Thought Leadership and New Ideas

What are supplements? Why are they beneficial for autoimmune health?

Dietary or nutritional supplements are products intended to supplement the diet and may include vitamins, minerals, amino acids, enzymes, botanicals or herbal supplements. They are not intended to treat, diagnose, mitigate, prevent, or cure diseases. 

Dietary supplements are usually oral either in a pill, capsule, tablet, gummies, drink, powder, or liquid tincture. Some are even packaged as an edible energy bar.  Most adults in the United States take at least one or more supplements and three in five adults take supplements regularly.

Supplements however are not intended to replace a healthy eating routine. It is important to try to get as many nutrients from the diet as possible but sometimes those with autoimmune syndromes can have trouble meeting all of those needs.

For example, during an autoimmune flare a patient is in a high inflammatory, even a catabolic state. During this flare it may be difficult to achieve all vitamin and mineral requirements through the diet alone. Specific supplements have anti-inflammatory and anti-oxidant activity that may help support lowering pain and swelling during a flare.

Some rheumatology medications such as corticosteroids, methotrexate, and NSAIDs can interfere with mineral and vitamin pathways or absorption, which can lead to deficiencies. If you think a supplement may be beneficial for you, it is important to work closely with your health care team before implementing. 

What do I need to be aware of when taking supplements? Are there any associated risks?   

Supplements are generally safe, but they can have associated side effects, especially if taking high doses or if taken with concomitant medications. Many supplements can cause allergic rashes, gastrointestinal upset, and some can increase the risk of bleeding. It is important to stop them if you have an upcoming surgery or procedure planned.  

It’s important to request your provider check that there are no drug-supplement interactions or no supplement-supplement interactions. This can be done by checking many resources such as the natural medicine comprehensive database’s interaction checker or HerbMedPRo. 

For example, turmeric/curcurmin and fish oil may increase the risk of bleeding and interact with a blood thinning medication called warfarin or coumadin. Caution is advised. Antioxidant supplementation may reduce the effect of some cancer chemotherapy.

Too much iron can cause nausea, constipation, damage in the liver, and increases risk of infections. Some supplements may stimulate the immune system too much, such as Echinacea and Astragalus. Others, such as St. John’s Wort can interfere with many medications. Supplements for nursing, pregnant, or growing children are to be used with caution and usually only prescribed under the direct care of a health care provider. 

What are common supplements for RA, AS, PsA? Why is each important, what do they do?  

There are some common supplements used to help support inflammatory autoimmune conditions such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. There may be potential health benefits to some supplements, but often robust clinical trial data are lacking and more research is needed. 

Multivitamin

‍It may be difficult for someone with a chronic medical condition or someone on a restricted diet such as elimination diet, gluten free diet, or vegan diet to obtain all the nutrients and antioxidants from food sources.

Some RA patients can be deficient in calcium, iron, folic acid, zinc, Vit D, and  B vitamins. A good grade multivitamin will also contain  plenty of antioxidants such as VIt A, Vit E, Vit C, selenium, lycopene, lutein, and beta-carotene to help combat inflammation and oxidative stress damage caused by autoimmune diseases.

‍Vitamin D 

Vitamin D is naturally produced in our bodies from sunlight or ingested through foods or supplement sources. Many individuals living at north latitudes may not get enough Vitamin D. Vitamin D absorption in the gastrointestinal tract can be lowered from many medications or medical conditions.

Low vitamin D has been associated with numerous autoimmune diseases and is needed for healthy bones. As we age, our body is less effective at making Vitamin D and many medications can interfere with our body’s absorption such as corticosteroids and proton pump inhibitors. A British Medical Journal (BMJ) study showed that taking Vitamin D supplement can reduce the incidence of autoimmune disease by 22%. It is always best to get your vitamin D level tested in the blood and review an optimal supplemental dose with your provider before consuming.

Too much Vitamin D can harm your body and increase calcium levels in blood and tissues. If you supplement with an extra Vitamin D capsule or liquid, it is imperative to check your multivitamin’s total dose of Vitamin D and your other supplements to make sure you are not taking too much and taking a safe total daily dose. 

‍Omega- 3

‍Omega-3 fatty acids are polyunsaturated fats that are essential to ingest because they cannot be made in the body. Omega-3s, include ALA (alpha-linolenic acid found in plants such as flaxseeds and nuts, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in fatty fish.

These fatty acids have anti-inflammatory activities and are the substrates for specialized pro-resolving lipid mediators (SPMs). These mediators play a role in protection against harmful uncontrolled inflammation.

The intake of fish oil or fish can have an impact on the production of proinflammatory cytokines. EPA and DHA also can be ingested as supplements, such as fish oils, cod liver oil, krill oil, salmon oil, and some algal oils. 

If you are vegan, an algal oil may be of some benefit as eating nuts and seeds alone may not be enough to increase one’s omega -3- fatty acid total levels. Studies lean toward benefits from ingesting omega- 3s  or fish in those with rheumatoid arthritis but longer duration studies are needed. Doses of 2-3 grams per day were most effective. One study even found that fish oil helped achieve remission in rheumatoid arthritis patients taking disease modifying agents and that those medications were safely lowered.

‍Curcumin (Tumeric)

‍Curcumin is the active component of the spice turmeric and has anti-inflammatory and anti-oxidant properties. A recent meta-analysis found that curcumin is beneficial for RA and can improve inflammation.

Curcumin blocks inflammation, the same way that cyclooxygenase-2 (COX-2) inhibitor drug celecoxib (Celebrex) blocks. It may help to balance the immune system not only in our systemic system but in the gut too. Curcumin may not be absorbed very well so look for brands with black pepper, phospholipids, or nanoparticles for better absorption and ingest with food.

‍Probiotics

‍Probiotics may improve inflammation in several autoimmune conditions, but long term large trials are needed. Poor oral health, gut microbiota imbalances, and Western diets promoting gut dysbiosis may be a contributing factor in many autoimmune conditions such as rheumatoid arthritis. 

Improving gastrointestinal health may aid in reducing systemic inflammation. Strains such as Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus rhamnosus or reuteri and Bifidobacterium bifidum may be particularly helpful for rheumatoid arthritis and other inflammatory arthritis. 

‍Magnesium

‍Magnesium is an important nutrient for health, but many individuals do not get enough in their diet. Nuts, seeds, avocados, bananas and beans are high in magnesium. This mineral may aid in sleep, muscle discomfort, gastrointestinal mobility and immunity. One study showed that lower magnesium levels were associated with an increased prevalence of rheumatoid arthritis. Optimal doses and which type of magnesium to supplement with should be reviewed in detail with your provider.

How do I know if I should take supplements?

If you are suffering from a chronic autoimmune disease, having persistent inflammation, or experiencing side effects from medications, consult with your health care team to see if there is a role for certain supplements. Supplements cannot claim to cure diseases. If you have problems obtaining essential supplements from the diet due to restrictions, malabsorption, or medication effects speak with your health care team as certain supplements may be medically necessary. Review all doses, brands, and interactions with the team. Healthcare teams trained in Integrative, Lifestyle, or Functional medicine are experienced in recommending  supplements judiciously to optimize your health. 

What are safe sources to purchase supplements from?

Sources to purchase supplements can vary from Amazon to boutique websites. It is important to obtain your supplements from a reputable source where storage, vetting, and shipment are up to standards. Fullscript is an online platform that works with patients and providers to deliver supplements up to best practices.

It is important to understand that supplements are not regulated for effectiveness and safety by the FDA the same way food and pharmaceuticals are. Look that the supplements you are taking have seals and verifications on the label. The NIH has several independent organizations that offer quality testing to ensure the supplements are safe, free of contaminants, and contain the appropriate ingredients.

Look for these seals:  NSF, GMP, U.S.P. on the supplement bottle, which means that the product has been essentially vetted. Consumer Lab is an independent organization that tests products for potency, purity, and quality and they recall products. The NIH also has a free Dietary Supplements Fact Sheets that reviews supplement’s ingredients, claims, and warnings. It is always best to review starting a new supplement with your entire health care team.

What should people be cautious of when purchasing supplements, such as filler ingredients, added sugars, etc. ?

Generally, supplements are safe, but there can be concerns over quality, contamination, and adulteration. The Office of Dietary Supplements, a branch of the NIH, has trusted information on what you need to know before consuming supplements.

Always look for a Supplement Facts label on the product. This should include a descriptive name of the product, name of manufacturer, a complete list of ingredients and the amount of each ingredient, directions for use, nutrition labeling, serving size, amount, and active ingredients. Talk with your health care team to find the best source for purchasing supplements.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Dr. Beth Biggee is an Integrative Lifestyle Rheumatologist at Rheumission, bridging the gap between traditional and complementary medicine. With over two decades of expertise in Rheumatology, her distinguished career is marked by triple board certifications in Rheumatology, Integrative Medicine, and Lifestyle Medicine. She earned her medical degree from SUNY Upstate Medical Center in Syracuse, NY, and completed her Internal Medicine residency at the Yale New Haven Hospital. Dr. Biggee specialized in Rheumatology through a fellowship at Tufts Medical School in Boston. Her holistic vision of health was further enriched by completing Andrew Weil's renowned Integrative Medicine fellowship at the University of Arizona and by becoming a Certified Lifestyle Physician through the American Board of Lifestyle Medicine.

Beyond her medical training, Dr. Biggee has deepened her expertise in healing modalities such as learning HeartMath, a cutting-edge neurofeedback technique for stress management, and practicing Usui Holy Fire Reiki. She also holds a certification in Auricular Acupuncture from the Helms Medical Institute. Her passion for plant-based therapies led her to enroll in the Herbal Medicine Foundations Program at Medicine Lodge Academy, and she has pursued extensive hands-on training in Ayurvedic medicine for physicians.

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

As we all know, Psoriatic Arthritis (PsA) is a long-term autoimmune condition marked by joint pain, stiffness, and swelling, often accompanied by the skin symptoms of psoriasis. Although the exact cause is unknown, a mix of genetic and environmental factors is believed to trigger its onset (Mease, 2011).

Psoriatic Arthritis (PsA) is a multifaceted autoimmune disease that affects not only the joints and skin but also various other systems in the body. Managing PsA requires a comprehensive understanding of its symptoms, triggers, and impact on overall health. This guide explores the wide-ranging effects of PsA and provides considerations for living with the condition that Rheumission’s care team can help you with during and between appointments.

Psoriatic Arthritis is much more complex than joint pain and swelling. It's important to understand how an autoimmune condition affects your whole body so that you can make each day the best it can be, whether you are preventing a flare, in a flare, or in a time where symptoms are well-managed.

Understanding diagnosis types, symptoms that appear unrelated but connected to your PsA, the role of gut health, the importance of nail and skin care, and key lifestyle factors such as weight management are all important to managing your condition. 

We hope this post will give you a wider understanding of your PsA health, helping you work with your integrative rheumatologist and care team to live a fuller, healthier life.

Part 1: Top 8 Symptoms of Psoriatic Arthritis

While joint pain and skin symptoms are hallmark features of PsA, the condition can present with a wide variety of symptoms that affect multiple aspects of health and well-being. If you are new to diagnosis, the following list may help you review and reflect on how you’ve been feeling and what you’ve been experiencing. 

1. Joint Pain and Stiffness

• Common Locations: Fingers, toes, knees, spine, and hips 
• Key Features: Swelling, warmth, and stiffness, particularly in the morning or after inactivity.

2. Skin and Nail Changes

• Psoriasis Plaques: Red, scaly patches on the scalp, elbows, knees, or lower back. 
• Nail Symptoms: Pitting, ridging, and separation from the nail bed.

3. Fatigue

• Prevalence: Affects more than 50% of people with PsA
• Cause: Likely linked to systemic inflammation, poor sleep, and mental health challenges.

4. Mental Health 

• Anxiety and Depression: Common due to chronic pain, fatigue, and the psychological impact of visible skin symptoms 
• Brain Fog: Difficulty concentrating or remembering, often related to inflammation.

5. Sleep Issues

• Causes: Pain, itching, and anxiety can interfere with restful sleep 
• Impact: Sleep deprivation exacerbates fatigue and lowers quality of life.

6. Eye and Vision Challenges

• Uveitis: Inflammation of the eye causing redness, pain, and blurred vision 
• Dry Eye Syndrome: A common secondary condition.

7. Gastrointestinal Issues

• Inflammatory Bowel Disease (IBD): PsA increases the risk of IBD, highlighting the gut-skin-joint connection 

8. Cardiovascular Risks

• Heart Disease: Chronic inflammation contributes to higher cardiovascular risks in PsA patients.

Part 2: 5 Things to Know about Psoriatic Arthritis + what they mean for you

#1: Nail and Skin Changes as Key Indicators

Nail and skin changes are hallmark symptoms of Psoriatic Arthritis. Nail pitting, ridging, and separation from the nail bed are common. Similarly, psoriasis plaques can worsen during PsA flares. The connection between skin and joints highlights the systemic nature of the disease (Menter et al., 2009).

What does this mean for you? Pay attention to changes in your nails and skin as they can be early indicators of disease activity. Treat your skin with gentle, psoriasis-friendly products, and consult a dermatologist or rheumatologist if symptoms worsen. Early intervention is key.

#2: Psoriatic Arthritis' Impact Beyond Joints

While PsA primarily affects joints, it also involves other parts of the body. Inflammation can contribute to symptoms such as fatigue, uveitis (eye inflammation), cardiovascular disease, and depression or anxiety (Gladman et al., 2018). Enthesitis, or inflammation where tendons attach to bones, is another common symptom.

What does this mean for you? Being aware of PsA’s systemic nature can help you and your provider monitor and address symptoms beyond joint pain. Regular check-ups for cardiovascular health, mental health, and eye health are crucial. This whole body approach ensures comprehensive care in managing your condition..

#3: The Role of Diet in PsA Management

A balanced, anti-inflammatory diet can help manage PsA. Foods rich in omega-3 fatty acids, antioxidants, and vitamins, such as fatty fish, leafy greens, and fruits, are particularly beneficial. Research suggests that turmeric and ginger may also help reduce inflammation (Calder, 2017).

What does this mean for you? Adopting an anti-inflammatory diet can be a powerful tool in managing Psoriatic Arthritis. Consider consulting with a registered dietitian familiar with autoimmune conditions to create a diet plan that supports your treatment regimen and overall health.

#4: Gut Health’s Connection to Psoriatic Arthritis

Emerging research highlights the relationship between gut health and autoimmune diseases like PsA. An imbalance in gut bacteria, known as dysbiosis, may contribute to inflammation and disease activity (Myers et al., 2009).

What does this mean for you? Incorporating gut-friendly foods such as probiotics, found in yogurt, kefir, and fermented foods, and prebiotics, found in fiber-rich fruits and vegetables, can support your overall health. Avoiding processed foods and excess sugar may also help reduce inflammation.

#5: Weight Management’s Role in PsA

Carrying excess weight can worsen PsA symptoms by increasing joint stress and inflammation. Additionally, fat tissue produces proinflammatory molecules that may exacerbate the disease (Kumthekar et al., 2020).

What does this mean for you? Maintaining a healthy weight can reduce stress on your joints and improve your response to treatment. Partner with your healthcare provider to develop a sustainable weight management plan that includes regular physical activity and a balanced diet.

Part 3: 6 Ideas for Managing Psoriatic Arthritis: keep condition activity low, help prevent progression

Managing PsA effectively involves addressing both the physical and emotional impacts of the disease. Rheumission employs the strategies below to ensure that medications plus lifestyle habits and choices pair together to give you the best chance of keeping your symptoms managed and reduce the risk of progression.

1. Holistic Treatment Approach

• Medications and Supplements: Exact types of medication and supplements will depend on symptoms, current medications and supplements, and prior medication regimen. 
• Lifestyle Therapies: The six pillars of lifestyle medicine will review how you are living and what new habits and strategies can be tried to help improve symptom management 

2. Nutrition and Diet

• Anti-Inflammatory Diet: Rich in omega-3 fatty acids, fruits, vegetables, and whole grains 
• Gut Health: Incorporate probiotics and prebiotics to support the gut microbiome 

3. Regular Physical Activity

• Low-Impact Exercise: Swimming, walking, and tai chi to maintain joint mobility and strength 
• Stretching Routines: Prevent stiffness and improve flexibility.

4. Mental Health Support

• Counseling: A variety of therapy types, depending on what you’ve tried before, or where you are in your mental health can help manage anxiety and depression.
• Support Groups: Connect with others living with PsA for shared experiences and encouragement.

5. Managing Triggers

• Stress Reduction: Practice relaxation techniques to lower flare-up risks.
• Environmental Factors: Avoid cold weather exposure and maintain skin hydration to reduce irritation.

6. Comprehensive Care Coordination

• Integrative Rheumatologist: Central to managing joint and systemic inflammation.
• Dermatologist: Key for addressing skin and nail symptoms.
• Other Specialists: Cardiologists, gastroenterologists, and mental health professionals for managing other existing conditions as appropriate for your individual health.

Looking ahead: Feeling better with Psoriatic Arthritis

Understanding the full spectrum of psoriatic arthritis symptoms and adopting a holistic approach to treatment can improve how you feel each day, and the plans and goals you have for your life now and into the future. Collaborating with a multidisciplinary team such as the one at Rheumission will give you the support and care to develop a plan tailored to your unique needs and circumstances.

Understanding the deeper elements of Psoriatic Arthritis, from nail and skin care to the importance of diet and weight management, is vital in managing this chronic condition. We are always available to answer more questions and help you create a treatment plan that addresses all these factors.

To learn more about our Rheumission approach to care, please visit the Why Rheumission section of our site or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now and where you want to be. We are always here for you.

About the author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References

1. Mease, P. J. (2011). Psoriatic arthritis: Update on pathophysiology, assessment and management. Annals of Rheumatic Diseases.

2. Menter, A., et al. (2009). Guidelines of care for the management of psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology.

3. Gladman, D. D., et al. (2018). Psoriatic arthritis: Epidemiology, clinical features, course, and outcome. Annals of the Rheumatic Diseases.

4. Zhao, S. S., et al. (2020). Systematic review of mental health comorbidities in psoriatic arthritis. Clinical Rheumatology.

5. Kumthekar, A, et al. (2020). Obesity and Psoriatic Arthritis: A Narrative Review. Rheumatology and Therapy.

6. Myers, B., et al. (2019). The gut microbiome in psoriasis and psoriatic arthritis. Best Practice & Research: Clinical Rheumatology.

7. Calder, P. C. (2017). Omega-3 fatty acids and inflammatory processes: From molecules to man. Biochemical Society Transactions.

What is Lifestyle Medicine?

Lifestyle medicine focuses on the whole person, and even whole communities, by addressing the pillars of health to prevent, treat, and often reverse chronic diseases. The pillars of health include:

• Whole-food, plant-based nutrition
• Regular physical activity
• Restorative sleep
• Stress management
• Social connection
• Avoidance of toxic substances such as drugs and alcohol

Lifestyle medicine, like standard medical care, is rooted in evidenced-based practices, but it differs by first using the least invasive behavioral strategies to improve health. Techniques are human-centered rather than disease-centered, addressing the whole person. 

Narrative medicine is used to get to the root of problems. Narrative medicine is relatively new and was pioneered beginning in 2000 at Columbia University’s Department of Medical Humanities and Ethics. It involves the training of providers to receive and incorporate patient stories of their life and family history into the assessment of a diagnosis, and the best treatments for a care plan.

How will I work with my Lifestyle Medicine provider?

Lifestyle medicine practitioners use empathy, compassion, inclusion, deep listening, and education to address and improve human whole health. Such interventions may include:

• Working one-on-one with a nutritionist
• Exploring customized exercise plans appropriately tailored to achievable goals
• Addressing healthy sleep habits
• Introducing mind-body techniques
• Working with therapists to reduce stress and improve connection
• Guidance on reducing substance usage.

Building on the therapeutic relationship, lifestyle medicine educates, facilitates, and empowers you to promote behavioral changes using the pillars of health. This approach aligns with the Quintuple Aim of better health outcomes, lower cost, improved patient satisfaction, improved provider well-being, and advancement of health equity.

How is Lifestyle Medicine Connected to Chronic Disease & Autoimmune?

Chronic disease is at an all-time high. Six out of ten adults in the U.S. suffer from chronic diseases. Many chronic diseases are driven by unhealthy lifestyle practices, such as poor nutrition, reduced physical activity, reduced restorative sleep, increased stress, lack of coping skills, and smoking. 

Many chronic diseases arise due to genetics, but genetic variants alone do not explain disease risk in total. Many environmental factors, such as unbalanced nutrition or environmental exposure such as smoking may lead to and exacerbate chronic diseases, especially autoimmune diseases.

Autoimmune diseases affect up to 50 Million U.S. residents, and the rate of new autoimmune diseases each year keeps increasing. The exact reason that autoimmunity and autoimmune diseases are on the rise remain unclear. A theory is that certain multiple environmental interactions adversely affect certain genetically susceptible individuals. According to one recent study, “The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention” (Current Opinion in Immunology 2023), possible environmental interactions could be changes in our food, contacts with xenobiotics, air pollution, infections, unhealthy lifestyles, psychosocial stress, and climate change.

Lifestyle medicine, by addressing the pillars of health, is an excellent tool to address, prevent, treat, and minimize disease activity in autoimmune conditions. If there is a link between infections and onset of certain autoimmune conditions, lifestyle medicine can help foster healthy habits to try to prevent infections such as adequate  sleep, eating healthy balanced nutrition, and reducing stress.   

How can Lifestyle Medicine improve my health and symptoms?

Starting with the pillar of nutrition: a high animal fat, high refined sugar Western diet has been linked not only to heart disease, but also certain autoimmune diseases.  Alternatively, a plant-based Mediterranean diet high in fiber and antioxidants has been shown to reduce pain, increase function, and lower disease activity in patients with rheumatoid arthritis¹.

Next, the pillar of physical activity: for ankylosing spondylitis, a review of ten studies showed that an exercise program compared to no exercise program improved pain, function, and lowered disease activity².  

For the pillar of restorative sleep: Patients with sleep disorders are at high risk of developing autoimmune conditions such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus, and Sjögren’s syndrome. Addressing sleep is a crucial pillar of health in Lifestyle Medicine.

In the pillar of stress reduction: stress is another pillar that has played a role in the causation and worsening of autoimmune diseases. Many patients with systemic lupus recall a traumatic event before the onset of their diagnosis. High stress has been shown to worsen disease severity in lupus patients contributing to flares and organ damage³.

On the pillar of substance usage: Smoking has been related to many autoimmune condition diagnoses, in particular rheumatoid arthritis. Not only is smoking a risk factor for developing rheumatoid arthritis, but a smoking patient has an increased risk of worsened disease activity, and lack of response to certain medications. Lupus patients respond poorly to certain medications if smoking as well.

Lifestyle medicine is real-life medicine with a team approach. Collaborative visits are not only with the lifestyle medicine provider but usually with a nutritionist, psychologist, and care coordinator. Options are presented for a care plan, and a whole team helps and works with you to adopt and adapt your life – taking into account your lifestyle, household, and other factors –  to a customized lifestyle plan, set goals, and achieve lower disease activity. It typically takes people with autoimmune condition(s) three to six months to improve function, lessen pain and fatigue, and lower disease activity. Some people can experience improvement in as short as six weeks. 

Not only does lifestyle medicine improve autoimmune symptoms, but it also can improve cardiovascular disease, metabolic issues, mental health and weight concerns at the same time. This approach may also reduce risks for dementia, cancer, and developing other autoimmune diseases throughout your lifetime. Lifestyle medicine is for a lifetime. This approach not only helps to achieve low disease activity for you now, but throughout your life. 

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Dr. Beth Biggee is an Integrative Lifestyle Rheumatologist at Rheumission, bridging the gap between traditional and complementary medicine. With over two decades of expertise in Rheumatology, her distinguished career is marked by triple board certifications in Rheumatology, Integrative Medicine, and Lifestyle Medicine. She earned her medical degree from SUNY Upstate Medical Center in Syracuse, NY, and completed her Internal Medicine residency at the Yale New Haven Hospital. Dr. Biggee specialized in Rheumatology through a fellowship at Tufts Medical School in Boston. Her holistic vision of health was further enriched by completing Andrew Weil's renowned Integrative Medicine fellowship at the University of Arizona and by becoming a Certified Lifestyle Physician through the American Board of Lifestyle Medicine.

Beyond her medical training, Dr. Biggee has deepened her expertise in healing modalities such as learning HeartMath, a cutting-edge neurofeedback technique for stress management, and practicing Usui Holy Fire Reiki. She also holds a certification in Auricular Acupuncture from the Helms Medical Institute. Her passion for plant-based therapies led her to enroll in the Herbal Medicine Foundations Program at Medicine Lodge Academy, and she has pursued extensive hands-on training in Ayurvedic medicine for physicians.

References

1. Forsyth C, Kouvari M, D'Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, Kellett J, Naumovski N. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018 May;38(5):737-747. doi: 10.1007/s00296-017-3912-1. Epub 2017 Dec 18. PMID: 29256100.
2. Hu X, Chen J, Tang W, Chen W, Sang Y, Jia L. Effects of exercise programmes on pain, disease activity and function in ankylosing spondylitis: A meta-analysis of randomized controlled trials. Eur J Clin Invest. 2020 Dec;50(12):e13352. doi: 10.1111/eci.13352. Epub 2020 Aug 11. PMID: 32683694.
3. Jolly M, Katz P. Predictors of stress in patients with Lupus. Front Med (Lausanne). 2022 Sep 29;9:986968. doi: 10.3389/fmed.2022.986968. PMID: 36250087; PMCID: PMC955694

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

What is conventional or traditional rheumatology?

Conventional rheumatology describes the medical care that is most common and that we are most familiar with in the US. In conventional rheumatology, the focus is on taking history and performing an exam, obtaining appropriate labs and imaging, making a disease diagnosis, and treating a diagnosis with prescription medications. Diagnosis and management are focused on the disease.

What treatments and medications are common in conventional rheumatology?

After taking a history and exam; labs, x-rays, ultrasound, and/or MRI may be ordered to assist in making the diagnosis. Treatments including medications in different forms including oral, injections and infusions are typically prescribed.

This includes medications that treat the cause of the inflammation, such as DMARDs and biologics. Corticosteroids, such as prednisone, and NSAIDs, such as aspirin and ibuprofen, treat flares of inflammation. Joint injections and physical therapy are additional treatments used frequently to manage rheumatologic disease.

What does the typical patient experience look like in traditional rheumatology, including diagnosis time, wait times, and referrals to other specialists?  

There is often a long wait, several months in some cases, for a visit with a rheumatology specialist. Access to rheumatologists can be limited due to high demand and lack of enough specialists. This adds to the all-too-common delay in a diagnosis, which can be several months to years. Sometimes, a referral will be required from a person’s PCP to see a rheumatologist, depending on the insurance plan or practice.

What is integrative rheumatology?

Integrative Rheumatology is a combination of conventional rheumatology care, with the addition of holistic or complimentary treatments or care plans, making this an integrative approach to treating patients. The patient’s symptoms will be evaluated, diagnosed and managed from a whole body approach.

Rheumatologic diseases are most often systemic diseases that are affected by diet and lifestyle. Addressing diet, exercise, sleep, stress and mental health are some of the paths to assisting in achieving remission from disease, which cannot always be attained with medication alone. Integrative Rheumatology focuses on these lifestyle pillars, making changes in nutrition, sleep patterns, stress management, physical activity and mental health to improve a patient’s overall wellness. A team approach with experts in several of these areas is used in many cases. Improving these underlying areas of health will contribute to improving the disease.

Integrative health aims for well-coordinated care among different providers and institutions by bringing conventional and complementary approaches together to care for the whole person².

How is integrative different from conventional? Key differences / similarities?

Starting with similarities, both conventional and integrative rheumatology will include taking a patient’s history and performing a physical exam (which in a virtual setting, means showing areas of swelling to the camera, or taking a photo and sending it in a secure way to your provider). Blood tests and imaging may be ordered to assist further in making a diagnosis. Medications would be the first line of treatment in conventional rheumatology, while addressing lifestyle changes would be a main focus in integrative rheumatology, with medication also being prescribed when needed. 

The first difference between conventional and integrative rheumatology is in asking about your medical and family history. The history taken by an integrative rheumatologist will include diet, sleep, exercise, stress and other lifestyle aspects. The ongoing management in integrative rheumatology involves management of all these areas to bring disease under control, from a whole body approach.

What tools/treatments are common in integrative rheum?

Nutrition is a major focus and usually includes introducing an anti-inflammatory diet, often with a visit to a registered dietician recommended to guide the transition to a new diet. At Rheumission, our registered dietitian has specialized training to work with autoimmune patients. We also ensure that your food journey is taken at the pace that works for your lifestyle, which may mean you go through the anti-inflammatory diet more slowly or more quickly than others.

We have learned there is a significant connection between the gut, microbiome and inflammation in our bodies. Supplements are utilized for most patients, along with recommendations for physical activity, stress management, improving sleep and mind body medicine tools to manage symptoms of the disease. Acupuncture is another therapy often recommended.

What does the typical patient experience look like in integrative rheumatology?

The history taken will be a little different as noted above. Initially, treatment will focus on nutrition, moving towards an anti-inflammatory diet, as described above. Supplements are recommended, as well as regular physical activity that is gentle and does not stress your joints and muscles.

Stress management and mind body tools such as meditation, breath work and relaxation techniques are used to decrease the underlying inflammatory state in the body.

At Rheumission, we are fortunate to have a team of providers with expertise in all of these treatments and lifestyle changes to work with and help our patients. Your team will include lifestyle medicine providers, a registered dietician, and an autoimmune psychologist to support our patients.

‍What does training for integrative rheumatology include?

Training is usually additional training after completing the traditional education and residency as a physician, PA or NP. There are Integrative Medicine fellowships available at several medical schools in the country. The integrative providers at Rheumission were all trained at the Andrew Weil Center for Integrative Medicine at the University of Arizona.

As a provider, what made you decide to work in integrative rather than conventional?

An integrative approach is how I have tried best to live my own life and manage illness with positive results. I strongly believe there is so much we can do to prevent and manage disease with improvement in lifestyle modalities. It is very rewarding to work with patients who are actively involved in their disease management and wellness.

What benefits do you think integrative rheumatology brings patients?

Because rheumatologic diseases are systemic diseases significantly impacted by one’s lifestyle, including stress, nutrition, and sleep, improving these channels can have a significant impact on improving disease and achieving remission. Often, medication alone is not enough to achieve improvements when there is continued underlying inflammation triggered by poor diet, inadequate sleep or significant stress. Addressing the patient’s disease from a whole body perspective is very effective.

About the Author

Jill Ryan is a seasoned Rheumatology Physician Assistant with over 30 years of experience and a strong commitment to patient care. She worked at Dartmouth Health System as a Rheumatology Physician Assistant for 24 years, and prior to that role, as an Internal Medicine Physician Assistant for 8 years. Jill is deeply passionate about caring for patients and guiding them on their wellness journeys. With training in integrative medicine, she focuses on holistic approaches that empower individuals to manage autoimmune diseases effectively, believing in the importance of patient education and developing personalized care plans that promote overall health and well-being.

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References

1. Integrative Rheumatology by Randy Horowitz, MD, PhD, Daniel Muller, MD, PhD. 2011.

2. NIH: National Center for Complementary and Integrative Health. Complementary, alternative, or integrative health: What’s in a name? 2022 Oct.

The mind and body are deeply intertwined, and each has positive or negative effects on the other. As a person living with autoimmune, there are many ways in which your condition(s) can impact your mental health, and vice versa. It can be difficult to impossible to know which is driving your symptoms and experiences.

We now know that depression and anxiety affect more than 50% of patients with autoimmune conditions (and possibly more)¹. Plus, it is believed that mental health numbers are underestimated and oftentimes, the conditions are not understood or addressed in traditional healthcare settings. Needless to say, your mental health has an impact on your overall well-being, and it matters!

Is my autoimmune condition causing anxiety and depression symptoms?

Research has shown that physiological changes – defined as changes to the functioning of your body based on external factors – associated with stress, depression, or anxiety, can in fact be triggered by chronic health conditions, including autoimmune². 

So yes, your autoimmune condition – and the mild to severe havoc it is causing to your body – can set off a stress, depression or anxiety response to your system.

That said, physiological changes associated with an autoimmune condition can also live alongside a separate diagnosis of depression and/or anxiety. So, sometimes feelings of anxiety or depression are a result of your autoimmune disease, and other times, they are separate conditions co-existing in your body due to separate condition triggers. 

It’s hard to know which situation your body is in, because all that really matters is that you feel symptoms from your autoimmune condition, such as pain, fatigue, swelling… as well as the mental and emotional symptoms of anxiety, depression, and/or stress. 

What are some of the ways anxiety and depression related to my condition might be showing up for me?

Common stress or anxiety feelings we hear include a fear that the pain will never end or general stress about their body, health, and quality of life. Some worry that they won’t be able to return to work, or will miss out on important life events, like friend’s weddings or playing with their grandchildren.

Common feelings of sadness or depression that we hear include sadness that the pain is holding them back from who they were before, and now blame this feeling on their diagnosis. Said sadness can result in various behaviors, such as changes in appetite and eating patterns, tiredness or fatigue, memory loss, and trouble concentrating. 

Both autoimmune and mental health conditions are invisible to the outside eye. The symptoms and stress of managing these conditions is real and difficult to show to others. This can make one feel alone or misunderstood in their journey.

What are the reasons why my autoimmune condition is triggering the feelings of anxiety and/or depression?

The symptoms we associate with both stress and inflammation are found in patients with autoimmune conditions and patients with anxiety or depression^3,4. So, your underlying mood and mental health symptoms as you cope with and make adjustments to your life because of your autoimmune condition are multiplied by your body also coping with all of the internal changes you’re experiencing. 

In a previous post, we talked about how your thoughts, emotions, and behavior can impact the pain you experience. From research and clinical experience, we know that patients with autoimmune conditions may experience pain at one point, several points, or throughout their lives. That pain can impact one’s outlook on life and contribute to the development of anxiety and depression symptoms.

Pain isn’t the only driving force for autoimmune-related mood changes. The stress of managing a chronic condition and changes to one’s quality of life can also cause the development of mental health conditions or symptoms.

The stress caused or worsened by the diagnoses of an autoimmune condition is real AND difficult to show to others. The changes in mood can also make someone with an autoimmune condition more vulnerable to experiencing flares, or worsen the severity of flares. 

Taking the time to check in with yourself and be aware of how you’re feeling today and the impact that your condition is having on your mental health can make a big difference in shifting your day to day mindset.

What are some ways I can use self care or other lifestyle changes to ease my negative thoughts and feelings?

First, while living with mental health and autoimmune conditions (or both!) can feel isolating, YOU ARE NOT ALONE. 

Your mental health impacts your overall health and is extremely important for your treatment and healing. Therapy can help patients with inflammation-related conditions experience improvements in their mood, pain, and overall well-being. 

In addition to therapy, social support can act as a buffer and can protect you from frequent mood changes. It can also help patients with depression and/or anxiety-related symptoms improve their mood⁵. 

Social support can be as simple as talking to someone in the check-out line, joining a new group that meets in-person or online, volunteering with an organization dedicated to a cause that is important to you, or logging onto a zoom with like-minded people who care about similar issues to you.

How can Rheumission help me cope with stress and anxiety as a part of my overall autoimmune condition healthcare?

At Rheumission, we provide holistic, integrative care that addresses your mental health, with a focus on how your autoimmune condition impacts your mental health and vice versa. We employ techniques such as Cognitive-Behavioral Therapy, Acceptance Commitment Therapy, and Mindfulness practices. 

Therapy can help patients with inflammation-related conditions experience an improvement in their mood, pain, and overall well-being^6,7. 

In therapy, among other factors that are addressed, we want to learn about the triggers behind flares, the connection between thoughts-behaviors-emotions, and what alleviates or contributes to the depression and/or anxiety symptoms you may be experiencing.

As mentioned above, social support has also shown to improve one’s mental health. We can discuss different ways to stay connected and feel seen and heard by those around you. Our goal is to listen to you, learn from you and work with you as you navigate this journey and live a life that is meaningful to you.  

About the Author

Lize Tibiriçá, PsyD, is a Clinical Psychologist who also holds a master’s degree in Ergonomics and Occupational Safety. Dr. Tibiriçá utilizes an integrative approach to psychology specifically designed to meet each person's needs and facilitate long-lasting change. She is dedicated to working with her clients to improve their quality of life and well-being. She listens to and invites her clients to actively participate in decisions related to their treatment.

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References

1. Sloan, M et al (2024). Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study. Rheumatology (Oxford, England), 63(5), 1259–1272. 

2. U.S. Department of Health and Human Services. (n.d.). Understanding the link between chronic disease and Depression. National Institute of Mental Health.

3. Bennett, F. C., & Molofsky, A. V. (2019). The immune system and psychiatric disease: a basic science perspective. Clinical and experimental immunology, 197(3), 294–307.

4. Lee, C. H., & Giuliani, F. (2019). The Role of Inflammation in Depression and Fatigue. Frontiers in immunology, 10, 1696. 

5. Li, G et al. (2023). Understanding the protective effect of social support on depression symptomatology from a longitudinal network perspective. BMJ Ment Health.

6. Navarrete-Navarrete, N. et al. (2010). Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial. Psychotherapy and psychosomatics, 79(2), 107–115.

7. Shields, G. S., Spahr, C. M., & Slavich, G. M. (2020). Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA psychiatry, 77(10), 1031–1043.

Chronic pain affects over 50 million adults in the United States², and for approximately 17 million of these individuals, it limits their ability to engage in daily activities. This statistic alone is staggering but doesn’t tell the full story. 

In addition to the profound effects on physical health, pain also has a negative impact on emotional well-being and behavior. Often, people living with chronic pain report feelings of sadness or depression³, heightened anxiety¹, a decline in energy levels⁵, and sleep disturbances⁴. 

Chronic pain, physical health, and mental health are interconnected in a complex cycle that can be difficult to break.

‍The Connection Between Pain,  Emotions, and Behaviors

Let’s look at a common scenario many people with chronic pain experience. Imagine you wake up in the morning with intense pain. Immediately, you feel a wave of anxiety and sadness, worrying about how bad the pain will get throughout the day. 

Thoughts like, “What if this doesn’t get better?” or “I’m not sure I can handle this,” begin to dominate your mind. 

These emotions may impact your behavior during the rest of your day. You may avoid physical activity, fearing that movement will worsen the pain. You might cancel plans with friends or family, anticipating that your pain-induced irritability or low mood could negatively affect others.

As the day progresses, the pain worsens and the sadness continues, leading you to find comfort in unhealthy choices. You might reach for comfort food to soothe your emotions, coffee to boost energy, or even alcohol to numb the pain.

Unfortunately, these coping mechanisms often backfire. Unhealthy eating, increased caffeine, and alcohol intake can further intensify your symptoms.

And so, the cycle continues: you wake up the next day more exhausted, irritable, and anxious, with the pain feeling worse than before. 

Now, let’s imagine a different scenario. Picture waking up in the morning with little or no pain after a restful night’s sleep. Your emotions are more positive, you feel more relaxed and optimistic about the day ahead. Since you slept well, you have the energy to engage in behaviors and activities you enjoy, such as a light exercise routine or spending time with loved ones. 

Throughout the day, you make healthier food choices, opting for fruits and vegetables that nourish your body and contribute to your overall well-being. You don’t need caffeine to stay alert or alcohol to cope with discomfort because your pain is manageable. By the end of the day, you feel accomplished and content, and when it’s time to sleep, you fall asleep easily, ready to face another day.

These two scenarios highlight the deep connection between pain, emotions, and behaviors. Chronic pain is not just a physical experience; it affects every aspect of your life, from your mood to your energy levels, to your decision-making. Understanding this connection is so important for managing chronic pain.

While pain medication and other pharmacological treatments can provide relief, they often address only one part of the problem. Chronic pain requires a more holistic approach—one that considers how pain impacts your thoughts, behaviors, and emotions.

Rheumission’s Approach

At Rheumission, we understand that managing chronic pain goes beyond prescribing medication. Our multidisciplinary team of autoimmune experts, including rheumatologists, registered dietitians, lifestyle medicine providers, and chronic pain psychologists, collaborates to provide whole-person care tailored to you and your needs. 

Our goal is to improve not only your physical pain, but your overall quality of life, by addressing how pain impacts your emotions and behaviors.

One of the key components of our approach is the inclusion of autoimmune psychological support. During your sessions, your provider will ask you questions about your pain, such as when and where the pain occurs, how it affects your mood, and how you respond to it. Together, you and your autoimmune psychologist will explore the emotional and behavioral patterns that may be contributing to the persistence or worsening of your pain. 

You’ll talk about coping strategies that can help you break the cycle of pain, negative emotions, and unhelpful behaviors. These strategies may include mindfulness practices, cognitive-behavioral therapy (CBT), or techniques for improving sleep quality and managing stress.

Ultimately, the goal of our holistic treatment approach is to empower you to take control of your pain and improve your quality of life. We believe that addressing pain’s impact on both your physical and mental health can help you achieve lasting relief and well-being. 

If you are living with chronic pain, know that you are not alone, and there are solutions that can help. Together, we can break the cycle of pain and empower you to reclaim your life.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Lize Tibiriçá, PsyD, is a Clinical Psychologist who also holds a master’s degree in Ergonomics and Occupational Safety. Dr. Tibiriçá utilizes an integrative approach to psychology specifically designed to meet each person's needs and facilitate long-lasting change. She is dedicated to working with her clients to improve their quality of life and well-being. She listens to and invites her clients to actively participate in decisions related to their treatment.

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References:

1. McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain. 2003;106:127–33. doi: 10.1016/s0304-3959(03)00301-4. 

2. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. DOI: http://dx.doi.org/10.15585/mmwr.mm7215a1

3. Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Pain and Psychology-A Reciprocal Relationship. Ochsner J. 2017;17(2):173-180.

4. Whale K, Gooberman-Hill R. The Importance of Sleep for People With Chronic Pain: Current Insights and Evidence. JBMR Plus. 2022;6(7):e10658. Published 2022 Jun 17. doi:10.1002/jbm4.10658

5. Yamada K, Adams H, Ellis T, et al. The temporal relation between pain and fatigue in individuals receiving treatment for chronic musculoskeletal pain. BMC Musculoskelet Disord. 2022;23(1):219. Published 2022 Mar 8. doi:10.1186/s12891-022-05162-7

Do you ever feel overwhelmed by a constant and never-ending to-do list? Trying to juggle work, family, and other responsibilities all while managing an autoimmune condition? You’re not alone.

Stress can play a significant role in disease flares, increased pain, and can even cause a decline in overall health. This is especially true for people living with autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. But there’s good news: developing a mindfulness practice can be a powerful tool in reducing stress and improving your overall health and well-being. 

How Does Stress Impact Autoimmune Conditions?

Autoimmune conditions throw your immune system into overdrive, mistakenly attacking healthy tissues and increasing inflammation. High stress levels can trigger or worsen this inflammatory response, leading to more pain, stiffness, and joint damage. Stress can also heighten your pain sensitivity, so reducing stress can help you better manage it.

Chronic stress can increase inflammation and weaken your immune system’s ability to function properly. This can lead to more frequent or severe flares¹. The connection between stress and immune system functionality makes managing stress crucial for autoimmune patients, and mindfulness is a powerful way to do so. 

What Is Mindfulness?

At its core, mindfulness is the non-judgemental awareness of the present moment. It’s about centering your focus on what is happening right now - your thoughts, emotions, sensations, and surroundings - without letting your mind dwell on the past or wander to the future.

This small shift can have much larger effects, especially for those living with autoimmune conditions, where stress and inflammation are often interconnected. Mindfulness & meditation can reduce the production of stress hormones, thus improving emotional regulation and promoting relaxation. This, in turn, can help reduce inflammation and other symptoms².

How Mindfulness Reduces Stress and Inflammation

Mindfulness calms the body’s stress response by reducing levels of cortisol, known as the “stress hormone”. By lowering cortisol, mindfulness can improve immune function and reduce inflammation³. Mindfulness can help you feel more in control of your stress and your health³.

For autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, stress management through a consistent mindfulness practice may reduce flares, lower pain, and balance your mood⁴. Over time, this can contribute to better condition management and an overall improved quality of life. 

Mindfulness offers several physical and emotional benefits, including:

• Reduced stress and anxiety: Mindfulness promotes relaxation, helping lower cortisol levels and calm the nervous system. 
• Improved mood and emotional regulation: By grounding yourself in the present moment, you can keep your mind from spiraling into negative thoughts, reducing your risk of anxiety, depression, or chronic stress. 
• Better pain management: Stress can amplify your perception of pain, increasing the amount of physical discomfort you feel, especially during a flare. Mindfulness can bring down your level of stress, thus reducing your pain sensitivity.
• Increased focus and concentration: A common symptom of autoimmune conditions is brain fog. Meditation and mindfulness can help you feel more focused and rooted in the present. This can help to improve your memory and decision-making.

How to Get Started with Mindfulness

If you’re new to mindfulness, starting small is key. You don’t need to commit hours of your time to meditation to feel the positive effects. Even a few minutes a day can make a big difference. Here are a few tips to help you get started:

1. Start Small: Try starting with just 3-5 minutes of mindfulness each day. If you find yourself waiting in the car pickup line, or with a few extra minutes between meetings, this can be a good small chunk of time to start. Over time, you can gradually meditate for longer periods. 

2. Reduce Distractions: Find a quiet place where you won’t be interrupted, sit comfortably, and focus all of your attention on your breath. If possible, put away your phone and reduce any background noise. 

3. Practice Self-Compassion: The core piece of mindfulness is non-judgemental awareness, which means it is perfectly normal for your mind to wander. When it does, simply acknowledge the thought and bring yourself back to your breath and the present moment. And it’s called a mindfulness practice because the more you try, the easier it becomes to clear the mind. 

4. Try Guided Meditations: If you’re having trouble getting started or focusing on your own, guided meditation can be a great tool. There are plenty of free apps and online videos that can lead you through mindfulness exercises.

5. Integrate Mindfulness into Your Existing Routine: Mindfulness doesn’t have to be a separate activity. You can practice it during everyday tasks like taking a shower, eating, or even walking. Focus on the sensations you’re experiencing—how the water feels on your skin, the taste and texture of your food, or the sound of your footsteps. This helps anchor you in the present moment.

Practical Mindfulness Tips for Busy Lives

Many people don’t have the time in their busy schedules to set aside for meditation or mindfulness. The truth is that you can incorporate mindfulness or quiet moments into your existing routine without adding anything to it. Here are a few examples:

• While falling asleep, think of three things that went well today. This short practice can help shift your focus from worries to positivity and gratitude. 
• While on a walk, sitting in your car at a traffic light, or in line at the store, go through the 5 senses one at a time. I like to recommend focusing on 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, and 1 thing you can taste.
• Focus on your senses during a daily activity, like taking a shower or washing the dishes. Pay attention to the sensations of the water, the smell of the soap, and the sound of the running water. This can turn an ordinary moment into a meditative experience.

Final Thoughts

Mindfulness is more than a stress-management tool—it’s a way to regain control of your health and well-being. While living with an autoimmune condition can feel overwhelming, practicing mindfulness allows you to cultivate a sense of peace, even in the face of challenges.

Start small, be patient with yourself, and remember that mindfulness is a practice. Over time, it can transform how you manage stress, how you feel, and how you approach life with your autoimmune condition.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Christina Lascano, MPAS, DipACLM, PA-C, is a highly skilled, board-certified Physician Assistant with additional board certification in Lifestyle Medicine from the American College of Lifestyle Medicine. Christina graduated from the University of North Texas Health Science Center in 2017, earning a Masters of Physician Assistant Studies. She also holds a Bachelor of Science in Allied Health from Texas A&M University, which she completed in 2014. With over seven years of dedicated experience as a PA, Christina is committed to empowering her patients through personalized and prescriptive lifestyle interventions, striving to enhance their health and overall quality of life.

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References:

1. Harvard Health Publishing. (2014). Mindfulness meditation may ease anxiety, mental stress.

2. American Psychological Association (APA). (2012). Mindfulness meditation: A research-proven way to reduce stress.

3. National Center for Complementary and Integrative Health (NCCIH). (2022). Meditation and Mindfulness: Effectiveness and Safety.

4. Arthritis Foundation. (2023). How stress affects arthritis.

If you are reading this, you know that Sjögren’s Syndrome is an autoimmune condition where your immune system attacks the glands that produce moisture: your tear and salivary glands. This condition can cause dry eyes and mouth, but it can also affect other parts of your body. As with all other rheumatology and autoimmune conditions, it can be difficult to diagnose if you don’t have the right provider. The information below is meant to guide you with more information to have a comprehensive conversation with your doctor, or find a doctor who can help diagnose and treat your condition and overall health.

What Are Early Symptoms That Could Be Sjogrens?

Catching Sjögren’s early can make a big difference in managing it effectively. If you notice these symptoms, it’s worth discussing them with your doctor to get a proper evaluation³. Here are some early signs to look out for:

• Persistent dry eyes and mouth
• Swelling of the salivary glands
• Joint pain or swelling
• Skin rashes or dry skin
• Persistent cough
• Vaginal dryness in women

Does Sjögren’s Syndrome Progress Over Time? 

Yes, Sjögren’s can progress if not treated. It typically presents in mild, moderate, or severe forms. Here’s what each stage looks like:

• Mild Sjögren’s: Symptoms like dry eyes and mouth are present, but manageable with lifestyle changes and over-the-counter products.
• Moderate Sjögren’s: Symptoms are more persistent and may require prescription medications. There might be joint pain and fatigue.
• Severe Sjögren’s: The condition affects multiple organs and requires comprehensive treatment. Patients might experience significant dryness, severe fatigue, joint pain, and complications such as in the lungs or kidneys¹.

How is Sjögren’s Syndrome Diagnosed? 

The journey to diagnosing Sjögren’s Syndrome involves several steps. Your doctor will look at your symptoms, medical history, and perform some tests. Here’s what you can expect:

1. Physical Examination: Your doctor will check your eyes and mouth for dryness.
2. Symptom Review: You’ll discuss how dry your eyes, mouth, nose, throat, and skin feel.
3. Blood Tests: These tests look for specific antibodies like anti-SSA (Ro) and anti-SSB (La) that indicate Sjögren’s².
4. Saliva and Tear Production Tests: Techniques like the Schirmer’s test measure how much tears your eyes produce.
5. Imaging Studies: Tests like ultrasounds of your salivary glands show their structure and function².

Even if you don’t test positive for these antibodies, you can still have Sjögren’s. It’s all about the bigger picture. So if your lab results come back negative, but you still have all the symptoms of Sjögren’s, this is called Seronegative Sjögren’s. Your diagnosis will depend on your symptoms, physical exams, and other tests. It’s important to keep working with your doctor, or find a doctor who can provide a second opinion, to get a full understanding of your health³.

Does Sjögren’s Look Similar to Other Conditions? 

Several conditions can mimic Sjögren’s, making it tricky to diagnose. Here are a few:

• Systemic Lupus Erythematosus (SLE): Causes joint pain, fatigue, and dry eyes/mouth.
• Rheumatoid Arthritis (RA): Affects joints and can cause dryness.
• Multiple Sclerosis (MS): Causes fatigue and muscle weakness.
• Thyroid Disorders: Conditions like hypothyroidism can cause similar symptoms.
• Chronic Fatigue Syndrome (CFS): Features persistent fatigue and joint/muscle pain.
• Medication-induced Dryness: Some medications can cause dry eyes and mouth.

Getting the right diagnosis means you can start the right treatment and feel better sooner¹.

Now That I’ve Been Diagnosed, What Are My Treatment Options? Finding What Works for You. 

Managing Sjögren’s Syndrome involves treating the symptoms and the underlying autoimmune response. Here’s a look at some treatment options:

• Artificial Tears and Eye Drops: These help with dry eyes².
• Saliva Substitutes: These can ease dry mouth symptoms.
• NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen help with inflammation and pain.
• Prescription Medications: Can be used for joint pain and fatigue¹, and saliva production³.

• Topical Corticosteroids: Used for localized inflammation.

Your doctor will help you find the right medications and dosages. Keep a symptom log to see how these treatments impact your symptom, and whether they create new symptoms or side effects.

What Lifestyle Changes Can Be Part of My Treatment Plan? 

Making a few changes to your daily routine can make a big difference. Here’s how:

• Stay Hydrated: Drink plenty of water to combat dryness.
• Use Humidifiers: They add moisture to the air and help with dryness in your eyes, mouth, and throat.
• Good Oral Hygiene: Use a soft toothbrush and fluoride toothpaste. Regular dental check-ups are crucial.
• Eye Care: Use artificial tears and protect your eyes from irritants².
• Protect Your Joints: Gentle exercises can improve joint mobility. Avoid activities that stress your joints.
• Manage Stress: Stress can worsen symptoms. Try relaxation techniques like deep breathing or meditation.
• Balanced Diet: Eat foods rich in nutrients and omega-3 fatty acids. Avoid spicy or acidic foods that can irritate your mouth.

Which Supplements Will Help the Most? 

While there’s no cure for Sjögren’s, certain supplements can help. Always talk to your doctor before starting any new supplement. Here are a few that might help:

• Omega-3 Fatty Acids: These have anti-inflammatory properties⁴.
• Vitamin D: Supports bone health and immune function².
• B-Complex Vitamins: Helps with nerve function and energy levels.
• Vitamin C: An antioxidant that boosts your immune system.
• Probiotics: Promote a healthy gut microbiome.
• Coenzyme Q10: Helps with cell energy production.

What Is My Potential Impact to My Daily Life? 

Living with Sjögren’s can significantly affect daily activities, but every day is different. With the right treatment, you can have many more good days than hard ones. Here are some common challenges and tips to manage them:

• Fatigue Management: Plan your day to include rest periods and prioritize activities to conserve energy.
• Hydration on the Go: Carry a water bottle and use portable humidifiers or misters.
• Oral Care: Keep sugar-free candies or lozenges handy to stimulate saliva production.
• Joint Protection: Use ergonomic tools and avoid repetitive motions that strain your joints.
• Skin Care: Use moisturizers regularly to combat dry skin and prevent irritation.

Understanding the ways your body responds to your condition, and how to best manage each day can truly help improve your quality of life³.

By understanding Sjögren’s Syndrome and making informed decisions about diagnosis, treatment, and lifestyle changes, you can manage your symptoms better, and improve your life. Rheumission is here to help, whether to answer questions you may have, or to see you for an initial diagnosis or second opinion.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

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Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References

1. Shiboski, C. H., Shiboski, S. C., & Criswell, L. A. (2017). American College of Rheumatology classification criteria for Sjögren’s syndrome: A data-driven, expert consensus approach in the SICCA cohort. Arthritis Care & Research, 69(6), 948-956. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349440/ 

2. Ramos-Casals, M., Brito-Zerón, P., & Kostov, B. (2020). EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Annals of the Rheumatic Diseases, 79(1), 3-18. https://pubmed.ncbi.nlm.nih.gov/31672775/ 

3. Vivino, F. B., Bunya, V. Y., & Massaro-Giordano, M. (2019). Sjögren's syndrome: An update on disease pathogenesis, clinical manifestations and treatment. Clinical Immunology, 203, 81-92. https://pubmed.ncbi.nlm.nih.gov/31022578/ 

4. Baer, A. N., & Walitt, B. (2017). Sjögren’s syndrome and other causes of sicca in older adults. Clinics in Geriatric Medicine, 33(1), 87-103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125547/

As someone who's faced the challenges of chronic illness and autoimmune disease, I understand how crucial it is to have a healthcare approach that sees you as a whole person, not just a set of symptoms. But what is integrative medicine? How is it different from other types of medicine, and how can it help you on your health journey? I'll try to explain this with 8 factors that set it apart, which are all so important for holistic treatment to help you find a new normal on your autoimmune journey.

What is Integrative Medicine?

Integrative medicine is a holistic approach that combines conventional treatments with complementary therapies. It focuses on treating the whole person – mind, body, and spirit. Unlike conventional medicine, which often zeroes in on specific symptoms and diseases, integrative medicine looks at all aspects of your health and well-being. This approach has helped me immensely, both as a patient and a provider to people with rheumatology conditions.

Integrative Medicine vs. Conventional and Functional Medicine

You might be wondering how integrative medicine differs from conventional and functional medicine. Conventional medicine is what most of us are familiar with – doctors diagnosing and treating diseases primarily with pharmaceuticals and surgery. Functional medicine, on the other hand, aims to identify and address the root causes of diseases, often through personalized nutrition and extensive food and other testing. Integrative medicine encompasses the best of both worlds, combining conventional treatments with holistic practices like nutrition, exercise, and mindfulness^1,2.

Studies have shown that patients often report higher satisfaction with integrative medicine because it provides a more personalized and compassionate approach to care​^1,2. Patients feel more connected to their healthcare team, and this relationship can lead to better health outcomes.

So with that background, here are the top 8 reasons Integrative Medicine is different and better for your treatment, slowing condition progression, and overall improvement of your quality of life.

#1: The Power of Food and Nourishment

One of the pillars of integrative medicine is nutrition. You’ve probably heard the saying, “food is fuel,” and it’s true! Research has shown that phytonutrients found in fruits, vegetables, and other plant-based foods can have anti-inflammatory effects on the body. Changing my diet has been a game-changer for me and my patients. Unfortunately, conventional medicine often overlooks nutrition, but integrative practitioners are working to change that​².

#2: Movement and Exercise

Another key component is exercise and gentle movement. Whether it’s strengthening exercises, stretches, yoga, or simply walking, physical activity is essential for improving health. Exercise not only benefits the body but also the mind, helping to reduce stress and improve mood¹.

#3: Focusing on the Mind

Our mental health is just as important as our physical health. Integrative medicine uses techniques like guided imagery, hypnotherapy, and mindfulness to help manage both physical and mental health challenges. These therapies can be incredibly effective for reducing stress and improving overall well-being^​1,2​.

#4: Alternative Treatments

Integrative medicine also includes alternative treatments such as acupuncture, vagus nerve treatment, and therapeutic massages. While these treatments might not work for everyone, they can be beneficial when used alongside conventional therapies.

#5: Environmental Medicine

Integrative medicine considers the impact of environmental factors on health. Pollution, toxins in products, and other environmental influences can contribute to chronic inflammation and other health issues. By addressing these factors, integrative medicine offers a more comprehensive approach to treatment².

#6: The Importance of Sleep

Sleep is a critical component of overall health, yet it's often neglected. Integrative medicine emphasizes the importance of good sleep hygiene and aims to identify and treat sleep disorders that may be contributing to chronic health issues. Techniques such as improving sleep environments, establishing regular sleep routines, and using relaxation therapies can make a significant difference in a patient's sleep quality​².

#7: Social Connections and Support Networks

Strong social connections and support networks play a vital role in maintaining health and wellness. Integrative medicine encourages patients to foster relationships and build communities that provide emotional support. This can include group therapy sessions, community activities, or simply maintaining close contact with family and friends. The sense of belonging and support can greatly enhance mental and emotional health​^​1,2.

#8: Personalized Medicine

Integrative medicine is all about personalized care. Each patient is unique, and their treatment plans should reflect that. Integrative medicine providers take the time to understand the individual's health history, lifestyle, and personal goals. This personalized approach ensures that treatments are tailored to the specific needs of each patient, leading to more effective and meaningful health results that you can see and feel in your daily life².

A New Approach to Healthcare

Integrative medicine is an open-minded and beneficial way to approach healthcare. Despite some misconceptions, it doesn’t reject conventional medicine, but enhances it with additional tools and strategies. This dynamic approach is the future of healthcare, especially for those of us living with chronic illness​^​1.

If this resonates with you, consider seeking out a doctor who practices integrative medicine. Our doors are always open at Rheumission, and many other practices share our whole person approach to health.

Take control of your health journey and explore the benefits of integrative medicine today. You deserve a healthcare approach that sees and treats you as a whole person. Stay healthy and strong!

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

‍

About the Author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

‍

Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

‍

References

1. Mastorci, F. (2023). Toward Patient Care: Integrative and Complementary Approaches. https://link.springer.com/chapter/10.1007/978-3-031-23852-9_11 

2. "The possibilities and challenges of integrative medicine implementation in clinical psychology: a qualitative study in Indonesia." (2020). BMC Complementary Medicine and Therapies, 20(1), 1-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362562/

As we all know only too well, Rheumatoid Arthritis (RA) is a long-term autoimmune condition marked by painful, swollen joints, progressing over time if not controlled. Although its exact cause is unknown, a mix of genetics and environmental factors is believed to trigger its initial onset¹. 

Rheumatoid Arthritis is much more complex than joint pain and swelling, which you probably know if you have lived with the condition for any length of time. It's so important to understand how an autoimmune condition affects your whole body so that you can make each day the best it can be, for you and your family/friends.

Understanding diagnosis types, symptoms that appear unrelated but are actually all tied back to your RA, gut health's critical tie-in, your mouth's overall health information and the hallmark warning against smoking are all important factors to know about your condition. We hope that this post will arm you with a wider understanding of your RA health, and help you work with your rheumatologist and wider care team to live a fuller, healthier life.

#1: Antibodies Influence Different RA Types

• Specific antibodies like anti-citrullinated protein antibodies and Rheumatoid Factor in the blood can help identify RA types and may be detectable years before symptoms appear².When these antibodies are present, it’s termed seropositive RA. When they are not present, your condition is defined as seronegative RA. Regardless of the type, you still have Rheumatoid Arthritis, and treatment approaches remain similar – don’t let any providers tell you differently. When these antibodies are present, it’s termed seropositive RA. When they are not present, your condition is defined as seronegative RA. Regardless of the type, you still have Rheumatoid Arthritis, and treatment approaches remain similar – don’t let any providers tell you differently.
• What does this mean for you? Understanding whether you have seropositive or seronegative RA can help tailor your treatment plan. If you test positive for these antibodies, you might receive earlier and more aggressive treatments to manage symptoms and prevent joint damage. Even if you are seronegative, the same treatment strategies apply, emphasizing the importance of monitoring and managing the disease and finding a rheumatologist who understands the role of antibodies -- and that they don't determine a diagnosis.

#2: Rheumatoid Arthritis' Impact Beyond Joints

• While RA primarily affects joints, it can also involve other organs and systems (as with any autoimmune condition). Rheumatoid Arthritis is associated with an increased risk of conditions like depression, obesity, brain fog, heart disease, and eye issues such as scleritis, which causes redness, pain, blurry vision, and light sensitivity^3,4. Additionally, people living with RA often experience greater fatigue. We feel the impact in daily life and activities from chronic pain and physical ability differences that didn’t occur before¹⁰.
• What does this mean for you? Being aware of the systemic nature of RA can help you and your healthcare provider monitor and address symptoms beyond joint pain. Regular check-ups for cardiovascular health, mental well-being, and eye health are crucial. This whole body approach ensures comprehensive care, improving your overall quality of life.

#3: Diet’s Role in Rheumatoid Arthritis Management

• Eating a diet rich in fish, fruits, and vegetables can lower the risk of developing RA. Essential nutrients, particularly beta-cryptoxanthin and vitamin D (often low in RA patients), play a crucial role in managing and even preventing the disease^5,6,7. Research also suggests that incorporating anti-inflammatory foods like turmeric and ginger can help reduce RA symptoms¹¹.
• What does this mean for you? Adopting an anti-inflammatory diet can be a powerful tool in managing Rheumatoid Arthritis. Adding even small amounts of foods that are rich in omega-3 fatty acids, antioxidants, and vitamins can help reduce inflammation and support joint health. Consider consulting with a registered dietitian who is familiar with autoimmune conditions. They can help create a diet plan that supports your treatment regimen can help improve your overall health as well as your RA-specific management.

#4: Oral Health’s Connection to Rheumatoid Arthritis

• A healthy mouth is vital in preventing RA. The oral biome, maintained by saliva, can be disrupted by harmful bacteria, potentially. Proper oral hygiene helps prevent this autoimmune response⁸.
• What does this mean for you? Maintaining good oral hygiene can reduce the risk of developing or progressing your Rheumatoid Arthritis. Regular dental check-ups, proper brushing and flossing, and avoiding habits that harm oral health are essential. This simple but effective measure can support your overall health and potentially reduce RA symptoms.

#5: Smoking Elevates Rheumatoid Arthritis Risk

• Tied to #4 above, smoking significantly impacts RA risk by altering the oral microbiome, increasing oxidative stress, and introducing harmful particulates.
• Both smoking/vaping, and second-hand smoke can worsen RA^8,9. Quitting smoking is essential for reducing Rheumatoid Arthritis risk, as well as limiting your exposure to smoke vapors and fumes. We know it's easy to say "quit smoking" -- but any reduction in nicotine consumption is a positive. Finding the right smoking cessation program for you, being gentle with yourself, and finding ways to replace the reasons you are smoking/vaping are all good things to bring together to help your health and well-being.
• What does this mean for you? If you smoke or vape, quitting can significantly reduce your risk of developing RA or progressing its symptoms. Avoiding second-hand smoke is also crucial. Seeking support through cessation programs or consulting with healthcare providers can provide the necessary tools and strategies to quit smoking and improve your overall health. While it may not seem that smoking should be connected to a systemic joint condition, the research proves the connection is there.

Understanding the deeper elements of RA, from the role of antibodies and diet to the importance of oral health and the impact of smoking, is vital in managing and preventing this chronic condition. Adopting a balanced lifestyle with a healthy diet, regular exercise, and good oral hygiene can go a long way in mitigating the risks associated with rheumatoid arthritis. We are always available to answer more questions, and help you create a treatment plan that covers all of the factors listed here.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way  helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

About the Author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

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Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

‍

References:

1. Chauhan K, Jandu JS, Goyal A, et al. Rheumatoid Arthritis. [Updated 2021 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. National Library of Medicine

2. Derksen, V., Huizinga, T., & van der Woude, D. (2017). The role of autoantibodies in the pathophysiology of rheumatoid arthritis. Seminars in immunopathology, 39(4), 437–446. PubMed/NIH

3. CDC. (2020, July 27). Rheumatoid arthritis (RA). Centers for Disease Control and Prevention. CDC.gov

4. Promelle, V., Goeb, V., & Gueudry, J. (2021). Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. Journal of clinical medicine, 10(10), 2118. PubMed/NIH

5. Skoczyńska, M., & Świerkot, J. (2018). The role of diet in rheumatoid arthritis. Reumatologia, 56(4), 259–267. National Library of Medicine

6. Vadell, A., Bärebring, L., Hulander, E., Gjertsson, I., Lindqvist, H. M., & Winkvist, A. (2020). Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. The American journal of clinical nutrition, 111(6), 1203–1213. PubMed/NIH

7. Sukharani, N., Dev, K., Rahul, F., Bai, P., Ali, A., Avinash, F., Kammawal, Y., Kumar, N., & Rizwan, A. (2021). Association Between Rheumatoid Arthritis and Serum Vitamin D Levels. Cureus, 13(9), e18255. National Library of Medicine

8. Nikitakis, N. G., Papaioannou, W., Sakkas, L. I., & Kousvelari, E. (2017). The autoimmunity-oral microbiome connection. Oral diseases, 23(7), 828–839. National Library of Medicine

9. Pizzino, G., Irrera, N., Cucinotta, M., Pallio, G., Mannino, F., Arcoraci, V., Squadrito, F., Altavilla, D., & Bitto, A. (2017). Oxidative Stress: Harms and Benefits for Human Health. Oxidative medicine and cellular longevity, 2017, 8416763. National Library of Medicine

10. Smolen, J. S., Aletaha, D., & McInnes, I. B. (2016). Rheumatoid arthritis. The Lancet, 388(10055), 2023-2038. The Lancet

11. Bhatt, D. L., & Topol, E. J. (2002). Anti-inflammatory therapy in rheumatoid arthritis: The potential role of natural products, vitamins, and trace elements. Cardiovascular Therapeutics, 20(3), 201-209. PubMed/NIH

Living with an autoimmune condition can feel like navigating a complex maze of doctors appointments, various treatments and expensive medications.

Many people with autoimmune arthritis, which we treat, find themselves searching for relief from years of pain and suffering. We understand this at Rheumission, since our method was developed by autoimmune patient-doctors.

In recent years, the fields of lifestyle medicine, integrative medicine and functional medicine have gained attention for their holistic approaches to health and wellness.

Here at Rheumission, we aim to combine the best tools and levers from integrative, functional and conventional medicine to help our patients reach remission.

But what exactly is lifestyle medicine? It’s an important new field of medicine that is helpful to understand both how it differs from other fields of medicine, and how it fits into the broader picture of managing conditions such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

What is lifestyle medicine and how will it help me?

The American College of Lifestyle Medicine defines lifestyle medicine as a “medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions.” 

In other words, as lifestyle medicine certified clinicians, we take a holistic approach and treat our patients first with evidence-based and prescriptive lifestyle change. 

We still use medications when needed, but our aim is to utilize the 6 pillars of lifestyle medicine to treat, prevent and even reverse disease:

• Whole food plant-based nutrition
• Physical activity
• Stress management
• Restorative sleep
• Avoidance of risky substances
• Positive social connections 

Lifestyle medicine is about empowering you to take an active role in your health in a new way, by supporting you with the tools necessary to improve not only your health, but also your quality of life! 

In lifestyle medicine, we often ask patients, “What is your why?” In other words, what gets you up in the mornings? What motivates you? Why do you want to improve your health? 

From my experience working in primary care and lifestyle medicine, some examples of a patient’s “why” may be to see their grandchildren graduate from college, to travel to new and exciting places or to be there for their children as they grow up. 

Usually it boils down to wanting more quality time with loved ones, traveling to see new places, or feeling fulfilled in one’s purpose in life. Once a patient connects with their deeper why, they are often more motivated to make the necessary changes for improved health and happiness. 

How will you use lifestyle medicine to help me with my autoimmune arthritis?

The pillars of lifestyle medicine encompass various aspects of daily life that profoundly impact health outcomes:

1. Nutrition: Scientific evidence strongly supports the use of whole-food, plant-predominant food choices for preventing and treating chronic disease.
   1. This diet is rich in fiber, antioxidants and essential nutrients found in minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds. 
   2. For people with autoimmune conditions, this is particularly important because a whole-food plant-based diet has been proven to be anti-inflammatory.
   3. Aim for half of your plate to be green leafy vegetables or non starchy vegetables, a quarter of the plate be protein - ideally a plant protein like legumes - and a quarter of the plate be whole grains or starchy vegetables. 

1. Physical Activity: Regular exercise is essential for maintaining joint mobility, muscle strength, and overall physical function.
   1. Low-impact activities like walking, swimming, yoga, and tai chi can be particularly beneficial for individuals with autoimmune arthritis, helping to manage pain and stiffness while improving cardiovascular health. 
   2. Find a form of movement that brings you joy, and aim to do it on a regular basis. 
2. Stress Management: Chronic stress can exacerbate inflammation and contribute to symptom flare-ups in rheumatic diseases.
   1. Techniques such as mindfulness meditation, deep breathing exercises, prayer, positive self-talk, progressive muscle relaxation, and cognitive-behavioral therapy can help individuals better cope with stress and improve their overall well-being.
   2. Find a mindfulness practice that you enjoy and aim to do it for at least 3 - 5 min per day. 
3. Restorative Sleep: Adequate sleep is crucial for immune function, tissue repair, and overall health. Poor sleep quality or sleep disturbances are common in patients with autoimmune arthritis.
   1. Lack of sleep triggers the sympathetic nervous system to release fight or flight neurotransmitters, impairs our gut microbiome and interferes with normal hormone balance and function. 
   2. All of these factors play a role in triggering an increase in pro-inflammatory particles which can worsen autoimmune symptoms and disease. 
   3. Establishing healthy sleep habits and addressing sleep disorders can significantly improve health outcomes and can reduce chronic pain. 
   4. Try to optimize your sleep environment and aim for 7 hours of sleep each night.
4. Positive Social Connections: Strong social connections and a supportive network of friends, family, and peers play a vital role in our physical, mental and emotional health.
   1. Engaging in meaningful social activities, joining support groups, and fostering positive relationships can provide emotional support and enhance overall well-being.
   2. Aim to have one positive and meaningful connection each week. 
5. Avoidance of Risky Substances: Engaging in tobacco use and alcohol consumption have been linked to higher risks of chronic diseases and mortality.
   1. Treating these habits typically requires multiple approaches and attempts over time. 
   2. Be patient with yourself and seek help from your clinicians and your support system. 

How is lifestyle medicine different from my primary care doctor?

At Rheumission, our lifestyle medicine clinicians have a background in primary care with additional training in lifestyle medicine. This additional training includes an emphasis on the lifestyle interventions described above. 

When you meet with our lifestyle medicine clinicians, they will focus on how the pillars of lifestyle medicine are affecting your chronic conditions, and will partner with you to make sustainable lifestyle changes. 

We encourage our patients to continue to see their primary care physician as the Rheumission team – including your integrative rheumatologist, lifestyle medicine clinicians, and autoimmune registered dietitian – will be partnering, and coordinating with your primary care provider in some instances, for your care. You can think of your Rheumission team as an additional team-based specialty that you are seeing.

How does lifestyle medicine differ from integrative or functional medicine?

While lifestyle medicine, functional medicine and integrative medicine all share common goals of promoting health and wellness, each approach has its unique focus and methodologies.

Lifestyle medicine has its distinct emphasis on promoting healthy behaviors and lifestyle modifications to prevent and manage chronic diseases. 

It recognizes that many chronic conditions, including autoimmune diseases, are influenced by lifestyle factors such as diet, physical activity, stress management, sleep quality, and social connections. Lifestyle medicine encourages individuals to adopt sustainable lifestyle changes that support their overall health and well-being.

Integrative medicine emphasizes the integration of conventional medical treatments with complementary and alternative therapies. It acknowledges the importance of addressing the physical, psychological, social, and spiritual aspects of health to achieve optimal well-being. In the context of autoimmune conditions, an integrative rheumatologist may combine conventional medications with interventions such as massage therapy, or mind-body practices, to manage symptoms and improve quality of life.

Functional medicine investigates the underlying root causes of disease by examining the interactions among genetic, environmental, and lifestyle factors. Practitioners of functional medicine take a systems-oriented approach, considering the interconnectedness of various bodily functions and how imbalances in one area can affect others. For individuals with autoimmune conditions, a functional medicine provider may focus on identifying triggers such as dietary factors, gut health issues, or environmental toxins that contribute to inflammation and symptom flare-ups.

At Rheumission, our two Medical Directors, Dr. Micah Yu, MD, and Dr. Melissa Mondala, MD, are both trained in the conventional medical model and in lifestyle medicine, integrative medicine and functional medicine. 

What is lifestyle medicine's role in the Rheumission Way?

Our lifestyle medicine clinicians work closely with the integrative rheumatologist, registered dietitian and autoimmune psychologist. We have a strong, interdisciplinary care team that works together and with you, our patient, to provide holistic, personalized ongoing care with the goal of sustained remission. 

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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Want to learn more about the integrative rheumatology pillar of Rheumission? Read our founding Integrative Rheumatology Director Dr. Micah Yu's post about how and why telehealth rheumatology appointments are just as good or better than in-person appointments for easier access and greater convenience, while offering an assessment of symptoms and treatment options that are the same as going in-person.

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About the Author

Christina Lascano, MPAS, DipACLM, PA-C, is a highly skilled, board-certified Physician Assistant with additional board certification in Lifestyle Medicine from the American College of Lifestyle Medicine. Christina graduated from the University of North Texas Health Science Center in 2017, earning a Masters of Physician Assistant Studies. She also holds a Bachelor of Science in Allied Health from Texas A&M University, which she completed in 2014. With over seven years of dedicated experience as a PA, Christina is committed to empowering her patients through personalized and prescriptive lifestyle interventions, striving to enhance their health and overall quality of life.

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Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

How does a virtual rheumatology care team work for you?

As you go through your patient journey, there’s one key element that becomes clear: finding the right, supportive rheumatologist and overall healthcare team is the most important part of life as a person with a chronic condition. 

The right doctor and team help keep you on a successful path to sustained remission – feeling good, positive and hopeful each day about the symptoms that touch most aspects of your life and the treatment to heal them.

When you're looking for or considering a new rheumatology practice, it may feel like a given that an in-person appointment is mandatory. And I understand that, as an autoimmune rheumatology patient myself, first diagnosed 14 years ago. 

However, through the years of my practice and as a patient, I see great benefits to a telehealth practice — if I felt I wasn't able to diagnose you, or treat your symptoms as well or better than an in-person appointment, I would not practice medicine this way.

Rheumission has adopted a virtual-first approach to treating rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We believe that our telehealth model improves accessibility, convenience, and better serves our patients overall. Below I’ll take you through the three reasons why.

Why is a virtual visit as good as an in-person visit?

A virtual rheumatology visit can be just as good as an in-person visit because, in both scenarios, the patient’s clinical history, labs, and imaging often inform the diagnosis.

Sometimes, swelling can be subtle and hard to visualize through a virtual exam. In these cases, the patient would be referred out for imaging. This is not dissimilar to in-person visits - rheumatologists often order imaging to fully visualize joint swelling before confirming a diagnosis. 

An in-person visit does allow me to press on joints and do needle injections and aspirations. If injections are needed for virtual patients, you may be referred to local clinics who can perform the test and then send me the results that we can review together.

How can I ensure that my diagnosis will be the same as if I saw you in-person?

A rheumatology diagnosis relies most heavily on the patient’s clinical history, labs, and imaging. However, there are some cases where parts of the physical exam are unclear, and the patient’s history, labs, and imaging do not provide enough information. In these few cases, a referral to an in-person rheumatologist may be needed. 

In all rheumatology visits, it’s important that I can focus on you, and listen closely to your history. Some in-person doctors barely examine patients or look at them during a visit. 

Communication does not need to be rushed during a telehealth visit, and communication styles are often very individual to the provider. At Rheumission, our initial visits are one hour long, and follow-up visits run for 30 minutes. This is an uncommonly high amount of time for medical appointments, but we understand and value deeply listening to our patients and their history, before jumping into treatment decisions.

What are some benefits of virtual care?

Virtual care increases accessibility and decreases wait times before appointments. If there’s a case where you need an in-person exam, you can start and continue on with virtual appointments rather than waiting months for any sort of care. 

As an autoimmune patient myself, I know that a lot of autoimmune patients struggle with brain fog and keeping track of their appointments. One benefit of virtual care is that it’s easier to jump into a visit or make up a visit after the fact. For example, say you forgot about your appointment and went to the beach. You remembered that you had an appointment once you got there, but you could still complete the exam outside of your home. Virtual visits can be completed anywhere at the convenience of the patient. If this were an in-person visit, it would be much more difficult to make up the visit if forgotten. 

A common issue with our world’s shift towards more remote/virtual models is a general decrease in physical activity. In the case of virtual appointments, you lose the walk to and from the clinic. 

This would be a loss for a conventional telehealth practice that does not include movement as a part of its treatment approach. However, here at Rheumission, we’ve adopted an integrative, lifestyle approach where we encourage patients to incorporate more movement into their routine as part of every treatment plan. 

So what's the most important thing to know about telehealth rheumatology visits?

Remote rheumatology visits are comparable to in-person appointments, with increased availability, convenience, and unrushed time for deeper conversations about your health. 

While remote models are still relatively new, we believe that the increased accessibility and coordination of care within a telehealth practice is the best way forward for rheumatology patients, which is why we set up Rheumission – so that we can give you the best care possible.

To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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About the Author

Dr. Micah Yu is an integrative rheumatologist who incorporates complementary medicine with traditional rheumatology. He is quadruple board-certified in Rheumatology, Internal Medicine, Integrative Medicine and Lifestyle Medicine. He obtained his MD from Chicago Medical School and holds a Masters in Healthcare Administration and Biomedical sciences. He completed his internal medicine residency and rheumatology fellowship at Loma Linda University in Southern California. He is a graduate of the Andrew Weil Integrative Medicine Fellowship at the University of Arizona. In addition, he is certified in functional medicine through the Institute of Functional Medicine. He has a very unique perspective on autoimmune disease and arthritis, as he is both a patient with arthritis and physician. Dr. Yu was diagnosed with gout at the age of 17 and later diagnosed with spondyloarthritis as well. He is able to understand his patient’s medical problems from a patient perspective. The foundation of his practice is to combine allopathic medicine with complementary medicine. He works with his patients to come up with a treatment plan that not only fights the disease, but also is aligned with his patient’s goals. In addition to Rheumission, Dr. Yu is on social media under @MYAutoimmuneMD educating about autoimmune diseases and integrative medicine.

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Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

At Rheumission, we firmly believe in harnessing the transformative power of food to elevate your health and improve your quality of life while living with chronic illness. Our approach is characterized by deep empathy and a multidisciplinary team dedicated to enhancing your life. It's not just about treating symptoms; it's about thriving, using anti-inflammatory nutrition & lifestyle, integrative rheumatology and lifestyle medicine pillars as our guiding stars.

Understanding food as medicine

So, what do we mean by "food as medicine"? It's a concept that extends far beyond just eating to fill our bellies. Food plays a crucial role in providing essential nutrients, but it also acts as a powerful agent in disease prevention and management. Rich in nutrients, anti-inflammatory agents, antioxidants, and fiber, nutritionally dense, whole foods are instrumental in combating chronic inflammation, neutralizing harmful reactive oxygen species, regulating hormones, and fostering a diverse gut microbiome. 

The benefits of adopting a diet rich in these elements are extensive. Anti-inflammatory dietary patterns not only help ward off weight challenges, but also improve autoimmune symptoms such as low energy, fatigue, poor sleep, brain fog, joint pain, and digestive issues. By lowering inflammation balancing blood sugars and essential hormones, and rebalancing the gut microbiome. Ultimately, this holistic approach aims to improve your overall quality of life.

How Rheumission incorporates food as medicine

Our nutritional strategy is meticulously crafted to boost your intake of dietary fiber and anti-inflammatory foods. We also use a strategic evidence based elimination diet approach to identify your food triggers to improve autoimmune symptoms related to foods and decrease flares.  Our primary objective is to engage with you where you are in your food journey, understanding your individual needs and circumstances. Our clinical team, particularly our registered dietitians who have autoimmune expertise, are committed to crafting a personalized care plan that resonates with your comfort and readiness, moving as quickly or as slowly as you want.

We offer two scientifically-supported nutritional protocols developed collaboratively by our integrative rheumatologist and autoimmune-expert registered dietitians. These protocols are structured into three key phases: 

• Elimination
• Gentle, personalized reintroduction
• Maintenance

Each is designed to encourage a plant-focused dietary pattern, which has been shown to significantly contribute to disease remission and a heightened sense of overall well-being.

Your Journey, Our Support

Choosing to embark on this journey with Rheumission means you're not just adopting a new diet; you're embracing a lifestyle change that places you at the center of your health narrative. 

Our team is here to provide you with professional guidance and the autonomy to decide which aspects of our protocols best suit your needs. This is not about prescribing a one-size-fits-all solution but rather about co-creating a path that you feel comfortable following and one that is sustainable in the long term. 

In every step of your journey, Rheumission is here to support you, providing the knowledge, tools, and encouragement you need to succeed. Whether you're looking to alleviate specific symptoms, manage a chronic condition, or simply enhance your overall health, our approach is flexible and responsive to your personal health goals.

Conclusion: A Path Toward Better Health

By integrating food as a fundamental element of medicine, Rheumission aims to not only improve your physical health but also to enhance your mental and emotional wellbeing. It's about creating a sustainable, enjoyable lifestyle that supports your health goals and brings joy and vitality into your daily life. 

We invite you to join us on this transformative journey, to explore the vast potential of food to heal and nourish not just the body, but the mind and spirit as well. Together, let's redefine what it means to live well, supported by a team that believes in your potential to thrive.

Through the Rheumission approach, discover the power of food to transform your health, one meal at a time. Let's move forward, with the confidence that we're not just making changes for today, but nurturing a healthier, more vibrant tomorrow.

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To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. Our approach is to help you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.

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Want to learn more about the integrative rheumatology pillar of Rheumission? Read our founding Integrative Rheumatology Director Dr. Micah Yu's post about how and why telehealth rheumatology appointments are just as good or better than in-person appointments for easier access and greater convenience, while offering an assessment of symptoms and treatment options that are the same as going in-person.

About the Author

Jenifer Tharani is a registered dietitian, anti-inflammatory nutrition & lifestyle expert, and daughter of a chronic pain warrior. Jenifer has completed masters degrees focusing on probiotics from California Polytechnic State University & anti-inflammatory nutrition from Texas State University. Jenifer completed her dietetics internship from Emory University Hospitals. She currently lives in Los Angeles, California. Jenifer believes that following an anti-inflammatory diet should be easy, realistic and fun instead of overwhelming, time consuming or boring. Her nutrition approach is rooted in mindful eating, plant forward diet, and anti-inflammatory lifestyle pillars. She is extremely passionate about helping patients adopt an anti-inflammatory and gut healing eating pattern. She believes in helping patients living with autoimmune illnesses with making small sustainable lifestyle changes to help improve symptoms & overall quality of life. Jenifer’s mantra is “Give a Man a Fish, and You Feed Him for a Day. Teach a Man to Fish, and You Feed Him for a Lifetime”. Her nutrition coaching sessions are designed to empower you with nutrition education, provide you with accountability to take action and experience transformations, and experience its ripple effects in every aspect of your life.

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Sources

• Bultman SJ. “The microbiome and its potential as a cancer preventive intervention.” Semin Oncol. 2016 Feb;43(1):97-106. doi: 10.1053/j.seminoncol.2015.09.001. Epub 2015 Sep 8. PMID: 26970128; PMCID: PMC4789109.
• Li W, Guo Y, Zhang C, Wu R, Yang AY, Gaspar J, Kong AN. “Dietary Phytochemicals and Cancer Chemoprevention: A Perspective on Oxidative Stress, Inflammation, and Epigenetics.” Chem Res Toxicol. 2016 Dec 19;29(12):2071-2095. doi: 10.1021/acs.chemrestox.6b00413. Epub 2016 Dec 5. PMID: 27989132.
• NIH. “What Do We Know About Diet and Prevention of Alzheimer’s Disease?”

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Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.