Ask the Doctor – Arthritis, ADHD, and Truvada

Zoltan Rona, MD, MSc

Should Arthritis Sufferers Avoid Gluten and Citrus?

(Re: September 2016 article Arthritis, Osteo versus Rheumatoid – and the Best Natural Treatments for Both)

Dear Dr. Rona:

I read your article about rheumatoid and osteoarthritis and found a couple of points that are somewhat contrary to common knowledge. In your article, it is suggested to avoid foods that contain gluten, and oats are included on this list. But common knowledge is that oats do not contain gluten as far as I know. Can you please clarify this for me, as it is disturbing to read this when I have based my diet on articles that I have read that contradict this.

The other point you make is that citrus should be avoided. But in the same vein, vitamin C and citrus are supposed to be helpful for arthritis; can this point be clarified as well? I usually read Vitality magazine and assume that its content can be relied on. That is why I am writing to have these questions answered. Mark Anachiotis, Kingston, Ont.

Dear Mark:

Those are very good questions. Contrary to popular belief, there are oat products available in the marketplace that do contain gluten. Some do not and those are fine. You have to read the labels. Look for “organic, gluten-free, non-GMO, no added sugar” on the label, and you can then eat them with confidence, provided you are not allergic to oats.

In serious cases of arthritis where one suffers from ‘leaky gut syndrome’, all grains should be avoided, including gluten-free oats, quinoa, millet, and buckwheat. My source of information about this is the book Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride.

If your arthritis is well controlled despite eating gluten-free grains, then there is no problem for you. If you experience a worsening of your condition, eliminate the grains entirely until at least your symptoms are under control.

Citrus fruit is also fine, provided you do not have an allergy to it. Once again, look for organic, non-GMO citrus, and that approach should avoid the common pesticides, additives, and other pro-inflammatory chemicals that could worsen your arthritis.

There are a number of lab tests that can tell you about intolerance to certain commonly eaten foods. The one that I often use in my practice is the IgG RAST blood test. This is now available through several labs including the Gamma Dynacare chain (905-790-3000).  Zoltan P. Rona, MD, M.Sc.

A Better Approach to ADHD Than Providing Drug Prescriptions For Our Kids

Soon after returning to school this year, my nephew was diagnosed with ADHD, and his parents were told that medication would be the best option to improve his symptoms. In the search for natural alternatives to medication, I came across an article of yours in the Vitality archives, published back in September 2014 (https://tinyurl.com/pkqpkmx).

In the article, you state that food allergies, digestive problems, and constipation are commonly associated with a diagnosis of ADHD. Can you recommend the best way to start addressing these problems in an effort to improve the child’s mental health and behaviour? Edwina Calderone, Detroit, Mich.

Dear Edwina:

The first thing you have to do is clean up your nephew’s diet. Sugar in any form, especially soft drinks, fruit drinks, and junk food (candy bars, chips, pizza, hot dogs, fries, etc.) must be eliminated in order to improve the symptoms of Attention Deficit Hyperactivity Disorder. Also, switch to non-GMO organic fresh fruits and vegetables, filtered water, seeds and nuts for snacks, as well as hemp hearts and other unsweetened foods. If your nephew is not a vegetarian, then organic, grass-fed beef, bison, and lamb are okay for his diet, in small amounts. Small fish (sardines, trout, salmon, tilapia) are also okay but no more often than twice a month due to mercury contamination concerns. As much as possible, stay away from packaged foods and all the preservatives, food dyes, and added sugar.

A food elimination diet to rule out food intolerances is a good idea. For an explanation of how to do an elimination diet, visit this website: https://tinyurl.com/p65zxkx

If an elimination diet is not possible due to time constraints, one other way of determining food intolerances is through a blood test called the IgG RAST offered through many labs in Canada and the U.S. Any medical doctor or naturopath can order these tests. (See: https://tinyurl.com/hafolz2 for more information on the Dynacare food intolerance test procedure.)

In addition to food sensitivities detected through food intolerance testing, it is the rare child in North America with ADHD who doesn’t react adversely to gluten. There is a good book, called Grain Brain published by neurologist Dr. David Perlmutter, about the effects of grains on the brain. I therefore routinely recommend that children with Attention Deficit Hyperactivity Disorder stay away entirely from gluten. To get more information on this topic, see Julie Daniluk’s book Meals That Heal Inflammation. By the way, gluten-free grain products are not necessarily healthy since they can contain added sugar and other potentially harmful additives.

Ideally, your nephew should get thorough biochemical/nutritional testing for vitamins and minerals through a natural health care practitioner, as well as testing for toxic heavy metals like lead, cadmium and mercury. In the meanwhile, he could start on some safe and effective nutritional supplements:

• Omega-3 fatty acids – 4000 mg daily
• Vitamin C – 1000 mg daily
• Magnesium-L-Threonate – 500 mg daily
• L-Theanine – 3000 mg daily
• Probiotics with a high bifidobacteria count – 45 billion cells or more daily

The best thing to do is to consult a natural health care practitioner for a personalized nutrition and supplement plan.

Zoltan P. Rona, MD, M.Sc.

Inquiry About the Drug Truvada

Dear Dr. Rona:

I am wondering whether any light can be shed on Truvada, which is a medication taken by HIV-negative people as a protection against the HIV virus. I have been on the medication for eight months and I have noticed that my energy levels have plummeted. Also, I experience joint pains all over, which has added to the general state of malaise. I have had a clean bill of health for a long time and when I got tested recently, blood tests indicated that my health is in pristine condition. Would there have been any studies or articles from a homeopathy perspective about the use of Truvada whose medicinal contents are emtricitabine and tenofovir disoproxil fumarate?  In dire need of your expert advice. Michel Smithers, Pickering, Ont.

Dear Michel:

With Truvada in your system for that extended period of time, I sincerely doubt that your health is “pristine.” I have always been leery of using a drug with serious potential side effects as a preventive for anything. As you can see from the list below, one of the side effects of this drug is liver toxicity. No doubt that can cause general malaise. Some Truvada side effects (see below) raise red flags for me (https://www.rxlist.com/truvada-side-effects-drug-center.htm).

Truvada side effects

• rapid heart rate, increased sweating, tremors, sleep problems (insomnia), feeling anxious or irritable;
• severe diarrhea, unexplained weight loss, menstrual changes, impotence, loss of interest in sex;
• swelling in your neck or throat (enlarged thyroid), feeling short of breath;
• weakness or prickly feeling in your fingers or toes, joint pain;
• problems with balance or eye movement, trouble speaking or swallowing;
• severe lower back pain, loss of bladder and/or bowel control;
• signs of a new infection such as fever, chills, skin lesions, or cough with yellow or green mucus; or
• signs of liver damage – nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-coloured stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• mild diarrhea, mild nausea or stomach pain;
• headache, dizziness, depressed mood;
• strange dreams;
• mild itching or skin rash;
• or changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

As for homeopathic remedies, there are no studies that I’m aware of which have been done on HIV prevention using homeopathy. Certainly, aside from the usual safe sex practices, there are many natural remedies that can boost immunity and prevent infections of any kind. Most importantly, adequate blood levels of vitamin D are essential. Immunity is also boosted by a paleo type diet, probiotics, vitamins A and C, zinc, and oil of oregano.

I suggest you get comprehensive lab testing done, especially liver function tests, plus hormone and vitamin and mineral levels. Consult with a naturopath or a doctor who specializes in complementary and alternative medicine. Zoltan P. Rona, MD, M.Sc.