Osteoarthritis
Understanding and preventing our nation’s primary crippler

By Joel Fuhrman, M.D.

Osteoarthritis (OA) is a nearly universal degenerative condition, affecting both men and women as they age. OA is the most common type of arthritis, affecting more than 28 million adults in the United States.

In OA, the cartilage cushion in the joints breaks down, which eventually can cause the bones to rub together. Pain, stiffness, and sometimes the formation of bone growths, called spurs, result. OA can affect any joint, but it is most common in the hands, feet, spine, and in large,weight-bearing joints such as the hips and knees. OA of the hip and knee represents the leading cause of pain and disability often referred to as the “primary crippler” of adults, and the percentage of the population with these symptoms has been increasing in recent years.

OA also is called degenerative joint disease (DJD) or ordinary arthritis. It differs from rheumatoid arthritis (RA) as it does not involve an immune system-mediated attack on the joints as is the case with RA.

Despite its prevalence and the fact that it worsens with age, OA is not the inevitable onsequence of aging. Recent scientific advances have enabled us to better understand
the contributory factors that promote arthritis, dispelling the myth that joint degeneration is merely an age-related phenomenon.

Joint degeneration

Currently, the pathogenesis of OA is explained by various contributing factors that adversely affect cartilage cells. In simple terms, the chondrocytes (cells that produce cartilage) become stressed, overworked, injured, and eventually die. This destruction of the chondrocytes makes
it impossible for your body to keep up with the production of high-quality collagen needed for normal wear and tear. As the cartilage erodes, the joint becomes inflamed, and lytic (caustic) enzymes can further degrade the cartilage matrix. As cartilage wears away on the ends of the
bones and cushioning is lost, the intensity of pain may increase. Pain may become quite severe if the cartilage has completely deteriorated.

Surprisingly, physical inactivity can be more harmful to the joints than overuse. Joint activity signals for the delivery of nutrients to the joints. A lack of exercise or varied movement can weaken the muscles that support the joints, and an underused joint may become stiff, painful, dysfunctional, and prone to injury and osteoarthritis.

Joints, because of their somewhat unusual blood supply, are extremely sensitive to negative nutritional influences compared with other parts of the body. When we abuse our body with poor nutrition, we not only raise our blood pressure and increase our risk of heart attack and stroke, but we also damage our joints. In fact,OA and degenerative bone disease of the spine could be early warning signs of heart disease in years to come.

The reason why joints have an increased susceptibility to damage from dietary folly is because of their indirect blood supply. Instead of direct oxygenation and nourishment from being bathed in blood (such as with muscles and organs), cartilage is nourished from the fluid in the joint capsule. Oxygen comes from tiny capillaries that surround the joint capsule and diffuses across the joint capsule membrane and into the joint fluid.With normal microcirculation and good nutrition, plenty of oxygen and nutrients bathe the cartilaginous surface of the joints.

This intricate and fragile system can be vulnerable to nutritional stresses. The nourishment to the
cartilaginous surface of the joint can be curtailed even by the smallest impediment to normal blood flow. When atherosclerosis is present, the delivery system can be easily disrupted by as simple a thing as eating a high-fat meal. Even the earlier stages of atherosclerosis can impede oxygen delivery to the joint, revealing itself in joint problems that occur decades before the
heart problem is diagnosed.

When you eat a piece of high-fat food—such as cheese pizza, bacon, or steak—the saturated fats thicken the blood and make the red blood cells sticky. This clumping together of red blood cells makes them too large to enter the small capillaries that surround and nourish the joint
capsules. Atherosclerotic deposits thicken the walls and narrow the vascular bed, further impeding delivery of oxygen and nutrients to the joint area where most cartilage and bone remodeling takes place. Defective remodeling then occurs,with gradual destruction of the joint.

High nutrient supply

High cholesterol levels and other blood markers of heightened cardiovascular risk are a documented risk factor for both knee and generalized osteoarthritis. It is not difficult to understand why osteoarthritis is related to meat and cheese consumption, since sufferers of
both conditions are more likely to have high cholesterol and high triglyceride levels.These are typical signs of a diet that promotes atherosclerosis, impaired circulation, and subsequent cartilage compromise.

Populations with lower rates of heart disease, such as the Chinese, correspondingly have lower rates of osteoarthritis in the same age bracket. The elderly in Beijing, China were found to have 80-90 percent less osteoarthritis than elderly Americans. Radiographic signs of arthritis in the age range of 60-89 were found in only about one percent in the Chinese portion of the study, and the percentage did not increase with age.

Cardiac risk factors also are risk factors for arthritis, but there is more to the story. Marginal nutrient intake also can interfere with the chondrocytes’ ability to make structurally strong cartilage. Contrary to the view held for many years, in osteoarthritis the cartilage does not passively erode away; in fact, the body works hard to protect itself. In the early years when the
joints are stressed by improper nutrition, the body increases the production of cartilage in an attempt to compensate.The production of cartilage matrix has been observed to increase as much as six times the normal amount in the beginning phase of osteoarthritis.

The problem lies in the production of poor quality cartilage.Without optimal nutrition, DNA synthesis goes on, but does not perform singing the best tune. As time goes on and the disease advances, the chondrocytes start to die and collagen synthesis falls.

Mounting research has pointed to the fact that a high intake of carotenoids, particularly lutein and beta-cryptoxanthin, found in colorful vegetables, is necessary for high quality cartilage.Studies also have shown that low levels of boron,selenium, glutathione, and sulfur are
related to osteoarthritis incidence and exacerbation. The good news is that if osteoarthritis is caught early—before much loss of cartilage and death of chondrocytes—and nutritional excellence is initiated, most of the damage still can be reversible.

Fish oil supplements, docosahexaenoic acid (DHA), glucosamine, and chondroitin have been shown to be helpful in retarding the advancement and reducing the symptoms of osteoarthritis. Eicosapentaenoic acid (EPA) and DHA have anti-inflammatory properties that can reduce joint inflammation, and glucosamine and chondroitin can supply nutrients needed for cartilage
synthesis. Keep in mind, however, that just as with other diseases, supplements alone are not all that is necessary for optimal results. However helpful supplements may be, without the adoption of a superior diet containing the full concert of healthful phytochemicals and antioxidants that results in low cholesterol, one cannot expect maximum healing and maximum protection against OA. Once excellent nutrition is instituted, the body adequately produces its own cartilage
precursors, and supplements have little effect.

Healthy Travel Tips

Vacationing with family in Orlando, Fla., Dr. Fuhrman sends the following tips:
“We always take raw nuts, almond and cashew butter, and dried fruits with us. On arrival,
we buy lots of our favorite fruits. For breakfast,we make oatmeal with raisins in the electric coffee pot in the hotel room. To maximize our fun and not waste time or money sitting in restaurants, we pack fresh fruits and nuts for our daily excursions. That lasts us until dinner, when we usually can find a nice buffet with a big salad bar and vegetable options.”

A Remarkable Osteoarthritis Recovery
Diet and lifestyle changes lead to dramatic restoration of health!

Mike Nichols lived many years of his life in pain. By the time he was age 36, his back was such a problem for him that he could not sit for very long. For weeks at a time, he had to hire a driver to take him to work each day, so he could lie down in the back seat. He saw a chiropractor three
times a week, and went to a rheumatologist for prescriptions for pain medications and muscle relaxants. He traveled to New York City to see specialists— osteopaths and orthopedic surgeons—who he thought could help him with his pain. X rays of his back showed degenerative back disease, and, in addition to his back pain, his knees and hips bothered him, too.

By the time Mike came to see me, he was age 46.He weighed 236 lbs., his cholesterol was 245 mg/dl,and he frequently complained of burning when he urinated, the cause of which no doctor could discern. As you might imagine,he was sick of suffering ill health and disability at such a young age and hoped I could help him.

His was certainly not an unusual case. Many Americans suffer with similar complaints.What makes Mike’s case atypical is that he followed my nutritional recommendations and persevered until he achieved a complete recovery.

His urinary problems ended after about six weeks. After one year, he weighed 178 lbs. and his cholesterol came down to 190 mg/dl. Unfortunately, his chronic back complaints and joint aches had not gone away.

To his credit, Mike did not let the continual back and joint problems dissuade him from his commitment to a healthy lifestyle. He enjoyed the high-nutrient diet and lifestyle I designed for him and was firmly committed to healthful eating for the rest of his life.

After two years,he weighed 168, his cholesterol was 175, he no longer had knee and hip complaints, and he had noted a definite improvement with his back problem. Over the next year, his back aches simply faded away. Now, five years after first seeing me as a patient, Mike feels terrific. His total cholesterol is down to 160, he goes to the gym, does abdominal and back exercises, and can drive around in his car without any problems. His health is virtually restored!