Regenerative Strategies to Prevent and Treat Osteoarthritis (Part 2 of 2)
By Dr. Ayo Bankole
Osteoarthritis (OA) is a painful degenerative and inflammatory condition of mostly, but not exclusive to large, weight bearing joints, namely the hips and knees. OA progression is highly associated with a reduced quality of life. It is also the most common cause of disability in the United States. To date, there is no cure per se for osteoarthritis. Since this crippling and slowly progressive disease lacks a known cure, the best hope for improved outcome should include efforts aimed at prevention. Therapy should start early on and should involve lifestyle methods, based on a regenerative paradigm. A regenerative paradigm entails therapies with the potential to restore, repair and regenerate function and structure to cells and tissue. Here in part two, I discuss the evidence and benefits of glycosaminoglycans and fruit polyphenols in preventing and treating osteoarthritis. In part one I discussed the role of a Mediterranean diet and maintenance of a healthy body weight in the prevention and treatment of osteoarthritis.
Glycosaminoglycans (GAGs) are molecular compounds that are the major structural components of connective tissue. They include but are not limited to hyaluronan, chondroitin and glucosamine. Unlike in America, Glucosamine is recommended as first line therapy for arthritis in Europe by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, due to its’ ability to control pain, improve function, and delay structural changes of the joints (6). Both, glucosamine and chondroitin exert arthritis modifying benefits that include increasing the production of cartilage forming cells, type II collagen, and proteoglycan (the major protein GAGs subunits that make up our cartilage and stabilize the extra cellular matrix [ECM]), reduce death of connective tissue cells and to reduce inflammatory mediators that hasten joint pain and deterioration. ECM contains GAGs and other components that provide connective tissue structure and support to withstand compressive forces. Glucosamine and chondroitin can slow cartilage deterioration enough to clinically improve joint function and decrease joint pain. Chondroitin has been shown to improve stiffness of arthritis joints also. According to Henrotin et al, these substances demonstrate a “small but significant reduction in the rate of joint space narrowing” (7). Glucosamine typically requires a minimum of four to six weeks for effect. Although not all studies have yielded positive results, individuals should consider GAGs because of their high safety profile and low rate of side effects.
Polyphenols and other nutritionally related compounds are shown to enhance joint function by virtue of their anti-inflammatory and antioxidant properties. Polyphenols include a variety of compounds such as genistein found in soybeans, hydroxytyrosol from olives and epigallocatechin gallate found in green tea. Others include flavonoids (the most studied type of polyphenol), flavanols and anthocyanidins, all subclasses of polyphenols from fruit and berries. According to both animal models and human studies, these fruit and berry derived compounds are shown to reduce arthritis symptoms. Pomegranates especially, but also bilberries, blueberries, and black raspberries, due to their high antioxidant rich polyphenol content are credited with anti-inflammatory properties. These molecules are known to decrease the expression of matrix metalloproteinases (MMPs), a group of enzymes responsible for cartilage degradation and associated with the progression of OA. Along with suppressing MMPs, they are also known to decrease levels of inflammatory signals and prostaglandins in joint fluid and plasma in animals. Human studies using fruit polyphenols in arthritis confirm these findings (8). In a study involving individuals with knee OA, consumption of pomegranate juice (200ml/day) for six weeks improved stiffness and physical function scores, and decreased serum MMP levels. Similarly, a strawberry beverage providing approximately 1500 mg total polyphenols and 66mg anthocyanins per day gave significant decreases in inflammatory markers like interleukin-6, interleukin-1-β, MMP and decreases in knee pain scores (9).
The mechanisms of pain, inflammation, and degradation of articular cartilage, joints, and joint related connective tissue leading finally to osteoarthritis are multifaceted. There is sufficient evidence to show that osteoarthritis and its related pain and dysfunction is best addressed early and that nutritional habits like adopting a Mediterranean diet, proper blood sugar control, exercising regularly and maintaining appropriate body weight can play a key role in treatment and prevention. The above measures along with consuming foods rich in flavonoids, anthocyanins, hydroxytyrosol, and other polyphenols are not only shown to decrease pro-inflammatory mediators like MMP and some interleukins involved in pain and osteoarthritis, but also are shown to improve joint function and pain scores. Finally, glycosaminoglycans like glucosamine and others are the major structural components of connective tissue and are known to increase the production of cartilage forming cells, slow down deterioration and decrease destructive inflammatory mediators. These methods combined represent some components of a regenerative approach to chronic joint pain and osteoarthritis that in absence of injury, hold the potential to reduce the need for prolotherapy.
Dr. Ayo Bankole is a state licensed doctor providing Regenerative Medicine for over a decade. He has advanced training in the technique and is a member of the American Osteopathic Association of Prolotherapy Regenerative Medicine, www.prolotherapycollege.org, and American College for Advancement in Medicine, www.acam.org and the California Association of Naturopathic Doctors, www.calnd.org.
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