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Osteoarthritis: An Alternative Medical Approach (Part II)

gentiana affinis

Gentian (Gentiana affinis)

Inflammation is the next logical place to go in this discussion. In part 1 we discussed the physical mechanisms of osteoarthritis, OA, and now we will spend some time with the biochemistry. I think this exercise is important for your full understanding of why we would make the recommendations that we do in the herbal and alternative world.

First let’s look at the conventional recommendations.

The conventional world uses non-steroidal anti-inflammatories. The COX-2 inhibiting drugs are the most common.  The tragedy in the modern world is that those drugs have been shown to be non- effective, and in fact when you use them over the long term they actually increase one of the key inflammatory mediators, a thing called interleukin 1 beta, which actually drives the disease harder. The crazy thing is, people take these NSAIDS long term thinking that they are helping when in fact they are making the disease worse. Additionally, some of those drugs were taken off the market because of adverse cardiovascular events and another tragedy is that some of these medications that are still in the market have these cardiovascular risks associated with them. So if you want to take a sensible view into OA we are going to want to down regulate interleukin 1 beta and down regulate tumor necrosis factor alpha and we want to have a target on the downstream consequences of that inflammation so nitric oxide is also involved. Too much nitric oxide at the chondrocyte is bad. We’ve got reactive oxygen species that are being produced as well and leukotrienes are going to be more relevant as an inflammatory target then prostaglandins, which is the main target of the conventional NSAIDS medications.

Inflammation

Inflammation is really a repair response and it should be an acute thing, however with OA it becomes chronic.  At the chronic level these inflammatory mediators create an overexposure, which compromises the repair process. From an herbal and alternative view we want to dampen and quiet down this inflammatory response and this is one of the key goals.

Earlier in part 1 http://www.seasidewellnesscenter.com/osteoarthritis/ we talked about “cross talk” and complex feedback loops within articular cartilage that causes these problems. The inflammatory mediators are mostly tumor necrosis factor alpha and interleukin 1 beta.  Another thing that we will discuss later is advanced glycation endproducts. These are the key mediators of that “cross talk.”

Relieving the Pain

Pain is the usual reason that patients see me and they don’t necessarily care what is going on biochemically. They just want the pain to go away in there knee, for instance. When you look into the research on OA it can be quite illusive. Cartilage doesn’t have a nerve supply so that can’t be the tissue that generates the pain. In contrast to that we have subchondral bone, synovium and we have the marginal periosteum (the lining of the bone itself).  We also have ligaments and the joint capsule all of which are richly innervated so if there is any sort of inflammation, pressure, or any sort of metabolic disturbance in any one of these tissues, then pain can be a downstream consequence. In terms of pinpointing what may be the actual cause of the pain, well, that may be a bit more of a challenge. When you look at the research there seems to be a greater correlation between pain and synovitis and also changes in the subchondral bone. Those are the two things that would be typically targeted for long term resolution of the pain. We may choose to use herbs, essential oils and nutrients, which may reduce the pain in the short term but the goal is to resolve the underlying issue so that the pain will go away.

Grosser pathological changes such as subchondral bone exposure, such as osteophytes and edema probably cause pain in highly advanced disease as well.  In some patients there may be alterations in the central nervous system pathways associated with the chronic pain, which we call central sensitization.  Since this has been identified in some patients with OA there may be involvement with some neurological mediators like substance P, for example, which brings into play some of the herbs which work in the nervous system category that you may not think of when considering OA.

OA a Systemic Disease

If we take a step backwards and ask the question, is OA a systemic disease, we have already introduced ourselves to the idea the metabolic changes such as insulin resistance, etc. may be underpinning OA and if that is the case then it is not going to be just joint stress that is the problem, it is going to be the susceptibility of that joint as a result of what is happening within the metabolic environment of the patient.

When you look at archaeological evidence going back a few hundred years, and you review skeletons based on OA findings in the obvious places like the knees and hips it has been discovered that when you have OA in one of those main locations there is also evidence of OA in all of the synovial joints. So when a patient comes to me with hip OA or knee OA I take the view that there is very likely a metabolic basis if it is not just injury or alignment related, and there is probably going to be OA disease in all the other joints as well. The more widespread the OA is the more likely the disease is going to advance and become chronic. A patient who has had a knee or hip injury only, is not likely to have OA systemically, but when the onset of OA is insidious we have to consider the relationship between metabolic syndrome and OA.

What then are the causes of this progressive systemic OA?

Advanced glycation end products is therefore the next topic when considering the biochemistry of OA.  Advanced glycation end products are prominent features of aging and are caused by the modification of a protein by sugar, particularly by glucose and fructose. To be technically correct, sugars can interact with nucleic acids and lipids and many other molecular types in our body. Glycated proteins undergo a series of reactions that take them into the category of advanced glycation end-products. Advanced glycation end-products are inflammatory in nature and there aren’t any enzymes in the body that can break these things down. Once they are produced they become permanent features in the body. The age related accumulation of these glycated proteins in articular cartilage causes the cartilage to become stiff. The collagen network becomes more brittle and more prone to damage. When we have patients with a lifelong challenge with these metabolic conditions, where their after meal glucose and fasting glucose is elevated, we know that the sugar infiltrates many places in their body producing these advanced glycation end-products. When we look at a patient’s blood we look at Hemoglobin A1C, which is a glycated form of hemoglobin. I am assuming that my readers are mostly familiar with this but may not use the term very often or have never had it explained in this way. This is in fact the intersection between what is happening metabolically and the development of the disease OA. So, advanced glycation end-products create a type of articular cartilage which is more prone to becoming damaged. As we said earlier in part I, once you start to get some damage at the articular surface and some of those surface tissues start to crack and break off you can get inflammation and the pieces of those cells can cause the synovitis. So right here we can mark a point and say that this is where it all starts to go wrong for the patient. When we look at patients in terms of their severity of OA it correlates  very tightly with increased levels of advanced glycation end-products. There is a very close relationship between these two things.

Advanced glycation end-products in cartilage trigger particular receptors for these compounds. These receptors are present on chondrocytes and fibroblast like synoviocytes. This increases the breakdown activity at those particular tissues. The presence of the advanced glycation end-products leads to an increase and a production of the cytokines and the matrix degrading enzymes, MMPs, that we discussed in part 1. When advanced glycation end-products interact with their receptor a thing called nuclear factor kappa B (NF-kB)  gets unregulated and that causes an increase in matrix metalloproteinase #13,  interleukin 6 and cyclooxygenase 2. This is part of the biochemical cycle in the development of OA.

Let’s now review what we have talked about in the context of the information given in the blog series on metabolic syndrome and up to this point in our discussion of OA in terms of alternative treatment.

Let’s take action and reduce the causes of OA.

Diet is the key and the sooner in a person’s life the better. Let’s start by breastfeeding our babies and then transitioning into a diet that does not elevate our blood sugar and insulin levels to the point where we are producing advanced glycation end-products. This takes a low carbohydrate diet. I promote Dr. Melvin Pages diet because it is time tested. Here is the link:

https://cdn.vortala.com/childsites/uploads/2002/files/the-page-fundamental-diet-plan-2011.pdf

The only additions that I would make is a stern warning on any commercial carbohydrate substance such as flour, pasta, bread, crackers, etc. It must be of an organic source. The chemical glyphosate is currently being used not only on the GMO wheat, corn and soybean crops but is also being used as a way to create rapid dry-down of non-GMO wheat crops. With no labeling regulations in the U.S. A. you can not trust that the residue of this poison is not in a wheat product that is not labeled organic. The same caution goes with the meats , nuts, seeds, eggs, fish and fowl that you are selecting. With no labeling as to country of origin you are in the dark as to the quality and purity of the food. Buyer beware. Local grown and non-commercial sources solve some of the problems but not all. I still like the organic label with my protein sources and especially my dairy sources. Do not overeat and do not mix meats and sweets at the same meal.

  • Next is the bitter herbs such as MediHerb’s DiGest which contains gentian to stimulate the endocrine cell bitter receptors that line the mucosal membranes of the tongue, gut and small bowel.
  • Next is the MediHerb  herbal, Gymnema, which stimulates certain (incretins) GLP-1 receptors that line the small and  large bowel and help control satiety and blood sugar levels by stimulating insulin release in ways other than elevations of blood sugar.
  • Next is the herbals such as MediHerb’s Gut Flora Complex which contains anise, oregano, andrographis and philodendron stem bark which serves to provide a correct environment for bifido bacterial growth, which produces much of our needed lactic acid and vitamins and helps in the repair and tightening of the brush border to prevent leaky gut syndrome.
  • Digestive aids such as Standard Process Zypan has  HCL and zymogen which helps to clear food out of the gut and break down complex proteins. Prebiotics such as inulin and gastro-fiber helps bacterial growth and probiotics help in reestablishing and maintaining lost bifido and lactic acid yeast necessary to  healthy digestive function.
  • Herbal complexes such as MediHerb’s Boswellia Complex contains Boswellia, Ginger, Turmeric and Celery Seed. This complex has a direct influence on the inflammatory processes of OA. (More on this product and topic in Part III)
  • Reflexology using Essential oils such as Young Living Essential Oil  DiGize, Valor II, Pan Away, Frankincense, oregano help to soothe, balance and support a stressed musculo-skeletal and digestive system.
  • Chiropractic care to balance and release nervous system interference and mobilize joint fixation.

With these alternatives in play I rarely see a patient not improve and avoid the use of injurious medications and surgical interventions. Getting this aspect of diet and digestive system function fixed is the key to shutting down the OA processes. We will discuss the relationships between OA and cardiovascular health and more on herbal support for the inflammatory processes in part 3 of this series on osteoarthritis.

It has been a busy summer with lot’s of great family time so my ability to finish this series has been subdued. We’ll get this done though because I know that your health and wellbeing will be enhanced with this information, especially if you act. If you are interested in our analysis and alternative approach to wellbeing please call Seaside Wellness Center for an appointment. (910) 352-2723

 

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