But at the age of 19, something happened to her knee that put a stop to her active lifestyle. "It swelled up to a huge size and no one was sure why," said Angela, now aged 48 and living in Glasgow, Scotland. "I didn't have a specific injury or fall... It was incredibly painful, and I could only walk with the help of crutches."
Over the next 20 years, Angela had six operations on her knee in an attempt to locate and solve the problem. But all this did was leave her with severe scarring. "There was no fancy keyhole surgery in those days," said Angela. "People ask me if I've been in a shark attack!"
To manage the pain, which often left her bedridden for days, Angela was prescribed powerful painkillers. But they "seemed to become less effective the longer I took them."
After the sixth failed operation, Angela's consultant decided enough was enough, and referred her to a rheumatology clinic. "The rheumatologist gave me hope for the first time in years," said Angela. "He said he would be able to help."
Angela was prescribed a cocktail of anti-inflammatory drugs including sulfasalazine, an immune system-suppressing drug used to treat rheumatoid arthritis.
"They thought the problem could be with my immune system rather than a mechanical issue," said Angela, "although they never actually diagnosed me with rheumatoid arthritis."
Initially, Angela suffered with terrible side-effects from the drugs. But she was persuaded to persist with them, and after three months she began to notice an improvement in her knee. "The swelling went down dramatically for the first time," Angela said, "and it was not long before I was able to dispense with the crutches."
Buoyed by the success of the drug treatment, Angela started to look into other approaches that could potentially help her knee further, such as an anti-inflammatory diet and herbal medicine.
"I had a friend who was studying nutrition at the time. She put me on a three-week juice fast followed by a Paleo-style diet," said Angela. "I also started taking anti-inflammatory herbs like devil's claw and chamomile."
Angela was keen to reduce the amount of medication she was on, but her rheumatologist advised against it, telling her she'd likely have to take the drugs for the rest of her life.
But a couple of years later, Angela went on vacation and forgot to take her drugs with her. Her initial feeling of panic turned to hope when she realized that neither her mobility nor her pain levels changed when she stopped taking the medication. "The pain didn't worsen, and I could still get around, so I didn't take any more drugs."
At her next check-up, Angela's rheumatologist told her that it was a bad idea to stop taking the drugs, especially so suddenly. "I understood. It's definitely not something I would ever advise anyone else to do, as stopping medication can have dangerous repercussions."
But Angela was adamant about being drug-free, and she decided to focus fully on natural treatments instead.
"When I told the rheumatologist which herbs I was taking and what other changes I was making to my lifestyle and diet, he was unimpressed. I told him that I had challenged myself to do a triathlon in two years' time, to which he replied that there was 'no chance.'"
Swim, bike, run
Still, Angela continued with the herbs and her Paleo-style diet, and added the supplement MSM, or methylsulfonylmethane, to her alternative regime. MSM is an organic sulfur compound, found naturally in fruits, vegetables, animals and humans, that's become a popular natural remedy for pain and inflammation (see box, page 70).
At this point, Angela's knee was much improved, although not 100 percent back to normal—she still experienced pain and reduced mobility. But she was serious about wanting to do a triathlon, so she enlisted the help of Samantha Gardiner, a Great Britain Age-Group triathlete and practitioner of the Feldenkrais method, a type of exercise therapy focusing on both mind and body.
"I started swimming with Samantha and went from strength to strength," said Angela. "She got me into open water swimming. I found it to be extremely helpful. It's very good for your immune system."
With Samantha's help, Angela gradually added cycling and running to her training plan. "It was painful at first, but my body increasingly began to respond to exercise...It was like my legs were remembering what they used to do."
Angela struggled with running the most, but found that 'barefoot' running helped—running with special, minimally cushioned shoes and landing on the ball rather than the heel of the foot. "It's supposed to reduce the risk of injury," said Angela.
After about 18 months of training with Samantha, Angela completed her first triathlon, at the age of 46—a 750 m swim, 20 k cycle and 5 k run. "It was amazing," said Angela. "I wasn't worried about the time or the fact that I had to walk for some of it. I was just enjoying the moment and being able to do these things again."
Today, Angela says she's in the best shape of her life. "It's been four years since I've taken any kind of medication and my knee is fine. I'm pain free and enjoy more mobility than I've had since I was a teenager."
She still doesn't know exactly what was wrong with her knee, or which treatment, or combination of treatments, solved the problem, but she continues to follow a Paleo-style diet, take appropriate herbs and supplements, and stay active by swimming, cycling and running.
Angela was so convinced by her switch to a drug-free approach that she decided to leave her career in fashion for one in natural medicine, and thanks to the College of Naturopathic Medicine (CNM) where she studied, she's now a qualified practitioner with clinics in Manchester and Glasgow.
"Having done so much investigating on my personal health journey, I wanted both to help myself with all the information I would be learning, and do something meaningful and help people improve their health. I've got my nutrition and naturopathy diplomas, and I'm currently waiting for my results in herbal medicine."
Angela can't quite believe she's gone from hobbling around on crutches to completing a triathlon in just a few years—and without the drugs her doctor told her she would need to take for life. So will she be doing more triathlons? "You bet!" she says. "I'm so looking forward to the next one."
Angela's anti-inflammatory diet
Angela followed a modified Paleo diet, which involves eating foods our ancient ancestors would have eaten, like meat, fish, vegetables, nuts and seeds, and avoiding foods like dairy, grains, and anything high in sugar or processed. Here's an example of what Angela would eat on a typical day.
One egg plus a bowl of salad (arugula, radish, broccoli, cucumber, peppers, tomatoes, avocado) dressed with olive oil, garlic, lemon and chilli and sprinkled with nuts and seeds
Salad (same as breakfast) with either fish or chicken
Fish or chicken with roasted or stir-fried mixed vegetables, brown rice or quinoa, plus beans, lentils or chickpeas
Cucumber, carrots or dark chocolate as a treat
Filtered and 'alkalized' water; water mixed with Vibrant Health superfood powders plus a pinch of cayenne pepper and lemon juice
MSM: a miracle supplement?
Largely thanks to the book The Miracle of MSM: The Natural Solution for Pain by Drs. Stanley Jacob and Ronald Lawrence (G.P. Putnam's Sons, 1999), methylsulfonylmethane, or MSM, has become a popular dietary supplement for chronic pain and inflammatory conditions like arthritis.
A form of biologically active sulfur, MSM is a compound found in fruits, vegetables, grains, animals and humans that proponents claim can remedy everything from joint pain to hay fever. But what does the science say?
Several studies suggest that MSM may be useful for arthritis. Laboratory and animal studies have found the supplement to have anti-inflammatory activity1 as well as cartilage-protecting effects.2 And controlled clinical trials of patients with osteoarthritis show that it can improve pain, stiffness, swelling and physical function.3
MSM has also been found to improve inflammation in a number of other conditions including colitis and lung and liver injuries, at least in animal studies, while human trials have reported that it can help with exercise-induced muscle damage and hay fever.4
According to one of the latest scientific reviews of the supplement, "MSM is well-tolerated by most individuals at dosages of up to four grams daily, with few known and mild side-effects."4 In fact, MSM is 'generally recognized as safe' (GRAS) by the Food and Drug Administration.
College of Naturopathic Medicine