Medical Notes: Dramatic effects of diet changes

FEW HEALTH problems are as frustrating, both for doctor and patient, as severe arthritis, as I learned in my first bedside experience with intractable joint problems. The patient had already had five operations on his knees. Eventually, surgeons replaced both hips and both shoulders, and did elaborate operations on other joints. A physician himself, he greeted each procedure with fatalism.

In 1991, however, everything changed. The Lancet published a study showing that joint pain had a discernible cause, at least for many people. Just as a sore throat might result from a streptococcal attack, or lung cancer might come from carcinogens in tobacco smoke, sore joints were the battlefield where white blood cells attacked irritating proteins from various foods. This immunologic warfare damaged the tender joint linings, causing pain, swelling, and stiffness.

Hints that foods played a role in arthritis had emerged a decade earlier, when the British Medical Journal reported on a woman who had had rheumatoid arthritis for 25 years that turned out to be a sensitivity to corn. When the corn was eliminated from her diet, her symptoms disappeared. Shortly afterwards, doctors reported the case of a 15-year-old girl who recovered from severe arthritis when she avoided cow's milk.

In the Lancet report, researchers showed that by avoiding certain foods most arthritis patients had noticeable, sometimes dramatic, improvements. Doctors can now guide the patient to avoid 10 foods (dairy products, corn, meats, wheat, eggs, citrus fruits, potatoes, tomatoes, nuts, and coffee) until the joints cool down. This usually takes about three weeks. Then each food is reintroduced individually to see which ones cause the pain to return and which do not. By identifying food triggers, arthritis can improve dramatically, or even go away.

A study at London's Hospital for Sick Children showed that migraines respond to a similar diet-detective approach, using a similar list of culprit foods. Chest pain, menstrual pain, digestive pains, and innumerable other aches and pains yield to diet changes in ways few would have suspected until very recently.

One of the most striking breakthroughs is the discovery that foods may play a central role in back pain. As children consume the fatty foods so common in Western Europe and North America artery blockages begin to form. The first arteries sealed off are not those leading to the heart or the brain, but rather those leading to the lower back. By the age of 20, 10 per cent of us have an advanced blockage in one or more of these arteries. The average back pain sufferer has lost two to three of them.

A blockage in an artery to the spine deprives it of oxygen, causing the vertebrae and the fragile discs between them to degenerate. The soft inside of the crumbling disc herniates out, pinching a nerve and causing chronic pain.

Dr Dean Ornish, a young University of California researcher, showed that a change in the menu reopens clogged arteries. The prescription was simple: set aside meats - even chicken or fish, because they all pack cholesterol - and other fatty foods. Add modest, but regular, exercise, such as a brisk half-hour walk. Avoid smoking, and keep stress under wraps. The results were astounding: the arteries began cleaning themselves out, so much so that the difference was clearly visible on angiograms in 82 per cent of patients in the first year.

This revolutionary method clearly works in the heart. Now is the time to put it to the test for back pain. The hope is that circulation to the back can be restored, allowing healing to begin. Caught early, perhaps back problems can be arrested.

A diet change does not help everyone. But neither do even our best medications. We are now at the point where we can safely say our most powerful treatments are not in pill bottles, but on our plates.

Neal D. Barnard is the author of `Foods That Fight Pain' (Bantam, 10 June, pounds 7.99)