We discuss in this interview:

• Dr. Micah Yu shares his own personal story with inflammatory arthritis
• How a wrong diet can trigger inflammation
• Changing lifestyle, changing disease symptoms
• How inflammation drastically dropped after two months of plant-based diet
• ESR and CRP values and their significance
• Dr Yu’s Doctor Lifestyle clinic and his lifestyle medicine method
• The importance of a personalized approach
• The role of medications
• Biologic drugs
• Join the live Q&A with Dr. Micah Yu and our other special guests – join Rheumatoid Solutions

In this week’s podcast, we were joined by Dr. Micah Yu. He is an integrated Plant-Based Rheumatologist who has had Rheumatoid Arthritis (RA) himself since the age of 16. He specializes in plant-based treatments for RA and spent an hour explaining how we could improve our condition by following a similar regime.

Dr. Micah’s Health Journey

Dr. Micah first developed RA as a teenager in high school. Aged around 16, he describes himself as overweight and unhealthy. Intending to get in better shape, he followed the Atkins diet for six months, eating 200g of protein daily. 

The first time he realized this could be causing him arthritis problems was when his big toe flared with pain. It felt like someone had slammed it with a block of wood overnight.

His father, a medical doctor, suspected he had gout and tested his uric acid levels. They were measured at 14, compared to a healthy level of 6, confirming the diagnosis. He quickly changed his diet by coming off Atkins, but at college, he continued to drink alcohol and eat meat. As a result, he still suffered painful gout flare-ups a few times per year.

After college, these became worse, causing joint pain in his jaw, wrists, ankles, and knees. Dr. Micah had to stop eating regular food for weeks at a time because of jaw pain, leading to him eating yogurt and other soft foods. He also missed classes at medical school due to leg pain.

What struck Dr. Micah as puzzling was that his gout was now under control, and medication had his uric acid markers at normal levels. But his inflammatory markers were high – something else was going on!

Dr. Micah went on to complete his Rheumatology fellowship at Loma Linda University, fortuitously located in one of the blue zones. Alongside his wife, Dr. Melissa Mondala, also a medical doctor, Dr. Micah wanted to move home to Southern California. Situated in the epicenter of health and wellness, Lorna Linda University is a leading academic provider of lifestyle medicine. 

During his residency, Dr. Micah was diagnosed with ankylosing spondylitis after a flare-up of his symptoms. A couple of months later, Dr. Micah was also diagnosed with pseudogout, with calcium deposits in his foot. 

Working 80-hour weeks while completing the ICU rotation of his residency, Dr. Micah suffered from inflammation in his hip, causing him to limp visibly. Keen not to miss work; he had to resort to sitting down often. He ate quickly and consumed lots of fast food to fit in with his hectic schedule. 

While at Lorna Linda University, Dr. Micah’s wife learned about lifestyle medicine and the benefits of a plant-based diet. Lifestyle medicine aims to treat the underlying causes of a disease rather than its symptoms. During Thanksgiving 2017, Dr. Micah tried his first plant-based meal, prepared for him by his wife. Unfortunately, he wasn’t very impressed! He was so used to fast food; it just didn’t taste the same. 

At the end of his residency, starting in November 2017, Dr. Micah went to Guam for his rotation. He joined a Seventh-Day Adventist community of doctors and nurses enjoying a plant-based lifestyle. This was his first real experience of eating this way.

To learn more, he read Dr. Greger’s “How Not to Die” book and was encouraged by its stories of the transformation a plant-based diet can bring about. Motivated by what he discovered, this persuaded Dr. Micah to go all-in on the plant-based lifestyle when he watched the film “Forks Over Knives.”

The changes were nothing short of astounding.

Within two months, Dr. Micah began to feel like he was already free of his diseases. Then, after another month, he tested his blood for the inflammatory marker C-Reactive Protein (CRP). For the first time in ten years, he received a negative reading, and his Erythrocyte Sedimentation Rate (ESR) (another marker of inflammation) had halved.

RA patients typically have elevated ESR and CRP levels. This is due to the inflammatory processes occurring in their bodies. 

Two years later, Dr. Micah’s ESR level was negative at 3-4 mm/hour, after 13 years of being positive. He rarely has any attacks now and recently had a two-year gap between bouts. Dr. Micah admits to occasionally having processed food but never meat. And when he does get an attack, the pain is measured as a one and not the ten it used to be.

Dr. Micah’s Integrative Approach

Alongside his wife, Dr. Micah founded the Dr. Lifestyle Clinic, providing healthcare with an integrative approach. Dr. Micah specializes in Integrative Rheumatology. His wife specializes in Primary Care, Lifestyle Medicine, and Psychiatry. Currently, Dr. Micah is pursuing his second fellowship at the University of Arizona, learning about Ayurveda Chinese Medicine and the beneficial effects of aromatherapy, essential oils, supplements, and herbs. 

When meeting with patients in his clinic, Dr. Micah reviews their symptoms, current medications, and medical history to ensure that they have an accurate diagnosis. Then, delving deeper into the patient’s nutrition, sleep, exercise, stress levels, trauma, environmental toxins, and heavy metals, he gets a better picture of their lifestyle. 

Dr. Micah discusses each patient’s goals with them to learn more about what they hope to achieve. He is passionate about making sustainable changes, so he will determine whether his patients are ready to switch to an entirely plant-based diet or would respond better with a gradual approach. 

When clinically necessary, Dr. Micah will prescribe medication alongside an anti-inflammatory diet. The importance of controlling existing inflammation is evident, and sometimes this may only be achieved using medicine. However, Dr. Micah knows the importance of having a good diet to support medical interventions. Interestingly, new research suggests that RA patients may respond differently to medications, depending upon the composition of their gut microbiome.

Reversing Arthritis with a Plant-Based Diet

Research suggests that a plant-based diet comprised of plenty of fruits, vegetables, legumes, and whole grains, can help to improve the symptoms of rheumatoid arthritis and other arthritic conditions. A recent study shows that a vegan diet can significantly decrease inflammation and pain levels in RA patients. 

According to Dr. Micah, dysbiosis of the gut microbiome plays a role in disease across all spectrums, including RA. Dysbiosis occurs when unhealthy gut bacteria overwhelm your healthy gut bacteria, resulting in a ‘leaky gut.’ 

When you have a ‘leaky’ gut, the connections between gut cells – tight junctions – open slightly. As a result, digested food, toxins, and microbes can penetrate the gut lining, leading to inflammation. This results in the activation of an inflammatory cascade and eventual joint inflammation associated with RA. 

Can a Plant-Based Diet Reverse Inflammation?

So, can eating a plant-based diet help reverse the inflammation associated with RA? 

Dr. Micah believes that it can. Eating a plant-based diet, full of fiber and phytonutrients, helps to increase the number of regulatory T cells (T Reg cells) in the gut by breaking complex carbohydrates into short-chain fatty acids. T Reg cells are a group of immune cells distributed throughout the gut and exert anti-inflammatory effects. 

Meanwhile, the reverse occurs when you consume a highly processed diet. You get an increase in T Helper 17 cells and activation of the inflammatory cascade. 

Each patient is unique, and different foods will trigger their symptoms. Therefore, it is essential to find what your trigger foods are. Here, we discuss some common ones:

Does Eating Meat Make Arthritis Worse?

Diets high in red meat have been associated with an increased risk of RA, particularly early-onset RA.

During his time at college, still consuming meat, Dr. Micah found that he had regular flare-ups, including gout. However, after eliminating meat, despite still eating some processed foods, he found his condition in remission, with only very infrequent, mild flares. 

Evidence suggests that limiting your consumption of processed red meat is a smart idea. With high levels of saturated fat and omega-6 acids, red meat can exacerbate inflammation. 

Does Salt Make Rheumatoid Arthritis Worse?

While it can be difficult to eliminate salt from your diet, Dr. Micah discusses the impact that a high-salt diet can have on RA. 

Salts, in high excess, can be very, very inflammatory. This is because salt works to increase your T Helper 17 cells and deplete your T Reg cells. In RA patients, T Reg cells are already depleted. T Reg cells regulate the immune response, preventing the body from fighting itself, hence the autoimmune nature of RA. 

Notably, a high salt diet can activate the same pathways as common biologic medication. This means that consuming a high-salt diet can decrease the effects of biologic drugs. Use salt to taste if you are not ready to cut it out entirely.

What are the Inflammatory Effects of Oil?

Likewise, Dr. Micah highlights the dangers of consuming a diet rich in oil. 

He states, “When reheated over and over again, as it is in restaurants, oil can be very inflammatory. Additionally, each oil has a different smoke point, so when you cook above that, it becomes carcinogenic. If you have some oil, extra virgin olive oil is probably the best to choose. If eating out in a restaurant, let’s quickly chat with the chef and ask them to minimize the amount of oil they use in your food.” 

Can Dairy Make Arthritis Worse?

Some patients with RA may experience a worsening of their symptoms when they consume dairy. You may be surprised to learn that dairy can have a negative impact on RA, given its well-publicized health benefits. The problem is casein. 

Casein is a protein found in milk that can contribute to inflammation. Therefore, limiting your consumption of dairy-based foods may help to improve RA symptoms.

Moving Forwards With an Integrative Outlook

Dr. Micah is working hard to revolutionize the RA field by combining functional lifestyle and integrative medicine. He is one of the very few, if not the only, plant-based rheumatologist around! Dr. Micah and his wife often treat patients in parallel. For example, he helps to manage their autoimmune disease, while his wife supports them with coexisting anxiety and depression. 

Dr. Micah is happy to consult virtually with patients from around the world, so check out his website at www.drlifestyle.org. Dr. Micah is located in Newport Beach and is available for face-to-face appointments for those living in California.