April 2004

Vol. 3     No. 4  

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How to Prevent and Treat Degenerative (Osteo) Arthritis

The most common form of arthritis afflicting humans is osteoarthritis, often referred to as “degenerative arthritis,” because the joints slowly deteriorate as a result of “normal wear and tear associated with aging.”  Doctors commonly advise people to lose weight, especially if they have disease of the joints of the lower extremities, and to avoid prolonged and strenuous use of the affected joints.

Beyond this commonsense advice, if you see a doctor for a painful joint condition you will almost certainly receive a prescription for a “pain-killer.”  More specifically, you will be given non-steroidal antiinflammatory drugs (NSAIDs).  Common, over-the-counter varieties you may be familiar with are Motrin and Advil.  Unfortunately, many of these same drugs have been shown to damage the very joints that they are supposed to help.  Obviously, there is a need for better approaches to this common condition.

A Healthier Diet, First

Osteoarthritis is not an inevitable part of growing older – people can live a lifetime with pain-free, fully-functional joints – actually, I think that is the way it is supposed to be. However, commonly, in developed (Western) countries the joints of people worsen with age.  Only 2% of women less than 45 years old in the United States show signs of osteoarthritis; eventually this form of crippling arthritis is seen in x-rays of the hands of over 70% of people age 65 years and older.  However, this same disease is comparatively rare in African and Asian countries, where people physically labor to survive.2   The difference is that the diet of these arthritis-free people is based on unrefined plant foods with few animal products and added fats.  In Western societies, joints wear out while doing such usual activities as driving a car past a drive-through window at McDonald’s and lifting a fork full of cheese to the lips.

The typical American diet damages the joints in several ways.  Over two-thirds of the people on this high-fat, high-calorie diet are overweight and almost one-third are obese.  This extra weight damages the joints of the lower extremities (hips, knees, ankles, and feet) simply through excess stress (the exaggerated effects of gravity).  But there are other reasons an unhealthy diet injures joints:

  • Malnourishment from the Western diet deprives the bones and joints of the raw materials they need to become strong enough to resist the normal wear and tear of daily activities.
     
  • Circulation to these joints is also compromised by fat floating around in the bloodstream after a typical meal.
     
  • Possibly the most damaging effect is from the components of the Western diet, that cause inflammation which damages the joints, especially the proteins from dairy products – causing arthritis and eventually permanent destruction of these moving parts.  

The overall benefits of a healthier diet and weight loss were shown in a recent study published in the American Journal of Clinical Nutrition.3  Three-hundred and sixteen older, overweight or obese, sedentary men and women with x-ray evidence of knee osteoarthritis were randomly assigned to one of four 18-month treatments: healthy lifestyle control, diet-induced weight loss, exercise, and diet plus exercise.  Those who lost weight due to an improved diet showed a decrease in inflammation measured by a variety of tests.  Exercise did not seem to make a positive difference in this study.

At least 25 studies have been published to date that show the benefits of a low-fat, plant-based diet on inflammatory arthritis (see my home page article “Diet: Only Hope for Arthritis”).  Most of this research has been done on people who have been told they have rheumatoid arthritis, which is an arthritis characterized by severe inflammation.  In reality, all arthritis conditions have elements of both inflammation and destruction – and the overall condition of the patient can range from one end of this spectrum to the other.

There is hope for people suffering from osteoarthritis, because the inflammation component can be reduced or stopped with corrective measures, such as a healthy diet and accompanying weight loss.  I believe a low-fat, pure-vegetarian diet, combined with non-injurious physical activity, provides the best chance to avoid osteoarthritis later in life; and even help those who already suffer with this condition.  But there is another “medication” approach that should be used when further benefits are needed.

A “Natural” Arthritis Medication that Really Works

The joints are the locations in the body where bones make their connections.  Cartilage covers the connecting surfaces of two bones where they join, allowing them to effortlessly glide one bone over the other. This articular cartilage is made of two types of large molecules, proteoglycans and collagen.  Proteoglycans provide elasticity and stiffness on compression; collagen provides the strength.  Substrates for the building blocks of joint proteoglycans can be provided in the form of a nutritional supplement made from seashells, called glucosamine.  Medical benefits for glucosamine have been reported in the scientific literature for more than 35 years.4  This medication can lead to long-lasting pain reduction and functional improvement by increasing cartilage building activities, reducing enzymatic destruction of the cartilage, and by providing anti-inflammatory effects.  Glucosamine also acts to prevent the death of cartilage cells – not only halting joint destruction, but reversing it.

Researchers reporting in the April 2004 issue of the journal Menopause found (for the first time in a properly executed study) that the use of this seashell-derived supplement will stop the progression of osteoarthritis (degenerative arthritis) of the knee of postmenopausal women. 5   In fact, there was actually a small improvement, on average, in the joints of the 319 women studied.  The placebo group showed a small amount of worsening.  Three times as many in the placebo group showed narrowing (evidence of destruction) of their joints compared to the glucosamine group (33 vs. 11).  A dosage of 1500 mg was given once daily by mouth.  Two other recent and important studies have also shown improvement in pain and halting of progression of the joint deterioration.6,7

Glucosamine is very well tolerated by patients of all ages under short- and long-term treatment.  At the very most, mild gastrointestinal upset, drowsiness and headache may occur – in most research, this medication has been found to have no more adverse effects than placebo.  Glucosamine comes in a sulfate and hydrochloride form – both are equally effective.  Cost of this medication is less than $20 a month for 1500 mg daily.  Often you will find glucosamine packaged with chondroitin – a byproduct of cow cartilage.  My concern is that this cow material may contain infectious microbes, such as those that have been found to cause mad cow disease.8   You will also find combinations of glucosamine with calcium, magnesium, boron and other minerals.  The effects of these minerals have not been determined and they may cause unwanted imbalances in your system.  Therefore, I recommend that you purchase a product that is made only of glucosamine.  Finally, people with healthy joints should not be taking glucosamine in order to prevent a future problem that may never occur, since we really do not know for sure whether or not there are any long-term adverse effects from taking daily doses of powdered seashells.

References:

1) Ding C.  Do NSAIDs affect the progression of osteoarthritis?  Inflammation. 2002 Jun;26(3):139-42. Review.

2)  Brighton SW.  The prevalence of osteoarthrosis in a rural African community.
Br J Rheumatol. 1985 Nov;24(4):321-5.

3)  Nicklas BJ.  Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial.  Am J Clin Nutr. 2004 Apr;79(4):544-51.

4)  Vetter G.  Glucosamine in the therapy of degenerative rheumatism. Dtsch Med J. 1965 Jul 5;16(13):446-9.

5)  Bruyere O, Pavelka K, Rovati LC, Deroisy R, Olejarova M, Gatterova J, Giacovelli G, Reginster JY.  Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies. Menopause. 2004 Mar-Apr;11(2):138-43.

6)  Reginster JY.  Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001 Jan 27;357(9252):251-6.

7) Pavelka K.  Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study.  Arch Intern Med. 2002 Oct 14;162(18):2113-23.

8)  Mad cow disease and chondroitin sulfate. Harv Health Lett. 2001 May;26(7):3.

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