Nutrition therapy in the management of osteoarthritis

Nutritional therapy or functional clinical nutrition is a branch of functional medicine that approaches health imbalances underlying health conditions by adopting patient-centred healthcare within a holistic context relevant to each individual case by case, by assessing antecedents, triggers and biochemical mediators that may have a profound impact on the systemic function of the person seeking nutritional assistance.[i] In this sense, as well as supporting healthy function of physiology, functional medicine also looks at how the mind may affect the body’s health. It is well documented that practice of meditation and mindfulness may have a positive effect in reducing chronic pain.[ii]

Functional medicine looks at the biochemical function of the body as a balance between internal and external environments. Jones (2010) states that ‘diet is an environmental input that is critically important in determining function and vigor’.[iii]

Nutritional therapy works with food and with supplements that may be working well as adjunct therapy to exercise and pharmaceutical treatment when necessary.

Glucosamine sulfate is a natural supplement found in shells and shellfish, but also a biochemical component found in the synovial fluid around joints, and commonly used as a nutraceutical (dietary supplement derived from herbs) option for the management of OA.[iv] Sulfate is needed by the body to produce cartilage.[v] Randomized control trials have highlighted the superiority of Glucosamine sulfate to other forms of Glucosamine (for instance Glucosamine hydrochloride/N-Acetyl Glucosamine) in the successful treatment of OA.[vi], [vii]

A recent review has evaluated the importance of other nutraceuticals that play an important part in the support of joint health and combat inflammation: pomegranate, green tea, cat’s claw, devil’s claw, ginger, Indian olibanum, turmeric and ananas (pineapple).[viii], [ix] Though there seems to be still inconclusive evidence on the role of ginger, turmeric and ananas, and only pre-clinical evidence of positive effects of the other neutraceuticals is available. Although no side effects seem to be connected to these dietary supplements, more studies are in need to reach more conclusive answers on their use in OA treatment.

Implementation an elimination diet may also be of great support. Randomized control trials have shown positive responses to gluten exclusion from diet in patients with osteoarthritis and polyarthritis (is arthritis in five or more joints at the same time).[x]

Finally, given the higher risk to OA for the female gender, especially after menopause, support of sex hormones is fundamental.[xi], [xii] Although the relationship between female hormone imbalances and OA is still controversial, use of phytoestrogens in dietary intake has been shown to positively effect on inflammation, as well as on the support of female sex hormones.[xiii]

Ten tips to address OA

1. Exercise regularly, possibly one hour three times per week. Yoga and swimming have been shown to improve the health of articulation joints.[xiv]

2. Try and stay at your optimal weight. If overweight, ask your nutritional therapist for a safe approach to weight loss management.

3. Add practice of meditation or mindfulness to your relaxation time.

4. Eliminate gluten from your diet, or go for gluten free options (eg. gluten free oats). Gluten is a protein contained in some grains, such as wheat, oats, rye and barley.

5. Add shellfish to your diet (therapeutic amount 250g per day).[xv] Shellfish have been shown to contain high levels of glucosamine sulfate. This is only advisable to those people who do not have an allergy to shellfish.

6. Replace coffee and tea with green tea (rich in nutraceuticals that combat inflammation).

7. Add ginger and turmeric to your vegetable casserole dish.[xvi]

8. Add cruciferous plants (brassicas, cabbage, Brussels sprouts, broccoli) which rich in sulfur-containing phytochemicals to your diet.[xvii]

9. Add food containing phytoestrogens to your diet: miso in your soup, tofu in your salad, linseed and linseed oil in your vinaigrette.

10. Add a glass of red wine (containing resveratrol) to your dinner.

Notes

[i] Galland L (2010) Patient-centered care: antecedents, triggers, and mediators. In Jones DS (2010) Textbook of functional medicine. Gig Harbour: The Institute of Functional Medicine, pp. 79-87.

[ii] Kabat-Zinn et al. (1987) Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance. Clin J Pain, 2: 159-173.

[iii] Jones DS (2010) Textbook of functional medicine. Gig Harbour: The Institute of Functional Medicine, p. 109.

[iv] Mehta K et al (2007) Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial. BMC Complementary and Alternative Medicine, 7: 34.

[v] Poole A et al. (2001) Composition and structure of articular cartilage: a template for tissue repair. Clinical orthopaedics and related research, 391: S26-S33.

[vi] Mehta K et al (2007) Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial. BMC Complementary and Alternative Medicine, 7: 34.

[vii] Wu D et al. (2013) Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomized, double-blind, placebo-controlled trials. International Journal of Clinical Practice, 67 (6): 585-594.

[viii] Akhtar N and Haqqi TM (2014) Current nutraceuticals in the management of osteoarthritis: a review. Therapeutic advances in musculoskeletal disease, 4 (3): 181-207.

[ix] Efe C et al. Silent celiac disease presenting with polyarthritis. JCR: Journal of Clinical Rheumatology, 16 (4): 195-196.

[x] Kazėnaitė et al. (2004) Serological and histological markers of glutenic enteropathy in rheumatoid arthritis and osteoarthritis patients. Acta Medica Lituanica, 11 (2): 57-64.

[xi] Linn S et al. (2012) Role of sex hormones in the development of osteoarthritis. PM R, 4 (5): S169-173.

[xii] de Klerk BM et al. (2009) No clear association between female hormonal aspects and osteoarthritis of the hand, hip and knee: a systematic review. Rheumatology, 48, 9: 1160-1165.

[xiii] Labinskyy N et al. (2006) Vascular dysfunction in aging: potential effects of resveratrol, an anti-inflammatory phytoestrogen. Current medicinal chemistry, 13 (9): 989.

[xiv] Iyengar BKS (2015) Light on Yoga. London: Harper Thorsons, pp. 488-489.

[xv] Henrotin Y et al. (2012) Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis. Arthritis Res Ther 14 (1): 201.

[xvi] Hämäläinen M et al. (2007) Anti-inflammatory effects of flavonoids: genistein, kaempferol, quercetin, and daidzein inhibit STAT-1 and NF-κ B activations, whereas flavone, isorhamnetin, naringenin, and pelargonidin inhibit only NF-κ B activation along with their inhibitory effect on iNOS expression and NO production in activated macrophages. Mediators of inflammation, 45673-45673.

[xvii] Saito K (2004) Sulfur assimilatory metabolism. The long and smelling road. Plant Physiology, 136: 2443-2450.

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