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Joint Health - Osteoarthritis
Arthritis affects more Canadian adults than cancer, heart disease, respiratory conditions and spinal cord trauma. (1) Osteoarthritis, the most common of all arthritic conditions strikes 1 in 10 Canadians and is among the most commonly diagnosed chronic condition in this country today. (2) Also known as Joint Degeneration Disease, Osteoarthritis can have a devastating impact on one’s quality of life, making simple tasks like buttoning a shirt or holding a pen too painful to complete.
There are more than 100 different types of arthritis that can be broadly categorized into two major groups: osteoarthritis and inflammatory arthritis. Inflammatory arthritis encompasses the autoimmune forms of arthritis where the body’s own immune system attacks tissues and joints resulting in inflammation and damage. Rheumatoid arthritis is the most common form of inflammatory arthritis. Other forms include ankylosing spondylitis, psoriatic arthritis and lupus.
Osteoarthritis – or degenerative joint disease – is the most common form of all types of arthritis, affecting thirteen percent of Canadian adults. (1) The word arthritis means inflammation of the joint, taken from the Greek arthron meaning joint and the Latin itis for inflammation. Osteoarthritis occurs when the tough, elastic, shock-absorbing cartilage that covers and protects the ends of bones begins to wear away. What was once a smooth and slippery surface permitting almost frictionless movement becomes pitted and rough, often deteriorating until there is painful bone-on-bone contact in the joint. The weight-bearing joints of the hips, knees, neck and spine as well as the hands are affected most often but really any joint in the body can be damaged.
Osteoarthritis generally progresses gradually over a period of months to years. Signs and symptoms include (2):
• Pain. In the early stages, your joint may start to hurt during or after rigorous or high impact activities. As the joint deterioration progresses, pain is triggered with ordinary activities and is generally relieved with rest.
• Tenderness. Your joint may feel tender when pressure is applied to it.
• Stiffness. This is most noticeable in the morning or after a period of inactivity.
• Loss of flexibility. You may not be able to move the joint through its full range of motion. This is often compounded by increased swelling.
• Bone spurs. As the cartilage wears down, the joints may slowly become bigger and boney as the body tries to heal itself.
• Muscle weakness. As the pain and stiffness cause the joints to be used less, the muscles surrounding the joints tend to weaken.
Factors to Consider:Factors to Consider
Age – As with many things, the likelihood of developing osteoarthritis increases with age. However, bone and joint degeneration are not an inevitable part of aging and we will share with you ways to safeguard your mobility for a lifetime. (3,4)
Nonsteroidal Anti-Inflammatory Drugs – NSAIDS including Celebrex, aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve) are among the most commonly used drugs for the treatment of osteoarthritis. However, it is well documented in scientific studies that these drugs accelerate the articular cartilage breakdown in joints and promote the progression of osteoarthritis. (5)
Excess weight – More body weight puts more stress on your weight-bearing joints such as the knees. Every pound you gain adds 3-4 pounds of extra weight on your knees. (6) Weight loss can decrease the pain and speed of deterioration of the joint. In Canada, 74% of hip replacements and 87% of knee replacements are performed on overweight or obese people. (16)
Joint Injury – Previous injuries from sports activities or accidents can increase the risk of osteoarthritis in the affected joints. This is often called secondary osteoarthritis.
Smoking – A 30 month longitudinal study (meaning a study conducted over a certain time frame) on men with knee osteoarthritis found that the smokers were more likely to have cartilage loss and greater pain than the non-smokers. (7) It is known that smoking increases oxidative stress in the body and this may be one of the mechanisms contributing to cartilage loss. (8, 9) Cigarette smoking also decreases the amount of oxygen in the blood, perhaps making cartilage repair by the body more difficult. (10)
Family history – It is known that you are more likely to develop osteoarthritis if your parents had it and now a major European study published in the Lancet in 2010 has found clues to the genetic causes of osteoarthritis. (11) The study highlighted eight genetic regions linked to the development, production and maintenance of healthy cartilage as well as genetic regions involved in the regulation of body weight, which is a strong risk factor for osteoarthritis. It must be noted however, that osteoarthritis is a complex disorder with both genetic and environmental causes which can be modified with diet and lifestyle.
Address the Stress
Just as lifestyle habits such as drinking alcohol and smoking cigarettes can rob the body of important minerals needed for bone and joint health, so too can stress.
When you experience stressful feelings, your internal environment, or pH becomes increasingly acidic. The body is constantly working to maintain an alkaline internal pH for the maintenance of health and wellness.
Minerals are very alkalizing and so when your internal “chemical soup” starts to boil over, the body will draw minerals out of storage and use them to bring the internal pH back to baseline.
Stressful feelings can place an excess burden on your bones and joints by robbing them of much needed nutrients. Poor dietary habits contribute to the body’s depletion.
Conventional Medical Diagnosis and Treatment
There is no one single test or blood test for osteoarthritis, although your doctor may draw blood to exclude other arthritis conditions that can mimic osteoarthritis. X-rays are often used and are helpful to show loss of joint cartilage, narrowing of the joint space between bones and bone spur formation. Arthrocentesis, the removal of joint fluid by a sterile needle, may help your doctor exclude gout and infection. Arthroscopic surgery, where a viewing tube is inserted into the affected joint, can show damage to the cartilage and repairs can sometimes be made at the same time. Most importantly though your doctor will do a careful analysis of appearance and symptoms in order to diagnose osteoarthritis.
Although you have likely been told that no cure exists for osteoarthritis, treatments can slow or halt the progression of the disease, relieve pain and improve joint function and mobility.
• Physical Activity – The old adage of ‘use it or lose it’ very definitely applies for osteoarthritis. Low-impact exercise like walking, bicycling and swimming are helpful for maintaining joint range of motion and mobility and decreasing stiffness. But is it not just about going out and getting some exercise. You also want to be aware of how much you move during the day apart from actual exercise. Getting up at least once every hour to move around will help reduce stiffness and keep joints limber. Stretching is important for joint mobility and should be part of your daily routine, but don’t stretch cold muscles – do a light warm up first to loosen up. Toning up and gaining some muscle is also helpful for improving balance and supporting the joints. Here is a link to the Top 10 Exercises for Arthritis from The Arthritis Society.http://www.arthritis.ca/document.doc?id=329
• Therapies – Physiotherapy can help strengthen the muscles around joints and increase range of motion to help increase mobility. Occupational therapy will help you with assistive devices and learning ways of doing everyday tasks without putting extra stress on painful joints. Massage, acupuncture and relaxation and meditation techniques can also help with pain reduction and coping skills.
• Medications – Drugs are prescribed for osteoarthritis to control the pain, stiffness and swelling with the hope of maintaining joint function. Acetominophen (Tylenol, others) relieves pain but does not reduce inflammation. Taking more than the recommended dosage can cause severe liver damage and its side effects are multiplied when combined with alcohol. (12, 13) Nonsteroidal anti-inflammatory drugs (NSAIDs) (Aspirin, Motrin, Advil, Aleve) relieve pain and reduce inflammation. This class of drug can cause stomach upset, ringing in the ears, cardiovascular problems, bleeding problems and liver and kidney damage. (14) As mentioned earlier, these drugs promote the progression of osteoarthritis even as they help with the pain. (5) Narcotics (Tylenol with Codeine, OxyContin, Percocet) are prescription medications that may provide relief for more severe osteoarthritis pain but do not reduce inflammation. These stronger drugs carry a risk of developing tolerance and dependence, as well as the same risks of using acetaminophen. Topical medications – There are a number of over-the-counter creams and rubs available to help with the symptoms of osteoarthritis. Salicylates are one of the active ingredients found in these medications and they work by decreasing pain and inflammation. Capsaicin is another ingredient that works by blocking the transmission to the brain of a pain-relaying substance, funnily enough, called Substance P. Camphor, eucalyptus oil and menthol are ingredients that trick the body into feeling the coolness or heat of these agents as opposed to the painful joint.
• Surgical and other procedures – Cortisone shots may relieve the pain in the joint by reducing the inflammation. However, the number of cortisone shots you can get each year is limited because the corticosteroid can actually thin the joint cartilage and weaken the ligaments surrounding the joint. (15) Lubrication injections of hyaluronic acid may bring pain relief by lubricating and cushioning the joint. These injections contain a substance similar to a component normally found in the joint fluid.
• Joint replacement – In joint replacement surgery (arthroplasty), the damaged joint surfaces are removed and replaced with plastic and/or metal. The hip and the knee are the most commonly replaced joints. In Canada in 2006, there were 57,300 hip or knee replacements performed and that number is growing every year. (16) Surgical risks include infection and blood clots. Artificial joints can wear out or come loose and may need to be replaced over time.
We put food into our bodies many times per day, day in and day out. This food is broken down by our digestive system into its component parts which then travel throughout the body to give instructions to our individual cells. So food is really information that has a profound effect on our health. We want to put the right information in to get the right response of health as opposed to disease or dysfunction. There is ample evidence of reduced disease risk with the Mediterranean-style diet – a prime example of an anti-inflammatory diet that can be used to treat osteoarthritis. (17)
An anti-inflammatory diet includes:
• Foods that have a low glycemic load. Foods with added sugar and/or processed grains (flour) are digested quickly, flooding the blood with glucose. To clear this large volume of glucose, your pancreas pumps out insulin to shuttle the sugar from your blood into the cells where it is converted to a useable form of energy. When this pattern is repeated over time, the cells become damaged and less responsive to the action of insulin. Larger amounts of glucose and AGEs (advanced glycation and products – these are formed when sugar molecules in the blood attach to protein molecules on the surface of cells causing them to lose function) remain in the blood and the body responds with an inflammatory reaction to try to heal the damaged tissues. (18) Eating whole foods that contain more fibre and avoiding processed foods will help ensure a more gradual flow of glucose into the blood and an avoidance of damaging insulin spikes.
• A proper balance of omega-3 oils. We are increasingly understanding the enormous differences in types of fat and the effects on our health. For instance, trans fats (hydrogenated oils, partially-hydrogenated oils, shortening, fried foods) are known to increase the very small dense LDL cholesterol particles in the blood which the body tries to counteract with inflammation in a bid to promote healing. (19) Omega-6 fats, while essential to the body, must be present in an appropriate ratio to omega-3 fats, which are also essential. The problem here is that the North American diet contains too much omega-6 (corn, peanut, soybean, canola, sunflower, safflower, grape seed) in relation to omega-3 (sardines, mackerel, herring, salmon, anchovies, arctic char, caviar, walnuts, flax seeds, chia seeds) and this imbalance also tips the scales in favour of inflammation. (20)
• High levels of phytonutrients. Phytonutrients are compounds in plants that help them defend themselves from such things as pests, mold and sun. These phytonutrients also give fruits and vegetables their colour, fragrance and taste. Although these compounds are not well absorbed into cells, their power is that they influence cellular function through the expression of genes that regulate the production of anti-inflammatory compounds in the body. (21) Eating adequate amounts of vegetables, herbs, spices and fruits will promote this process and help reduce chronic inflammatory conditions.
• Probiotics, prebiotics, fermented foods and fibre. The health of the intestinal tract determines which nutrients are absorbed and which toxins, allergens, and microbes are kept out. Since 70% of the immune system cells are found along the lining of the digestive tract, your immune system response is hugely affected by the foods that interact with your gut. Probiotics and fermented foods (sauerkraut, kefir, plain yogurt, miso) promote a healthy bacterial balance in the digestive tract while prebiotics and fibre help support this balance. Determining whether or not you have any food allergies or sensitivities is important and is at the root of a healthy gut and an optimal immune and inflammatory response. (20, 21)
• Attention to the nightshade family of foods. In some genetically-sensitive people, regular consumption of nightshades (tomatoes, potatoes, eggplant, all peppers, tobacco) can worsen osteoarthritis. (22) It is believed that the alkaloids in these foods promote inflammation and inhibit normal collagen repair in the joints. Not everyone has this genetic trait so you may want to remove all nightshades from you diet for at least 3-4 weeks and observe the impact on your condition.
Egg Shell Membrane
Biovaflex egg shell membrane is a natural, water-soluble complex of proteins and small peptides produced by a patented hydrolyzation process. This compound provides a unique source of key bioactive compounds important for tissue structure and integrity. In a human clinical trial conducted with participants who had knee osteoarthritis, significant improvement was documented in mobility, joint function and pain symptoms as measured by the WOMAC score (Western Ontario and McMaster Universities Arthritis Index). (33)
Omega-3 oil/Krill oil
There have long been anecdotal reports about the benefits of fish oils for joint health, and while omega-3 fats help reduce general inflammation (and therefore stiffness) in the body and are vital for healthy cell membranes, there has been little strong scientific evidence to support its direct effect on osteoarthritis. Recent animal research from the University of Bristol however, has shown that the omega-3 in fish oil could “substantially and significantly” reduce the signs and symptoms of osteoarthritis. (26) According to the lead researcher Dr. John Tarlton, “there was strong evidence that omega-3 influences the biochemistry of the disease, and therefore not only helps prevent disease, but also slows its progression, potentially controlling established osteoarthritis.” (27) Further studies are needed to confirm the effects in human osteoarthritis. The high omega-6 polyunsaturated fatty acid intake in the standard North American diet has been associated with a number of inflammatory disorders such as heart disease and osteoarthritis. (28) This modern diet has a ratio of omega-6: omega-3 of between 15 and 30:1, whereas the hunter-gatherer diets for which we are naturally adapted had roughly equal levels of omega-6 and omega-3. (29) Supplementation of omega-3 would address this imbalance and its resulting health consequences.
Astaxanthin is the most abundant carotenoid pigment found in crab, shrimp and krill. Its unique molecular structure makes it one of the most powerful lipophilic antioxidants. As such, it protects the body from oxidation which leads to cell and tissue damage.
Vitamin D is crucial for your overall health. Among other jobs in the body, it helps maintain strong bones, regulate immune activity and reduce inflammation. A number of research studies suggest that getting enough vitamin D may slow the progression and worsening of osteoarthritis. Vitamin D appears to bind with certain receptors in the cartilage where it affects chemical activity in the cells themselves. (31, 32)
Cat’s Claw Extract (Unicaria guianensis)
Cat’s Claw is a woody vine native to Central and South America that demonstrates powerful antioxidant and anti-inflammatory effects as well as immune-modulation capabilities. One study has shown that cat’s claw may help to preserve healthy cartilage in aging joints by suppressing inflammatory agents that can degrade cartilage while activating a compound that actually protects cartilage. (23) Participants and physicians in another clinical trial recorded significant improvements within just one week in the subjective assessment of osteoarthritis pain. (24)
Maca Extract (Lepidium meyenii)
Maca is a root vegetable that only grows high in the Andes Mountains of Peru. It has been used by the Incas for millennia as an adaptogenic tonic to help restore energy, vitality and sexual health. One study showed that Maca can activate the expression of Insulin-like Growth Factor 1 (IGF-1) in local tissues independent of other stimuli. (25) IGF-1 is a strong stimulator of cell growth and repair but it is normally supressed when there is inflammation present as with osteoarthritis. When IGF-1 is turned on, there can be new cartilage regeneration and strengthening of the supporting muscles and ligaments.
Curcumin (Curcuma longa)
Curcumin is a constituent of turmeric and has been used medicinally in both Traditional Chinese and Ayurvedic medicine for a variety of inflammatory conditions and liver disorders. A study published in Alternative Medicine Review showed that curcumin increased mobility, relieved pain and reduced inflammatory markers in subjects with osteoarthritis. (30)
Zwell Lifestyle Recommendations
Eat whole foods. A diet rich in nutrients from unprocessed foods is foundational for health. Putting the right building blocks into the body in terms of good fats, slow carbohydrates and lean proteins, means the body can repair and regenerate bone and cartilage – which it tries to do for your entire life. Processed foods deplete the body of important vitamins, minerals and enzymes that are needed to stop or slow the progression of osteoarthritis. Being overweight puts a lot more stress on all our joints and dramatically increases the likelihood of joint replacement. Achieving and maintaining your optimal weight along with a good amount of muscle will help keep you more active with healthier joints. Please see the components of an anti-inflammatory diet listed above under Nutritional Guidelines.
Drink water. Water is as essential a nutrient to the body as are proteins, fats and carbohydrates. Consuming enough water allows for a better flow of nutrients into the cells and facilitates better toxin removal. Being dehydrated forces the body to operate at sub-optimal levels of health. Good hydration can also help lubricate the joints and protect the cartilage.
Sweat. In a 2009 poll commissioned by the Arthritis Society of Canada, almost two-thirds of Canadians living with arthritis reported that they believe physical activity poses the risk of aggravating their symptoms. Many remain sedentary in an attempt to keep their joints comfortable but this is a dangerous and unhealthy misconception. In fact, strengthening the muscles, ligaments and tissues surrounding affected joints can diminish pain, increase mobility, improve flexibility and promote long-term health. “The benefits of physical activity for people with arthritis are remarkable,” notes Dr. Joanne Homik, Chair of The Arthritis Society’s Medical Advisory Committee.
Connect. Pain and decreased mobility can often lead to feelings of isolation and depression. But a diagnosis of osteoarthritis does not need to be a life sentence. Use the strategies we have outlined here to manage and even reverse your symptoms. Be active in every way; proactive, interactive and physically active. The end result can be very enjoyable!
1. The Arthritis Society of Canada
2. The Mayo Clinic
3. Encyclopaedia of Natural Medicine. Michael Murray, Joseph Pizzorno. Simon & Schuster, 2012.
4. JH Bland, SM Cooper.” Osteoarthritis: A review of the cell biology involved and the evidence for reversibility: Management rationally related to known genesis and pathophysiology.” Sem Arthr Rheum 14 (1984): 106-33.
5. RA Hauser, MD. The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-Inflammatory Drugs. Journal of Prolotherapy. 2010;(2) 1:305-322.
7. Ann Rheum Dis. Jan 2007;66(1): 18-22.
8. Durak I, Bingol N K, Avci A, Cimen M Y, Kacmaz M, Karaca L. et al. « Acute effects of smoking of cigarettes with different tar content on plasma oxidant/antioxidant status.” Inhal Toxicol 2000. 12641–647
9. Tiku M L, Shah R, Allison G T. “Evidence linking chondrocyte lipid peroxidation to cartilage matrix protein degradation. Possible role in cartilage aging and the pathogenesis of osteoarthritis.” J Biol Chem 2000. 27520069–20076.)
10. McDonough P, Moffatt R J. “Smoking‐induced elevations in blood carboxyhaemoglobin levels. Effect on maximal oxygen uptake.” Sports Med 1999. 27275–283
13. Hughes, John (2008). Pain Management: From Basics to Clinical Practice. Elsevier Health Sciences. ISBN 9780443103360.
17. KT Knoops, LC deGroot, D Kromhout, AE Perrin, O Moreiras-Varela, et al. “Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.” JAMA. 2004 Sept 22;292(12):1433-39.
20. J Daniluk. Meals That Heal Inflammation. Random House, 2011.
21. JS Bland. The Disease Delusion. Harper Collins. 2014.
22. NF Childers, MS Margoles. “An apparent relation of Nightshades (Solanaceae) to arthritis.” J Neutrol Orthop Med Surg 1993; 14: 227-231.
23. Miller MJ, Ahmed S, Bobrowski P, Haqqi TM. “The chrondoprotective actions of a natural product are associated with the activation of IGF-1 production by human chondrocytes despite the presence of IL-1beta.” BMC Complement Altern Med. 2006 Apr 7;6:13.
24. Piscoya J, Rodriguez Z, Bustamante SA, Okuhama NN, Miller MJ, Sandoval M. “Efficacy and safety of freeze-dried cat’s claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis”. Inflamm Res. 2001 Sep;50(9):442-8.
25. “The chondroprotective actions of a natural product are associated with the activation of IGF-1 production by human chondrocytes despite the presence of IL-1B.” BMC Complement Altern Med. 2006; 6: 13.
26. L. Knott, N.C. Avery, A.P. Hollander, J.F. Tarlton. “Regulation of osteoarthritis by omega-3 (n-3) polyunsaturated fatty acids in a naturally occurring model of disease.” Osteoarthritis and Cartilage, 2011; 19 (9): 1150
28. Simopoulos A.P. “Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases.” Biomed Pharmacother. 2006;60:502–507
29. Wang Y., Wluka A.E., Hodge A.M., English D.R., Giles G.G., O’Sullivan R. “Effect of fatty acids on bone marrow lesions and knee cartilage in healthy, middle-aged subjects without clinical knee osteoarthritis.” Osteoarthritis Cartilage. 2008;16:579–583.
31. C Ding et al. “Serum Levels of Vitamin D, Sunlight Exposure, and Knee Cartilage Loss in Older Adults: The Tasmanian Older Adult Cohort Study.” Arthritis & Rheumatism. May 2009, vol. 60, no. 5, pp. 1381-1389.
32. AP Bergink et al. “Vitamin D Status, Bone Mineral Density, and the Development of Radiographic Osteoarthritis of the Knee: The Rotterdam Study.” Journal of Clinical Rheumatology. August 2009, vol. 15, no. 5, pp. 230-237.
33. Kevin J Ruff, Dale P DeVore, Michael D Leu, Mark A Robinson. Eggshell membrane: A possible new natural therapeutic for joint and connective tissue disorders. Results from two open-label human clinical studies. Clinical Interventions in Aging. May 2009 Volume 2009:4 Pages 235—240