Why Rheumatoid Arthritis Often Defies Drugs (& What Else you Can Try)
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Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation). These are mostly, but not all, autoimmune diseases, in which the body’s immune system mistakenly attacks our own joints.
Rheumatoid arthritis is one of those. Indeed, it’s the common of the autoimmune forms of arthritis. Some quick facts:
- Approximately one third of people stop work within two years of its onset, and this increases thereafter.
- It affects a little under 1% of the global population, but the older we get, the more likely it becomes
- Early onset of rheumatoid arthritis is most likely to show up around the age of 50 (but it can show up at any age)
- However, incidence (not onset) of rheumatoid arthritis peaks in the 70s age bracket
- It is 2–4 times more common in women than in men
When meds don’t work (and why)
There are three main kinds:
- Pain relief (always hit-and-miss, unless going for literal anaesthetic)
- Anti-inflammatory (can rarely go too far wrong, although some can give different problems)
- Arthritis-specific, which are usually also anti-inflammatory in their own way, but deserve a special mention
For example, a lot of arthritis medications act via the interleukin-17 pathways.
However, researchers (Dr. Martina Zoccheddu et al.) found that in rheumatoid arthritis, the immune cells that normally make IL-17 gradually stop producing it, which explains why IL-17-targeted drugs lose effectiveness as the disease progresses.
Even worse, once these cells stop making IL-17, they turn into aggressive forms that can still sustain joint inflammation independently of IL-17, meaning that the meds can end up doing more harm than good in the long-run!
To quote Dr. Joyce So when asked about this,
❝This important new insight contributes to shifting the paradigm of how we understand rheumatoid arthritis progression and why IL-17 treatments haven’t worked as well as expected. Only with a precise understanding of the biological mechanisms of disease can effective, precision therapies be developed.
In the meantime, clinicians can help patients in early or presymptomatic stages make the most of treatments that may lose effectiveness over time.❞
You can find the paper itself, here: TH17 cells converted into exTH17 cells sustain rheumatoid-like IL-17–independent inflammatory arthritis
About those early or presymptomatic stages…
Another team of researchers (Dr. Marla Glass et al.) recently found that rheumatoid arthritis begins long before pain, with people who carry a particular kind of antibodies showing body-wide inflammation, malfunctioning immune cells, and gene-regulation changes for at least seven years before symptoms show up.
In other words, the immune system is behaving as though rheumatoid arthritis is already active, and so, in a way, arguably it is already active.
This is all going on in ways that you wouldn’t see without doing blood tests, though.
For example (we will quote these key points directly):
- Widespread inflammation: The researchers observed that people at risk for RA already showed signs of systemic inflammation throughout the body. This inflammation was not limited to the joints. Instead, it resembled the body-wide inflammatory pattern commonly seen in individuals with active RA.
- Immune cell dysfunction: Multiple immune cell types showed unusual behavior.
- B cells, which normally create protective antibodies, were found in a heightened pro-inflammatory state.
- T helper cells, especially those similar to Tfh17 cells, had expanded far beyond typical levels. These cells help coordinate immune responses, including the creation of autoantibodies (antibodies that attack the body’s own tissues). Their expansion helps explain why the immune system begins targeting healthy tissue.
- Cellular reprogramming: One of the most striking discoveries was that even “naive” T cells, which have not yet encountered pathogens, showed epigenetic changes. Although their DNA sequence remained intact, the regulation of their genes had shifted. This altered gene activity suggests these cells were being reprogrammed before encountering any threats.
- Joint-like inflammation detected in blood: The team also found that monocytes (a type of white blood cell) circulating in the bloodstream were producing high amounts of inflammatory molecules. Remarkably, these cells closely resembled the macrophages typically found in the inflamed joints of RA patients, indicating that the immune system was already setting the stage for joint inflammation.
You can find this paper itself, here: Progression to rheumatoid arthritis in at-risk individuals is defined by systemic inflammation and by T and B cell dysregulation
What that means in practical terms
If you get a rheumatoid arthritis diagnosis, even if it feels like you got it quickly, chances are you’ve technically had it for a long time already.
So, if you don’t have such a diagnosis, it is good to behave as though you did (aside from the pain relief component, of course, if you have no pain), because honestly, the advice for managing arthritis is very good advice anyway, since it tends to target improving joint health and reducing chronic inflammation.
With that in mind, do check out:
And for a very deep dive into excellent exercise vs arthritis, see:
Yoga Therapy for Arthritis – by Dr. Steffany Moonaz & Erin Byron
…which is a particularly good book, much better than most of its kind, because:
- One of the problems with arthritis and exercise is that arthritis can often impede exercise.
- Another of the problems with arthritis and exercise is that some kinds of exercise can exacerbate arthritis.
This book deals with both of those issues, by providing yoga specifically tailored to living with arthritis. Indeed, the first-listed author’s PhD in public health was the result of 8 years of study developing an evidence-based yoga program for people with arthritis, including osteoarthritis and rheumatoid arthritis.
The authors take the view that arthritis is a whole-person disease (i.e. it affects all parts of you), and so addressing it requires a whole-person approach, which is what this book delivers, and so that’s why we highly recommend it.
And if you do have the pain component already…
We’ve written quite a bit about pain management, including:
- Before You Reach For That Tylenol…
- How To Stop Pain Spreading
- How To Dial Down Your Pain
- Managing Chronic Pain (Realistically!)
- Get The Right Help For Your Pain
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)
Take care!
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How To Manage Your Mood With Food (8 Ways)
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It is hard to be mentally healthy for long without good diet. Food can not only affect our mood directly, but also indirectly because of how our brain works (or doesn’t, if we don’t have the right nutrients, or it is being sabotaged in some other dietary fashion).
Selecting the food for setting the mood
Mind, the mental health charity, have these advices to share (with some bonus notes of our own):
- Eat regularly: blood sugar peaks and troughs can heighten feelings of tiredness, irritability, or depression. Instead, enjoy foods that are high in energy but low in glycemic index, such as nuts, seeds, and oats—that way you’ll have plenty of energy, that lasts longer.
- Choose the right fats: omega-3 fatty acids are essential for the brain. So are omega-6 fatty acids, but it is rare to have a deficiency in omega-6, and indeed, many people have the ratio of omega-3 to omega-6 far too imbalanced in omega-6’s favor. So, focussing on getting more omega-3 fatty acids is important. Nuts and seeds are again great, as are avocados, eggs, and oily fish.
- Get a healthy amount of protein: and importantly, with a good mix of amino acids—so a variety of sources of protein is best. In particular, if you are vegan, paying attention to ensure you get a full spread of amino acids is critical, as not many plants have all the ones we need (soy does, though). The reason this is important for mood is because many of those amino acids double up as the building blocks of neurotransmitters, so they’re not entirely interchangeable.
- Stay hydrated: our bodies are famously made of mostly water, and our brain will not work well if it’s dehydrated. The human body can squeeze water out of almost anything that has water in it, but water from food (such as fruit, or soups) is best. If enjoying actual drinks, then herbal teas are excellent for hydration.
- Eat a rainbow of fruits and vegetables: these have many nutrients that are important for brain health, and the point of the colors is that most of those pigments are themselves nutrients. Additionally, the fiber content of fruits and vegetables is of topmost important for your heart, and as you’ll remember (we say it often, because it’s true): what’s good for your heart is good for your brain.
- Limit caffeine intake: for many people, excess caffeine can lead to feelings of anxiety, disrupt your sleep, and for everyone who has developed an addiction to it, it will cause withdrawal symptoms if stopped abruptly. Cutting back on caffeine, or even eliminating it, may improve your mood and sleep quality. Note, however, that if you have ADHD, then your brain’s physiological relationship with caffeine is a little different, and stimulants will be more beneficial (and less deleterious) for you than for most people. If unsure, speak with your doctor about this one.
- Support your gut health: because of the gut-brain axis (via the vagal nerve), and also because nearly all of our endogenous serotonin is made in the gut (along with other neurotransmitters/hormones), getting plenty of fiber is important, and probiotics can help too.
- Consider food intolerances: if you know you have one, then keep that in mind and tailor your diet accordingly. If you suspect you have one, seek a nutritionist’s help to find out for sure. These can affect many aspects of health, including mood, so should not be dismissed as a triviality.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The 6 Pillars Of Nutritional Psychiatry
Take care!
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Rebounding Into The Best Of Health
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“Trampoline” is a brand-name that’s been popularized as a generic name, and “rebounding”, the name used in this video, is the same thing as “trampolining”. With that in mind, let us bounce swiftly onwards:
Surprising benefits
It’s easy to think “isn’t that cheating?” to the point that such “cheating” could be useless, since surely the device is doing most of the work?
The thing is, while indeed it’s doing a lot of the work for you, your muscles are still doing a lot—mostly stabilization work, which is of course a critical thing for our muscles to be able to do. While it’s rare that we need to do a somersault in everyday life, it’s common that we have to keep ourselves from falling over, after all.
It also represents a kind of gentle resistance exercise, and as such, improves bone density—something first discovered during NASA research for astronauts. Other related benefits pertain to the body’s ability to deal with acceleration and deceleration; it also benefits the lymphatic system, which unlike the blood’s circulatory system, has no pump of its own. Rebounding does also benefit the cardiovascular system, though, as now the heart gets confused (in the healthy way, a little like it gets confused with high-intensity interval training).
Those are the main evidence-based benefits; anecdotally (but credibly, since these things can be said of most exercise) it’s also claimed that it benefits posture, improves sleep and mood, promotes weight loss and better digestion, reduces bloating, improves skin (the latter being due to improved circulation), and alleviates arthritis (most moderate exercise improves immune response, and thus reduces chronic inflammation, so again, this is reasonable, even if anecdotal).
For more details on all of these and more, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Exercise Less, Move More
- How To Do HIIT (Without Wrecking Your Body)
- Resistance Is Useful! (Especially As We Get Older)
- HIIT, But Make It HIRT
- The Lymphatic System Against Cancer & More
Take care!
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Is dark chocolate healthier than milk chocolate? 2 dietitians explain
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Easter chocolate is all over supermarket shelves. Some people reach straight for milk chocolate eggs while others pause at the darker varieties, assuming they’re healthier.
Dark chocolate has gained a reputation as the “better” choice because it usually contains more cocoa and less sugar than milk chocolate.
But is dark chocolate actually healthier?
Let’s see how the evidence stacks up.
Alexander Grey/Unsplash How do they compare?
All chocolate begins with the cocoa (or cacao) bean. Cocoa beans are the seeds of the Theobroma cacao tree, a tropical plant native to Central and South America.
Processing the bean gives you cocoa solids (the bitter part) and cocoa butter (the fat part that gives chocolate its smooth texture).
Chocolate is made from cocoa solids, cocoa butter and sugar. Milk chocolate also contains milk powder or condensed milk.
Dark chocolate typically contains a much higher proportion of cocoa solids, usually 50–90%.
Milk chocolate generally contains 20–30% cocoa solids, with the remaining bulk made up of milk ingredients and sugar.
How about nutritional benefits?
Because dark chocolate contains more cocoa solids than milk chocolate, it naturally provides slightly higher amounts of certain minerals.
This table shows the differences between milk chocolate (30% cocoa) and dark chocolate (more than 60% cocoa) per 20-gram serve. That’s about one row of a Lindt chocolate block.
As you can see, dark chocolate provides more minerals such as magnesium, iron and zinc. It also contains noticeably more caffeine (but far less than in a typical cup of coffee, which would contain about 100mg).
Milk chocolate offers significantly more calcium due to its milk solids, but it generally contains more added sugar.
Cocoa is naturally rich in plant compounds called polyphenols. These act as antioxidants in the body, helping to protect the body’s cells from damage.
Because dark chocolate contains more cocoa, it naturally contains higher levels of these compounds. In fact, dark chocolate contains roughly five times more flavanols (a type of polyphenol) than milk chocolate.
Compared to other foods often praised for their antioxidant content, cocoa contains around 17 times more catechins (another type of polyphenol) per serving than black tea. It also contains around three times more than red wine.
Does dark chocolate improve your health?
Research into cocoa and dark chocolate has produced some interesting findings, particularly about heart health.
Cocoa flavanols appear to help blood vessels relax and support better blood flow. Some clinical trials have reported small reductions in blood pressure and improvements in measures of blood vessel function after consuming cocoa products.
There is also broader evidence suggesting diets rich in flavanols may be linked with a lower risk of cardiovascular disease overall.
However, these findings come with important caveats.
Many of these trials use cocoa extracts containing high levels of flavanols. Others contain specially formulated chocolate rather than the typical chocolate bars or Easter eggs you’d find in supermarkets. The doses tested are also often far larger and far more concentrated than what people normally consume.
A large umbrella review (a review of reviews) involving more than one million participants did find links between eating chocolate and lower risks of cardiovascular disease, stroke and diabetes.
But the overall quality of evidence was rated as weak or very low, largely because many of the studies were observational. Observational studies can identify patterns, but they cannot prove chocolate itself caused those benefits.
The bottom line is that cocoa does contain beneficial plant compounds but the chocolate most of us enjoy is not a health supplement.
But I thought dark chocolate has less sugar?
Choosing dark chocolate doesn’t automatically make it the healthier option, especially where sugar is concerned. Some dark chocolate contains surprisingly high amounts.
Depending on the cocoa percentage and recipe, some dark chocolate products contain 40–50% sugar.
So a 150g dark chocolate Easter bunny containing 50% sugar, for example, can contain about 19 teaspoons of added sugar.
This applies to Easter eggs too. Some dark chocolate Easter eggs sold in supermarkets still list sugar as one of their first and main ingredients, ahead of cocoa butter. This means sugar makes up a significant chunk of what you’re eating.
So it’s always worth flipping the packet over and checking the ingredients list and nutritional panel to be sure.
What to choose this Easter?
Dark chocolate has a nutritional advantage over milk chocolate. But how much depends on the cocoa percentage and how it’s been made.
As a general rule, aim for 70% cocoa or more, and flip the packet over before you buy. In a higher-quality dark chocolate, cocoa should appear first in the ingredients list – not sugar.
A higher-quality dark chocolate might have its ingredients listed in this order: cocoa mass, cocoa powder, cocoa butter, sugar, vanilla.
A lower-quality dark chocolate might look like this: sugar, cocoa mass, cocoa butter, emulsifiers, flavour, milk solids.
If sugar is listed first, it’s the largest ingredient by weight.
Beyond that, choose chocolate you actually enjoy and watch your portion size. Remember that your overall diet matters far more than a few Easter eggs.
The real health benefit of Easter chocolate? The enjoyment of sharing it.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hantavirus quarantine has started. Two infection control experts explain what to expect
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Six passengers from the hantavirus cruise ship have started their quarantine at Australia’s purpose-built facility in Western Australia.
Over the next three weeks, the Australians and one New Zealander will be housed at the 500-bed Bullsbrook facility north-east of Perth, one of three purpose-built “centres for national resilience” around the country.
There, staff from the National Critical Care and Trauma Response Centre will monitor the returned passengers’ health, before authorities decide what happens next.
We are both infection prevention and control experts who advised the Victorian government on best-practice quarantine arrangements during COVID. This included the design of a dedicated quarantine facility.
Here’s how the Perth facility – and similar purpose-built ones in Melbourne and Brisbane – have been designed to minimise the spread of infectious diseases.
Multiplex What actually is quarantine?
The word itself comes from the Italian phrase quaranta giorni, meaning “40 days”. Back during the Black Death, ships had to anchor off the coast for 40 days before they could land in European cities to make sure no one on board was sick.
Today, quarantine is specifically for people who have been exposed to a virus – in this case the Andes strain of hantavirus – but aren’t showing any symptoms yet.
Experience from managing other infectious diseases, including COVID, has taught us that people can spread a virus before they even feel sick. We use quarantine to protect the community and also to make sure the person who was exposed doesn’t catch anything else.
During the early stages of the COVID pandemic, Australia was among countries that used hotels for quarantine purposes. But hotels are designed for comfort, not for stopping airborne pathogens. Shared spaces, inadequate ventilation systems, poor workflow (see points two and three below), and staff often with little or no expertise in infection control contributed to several breaches.
Many of these hotels were in the middle of busy cities. This was risky because any breach could immediately expose a lot of people in a crowded area.
So Australia built three centres for national resilience in Mickleham (near Melbourne), Perth and Brisbane. These were placed outside crowded city centres but still close to airports.
So what are these facilities like?
When architects and health experts design these facilities, they focus on four main things: fresh air, design, workflow and dignity.
1. Fresh air inside and out
These buildings need a constant supply of fresh air. The air is never recirculated (reused). Instead, old air is pushed outside so people aren’t breathing in “re-breathed” particles from someone else. So a lot of thought goes into air handling, that is, stopping germs from hanging around in the air and spreading to others.
That includes designing facilities with verandahs (for residents) and open-air walkways (for staff).
Perth’s facility has verandahs and open-air walkways to minimise the spread of infectious diseases. Multiplex 2. Designed with zones
The safest way to run a facility is to split it into three “traffic light” zones:
- the green zone (clean): where staff enter, have their offices, and take breaks
- orange zone (transition): a buffer area, like a verandah or porch, where staff put on their protective gear or hand over meals and medical samples
- red zone (contaminated): the actual room or area where the person stays. Anyone entering this area must wear full personal protective equipment. This often includes properly fitted long-sleeved gowns, gloves, N95 masks and face shields or goggles, combined with mandatory training in “donning and doffing” (putting on and taking off personal protective equipment).
3. One-way workflow
A crucial rule in infection control is that you never move “dirty” items back into “clean” areas. Everything must move in one direction: from clean to dirty.
So staff and supplies follow a strict path to ensure nothing from the “red zone” accidentally moves back into the “green zone”. This could include infectious air, as well as people and objects or equipment.
Sometimes, however, objects from the “red zone” have to move back into other zones, but need to be cleaned and disinfected first. This would be the case for the dirty laundry of people in quarantine. In this case, there are strict protocols to make sure any risk is minimised. Once cleaned and disinfected, these items can then be re-used.
4. Ensuring dignity
One of the hardest parts of quarantine is the mental toll. Staying in a room for weeks is hard. Those in quarantine often experience mental health stressors.
This may include a fear of infection, constantly being on alert for symptoms, and having trouble sleeping.
In the old hotel quarantine, some people couldn’t even go outside. By contrast, purpose-built facilities are designed to be more humane. This means:
- accessing natural light, outdoor space and fresh air
- good quality food and water
- internet and entertainment so they can stay connected
- emotional support to help with the stress of being isolated.
What happens now?
If anyone in the Perth facility does become sick, there is a medical clinic on-site so they can be treated or stabilised before transferring to hospital. People in quarantine also have access to telehealth.
What happens after the three-week period is up has yet to be decided. The World Health Organization recommends active monitoring and home or facility quarantine of high-risk contacts for 42 days after their last potential exposure.
As hantaviruses are rarely transmitted between people, the risk to the general public remains low and the virus is not a pandemic threat.
But this outbreak is a reminder that we need to be prepared for future outbreaks of infectious diseases. So our quarantine facilities need to be ready to go should they be needed again.
Philip Russo, Professor, Director of Research, Nursing and Midwifery, Monash University and Brett Mitchell, Professor of Nursing and Health Services Research, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Apple vs Kiwi Fruit – Which is Healthier?
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Our Verdict
When comparing apples to kiwi fruit, we picked the kiwi.
Why?
It wasn’t close!
In terms of macros, kiwi has more fiber and protein, scoring an easy first-round victory.
In the category of vitamins, apples are not higher in any vitamins, while kiwi is higher in vitamins A, B1, B3, B5, B6, B7, B9, C, E, and (appropriately enough) especially K, sweeping this round easily.
Looking at minerals, apples are not higher in any minerals, while kiwi has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, for another total win here.
In other considerations, kiwi also has some anticancer properties that apples can’t boast, so that’s another point in kiwi’s favor.
Adding up the sections makes for an overwhelmingly clear overall win for kiwi fruit, but by all means enjoy either or both, as diversity is best!
Want to learn more?
You might like:
Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list!
Enjoy!
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The Large-Scale Effects Of Mindful Eating
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We’ve written before about mindful eating; our first article on the topic was putting a spotlight on Dr. Rupy “The Kitchen Doctor” Aula, and his recommendations:
Interoception: Improving Our Awareness Of Body Cues
For the most part, mindful eating is thought of as a way to slow down our consumption of any given meal, and thus appreciate it more, as well as enjoying better digestion (and thus, better nutrient absorption—more on that at the end of today’s feature, in the “learn more” section).
Indeed, it’s often (rightly) touted as a way to Hack Your Hunger ← our article on same, for which mindful eating is one part
But what about the big picture?
What the French discovered
A French team of researchers (Dr. Pauline Paolassini-Guesnier et al.) investigated mindful eating on a large (n=13,768) scale.
Since this needs defining in order to do science to it, mindful eating was defined for the purposes of this study as being present, attentive, and non-judgmental during eating, responding to internal cues rather than external triggers. These items were measured by questionnaire, along with other factors such as hunger/satiety, and food journal recording what people actually ate.
Higher mindful eating scores correlated with:
- Increased adherence to healthy plant-based diets.
- Reduced intake of unhealthy plant-based foods, meat, and dairy.
- Higher likelihood of being vegetarian, pescatarian, or vegan.
Note: this study in no way promoted, suggested, or asked leading questions about, adherence to a healthy plant-based diet, or avoidance of animal products. These were simply observed results.
Interestingly, no comparable association was found between mindful eating and fish consumption (or lack thereof). There are two reasonable hypotheses to explain this:
- When it comes to health, there is more growing awareness about the harmful effects of various kinds of terrestrial meat (especially red meat, and pork which brings similar metabolic risks) and dairy, while fish is popularly still considered healthy in moderation (science broadly agrees).
- When it comes to ethical considerations, humans tend to empathize more with our fellow mammals than we do with fish, and this may also sway decisions about dietary choices.
We are a health science publication, not moral philosophy publication, so we’ve not written any ethical treatises here, but we have written on the topic of the health risks (and benefits) of animal products: Do We Need Animal Products To Be Healthy?
There were some limitations, most notably that the study sample over-represented health-conscious people, and the cross-sectional design on the study can’t confirm causality (i.e. it looks a lot like mindful eating promotes these healthier dietary patterns, but it could be that the healthier dietary patterns promote mindful eating, or both).
You can read the paper in full, here: Mindful eating is associated with a healthier plant-based diet in the NutriNet-Santé study
Want to learn more?
If you’d like to take up mindful eating, we wrote a step-by-step guide:
Mindful Eating: How To Get More Out Of What’s On Your Plate
Enjoy!
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