Regenerative Strategies to Prevent and Treat Osteoarthritis (Part 1 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, effecting 30 million people (about the population of Texas) and resulting in one million knee and hip replacements annually. To date, there is no cure per se for osteoarthritis. First line pharmacotherapy with Acetaminophen and Ibuprofen or other non-steroidal, or steroidal anti-inflammatories have not shown to stabilize or reverse the on-going cartilage deterioration characteristic of osteoarthritis; often leading patients down a road devoid of treatment options other than steroid injections and finally total joint replacement. 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. Although regenerative injection therapy, otherwise known as prolotherapy fits squarely into this regenerative paradigm, in the absence of injury, the approach described in this article could lessen the need for OA requiring prolotherapy. Here, in part one I discuss the role of a Mediterranean diet and maintenance of a healthy body weight in preventing and treating osteoarthritis. Then in part two I describe the benefits and evidence supporting glycosaminoglycans and fruit polyphenols in the prevention and treatment of osteoarthritis.
Diet and nutrition have long been recognized to be related to arthritis. The Mediterranean diet (MD) is supported by nearly ten studies, three or more of which are systematic reviews, to benefit arthritis sufferers. Notwithstanding some regional variances, common traits of the MD include high representation of vegetables, fruits, legumes, nuts, seeds and cereals; fish and seafood; and moderate consumption of poultry, eggs, and dairy products. The moderate intake of red wine and the reliance on olive oil as the main source of dietary fats are features as well. One small study of 100 participants in England showed improved knee flexion and hip rotation, decrease levels of the inflammatory signal IL-1-alpha and decreases in a specific cartilage degradation byproduct by eight percent. Even more compelling is a study of the relationship between the MD and cartilage thickness in 800 osteoarthritis sufferers. The investigators determined that “significant improvement” in cartilage thickness was highly correlated with adherence to the MD according to several plains measured by MRI (1). Olives and olive oil are prominent in the MD. While hydroxytyrosol, a major flavanol found in olives, has been associated with health benefits including antioxidant, anti-inflammatory and anti-diabetic effects; it is also shown to alleviate arthritis in animal models and humans as part of a Mediterranean diet (2).
Exercise and Healthy Weight Maintenance
Being overweight and having type 2 Diabetes are both long-established risks for OA. Conversely, exercise and weight loss have been independently shown to decrease the risk of arthritis but also to decrease pain and improve function. Weight loss has been shown to improve function and reduce arthritis pain of larger weight bearing joints such as the hips and knees in those who exercise regularly relative to less active adults. According to a 2016 study (3), not only is pain and function improved in middle-aged women who exercise and achieve moderate (5% of body weight) weight loss, but they enjoyed a “significant reduced risk of arthritis” as confirmed by radiographic images. Physical activity has also been shown to reduce arthritis associated medical visits and costs after twelve months. Studies have even shown that the benefits of exercise in those with osteoarthritis can be maintained for up to six months after exercise has stopped (4). Both exercise and weight loss are shown to decrease inflammatory signals associated with the inflammation and deterioration of arthritis, to reduce joint pain, to improve physical function and to minimize obesity associated arthritis risks to joints (5).
In part two I discuss the benefits and evidence supporting glycosaminoglycans and fruit polyphenols in the prevention and treatment of osteoarthritis; along with summarizing the regenerative paradigm to potentially restore, repair and regenerate function and structure to cells and tissue of joints.
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.
Part 1 References:
1. Castrogiovanni P, Trovato FM, Loreto C. Nutraceutical Supplements in the Management and Prevention of Osteoarthritis.Int J Mol Sci. 2016 Dec 6;17(12). pii: E2042.
2. Eugene J. Kucharz EJ Volodymyr Kovalenko,Sándor Szántó. A review of glucosamine for knee osteoarthritis: why patented crystalline glucosamine sulfate should be differentiated from other glucosamines to maximize clinical outcomes 2016 Feb, pp 997-1004
3. Runhaar J, de Vos BC, van Middelkoop M, Vroegindeweij D. Prevention of Incident Knee Osteoarthritis by Moderate Weight Loss in Overweight and Obese Females.
4. Arthritis Care Res (Hoboken). 2016 Oct;68(10):1428-33. doi: 10.1002/acr.22854. Epub 2016 Aug.
5. Vincent HK, Heywood K, Connelly J, Hurley RW. Obesity and weight loss in the treatment prevention of osteoarthritis.PM R. 2012 May;4(5 Suppl):S59-67. doi: 10.1016/j.pmrj.2012.01.005.