Clint reviews a person’s Rheumatoid Arthritis situation in this podcast and then covers:

• Dealing with raised liver enzymes AST and ALT
• Considerations before starting Methotrexate
• Common side effects of Methotrexate and prednisone
• The five ways to reduce pain
• The role of supplements in RA treatment
• The power of the Moringa plant
• Updates on how to deal with wrist and finger pain

Hi, Clint here with the first of the feedback Friday sessions. In these sessions I’m going to take one of the updates that I’ve received from inside Rheumatoid Support, and I’m going to share with you what I have shared with them so that you can also gain that insight or that thought process or even just my opinion, and maybe it’ll be applicable and helpful for you as well. So in these episodes, I’m going to completely remove all identifiable aspects of the person’s post so that there is complete privacy. And I also have taken the liberty to put a pencil line through any parts of their information that they’ve shared with me that could identify them, such as, you know, where they live or their doctor’s name and so forth. So I have removed that. But the rest of the information that I will readout is accurate from their initial updates to me.

So let’s get started, this update is from someone who has been on the program for seven months. So she’s referring to the Paddison Program, she said she’s making quite good progress, but there have been some hurdles along the way. She is still unmedicated and not even any painkillers. She has pain in her fingers, remains fairly consistent, mild pain, discomfort floating between joints, so it’s moving around. But in the last two months, I have started to develop significant pain in my right wrist. Pressure from inflammation in the risk joint has caused some swelling and some range of motion loss. She’s unable to achieve full wrist extension at the moment, cannot twist rotator wrist without pain. Around four months ago, she noticed that her left elbow was sore when she leaned against it on a table, the point of the elbow appears to develop a bump on the end, which is visible in the mirror when compared against the other elbow. She forgets about it unless she leans on a hard surface. She’s not sure if this is related to rheumatoid. Diet has been going very well, she says I’ve embraced the low fat, whole plant-based diet and have been able to work through the reintroduction sequence, even bringing in quite a few of the advanced foods. On reflection, I might be introducing foods a bit too fast. I have dropped back into reset foods whenever the pain increases. I’ve been eating baseline foods a bit more in the past couple of weeks, but current pain in the wrist is quite persistent.

Supplements, at around day 30 of the program I started taking B12, then day 50 Bromelain, day 70 Potassium, day 80 a probiotic. At the beginning of October at the direction of my rheumatologist, I stopped taking all supplements. Exercise has been very consistent for the first six months of the program. My routine has included, number one skipping for as long as I can Both morning and night, which gets my heart rate up pretty quickly. Number two, cycling for 10 minutes on a stationary dual action exercise bike both morning and night. Number three, Yoga class for one and a half hours Once per week. Over the past month, I’ve adjusted my routine slightly, skipping for as long as I can In the morning only. Cycling for 30 minutes on a stationary exercise bike. I’m sweating and puffing more with the increased cycling and remaining 1 Yoga a week. Stress has been nonexistent for the past six weeks and I’ve been getting plenty of good sleep too. But during high work periods, I can see the direct correlation between my pain levels
and my stress and sleep. But this holiday period has blown my radar a little as I’ve had no stress and plenty of sleep, and yet I’ve developed significant pain in a new bigger joint. Blood test results over the past year have been interesting, refer to the table below. I’m not really sure how to interpret the fluctuations. In October last year, my rheumatologist and GP were concerned about my elevated liver test results, and my rheumatologist directed me to stop taking all supplements and requested retest in one month. November liver results for ALPGGT and AST were even higher. My liver enzymes have fluctuated over a number of years without any cause. GP had me tested for autoimmune hepatitis, autoimmune liver antibodies were not detected and have referred me to some specialists to advise on management. So I refer to her latest C reactive protein and SED rate, she’s provided a wonderful table here of a bunch of different parameters versus time, and her SED rate or ESR on the 13th of January 2020, which is a week ago as I’m recording this was 20 millimeters per hour and her C reactive protein is 1.8 milligrams per litre.

So on Australian standards, her ESR is just within range or on the border of range, and 1.8 mg per litre for CRP is very normal, very good actually. Which is probably why she can skip for as long as she wants in the
morning it’s very, very good. And as we close out her update here, she says I’m having a third MRI tomorrow and will follow up with my rheumatologist on 9th of February. I anticipate that my rheumatologist will want to start some drug treatment when she sees me. I’d like to be prepared for the appointment to be able to discuss the right medication for me, especially in light of my history of
fluctuating liver enzymes. Am I right in thinking medication is somewhat inevitable in my situation? I can hear you saying medications is not the enemy, inflammation is. I’d like your advice on the right medication so I can get the most healing done and the other recommendations and advice that you might have. Clint, thank you for taking the time to read this very long message to me I really appreciate it.

Okay, sure, she’s covered a lot of things here and I’m going to go through and I will I have already commented and replied to her before I have recorded this. So I’m going to refer to my notes that I posted to her and also have made a couple of other additions that I wanted to expand upon a little bit. So she’s not on any medications. Okay. So there are five ways that we can reduce pain. We can reduce it with medications, diet, exercise, stress reduction and exercise. The major three are exercise, diet, and medications. Each one of those, if we were to push it to the extreme, can get tremendous an immediate, massive inflammation reduction. For example, after a become yoga class, I would highly imagine that c reactive protein is lower than before doing the class. It’s an hour and a half of hot, sweaty, hard yoga. Okay, I would guess that that would be the case. Certainly, I’ve got another case study, someone inside rheumatoid support who is doing tremendously. She’s done a month of Bikram yoga, having previously done just one class a week, but she’s just done a month, and it’s transformed her life. So a ton of exercise is going to shift the needle tremendously. You just. We know from a dietary point of view, if you stop eating and take the extreme dietary intervention, it just do green juices for two days, unbelievable reduction in inflammation. And then medications, if you were to go on prednisone 25 milligram tomorrow, you probably feel absolutely no symptoms.

Okay. So we can really dramatically influence our inflammation levels with diet, exercise and drugs. Supplements and stress reduction, much more subtle. And we have those, too. So she’s basically saying, is it inevitable that I’m going to go on medications? Well, her C reactive protein is only 1.8, so it’s very low. SED rate it’s at 20, so it’s still normal. And most GP would say that’s fine. But rheumatologist are looking very in a scrutinizing way for any traces of inflammation so as to prevent long term joint damage. So they may be of the opinion or her rheumatologist may be of the opinion and say, look, your fingers are still showing signs of inflammation. You’ve got this wrist pain, and now this, you know, a little nodule that started on the edge of your elbow. That probably lends itself enough to start a medication. The complication here is that she’s had a long history of elevated enzymes coming from the liver. And what that is, is oxidative stress in the liver. And when the liver gets oxidative stress, these liver enzymes show up as elevated in blood test that’s ALT and AST, and she’s had a long history that. Well, Methotrexate, which is probably one of the more likely medications that get prescribed as a starting point by the rheumatologist. It’s notorious for having a side effect of elevating the ALT and AST because it causes oxidative stress in the liver. This is why we take the folic acid with the Methotrexate to try and keep that effect to a minimum.

And so this is the big picture that she’s got going on here. Her exercise is fantastic. So next, let me tell you how I responded to her. I said I’ve never heard of an ALT and AST being raised from the supplements that you have mentioned. So I can’t imagine that bromaline, And what else was she taking here, that probiotics? And was it vitamin D? You know, these things are almost not impossible, but very unlikely to be
raising these liver enzymes. And besides, she only started taking these some months ago and has had a long history of elevated ALT and AST. So I can understand why the rheumatologist asked her to take away some things that could be providing benefits to other areas that don’t seem connected at all with raising those liver enzymes, although it could be wrong. So I’m surprised at the suggestion to stop these. And next, I just wanted to point out something to her, which is the Moringa extracted powder, so moringa, is a plant very high in antioxidants, and very high in all sorts of fabulous things like vitamin C and potassium. And so there’s a study that I provided with her showing her that moringa plant in a powdered form that you can buy on Amazon. The moringa plant has been shown to lower ALT and AST, resulting from the oxidative stress of the liver in a study on rats. And so they provided the Moringa leaf to the rats and the oxidative stress and the ALT and AST dropped in those rats. So I would suggest that she go ahead and get some Moringa powder or capsules, capsule dated powder or just put the powder into her green smoothies. But I went on to say that, you know, look, just because Moringa has been shown in the study to lower the ALT and AST, it’s probably fair that a lot of these other leafy greens are going to have a nice reduction effect on oxidative stress as well. So it’s not like we’ve got one thing here that will probably only do it. But I would emphasize more green smoothies and look at just getting green intake up in general, because normally what one leafy green can do, often another can do at a lower or higher level. So I actually said get the powered Greens taking them at the recommended or above recommended dose and resume a strong leafy green intake. Okay. Just as I mentioned there.

She’s asked about medications, and I’m always cautious about making comments about medications. There are many contraindications of medications that need to be carefully considered, which is why a rheumatologist needs to review someone’s current situation and look at whether or not, a certain drug is applicable to them at a certain time. So in terms of just general information, the starter medications mostly are either Methotrexate or Sulfasalazine or Plaquenil, these are three examples that the rheumatologist may suggest to you. I have only taken one of those personally, that was the Methotrexate. I don’t have personal experience with the other two. So it’s best just to find out what the rheumatologist recommends in your circumstances and then decide together. Again, she’s got this history of ALT and AST issues so perhaps with a lot of green smoothies and Moringa extract, and also what I needed to do one time was to take folic acid before and after my Methotrexate. So there’s two approaches with trying to minimize the effect of oxidative stress on the liver on Methotrexate. One is to take a small dose around 1 milligram a day of folic acid and then you skip it for a day or two prior to your Methotrexate once a week
or do what I used to do and it’s been so long now I can’t remember if I took it the day before or the day after the Methotrexate. I’m pretty sure I took it the day before the Methotrexate and I took a 5-milligram dose. But when my liver enzymes started to elevate, my rheumatologist suggests I also take a folic acid of 5 mg the day after my Methotrexate. And low and behold, that did the magic trick and brought my elevated enzymes back down again.

I’ve left a final message here for her, and I said be on guard for a recommendation from the rheumatologist of prednisone, and my opinion on this is based on, you know, she’s only got one point eight milligram per litre C reactive protein. She’s skipping every day in the morning and riding a stationary bike like a champion. So we’re not talking about someone who can’t get out of bed and is debilitated, needs to have prednisone to be able to operate just for a short time. So I don’t see, in my opinion is a breach of prednisone if she’s going to start Methotrexate is is overkill. But I’m often surprised at the
recommendations from the doctors sometimes that that that might be the appropriate way. And so all I do is share my opinion and say with you in such little pain, really, that just let the Methotrexate do its thing. That’s what I would do and that’s what I did. I’d never took the prednisone as a bridge.

And then the other thing that I have added here, she’s raised questions around wrists, her wrist pain. I’ve released recently a podcast all about wrists with Katie, definitely go and check that out. Fantastic effort from Katie to be able to improve her risk tremendously. So a lot of content in that episode. And her fingers, she’s got pain moving around in the fingers. I did a podcast recently all about fingers, how to reduce finger pain. So that’s the place to get the updated information on that. And then she’s got this little, little bit of pain in the elbow that she only notices when she leans it on a table. It could be a little bit of a nodule starting. These nodules tend to be a little builds up of soft tissue, which can also be eliminated
with time. I had a couple here and there, one on the side of my foot, which eventually went away. But they can be painful on the elbow as she’s leaning against the table. So what I’ve encouraged her to do is
just to start doing a little more exercise with those arms. I’ve had a long history of experience and problems with elbow pain, a synovectomy at one point complete synovectomy surgery on the left elbow, and I was on a continuous passive motion machine for six weeks, 10 hours a day. Back and forth on that thing was really, really, really hard work. And the right elbow also had a lot of trouble and actually still develops tendinitis because it’s not straight and has trouble. Okay. So what I need to do all the time with my elbows is to keep them moving and work on having good biceps and triceps muscles and connective tissue. That’s not easy, you know, it’s hard trying to find the right exercises at the gym in my scenario, because I’ve got the damage in those both elbows. But I do it and I work on it. So I’ve encouraged her to refer to the elbow reversal videos that I’ve got inside rheumatoidsujpport.com. And they are focused on a range of different exercises that can build those muscle groups without loading the elbow in a way that it doesn’t like. And they’re generally around push exercises, so what the elbow tends to like best is when the arm is used to push things away. So this is like a punch, a punch forward. We might have a resistance
band behind you and you are using your arm to move your entire fist and rest of the arm away from your body. These are safe and good for the elbow. And so there’s a range of different videos she can watch
to help her elbow and muscles.

Okay, so that is feedback Friday, I hope you enjoyed that. She had quite a lot of different things that we had to cover in that particular first episode. If you enjoyed it, please go over the iTunes and give me a five-star review on iTunes. The Rheumatoid Solutions podcast leave a comment and a five-star review on iTunes would help more people find this show. And of course, if you want my personal help, rheumatoidsupport.com is the place to be. And I provide these responses to people on a daily basis and provide them with my personal opinions in what I would do in their situation to get a better outcome. Thanks for listening.