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How to Prevent Osteoarthritis After Injury

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knee osteoarthritis symptoms
Knee arthritis and steroid injections

The more astute of us are rightfully concerned with developing arthritis as we age. Luckily, this is not a foregone conclusion.

Most people incorrectly think that injury to a joint is the only major factor that leads to the later development of arthritis in that joint. While any injury to a joint is an important player, there are other factors at play.

(I also have patients who state that his or her left knee pain is just from old age.  At this point I ask how much older it is than the other knee…)

For arthritis of the spine related to disc degeneration, we have known for a long time that a lifestyle that is pro-heart disease will also increase your risk for disc degeneration and spinal arthritis. The reason for this is simple—discs do not have their own blood supply. Instead, they are fed indirectly by small blood vessels. If these small blood vessels become filled with plaque, they can no longer deliver needed nutrients to the discs. With normal use, these discs will break down because they can’t meet the demands of daily life.

The surfaces of your joints are not too much different. Poor blood vessel health will lower the ability of your joint surfaces to get the nutrients they need to respond to day to day demands.

This means that a lifestyle that is designed to protect your heart will also protect your joints. Pretty cool. NOT killing two birds with one stone, so to speak.

This particular study may give us even more insight into how we can protect our joints. In it, researchers looked at the ability of different types of fats (specifically saturated fats, omega 3 and omega 6 fatty acids) to protect against damage to the medial meniscus of the knees of mice.

They found that saturated fats and omega 6 fatty acids did not protect against the later development of osteoarthritis and even increased the amount of arthritis that resulted, they increased extra bone formation around the joint (a hallmark of osteoarthritis) and increased scar formation.

Let me put this more plainly: The dietary choices you make WILL absolutely increase the damage to your joints that occurs with an injury, leading to more osteoarthritis in your joints years later.

Luckily, the omega 3 fatty acids were a different story.

The omega 3 fatty acids were able to enhance wound repair as well as lower the risk of later development of arthritis. Pretty cool that diet can play this powerful of a role.

In case you need a refresher on which fats to avoid, here’s some help:

  • The main source of saturated fats include fats contained in our society’s poorly raised livestock.
  • Omega 6 fatty acids are found in certain oils like corn, sunflower, soybean and peanut oils.
  • Omega 3 fatty acids are found in nuts, seeds (such as flax), wild caught fish and game, certain grains (salba, quinoa as examples) and grass fed beef.

Just by making smart dietary choices combined with maintaining an ideal body weight and staying active you can go a long way towards protecting your joints for years to come.

Is would also seem that, just in case all the other things that they are good for has not been enough, fish oils supplements would play a role in preventing osteoarthritis, especially after injury.

Osteoarthritis is NOT something that has to happen to your joints. Think about that the next time you reach for that bag of chips…

 

Autism, Schizophrenia and Depression; Surprising Thing They Have in Common

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Disorders of the mind have never been as easy to grasp for doctors. While therapists have a larger toolbox, most physicians are limited to medications.

For me, medications that screw with the essential way that your brain cells function in relationship to one another are a wee bit on the scary side.  We really know so little about the brain so it seems that using medications to alter it would be akin to cavemen using rocks to fix an iPad.

But alas, this is all we do in modern medicine.  The lucky ones will find their way to a good therapist and find tools to help.

But rarely does the topic of lifestyle changes come up.  The prevailing attitude is the opposite—there is little that can be done in the way of diet and lifestyle to manage these conditions.  But contrary to this opinion is an increasingly growing body of medical literature stating the opposite.

There is one key factor all these conditions and all this research have in common.

Inflammation.

Yup, that all so subtle, lifestyle-driven state of immune dysfunction.  It ranges from full-blown autoimmune conditions where the immune system is attacking tissues and organs it should not be to allergies and asthma when the immune system completely ignores the tissues inside and runs around like a Tasmanian devil trying to keep innocuous dust and particles at bay.

In all these situations, the resources used to drive the inflammation leaves the inflamed patient fatigued and prone to infections.  The constant insult to the body, the zapping of the body’s resources, the need to repair tissues again and again ultimately increases the risk for all chronic diseases, especially heart disease, dementia and many cancers.

But what does this inflammation do to the brain in the here and now?

It is very clear that current inflammation wreaks havoc on the brain.  This little fact, however, has escaped the notice of psychiatrists for decades.  Until now.

At this years’ (2014) annual meeting of the American Psychiatric Association the cat was let out of the bag by Dr. Eric Hollander of Montefiore Medical Center and Albert Einstein College of Medicine, New York City.  During the next several presentations, Dr. Hollander and others covered several important examples that demonstrate the links between inflammation and psychiatric disorders.

Dr. Andrew Miller of Emory University School of Medicine, Atlanta discussed the relationship between depression and inflammation.  He used these findings as proof:

  • Several studies have demonstrated that patients with depression have higher levels of inflammatory messengers (cytokines) in their blood and cerebral spinal fluid (specifically IL-6, TNF-alpha and CRP).
  • In treatment-resistant depression (about one-third of all depressed patients) there is an increase in inflammatory chemicals that have the ability to sabotage and deactivate the action of antidepressant therapy.
  • In one of the first studies in psychiatry linking a biomarker to treatment response, the high-powered drug used to block TNF-alpha (infliximab) was used in those with treatment-resistant depression.  Those patients who had high CRP levels had the best response to infliximab.
  • In a related study, Miller’s team were able to tell, using gene expression profiles, which patients were going to responded to infliximab within 6 hours of the first infusion.

The topic of schizophrenia was addressed by Dr. Norbert Müller of Ludwig Maximilian University of Munich, Germany.  Here were his points:

  • Infections and inflammation play a role in the development of schizophrenia; prenatal and postnatal infections are risk factors for schizophrenia.  The risk increases with the number of infections.
  • A number of studies using anti-inflammatory cyclooxygenase-2 (COX-2) inhibitors in addition to antipsychotic medication have had positive effects.
  • Timing is important: no benefit was seen in who had chronic schizophrenia, but anti-inflammatory therapies given early in the course of the disease were effective.

Dr. Hollander addressed the relationship between autistic spectrum disorders (ASD) and inflammation.  He notes:

  • Increases in inflammatory chemicals have been found both in the cerebrospinal fluid of patients with ASD and in brain tissue at autopsy in those with autism.
  • The bacteria in the gut may play a large role (the gut “microbiome”).
  • In support of the “hygiene hypothesis,” developed countries have higher rates of autoimmune conditions.
  • Hollander and others have focused on affecting the microbiome using a medicalized parasite, Trichuris suis ova (TSO-the eggs of a porcine whipworm). Trichuris suis ova is safe in humans, does not multiply in the host, is not transmittable by contact, and is cleared from the system spontaneously.  It works by balancing the inflammatory response to increase its survival. This balance in our system has shown some success in autoimmune diseases such as Crohn’s disease.
  • His group has been carrying out a small study of TSO in 10 high-functioning adults with ASD for 3 months and have found a potential benefit.
  • In another interesting study, researchers studied 10 children with ASD who were known to improve when they had fevers.  The children spent alternate days soaking in a hot tub at 102°F (to mimic fever) or at 98°F (control condition), showing improvements on the hot tub days.  It is believed that upping the body temp releases anti-inflammatory signals that positively affect behavior.

All of this information is a bit to swallow at once.  However, the real take home message is that inflammation is very bad for the brain, whether it is related to one of the three conditions covered here or another one like migraines, epilepsy or dementia.

Brain health is all-encompassing.  If you have no conditions it is still just as important to keep your brain healthy today for tomorrow’s brain health.  Leading an anti-inflammatory lifestyle is critical.  While the full nature of an anti-inflammatory lifestyle is beyond the scope of this article, you can better believe it involves exercise, stress management and a plant-based diet high in healthy fats.