Rheumatoid Arthritis

This is the diet used by Dr Gail Darlington and colleagues in their study published

in The Lancet {Darlington LG, Ramsey NW, Mansfield JR (1986): Placebo controlled,

blind study of dietary manipulation therapy in rheumatoid arthritis.

The Lancet 1(8475), 236–38; see section 7.2}. However, Dr Darlington (pers.

comm., 2005) comments:

‘Many patients find it very difficult to comply with the diet at this level of

strictness in the elimination phase. For the past five years or so, I have permitted

really rare fruits and vegetables such as sweet potatoes, papaya, mango, papaw

and kiwi fruit in the elimination phase which aids compliance and at the same

time makes it easier for patients to hold their weight. I am not aware of any loss

of efficacy as a result of this minor level of leniency although I cannot back up

that statement with scientific data.’

 

The diet was later retyped into the format below and used by Dr Dorothy

Pattison when she was Senior Dietician with St Albans and Hemel Hempstead

NHS Trust, 1992–1995, mainly, but not exclusively with RA patients. Undertaking

the diet regimen was the patient’s decision and agreed by the rheumatologist.

Dr Pattison (pers. comm., 2005) reported:

 

‘A small number of patients (approximately 6%) identified foods that aggravated

symptoms but other positive outcomes were weight loss (when overweight –

though surprisingly few patients experienced “unwanted” weight loss), improved

eating habits and improved “feeling of wellbeing”. Though these are not particularly

robust measures, they were important to the patients. There were plenty

of people who could not follow the regime, but at least they had given it a try.’

 

Dr Darlington (pers. comm., 2005) comments:

‘The diet sheet you quote for the dietary elimination and reintroduction of foods

is at a level of strictness which I used originally, to be a complete purist in our

original research studies.’

 

The diet

Stage 1

For seven days your diet will be totally restricted to the following:

Trout, salmon, cod either grilled, roasted, hot or cold

Pears (fresh) which can be eaten raw or baked or boiled but with

no additions

Carrots (fresh or frozen) raw or boiled in mineral water

Mineral water still or sparkling spring water (no additions)

Use only sea salt

NB Pear juice can be made by removing the skin from pears and liquidising

them with spring water.

Optional

On the first day of the diet, in the morning, three teaspoons of Epsom salts in half

a pint of warm water may be taken to eliminate previous foods from the bowel. If

constipation occurs later in the seven days, a further dose may be given.

It is vital to the whole investigation that there is absolutely no break in this diet.

A small sip of coffee, for example, in those seven days could completely change the

pattern of response that is crucial for detecting an adverse reaction to a specific food.

As well as restricting your diet, it is very important NOT TO SMOKE.

It is very possible that initially you will feel worse than usual, especially in the

first three days. Keep a comprehensive record of all symptoms you notice on each

day of this restricted diet, for example, headaches, tiredness, dizziness, aching

muscles, catarrh, joint swelling and other such symptoms.

Medications almost always include food substances. Wheat, corn, potato and

yeast are used as base materials or fillers in a wide range of tablets. Try and avoid

using medications for symptom relief or keep the use of these to a minimum.

DO NOT ALTER YOUR MEDICATION FOR ARTHRITIS WITHOUT FIRST

DISCUSSING THIS WITH YOUR CONSULTANT RHEUMATOLOGIST.

 

Stage II

 

The first four foods to be assessed in Stage II are broccoli, runner beans (fresh or

frozen), pineapple (fresh) and turkey (fresh). It is worthwhile buying these foods in

advance, so that they are ready for use after your seventh day consultation with

your nutritionist. These foods will be introduced one at a time in the second stage,

followed by many others as the week goes on.

The main aim in stage II is to obtain a list of about 20 foods that do not cause

you to have an adverse reaction. By the end of Stage II you should have a reasonable

range of ‘safe’ foods to eat while you are testing further foodstuffs. These

initial foods have a relatively small risk of producing a reaction – but no food is

completely safe.

A suggested order of introduction is given below. It is advisable to keep rigidly

to this as the order has been arranged for two specific reasons. Firstly to ensure

that the ‘safest’ foods are introduced first and secondly to ensure that new foods are

tested in such a way that members of similar food families are separated by four

days. This avoids the possibility of false-negative responses from cross-reaction

within the food family.

 

Stage II: list of foods

 

Broccoli Fresh or frozen

Runner beans Fresh or frozen

Pineapple Fresh

Turkey Fresh or frozen, whole or pieces

 

Stick to the foods that have been suggested for each day but these foods can be

tested in any order on that particular day. Once a food has been tested and found

to be ‘safe’ it can be included in any subsequent meal. It is a cumulative process

with each meal usually consisting of the new food to be tested plus any foods

already found to be safe.

When testing a food, the most important feature to watch for is the recurrence

of symptoms. Symptoms would normally occur within five hours of eating a sensitive

food. Therefore, if one food is introduced at breakfast time, e.g. 8am and no

adverse response occurs by 1pm, then it is usually safe to introduce another food

at approximately 1pm. Similarly, if no response occurs to the lunchtime food by

6pm, it is usually safe to try a further new food then.

Never introduce two new foods at the same time as it will be impossible to tell

which food is causing an adverse reaction if one does occur.

Symptoms can vary from person to person, e.g. one person may develop a

headache while someone else may have increased joint pain or swelling and others

just might feel lethargic or depressed. Reactions may also vary in intensity. There

is usually little doubt about strong reactions but mild reactions can be difficult to

be certain of. If you are uncertain, a reaction can be confirmed or rejected by retesting

a food at a later stage.

 

There are two major rules on food testing:

(1) If in doubt about a food reaction leave the food out of the diet.

(2) Never re-test a food in less than five days from the original test.

Important notes: if an adverse reaction does occur and symptoms return, then

no further testing should be done until symptoms clear. To assess whether a food

reaction has occurred or not you must be quite sure about what symptoms occurred

when the new food was tried.

If an adverse reaction does occur then you must restrict yourself to only the

foods that have been tested and found to be ‘safe’ until symptoms clear. This may

take between 1 and 3 days.

Remember to keep a strict food and symptom diary to record what you eat and

if any reactions occur.

 

Stage III list of foods

Eggs – not fried in oil

Potatoes – not fried in oil

Wheat as wholemeal bread IF yeast test is negative

Use homemade bread or from a bakery in order to reduce the level

of additives. Alternatively, use pure wheat flakes or wholewheat

macaroni (plain and boiled)

You must test wheat at every meal for the next two days

Percolated coffee (coffee beans)

Mushrooms

Cane sugar (demerara)

Oranges Black pepper

Beet sugar (white)

Bacon IF pork test negative

Corn test. Using corn on the cob or glucose powder.

Use at least two dessertspoons of glucose powder or fresh corn on

the cob at every meal for two days

Onion

Natural peanuts (in the shell)

Cheddar cheese (if other dairy test negative)

Spinach

 

Stage IV: list of foods

 

White bread IF yeast and wheat tests negative

Garlic

Peas Fresh or frozen (NOT petit pois)

Grapefruit Fresh

Dates Natural (try health food shop)

Cucumber Fresh

Celery Fresh

Cauliflower Fresh or frozen

Rye bread – this is a two-day test. IF the yeast test was positive,

use yeast-free rye based alternative, e.g. Ryvita. If using bread, try

homemade or from a bakery as beforeTuna fish Fresh tuna steak – in most

supermarkets or fishmongers

*Rhubarb

*Honey Natural, clear

*Instant coffee – this is a chemical test. Look for a coffee without

corn added. Do not test if you reacted to ordinary coffee.

Asparagus

Lemon

*Olive oil

Lentils

*Tinned carrots – do not test if you reacted to fresh carrots. This is

a test for the phenolic resin lining of the tin. Check that the tin says

‘no sugar added’

Oats e.g. porridge oats. Take at every meal for two days

*Monosodium glutamate – this is a flavour enhancer used in many

processed foods. Can be obtained from some supermarkets and

Chinese supermarkets. To test, sprinkle on top of some meat.

*Prawns or shrimps

*Brussels sprouts

*Saccharin tablets

*Herrings

*Almonds

Malt extract – at every meal for 1 day (in supermarket or health

food shop)

Avocado pear

Green or red peppers

Raisins

Chocolate – contains wheat, corn and sugar. Do not test if any of

these caused a reaction

Spice mixture

 

Food items marked with an asterisk* are unrelated to other items and can be

interchanged as long as the spacing between other foods is undisturbed. Food

dyes, emulsifiers and other additives have not been specifically assessed but when

standard foods have been evaluated reactions to such chemicals are usually obvious.

Seasonal fruits such as cherries, plums, apricots, peaches, strawberries, raspberries,

gooseberries and blackcurrants have not been included but should be tested

during their season.

 

You have at this point assessed more than 60 different food items, which

account for at least 95% of what most people eat.

 

For help, guidance and support through difficult elimination diets please contact Cynthia Sillars on 07599520406 or email cynthia@healingtouchtherapy.co.uk