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Osteoarthritis is Not Your Destiny

Our 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 [7], 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 [8], 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 [9], ice cream, O6 fats (not that I sought them out, I just didn’t really distinguish between fats), and sugar [10]. 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 [11]?

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 [12] (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 [13] (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 [14] that I’ve mentioned before, are highly significant predictors of osteoarthritis of the knee [15]. Can you guess which type of polyunsaturated fatty acid leads to excessive levels of IL-6? Exactly [16].

Skip the corn, soybean, canola, and vegetable oil and the resultant pro-inflammatory eicosanoids. Use animal fat [17], butter [18], olive oil [19], and coconut oil [20] instead, and eat plenty of fatty fish [21] or take fish oil [22].

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 [23], low vitamin D status is linked to increased osteoarthritis [24].

Use turmeric: Turmeric [25], specifically curcumin, its active ingredient, appears to protect chondrocytes [26].

Eat Indian dishes [27] (just make sure ghee [28] is used!).

Consider glucosamine supplements: Art Ayers had an interesting take on glucosamine [29]. 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 [30], 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 [31] 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 [32] 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 [33]. 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 [34] increases systemic inflammation and increases your desire for inflammatory, cheap carbs like grains. Try sprinting [35] or hiking [36] 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 [37] (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 [38]. Reduce inflammation, both acute and systemic. Use anti-inflammatory spices. Get the right amount of exercise at the right intensity. Get some sun [39]. Avoid autoimmune triggers, like gluten (and, for some, potatoes). Consider smart supplementation [40]. Although to my knowledge this hasn’t been mentioned in research, I’d also suggest getting plenty of sleep [41] 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.