Fett - The keystone approach: healing arthritis and psoriasis by restoring the microbiome

The Keystone Approach: Healing Arthritis and Psoriasis by Restoring the Microbiome

Copyright 2018 by Rebecca Fett

Published in the United States by Franklin Fox Publishing LLC, New York.

All rights reserved. No part of this book may be reproduced in any form by any means without the express permission of the publisher.

This book is intended to provide helpful and informative material. It is not intended to provide medical advice and cannot replace the advice of a medical professional. The reader should consult his or her doctor before adopting any of the suggestions in this book. The author and publisher specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise, which is incurred as a consequence of the use and application of any of the contents of this book.

ISBN-13: 978-0-9911269-8-9 (ebook)

ISBN-13: 978-0-9911269-5-8 (print)

ISBN-10: 0-9911269-5-5

www.keystonebook.com

The world of autoimmune disease is a very different place than it was even five years ago. New evidence is emerging on a daily basis that points to the gut and the microbiome as the origin of a variety of autoimmune diseases. This new paradigm opens up an array of treatment optionsoptions that go beyond merely suppressing the inflammatory response to actually addressing the underlying causes of that inflammation.

The Keystone Approach is your guide to this novel scientific frontier, with a particular focus on dietary changes and specific probiotics. Together, these measures can heal the gut and restore balance to the microbiome. When we do so, we remove the main triggers that drive inflammation in many autoimmune diseases, particularly those conditions in the spondylarthropathy family. This family includes

• Psoriasis/ psoriatic arthritis
• Ankylosing spondylitis
• Juvenile idiopathic arthritis
• Crohns disease
• Ulcerative colitis
• Uveitis

Although these conditions are the main focus of the scientific research discussed in this book, I also cover the latest studies on how diet and gut health impacts other autoimmune diseases, such as rheumatoid arthritis. These research findings are then translated into simple, actionable steps. But first, the story of my own battle against autoimmunity.

* * *

A doctor first suspected that I had psoriatic arthritis when I was 18. At the time, my only symptoms were mild back pain and a small patch of psoriasis, but I understood that if I did indeed have psoriatic arthritis, it could become much worse. This form of arthritis affects up to 30 percent of people with psoriasis and can become debilitating.

Six months after the pain began, I noticed that it seemed a little better when I avoided bread and pasta, so I insisted on a celiac test. The test showed that I did have celiac disease, and after completely eliminating gluten from my diet for several months, my psoriasis and back pain mostly resolved. It appeared that I did not have psoriatic arthritis after all.

I went on to complete a degree in biochemistry and molecular biology, and then law school, with only minor aches and pains that I attributed to the physical toll of spending too much time studying.

By my mid-20s, after several years of working long hours at a large law firm in New York, my pain returned with a vengeance. My shoulders, knees, hips, and lower back ached constantly, and joints seemed to dislocate with the slightest provocation. The possibility of psoriatic arthritis was quickly brushed awayI had very little psoriasis, no joint stiffness or swelling, and no blood markers of arthritis. I simply did not fit the old-fashioned textbook definition.

I was given a wide range of diagnoses by various specialists and offered all manner of pain medications. After experiencing severe side effects from these medications, I elected to focus on physical therapy. I hoped that with enough effort and perseverance, my muscles could eventually stabilize my joints. I spent five years religiously devoted to physical therapy, wanting to believe that my recovery was just around the corner.

It was not. By age 30, the pain in my sacroiliac joints (in the lower back) was so severe that I started having great difficulty walking more than a few blocks or sitting for more than 15 minutes. I had pain flare-ups that kept me housebound for weeks at a time and kept me awake much of the night. I tried various injections and anti-inflammatory medications, with little relief.

Around this time, my psoriasis also returned, and a range of other classic symptoms of psoriatic arthritis emerged (such as characteristic nail changes). It became clear that I had probably been suffering from psoriatic arthritis all along.

Understanding the nature of the problem was both a setback and a relief. On one hand, the diagnosis meant that no amount of exercise would ever enable my joints to function normally. It also meant I had wasted many years that I could have spent focusing on the root cause of the paina malfunctioning immune system. But on the other hand, a malfunctioning immune system was something I understood all too well, and now I finally had an explanation for my pain.

The precise details of autoimmunity were at this point already very familiar to me from my immunology studies at university and from my work as a patent litigation attorney for biotechnology companies. As the immunology specialist in lawsuits with billions of dollars at stake, I had actually spent much of the past nine years analyzing the scientific and clinical evidence underpinning the biologics used to treat various autoimmune diseases. My office was filled with boxes of confidential clinical trial reports and FDA submissions, and it was my job to analyze them and talk to experts in the field.

I had essentially spent nine years thinking in great detail about the invisible inflammatory molecules that drive all the damage in autoimmune disease. And now I learned that these same molecules were causing the pain that had taken over my life.

I understood that the new biologic medications were likely my best hope for recoveryif I was willing to take the risks associated with infections and possibly a higher risk of cancer. Although biologics only slightly raise the risk of infection, this was a major obstacle in my particular case. As a teenager, I had undergone surgery that left me with a lifelong susceptibility to serious infections. I had been advised to take preventive antibiotics for life because some common infections carried a 50 to 60 percent mortality rate in my case. I refused the antibiotics but was also reluctant to take any medication that could add to my infection risk. Since my arthritis was progressing slowly and not causing any obvious joint damage, it seemed prudent to exhaust every other option first.

I knew that biologics work so well because they interrupt the specific mediators of inflammation that orchestrate skin and joint damage. Surely there had to be another way to accomplish the same goal. What other factors contribute to elevated inflammatory mediators, and what other factors can reduce them?

As I began to focus more on these questions, I made the difficult decision to pause my legal career and focus on my health. I left New York and moved to a small town by the beach with my husband and two young sons. My new job became scouring the scientific literature for any evidence that diet or lifestyle changes could change the course of my autoimmune disease. I expected to find some clues but was unprepared for the extraordinary amount of good-quality clinical evidence supporting relatively simple strategies.

Perhaps the biggest revelation was the discovery that gut health has a profound impact on the level of inflammation in the skin and joints. A persuasive body of research shows that excess immune activation in the gut is a common feature of psoriasis and several types of inflammatory arthritis, particularly juvenile, psoriatic, and ankylosing spondylitis.