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Osteoarthritis

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According to the NIH:

Osteoarthritis (OA) is the most common type of arthritis. It occurs most often in the hands, knees, hips, and spine.

OA affects cartilage—the slippery tissue that covers the ends of bones in a joint. Cartilage allows bones to glide over each other and absorbs the shock of movement. In OA, the top layer of cartilage breaks down and wears away, allowing the bones under it to rub against each other. This can cause pain, swelling, and difficulty in moving the joint.

OA is most common in older people, but younger people can have it too, especially in joints that have been injured.

For more information, see:

I first started seriously learning about osteoarthritis when my 83-yo father started experiencing pain in his daily walks.  His latest radiology report stated:

CLINICAL INDICATION:
83-year-old male, non-traumatic swelling of the left knee reducing ability to walk over long distances OA changes?

COMPARISON:
September 30, 2016.

FINDINGS:
Tricompartmental spurring. Mild narrowing of the medial tibiofemoral compartment joint space. Mild patellofemoral compartment joint space narrowing. There is calcification projecting over the expected location of the distal quadriceps tendon. In retrospect, this finding is also present on the prior study. There is an effusion in the suprapatellar recess, larger impaired to previous. No intraarticular loose bodies are identified. No aggressive bone lesions or periosteal reaction. No fracture. Moderately severe vascular calcification.

IMPRESSlON:
Mild degenerative changes. See above for other findings.

To maintain his metabolic health, my father needs to stay active but the knee pain severely slowed him down. It often caused a pronounced limp and the need to walk with a cane.  It is common to treat this pain with analgesics but there are side effects.  However, while articular cartilage grows slowly and there is a belief that osteoarthritis is progressive, there is some evidence and annecdotes that articular cartilage regeneration is possible.

Osteoarthritis

DISCLAIMER: My background is engineering and what I have written here is from my personal interest in staying healthy. If you disagree with any of it, let know what you feel is inaccurate and include some references so I can make corrections. This is a work in progress so check back often for updates as I continue to learn. CONSULT WITH YOUR DOCTOR BEFORE MAKING DIET AND LIFESTYLE CHANGES.


The Standard of Care includes non-pharmacological treatments such as  weight loss, analgesics, exercise, and physical therapy for the initial stages of OA and progresses to more invasive treatments such as injections and surgery.  Paul Mason suggests that a dietary intervention can also provide relief and possibly reversal.  He explains that an inflammatory state from metabolic dysfunction can cause inflammation in the synovial joint (including the fluid pocket around articular cartilage), leading to degradation in the cartiliage.  An important factor in cartiliage degeneration is Matrix Metallo-Proteinaise, which is produced in excess by non alcoholic fatty liver disease.  So weight loss has two benefits: reduced mechanical loading of weight-bearing joints and improved liver health.  Hypersinsulinemia has also been implicated in synovial dysfunction, which may be the underlying cause of age being a risk factor of osteoarthritis.

I've been monitoring my father's labwork for HbA1c, C-Reactive Protein, and eGFR.  I also try to get C-Peptide but the physician doesn't always include this test in the lab requisitions.  I try to get his labwork done every 3 months.

It appears that it is possible to prevent or at least mitigate the age-related osteoarthritis through diet and lifestyle


I've been helping my father become metabolically healthy by following a ketogenic (low-carb, high-fat) with a focus on eating as much animal-sourced proteins as possible and staying physically active.  While bone density is an important consideration for women, it is also a consideration for men.  Weight-bearing exercises and adequate (high-quality) protein consumption for seniors (1.2-1.6g / kg of body weight) will help mitigate sarcopenia and osteoporosis for all seniors.  Improving metabolic health through the dietary intervention improve OA by keeping insulin low and by reducing inflammation in the body.  Alternating between the fasted and fed states promotes autophagy and cellular regeneration through the AMPK and mTOR pathways.  Low-load repetitive exercise (like cycling) increases circulation of synovial fluid, which in turn helps to exchange nutrients and waste products between chondrocytes and the blood stream.

The course of action we're going to do to help regenerate the articular cartilage in the knees is:

  • primarily ketogenic and possibly Paleo-Ketogenic Diet
  • intermittent fasting (time-restricted eating): daily 4-6 hour eating window
  • increased Omega 3 Fatty Acid food consumption (salmon, sardines, etc)
  • increased bone broth consumption (use broth from crockpot-cooked meat)
  • avoidance of night-shade vegetables (tomatoes, potatoes, peppers, etc) and legumes
  • low-impact, moderate mechanical loading of joints through resistance training
  • low-exertion cardiovascular exercise on a recumbent bicycle
  • gluteus muscle strengthening exercises