Rheumatoid Arthritis and Obesity

Rheumatoid Arthritis and Obesity

Reference:  Crowson et at Arthritis Care

In the last 30 years rheumatoid arthritis has increased by 9 people per 100,000,  an increase from 21/100,000/year  to 30 cases/100,000/year now.   Three quarters of its victims are women, though men get it too.  To date, our treatments have not always been very effective at reversing it, just holding it off.  That increase wouldn’t be so remarkable if it wasn’t for the fact that obesity is now being attributed for 52% of that increase.

That’s what Crowson and her colleagues found at the Mayo Clinic when they followed some 830 folks with RA and compared them to an age matched demographic group.  It was reported Monday, June 25th on NPR and I had a question about it on my email before I even got to work.

The net effect of obesity on risk for RA seems to be that it raises your risk for RA about 25%.  That’s something on the same order of your risk of getting lung cancer is you smoke.  We make a fit about smoking because that link is pretty tight.  What about being overweight for our risk of RA, which is one of the nastier illnesses around?

And just how does this association work?  The author points out that clearly there are many background causes for RA.  Because women get it more than men, the thought was that estrogen had something to do with it.  But lots of women get better when they are pregnant, and HRT has not shown to make it worse.  But overweight men make more estrogen. Could that explain the male component?

Or is the underlying pathology really the damage caused by inflammation?  And where does the inflammation come from?  That’s the key I take away from this study.  Fat cells, (one more time) nor NOT little, passive, quiet, calorie storage devices.  They perversely turn into active endocrine glands.  They spew out inflammatory markers that set off inflammation all over your body.  You just have to biopsy fat tissue and look at it under the microscope.  (JCI from 2003)

Hence, it should make sense that as we American’s have packed on the pounds, we have gotten fatter and then developed more RA.  Crowson even offered up a patient who talked about how much better she felt when she lost 65 pounds and how her rheumatoid arthritis got better.

What else might be one of those multifactorial causes for RA?  Earlier this year I did a series on wheat and since that series, I’ve had three different clients of mine who had RA tell me they got better when they stopped eating wheat.  I measured the wheat antibodies in one of them and found it to be equivocal.  None of those three clients has overt celiac disease.  But I referred all of them to read the Scientific America article in 2009, August by Fasano.  That article suggests that the process by which wheat gets our gut upset and inflamed may have a lot of overlap with how we get autoimmune disease in general.  I have more than a handful of clients whose Hashimoto’s disease of their thyroid got better when they stopped eating wheat. What do we get fat from?  Eating wheat.  Is it the wheat, or the reaction in our gut?  Something is awry with our food supply.

WWW:  What will work for me?  Each week I’m eating a little less wheat.  Summer makes it easy.  The farmer’s market is magnificent.  Grill those veges, eat that salad, enjoy your summer.  Drop the wheat and the arthritis.