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. Is bad to cut out a particular food source completely (unless you are allergic), you need balanced diet. Don’t eat too much of anything, balance it to your needs. Dude here says ditch the grains, pretty irresponsible to say that considering wheat(whole wheat) contains fibers to help our digestive system, amongst other nutrients.

    m3kw wrote on September 8th, 2010
    • I think you need to read Mark’s book…from front to back and again if need be.

      Dorothy wrote on September 8th, 2010
    • If you want fiber that badly, eat broccoli. I don’t know why people think you can’t have fiber if you don’t eat grain. What do they think is in vegetables?

      Better cook the broccoli first, though, especially if it tastes bitter when raw.

      Dana wrote on September 9th, 2010
  2. I’ve had intermittent problems with my knees over the years, regardless of my weight. In about 2003 or so, I started noticing them locking up if I sat with my knees bent in one position for too long. I was taking occasional two-hour car trips to Toledo at the time, and would have to stop occasionally at rest areas to get out and stretch my legs. And it wasn’t always the same knee. It’d be one, the other, or both (and not always the same pain intensity, when both).

    First time I tried low-carbing was early 2004. Not long after I started, I took another trip to Toledo. Lo and behold I was able to ride for the entire trip without having to stop for a break.

    That’s just low-carbing, mind you. Not Primal. Just cutting out grains and potatoes.

    I’m convinced, anyway.

    Dana wrote on September 9th, 2010
  3. Mark, I was diagnosed with severe osteoarthritis and CW recommended total knee replacement in both knees. I could barely walk let alone go up and down stairs: My knees were on fire!!! I have learned the direct correlation between diet, pain and sensible exercise. Supplementing with fish oil has been helpful. One might also look into supplementing with niacinamide. Dr. William Hoffman devoted his life to the study of arthritis and in the 1940’s wrote about supplementing with niacinamide It has been very helpful to me. I hope that someones fire is put out!!!!!!!!!! Jim Cannon

    Jim Cannon wrote on September 9th, 2010
  4. I forgot one link in my post: Why is there no research about preventing or healing OA? Big Pharma wants treating the symptoms, not curing. Chemist Shane Ellison, a former insider in Big Pharma, can you tell about that:
    http://www.youtube.com/watch?v=fOT5DSIUTOY

    Andrea Schüler wrote on September 10th, 2010
  5. Great blog post I`ll definitely be back to observe your web blog again

    dubai properties wrote on September 11th, 2011
  6. Thanks for posting about this Mark. I was searching about osteoarthritis in the hands after really noticing my dad’s hands recently. He’s 84 on the SAD (we’ve got the longevity genes anyway) but his finger joints are swollen worse than any of the pictures I’ve seen online. I don’t want this to be my legacy (I plan to live to be 120). I should always start my research at MDA first! Thanks again!

    Shebeeste wrote on December 16th, 2011
  7. I had knee replacement surgery scheduled and after a few months of eating primal and losing 35 pounds all of the pain in my knee disappeared. While my joints may still be fragile, and I wouldn’t run a mile anymore, I am still very active and bike a lot and no more pain, no more pacing the floor at night sleeplessly, no more wincing on each and every step. I have been primal for over two years and will never go back.

    Dorothy Ruper wrote on December 16th, 2011
  8. fell on rock sidewalk on knee before Christmas (its middle of Jan now) the gash on knee cap is healed but I have a dent in knee cap under the scar and a hard lump under the scar. I cleaned gash, used R.I.C.E.method and useing hot Epsom Salt Compresses, with green tea bags on knee cap. sleep with frozen bag of peas on knee and one behind the knee, sore where dent is, but i can bend it,what else? gonna try to get ex ray in two weeks, gonna take glucosomine in the mean time, what else can i take or do?

    sharon settles wrote on January 18th, 2012
  9. I went wheat free for 6 months and then had pizza at a party a few days ago and I am in so much pain, I won’t do that again!

    Anne wrote on February 2nd, 2012
  10. Mark, I could listen to you all day long!!! Is this info in your book ? I’m 53, quit dairy bout a year and a half ago. My Bone density scan reports 2% loss:( ate spinach daily now having a kale and other fruit vegi juice daily? I feel so excited to begin using stock!!! Thank you for your contribution to my quest to live a sparkly inviting life that leads to eternal life and as much heaven on earth there is! Health equals heaven on Earth :) xo <3

    Jo Anne wrote on July 29th, 2012
  11. My Cousin has the most serious form of Celiac disease which I understand is gluten intolernace. However you suggest those with wheat allergy should avoid beer. I am told he can drink beer. He is on a specail diet and has perscription bread etc.

    Jan wrote on December 30th, 2012
    • whoever told him he could have beer is dead wrong!

      Elisabeth wrote on June 21st, 2013
  12. Estoy diagnostica de condromalacia rotuliana en las dos rodillas,por tener las rótulas desalineadas,tengo 52 años y la rodilla derecha debido a ello,se me ha formado una sinovitis fuerte,estoy tomando condroitin sulfato,silicea coloidal,y colágeno hidrolizado,el médico me ha dicho que debería hacerme infiltraciones de factores de crecimiento de mi plasma sanguíneo.¿que opina usted de eso?¿que otros consejos me puede dar?Me he comprado vitamina k2 de natto con d3.Gracias.

    paqui wrote on February 14th, 2013
  13. Hi!

    There’s been much posting here about knees, and the importance of squats to maintain knee mobility, but my question has to do with feet – in particular the big toe.

    I have increased stiffness and pain in one of my big toes. I think it first manifested two years ago, but was mis-diagnosed as sesamoiditis and I was presceibed orthotics (which I wore for about 3 years before removing them from my shoes this past winter). one year ago, i presented to a physio with severe big toe pain- she pulled on it (while stabilizing the first metatarsal) and dismissively told me that i would have OA in that joint.

    My background is 25 yrs of ballet dancing and running – the chronic cardio kind which I must say, I truly do love. Anyway, I’ve been given the formal diagnosis at this point of hallux limitus (which is apparently ridiculously common in ballet dancers). Ive already been subconsciously altering my gait to decrease the pain and range of motion going through the affected joint and now have knee and ankle pain to boot. I dont want this to progress to hallux rigidus. Ive been paleo since 2010 and have started consuming bone broth (home made). I’d like to transition to bare foot, but I have a previous history of stress fractures in my metatarsals. Any advice on how to get normal motion through the big toe-1st metatarasal joint?

    Thanks!

    aly wrote on June 9th, 2013
  14. Hi, I have back pain when I was wake from bed,, some time also on my figger knee join what should I have to do ..?

    raja wrote on February 2nd, 2014
  15. Mark,

    You reference adding glucosamine and a potential benefit of TG2 binding with gluten and thereby removing pro-inflammatory antibodies. Would this benefit apply if someone is gluten free? I’m reading your post with great interest and developing a personal joint pain therapy protocol.

    I was an ultra runner and all around active adventure geek, but 12 years ago at age 42 stopped recovering, from everything! I became chronically exhausted and so so much more. But it didn’t steal my spirit. After several dozen self experiments, I’ve just discovered low carb 7 weeks ago. Wow, I’m experiencing a significant turnaround. I now appreciate what it feels like to be born again.

    I know it’s still early, but my soaring spirit is winning over patience. I’m keen to improve my non-restorative sleep (maybe it’s more about sleep arousals, sleep study said I don’t have apnea but do arouse 200 times), and the wicked joint pains I wake with each morning, and it’s getting a little worse now that I’m able to exercise again. Oh did I mention, I’m able to exercise again, woohoo!!!

    My plan is to implement all the suggestions above, but any other tips would be appreciated. BTW, rheumatologists have suggested squat, nada, nothing, accept of course pain meds. But they have commented my joints are in remarkably good condition considering the punishment I’ve put them through. This gives me great hope.

    Thanks,
    Greg

    Greg wrote on March 25th, 2014
  16. So glad I found this post .. and will read all the links. I recently started having problems with swelling and stiffness in my hands and although I don’t eat a full paleo diet .. I’m probably going to start as living off Advil probably isn’t a good idea :-P

    In fact, I have home made vegetable soup with organic chicken breast and 1 slice of buttered wheat bread (guess I’ll be tossing the bread).

    M.

    MonicaP wrote on May 12th, 2014
  17. What are your views on stem cell treatments for osteoarthritis of the hips?
    From what I can see on the promoters’ web sites, the results don’t seem much better than placebo effect.

    Tony wrote on November 7th, 2014

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