“The happiness of this life depends less on what befalls you than the way in which you take it.”
I guess being struck with a chronic disease like an arthritic-related autoimmune disorder in the prime of your life kinda sucks right? From the ever-present pain in certain joints that feel like they are on fire and being eaten from the inside, to using crutches to get around at home, to rolling about in bed every night trying to find the best ‘pain-free’ position that unfortunately doesn’t last long, to resorting to pain-killers sometimes just to get a good night’s sleep, to making excuses to avoid social gatherings and grad trips or even going out of the house often because my body just isn’t up to it and lastly, to constantly worry about the future. Worry if I will ever be able to live a normal pain-free life, find my dream job and soul mate, get married and have kids, take care of my folks, grow old and travel the world.
Of course, I could constantly wallow in self-pity and such victimizing thoughts but that would not do me or my situation any good. The negative attitude would probably exaggerate and make any suffering worse. Besides, no one can tolerate a moody, grumpy, emotional person for long, probably not even one’s family. Hence the only other thing I can and have resolved to do is to fight on and try to do so with a SMILE. 😀 I need to have faith that things will get better and stay positive no matter the situation. I will not rest until I’ve achieved remission of my symptoms and (I dare say) find a cure/reverse this autoimmune disorder!
January 2017: Recovering from fasting
Following the 7 day fast, and totalling 15 days of fasting in December, my weight dropped to 50kg and I experienced a lot of muscular atrophy. I now realized its because I spent most of that month bedridden and convinced that I was in too much pain to exercise, I had also forgone exercise altogether. This, combined with all that fasting, was a fast track to losing weight, bone density and muscle.
Furthermore, the fasting did work in reducing inflammation and some of my pain but it did not eliminate them. I then took my 7th shot of Humira before finally getting to see the Rheumatologist at SGH (I had waited 2 months for this appointment). That shot of Humira cause some unexpected side effects like caused swelling and itch around the injection site. Similarly, the 8th shot of Humira 2 weeks later had the same effect. I then resolved to stop all immunosuppressive medications from then on. Its now 127 days since my 8th shot.
Around this time, two weeks after the 7-Day Fast and when I felt ready again, I started an exercise regime consisting mostly of Gymnastics Strength training from Gymnastics Bodies and Gymnastics Rings Training from GMB Fitness. These involved lots of mobility and bodyweight resistance exercises and I stopped all weight lifting exercises – rationalizing that my joints were not healthy enough to handle added weight for the time being. I also decided to follow the weekly programs and see how I progressed throughout the weeks. This was different from the past where I would just come up with an exercise program on-the-spot immediately before training.
These calisthenics-based exercise programs worked really well and I felt I gained back most of my lost muscle in a couple of weeks. In fact, a chance encounter with a friend in February revealed that he couldn’t tell I had fasted so much in December.
Presently as I write this, it is now Week 25 of starting the abovementioned exercise regime and my weight has stabilized at ~56kg. I’m slowly putting on muscle mass but now know/realize that muscle gain (as opposed to weight gain) is a product of the stress you put your body through (i.e. resistance exercise be it body weight/weight lifting). Weight gain (not muscle – i.e. water, fats, etc) is a product of what and how much you eat. You can still gain muscle during a fast as long as you engage in some form of resistance exercise. Your body will build new muscle when you break the fast and eat nutritious food. Adversely, when fasting, if you don’t engage in regular exercise or daily activities and just lie down in bed, you will probably lose lots of lean tissue mass through the mechanism of atrophy simply because you did not send the appropriate signals for your body to conserve them. Similarly, eating too much and eating junk food while not exercising will cause your body to put on fats.
Bottom line: your body will adapt to the stressors you put it through.
Dietary Changes: Around this time, I had been researching and reading up on an elimination diet for people with autoimmune disorders – the Paleo Autoimmune Protocol (AIP). It called for 30-60 days of eliminating all foods that could potentially trigger an autoimmune response (increase in inflammation and symptoms). I went for the full 60 days of elimination. It was tough and I practically cooked almost every meal and packed my lunches to school every day.
After 60 days, I added back foods one at a time starting with egg yolks, ghee, rice, egg whites, black & white pepper, butter, cocoa, coffee, kefir and kombucha. I know I kinda didn’t really do them in the order that was recommended (from the least likely foods that would trigger a reaction) but rather reintroduced foods that I thought were the most common in our culture, like rice.
Additionally, I found it very hard to tell apart the subtle symptom related triggers from introducing these foods. Sometimes my foot would hurt more but I’d be wondering if it was because I did more walking the day before, or if it was because of the eggs I ate or is it all just in my head?? The variation in pain would increase or decrease almost randomly and unpredictably. I felt that going by this symptom alone was a headache.
It is now Day 182 since starting the protocol and I still continue to introduce foods but now generally don’t pay much attention to any small variation in pain levels. There are other more obvious signs such as heavy mucus production and sniffing when I eat too much chilli (even though very minute amounts produce no symptoms for me). Or when I eat something that really doesn’t agree with my gut, I get some serious stomach churning and sometimes pain in a particular area of my abdomen. This happened in a recent episode of food poisoning from contaminated frozen mussels and sometimes when I eat certain foods outside. Its a good warning sign to avoid those foods in the future.
Eating for Gut Health: More and more, I have realized that autoimmune disorders are inextricably linked to the health of one’s gastrointestinal system and symbiotic relationship with the trillions of bacteria that make up the microbiome living in us.  Hence, I have started to include more raw foods like salads which provide prebiotics like lots of fibre to feed the good bacteria.
Additionally, I’ve increased my consumption of fermented foods and try to eat some with every meal now. This is especially important in our asian culture because we love to eat cooked foods which have diminished nutrient and enzyme values. I started with our local “Suan and Xian Cai” (chinese salted veggies) which were easily found in my local fresh market (I avoid the ready packed ones which have lots of preservatives). Then I found that the local Cold Storage was selling Fasskraut, a german variation of Sauerkraut and started eating this too (although I think the store-bought versions don’t have as much good bacteria as home-made ones, probably due to lesser fermentation times). Recently, after a 14-Day fast, I read about the amazing healing benefits of regular Milk Kefir and Kombucha consumption and have begun incorporating them in my daily diet too. I even went for a workshop to learn about milk kefir and started culturing our own kombucha and kefir at home! Soon we will try fermenting veggies like Kimchi!
And not forgetting copious consumption of good old bone broth for its rich gelatin content to heal the gut lining and joints as well as its abundance of minerals and essential amino acids. I have been making this for the past 2 years, mostly with beef bones and whole chickens. Only recently did I learn to make fish bone broth. This was hands-down the tastiest variation!
March 2017: Changing medications and going back to fasting
When I told my doctor that I wanted to cut out all immunosuppressive medications like Humira, he advised me to start on something milder (and very much cheaper) – Steroids. Specifically Prednisolone and Methotrexate. Since the pain was slowly returning in my right foot and I did not want to take NSAIDs long-term because of their potential damage to the gut, I went ahead with his advice.
Taking at the start taking 2 pills of prednisolone a day worked quite well. I would wake up with lots of pain but some time after popping those pills, the pain would go away. By nightfall the pain might return and by the next morning, it was again at its worst. This just didn’t make sense to me. I hated the idea of just treating the symptoms while not doing anything to treat the root cause. I was supposed to continue this until the methotrexate started to work in a month or more.
I didn’t like the way these two medications made me feel too. Somehow I didn’t feel normal… something didn’t feel right. I would not feel the usual workout fatigue/aches. Although that might be a good thing for some people, I didn’t like it one bit. More research led me to find out that Prednisolone is a corticosteroid that mimics the effects of cortisol.  It inhibits the inflammatory response to a variety of inciting agents and, it is presumed, delay or slow healing. 
Another side effect is the increased risk of infection and this became a reality when I was hospitalized for a gastrointestinal infection after eating some frozen mussels. Everyone in my family had eaten them too and they were fine. The doctors that assessed me told me the prednisolone was the most likely reason.
This was the last straw.
I then decided to do my longest fast to date – 14 Days. I was hoping that 14 days would be enough to achieve remission but I guess I was being a little too hopeful. The case studies I read mentioned up to 21 days. It was a good try nonetheless and I experienced some benefits such as a reduction in symptoms and pain which unfortunately did not last. Additionally, I learnt a bit from that experience. More specifically that I didn’t need to rely on too much supplements and green juices when fasting. These would stimulate the body to produce digestive enzymes and divert energy away from detox and healing.
Seeking a second opinion
Also around this period, I was doing a bit of reading about Naturopathic Medicine. The idea of treating the root cause and the body as a whole through stimulating its own natural healing abilities resonated with me. It was exactly the type of treatment I was prescribing to myself through all that fasting and changing my diet. I was inspired to learn more and possibly pursue graduate studies in this field. Thus, I started googling for naturopathic physicians in Singapore and eventually found my current doctor. As a bonus, she was trained in Bastyr University – one of the best in the world for this field and the one I was aiming for too.
Dr.Kamut was very patient the first time around and investigated about my entire background from sporting history to current impediment. She knew about various foods linked to autoimmune disease and arthritic conditions and started advising me on diet and prescribing mostly natural supplements for my treatment. Additionally, she had a battery of tests at her disposal such as a comprehensive stool analysis. This is something a conventional physician like my rheumatoid specialist at SGH would never do. He accepts that there are some papers and theories linking gut microbiome dysbiosis but would never test and specifically try to treat it.
Following the stool analysis, we found a distinct overpopulation of the Klebsiella bacteria, some potentially troubling bacteria and yeast as well as very low populations of good bacteria. And that brings me to today where its the second week of treatment for gut dysbiosis with natural antimicrobials/antifungals.
Additionally, I have also done a 3.5 day fast on the first week. No juices and supplements this time around. Just bone broth and antimicrobials. That fast almost resolved all pain and swelling, possibly with the help of the antimicrobials. However, as soon as I started refeeding, the pain came back. This is both disheartening but promising. I think my body is starting to adapt quite fast to the benefits of fasting such as cellular detox and reduced immune system activity and inflammation. This might mean I might not need to fast up to 21 days to achieve remission! Another ‘evidence’ to prove my point is the outbreak of pimples/acne which took 5 to 7 days to appear but now has started after 3 days. Outbreaks are a symptom of detox but could also be a sign of increased stress on the body, which fasting can cause so the evidence is mixed.
I’m glad I managed to tide through my last semester of university without the pain causing too much problems. It was only in the last few weeks that my feet started hurting really bad. No problem, I just walked around really slowly pretending to admire the bushes or trees or be absorbed in the podcast I was listening to.
I’m also thankful for the holidays and am going to take a few months to do nothing and just prioritize recovery. I’ve applied for Naturopathic Medicine in Bastyr University but due to visa complications, will have to spend a year completing prerequisites through online courses at home. I guess that’s another blessing in disguise (looking at the glass half full). This just means more leeway and time to recover fully. I could study, continue blogging, learning and researching, experimenting and hopefully put this disease into remission permanently.
Lastly, 2 days after that 3.5 day fast, I have now begun my latest attempt to fast 21-days. I’m 3 days in and the pimples are slowing down in activity. This time the pain is taking longer to go down, but I’d say it’s already around 70% lesser. I can now walk around the house without crutches too.
Fingers crossed, I hope I can ‘cure’ myself of this disease after 21 days.
*update: Oct 15th, 2017
My body started to give me signs of true hunger such as incessant stomach rumblings and hunger which started on the 14th day. By the 16th day I broke the fast. Within a week the symptoms returned and I started taking NSAIDs once a day for the pain. A few weeks later my rheumatologist started me on another type of NSAID, a more specific COX-2 (enzyme) inhibitor for inflammation and pain. Together with consistent dietary and lifestyle changes, I have made slow but steady progress over the months since.