Video Summary

Speaker: Dr. Tony Hampton
Topic: Using food as a lever to calm rheumatoid arthritis (RA), how to measure remission, and how to taper medications safely with data.

Opening patient stories

• A patient reported her RA pain vanished after cutting out sugar.
• The same patient also reversed type 2 diabetes with diet, bringing A1C to 5.1; some clinicians were skeptical of diet as the cause.

What RA is and why measurement matters

• RA is an immune-mediated arthritis that inflames and, if uncontrolled, damages joints.
• Treatment aims for remission, not just “less pain.”
• Remission is defined with composite scores (e.g., swollen joint count, tender joint count, patient global assessment, and CRP):
  • Boolean remission: very strict; thresholds summarized as “≤ 1.”
  • Index cutoffs: SDAI < 3.3 or CDAI < 2.8 → in plain terms, almost no swollen or tender joints.
  • DAS28-CRP also referenced and used in trials.

Food patterns discussed

• Low-carb / ketogenic (and even carnivore for some):
  • Aim for roughly 20–50 total carbs/day (unless doing strict carnivore).
  • Typical foods: non-starchy vegetables, fish, eggs, meat, dairy (if tolerated), olives, avocado, extra-virgin olive oil.
• Mediterranean-like (anti-inflammatory) approach:
  • Emphasizes extra-virgin olive oil, oily fish, herbs, nuts, leafy greens.
  • Caveat mentioned: still avoid a lot of grains (i.e., a lower-carb Mediterranean pattern).
• Fasting / time-restricted eating also discussed as helpful tools for some.

Mechanistic note

• Ketone bodies (e.g., beta-hydroxybutyrate)—which rise on low-carb/keto—can directly inhibit the NLRP3 inflammasome, a key immune alarm pathway driving inflammation.

Evidence referenced (from the video)

• Mediterranean-style RCTs showed lower disease activity, improved function, and less stiffness versus control.
• ADIRA trial (Sweden): improved DAS28-CRP and patient-reported outcomes on an anti-inflammatory Mediterranean-like diet.
• Classic Lancet trial: a short fasting phase followed by a plant-based diet lowered RA activity for months.

What to reduce/avoid

• Sugar highlighted as a driver that can worsen inflammation and RA risk; removing sugar is framed as a step that can help earn the right to taper medicines.

“Playbook” / data to track for clinic visits

• Track DAS28-CRP, SDAI, or CDAI; aim for Boolean remission if possible.
• Use labs that move with inflammation: CRP (and ESR).
• Don’t chase RF or anti-CCP for activity (helpful for diagnosis but often remain positive).
• Consider ultrasound to rule out silent synovitis.
• Document function (e.g., a daily diary or HAQ-DI).
• If relevant to your case, bring metabolic markers (e.g., A1C) showing dietary progress.

Tapering guidance mentioned

• After ~6 months of sustained remission, it’s reasonable to consider dose reduction of disease-modifying therapy—not abruptly stopping.
• “Don’t ghost your meds.” Earn your taper with objective data and work with your clinician.