Reply To: 57 yo M recently diagnosed with rheumatoid arthritis – update

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Welcome! Forums 57 yo M recently diagnosed with rheumatoid arthritis – update Reply To: 57 yo M recently diagnosed with rheumatoid arthritis – update


Hello Jenny,

Thank you for following up on this case here. I do think that what he experienced was what many often refer to as a “die-off” or “Herx” reaction. One of the reasons this occurs is due to the release of endotoxin, which blocks detoxification pathways, contributing to intrahepatic cholestasis and reduced elimination of toxins from the kidneys as well. When this occurs, toxins as well as bile acids are not transported out of the hepatocytes as they should be, but rather go back into the bloodstream. This, in combination with the immune system activation due to endotoxin release, leads to what people commonly call a die-off reaction. I recently did some extensive writing and research on this topic, which will soon be in an upcoming Townsend letter, although I don’t have it to share here quite yet!

One of the things which acts to bind endotoxin is activated charcoal. Chitosan, derived from shellfish, also binds endotoxin, but less strongly than activated charcoal.  Citrus pectin and lactoferrin also act to bind endotoxin. Lactoferrin additionally has an antimicrobial effect, and may be effective for addressing the gut dysbiosis this man is experiencing. By using agents such as these to bind endotoxin (and other toxins) in the gut, detoxification pathways are not impeded, the overall toxin load is diminished, and thus, there will be much less of an adverse reaction.

Chen CH, et al. Suppression of endotoxin-induced proinflammatory responses by citrus pectin through blocking LPS signaling pathways. Biochem Pharmacol. 2006 Oct 16;72(8):1001-9.

Elass-Rochard E, et al. Lactoferrin inhibits the endotoxin interaction with CD14 by competition with the lipopolysaccharide-binding protein. Infect Immun. 1998 Feb;66(2):486-91.

Caccavo D, et al. Antimicrobial and immunoregulatory functions of lactoferrin and its potential therapeutic application. J Endotoxin Res. 2002;8(6):403-17.


Phosphatidylcholine is important for healthy bile flow as well as the elimination of toxins from the liver. The diet of many is deficient in phosphatidylcholine. Phosphatidylcholine also is important for the mucosal barrier of the gut, serving to protect it in the setting of infection and toxin exposure. Other agents that support the healing of the gut can be helpful in reducing a detoxification reaction because by diminishing intestinal permeability they reduce the endotoxin translocation into circulation.

Epithelial Growth Factor (EGF) is a polypeptide that stimulates growth and repair of epithelial tissue. I have seen supplementation with this be very helpful for skin conditions such as your client experiences. EGF is a normal constituent of saliva production during the act of eating, is also secreted into the gut lumen and found in colostrum and milk.  Salivary EGF also upregulates small intestinal absorption of electrolytes and nutrients.  Michael Ash has written more about the use of epithelial growth factor in the resource “Epithelial Growth Factor For Reduced Gut Permeability / Pathogen Attachment And Nutrient Uptake” which can be found here –  Additional agents that support intestinal mucosa integrity are glutamine, slippery elm, and N-acetylglucosamine (NAG).

Support for Nrf2 which turns on cellular transcription of Phase II enzymes such as glutathione S-transferase (GST), glutathione reductase (GSR), glutathione peroxidase (GPX), and nicotinamide adenine dinucleotide phosphate (NADPH), a reducing agent also may be helpful, particularly if testing has noted that he has compromised Phase II detox.

Harvey CJ, et al. Nrf2-regulated glutathione recycling independent of biosynthesis is critical for cell survival during oxidative stress. Free Radic Biol Med. 2009 Feb 15;46(4):443-53.


By supporting gut healing, the binding of toxins, and liver/biliary elimination of toxins, the body will better handle the impact of antimicrobial therapies. That said, they should be introduced gradually to avoid an adverse reaction such as he had the first time.

I also do agree, the exercise is excessive given his current health situation. Intense exercise creates oxidative stress in the body, which of course can further lead to immune system activation. It would be more appropriate to go on a gentle ride of 20 miles or less, which gets the joints moving and endorphins flowing but is less challenging on all of his systems.


The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.

Support for cellular glutathione production and detoxification pathways

ThioDox (ARG): 1-2 capsules twice daily.


Nrf2 Renew (ARG): 1-2 capsules twice daily.

Support for cellular, liver, and gallbladder health

Phosphatidylcholine (BRC): 2 capsules twice daily with meal.

GI support for endotoxin elimination, microbial balance, mucosal repair, and immune function

Laktoferrin With Colostrum (ARG): 4 capsules at night before bed.

Very gradually reintroducing

Humic-Monolaurin Complex (ARG): Gradually increase to 2-3 capsules twice daily away from food. Combination of humic acid, Russian Choice Immune, and olive leaf extract.  Supports healthy response to viruses.


Please consider these suggestions in light of the other clinical information pertaining to this individual.  If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered.  I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.

In health,

Dr. Decker