Reactive Arthritis: Nutritional Approaches to Healing - Part Two

In this second installment on Reactive Arthritis, Katherine Poehlmann, PhD, outlines potential triggers, the immune response, and resultant chemical imbalances. She discusses approaches to help combat inflammation, including hyaluronic acid in injectable form, supplements, and natural foods. She writes about the beneficial actions of ascorbic acid, dietary approaches to healing, and clinics recognized as centers of excellence in nutritional healing.



Katherine Poehlmann, PhD

Reactive arthritis (ReA) manifests as joint pain and inflammation, but the infection triggering the reaction starts in the intestines, respiratory tract, nose, ears, genitals, or urinary tract. The secondary inflammation, usually in the hips, knees, ankles, jaw, and spine (spondylitis), can also affect the circulatory ducts, heart, eyes, skin, and urethra. ReA is seen more often in young adults (age 20-40), but can afflict any age group. Doctors will usually prescribe Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), corticosteroids (topical or injected), or drugs intended to treat Rheumatoid Arthritis (1). Clinicians prescribing NSAIDs may not emphasize that infections increase the need for healing nutrition, They may not consider the need for appropriate antibiotics with probiotics to correct the gut microbiome.

When combating infection, the immune system depletes antioxidants (especially glutathione and vitamin C stored in the tissues) by converting them to their oxide form and this induces cell death (apoptosis) of microbe-infected cells. This process generates toxins which further deplete our antioxidant vitamin C stores. Ascorbate-depleted tissues begin to deteriorate and histamine levels increase as toxins and free radicals displace the now insufficient amounts of antioxidants. Redness of inflammation is a symptom of an ongoing histamine-toxin-oxide-apoptosis destructive chemical chain reaction. Toxic shock, lethargy, pain, itching, asthma, and anaphylaxis are all indications of rapid onset scurvy (severe depletion of vitamin C, or Dr. Cathcart’s term anascorbemia. (2).

As noted in Part One, the generated toxins, bioactive molecules, and enzymes can upset the chemical balance of other nearby regions of the body.  This occurs especially in areas adjacent to synovial tissue, such as the joints, tendons, bursae, and sheaths (e.g., carpal tunnel).

The bacteria-expressed enzyme, hyaluronidase, destroys the beneficial hyaluronan, a long-chain sugar molecule that naturally separates and lubricates the parts of the joints.  The Streptococcus pneumoniae bacterium (among others) generates this destructive enzyme which acts as a penetrating factor facilitating the bacterial form’s spreading through the body. Vitamin C disables hyaluronidase.

When this harmful enzyme is in the joint, it unlinks and disintegrates the lubricating molecule faster than it can be naturally regenerated. This action contributes to the deterioration of the joints that characterizes Osteoarthritis. Injections of hyaluronic acid (HA) directly into knee joints can provide temporary relief for up to 12 months.

HA supplements in capsule form are available, but a better source is in Japanese tuberous vegetables, which also contain many other beneficial nutrients in a one-inch slice eaten daily. Look for satsumaimo (a type of sweet potato), yamaimo (also called nagaimo, a sticky white yam), konyaku (a prepared gelatinous root vegetable product), and imoji (a potato root) in Asian supermarkets.

Ascorbic acid (AA = vitamin C) in sufficient concentrations (6 to12 grams per day, consumed orally) can both disable the hyaluronidase enzyme and also enhance a depressed immune system’s leukocyte response to bacterial infection (3, 4). Other enzymes also attack and erode the collagen in cartilage. Ascorbic acid is called a collagen stabilizer because AA plus lysine (gelatin) together produce carnitine and other tissue-rebuilding molecules. AA in sufficient amounts given intravenously is a proven anti-viral remedy (5). High and frequent AA intake has improved healing rates by factors of 3 to 5 times in a dosage proportional manner (Levy, Dr. Thomas, Curing the Incurable). Mercury fillings and root canals can be causes for high AA intake dependency. (Levy, Dr. Thomas, The Toxic Tooth)

ReA symptoms can sometimes be the result of allergic reactions to foods that trigger an immune system response, depleting AA. Dietary changes can make a dramatic difference in reducing pain and inflammation. The primary allergens are sugars (lactose), grains, dairy, meats, and gluten. High fructose corn syrup (HFCS) is a multiple sugar additive that promotes growth of allergy-causing pathogenic bacteria.

Basic paleo or vegan diets are high in glutathione and antioxidant vitamins A, C, and E that help neutralize harmful free radicals. Processed foods should be kept to a minimum since they contain HFCS, chemicals, and preservatives that are seen as foreign invaders by the immune system.

The healing reconstruction of the body cannot resume unless other nutritional elements are replenished, either orally or intravenously. Numerous guidelines by practitioners of orthomolecular nutrition and functional medicine are provided in the references.

Exercise is an important component of a healthy lifestyle. Gentle stretching and water aerobics are ideally suited to those who seek relief from joint pain but have limited range of motion.

Do not underestimate the value of drinking enough water. When the body is dehydrated, histamine production increases significantly. Our cells are roughly 67% water, so rehydrating should be a priority, especially during pollen season and whenever the immune system is battling an infection.

Centers of excellence providing nutritional healing and integrative health services (include both conventional health care practices and complementary medicine) can be found throughout the United States. The Institute for Functional Medicine can help you find a practitioner in your area. Trusted Internet sites can provide valuable nutrition and diet information. Three of these appear in references 6, 7, and 8. It is important to seek professional help of both medical and nutritional experts with good patient reviews to achieve the best results.


1.  National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers About Reactive Arthritis

2.  How to Determine a Therapeutic Dose of Vitamin C, by Dr. Robert F. Cathcart, M.D.

3.  Journal of Applied Nutrition Vol. 23, No’s 3 & 4, Winter 1971: Observations On the Dose and Administration of Ascorbic Acid When Employed Beyond the Range Of A Vitamin In Human Pathology, by Frederick R. Klenner, M.D., F.C.C.P.

4.  Life Extension: The Link Between Vitamin C and Optimal Immunity

5.  [Complete collection of Dr. Thomas Levy’s writings, including AA IV treatments]

6.  Exercise and Diet Combat Inflammation, Allowing You To Live Longer, by Dr. Joseph Mercola, D.O.

7.  Life is Hard, Food Should Be Easy: Joy Bauer, MS, RDN, a website offering nutrition suggestions.

8.  [Multiple sources provide a list of links to nutrition papers from reliable health websites… Journal of Ortho-Molecular Medicine, Drs Klenner, Cathcart, Levy, Ely, Pauling, … etc.

9.  The Healing Factor: Vitamin C Against Disease, by Dr. Irwin Stone

10. Clinical Guide to the Use of Vitamin C, by Dr. Lendon H. Smith

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