Somebody sent me this great question and I thought I would post it:
Question: Hi Monica! My name is XX and I am on a plant-based diet for treating my RA. I am on Plaquinel and Sulfasalazine and don’t want to be forever. I have limited range of motion of my fingers. I struggle severely with elimination diet. I’m kind of a foodie. Being Vegan is easy, it’s giving up coffee and sometimes the sweet stuff that I struggle with. But I know RA is a bigger struggle. I think I have a mental/emotional block. Anyway I’m also concerned about my overall nutrition because I’m Vitamin D deficient and anemic (not the inflammatory kind). My CRP and ESR have been normal since day 1. All my labs look great in fact besides the above mentioned. I’m just looking for a Doctor who can kind me accordingly. Do you ever do skype consultations or recommend anyone. I live in Colorado but I’m from Baltimore! I appreciate you and the work you’re doing!
Dr. A response: Great question! The acidity of coffee in triggering a leaky gut is debatable. Coffee is considered an anti-inflammatory and in some studies there is suggestion benefit. in overall mortality. Specifically, chronic coffee consumption may bring down blood pressure, improve blood sugar and decrease plaque in the heart. I drink green tea daily and never gave it up. There is data on tea (both black and green) to show dilation of blood vessels and possible mortality benefit. I am okay with you drinking your coffee unless you think that it is triggering a reaction. Just don’t ruin the coffee with milk and sugar. I also think unprocessed sweets are okay once and a while. I for instance eat a nice dark chocolate periodically and enjoy it. Be creative. When food calls for sugar: add dates, maple syrup or banana. The things to be strict about in your diet are the “no meat and no milk.” Fish may be okay for some people and has a high omega 3 fatty acid content. But so many issues with pollutants in fish these days. Egg should be eliminated because increases cardiovascular risk and RA patients are at higher risk for heart disease. Most vegans are not anemic from low iron. You just need to eat lots of greens. B12 deficiency is possible and B12 has to be supplemented. Vitamin D is interesting. Lots of new data saying how important it is. But most people who live in the north are vitamin D deficient most of the year. Plus we use so much sun block–hard to avoid with the amount of ozone breakdown. Many people need to supplement with vitamin D tabs–not just vegans. Remember Vitamin D is not easy to get for anyone. It is just that in the US, we fortify our OJ and milk with vitamin D. Most almond milks are fortified as well. But if you are significantly low, you may have to supplement. Does that help?