By Stephanie Allmon

sallmon@star-telegram.com

Whether science bears out Catherine Ruehle's assertion that she is staying well through nutrition and lifestyle changes alone -- without the use of prescription drugs -- depends on which medical and nutrition experts are asked.

Those who adhere to the emerging philosophy of healthcare called "functional medicine" believe that chronic illnesses and autoimmune disorders such as rheumatoid arthritis are highly attributable to genetic makeup and environmental and lifestyle factors, and that those things should be taken into account by physicians. Too often, they say, doctors use an acute-care model (say, that of a broken bone or appendicitis) to treat chronic disease; they treat the symptoms rather than the causes. The Institute for Functional Medicine (www.functionalmedicine.org) states, "Most physicians are not adequately trained to assess the underlying causes of complex, chronic disease and to apply strategies such as nutrition, diet and exercise to both treat and prevent these illnesses in their patients."Fort Worth registered dietitian Kim Hogue, a member of the IMF, has not consulted with Ruehle but says she thinks her approach makes perfect sense."Food is medicine," Hogue says, adding that gluten, in particular, is a substance that many people don't know they're sensitive to. One of the first courses of action she as a dietician would advise RA patients to take is to eliminate potential food triggers from their diet and slowly try to add them back in, as Ruehle did.In fact, one study cited by WebMD in its Rheumatoid Arthritis Health Center indicates that 30 to 40 percent of RA patients may benefit by eliminating "suspect" foods from their diet, and that an elimination diet is a good way to identify them.Dr. Virginia Reddy, clinical assistant professor of internal medicine in the division of rheumatology at UT Southwestern Medical Center, also has neither consulted with Ruehle nor seen her medical records. She says that, although some studies show that some foods can have an anti-inflammatory effect and that lifestyle factors such as stress and cigarette smoking can contribute to RA flare-ups, a lifestyle-only approach to managing the disease is risky."I think the vast majority of people would not have their disease controlled with such an approach," she says. "There's a spectrum of the disease from very mild to very severe, so potentially people with mild disease where there's not any joint damage ... could manage it well with lifestyle modifications, but for the vast majority it would be a risky approach because when left untreated, in [most patients], RA is going to be disabling."Although a diagnosis of RA used to be a "very scary sentence," Reddy said, now there are very effective treatment options resulting from a tremendous amount of research going on every day.Reddy acknowledges that RA drugs, including steroids, do have potentially harmful side effects. But most of her patients who have experienced the debilitating pain that comes with a full onset of RA "find it very much to be worth it," she says.Patients often do want to talk about lifestyle changes they can make to help control their arthritis."I definitely recommend to all my patients a generally healthy lifestyle, getting sleep, exercising, eating a healthy, balanced diet and not being overweight," she says. But she adds, "In terms of an 'RA diet,' there have been some small studies looking at specific diets in RA patients, but they have not shown any conclusive results."These include studies investigating vegetarian, Mediterranean, elemental and elimination diets, Reddy said."However," she said, "these studies were, in general, too small to draw any particular conclusions about these diets, as more patients on the diets in many of these studies both lost weight (which might have helped the arthritis), but also more patients dropped out of the treatment arms due to adverse events related to the diets."

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