Aljona is a very active member of our coaching program, and today she shares the tremendous improvements she achieved through Personalised RA Coaching Program – Book Your RA Reversal Strategy Session Here 

We discuss in this interview:

• Aljona’s tremendous improvements since she couldn’t walk three years ago
• Her experience with methotrexate, prednisolone and sulfasalazine
• Moving from the baseline by introducing new foods
• CRP values decreasing from 45 to 2 with the Paddison Program Personalised Coaching Program
• Managing little pain levels
• Setting the right goals
• Papaya and other diet tips
• Exercise and its interaction with diet

Clint – Welcome back to the Rheumatoid Solutions podcast. My guest today is in Sweden, originally from Estonia, but she’s studying in Sweden and she’s been a long term user of the Paddison Program, she’s part of our coaching and she’s done great. She’s going to share today her improvements with rheumatoid arthritis. Her name is well, it looks like Aljona, but it’s pronounced Aljona as she tells me. And she’s been tremendous inside our community, inspiring others. And also, she even created some of the workout content that we now share with our members, because she was so good at doing these exercises and using them to reduce inflammation in her joints, that she picked up a camera and filmed the way she did it, and I thought, it’s great that it’s not just coming from me. It’s great that one of our wonderful superstars is showing how she’s doing these, and so that was a great value, so thank you for that, Aljona let’s hear about your journey. First of all, give us a little snapshot of the before and after here. Where were you at your worst and how are you today?

Aljona – Thank you very much for having me here, it’s a pleasure. And I will just try very quickly to start that when I it was almost three years ago, and my worst state was that I actually couldn’t walk. And surprisingly I had pain almost in all joints it was feet, it was hips, knees, fingers, wrists, shoulders like everything. And the surprising thing was that my arthritis was so active and aggressive that I developed this kind of pain very quickly. Just within a couple of months, I went from one knee to almost everything. And right now, I go to the gym, I can walk, I can run, and I can do very normal things people do. And I feel like I’m completely normal. And quite often I don’t even think about the disease. And I think this is, like, the most amazing thing, because I really want to feel normal and I enjoy this feeling. And yeah, also, I’m doing exercises and I go to the gym and I didn’t do that before I had the disease, which is quite surprising because I’m even at some point I even better than I used to be before the disease, which is kind of amazing.

Clint – Wonderful. Medications, what did the doctor suggest? What did you go on?

Aljona – It was very challenging with medications because actually if you looked at my blood test at the beginning, only one thing was not normal, it was anti-ccp everything else was perfect. And yeah, I have had several rheumatologists and I started with methotrexate and it didn’t work for me because I developed symptoms in my liver. I guess it reacted badly to this medicine, but the challenge was that I don’t know why it works like that, but the first rheumatologist told me that I, you know, we don’t have other medicines for this condition. You can only take like methotrexate. And I knew exactly that it didn’t work for me and I didn’t want to take it again. So, I went to another doctor and she looked at me and she said to me, oh my gosh, you have such a bad condition, and probably you have a very bad prognosis. And she told me also that I don’t know which medication to give you because since methotrexate doesn’t work for you, it seems like if you go up, it will be even worse in terms of side effects. So I was like, what should I do? And I was for some time I haven’t been taking medication. But then I found another rheumatologist and I was really glad that she actually tried sulfasalazine because it’s the most, the mildest medication. And other doctors told me that, no, we cannot try them because they eventually will not work for you. But she was like, let’s try. But also, she really wanted me to take prednisolone first with Sulfasalazine because she saw my condition. So yeah, I used only two of these drugs and right now I’m on sulfasalazine only.

Clint – What dosage of Sulfasalazine did you start with and what dosage of steroid?

Aljona – For the steroid, it was five milligram, I guess. Yeah. Yes. And sulfasalazine. It’s 2000 milligrams I guess I don’t remember. So this sulfasalazine, I have the same dosage, but my rheumatologist told me that I can try lower it, but I’m just waiting to feel more confident and like I’m not rushing into trying something new. But I don’t take prednisolone for a long time, I haven’t been taking it. I guess more than one year ago I stopped taking prednisolone, I guess.

Clint – What else were you doing to help bring the symptoms under control? And how do you know that the stuff that you did on your own benefited you, and it just wasn’t the sulfasalazine and the steroid.

Aljona – And I’m pretty sure that it’s not the medicine that makes me feel better. Only I guess it’s helping, but it’s definitely not the only thing because first of all, my rheumatologist is quite surprised because when she gave me Sulfasalazine, she told me that actually, eventually people change medications later and they start taking something more serious and more like, I don’t want to say serious, but something stronger. So still, I’m taking just sulfasalazine and she’s kind of always pretty pleased with how I’m doing. The second thing is that when I started taking prednisolone, the thing I told myself is, okay now, probably I will feel much better because I know how prednisolone works, but it means that I must start doing things at my maximum. So before I couldn’t do exercise just because it was very painful, if I did, it was just tiny bit. But when I started taking prednisolone, I was going to the gym almost every day and I did cardio exercise, I did strength training and everything I could just as much as I could with no excuses. And I knew that I need that to eventually and stop taking prednisolone. I know it’s hard, but I knew that I have to build this kind of basis to be confident, to take it off later. So I think that everything I did in terms of diet and I followed the baseline for a long time, like kind of baseline and maybe the next stage together for a long time just to make sure I don’t try risky things before I try to go off the prednisolone. So I think these things work like 100%, I’m sure in this.

Clint – Right. You mentioned baseline, you’re referring to the eating plan. At what point did you introduce the dietary changes, the exercise relative to the drugs?

Aljona – In terms of diet, as I told you, I tried to be very careful with introducing new things. So basically when I started, like I think when I completely got off prednisolone, I started trying things more confidently because I knew that I need a wider variety of diet. And it’s actually beneficial if you take more different kinds of foods. So before I maybe had just a little bit of nuts or something, just very little bit, now I’m more confident with eating a wider variety of such things or seeds. And like even right now I can eat also tahini or something like that. So I’m not restricting myself only to like quinoa and sweet potatoes, I can try like different things and I like fruit. I think fruit has been really amazing because I forgot to mention papaya. Papaya was just like even before I started taking medications. When I tried papaya, it was like, wow. Because like next day I already had fewer symptoms. It was tricky because I didn’t take medications. Not always like that, but I felt like papaya and fruit in general works very well. So more fruits, more nuts, different kinds of vegetables, potatoes. And in terms of exercise, um, I guess the most vulnerable body parts are at risk for me. So slowly, when I started to feel better, I just tried to increase weights. I used and tried different exercises, and right now I’m. I think that I’m doing very great in terms of my risk. So I can do even more things.

Clint – Amazing. Let’s talk more about that in a second. Have you seen C-reactive protein and sed rate markers throughout this journey, And how have they shifted?

Aljona – I would say they shifted much because the highest I had C-reactive protein was 45, it was almost two years ago, I guess. And right now, it’s below 2 consistently. I couldn’t get it below one, but maybe eventually, later I will I’m trying. I guess I used to have a severe condition, and I guess it just will take more time. But it’s consistently has been two or less than two and once close to one as well. And the second I forgot how to call it sedimentation rate.

Clint – Yes.

Aljona – It’s always below two.

Clint – Fantastic.

Aljona – But it was. It was also quite high. More than 30 kind of 40 back then.

Clint – Awesome. Okay. On a scale of 1 to 10, how is the wrist now that you’re dealing with where one is just the mildest of problem that you’re trying to get right, and ten is, oh, my gosh, like, I need to talk to the doctor about drugs again.

Aljona – I think it’s close to one. It’s sometimes it’s just I would say one and sometimes maybe 1.5. But right now I feel really great in my wrist.

Clint – And any other problems anywhere else?

Aljona – I think, which is sometimes like confusing. Sometimes I get a little bit of pain, but not even in joints, in my tendons. I feel like sometimes I have kind of tendonitis and I guess it can be from exercise, so maybe I’m doing something wrong. And also these joints, I have noticed if I did something not very well in terms of exercise, sometimes I get this mild joint pain, but if I try to rest from this type of exercise it gets better.

Clint – Awesome. And with your current sort of direction that things are going, where do you think you’ll be able to get to with the wrist and with that bit of tendinitis and with the medication, how do you feel that it’s tracking?

Aljona – I feel like this wrist I, I’m really I’m happy seeing such a progress because I can do so many things at the gym I couldn’t do before. And it’s much stronger so I can lift dumbbells without pain. And it’s much more flexible than it used to be, so I can’t even for a little period, for a small period of time to be in the plank when I stay like this, I couldn’t do that before. I can it’s not like super flexible, but I can do this sometimes. So I think it’s amazing and I believe it will get better with time because I usually tell myself that it will take time, just don’t worry, because it’s a long process, it’s not happening overnight. And tendonitis I will look how I’m doing because today, um, my husband will bring me my infrared lamp and I will try like also doing with this and see how I react to that. And I will see maybe I need more rest and not doing with this hand some for some time something.

Clint – Where do you get the tendinitis?

Aljona – Here in this part. So sometimes it’s just Finger. And it can be just from pressure because sometimes I can get pressure here. But in general during the day I don’t feel it, but usually it’s morning when I feel it the most after not moving.

Clint – Got it. Okay. I’ve got about eight things here that you’ve mentioned that I will touch upon and go into more detail, and I’ll comment on and give feedback on in a minute. Where do you want to get to? I know I asked you what direction you think you’re going. What’s your big goal? Are you planning to come off the medication one day entirely? If your symptoms and your sed rate and C-reactive protein all continue to look amazing? What do you want to do? Like, what’s the big picture here? And what are you striving for?

Aljona – Yeah, I would not say that my goal is necessarily to get rid of medication because this was a mistake for me in the past, because it was my goal and I was all I need to like, uh, get rid of medication. And it made things much more difficult for me. And my goal is just to be healthy and to thrive on what I’m doing now and to be consistent with this lifestyle, to have all things I’m doing now and to enjoy, like in terms of diet and exercise. Just really to be consistent with this. And this medication, I will just see if I feel like my CRP is so low that I feel so confident to try to lower it down a little bit. I will do that, but I don’t think that I can be very confident right now to say where I will be with this medication, because it’s not my goal right now. My goal is just to be consistent with what I’m doing and feeling better with all these things. But definitely I don’t want to take more medications, this is for sure.

Clint – Right. So your goal on medications is at the very maximum to do what you’re doing. If everything falls into place and you continue to exhibit control over your symptoms with what you’re doing with your lifestyle.

Aljona – And I trust my rheumatologist and I know she’s like she has already suggested trying lowering if I want, I don’t have to but if I want, for example buy one tablet or something like that one pill. So I will see because I feel like she can be also supportive in terms of this, maybe not completely, but as much as I can.

Clint – Amazing. Okay, let me summarize here. So I understand because you’ve had a dramatic turnaround here 45 as a C-reactive protein down to 2mg/l. You had it all over your body in all those different joints. You tried methotrexate, but this didn’t work, you’ve shifted to sulfasalazine. Sulfasalazine I’ll come back to that in a second. And then you were on five milligrams of steroids. Some people get stuck on steroids for years and years. Often it’s used as a bridge, as they call it, to allow some of these disease modifying drugs to work, which can take weeks if not months. Sometimes things like sulfasalazine and methotrexate, especially hydroxychloroquine, can take 10, to 12 weeks. And so you’ve then embraced the Paddison Program in parallel with all of the exercise aspects to it, you’ve just embraced it from start to finish. Managed to get off your steroid completely and stayed on the same dose of the sulfasalazine with now your rheumatologist saying that if you want to try and taper off, you can. But because you’re very wise and you’ve got a lot of information, we’ve been communicating regularly for the past two years together in our community and doing wonderful things and sharing and stuff. You know that exactly what you said, the goal is not to get off meds. The goal is maximum health and therefore minimum symptoms. And with minimum symptoms, that’s when we are open to discussions around lowering meds and taking the fewest possible supplements and requiring, the less interventions of all kinds. So absolutely phenomenal. Like to listen to you tell that story it cannot be anything other than inspiring and uplifting to people with this condition.

Clint – Sulfasalazine is not a common drug to go on. So methotrexate is the 90% of people with RA take methotrexate at some point in their disease journey. Sulfasalazine is often used only as the backup, just like in your case where the first primary treatment doesn’t work and then sulfasalazine is second. My rheumatologist describes it as an old drug that no one uses anymore. Sulfasalazine an old drug that no one uses anymore. Okay. So it does have a small antibiotic component which can actually slightly positively impact the microbiome, surprisingly. So its mechanism of action is still a little bit unknown.

Clint – So you are doing ridiculously well having so many symptoms to begin with, and such high C-reactive protein to be taking this quite uncommon, not very frequently administered drug without any steroid, and with just a one out of ten wrist pain. I mean, come on you’re kidding me. Okay, so this is why I wanted to get you on the show. Next thing, Papaya, what an incredible fruit. When my wife and I were in Hawaii on our honeymoon, I ate papaya every single day with my meals and discovered after three weeks of wonderful honeymooning. Although I had to do Bikram for about three hours a day to walk. I was able to tolerate so many more foods, amazing fruit. Yeah. So I’ll just stop talking for a second. Were you eating these papayas as often as that, or were you just dabbling? I mean, did you use it as a therapy or just as a sort of as a side?

Aljona – Therapy, because I don’t know. How about where you live, but in Estonia, it was incredibly Expensive to buy papaya, but because it was helping, I used it as a therapy. And then maybe just because it was kind of expensive, I went, uh, for, uh, digestive enzymes because it worked similarly. So yeah, but Papaya was really amazing. And one thing I forgot to mention, my digestion was awful, like completely awful. I couldn’t digest anything, even quinoa. So and I see it parallel my improvements in my microbiome and digestion and rheumatoid arthritis like in parallel. I think these things are connected for sure, and inflammation usually impacts our cat as well.

Clint – Absolutely. When I talk to people who are about to start working with us on these strategy calls, I don’t think there’s a person I’ve ever spoken with who hasn’t said oh, and I also have noticed that I get some bloating or indigestion, or I’ve got food sensitivities, or I get sometimes like intestinal cramps, or maybe I don’t have frequent bowel movements or I got diarrhea or etc. So people always feel the connection, but they aren’t aware of the ultimate devastating effect of actually the joints and the connection. You’ve expanded your diet a lot. You’re mentioning you’re eating nuts and seeds and stuff. Can you tell us, for people who don’t know anything about the program, can you tell us the sort of just general groupings of foods that you went through? So that everyone can get an idea of the just the, the process involved here and where you’re what you’re eating now. Like, what sort of foods you now have graduated to.

Aljona – It was a bit a long time ago, but I remember that I just ate quinoa, buckwheat, sweet potatoes, and veggies like green veggies and something like that. And I didn’t even eat fruit. And I think it was a little bit of a mistake because right now we have more fruit at the baseline and at that time we didn’t, but I think fruit is very amazing. So gradually I increased the amount of fruit I could eat, including bananas and everything. Just I like fruits, I like sweet food, and I think fruit is a great like substitution for sugar. So I felt like I was satisfied as well. And slowly I started adding some kind of beans, for example, uh, edamame beans and, uh, like different kinds, like chickpea and black beans, maybe a bit later, but, uh, just to have more kind of healthy protein options and also soy milk. I started using soy milk in my breakfast and I felt great about it. And gradually I started adding also nuts and seeds and, um, yeah, eventually even more fruit and different kinds of like potatoes. Not only sweet potatoes, but also the usual potatoes, and I like potatoes. Right now what I can say that I am also more confident going eating out because I used to be a little bit, like, cautious when I go, uh, to the cafeteria and I see that they have, let’s say, healthy balls with veggies. But I knew that they use oil because they usually use a little bit. But right now I’m really fine with that. Even if they use, I know a little bit it doesn’t affect me. And I love smoothie bowls and if I go outside, smoothie bowl is a great option I could eat so I don’t feel that like unconfident anymore in terms of eating out. So I think that I have expanded my food choices quite much and I feel very normal. In fact I already was vegan before I started the Paddison Program and caught the disease. And I feel that my diet now is kind of very similar to what I have been eating before the Paddison Program. And I also, I didn’t use oils before because I’m not used to eating oily food. It’s just quite usual for me. And yeah, I feel quite great in terms of what I can eat right now.

Clint – Very interesting. On the surface, you think that doesn’t make sense, like you’re kind of eating the same things now is what you’re doing before. And I’ve got two thoughts around that. Number one, you weren’t exercising at all right prior nothing.

Aljona – A Little bit, not at the gym.

Clint – Right okay which is crucial. Like the resistance training side of things is crucial. And number two, even when people are at a starting point where the diet looks good, I still take people through that 6 to 8 week process that it now is. To restore all of the microbes that we need to produce the short chain fatty acids in the bowel, and to rebuild the diversity and put back into the diet or to ensure that is in the diet, all the different types of the prebiotic fibers. So the beta glucans and the fructooligosaccharides and the resistant starches and so forth, so that we get that all in there. So it’s interesting, I like that as a topic point that we’ve covered here is that you can be eating on the surface, what looks like the right diet, still develop dysbiosis through a trigger and then need to reset everything over again. Can you remember if there was a very heavy, stressful event at the time or like emotional trauma? If you were maybe sitting exams or whether you took antibiotics or had a tooth infection or as a child took antibiotics as a teen for acne or ear infections as a baby, or were you cesarean birth and not natural birth? Have you tried to piece some of this puzzle together as to what might have triggered this?

Aljona – Yeah, it’s a very difficult question and I have been thinking a lot what could be, but really I’m not sure and I can never be sure of 100%. But I didn’t take much antibiotics, so it’s not that I guess I have struggles with stress. It’s hard for me to manage stress, and I feel like my stress levels are also connected to my gut. And when it’s very stressful, I kind of experience the digestive symptoms. And also I don’t really want to like very confidently say it was because of the vaccine, but because the first symptom in my knee I developed after taking a Covid vaccine. But as I know, usually it doesn’t work like that it only one thing triggered something because otherwise it would be so easy to say that vaccine causes arthritis. But I think that maybe some things together could cause something like that. Yeah, but I just don’t want to see people that be cautious of vaccines because it’s not true. And it’s just an idea if we combine everything together, maybe it could be, but I don’t know.

Clint – Yeah. It’s just too delicate a topic for us to explore. Or we can say. And I I even published a 1200 people survey on this exact topic. And we found that approximately 22% of people with inflammatory arthritis claimed in the survey that they had an increase in symptoms associated with the timing after having the vaccine. So this is public information that we published in a medical journal. So this isn’t being controversial, this is just results from a survey that we that we conducted with our mailing list. Obviously, that’s another topic completely. We’ve done another podcast about this, but interesting. What we do know is that you can have viral bacterial triggers to disrupt the microbiome, and that with a disrupted microbiome, pathogens can then dominate the real estate in the bowel and disrupt the production of our short chain fatty acids. And so this can be coming in from a h.pylori this B coming in from p gingivalis in the mouth. This can be coming in from klebsiella which is always associated with ankylosing spondylitis. This can be coming in from Epstein-Barr virus. When the immune system is suppressed, Epstein-Barr can become a dominant pathogen and therefore maintain a dysbiotic bowel. So whether or not it was that, as you say, something has just tilted the balance out of the bowel, and then you’ve developed this gut permeability and symptoms from stuff getting in the bloodstream. I like these discussions, I think it’s very valuable to ponder on this stuff. The good news is, through all the work that you’ve done, you’ve restored balance again. You’ve probably got a little bit of damage in that wrist from 2 to 3 years of inflammation, making it a vulnerable target to further inflammation. Meaning you’ve got to do everything really well to be able to clean out that little corner of the room that gathers dust. So let’s talk about the wrist and then we’ll wrap up here. Can you tell me exactly what you’ve done with the wrist to help it and it being your worst joint, all the details for people also suffering from wrist pain?

Aljona – Yeah, it’s definitely exercise. And even something like elbow pumps, like you can do a lot of them and just kind of helping to get some kind of movement, even if it’s a little bit. And then I think strength training is a must. I don’t want to say that you should try to do so much if it’s painful, but just try a little bit. Start with very, very light weights, and then move to more if you feel like it. Because I did like only for wrist exercises, but also like for my biceps and everything and yeah, kind of just combining everything together and cardio. Like I remember that when I had more problems in my wrist, I really tried to do cardio. It could be just a rowing machine and, uh, different kinds of exercises just to get that, To, um, you know, uh, to train my heart as well, and everything to sweat and to get this kind of, uh, anti-inflammatory flow into my body. So I think everything together is very important to combine. It’s not only strength training is working, it’s also cardio and it’s diet I think it’s everything together. And my rheumatologist told me that it’s crucial to get the disease under control within the first two years because the disease within this period of time is the most active. So just really important to do everything combined, even if it’s medication, just to make sure that you don’t get a lot of damage to the joint, you have the most vulnerable.

Clint – I Can attest to that. I refused methotrexate for the first 12 months, and I lost so much cartilage in my knee in that first 12 months. I don’t know how much quantitatively, but because I tore my ACL at the same time, I had a ACL tear that was all inflamed and then rheumatoid in the knee. So, yes, medications would have helped to manage that better if I had started earlier. The wrist I want to come back there. First of all, across the board, what is your exercise cadence? Do you go every day? Every other day? Has it changed in terms of frequency? What works for you best?

Aljona – Yeah. It always works best if I do it more frequently. But because I’m a student, it’s sometimes very challenging, and sometimes you’ve got so many tasks to do. But I’m really trying to do at least two times a week of strength training. Better if I do three plus, very good if I do three plus and I’m trying to do that. Now I’m trying to incorporate more cardio as well because I’m the type of person who a little bit hates cardio it’s sometimes very hard, but I know it’s very beneficial so I need to do that. And what I’m trying to use, like Sweden is a nice place in terms of this, because you can rent a bike just for 20 kind of euros per year and you can use a bike. Yes. It’s so cheap, right? You can rent a bike, which is like just for one hour. I live in Malmo, so you can use Malmo by bike, and you can just rent it and you can go to school. For example, I have kind of three kilometers to my place where I study, and I’m trying to use bikes because these bikes are tricky. They are not so comfortable to use, but you get very good exercise. So you get like sometimes you are very sweating, but it’s good. So I’m really trying if the weather is nice, I’m trying to use bikes, and if not, I’m just going to the gym and try to do it there.

Clint – Yeah, riding around is fantastic where you can do it, where it’s safe, where it doesn’t again hurt the wrist the area where I used to struggle with riding push bikes, as we call them here, was the road vibration coming up through the wheels, through the bars and upsetting my wrist. So it’s a great sign that you don’t have a problem riding the bike, because tells me that your wrists are really, really, really resilient. Last question on the wrist. Have you found that more and more distraction through the wrist, through pull exercises, hanging from bars? How has this helped? And for people who think that’s going to kill my wrist, can you provide some reassurance in what you do?

Aljona – Yeah, I find this very helpful. And I’m trying to get more, uh, such exercises not pressuring. Sometimes I do this as well just to combine different things. But more, of course, like, uh, like that. And it’s usually like you can use cable exercises just to, like pull things, not to push. And, uh, hanging from the bar as well, and everything like that. But the thing I have always been using, I, I don’t know how good it is because sometimes you can a little bit, uh, I want to I don’t want to say damage, but I just, I was trying to do something like that a little bit just to distract. I found it helpful, but you, you should be careful, because you can also do something for the other hand when you do always like this. But sometimes it helps my wrist, but you should get this balance because you can a little bit You can do something worse for this and just occasionally, but you got to be careful with that. But yeah, really distraction exercises I would say work for me.

Clint – They work for everyone. So I’m glad that they’re working for you and you’re not the outlier, that’s encouraging. I wanted to say, have you ever tried pressure therapy into the palm to just to use the opposite thumb to try and press into those areas that hurt in your palm and that might be able to provide some relief? And what you can even do is put the back of your hand against a table, something firm, and then use your elbow, the other elbow to massage into your palm, which may help relieve some of that tendonitis. So give that a try, and that’s something you and you and I can talk about over the coming weeks inside the coaching portal and find out if that helps you.

Clint – Thank you so much, Aljona, for sharing your update. You know, you and I spoke before this and you said, but I want to do this once. I’m absolutely perfect. And I said, look, this is the real world, we’re always working on something. And why would we delay several months, um, a story that’s going to uplift and inspire people right now? And the message is not going to be much different, whether or not you’ve got a one out of ten wrist pain or a zero. So thank you for coming on and sharing the lessons that you’ve learned. I really appreciate it.

Aljona – Thank you very much. It was a pleasure. And you are right. Like we we have to be real and not perfect. Thank you.