I have Rheumatoid Arthritis and have read the Clever Guts Diet Book recently regarding gut biome and the the anti-inflammatory effect of having a healthy gut. I have been looking in to taking specifically fermented Kefir and also fermented foods such as sauerkraut (I have made my own). The company where I got my kefir from provide a booklet with the product which states that it shouldn’t be taken if you are on immuno-suppressants as it negates the purpose of the kefir, namely in boosting your immune system. (Rather like having your foot on the accelerator at the same time as the brake).

I eat a very healthy diet. Very little or no sugar, reduced carbohydrates and eating more wholegrains etc. and also to eat fermented foods. But this appears to be very conflicting advice. By eating a very healthy diet I would be boosting my immune system, but am at the same time knocking it back because I am on Methotrexate and Golimumab for my RA! I would be interested to hear what my best course of action is.

The immune system is highly complex: an array of human cells interacting with our microbiome and with the environment. To function optimally a system needs to be balanced, neither boosted nor suppressed.

Inflammation is a part of many chronic degenerative diseases, but also an essential part of wound healing. There are destructive and constructive phases within healing, both equally important.

The immune processes which identify and destroy harmful intruders (bacteria/ viruses) can mistakenly turn upon the harmless (pollen/ food allergies) or upon our own body (autoimmune). We certainly don’t want to boost all these functions!

The safest course of action would be best discussed with your medical team (consultant doctor/ registered dietician/ pharmacist).

A properly balanced and varied wholefood diet and active outdoor lifestyle is what the human body and microbiome evolved alongside. That doesn’t enhance or boost the entire immune system, but gives the best chance of ‘normal’ or ‘healthy’ function.
So, as some parts of the immune system stop overreacting or are calmed, symptoms of many mild to moderate inflammatory or allergic conditions are reduced.

Exactly how your health conditions and drug regimen impacts your immune system is a specialist area. Until you can get advice from a health professional with access to your medical notes, it would be wise to stick to prebiotics and minimise probiotics.

Hi CAW10 – Kefir should be fine, and beneficial UNLESS you are specifically intolerant of lactulose (milk sugar). That said, the fermentation process means the bugs eat up the majority of the lactulose so the levels in Kefir are low. The leaflet is misleading. Either you promote the good bugs in your microbiome (per the clever guts diet) or you allow the bad bugs (pro-inflammatory) to survive and thrive. Besides the meds you mention are you taking any other prescribed meds? Based on what you say I’d 100% follow the clever guts advice.

Question: how easy do you find it to skip meals? If relatively easy then consider Mosely’s 5:2 diet in addition. It works perfectly with CleverGuts and the fasting element is profoundly ANTIinflammatory hence ideal for RA.

Hi, the other meds I take are occasionally a Meloxicam (anti-inflammatory) if I need it and folic acid. I’m taking Turmeric capsules, which I think are helping a lot with inflammation. I have a Vit D3 spray supplement and take Olive leaf capsules (especially if I think I’m starting with a cold virus). I am also following the 5:2 diet but am not always rigid with it. Maybe I should be. That said, I can regularly have a 12-14hr window of fasting by delaying breakfast. Since adopting a much healthier lifestyle my RA does seem to be a lot more controlled. My aim would ultimately be to achieve remission and get off all toxic meds. It appears to be a bit of a catch 22 though with immunosuppressants as I’m having a healthy diet/lifestyle and the drugs are knocking it all back! Unfortunately I need the drugs currently as my RA was quite aggressive and I have severe joint deformities. The drugs have definitely halted that to a large degree. Many thanks for your response.

Hi CAW100 please DON’T stop your meds prematurely. Without your meds you risk permanent, irreversible joint damage. Folic acid is crucial when taking methotrexate . VitD – you need at least 400iu/day- what dose is in the spray?

Minimum effective fasting window is 16h; 24 is ideal. A viable alternative to 5:2 is 16:8 (that is eat sensibly and well, but only for an 8hour eating window each day) I’ve moved to that recently (I eat one really healthy meal per day, I never feel hungry so long as I avoid carbs) and it works well.

If you post a typical day’s food (breakfast, lunch, dinner, snacks, alcohol) I can probably advise further. Definitely go with the fermented foods but “start low, go slow” on other words introduce them one at a time, in escalating quantities that way any adverse reaction will be mild and you will know what caused it. Too many large changes all at once and you can get into a real mess.

So the plan? Keep on with your meds. Make your diet and lifestyle anti-inflammatory. Aim for 8hours quality sleep is key. Do at least some low grade exercise- walking can be ideal.. Once stable then and ONLY then cautiously withdraw your meds under discussion with your GP/Rheumatologist

Good luck!

Graham

Hi Graham, don’t worry I would never stop my meds without medical supervision! And I think I’m a long way off that yet anyway.
I have 3000iu/day spray (Dlux spray)
Typical breakfast bowl is fruit (mainly berries, the odd prune or date or dried apple/apricot, plus any other seasonal fruit) with a spoon of chia seeds and oat bran (plus occasionally flax seed) all soaked with unsweetened almond milk. I top this with goats milk yogurt and homemade granola (I put honey and maple syrup in my granola and cinnamon). And drink green tea. sometimes fresh fruit juice, but only a small glass to take my meds with.

Lunch – maybe homemade veggie soups, sometimes cheese and oatcakes. On a fast day I might have an apple with cheese and a handful of nuts. I’m doing really well cutting out sugar.

Dinner – red meat about once a week, or chicken. Fish at least twice a week and generally veggie meals the rest of the time. I almost always cook from scratch at home and have done for many, many years. I’ve generally had a healthy-ish diet for a long time. Its only recently I’ve been adding in sauerkraut (made my own – 2nd batch ready) which we add to a salad and I’m mindful not to have huge amounts. Since my new regime my digestion has been a lot better!!
Exercise – I attend a ‘move well’ class and our teacher is a qualified anatomy in motion practitioner and is very good. If I can’t manage something she will find other ways to do the exercises. I also walk a lot and try and get in at least 8000 steps a day.
Sleep isn’t always great, but I am trying to get in to a better routine. And I have been doing mindfulness meditation for a while now.
You’d think reading this I was Mrs Perfect-super-healthy!! Thank you once again for your input and support.

Hi CAW100: the ideal dose of VitD is 4000iu so suggest you adjust accordingly. Slight tweak – fresh fruit rather than dry will likely preserve micronutrients whereas dry tends to concentrate the sugars? You seem to have a perfect lifestyle! Adding a variety of fermented foods can only be a good thing. Can you tell what causes your RA to flare? Good luck! Graham

CAW100: Might be worth tracking/ calculating the ratio of (mostly inflammatory) omega-6 to (anti inflammatory) omega-3 in your diet.

Most nuts, some seeds, vegetable oils and wholegrains are rich in O-6. Oily fish and eggs from seed fed hens are the only rich sources of long chain O-3s. There are short chain O-3s in flax and chia seeds, but conversion in the human body to the useable long chain format can be as low as 10%.

Also might be worth calculating the sugars in your breakfast. It may be that some days are surprisingly high, between the seasonal fruit, honey, maple syrup, dried fruit.

If you have been logging weights in your food diary this should be quite easy.

Did you mean 400iu or 4000iu re VitD3? The spray I have (DLux) is 3000iu as I have been reading that we require considerably more than 400iu. And I have no idea what triggers a flare. I’ve tried tracking it and it can be a variety of things from doing to much of something (I was rolling out pastry and my left wrist flared!) to weather (low pressure in particular). Particular foods never seem to have been an issue. I am also aware that stress is a big factor.

Hopefully I am on the right track.
Thanks.

Thanks again for your input. I have realised that the dried fruits are high in sugars. My husband thought they would make a change! So we will go back to frozen mixed berries (in winter) and top up with fresh seasonal fruits. They are the only ‘sugars’ I consume during the day really apart from my granola, which doesn’t have a great deal of honey & maple syrup in, just to bind it really. I haven’t been logging weights in a food diary as I find it difficult to calculate and am not even sure how accurate it would be. If I can find a reliable chart that is British food stuffs (most seem to be aimed at the American market) then I may try.

CAW100: it Is a royal pain when you begin your detailed food and symptom diary, but weights (solids) and volume (liquids) is absolutely critical. Without you cannot know number of servings, balance of food groups, ratios mentioned.

For example in the UK a serving of any fresh/ frozen fruit or veg is 80g. This is a HUGE overflowing soup bowlful of salad leaves, half many fruits (apple/ banana), only two florets cauliflower.

CAW100: granola you would weigh/ measure the ingredients then again the serving after cooking/ before eating. As it loses water in the oven the calories/ fat/ carbs/ sugars are concentrated. Nutrition information per 100g and per recommended serving is on the package, or on supermarket website/ app if loose item, or on Self Nutrition Data. You can adjust the serving to UK weights or US cups on that site.

If you are not a maths person, there are sites like FitnessPal to calculate recipes or post here and we will happily try.

HTH!

Hi CAW100: Yes, my mistake, Dlux 3000 is plenty. BEWARE! Granola can be extremely high sugar. Suggest look on the back of the pack, look for Max insoluble fibre and MIN sugar. Do you like porridge? Best is steel cut oats- in terms of max insoluble fibre. Aim for minimum 20% and ideally 30% plus

CAW100: me again … My comments hereafter are general info, NOT targeted at your medical issues/ medication.

The ‘standard’ prescription dose of D-3 in the UK Is 800iu. This is to treat diagnosed insufficiency/ mild deficiency and based on the best quality scientific evidence available.

‘At risk’ groups of UK adults (as per NICE guidelines) are recommended to supplement at least 400iu D-3 a day again based on best evidence.

Other countries have different official guidelines based on the risk/ benefit/ availability of strong sunlight to their populations. In the UK (and similar latitudes) we can only convert vitamin D when exposed to sunlight for ~6 months of the year, and not early or late in daylight hours.

Hence dietary sources and body stores are critical throughout the cooler months. Oily fish intake is poor, and few healthy eating plans emphasise it sadly.

I’m in the same boat with immunosuppressants for Crohn’s disease. Have spoken to my GP about fermented foods – the issue is that the wrong bacteria may grow due to unclean utensils/contamination. This would be more likely if making your own at home, less likely if commercially produced, but still always a bacterial risk in anything “raw”. Am about to start the anti-MAP treatment for Crohn’s and hopefully get off these darn biologics!!