An Osteoarthritis Recovery Story

Jacqueline wrote us in late March asking for tips for osteoarthritis.

She had experienced continuous pain and stiffness in her thumbs for the last year, and occasional pain when gardening for more than 10 years. Her younger sister also has joint pain and can’t turn her neck. Her father, now 73, has had pain in his thumbs for decades which eventually spread to his fingers, and a shoulder spur which had required surgery. Jacqueline’s dad says that osteoarthritis “runs in the family.”

Of course, even if there is some sort of genetic basis for osteoarthritis, it will be modifiable through diet and nutrition.

Jacqueline had been eating low-carb since 2003: meat and vegetables for dinner, fruit and yogurt or eggs, bacon, and sausage for breakfast, but an occasional sandwich for lunch. Around 2007, Fitday gave her macronutrient ratios as near 65% fat, 17% carb, 17% protein. In 2009 she gave up wheat entirely. At that point she developed dry eyes.

Upon reading our “low-carb dangers” series which discussed dry eyes (see Dangers of Zero-Carb Diets, II: Mucus Deficiency and Gastrointestinal Cancers, Nov 15, 2010), she decided to add some carbs back to her diet. Potatoes and bananas cured her dry eyes.

But the joint pain remained, and she asked for any further suggestions. My reply was:

Shou-Ching had a condition like that and it got better with regular vitamin K2 supplementation. Presumably it was caused by improper calcification. Magnesium, vitamin D, and vitamin C are the next most likely to be important.

I think malnutrition is probably the major cause of osteoarthritis. (We know it can cause it in moose!)

For rheumatoid arthritis the cause is usually infectious. Low-dose antibiotics, as suggested by the Road Back Foundation, often work.

The dry eye indicates a glucose and/or vitamin C deficiency. Either will contribute to joint problems too, since the joint lubricants are all made from essentially the same materials as tear lubricants / mucus. So it’s good you’ve re-introduced starch, but I would add more than just some potatoes and tubers. After you’ve gotten used to very low-carb it can be hard to re-orient yourself to the quantities you may need. If glucosamine helps, that suggests you don’t have enough glucose to make your own glucosamine. I would eat more starches and take more C also.

I think you’re probably close and a little more diet experimentation should be able to fix the problem. Rice and vitamin K2 are probably your best friends.

Jacqueline implemented that advice. She wrote back in early May:

What I did:

I kept on taking the 1.5g glucosamine daily and tried, really tried to up my carbs (as starch) intake – you’re right, once you get used to not eating them, it can be quite hard to do. I seem to have succeeded somewhat as I have gone back to using Fitday a bit and have managed (on the days I was checking) about 100g carbs a day. If I didn’t manage with the carbs, I consciously tried to eat a bit more protein on the day instead.

I have increased the frequency with which I take magnesium and vitamin K2 … and started taking a vitamin C (1g) every day. I’m easing off on vitamin D though as summer and some sunshine is finally here. I’ve also pretty much stopped the fish oil – this is of course related to your recent posts – because I do eat oily fish weekly and other fish and seafood regularly….

I have also cut out my addiction to cashew nuts since I was in Paris for a few days before Easter….

Results:

The aching and stiffness has been receding steadily. The right thumb was already improving with my trying to increase carbs (because of the dry eyes) and taking the glucosamine. The right thumb now feels pretty much back to normal. The left thumb has also stopped aching especially over the last 2-3 weeks although it is still a bit prone to ‘catching’ with sudden pain – and a sort of pulling in the ligaments  – as if it can’t react quickly enough to a sudden move e.g. when driving. I am now – over the last few days – playing the piano a lot more (got a bit out of practice with the Paris trip etc.)  – and my thumbs are recovering well – not sore the next day like they were before.

Conclusion

There are basically three kinds of arthritis:

  • osteoarthritis, which I associate with nutrient deficiencies, is a loss of cartilage and lubricating fluid in the joints, or an improper calcification or ossification of the soft tissue;
  • reactive arthritis, which is due to infections; and
  • rheumatoid arthritis, which is an autoimmune disorder but the autoimmunity is usually caused by an infection and clearing the infection will usually clear the autoimmunity.

Food toxins can also collect in the joints and cause immune reactions that produce arthritis-like joint symptoms. Foods that frequently cause allergies, such as tree nuts, may be worth eliminating as a test, as Jacqueline eliminated cashew nuts.

Since diagnosing the cause of arthritis symptoms is an art more than a science, and nutrient deficiencies are easily remedied, they’re almost always a good place to start with any joint pain and stiffness.

I’m glad they’re working for Jacqueline! It’s nice when the easy fixes work.

Leave a comment ?

77 Comments.

  1. That’s great for her.

    I supplement with all of those, have a vit D level of 80 (within the past month), and can get no relief whatsoever. I’ve failed two rounds of phys tx on different joints (hip and knee) but still do all of the prescribed exercises as resistance training and to retain muscle strength, have low back pain with disk and facet disease for both lumbar spine and sacrum, & have OA in the base of the thumb on my non-dominant hand which sometimes is so painful that I can’t move it at all for hours at a time. Yowza.

    Having buried myself in PubMed, I learned that disk nutrition is via passive osmosis and that there is nothing known that can influence its nutrition and progressive dessication, that leptin is found in the synovial fluid as both an indicator of progressive disease and as an acute response to injury – signals inflammation, and that OA is pretty much treated as a foregone conclusion as a progressive degeneration when the science demonstrates that it’s a total joint failure (cartilage, marrow bone remodeling, synovial fluid, etc all involved).

    The pain wakes me up repeatedly, during the day I move, move, move (walk between 6-15 miles daily) to the point of intolerable pain which stops me in my tracks, and no pain med or joint injection (SI joint) has touched it, so I stopped taking all of them. Yoga leaves me in more pain (!), but I’m still practicing hoping that flexibility will improve.

    crp is .3, homocysteine is 8.8 (which is creeping up a bit from 6.something six months ago), no temp, IgM is low, IgA/IgG are normal but on the low end of the spectrum, and globulin always is low (1.9-2.2) with a high albumin/globulin ratio of 2.5.

    I had reduced EPA/DHA supplementation as I increased seafood intake, but my tot chol spiked to 266 from 208 with LDH also rising and HDL decreasing from 109-89, so I went back up on the fish oil and cut back dairy to just 4-6 oz of homemade full fat yogurt most days and cut nuts to a single daily brazil nut for selenium. (I don’t eat grassfed meat, so my O-6 level is higher than optimal).

    I’m on target with your carb/starch recs, I intermittently fast and I’m out of ideas. Anyone got anything to try?

  2. Hi aek,

    Have you tried antibiotics?

  3. My son has rheumatoid arthritis. It is completely eliminated when we are at the beginning of an elimination diet, but slowly comes back as we cannot stay on the beginning forever! This is basically eating boiled meat and vegetables. Does this mean that it is not infection related? I would be concerned to give him antibiotics for fear of wiping out the gut bacteria we have tried so hard build up. Can an infection be eliminated just by diet?

  4. Hi Monica,

    It is possible that an infection is involved, because there can be complex food-infection interactions.

    You might take a look at the Road Back Foundation site and the experience of people there with low-dose antibiotics. The idea of a low-dose is to assist the immune defense systemically but to allow a gut bacterial population to persist.

    It’s rare for an infection to be eliminated just by diet, but also it can be difficult to eliminate it just with antibiotics. Both together are a big help.

    Best, Paul

  5. hmm the dry eye osteo arthritis connection is interesting! Would you still suggest the same cause (vit C def) in someone eating a CW “healthy diet”? My aunt has both symptoms, but she eats lots of fruit and veggies. I would love to see her try eating more like the PHD.

  6. Here is one paper that you may find also interesting http://www.ncbi.nlm.nih.gov/pubmed/12832712

  7. Hi Real Food RD,

    I think vitamin C supplementation couldn’t do any harm but i wouldn’t expect that to be the cause in your aunt’s case. For a fruit and veggie dieter vitamin K2 is much more likely to be an issue in osteoarthritis, then D and magnesium.

    Vitamin D deficiency is a common cause of autoimmune issues and allergies, which is probably the cause of her dry eye. Does she go out in the sun at mid-day with skin exposed? If not she should consider D supplementation. Regardless, she should get her 25OHD level measured. Are her dry eyes worse in the winter?

    Best, Paul

  8. Hi Valtsu,

    That is a very interesting paper!

    High iron levels promote a variety of infections, and iron sequestration/deficiency limits the activity of many pathogens. So that could be the link.

    It’s good to give blood!

    Best, Paul

  9. Paul
    A very pertinent post for me as I am trying to determine the nature of my joint health. My symptoms are very mild. Unless physical stress is also present eg strain or overuse, there is no pain. But once tendonitis occurs it is very slow to heal, eg 2 montth-old golf elbow not responding to (ART) treatment. A pulled groin muscle (several months old) allowed me to ski but not to sprint. Most of my joints make some sort of sound eg clicking. The frequency and circumstance under which the joint will produce a “sound” correlates with the subjective perception of joint health. I can temporarily stop a particular joint from making a sound by mild, repetitive exercise. Does this imply some improvement in local vascularization, angiogenesis? Insufficient local nutrition? I have been on the full PHD including micronutrients for 10 months with good and unexpected results. Some longstanding chronic but periodic back pain has surprisingly cleared up. I am considering whether I should try antibiotics (doxycycline) or to persist with exercises. I am somewhat worried about the effect of antibiotics on my gut health (excellent) and convincing my GP to prescribe will be difficult.

  10. Hi Morris,

    Glad to hear your back is improved!

    Movement of the joints definitely will help. The body doesn’t make things it doesn’t need, so if you don’t move, it won’t make joint lubricant. Doing, say, lots of knee-bends will help lubricate the knees. Similarly with other joints. It’s good to move the joint through its full range of motion.

    It’s prudent to worry about the effect of antibiotics on your gut, as clearing out the good bacteria can allow pathogens to infiltrate and cause more serious disease.

    I don’t really know whether antibiotics would do you good. Since you say the symptoms are very mild, it might be best to avoid the antibiotics and stick to exercises, since antibiotics would be a high risk / low reward proposition and we don’t know that the chances of achieving the low reward are good. Unless, of course, you have some other symptom of bacterial infection.

    Best, Paul

  11. Which specific deficiencies do you believe cause improper ossification? Vitamin D probably, and maybe k2, and magnesium, but I’m not sure about others. I’m asking because when I had my knee surgery, my doctor noted that I had “pre-arthritic changes”, although that is expected in athletes, particularly in high impact sports like tennis. I also have 3 non-ossifying fibromas on that same femur. Basically, its a mess. Anyway, just curious as to what you think are the specific causes of ossification problems as this is a subject of interest for me.

  12. Hi Abby,

    Collagen uses a specific mix of amino acids which are best obtained from natural collagen sources, like beef broth. They have to be cross-linked which requires vitamin C.

    Most of the joint molecules and lubricants are compounded of sugar and protein — mostly glucose and galactose. Production may be downregulated if insufficient carbs (or carb+protein) are eaten. Some vitamins, like biotin and B6, are also involved.

    Obviously, D, K2, A, magnesium, calcium, and C are important in bone formation. Potassium is probably important too, since many cells don’t function well if that is deficient.

    I haven’t thoroughly examined the literature for other possibilities, but in general I think the joints are vulnerable to a variety of deficiencies. So overall, it’s important to eat a balanced and nourishing diet, and if you don’t the joints may be the first place it will show up.

    Best, Paul

  13. When you say potassium is important, is it just overall intake of potassium or potassium:sodium ratio as well? I get plenty of potassium, but I use a lot of salt too.

  14. Monica –
    The introductory phase of the GAPS diet is essentially stewed meat and vegetables but the later phases of the diet add back more problematic, difficult to digest foods. You might consult the GAPS diet book for ideas on the how, what, and when of adding back foods.

    Some people stay on the introductory phase of the GAPS diet for a long time. I’ve heard Chris Kresser say that he was on the GAPS diet for nine months before moving to a Perfect Health Diet.

    Good luck, Peter.

  15. Hi Paul
    Thanks for replying. The reason to suspect possible bacterial connection to my joint health is a definite correlation between eating casein/lactose and joint ache. This connection is (was) repeatable and dose dependent but it happened about 8 months ago and I’m not brave enough to repeat the experiments. It could well have been endotoxins.
    Best
    Morris

  16. Thanks for the informative post. I have been reading this site for a while, and really appreciate all the content you are writing.

    Since you help some of your readers, I thought I may ask about a problem I have. I understand this may not be possible. No worries.

    I started paleo about 1-2 years ago solely to fix my acne. Although I have seen improvements (in acne and other things), I still have moderate acne. I have kept a record of progress with pictures and a small description of my diet. I have tried many different variations of paleo, but nothing seems to work. If you can help me, I could send you the pictures/descriptions by email. Please let me know.

    Thanks, and keep posting great articles.

  17. Hi Abby,

    Overall level of potassium. Lots of salt is good.

    Hi Alejandro,

    Go ahead and send me pictures. It won’t help me now but when I research acne posts later, I’ll keep your pictures in mind and see if they prompt any ideas.

    One thing I can tell you is that lithium induces acne. Some people have sufficient lithium in their water to induce acne, especially in cases of potassium deficiency (lithium & potassium compete with one another, similar chemically). So getting plenty of potassium and changing water source can sometimes make a difference. Bromine is another compound that can induce acne. Iodine is the antidote there, along with salt and water, but it takes a long time to clear bromine. Avoid seaweed, avoid possible environmental sources of bromine.

    There is no single cause of acne. Many infections, in fact anything that induces certain immune responses, can cause it. So it is not simple to say why someone has acne.

    Best, Paul

  18. Hi Paul,

    I am so excited I bought your book and actually took the advice about a month ago. Bought supplements, brought white rice back into my diet. Enjoying heavy cream, butter (ghee), coconut oil. The osteoarthritis in my knees are feeling better and virtually pain free than anytime I have experienced in the past 3 years. I was just diagnosed last week with an eye condition called pinguecula, which apparently was caused from having dry eye. Never knew I had dry eye as my eyes were watery a lot of times. Also, never knew dry eye could be diet related. Go figure!

    I’ve known I had a problem with wheat for the past 15 years. So I have kept it low, but could not break completely free. When the pain intensified, I would back away for awhile, but kept going back bit by bit. If I continued, I would be experiencing symptoms related to IBS, or possibly colon cancer like my father.

    It was about 2 years ago I realized that grains in general kept giving me ‘issues’. Pain and swelling in hands and feet were the first signs. Horrid knee pain and pain at the base of my thumbs if I continued with grains. (We all have bad knees in our family and my mother has had two knee replacements.) I finally got to the point of liking baked brown rice, but brown rice didn’t like me. I figured I had to sprout grains and all would be well. Well, it was not to be. Grain fed meats give me the same issues as straight up grains, so I have to eat grass fed meat.

    I made grass fed bone broth for the first time and tried my first wakame seaweed salad today. Thought I was going to hate the salad, but it was wonderful. I feel like you wrote this book and started this website just for me. I could go on and on about the benefits I am reaping from adopting this ‘bend on paleo’ style eating, but you get the point.

    My joints were put to the test today as our elevator died at work yesterday. Even tho it’s just 1 floor up, I usually take the elevator because stairs hurt my knees. Today, I went up and down at least 5 times and figured I would have to take some advil by the time I got home. I did feel a bit of pain at some point, but nothing like I normally feel and recovery was fast. It’s almost 9:30 pm, and I have no plans on taking any advil as I feel fine.

    I’m just beaming and so glad the good Lord has led me in this direction. I can’t wait to see where my health will be at in 6 months. May God bless you and your wife for sharing your knowledge and explaining what you have learned by in your own quest for perfect health.

    With heartfelt thanks, Janis.

  19. Hi Paul,

    I have crepitus (crackling joints) from when I was born. ALL joints in my body cracks when I move them, however I have no pain.

    Do uou think it can be due to some form of arthritis?
    Do you have some suggestion?

    Thanks

  20. I am 34 and have crepitus for several months now (left ankle joint). It pops almost on each step, it gets worse after exercise, no matter if it didn’t involve legs (which is strange, I thought it might be inappropriate breathing or something, since I have nose deviation).
    It often pops very loud and I can feel it happening even when I can’t hear it (headphones). I don’t know if it hearts or I just imagine it, but I am sure I have feeling of warmth after lots of popping, but no visible sweeling.

    This happened after I introduced exercise motived by the fat loss – nothing extreme, around 1 hour of walking per day, and around 30 minutes of a bit more intensive exercise every 2nd day.

    I am on low-carb diet for 6 months or so ( usually 75g < CH =75%). I drink at least 2L water per day, and besides that only around 300ml coffee, 500ml white tea and 200ml cocoa drink and occasional 100ml black wine.

    Typical daily supplements in last 1-2 years include:
    – 3 x 4 g Sodium Ascorbate (powder) (8 m) (according to dynamic flow hypothesis)
    – 1 x 30 mg LET Coenzime Q10 (2 y)
    – 1 x Multivitamin with chelated minerals and no retinol. (2y)
    – 200 – 500 mg Magnesium as Citrate, or via special carbonated waters. (6 m)
    – 500 mcg Iodine (Kelp or carbonated water) (6m)
    – 5000 IU Vitamin D3 and 10-20 minutes of Sunshine (6m)
    – Fish oil (capsules or liquid – 250mg to 2g DHA/EPA) (2y)
    – 3×800 mg Piracetam and sometimes 5mg Hidergine (1y with 3m pause)
    – Depending on occasion but usually several times a week (1y): brewers yeast, coconut oil, protein shake, zinc, acc, lecithin, sesame paste, mumyo, alkylgliceride.

    Aside of that I use water shower filter and shower with coldest water available. (1y)

    I feel great, my BMI is just above 25 ATM, and I didn’t get sick in last 3 years. I use Vitamin C to bowel tolerance on first signs of body stress.
    This joint popping rally makes me uncertain – could it be some of the supplements ? I research my supplements well and tend to use powdered forms without fillers if available.

    I am autoimmune prone – had local sclerodermia, chronic eczema (mild) on legs, seborrhea, and generally different forms of dermatitis (itching, water chemicals sensitivity), some undiagnosed allergy to heat during winter etc… Nothing unbearable and in last 2 years pretty minimal.

    I can only add K2 to diet, but how much – I used 2 months around 70mcg/day.

    I also don’t know what form of arthritis it might be but I had problems with all my joints – usually wrists but I am programmer. Diagnosis of carpel tunel syndrome was negative. Its mild or non existent and not something I am concerned about ATM.

  21. BTW, people who want to try low dose antibiotics without inducing resistance could perhaps look theory behind Marshal Protocol. Its controversial protocol used for autoimmune diseases but there are bunch of people using it and perhaps some experience of others might be helpful in dealing with stuff like herx reaction, bacterial resistance (MP uses pulsing antibiotics to prevent it etc..)

    I wouldn’t try it myself, except as last resort tho.

  22. Hi Janis,

    That is fantastic! Thank you so much for sharing! It’s wonderful to hear good news.

    Hi kratos,

    I don’t know. You’re following our diet and supplements, correct? No signs of infection? I’ll look up crepitus but I would expect it to be like osteoarthritis.

    Hi majkinetor,

    In your case I would suspect a deficiency of vitamins A and K2 and excess of D.

    5000 IU of D3 is a lot especially if you get sunshine. 4000 IU from both sources combined is usually the optimum.

    Then you do not supplement A or K2 at all, even in a multivitamin.

    A is the bone-removing vitamin, D is the bone-building vitamin, and K2 prevents inappropriate calcification. With too much D and not enough A, your bones will grow and encroach on the joints. With too little K, your joint tissue will calcify and become brittle.

    I would reduce the D supplements to 2500 IU/day; eat a lot of A-rich foods like liver and egg yolks, or add a bit of A to your supplements – aim for ~5,000 IU preformed A and ~5,000 IU carotenoids daily; and supplement K2 with one of our higher dose formulations (> 1 mg/day).

    With this and a few months of movement I would bet your joints would ease up.

    I don’t believe in the Marshall Protocol.

    Best, Paul

  23. Thanks, Paul, for your response. I haven’t tried ATBs, and don’t know who would prescribe them since CBC is always WNL, although the WBC drops below norms from time to time.

    I think I had so many underlying physiologic derangements that nutritionally and lifestyle wise, I’ve corrected as much as I’m going to, sad to say. I’m perfect on paper (lab and PE values) with a QOL of zilch. That evens out to moderate and is significant of nothing (grin).

  24. Paul, thanks for the answer.

    As for Vitamin A, my previous multivitamin had 10K IU and at least 50% was in retinol form (4m usage). I also usually eat 2-3 eggs/day for breakfast and 2 times/week liver. I take fish oil and altho its not liver oil, I guess there is some of A & D in it too.

    I started supplementing D while trying to solve my dermatolgogy problems; 1) I have small psoriatic patch on my left elbow. 2) one of the natural treatmens for local scleroderma is D. 3) my allergy was occurring only during winter. 4) I was overweighted ( 27 < BMI < 29 ) for 10 years or so. 5) I have darker skin; 6) I eat dairy daily; all that stuff made me supplement Vitamin D3.

    I forgot to say that I also take some joint formula containing glucosamine, msms, ha and so on… it didn't make any difference so far (1 m use)

    The only K2 that I can by here is MQ7 (25 mcg/capsule).

    Would calcium serum tests mean something ? Or screening for calcification ?

    About MP, I don't believe in it either after reading theory behind, but, lets not forget that there are people using it for years and this produced some data (as even false hypothesis produce evidence and improve science). The anecdotal evidence about long term low dose antibiotic use might convince somebody for or against its usage with arthritis. I don't know, tho, how results would be relevant without olmestran which is hypothetised to promote VDR receptor function.

  25. I too can attest that the Perfect Health Diet has been very helpful for joint pain. I have had pain in my hips for over ten years now. Five or six years ago it was becoming quite annoying–I stopped running and rather disgustedly purchased a push cart for my golf bag instead of carrying it. The only suggestion the doc had was to take 800 mgs of Ibuprofen. When I started a low carb diet about four years ago, the discomfort clearly lessened. I started carrying my golf bag again and did a little jogging. Joint discomfort was still an ever present issue however. I started the Perfect Health Diet (ketogenic version) in February. One of the many positive effects has been a remarkable alleviation of joint discomfort. Some days there is no pain at all, and on other days just a few very minor twinges. I love this diet!!!

  26. Hi aek,

    Most people with infections have blood cell counts within normal limits. That doesn’t mean a thing. WBC dropping could be an infection sign. I had a C. pneumoniae infection which infects WBC and prevents apoptosis, so the cells become very old. Then if you do anything to cause loss of bacterial function, like fast, the bacteria will start hibernating, the cells will wake up and die off, and you’ll have low WBC counts for a week or two until they’re replenished from bone marrow.

    So you might want to try antibiotics and see if they cause your WBC count to drop.

    I certainly wouldn’t quit. Having normal labs, a great diet, and lousy health indicates a chronic infection to me. Most of these pathogens are parasites that show no acute symptoms but drag you down. Doctors are lousy at diagnosing them, and science has lagged at generating means of detecting them.

    Antibiotics are what I would try. You may see an immediate effect, good or bad, confirming the presence of an infection.

    Hi majkinetor,

    You might also try copper and selenium supplements, and raise K2. Copper deficiency can induce a vitamin A deficiency.

    Calcium is normally regulated within a tight range so it’s rare to have calcium out of range. If it was it would indicate problems, but not something relevant to joints most likely. Serum calcium does not indicate calcium status – you will lose your bones before your serum calcium changes, if the only deficiency is calcium.

    Re MP, the olmesartan is the part I believe is damaging. The low-dose antibiotics should be helpful.

  27. Hi Kate,

    It’s always great to hear from you, you have such happy news!

  28. Hi Paul,

    You are certainly generous in reading people’s comments and responding! (Thanks)

    If you get a chance could you comment here or in a post at some point on the chances of overcoming infections without specific supplement or antiobiotic intervention?

    Your findings of late seem to suggest that infections can be a common and underlying cause of many issues. But I’m not sure I can ascertain from your writings if you think some of these can be overcome by following the PHD alone?
    (other than more extreme/serious situations)

  29. Hi Greg,

    It depends on the person and the infection.

    In any infection there is a tipping point between the immune system and the pathogen; on one side the immune system tends to win, on the other the pathogen.

    Diet moves you in the right direction but is it enough to cross the tipping point? That depends.

    All human pathogens have ways of suppressing immune function, and as their numbers grow they get better and better at it. So the more severe the infection, the more likely you’ll need antimicrobial aids.

    Also, age matters. Genetic variations tend to make people more effective at fighting some infections and less effective at others. Europeans tend to struggle against tropical pathogens, Africans against northern ones.

    Diet matters since bad diets can really damage immune function and promote pathogen growth.

    Co-infections tend to promote each other synergistically. Each pathogen’s methods of suppressing immune function tend to make other infections more likely to grow.

    All healthy people are alike, but every unhealthy person is unhealthy in his own way. So I can’t really say whether diet alone will work in any given case. I can only say it will always improve matters.

    Best, Paul

  30. Paul- are you going to write any more books or are you currently working on anything?

  31. Hi Ellen,

    Yes, I’m going to write more books.

    On the diet side, we’ll do a cookbook, a v2 of the diet book sometime, maybe a popular version with meal plans and less science, and probably mini-ebooks for specific diseases where we have something to add.

    I’m also working on some economics / social science books.

    I don’t have a timetable for when any will come out. At the moment I’m gathering material for many projects and when I feel I have everything together, I’ll focus on writing.

  32. @majorkinetor & @kratos
    My experience with crepitus may be of interest to you & I am interested in hearing more about your experience. I’ve had joint “noises” for about 20 years (I’m 72yo) but no direct discomfort from the noise effect. The frequency and magnitude has increased over time but only very slowly. I tend to think that the degree of crepitude correlates (weakly) with general joint health eg time to recover from episodes of tendonitis or discomfort caused by overuse. I have ignored this “crepitude” as being an unavoidable aging effect until recently, when my manageable back/neck aches spontaneously improved and that happened about 3 months after adopting the PHD diet (although I didn’t know at the time that the diet was PHD). For example I can sleep on my back for the first time in 8 years and turn my neck 90 deg without any discomfort. Coincident with that, the crepitude has slightly improved as well. That remission has given me hope (vain?) that perhaps further improvement is possible. My complaint is that recovery from tendon strains is very slow, but this is confounded by more frequent and more intense physical activity. At any rate I have started to experiment with measures to reduce crepitude. My markers for the “degree” of crepitude are: Frequency between “noises” when intentionally forced, how “loud” the noise is, how often involuntary clicks occur. I find that my crepitude can be improved in the very short term by: large number of very easy repetitive exercise movements (eg arm rotations), warmth (hot shower), application of topical creams which interact with heat sensitive neurons. On waking there is always a reduction as well. The mechanism remains a mystery. The BG reading downstream (palm vs abdomen) of my elbow tendonitis after some mild exercise (empty hand curls) is 20mg/dL lower. This implies that nutrients are consumed at a higher rate locally at the inflammation site. Other factors may be increased enzyme activity due to higher local temperature. My speculation is that short term improvements may be strung together into a general better joint function. I have not found plausible explanations as to what causes crepitude. Perhaps smaller connective tissue cells or smaller cell number are the proximate reasons. I am trying to decide how long to persist with exercise before going the antibiotic route which has definite but unknown risks.

  33. God bless you, Paul! And give you the health and strength to continue.

  34. Hi Morris,

    Your blood glucose difference between hands and abdomen made me sit up and take notice. Very interesting!

    You might try vasodilators like spinach and arginine, both of which increase nitric oxide levels, and see if that decreases the blood glucose differential and crepitude symptoms in the hands.

    Hi Mary Lee,

    Thanks you!

  35. hi paul, been gluten and veg oil free since nov,psoriasis no better,any suggestions? or maybe a post onit?
    thanks

  36. Hi chris,

    Are you on our full diet and supplement regimen?

    If that doesn’t work then I would proceed to the antimicrobial dieting tactics described in Step 4 of our book.

    Our book program is basically a general approach to healing diseases of unknown cause. Usually even if they don’t work, they’ll moderate and clarify symptoms.

    I believe most autoimmune conditions are the result of a concealed infection confusing the immune system, but they are also made more likely by nutritional deficiencies and food toxins.

    Best, Paul

  37. Chris,

    I too suffer psoriasis. I find nuts, (all kinds) dairy, sugar, and eggs to be the most problematic foods.
    Oh, gluten too.

    If you eat the above foods, try eliminating just one
    at a time. I usually see improvement in about 3 days. Nuts are the worst offender for me.

    Be well.

  38. hi Paul,i will look into chapter 4,re the supplements just about got them covered .ill double check.
    thanks
    Hi Betty,
    I was egg free for years but been back o them a few years now,only havea few almonds these days an some black sesame seeds,ws dairy free same time as the egg free time but was into gluten then, no gluten now but eggs and some dairy.i seem to crave fat to sustain level blood sugars so the cheese and cream I enjoy,i think strress via hormone messup doesnt help.
    thanks

  39. Hi Paul.

    About low dose antibiotics (LDAB), I am concerned about my beneficial microbiota. Can you perhaps tell or give some references about that. I have bad experience with antibiotics (of large doses) which I used in a period of extreme common-cold-like sickness I had years ago. Genital Candida proliferation was one of the problems and it was severe.

    I recently listened Healthy Sceptic podcast about brain gut axis and there was note about number of patients that come with intestinal problems which have athletic foot and similar fungal problems that all seem to be related to disturbances in intestinal microbiota and people get better after regulating that.

    Moris
    As Paul said, your glucose differences made me sit and think. If you or anybody else can provide more detailed analyses of its usefulness I would appreciate it. Do you have any references for that or its something you figured out on your own.

    Anyway, my crepitus is unlike yours. It doesn’t get better after sleeping. It gets worse after any type of exercise. Every joint in my body cracks but on occasion which is normal. Contrary, left ankle joint cracks like crazy in last 3 months. I feel hot on joint after it gets frequent but I might be trippin. Sometimes it definitely hurts just a little when its frequency become that of every move. I noticed that stairs are most problematic and uphill movement. If I walk and pop occurs every 10th step, when I get to the uphill part it starts to occur every step, and it gets very loud.

    I guess I overwalked or perhaps its D overdose (which I doubt really, from what I know even 10000 IU D does not produce overdose – altho I was taking D for 1 week in doses of 50000 IU D3 – liquid form for babies). I started 1-2 hours per day the fastest walk I was able with largest footsteps I was able. Thats when it started….

    From that moment it doesn’t really matter what type of exercise I do, it will get worse after it. Squats are particularly bad – if I do 30-40 of them, next minute every single step produces loud pop that almost gets to physically move my foot.

  40. BTW, about sugar monitoring, I was thinking how is that related to the speed of blood flow – the rate of nutrient utilization on concrete spot depends on blood flow.

    I found this research
    http://cardiovascres.oxfordjournals.org/content/15/3/164.abstract

    Check this out:

    The apparatus was used to determine diameter, blood flow velocity and volumic flow of the brachial artery of 22 healthy men. The values were respectively 0.440 ± 0.010 cm, 9.15 ? 1.01 cm·s?1 and 85 ± 10 cm3·min?1. Administration of intravenous nitroglycerin significantly increased the arterial diameter (P < 0.001) without any significant change in volumic flow.

  41. Hi majkinetor,

    It does sound like vitamin D overdose may have played a major role. That’s a huge dose, especially if compounded with a deficiency of K2 or A.

    For low dose antibiotic evidence and patient experiences, the place to go is the Road Back Foundation. http://www.roadback.org/

    They have a bulletin board so you can ask questions and hear from other patients.

    I am of mixed feelings about low-dose antibiotics. You have to take them longer than higher doses, so the end result on the gut may be similar.

    Since you have a fungal infection, you should definitely accompany antibiotics with antifungals. I’ll be doing a series on fungal infections soon. I’ve found Chinese medicine to work pretty well against them.

    Best, Paul

  42. Is there any topical fungal remedy you might want to recommend ?

    So far I tried on my skin chronic skin ezcema : coconut oil, fish oil, bentonite clay, vitamin D, vitamin C, 10 & 20% urea creme, cox-2 inhibitor, povidone-iodine.

    Nothing seem to matter although recently I started using some commercial non-pharmaceutical creme from Garnier with L-Bifidus along with 200 IU oral doses of mixed tocopherols (Now Foods) which seem to make it better – it doesn’t itch any more, its just red.

    The hot watter and direct sunlight makes it worst. I shower now with very cold water exclusively (practicing hormesis a bit).

    As for vitamin D, I was using 10 000 IU Vit A (mixed retinol and beta carotene) and 70-100mcg Vit. K2-Mq7. I use butter in cooking regularly, yogurt (with bifido & lacto and oligofructose), kefir.

    This is how it looks on both legs:
    http://tinyurl.com/6er7jzy

    Thanks.

  43. Hi majkinetor,

    Topical remedies – you can try the over-the-counter antifungal lotions with clotrimazole.

    Vitamin A lotions might help.

    Chinese medicine has probably done me the most good, all things considered.

  44. Paul– so you’ll be doing a blog entry on Chinese Medicine in the near future? Very curious!

  45. This is interesting to me, since I recently had some inflamation come back in one of my knuckles and I can’t really figure out why. I had pretty severe arthritis in it from about age 15-17 after having bacterial meningitis (so the original cause was definitely bacterial), but it eventually went away on its own by the time I was out of high school.

    I’m now 30 and the inflamation came back a couple of months ago. I was doing fairly low carb paleo for a few months and I seemed to have various pains that cycled through my body over that time, and it seems to have settled in my knuckle now. I’ve added more starch back to my diet, but I’m still probably at more like 70-80 grams rather than 100. Could bacteria be a player at this point or it is probably just the need for a bit more glucose?

  46. Hi Ellen,

    Yes, just for fun. I don’t know anything about Chinese medicine but I can describe the patient experience!

    Hi Lindsay,

    Your experience is consistent with a lot of different causes.

    However, I would bet on a bacterial origin. Any bacteria that can cause arthritis for 2 years will be persistent at some level in your body for life, mainly in the same places it originally infected. It can flare up if the diet becomes favorable to the pathogen, immunity becomes weakened, you have a co-infection that favors it, lack of sun and low vitamin D during a tough winter, or any of a number of reasons.

    I don’t think 70 g of starch is enough to feed the infection, but you might want to stay at that level.

    You might give antibiotics a try, and get 25OHD level measured. Intermittent fasting with coconut oil for ketosis often helps against bacterial infections (hurts against fungal or protozoal infections). Our supplement regimen should help.

    If antibiotics help then you’ll know. If not then some experimentation will be in order.

    Best, Paul

  47. By the way, on another thread KKC suggests boron, in the form of calcium fructoborate, as a remedy for arthritis:

    http://perfecthealthdiet.com/?p=2168&cpage=1#comment-23184

  48. fucibet worked for me on an infectios psoriasis in the lower spine buttock creasetop.was resistant for a year to other creams.

    Mazin alkafaji is a chinese skin specialist,my 30year psoriasis cleard with his treatment but ufurtunately started to return after 12 months,i need to return to him i think.

    http://www.avicenna.co.uk/practitioners/mazin-al-khafaji/

  49. @majkinetor

    My reported BG is based on my own measurements with a finger-stick meter (Abbot FreeStyle). The measurements are repeatable although the one for the elbow tendonitis (20 mg/dL difference) is extreme. No theories, just speculations about influence of blood (nutrient) supply on rate of cell death /angiogenesis. My crepitus is very mild compared to yours, it produces no pain. As for exercise/therapy in my case if gentle motions of the similar type precede the exercise movement then the clicking is lessened. I suspect the clicking produces some (maybe very small) harm. A definite correlate for me is intermittent fasting, 32-36 hrs at 7-10 day intervals. IF correlates for me with gut bacteria inventory, the smaller the better.

  50. Hi Paul,

    Is it possible for a fungal or protozoal infection to invade the brain past the blood brain barrier and cause diseases that bacteria have been implicated in, i.e. Cpn and MS or Alzheimers’?

    I know those bugs are bigger but maybe an immune response to candida for instance could trigger MS like symptoms or MS itself?

    Thank you, your time, dedication an expertise are always greatly appreciated.

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