OA is a degenerative type of arthritis which is commonly, but not exclusively, an aging problem - I, for instance, have a teflon toe joint, which I acquired in my thirties. Most people over the age of 40 have at least some OA as shown by x-rays. The exact cause of the disease is unknown, but misaligned or overly stressed joints are most likely to get it. There are two types: 1) Primary OA - normal wear and tear, and 2) Secondary OA which can result from a joint injury, disease (like diabetes), poor posture, occupational overuse, etc. The problem begins as a breakdown of cartilage, and progresses to the growth of bone spurs, which restrict motion. In essence, a sufferer of this disease has roughened bone surfaces rubbing together. Most commonly afflicted joints are finger, hip, and knee, but others can be involved, as in the cervical or lumbar areas of the spine.
OA is slow and irreversible, but symptoms can normally be ameliorated - pain, by drugs like aspirin (see Note 1), and loss of flexibility, by exercise. And, actually, the problem can sometimes be surgically removed/altered, but some of us wouldn't consider that a cure or a reversal. Sometimes all surgery does is replace one problem with another one. Another aspect of the arthritis problem can be excessive body fat (We can't get away from that subject, can we? No we can't, it seems that just about anything that can go wrong with our bodies is related to excess fat.). The dead weight of fat puts extra stress on our joints. Extra muscle, on the other hand, helps us move, and provides the "furnaces" for burning fuel in our bodies. To reiterate, we have three areas through which we can attack arthritis: nutrition, drugs (no, not that kind), and exercise.
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Note 1 - Aspirin can be very effective, but has side-effects for some, who might find something like Advil more to their liking. It may be less effective than aspirin, but without its side-effects.
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NUTRITION
This section could almost be called "weight control" instead of NUTRITION. At this time there have been no specific foods identified to cure arthritis. All that can be said is to eat a healthy diet to maintain "ideal" body weight. However, there may be an immunological aspect of arthritis; hence, a nutritional one. Some rheumatic disease might be an allergic reaction to certain foods. Some diets may affect immune systems - might affect inflammation associated with arthritis. Various types of malnutrition - fasting, low protein, calorie restriction - abnormal diets can affect the immune system. Do, consume a moderate amount of both protein and fat. Reduce simple sugars - increase complex carbohydrates. Drink lots of non-alcoholic fluids.
Maintain "normal" vitamin/mineral content in your diet - nobody seems to know why, but all seem to think there must be some connection.
In addition to the admonition to eat a healthy diet, there are two other suggestions: avoid excessive alcohol intake, and avoid high-purine foods (see Note 2), especially during a flare-up.
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Note 2 - Purine foods include things like: anchovies, beans, lentils, dried peas, bouillon and broths, brains, crab, gravy, herring, liver, lobster, mackerel, mussels, oatmeal, poultry, sardines, and spinach. There are others in this eclectic list, but enough-is-enough.
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It turns out that anyone (a non-doctor, at least) who tries to really do some research on nutritional impacts on arthritis, is likely to be extremely frustrated by the lack of consistent, verifiable information - there isn't any. There seem to be two schools of thought on this subject. One says that there are no known nutritional therapies for arthritis. The second "school," actually this is a jumble of largely unsupported claims, and not a cohesive school at all.
An example of this line of thought is that a book that I ran across says that milk might be the perfect food for arthritis sufferers. The author, a doctor of course, claimed that milk (specifically, room temperature, homogenized, vitamin D milk) contains some "oils" (unspecified) which help to lubricate joints. Of course, a nutrition text book that I read said that milk aggravates arthritis in some patients. And still others don't tolerate milk well - it causes gastrointestinal problems. For them; however, this is usually a lactose (milk's version of sugar) intolerance, and can be avoided by using one of the low- or non-lactose milk products now on the market. Yogurt can also be substituted for milk, and usually avoids the problems of milk intolerance. A second example of the "diverse" school is "fish oil." Some (one?) studies in Norway suggested that fish oil improves arthritis (probably only the rheumatoid (RA) variety). Rather than using oil, eating the fish is thought by many to be better, and there may be some applicability to both OA and RA. Both Omega-3 fat and EPA (a fatty acid) are thought to possibly help. There are other schemes, like fasting (which, of course, has its own problems), followed by a vegetarian diet. It is clear that a person could spend a fortune and a limitless amount of time experimenting on him or her self. Unless you have unlimited resources and a death wish, it might make more sense to follow a conservative approach, and eat a healthy diet, and hope that the future brings some verifiable nutritional therapy.
Here are a few of the many theories on what might be good, or bad, to eat, but at least one can experiment with these suggestions without damaging your health. It has been theorized that lemons (fruit or juice) should be avoided by arthritis sufferers. Maybe all citrus fruit. Or maybe not. I have seen at least one recommendation for taking chicken broth - this came from someone's grandmother, I think. Another item was to minimize sugary foods like candy or pastries. This is sensible advice, at least in that it helps with weight management, if not arthritis directly.
There is one suggestion that I have seen that makes some sense: eat a diet rich in calcium (800-1000 mg per day, which is the normal RDA). You need vitamin D to absorb it, which is why vitamin D milk was recommended above. Being outdoors about 15 minutes a day is also a good source unless you live where it is frequently cloudy - sunlight is a good source of vitamin D. Also, dietary calcium is better absorbed than Tums or other supplements, some of which have undesirable side-effects. Note that I have also seen calcium listed among "stuff" that has not been proven to have any therapeutic affect on arthritis, but it is probably, at least, a good suggestion for normal health.
One last item, a group calling itself the "Life Extension Foundation" sells a product called "Condrox," which is a collection of amino acids and other "stuff." They claim that it helps, but I don't know if it really does or not, or to what degree, if it does.
When all is said and done, the bottom line seems to be as stated by the conventional scientific community's position on this subject, which may be expressed by the following statement: "Nutritional therapy for arthritis is not established." [This is according to "Primary Care Rheumatology," Sept-Oct 1992, Vol. 2, Number 5.]
DRUG THERAPY
As previously noted, aspirin, for pain, is a commonly recommended drug (or Advil, or maybe other over-the-counter pain killers). It should be noted that "coated" aspirin might alleviate aspirin's common gastrointestinal side-effects. Coated aspirin slows entry into the blood stream, and keeps them from dissolving in the stomach. Of course, there are a variety of prescription drugs available if aspirin doesn't work. These are commonly of two types: corticosteroids and penicillamine. Consult your doctor if you think you might benefit from one of these drugs.
EXERCISE
Isn't it funny that exercise seems to be a universal palliative while excess fat is a universal "housewrecker." Anyway, it helps flexibility, strength, and weight control, all of which can help an arthritis sufferer. There are three relevant types of exercise: stretching, strengthening, and endurance (aerobic). For any exercise program, an extensive warm-up should be incorporated. For an aerobic program, whether walking, jogging, bicycling, etc., just start the activity slowly to warm-up. A weight training program should start with some form of aerobics to warm-up, and then include a light warm-up set as a prelude to each exercise. Stretching should always follow a warm-up session; it should not be done from a cold start; however, warm water stretching is pretty safe. A warm swimming pool is a particularly good place to both stretch and exercise.
Some daily exercise should be done. Whatever you choose should be relatively gentle, and you should work affected areas through as full a range-of-motion as you can comfortably achieve. If the word "exercise" is particularly repugnant to you, "activity" is an acceptable, though less effective, alternative. It is beneficial if one just keeps active and moves arthritic parts as much as possible. Consistent, planned exercise is best, but, both would be even better. Actually, what you will do is the best of all exercises for any purpose.
An exercise program for an owner of an arthritic condition should include:
That's enough on exercise. Here are some other suggestions. Don't do anything for too long - take breaks. Avoid holding the same position for an extended time - move around. Learn to balance rest and exercise, especially around pain flareups. Try ice, or heat, or both, alternately.
Q What is the current thought on retarding/reversing bone loss, both through the normal aging process, and osteoporosis? Note that bone loss is described both in terms of bone mass and bone density. The meaning of these two terms are not precisely the same, but do they get used interchangeably?
J.F., Palo Alto, CA
A This is a bit confusing, now that you mention it. I will provide a definition of each, although they may not be universally accepted. For my purposes, bone mass refers to "thickness" of a bone, e.g., the girth of a "long bone," like the femur. Bone density is the "compactness" of a bone. There must be a better word than that, but I can't think of one at the moment. You will understand my meaning if you have ever seen an osteoporotic bone - they look like a piece of wood that has been attacked by termites.
It was once thought that loss of either was irreversible, but no longer. Exercise can help, as can estrogen/progesterone replacement (see MAF FITNESS NEWSLETTER, Issue 6, Oct 1994) .
Q I have read inconsistent ideas about when bone mass reaches its maximum, and then starts to decrease. Can you straighten this out for me?
C.B., Tigard, OR
A Maybe not, but I will try. I have seen the same kind of conflicting information. First, that bone mass reaches its maximum at age 20, and then declines slowly but steadily until we die. The last information that I encountered on this subject said that we reach maximum bone mass between the ages of 25-30, maintain it until ages 35-45, and then start losing about .2%-.5% per year. Maybe more important than the specific ages is the fact that we reach a maximum relatively early in life, and start losing it as a natural progression in the aging process. It was once though that this was a natural, insidious and relentless process, but it is now known that it can be retarded - even reversed - by weight-bearing/push-pull type exercise - yes, like weight training. It is important that we consume adequate amounts of calcium during our formative years, in order to maximize our bone mass before the apparently inexorable loss (unless we start hitting the weights) as we age. [Thanks a lot, now that I'm over 50 this really helps.]
Q During my younger days, I had a bit more muscle mass than I do now. I have worked with weights for may years, but without regaining the muscle. Am I not working hard enough?
R.M., Denver, Col
A Maybe not, but there are other possibilities. One touches on a physiology fact. Muscles can grow (hypertrophy), or they can shrink (atrophy) Or they can stay the same. There is, of course, an X-Factor at work here, but we will ignore it in this answer. Hypertrophy is a muscle's response to work (like weight training) ..... Oh-Oh, I think this answer is going to get a little more technical than I had wanted, but that's life. We are all, men and women, born with a fixed amount of muscle fibers. At least by the end of puberty, we have what we're going to get. We cannot grow more, but muscle size can be increased by stimulating the muscles to add more myofibrils (myofibrils are made of a number of proteins inside (at the very core) of skeletal muscles). These added myofibrils, of course, expand their muscle fiber homes. On the other hand, disuse of a muscle, as in the case of a casted, broken limb, causes muscle atrophy, which is a process that essentially "erases" muscle fibers. To regain your previous level of muscularity, you have to make your remaining fibers grow even more to make up for their reduced number. For those of us with an X-Factor which makes hypertrophy difficult, this is a big problem.