Osteoarthritis (OA) is the most common diagnosis that can affect any joint, but most often in the knees, hips, spine, small joint of the hand. Hallmark symptoms of osteoarthritis pain and stiffness of the joint. It is considered a degenerative disorder that results from the breakdown of the cartilage that provides the smooth surface of the joint for motion and acts as a cushion. This disease affects about 27 million Americans. Causes and risk factors for developing osteoarthritis are genetics, obesity, and overuse. 1
The pathophysiology link between obesity and osteoarthritis is related to both the direct excess of mechanical loads on the cartilage, but also the adipose tissue releasing leptin. In both scenarios, there ends up being an increase in inflammation, which helps to drive the tissue breakdown. 2 To describe this further, I often discuss with patients the “coin analogy.”
Let’s say the coin is osteoarthritis pain. On one side you have a mechanical inflammatory response related to things like injury, overuse, genetic (i.e. malformed joint), lack of movement (sedentary lifestyle, not moving through full range of motion of joints to allow lubrication) or obesity (increased joint forces). On the other side of the coin you have a systemic inflammatory responses related to adipose tissue effect (adipocytes produce inflammatory adipokines) 2, blood sugar dysregulation (diabetes or Metabolic Syndrome all related to poor dietary habits high in sugar and nutrient deficient foods), chronic gastrointestinal disruptors (like dysbiosis or microbiome imbalance) and systemic infection (bacterial or viral).
The case for osteoarthritis being called diabetes of the joint is linked primarily to the systemic inflammatory condition. Much like diabetes being associated with irregular blood sugar regulation and poor nutritional choices, so does osteoarthritis. As we will see later, osteoarthritis is multi-factorial, but there is a significant risk associated with systemic inflammatory process and the development of osteoarthritis.
Whether you come at the osteoarthritis pain from the local inflammatory pathway and/or systemic inflammatory pathway, you still have osteoarthritis and pain. The two inflammatory pathways are not mutually exclusive. For example, your systemic inflammatory condition like Metabolic Syndrome (as described in an earlier post) can lead to a disruption of the joint, which thereby begins the mechanical inflammatory response with abnormal joint movement. You can see the vicious cycle begin.
Diagnostic criteria include a physical exam of the painful joint assessing range of motion and strength. Xrays may be warranted to assess the joint space and integrity. Further testing like an MRI may be ordered to further evaluate the soft tissue surrounding the joint as well as the cartilage and labral integrity of the joint if appropriate.
One of the most common treatments for osteoarthritis is Non-Steroidal Anti-Inflammatories (NSAIDs), which may only hold a partial and temporary relief to the symptom of pain, but does not change the trajectory of the disease process or the health of the joint. They may even disrupt the supportive soft tissue of the joint. 3Additionally, NSAIDs and other anti-inflammatory medications have many side-effects including gastrointestinal upset.
So how do you manage, improve and maybe even decrease your personal risk of osteoarthritis?
In keeping with SOAR’s principles; Eat well, Move well, Sleep well, Soar On, we will try to cover the items in each category to remove, replace, in order to restore joint health and even delay progression.
Let’s start by addressing the nutritional components that drive systemic inflammation that contribute to a degradation of joint health. Systemic inflammatory dietary contributors (directly or indirectly) to poor joint health are:
What is more amazing, is the natural and whole food components that mitigate and even improve systemic inflammation. Here are a list of things that reduce systemic inflammation and thereby potentially decrease the pain and even improve joint health:
Pretty amazing that some very simple, whole food items carry a very large impact on your systemic inflammatory response that indirectly and directly will improve your joint health.
Remove. Replace. Restore.
Remove refined sugar, refined vegetable oils and food like substances.
Replace with whole fruits and vegetables along with wild fish and grass fed meats for an anti-inflammatory impact.
Restore a normal inflammatory response.
There are a few critical components to keeping the mechanical inflammation in check. My top recommendations to maintain joint health mechanically are:
Keeping the joint moving, even if osteoarthritis has already started will keep it lubricated. Once the degenerative process has been initiated, it can be halted with healthy movement. It is important to listen to the pain, but not to avoid movement because of the pain. The mechanical movement is important to keeping the joint nourished.
If you find your self struggling to get moving either before osteoarthritis or after the diagnosis, a movement specialist can help you along.
Remove. Replace. Restore
Remove stagnancy and fear of pain from osteoarthritis
Replace with gentle movement of the joint through its full range of motion. Initiate an exercise program and daily movement to keep the muscles strong.
Restore joint health.
The importance of sleep cannot be overstated as a means to recovery and repair, especially recovery from a mechanical injury to the joint. Your sleep-wake cycle is governed by your circadian rhythm regulated by the sun. Yet, did you realize that even the health of your joints and risk of osteoarthritis is also affected by disruption of your circadian rhythm?
Disruption of your circadian rhythm especially chronically appears to have osteoarthritis like pathological changes in the mouse joint while eating a high fat diet. 62 Alternating the light- dark cycle mimicking shift work disrupted the circadian rhythm producing proteoglycan loss involved in cartilage homeostasis.
In today’s world, even without shift work, we disrupt our own circadian rhythm by looking at screens (computer, ipad, phone, TV), heavy lighting when it is dark out, and evening staying up late in addition to eating the Standard American Diet. This sets us up for a host of diseases, now to include osteoarthritis.
How do you avoid disruption of the circadian rhythm?
Remove. Replace. Restore.
Remove screens from the bedroom and 1-2 hours before bed.
Replace regular bedtime in a dark, cool room. Get sunshine during the day. Eat a healthy vitamin rich diet.
Restore a normal circadian rhythm and healthy joints.
This principle is the most flexible of connection and purpose. For the sake of Osteoarthritis and joint health, this primarily indicates the need to connect to your joints. Listen. And if you can find a group of people who care to keep their joints healthy, then spend time with this group.
Connecting to people with similar goals is a great way to keep on track. Those with similar conditions can also be a great resource to share information.
Move your body on purpose; with a pet or a friend.
Remove. Replace. Restore.
Remove isolation and doing it alone.
Replace with connection to a group, a person, or pet to help keep you on track. Seek help from a professional if you get stuck.
Restore joint health.
If we return to our “coin” we can see that taking control over the things you can control you just may decrease your risk of developing osteoarthritis, and improve your condition using four simple steps.
Eat well. Move well. Sleep well. Soar On….even with osteoarthritis
1. Authritis foundation. www.arthritis.org.
2. Duclos M. Osteoarthritis, obesity and type 2 diabetes: The weight of waist circumference. Ann Phys Rehabil Med. 2016;59(3):157-160.
3. Chechik O, Dolkart O, Mozes G, Rak O, Alhajajra F, Maman E. Timing matters: NSAIDs interfere with the late proliferation stage of a repaired rotator cuff tendon healing in rats. Arch Orthop Trauma Surg. 2014;134(4):515-520.
4. American college of allergy, asthma, and immunology. www.acaai.org.
5. Blackmore KM, Wong J, Knight JA. A cross-sectional study of different patterns of oral contraceptive use among premenopausal women and circulating IGF-1: Implications for disease risk. BMC Womens Health. 2011;11:15-6874-11-15.
6. Dam AN, Berg AM, Farraye FA. Environmental influences on the onset and clinical course of crohn's disease-part 1: An overview of external risk factors. Gastroenterol Hepatol (N Y). 2013;9(11):711-717.
7. Berg AM, Dam AN, Farraye FA. Environmental influences on the onset and clinical course of crohn's disease-part 2: Infections and medication use. Gastroenterol Hepatol (N Y). 2013;9(12):803-810.
8. de Oliveira LP, Vieira CP, Da Re Guerra F, de Almeida Mdos S, Pimentel ER. Statins induce biochemical changes in the achilles tendon after chronic treatment. Toxicology. 2013;311(3):162-168.
9. Lingelbach LB, Mitchell AE, Rucker RB, McDonald RB. Accumulation of advanced glycation endproducts in aging male fischer 344 rats during long-term feeding of various dietary carbohydrates. J Nutr. 2000;130(5):1247-1255.
10. Li Y, Fessel G, Georgiadis M, Snedeker JG. Advanced glycation end-products diminish tendon collagen fiber sliding. Matrix Biol. 2013;32(3-4):169-177.
11. Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes. 2012;5:175-189.
12. Ruskin DN, Kawamura M, Masino SA. Reduced pain and inflammation in juvenile and adult rats fed a ketogenic diet. PLoS One. 2009;4(12):e8349.
13. Chen Y, Fan JX, Zhang ZL, et al. The negative influence of high-glucose ambience on neurogenesis in developing quail embryos. PLoS One. 2013;8(6):e66646.
14. Robbins PI, Raymond L. Aspartame and symptoms of carpal tunnel syndrome. J Occup Environ Med. 1999;41(6):418.
15. Horio Y, Sun Y, Liu C, Saito T, Kurasaki M. Aspartame-induced apoptosis in PC12 cells. Environ Toxicol Pharmacol. 2014;37(1):158-165.
16. Ashok I, Sheeladevi R. Biochemical responses and mitochondrial mediated activation of apoptosis on long-term effect of aspartame in rat brain. Redox Biol. 2014;2:820-831.
17. Abdel-Salam OM, Salem NA, El-Shamarka ME, Hussein JS, Ahmed NA, El-Nagar ME. Studies on the effects of aspartame on memory and oxidative stress in brain of mice. Eur Rev Med Pharmacol Sci. 2012;16(15):2092-2101.
18. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181-186.
19. Lindseth GN, Coolahan SE, Petros TV, Lindseth PD. Neurobehavioral effects of aspartame consumption. Res Nurs Health. 2014;37(3):185-193.
20. Bendsen NT, Christensen R, Bartels EM, Astrup A. Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: A systematic review and meta-analysis of cohort studies. Eur J Clin Nutr. 2011;65(7):773-783.
21. Trevizol F, Roversi K, Dias VT, et al. Cross-generational trans fat intake facilitates mania-like behavior: Oxidative and molecular markers in brain cortex. Neuroscience. 2015;286:353-363.
22. Barcelos RC, Vey LT, Segat HJ, et al. Cross-generational trans fat intake exacerbates UV radiation-induced damage in rat skin. Food Chem Toxicol. 2014;69:38-45.
23. Okada Y, Tsuzuki Y, Ueda T, et al. Trans fatty acids in diets act as a precipitating factor for gut inflammation? J Gastroenterol Hepatol. 2013;28 Suppl 4:29-32.
24. Ahmad SO, Park JH, Radel JD, Levant B. Reduced numbers of dopamine neurons in the substantia nigra pars compacta and ventral tegmental area of rats fed an n-3 polyunsaturated fatty acid-deficient diet: A stereological study. Neurosci Lett. 2008;438(3):303-307.
25. Karl JP, Alemany JA, Koenig C, et al. Diet, body composition, and physical fitness influences on IGF-I bioactivity in women. Growth Horm IGF Res. 2009;19(6):491-496.
26. Lipski, Elizabeth PhD CCn CHN. Digestive wellness. 4th Edition ed. United States of America: Mc GRaw Hill; 2012.
27. Dickerson FB, Stallings C, Origoni A, et al. Effect of probiotic supplementation on schizophrenia symptoms and association with gastrointestinal functioning: A randomized, placebo-controlled trial. Prim Care Companion CNS Disord. 2014;16(1):10.4088/PCC.13m01579. Epub 2014 Feb 13.
28. Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A, Sharif SK, Asghari-Jafarabadi M, Zavvari S. Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition. 2014;30(4):430-435.
29. Ahmad SO, Park JH, Radel JD, Levant B. Reduced numbers of dopamine neurons in the substantia nigra pars compacta and ventral tegmental area of rats fed an n-3 polyunsaturated fatty acid-deficient diet: A stereological study. Neurosci Lett. 2008;438(3):303-307.
30. Gomez-Pinilla F, Tyagi E. Diet and cognition: Interplay between cell metabolism and neuronal plasticity. Curr Opin Clin Nutr Metab Care. 2013;16(6):726-733.
31. Kaminski WE, Jendraschak E, Kiefl R, von Schacky C. Dietary omega-3 fatty acids lower levels of platelet-derived growth factor mRNA in human mononuclear cells. Blood. 1993;81(7):1871-1879.
32. Dawson DR,3rd, Branch-Mays G, Gonzalez OA, Ebersole JL. Dietary modulation of the inflammatory cascade. Periodontol 2000. 2014;64(1):161-197.
33. Silva PS, Sperandio da Silva GM, de Souza AP, et al. Effects of omega-3 polyunsaturated fatty acid supplementation in patients with chronic chagasic cardiomyopathy: Study protocol for a randomized controlled trial. Trials. 2013;14:379-6215-14-379.
34. Passos PP, Borba JM, Rocha-de-Melo AP, et al. Dopaminergic cell populations of the rat substantia nigra are differentially affected by essential fatty acid dietary restriction over two generations. J Chem Neuroanat. 2012;44(2):66-75.
35. Hansen RA, Harris MA, Pluhar GE, et al. Fish oil decreases matrix metalloproteinases in knee synovia of dogs with inflammatory joint disease. J Nutr Biochem. 2008;19(2):101-108.
36. Lionetti L, Mollica MP, Sica R, et al. Differential effects of high-fish oil and high-lard diets on cells and cytokines involved in the inflammatory process in rat insulin-sensitive tissues. Int J Mol Sci. 2014;15(2):3040-3063.
37. Wei HK, Zhou Y, Jiang S, et al. Feeding a DHA-enriched diet increases skeletal muscle protein synthesis in growing pigs: Association with increased skeletal muscle insulin action and local mRNA expression of insulin-like growth factor 1. Br J Nutr. 2013;110(4):671-680.
38. Luo C, Ren H, Wan JB, et al. Enriched endogenous omega-3 fatty acids in mice protect against global ischemia injury. J Lipid Res. 2014;55(7):1288-1297.
39. Cardoso HD, dos Santos Junior EF, de Santana DF, et al. Omega-3 deficiency and neurodegeneration in the substantia nigra: Involvement of increased nitric oxide production and reduced BDNF expression. Biochim Biophys Acta. 2014;1840(6):1902-1912.
40. San Miguel SM, Opperman LA, Allen EP, Zielinski JE, Svoboda KK. Antioxidant combinations protect oral fibroblasts against metal-induced toxicity. Arch Oral Biol. 2013;58(3):299-310.
41. Urios P, Grigorova-Borsos AM, Sternberg M. Flavonoids inhibit the formation of the cross-linking AGE pentosidine in collagen incubated with glucose, according to their structure. Eur J Nutr. 2007;46(3):139-146.
42. Kim JY, Kawabori M, Yenari MA. Innate inflammatory responses in stroke: Mechanisms and potential therapeutic targets. Curr Med Chem. 2014;21(18):2076-2097.
43. Demirkol A, Uludag M, Soran N, et al. Total oxidative stress and antioxidant status in patients with carpal tunnel syndrome. Redox Rep. 2012;17(6):234-238.
44. Park HB, Hah YS, Yang JW, Nam JB, Cho SH, Jeong ST. Antiapoptotic effects of anthocyanins on rotator cuff tenofibroblasts. J Orthop Res. 2010;28(9):1162-1169.
45. Grieger JA, Wood LG, Clifton VL. Antioxidant-rich dietary intervention for improving asthma control in pregnancies complicated by asthma: Study protocol for a randomized controlled trial. Trials. 2014;15:108-6215-15-108.
46. Grover AK, Samson SE. Benefits of antioxidant supplements for knee osteoarthritis: Rationale and reality. Nutr J. 2016;15:1-015-0115-z.
47. Gu H, Li K, Li X, et al. Oral resveratrol prevents osteoarthritis progression in C57BL/6J mice fed a high-fat diet. Nutrients. 2016;8(4):10.3390/nu8040233.
48. Angeline ME, Ma R, Pascual-Garrido C, et al. Effect of diet-induced vitamin D deficiency on rotator cuff healing in a rat model. Am J Sports Med. 2014;42(1):27-34.
49. Baggerly CA, Cuomo RE, French CB, et al. Sunlight and vitamin D: Necessary for public health. J Am Coll Nutr. 2015;34(4):359-365.
50. Han Q, Yang P, Wu Y, et al. Epigenetically modified bone marrow stromal cells (BMSCs) in silk scaffolds promote craniofacial bone repair and wound healing. Tissue Eng Part A. 2015.
51. Ao J, Li B. Amino acid composition and antioxidant activities of hydrolysates and peptide fractions from porcine collagen. Food Sci Technol Int. 2012;18(5):425-434.
52. Atiba A, Nishimura M, Kakinuma S, et al. Aloe vera oral administration accelerates acute radiation-delayed wound healing by stimulating transforming growth factor-beta and fibroblast growth factor production. Am J Surg. 2011;201(6):809-818.
53. Kongtharvonskul J, Anothaisintawee T, McEvoy M, Attia J, Woratanarat P, Thakkinstian A. Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: A systematic review and network meta-analysis. Eur J Med Res. 2015;20:24-015-0115-7.
54. Bruyere O, Altman RD, Reginster JY. Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4 Suppl):S12-7.
55. Bruyere O, Honore A, Ethgen O, et al. Correlation between radiographic severity of knee osteoarthritis and future disease progression. results from a 3-year prospective, placebo-controlled study evaluating the effect of glucosamine sulfate. Osteoarthritis Cartilage. 2003;11(1):1-5.
56. Hochberg MC, Martel-Pelletier J, Monfort J, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: A multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016;75(1):37-44.
57. Musumeci G, Trovato FM, Pichler K, Weinberg AM, Loreto C, Castrogiovanni P. Extra-virgin olive oil diet and mild physical activity prevent cartilage degeneration in an osteoarthritis model: An in vivo and in vitro study on lubricin expression. J Nutr Biochem. 2013;24(12):2064-2075.
58. Shakibaei M, Mobasheri A, Buhrmann C. Curcumin synergizes with resveratrol to stimulate the MAPK signaling pathway in human articular chondrocytes in vitro. Genes Nutr. 2011;6(2):171-179.
59. Somchit M, Changtam C, Kimseng R, et al. Demethoxycurcumin from curcuma longa rhizome suppresses iNOS induction in an in vitro inflamed human intestinal mucosa model. Asian Pac J Cancer Prev. 2014;15(4):1807-1810.
60. Ganjali S, Sahebkar A, Mahdipour E, et al. Investigation of the effects of curcumin on serum cytokines in obese individuals: A randomized controlled trial. ScientificWorldJournal. 2014;2014:898361.
61. Kohlstadt I, ed. Advancing medicine with food and nutrients. Second ed. Voca Raton, FL: Taylor and Francis Group, LLC; 2013.
62. Kc R, Li X, Forsyth CB, et al. Osteoarthritis-like pathologic changes in the knee joint induced by environmental disruption of circadian rhythms is potentiated by a high-fat diet. Sci Rep. 2015;5:16896.
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.