Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
2 Sep

Osteoarthritis is Not Your Destiny

osteoarthritiskneeOur concept of health only exists in opposition to its absence. Healthy is the default position. We’re not “supposed” to get strokes, coronary heart disease, diabetes, or cancer. Sure, a few people, here and there, are far more likely to suffer the ravages of the degenerative diseases of civilization, but the real numbers are inflated. For most of the population, we can avoid the worst of it, and if you spend a bit of time on MDA or any other ancestral online communities, you’ll see example after example of people taking charge of their health and experiencing newfound vibrancy. We’ve all gotta die someday, but we most assuredly do not have to die at 56 from a clogged artery.

But I cover longevity plenty. As you know, I’m also interested in increasing one’s enjoyment of life; I’m a big quality over quantity guy (both are good as long as the former is satisfied). And for my money, I can’t think of anything so central to our enjoyment of life as the ability move around pain free.

Last week, I discussed the causes of osteoarthritis in moose, and the general takeaway was that the greatest predictor of adult moose osteoarthritis is nutrition, not wear-and-tear. Thus, osteoarthritis is avoidable for moose. It is not their destiny. It is also not written that human men and human women must suffer the indignities and disability of osteoarthritis. We can live a long, full life of activity and physical engagement. We don’t have to accept broken down articular cartilage. Just in case you’re still subscribing to the paradigm of wear-and-tear, consider my experience.

I lived and trained with debilitating joint pain. At the time, I assumed (and had this assumption corroborated by every specialist I ever visited) that my arthritis resulted from the miles and miles of pounding abuse heaped upon my joints. It makes sense, on some level. Mechanical constructs eventually break down, right? Cars don’t last forever, tools need sharpening, and organic joints on our bodies eventually degrade and fall apart. Except organisms aren’t machines. We share similarities, and using mechanistic terminology can help us discuss and visualize health issues, but we are not fleshy machines. Machines require outside assistance and repair. Human bodies often require outside assistance and repair by skilled technicians (surgeons), but we also come equipped with self-regulatory functions. We don’t need a doctor’s assistance for every little cut, scratch, or nick we pick up along the way because our bodies can regrow skin and heal wounds. If someone slams a shopping cart into your car, leaving a dent, your car will never fix itself, no matter how small the dent is. A human – an outside force – needs to fix it. Not (always) so with human maladies.

Now, if you lop off an arm, you won’t be able to grow it back. There are limits. But our bodies can take a surprising amount of damage and bounce back. Broken bones can heal, and even healthy bones are constantly being broken down and reconstructed throughout life. Like muscles, bones respond to stress by refortifying and improving, which is why weight lifting is so good for improving bone density.

Our joints undergo similar machinations. Articular tissue responds to stress by refortifying and rebuilding itself, thanks to a kind of repair cell called a chondrocyte. Chondrocytes are to cartilage as osteoblasts are to bone, and they reside in and maintain the cartilaginous matrix that makes up the cartilage protecting and enabling joint function. They are constantly breaking down and restoring cartilage. Osteoblasts and chondrocytes both respond to weight-bearing stress. Both types of maintainer cells are derived from mesenchymal stem cells, which eventually differentiate into either chondrocytes or osteoblasts. Why do we praise the restorative function of osteoblasts while remaining ignorant of their cartilage-dwelling cousins?

So – both cartilage and bone can repair itself, but only to a point. It’s far more realistic to prevent the destruction of cartilage in the first place. Luckily, most people with some joint pain aren’t quite at bone-on-bone status. There’s room for improvement for most people. I was pretty far along and I bounced back. A friend of mine had a similar experience with his knee – a poor diet and tons of basketball led to missing knee cartilage and arthroscopic knee surgery at age 25. His surgeon figured it was the basketball – the wear-and-tear – that did it, and he assumed either a full knee replacement or super invasive experimental chondrocyte replacement would be required to restore basic function. Three years of Primal living later, he’s back lifting, running, and hiking more than ever. He’s never had MRI confirmation that cartilage has regrown, but he’s fully functional and has exceeded the wildest expectations of his surgeon.

I don’t think it’s wear-and-tear causing most of the osteoarthritis out there. I ran a ton, but I also ate a ton of inflammatory foods, like grains, ice cream, O6 fats (not that I sought them out, I just didn’t really distinguish between fats), and sugar. The running wasn’t helping, but something had to make my joints susceptible. These things are built to last, and we’ve always been an active, physical species. We haven’t always had cars and escalators to whisk us around the environment. Once I ditched the bad stuff and began eating Primally, everything clicked (except for my knees). And it’s not like I stopped exerting myself. On the contrary, I moved onto heavy weightlifting and sprints, all of which exert considerable amounts of stress on one’s joints. My joint integrity was simply no longer being undermined by poor dietary and lifestyle choices.

So, what can we do, beside lobby our doctors for invasive arthroscopic surgery recommendations, cease all physical activity, and never step outside without protective, padded footwear?

Ditch the grains, especially wheat: Avoiding grains in all forms – and yes, that includes beer (sadly) – was the single best move I made toward improving my joint function. Gluten intolerance is often connected to arthritis (yeah, avoid the vegan stuff and focus on the gluten avoidance), and Loren Cordain has tons of papers on possible connections between dietary lectins and arthritis (PDF). He focuses on rheumatoid arthritis, but I don’t think osteoarthritis and RA are so different. It’s just that osteoarthritis is assumed to be the “wear-and-tear” disease, but the moose story from last week (and the tale of the corn-fed Native Americans) refutes that.

Avoid excess omega 6 fats: Higher circulating levels of interleukin-6 (IL-6), a pro-inflammatory cytokine that I’ve mentioned before, are highly significant predictors of osteoarthritis of the knee. Can you guess which type of polyunsaturated fatty acid leads to excessive levels of IL-6? Exactly.

Skip the corn, soybean, canola, and vegetable oil and the resultant pro-inflammatory eicosanoids. Use animal fat, butter, olive oil, and coconut oil instead, and eat plenty of fatty fish or take fish oil.

Avoid potatoes: They’re not the worst things in the world, but some people report joint pain after consuming potatoes. I sometimes get tinges of my old knee pain if I eat potatoes on consecutive days, though the problem seems to worsen if I eat the skins.

Go for more Primal friendly starch sources, like sweet potatoes, yams, and winter squash instead.

Get plenty of sun or supplement with vitamin D: According to several studies, low vitamin D status is linked to increased osteoarthritis.

Use turmeric: Turmeric, specifically curcumin, its active ingredient, appears to protect chondrocytes.

Eat Indian dishes (just make sure ghee is used!).

Consider glucosamine supplements: Art Ayers had an interesting take on glucosamine. Rather than it providing the raw material for cartilage production as it’s commonly assumed, glucosamine actually binds to free transglutaminase 2 (TG2). TG2 is a well-known marker for osteoarthritis severity, and it often binds with gluten, resulting in the formation of pro-inflammatory antibodies. If glucosamine binds with TG2, less TG2 is available to bind with more inflammatory compounds.

Another option is to drink bone broth on a regular basis and gnaw on the articular endpoints of animal bones.

Lift heavy things: In order to support healthy cartilage, your joints must bear weight. PB Fitness is great for that, as is a more traditional barbell approach. Just don’t think biking or swimming is enough; those may be useful for folks with no cartilage at all, but if you want your chondrocytes to do their job, you have to provide the right stimulus, and that means load-bearing exercises. It remains unclear whether cartilage can actually regrow thanks to proper exercise, but we do know that resistance training improves osteoarthritis outcomes.

Either sprint or move slowly: Chronic Cardio increases systemic inflammation and increases your desire for inflammatory, cheap carbs like grains. Try sprinting or hiking instead.

Go barefoot: I’ve gone over this before, but I’ll reiterate. Wearing padded shoes disrupts your natural stride, and going barefoot allows valuable proprioreceptive input so you can intuitively adjust your landing to reduce stress on joints. Walking barefoot has also been shown to reduce loading on lower limb joints in patients with osteoarthritis (PDF).

When you get down to it, avoiding and managing osteoarthritis is pretty simple for your basic Primal eater. Avoid grains and other foods rich in dietary lectins. Reduce inflammation, both acute and systemic. Use anti-inflammatory spices. Get the right amount of exercise at the right intensity. Get some sun. Avoid autoimmune triggers, like gluten (and, for some, potatoes). Consider smart supplementation. Although to my knowledge this hasn’t been mentioned in research, I’d also suggest getting plenty of sleep every night, maintaining strong social bonds with loved ones and friends, and leading a low-stress lifestyle.

It’s pretty clear that the body deals with stressors rather indiscriminately, and a high stress lifestyle (no matter the source) is also an inflammatory one.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Ok, so what do you do if…You have plantar fachitis, your knees actually “grind” together and are over 50? Is it still possible to “counter” such annoying aelments? I wish I would have found MDA a long time ago!

    GayLynn wrote on September 2nd, 2010
    • Nutrition may play a role in your current condition, but I would look to a more structural cause for foot and knee pain. You may have an anterior tilt to your pelvis from tight hip flexers and low back muscles (sitting much of the day does this to all of us). The tilt causes your hips to internally rotate and your feet to overpronate. If you can work to losen up the muscles surrounding your pelvis and hips, and reduce your overall inflammation you may be in good shape.

      Whatever you do, don’t settle for thinking you need to be like that because you are 50. Couldn’t be further from the truth. Treat the cause not the symptoms!

      Susan Campbell wrote on September 2nd, 2010
      • Completely agree, seeing a masseur regularly (one that really understands the biomechanics) is a very simple non-invasive way of keeping all the articulations working as they should.

        If you imagine one tight muscle in a sequence you can immediately see how it will put joints out of line. For me the Iliacus is crucial (a hip flexor) very often less well qualified/interested masseurs don’t go that far back up the chain so to speak.

        My Dad (has bad OA in both knees – enough to warrant replacements if he so chooses), 65, has been eating primally since April, he has cut his pain relief meds to a third, can now walk around comfortably, is riding his bike including doing some sprints rising out of the saddle to do so. He is at least 28 lbs lighter but I strongly suspect a lot has to do with the low inflammatory nature of his diet now.

        Kelda wrote on September 2nd, 2010
    • I had plantar fasciitis, and it took a long time to heal. With the help of good shoes (I know that’s against what Mark believes) and time off running, anti-inflammatories and physical therapy, I finally healed. Now two years later, I have tendonitis in my outer right foot and left second toe area! I am so frustrated and want to run, even walk, but can barely do so without my shoes on . Also, have had cortizone shot and on anti-inflammatories now. Hoping I see improvement by next Tues to start the challenge.

      Lola wrote on September 2nd, 2010
      • Going barefoot isn’t possible for everyone. I was in a car accident four years ago which shattered my ankle into a dozen pieces; though it was surgically rebuilt, vascular necrosis set in and the bone continues to break down around the joint.

        I *cannot* walk more than a couple of steps without pain unless I have padding under my feet — in the house I wear rubber flipflops or thick slippers, out of it I wear sneakers or boots. Barefoot is just not an option for me.

        Ellen wrote on September 13th, 2010
  2. I wonder how quickly one would see a difference in the joints? Would like to recommend this to my (sceptical) mother but would like to give her a time frame in which she might expect to see results.

    PaleoMum wrote on September 2nd, 2010
    • I just keep in mind that it took decades to do the damage. Don’t expect results overnight.

      Dave, RN wrote on September 2nd, 2010
      • I tried the paleo diet in hopes to help my knee pain. My knee pain is nowhere near completely cured, but I could tell that there was a difference after 4 weeks. A lot of the tenderness that was in my knee cap is gone. Now to work out the other kinks.
        Good luck to your mom!

        gnataxela wrote on September 2nd, 2010
    • I am a 55 year old woman and had knee pain almost all of my adult life. I actually had knee replacement surgery scheduled for spring of 2009. Circumstances came up that made me postpone the surgery and in the meantime stumbled on primal eating in August 2009. Couldn’t walk without pain and couldn’t sleep at night and paced the floors with throbbing pain in my knees. Am now pain free, absolutely. Ride my stationary bike almost daily and workout with free weights and body weight. I take glucosamine and chondroiton, fishoil and vitamin d supplements. I will never turn back and love walking with a bounce in my step!

      Dorothy wrote on September 8th, 2010
    • I’ll have to give a short answer. I’ve had pain in my left knee for 28 years. In 2009, I started playing tennis again and the pain and swelling got bad. So bad, the swelling contributed to a ruptured MCL. Fast forward to 3 days ago. 15 days into the 21 day primal challenge and my knee pain is gone. In fact, on our walk on Thursday, I even did 4 sets of sprints. Like full speed sprints and I had no pain then and still have no pain. All day Thursday, I kept figuratively “pinching myself”. If someone told me this a few weeks ago, I wouldn’t believe it, and I hardly believed the anecdotal evidence above when I read this last year. Nonetheless, IT HAS HAPPENED FOR ME!!

      David wrote on January 21st, 2014
  3. This is an absolutely excellent post Mark!

    Can you tell me the difference between white/red potatoes and sweet potatoes or yams? Why are sweet potatoes and yams not as bad as regular potatoes?

    gilliebean wrote on September 2nd, 2010
    • I’ve got a potato post scheduled for the future. Stay tuned!

      Mark Sisson wrote on September 2nd, 2010
      • glad to hear that, I’ve been wondering too. :)

        Ely wrote on September 2nd, 2010
      • Yay! Thank you! :)

        gilliebean wrote on September 2nd, 2010
      • We have a favourite type of potato in New Zealand that is a gorgeous vibrant deep purple inside, but is not at all sweet. It basically tastes like rich, flavourful version of a white potato. (I don’t know if it exists in the U.S.) Here it’s called urenika potato, tutaekuri potato, or Maori potato. I never know how “primal” it is, so it would be awesome if you could address different potato types in your upcoming post!

        Dawn wrote on September 2nd, 2010
        • I used to eat purple potatoes all the time! I love them! Except that they stain my cutting boards! ;)

          gilliebean wrote on September 2nd, 2010
      • thanks that would be great to get more info on beer and potatoes both

        DThalman wrote on September 6th, 2010
    • Short answer: Different botanical families. White/red potatoes are nightshade tubers; yams and sweet potatoes are not nightshades. One of them, I think the sweet potato, is from the morning glory family. Don’t know about the yam. But nightshades have certain compounds in them that don’t interact well with a lot of people’s bodies. Oftentimes those people have to give up things like tomatoes and eggplants too–also nightshades.

      Dana wrote on September 9th, 2010
  4. I wish I could get my 86-year old mother to ditch CW and have a more open mind. I think she takes glucosamine supplements but only because the doctor recommended it.

    Thanks for the info, Mark.

    hiker wrote on September 2nd, 2010
  5. Great advice Mark! Can I just add that for people with osteo-arthritis, it will take some time to get better. Cartilage heals slowly, but it heals, contrary to what many orthopedics tell you. Thanks

    pieter d wrote on September 2nd, 2010
  6. It’s amazing how inflammation (via consuming the wrong foods) is the cause of SO many diseases and conditions in our bodies.

    In addition to avoiding eating the foods you mentioned, I would also add eating less in general, because overeating is also a major cause of chronic inflammation in our body.

    Susan Campbell wrote on September 2nd, 2010
    • Don’t agree here.

      Chronic inflammation is what’s bad. Acute inflammation is the good kind – like from a large meal or exercise. Chronic inflammation from LSD or grazing all day like an herbivore is what sucks.

      Active people (like me) need to eat a lot to keep going. I eat 4000 cal a day and I’m not fat or inflamed.

      Matt Lentzner wrote on September 2nd, 2010
      • I agree with the above post as well. I find I need to average about 3000 kcal a day to maintain my body weight, and this requires some big meals! Now, if we define overeating as constantly grazing, or eating before you’ve digested your previous meal, then yes – that is not the good kind. I feel really gross when I do that.

        But fasting all day, busting out some sprints followed by a 16 oz rib steak and all the buttery veggies you can eat, then lying around for an hour contently? I feel AMAZING doing that.

        Graham wrote on September 2nd, 2010
  7. Great post Mark! Isn’t it funny all problems have the same solution – eat real foods, drop grains/sugar/junk, move more, train smart and sleep deep!

    Raj wrote on September 2nd, 2010
    • Exactly. Living a primal lifestyle – a life modeled after our hunter-gatherer ancestors is really the key to unlock the greatness in everything.

      In order to feel fantastic in every which way for as long as possible then one needs to start improving there health in all areas – diet most importantly – and eventually convert to being fully primal.

      My father has had shoulder problems for a few years now. He is not onto dismissing grains and may never be. But, might point him to this article!

      Primal Toad wrote on September 2nd, 2010
  8. Awesome post Mark. I’ve been trending towards a primal lifestyle for several years now, and your site is providing even better ideas and increasing momentum to that end.

    I’m 28 & I’ve had 3 ACL repairs and notice how my knees scream at me the day after I drink a beer or few (it really is sad).

    I’d also love to hear you address the physiology aspect of knee problems ie sagittal vs frontal plane movements and the muscles involved.

    keep it up!

    dr wrote on September 2nd, 2010
  9. I’ve only been following MDA for less than a month but have had a lot of improvement overall. I have a knee that grinds when I go down stairs. It also stabs me once in a while without warning. I’ve noticed though that when I do my sprints, usually barefoot, that I feel no knee pain at all. I am wondering: A. if you know what makes a knee make that horrible grinding, crunching sound and B. why it doesn’t hurt when I sprint?

    Thanks!
    Michelle

    Michelle Hogan wrote on September 2nd, 2010
  10. Why oh Why oh Why can’t I get anyone to see this? sigh…
    I watch people younger than me grunt and groan; moving is such an effort. Here I am 50 & in better shape than I was at 40, and every week I improve above that!
    Thanks Mark for posting this – it should be a good boost for those contemplating The Challenge.

    Peggy wrote on September 2nd, 2010
  11. Thanks for the great post. I am scheduled for knee surgery in about six weeks to have a tear in my meniscus fixed and my ACL reconstructed. I was wondering if you have any additional suggestions, such as other supplements that would be beneficial to my knees healing. Thanks again!

    Mary wrote on September 2nd, 2010
    • I had the same surgery many years ago. I took the PT and rehad very seriously and came out with a knee that was better than ever. It’s the other knee that gives me problems now. Start squatting now to build up your hamstrings (the muscle that supports the ACL) and resume as soon as possible after the surgery.

      IMO, if you eat a strict PB diet and live a PB lifestyle you don’t need supplements. Everything you need is in your food. I would only consider fish oil to counter undesirable fat intake and vit D to make up for inadequate sun exposure.

      Matt Lentzner wrote on September 2nd, 2010
      • Same here – blew out ACL and reconstructed in 1988. Worked VERY hard in PT and my knee is better than ever. Have never had any problems with the knee. Since I’ve added the “grok squat” (slowly) the range of motion in my knee has improved even more.

        Rebecca wrote on September 2nd, 2010
        • I had an ACL reconstruction in 1988 too! Also, meniscus damage and the Doc showed me in the film what looked like cotton candy. He said that was arthritis and was worse (I was 17) than most 50 year olds… I was told I’d have to have a knee replacement by the time I was 30 if I stayed active. I’ve been sugar free for a few years now and noticed HUGE improvement in knee pain almost immediately. Since cutting grains out (mostly) my knees are better than they’ve been for years. Also- I never gained full mobility in that knee–but now after doing “grok squats” for a month+ I’m ALMOST THERE! Pushing 40 and I feel better than I have in a long, long time!

          kelle wrote on September 2nd, 2010
  12. Great Post! I’m only 20 and I’ve already been diagnosed with acute arthritus in my knees. I’ve been eating primal for a few months now and have already been able to tell a difference.

    Laura wrote on September 2nd, 2010
    • I was there nearly 20years ago — and i was a “healthy” XC/track runner! Wore custom ($$$) orthotics for years on end before ditching them about 18 months ago altogether (well, OK, I still use them in one pair of shoes, last ones that still have a real heel elevation) for more barefoot time, and more minimal shoes.

      Also started squatting heavy, and eating a primal diet — all of that combined has all but eliminated my knee pain (I’m on bodyweight squats now – PBF – but intend to throw in heavy days once a month or so for fun). It’s amazing what can be reversed/cured by eating the right food, really.

      Andy wrote on September 3rd, 2010
  13. awesome post mark! the heart scan blog just did a good one on osteoporosis and plaque heart build up and i got way scared. i have osteo and it sucks. weather = pain, not aving a PERFECT frikin diet = pain. walking longer than 30 mins = pain.

    prinmal has helpedto an extent, as i was supposedto have surgery on both my knees from MCL & miniscus damage i was told in unfixable without surgery, but lo and behold, a crapload of marrow, bone broth, sun & D and primal calories later i am much more mobile and can bend my knees past 90 degrees.

    so, improvement I possible but i would be lying if i said i thik i could one day be ‘pain free’

    Mallory wrote on September 2nd, 2010
  14. Mark, longtime reader, first time poster. Your site has changed my life in so many ways. The reason i’m posting is because at 33, after years of chronic cardio between running and the elliptical, i have a chronic case of what i believe to be tendonosis in my achilles tendon. is that a condition that can be relieved by diet also? Thanks.

    Derrick wrote on September 2nd, 2010
  15. Good points. It never ceases to amaze me how our culture has become convinced that our diseases of civilization are inevitable and it’s just a matter of medicating ourselves (or getting surgery) when they happen rather than preventing them intelligently in the first place.

    Darrin wrote on September 2nd, 2010
  16. Another great supplement to try for arthritis is boswellia. It has had some very favorable results in some clinical trials lately, but the best proof for me is how I feel and how by clients feel after taking it. I have (or had) moderate to severe end plate spurring in the L5 S1 area and started taking boswellin- after about a month I could feel the difference. I have been on it for a year and feel better than ever. My Mom, who has similar back problems has just started taking it and has had great results. I am a Massage Therapist and my clients who have tried it have had great results, too. Don’t get me wrong, I totally agree with the diet/inflammation link. This is just another tool in the toolbox.

    Molly wrote on September 2nd, 2010
  17. mark, you forgot to mention dairy as a MAYOR cause of RA. that’s a well known fact. see http://www.notmilk.com/forum/798.html for a nice anecdotal story. it’s the same with me – if i eat a piece of cheese (or other dairy), my knee begins to hur 30min later, and needs about 3 days to recover. please update your post – it’s important for people with RA to know, thanks.

    qualia wrote on September 2nd, 2010
    • Make sure you control for where the milk comes from. I’m suspicious that a lot of the so-called issues with dairy are actually problems with CAFO, artificial-hormone-injected, grain-fed liquid white crap.

      I’ve been using grass-fed heavy cream for a while now. My body loves it. I can’t even stand the taste of CAFO milk anymore. I do still get CAFO cheese but I don’t eat a lot of it at a go.

      Dana wrote on September 9th, 2010
  18. Mark, you pick up on something important with your mention of avoiding potatoes. They are a member of the nightshade group of plants (Family Solanaceae), and for some people any food in this group causes problems, usually painful joints. The source of the problem is the alkaloids in the foods, which is only partly reduced by cooking. An MD told me about this years ago and I thought he was nuts since I knew of the old wives tales about tomatoes being ‘poison’ and just knew that was rubbish. Turns out to be true for some people and it helped me overcome a case of tendonitis in my wrist. Avoid potatoes (not yams or sweet potatoes, different family of plants), tomatoes, tomatillos, peppers (sweet or hot) and eggplant. Not easy in today’s world but it can be done. If you try this for at least 2 to 3 weeks you can tell if this is a problem for you or not.

    Also, slightly off topic, nicotine is a nightshade! I have a theory that this might be part of the reason why some people can smoke like chimneys and live to be hearty & hale into their 90s while others succumb much earlier to the smoking related chronic diseases. The reality is probably not this simple since hundreds of chemicals are also added to cigarettes but I think it’s worth considering.

    Hillary wrote on September 2nd, 2010
  19. I don’t know if I’m allowed 2 consecutive postings, but I did want to mention something else I’ve found very helpful. A method of dealing with muscle & joint pain called “trigger point therapy”. Many of the pains we feel are actually ‘referred pain’ and are caused by a problem that is not necessarily located at the site of the pain itself. Muscles that are tight because of tension or injury or improper posture etc… often react by forming a small ‘knot’ known as a trigger point. The pain caused by the trigger point may actually be felt somewhere else. Sometimes even pain that feels like it is in the bone itself is caused by a trigger point in a muscle nearby.

    I ignored a lot of small pains in my knees over the past few years including popping noises, grinding, and once in a while a sensation like the knee would just give way. In mid-July I woke up with excruciating pain in my right knee and could barely walk. I did all the CW stuff (RICE, pain killers) which only helped very briefly. Had several weeks of MFR massage which did help somewhat but no real relief until I tried the trigger point self-massage.

    For the pain in my right knee, I have located 7 trigger points only one of which is actually on the knee itself. The others are along parts of my inner thigh (2), outer thigh (1), outer hip (2) and upper front thigh (1). Deep, slow massage of these points have made it possible for me to walk almost normally though I still do limp a little. I plan to see a therapist since something is still unbalanced in my hips.

    There is a great book for this technique which will help relieve pain immediately, in some cases relieve it permanently, while in others prevent unnecssary surgery and make life a little more tolerable while waiting to see an MD or therapist. The book is called “Trigger Point Therapy Workbook” by Clair Davies; available for less than $16 now and worth every penny. Loaded with many great & very clear drawings of muscle groups, how to locate the trigger point, how to massage properly & carefully, etc….

    Someone on another paleo forum I follow recommended this book so I wanted to put it out here in case it can help someone.

    Hillary wrote on September 2nd, 2010
  20. My dad has near debilitating Osteo in his back and hips. Both hips replaced before age 50. He recently moved in with us for a spell to recover and get his health a bit more in order before going back to living alone. I cannot believe the absolute garbage he eats. Before going Primal, I was still a conscientious eater (conventional diet) and still his food made me want to barf. Basically, if it was cheap, and came in a box or a can and required little or no cooking, that’s what he ate. Terrible.

    So yeah, I think there might be a coincidence between what you are talking about and the resultant malnutrition of so many Americans who otherwise look well fed.

    Grok'sbrotherJoe wrote on September 2nd, 2010
  21. My only problem with the PB is that I love Beer….yummy.

    Grok'sbrotherJoe wrote on September 2nd, 2010
  22. Great post! I’ve had bone on bone in both knees for years and arthritis in a bunch of other places.

    Vitamin D helps. Anybody with arthritis must, must, must get their D checked and be sure you are getting enough.

    My doctor is very pleased with the weight loss I’m getting from primal. She says every 5 lbs off total weight is like 20 lbs off the knees.

    What about adapted fitness for those of us who do need it? Do you have advice on that? I was puzzling today about what to do on the fitness part of the challenge.

    slacker wrote on September 2nd, 2010
  23. I’m 67, been doing primal stuff for about 3 months. The improvement in arthritis has been dramatic. Aside from my thumb joints and one knee, I feel loose as a goose. It’s like a mummy wrapping has been removed.

    This is without giving up white potatoes, rice or corn, which I don’t intend to give up, although I have reduced my use of them.

    Harry wrote on September 2nd, 2010
    • But gluten grains are gone, right? :)

      gilliebean wrote on September 2nd, 2010
  24. Eliminating Wheat and Gluten has completely rid my body of any pain after a major roll over car accident(Multiple Traumas- 2 years ago). It’s incredible! I also am a Myofascial Release therapist and there are awesome things you can do to self treat. I’m just about healed and it surprises me. Just by changing my diet, I DO NOT HURT ANYMORE!

    Phaedra wrote on September 2nd, 2010
  25. I think this is not quite accurate. I began suffering from the effects of osteoarthritis in my early 30s, and I have controlled the pain and stiffness for the past 10 years (I’m 69)with diet and exercise, so that I take no meds.

    However, when I consulted a well-known surgeon (NYC) about possible knee replacement, he pointed out that osteoarthritis is a DISEASE–not simply ‘wear and tear.’ It is aggravated by wear and tear, but many people overuse their joints and don’t get osteo at the young age I did. And it also accounts for the fact that my osteo affects areas of my body that are not subject to such strain.

    Yes, diet and exercise is superb for dealing with the DISEASE, but people should not blame themselves if they develop this disease even though they’re eating as you advise.

    Anita Gandolfo wrote on September 3rd, 2010
    • Presumably some people are more susceptible than others. Rather than looking at Mark’s advice as blaming the victim (“You’re like this because you ate wrong!”) instead I try to see it from the other direction (“Eating this way may help your condition, so why not?”)

      Jenny wrote on September 3rd, 2010
    • Type 2 diabetes is a disease too. And almost entirely caused by diet. (There is some reason to believe pollution can play a role, particularly dioxin exposure–but it’s not the whole story, or even most of it.)

      That said? You’re correct that blame is not useful. This is not about someone being good or bad. It IS, however, about natural consequences. If you jump out of a plane without a parachute, you’re gonna die, and it doesn’t matter whose fault it is. Nature is like that. No freebies given for good intentions.

      If someone eats well and still gets osteoarthritis, well, OK. I’ve heard it can happen in primitive indigenous people from time to time. Maybe ther’s a tendency apart from response to diet and exercise style. But for the vast majority of people that’s not going to be the case, or at least not the whole story.

      Don’t worry about whose fault it is–just take the information you’ve read and do something with it.

      Dana wrote on September 9th, 2010
  26. Mark just ruined Guiness and Coffee ice cream floats!

    warren wrote on September 3rd, 2010
  27. When I went gluten free my knee pain was the first symptom of many that disappeared. That was 7 yrs ago. I wake up with no joint pain. Before GF I had back, knee, hand and shoulder pain. My doctors were testing me for rheumatoid arthritis because my fingers were getting knobby. My fingers look fine now – nice a straight. All that happened with dropping gluten – I was still eating potatoes and sugars and high carb foods. For the past 2 years I have been eating a primal diet and my health continues to improve.

    Anne wrote on September 3rd, 2010
  28. Wait, no more beer? Surely the odd pint now and then can’t be too bad – how much gluten actually ends up in the final product?

    Evan wrote on September 3rd, 2010
  29. Could anyone leave a comment for me on the role and importance of chondroitin? So many of the glucosamine supplements I see are a combination of the two, yet I see glucosamine by itself as well.

    Jenni Whitley wrote on September 3rd, 2010
    • The book “The Arthritis Cure” said to take glucosamine with chondroitin in a certain rtaio. Many formulations follow this ratio. At least one recent study showed that the two in combination are more effective.
      I found that these really help with arthritis in my neck from an old whiplash injury.

      Joan wrote on September 5th, 2010
  30. You say osteoblasts are to chondrocytes. Wouldn’t a better comparison be osteoblasts are to chondroblasts, or osteocytes are to chondrocytes? Osteoblasts build bone and ostoclasts reabsorb bone. Similarly the same nomenclature applies to cartilaginous cells. Ok, I know it is a minor discrepancy, but it is an important nuance.

    Michael wrote on September 3rd, 2010
    • Chondrocytes consume cartilage and synthesize cartilage. They are like earthworms and eat their way through cartilage and replace cartilage in their wake. This is how juxtaposed cartilage tears are repaired. Cartilage actively inhibits blood vessel growth and chondrocytes only develop normally in low levels of glucose and oxygen. Mechanical stress on the cartilage is also required. They do this all within an envelope of heparan sulfate.

      Art wrote on September 3rd, 2010
  31. Mark,

    If I am reading the linked article on the correlations between Lectin consumption and Rheumatoidal Arthritis correctly, the table on page 3 shows that kidney beans, soy beans, peanuts, and other “healthy” legumes have far more lectin content than either wheat or rice.

    The article does seem to single out wheat germ as particularly bad, but I wonder, what about all of these healthy legumes?

    Any thoughts?

    Thanks for an always thought provoking site.

    Tom

    Tom Buchanan wrote on September 3rd, 2010
    • legumes aren’t actually healthy. I think that’s the point.

      Ely wrote on September 3rd, 2010
  32. What should’ve also been mentioned is bio-organic sodium.

    Bio-organic sodium is the slimey film that covers the walls of your digestive system from stomach to rectum. Bio-organic sodium is extremely alkaline, keeping stomach and intestines from being eaten by stomach acid, digestive juices. Bio-organic sodium is also in all joints, ligaments, lymph fluid, …

    Bio-organic sodium is NOT table salt.

    Lack of bio-organic sodium causes:
    Chronic indigestion, intestinal inflammation, irritation, constipation, severe hard stools, ulcers, stomach and intestine disorders, and JOINT PAIN, STIFFNESS.

    WHEN THE STOMACH WALL LACKS (BIO-)ORGANIC SODIUM, THE BODY STARTS TO PULL IT FROM JOINTS.(robbing Peter to pay Paul)
    The joints will undergo destructive biological changes. Synovial membrane, cartilage and bone integrity begin to degrade, the result is Arthritis.
    On top of that people take calcium supplements made of Calcium Carbonate which is chalk and isn’t absorbed into bone…it’s deposited into joints causing calcification of joint, bone fusing.

    Foods that over time cause this problem are:
    Grains, processed sugars, pasteurized milk and fully cooked meats.

    Raw Goat Milk is high in bio-organic sodium. It’s also high in L-Glutamine, an amino acid needed to bring the stomach and intestinal lining back to alkaline.

    Suvetar wrote on September 3rd, 2010
  33. For some ostoearthritis is a fact. It should be mentioned that much of the suffering and disability can be mitigated by daily use of the joint(s) in question in the way they should be used,ie, instead of daily training to limp, you should train daily to use the joint properly despite the “new” sensations in that limb. Much of the suffering of arthritis is soft tissue changes upstream and downstream from the joint. That can be addressed .

    OLDDUDE wrote on September 3rd, 2010
  34. Hi Mark,

    Great post. My only issue is that (sigh) I actually really like to run – the slow kind. I love to hike, walk, and grok around, but for me, going on a 5 mile jog (~11-12 minute miles) is right up there next to.. well I’ll leave it at that. I miss running so dearly, but my left knee (thickened medial patella plica) and left food (plantar thing) are achy whenever I try. I’ve been lifting heavy things in the meantime (with no pain) but I really am one of those people who can say that I just plain old love running – in my shoes, on the road. What’s a paleo girl to do?

    Can’t wait for the challenge!

    Ashley wrote on September 3rd, 2010
  35. I was diagnosed with arthritis of the knee at 42; the doc said don’t exercise (!). I had plantar fasciitis in my 30s; did the orthotic; started spraining my ankle. Figured out that immobilizing the ankle joint was not a good thing. I tossed out the orthotics and started building up the ankle, and
    stopped spraining it.

    Plantar fasciitis is mostly caused by a trigger point on the inside of the gastrocs. I *highly* recommend the Trigger Point Therapy Workbook, which will help you avoid pain and the surgeon.

    This year I *finally* am getting the excess weight off (primally), and have started daily walks which I couldn’t even consider last year. It’s just exhilarating for me to be able to walk a mile or two after so many years of pain. I’m 66 now, and haven’t given up hope. My fibromyalgia is improving greatly with regular exercise and eating a low-oxalate primal diet.

    ColoGrassFed wrote on September 6th, 2010
  36. I put off going to a highly recommended physical therapist for my bad knees and general muscle aches and injuries, because I felt that until I got the weight down, it was unreasonable to ask anybody to fix my knees and muscles.

    Then I got a form of Guillain Barre Syndrome, called Miller Fisher. Suddenly I started getting all the medical help I could, and that included the therapist. She turned out to be excellent at figuring out how everything in my left leg had gotten seized up, and in gradually freeing a lot of it.

    Plus, I found an article by Dr. Nieper, dating from 1974, about mineral transporters in supplements. After reading that, I bought Calcium AEP, which seemed to accelerate my very slow progress in fixing the neuropathy in my fingers; and I found calcium orotate, which supposedly sends calcium right into the cartilage, to defend it. It took awhile to find it for sale, because most versions of it have magnesium too, which gives me the runs. But I found it without magnesium, and started taking it. Within a few days I started feeling very slow but definite improvement in the way my knees flex and in the mobility of the small muscles above and below them. I’ve taken calcium orotate for about three weeks now, and I think it’s good stuff.

    Of course combined with eating primally, using many supplements such as 10k of D3, and magnesium oil and ubiquinol, and moving around as well as I can.

    I figure if the nutrient supplements and hands-on therapy can get everything working again, eventually one may get well enough to ease off some of them, depending more on the good food and motion. In the meantime, I’m glad they are there. Some, like the benfotiamine, methyl B12, and Vitamin D3 I intend to take as long as I can get hold of them.

    We don’t need to adjust only to our present conditions, but also to remember past injuries and problems. For me, myelin support will always be the name of the game. I believe that even if we can heal long-term problems, the body never truly forgets, so it’s good to provide long-term support.

    I hope to end up better off than I’ve been in many years — and stay that way.

    piano-doctor-lady wrote on September 6th, 2010
  37. Mark, thanks for this.
    After a ton of business travel and the associated weight gain, I decided I had to ‘do something’. I went on the ‘body for life’ programme for 12 weeks. Whilst the results on the outside were relatively pleasing, from a diet point of view it was a big change away from the paleo/primal diet I had been (trying to) follow for a while. One of the biggest changes by the end of the 12 weeks on a ‘low fat’ diet was increased pain in my thumb and finder joints. I have been scouring your site for articles on this, so this is timely. Since then, I have moved back to your dietary recommendations, am taking extra fish oil and glucosamine, and just spent a week in the sun on holidays – hands are fine. Interesting how it all fits together!

    jaypee wrote on September 7th, 2010
  38. Hi Mark, Nice post, but I would avoid all grains, legumes, nightshades and dairy. Eggs I would eat less frequently. http://bit.ly/a9Gvjk VBR Hans

    hans keer wrote on September 7th, 2010
  39. Hi Hans,

    Can you explain a bit more about any links between aspirin and leaky gut, and also the association with the nightshades? I’ve cut out grains, dairy, and legumes (except for occasional soy sauce with sashimi), but do love my cooked red bell peppers and marinara sauce. I’ve heard that if nightshades are cooked this decreases their toxins by some 50%. Can you please expand on this? I looked at your article – but didn’t see much on the aspirin relations, and the magnitude of the effects of the different categories (ie, are grains worse than nightshades? if so, how much worse?)

    Thanks,
    Ashley

    AM wrote on September 7th, 2010
  40. Great post Mark! OA is not wear and tear or aging as CW myth tell us, it is a disease like diabetes (or acute trauma like in sports accidents).
    Holistic Medicine knows this, mainstream medicine starts thinking intelligently. Prof. Dr. Henning Madry, Arthritis Research, University of Saarland, Germany says: Osteoarthritis is no wear and tear but a chronic disease like asthma and diabetes.Cartilage is damaged by accidents or sports injuries but very often it is induced by internal processes which are not understood. Cartilage gets weak and finally destroyed.
    This has nothing to do with aging per se. Many young people have OA today and many old people have no OA says Prof. Madry.
    http://idw-online.de/de/news377579

    Why are the causes not understood? Because nobody in the medical establishment looked for them. Big Pharma has no interest in research about the causes and definitively not in prevention or healing. Healthy people who are not drug junkies? Terrible for Big Pharma!
    Dr. Ron Rosedale, MD, says: “If you are going to treat a disease you need to get to the root of the disease….But the problem is that we don’t know what the root is, or we haven’t. They know what it is in many other areas of science, but the problem is that medicine really isn’t a science, it is a business.”

    Nothing in the human body “just wears out”. Your pancreas don’t just wear out, it’s the carbs or a genetic defect or environmental toxins or……..Your liver doesn’t “just wear out”. Stop drinking too much alcohol or eating too much fructose. Your eyes don’t “just wear out” – stop misusing and poisoning them. Read Jacob Liberman or Leo Angart on why eyes get bad, you’ll be surprised. Liberman and Angart are seniors and don’t need the glasses they had as young men. Liberman’s deconstruction of “conventional wisdom”” in ophtalmology is great.

    The reason for all degeneration is: the body is overloaded with physiological and psychological stress. And nobody can avoid all this unhealthy stressors all the time. So nobody can be in perfect health. But we can get closer than we are today. Degeneration is not a mysterious fate that just happens but there are reasons we can change, not individually of course, but as human society.

    Check the blog of physiotherapist Doug Kelsey (Texas). There you get good advice about how to prevent and rehab osteoarthritis.
    http://sportscenteraustin.blogs.com/the_view/2009/01/joint-protective-exercise.html
    http://sportscenteraustin.blogs.com/the_view/2008/04/chapter-12-the.html
    http://sportscenteraustin.blogs.com/the_view/2006/11/puffy_eyes_back.html

    Andrea Schüler wrote on September 8th, 2010

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