The most common form of arthritis is osteoarthritis, typically caused by wear and tear or trauma. If your parents have had arthritis, you are more likely to get it as well.
Less common arthritis forms are caused by auto-immune diseases (such as Rheumatoid or Psoriatic Arthritis). These systemic inflammatory diseases can cause dramatic damage to joints unless managed appropriately. I am going to focus on the more common osteoarthritis form in this blog, but all the steps that help osteoarthritis are also helpful for auto-immune induced arthritis as well. I highly recommend that if you have an auto-immune form of arthritis that you should seek help from a functional medicine focused physician as well.
Both my parents have had osteoarthritis, so not surprisingly I have it too—a bit in my spine, more in my thumbs, and especially my right knee. 25 years ago, I fell while downhill skiing in heavy powder and tore the ACL ligament and medial meniscus in my right knee. I had an initial surgery to repair the ACL but have also had four other surgeries to trim subsequent tears in the medial meniscus, leaving my right knee with bone rubbing on bone.
30-40 million people suffer from osteoarthritis and by age 65 nearly 50% of Americans report arthritis pain.
Your food choices do make a difference in your symptoms. An inflammatory diet makes your pain worse and an anti-inflammatory diet will make it better. This means eating sugar, refined and processed food will increase your inflammation levels and increase your level of arthritis pain. In contrast, eating a Mediterranean diet with more fruit, vegetables, beans, nuts, olive oil, herbs and spices, as well as seafood will decrease inflammation and arthritis symptoms.
Activity also improves joint pain. Walking, cycling, exercise on an elliptical machine, strength training, and other forms of non-pounding movement enhance joint function and symptoms. If you have arthritis in your knees, ankles, or back, running on hard surfaces such as concrete should be avoided if it causes pain, but otherwise, most movement is surprisingly good for your joints.
You can measure your level of inflammation with a simple hs-CRP test (high sensitivity C-reactive Protein, not to be confused with the basic, not high sensitivity CRP test which is far less sensitive). The hs-CRP test is fairly inexpensive, $20-$30 per test, and the doctor ordering it typically gets the results back within one day. A normal level is less than 1.0, high-risk for high levels of inflammation is a level of more than 3.0, and excellent inflammation control gives you a hs-CRP level less than 0.5.
This lab measurement does not need to be done fasting, but please do not measure your hs-CRP level within 3-4 weeks of when you have an acute injury or illness as your levels will jump initially and provide a false high reading—the test is intended to be done to measure your baseline level of inflammation.
Not only do your food choices make a big difference, but anti-inflammatory supplements can also lower inflammation and your hs-CRP level nicely. Some of my preferred options are long-chain omega-3 oils (commonly called fish oil) and Turmeric (Curcumin is the active agent in turmeric and comes in a concentrated form). Both omega-3 oil and Curcumin extract have been shown to lower hs-CRP levels and to reduce joint pain in clinical studies. Other anti-inflammatory herbs that I feel are not as effective as fish oil and Curcumin but that could be considered include:
- Green tea
- Willow bark
- Pycnogenol (pine tree extract)
- Capsaisin (chili pepper concentrate)
- Boswellia (Frankincense)
Other supplements used to manage arthritis include glucosamine sulfate and chondroitin, despite that they do not provide any anti-inflammatory benefit, both provide ingredients are believed to nourish cartilage cells. Chondroitin has very limited absorption (less than 10% of the compound is actually absorbed) and when combined with glucosamine sulfate, it has not been shown to be more effective than glucosamine sulfate alone (chondroitin thus adds a significant unnecessary expense). Initial studies suggested that glucosamine sulfate, which is very well absorbed, may slow degeneration of cartilage over time and it was used widely in the past 20 years, although it has not been clearly effective at reducing arthritis pain. There has also been some controversy as to whether taking glucosamine sulfate may adversely impact insulin resistance and worsen blood sugar control in diabetics, although it does not appear to raise blood sugar levels. Due to the controversies regarding its effectiveness, its use has decreased over time. The typical dosage for glucosamine sulfate in clinical studies is 500 mg taken three times per day.
The quality of fish oil and curcumin, likely these most effective agents used to treat arthritis, are critical issues. Many forms of fish oil are rancid and can actually increase inflammation. Most types of turmeric are very poorly absorbed (you absorb at most 2% of what you consume) and poorly absorbed forms can cause gastrointestinal distress, so the quality of the product you take really does matter.
Nearly a decade ago, I created a supplement pack for myself and patients at my clinic, which included a high-quality multivitamin, 1,000 mg of EPA and DHA fish oil, 1000 mg of highly absorbed curcumin, extra vitamin D and vitamin K, plus magnesium. I have noticed that when I take it daily my joints feel dramatically better, so I have continued it as have many of my patients for the last decade. Initially, I included glucosamine sulfate in the packets, but have more recently dropped it.
For details regarding this Joint Support pack, please click here.
Drugs used for arthritis are problematic. Highly-marketed NSAIDs (non-steroidal anti-inflammatory drugs, such as Advil, Naprosyn, Ibuprofen, Celebrex, Indomethacin, Diclofenac, etc) do reduce pain and swelling if used regularly over a 5-7 day period, yet they have many side effects, including that they accelerate long term damage to the cartilage in your joints—they actually accelerate arthritis damage! They also cause GI bleeding, kidney damage, serious bleed problems, and other major side effects. These drugs should be avoided and clearly not used more than 5-7 days once or twice per year.
The most commonly recommended drug for arthritis is Tylenol (acetaminophen), yet it does not reduce inflammation and can adversely impact your liver. There are also concerns that regular use of high-dose acetaminophen might accelerate memory loss and dementia as acetaminophen metabolism depletes systemic glutathione levels, an essential anti-oxidant and essential source of protection for the brain and every cell in your body.
I would much rather you use high quality long-chain omega-3 oil and curcumin instead of either of these medications. Randomized clinical studies that lasted 30-60 days, suggest that curcumin can be as effective as NSAID drugs for treating arthritis symptoms, although it takes longer to notice a decrease in pain than from taking NSAID medications.
However, if diet, activity, and supplements do not cover your pain, joint injections can be helpful to decrease inflammation, pain, and swelling for 3-12 months.
I will dive into a discussion and a comparison of joint injections using cortisone (steroids), hyaluronic acid, and PRP next, so please stay tuned for Part Two to this discussion.
Not all joint injections are the same. As you will discover, the most commonly used therapy might even be harmful long-term to your joints. Yet there are effective and safe options available that I will discuss in detail.
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, CNS
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