currently being studied (impact of environmental toxicity, gastrointestinal microbial infection, genetics, inflammatory susceptibility, etc.), the role of the naturopathic physician is to serve as a “medical detective” in discovering what the true cause is for each patient. Underlying all of these potentially important causes which are unique to RA, there is a need to set a foundation for sustainable wellness via diet, exercise, proper sleep, and stress reduction.
All of the symptoms our bodies express are the direct result of our interaction with our external environment, and they are intended to heal. In RA, the inflammation which causes the pain our patients feel is in response to some other disconnect between what our bodies need and the reality they encounter. While our current view of autoimmune disease is one of immune “over-reaction”, the truth is that the reaction is appropriate in response to discord between our genetics, our choices, and our ambient environment. Though there is a genetic component to much of what we know about disease, our practical understanding of the clinical role it plays is still extremely limited. Even more relevant, our ability to alter those genes (with the exception of a few metabolic diseases and specific cancers) to induce our innate healing capacity is far from making its way into your doctor’s office. For this reason, the best we can do until that research catches up is to make health promoting choices which are in tune with nature.
Here are some steps you can take in that direction:
  1. Eat the right food for you
  2. Move your body every day
  3. Maintain a positive mental attitude
  4. Choose specific targeted therapies to speed the process along

Does diet really matter?
Yes, it does indeed. There are several dietary approaches which may be useful for those who are suffering from the symptoms of RA (anti-inflammatory diet, elimination diet, controlled therapeutic fasts, Mediterranean diet etc.), and in working with a naturopath it is recommended that you find the ideal diet which suits your current needs. Since May is International Mediterranean Diet Month, it is an opportune time to discuss the merits of this diet for RA.
The diet was assessed in 51 patients with RA compared to an omnivorous diet for 12 weeks, with improvements in “inflammatory activity, an increase in physical function, and improved vitality.”[i] The diet is a useful adjunct to treating a wide array of conditions in addition to RA. The famous Nurses’ Health Study, which has been tracking the health of 121,000 nurses since 1976, has assessed the role that the Mediterranean diet plays in Telomere length (which is a functional marker of age). The researchers found that when they measured the telomere length of white blood cells in these nurses, those who ate a Mediterranean diet were more likely to have longer telomeres.  This is in addition to all of the other related benefits of the diet for things like cardiovascular and mental health, and for reducing cancer risk.  The Mediterranean diet consists of primarily seasonal plant based foods from local sources. Whole grains, legumes and nuts form the bulk of the diet. Healthy fats are encouraged, along with various herbs and spices for flavoring (instead of added salt, for example). Red meat is limited, but fish and poultry are eaten in moderation. Red wine (1 glass for women, 1-2 for men) with dinner is acceptable, as well as high quality dark chocolate (70% cacao or more) in moderation. Full fat dairy is eaten in low volumes, and fresh fruit is the main source of dessert.

Get moving
Based on all of the available research, there is no doubt that exercise is an important component in preventing and treating arthritis, albeit within the context of each individual’s ability to undergo physical activity. In a 7 year study of 30,112 women, there was a statistically significant 35% lower risk of RA among women in the highest category of leisure-time physical activity (median 40 – 60 minutes per day) and exercise (median 2 – 3 hours per week) compared to women in the lowest category (less than 20 minutes per day of walking/bicycling and less than 1 hour per week of exercise).[ii] A review of 9 studies concluded that yoga may be an important therapeutic tool for RA, improving “psychological and physiological” outcomes of arthritis. A general goal of 150 minutes of “moderate intensity” activity per week is recommended, with more recommended for those who can tolerate it.
Put a smile on
Much of what we feel on an emotional plane is echoed in our physical well-being. How we cope with the stressors of life is a useful indicator of our likelihood to develop chronic disease. The ability to maintain optimism in the face of hardship related to a diagnosis of RA leads to improved perception of physical function.[iii] While you may be thinking that a “fake” smile won’t do a person any good, the existing research shows that even inauthentic optimism primes our body to better handle our pain.[iv] In those suffering from RA and other causes of chronic pain, it is important to uncover and thoroughly explore (under supervision of a qualified health care professional) the themes of helplessness, negativity, low self-esteem, and rumination on past traumatic life events. The eventual goal is to process these feelings and to develop robust coping mechanisms for the future.
Targeted Therapies
Your naturopathic physician may choose to focus on improving your digestive health, reducing intestinal permeability, modulating bowel flora and much more. In addition, physical therapies such as acupuncture, soft tissue work, massage, topical application of creams and gels, and low-level laser therapy are all viable options.

[i] Sköldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for 
patients with rheumatoid arthritis. Ann Rheum Dis 2003;62:208. 

[ii] Di Giuseppe D, Bottai M, Askling J, Wolk A. Physical activity and risk of rheumatoid arthritis inwomen: a population-based prospective study. Arthritis Research & Therapy 2015;17:40.
[iii] Symmons DP. Environmental factors and the outcome of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2003;17:717-727.
[iv] Soussignan, R. Duchenne smile, emotional experience, and autonomic reactivity: A test of the facial feedback hypothesis. Emotion, 2002;2(1):52-74.
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