MARK HYMAN, MD

BOARD CERTIFIED IN FAMILY MEDICINE

EDITOR IN CHIEF, ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE
www.drhyman.
com

Getting to the Cause of Osteoarthritis

Experiencing joint pain, stiffness, swelling, crackling noises, bony

growths, and other painful and movement limiting symptoms, more than
20 million people in the United States have osteoarthritis (OA), the most
common form of arthritis. Symptoms typically appear in the
fifth and sixth decades of life.

A disease involving the breakdown of cartilage in the joint,

osteoarthritis most commonly occurs in the hands, hips, knees and
spine. With the loss of cartilage, the bones of any effected joints will
lose their cushioning, so that in movement, bone moves against bone,
which causes discomfort and limits range of motion.

In the past, people assumed that arthritis came about from the wear
and tear, and breakdown of these physical structures due to use.
However, now doctors have begun to recognize this disease as an
inflammatory disorder, often with significant systemic causes that can
and should be addressed.

In my medical practice, I’ve often found that food allergies, particularly

to gluten, play a part.
In one study, 11% of patients with osteoarthritis were found to have
gluten antibodies in their joints. This indicates a systemic
inflammatory reaction from eating gluten found in
wheat, barley, rye, spelt, kamut and oats—a far more widespread
problem than many people realize.

Lyme disease or other chronic infections can also be a factor. Often the
gut is a major source
of generalized systemic inflammation due to imbalances in the digestive
tract. That is
because 60% of our immune system resides in our intestinal tract.
Irritable bowel syndrome and inflammatory bowel disease can both lead
to arthritis and arthritis-like symptoms
because of how the gut and the rest of the body is connected through
the immune system.
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Diet contributes to chronic inflammation via such foods as meat,

alcohol, sugar, processed and refined foods. What’s more, nutritional
deficiencies such as low levels of omega 3 fatty
acids or antioxidants can lead to joint inflammation. Fortunately, all of
these contributors can be identified and addressed.

Testing for the Factors Contributing to Arthritis

Since we are all biochemically unique and each of us is an individual,

different people may be troubled by a disease, like arthritis, due to
different reasons. That’s why, for my arthritis patients, I undertake
specific tests, which I have found most helpful in pinpointing the exact
cause for that person. Most helpful are the following:

The C-reactive protein test: This can identify generalized

inflammation that may arise from many possible causes. Once this
is identified the specific cause must be found.
However some people who have a normal C-reactive protein test DO
have inflammation, but it shows up in a different way. If only medicine
were black and white!
The IGG food allergy or sensitivity test: This test reveals low-grade
food reactions and sensitivities that can also cause joint pains. Most
people don’t realize that they don’t need to have a full blown allergic
reaction to be impacted by food sensitivities. While allergic
reactions are more rare, sensitivities that produce symptoms are
common. The ones I see in my patients most are those to dairy, eggs,
gluten, yeast, soy, peanuts, and occasionally nightshades and corn.
Comprehensive Stool Analysis: The gut plays a big role in the
inflammatory process. Imbalances in the gut flora, (due to the
overgrowth of yeast, parasites or bacteria), can be ascertained.
Urinary Organic acids: This specialized test can identify by-products
and chemicals produced by abnormal bacteria in the gut that are
absorbed into the body, then excreted in
the urine. These organic acids can be helpful in looking at gut
imbalances particularly small bowel overgrowth of bacteria, and yeast,
which often trigger generalized inflammation in the body and arthritis.
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Testing for Lyme Disease and Other Infections: Hidden

infections, like Lyme disease, can trigger arthritis-like symptoms.
Testing for Autoimmune Markers: Rheumatoid arthritis arises
from an underlying autoimmune condition. This should be ruled out
through testing to identify rheumatoid factor, anti-nuclear antibodies
as well as other more complex markers for autoimmune disease.
Uric Acid Levels: When elevated, uric acid, can signify gout, with
symptoms similar to arthritis. Insulin resistance, or pre-diabetes
most often causes this.
Vitamin D Status: A vitamin D deficiency is a major cause of
osteoporosis, leading to chronic bone weakening and loss, a key
contributor to arthritis and as well as generalized muscle and joint
pains. Many people have low vitamin D levels due to reduced sun
exposure from our indoor lifestyles, as well as our lower intake of fatty
fish like mackerel, herring and sardines, which are good sources of
vitamin D. As a result, most people need vitamin D supplementation,
and the best type is vitamin D3.

Are You Gluten Sensitive?

IgG and IgA anti-gliadin antibodies and tissue
transglutaminase antibodies tests: These tests can help identify
gluten sensitivity, which can also trigger arthritis. Full blown celiac
disease affects 1% of the population or 3 million people, but up to
30% of the
population has the gene that predisposes them to some gluten
sensitivity which can lead to a generalized inflammation. Gene specific
tests including HLA-DQ8 and HLA-DQ2 are also helpful to diagnose cases
where the antibody levels are not clear. Stool testing can identify gluten
antibodies when the blood antibodies are negative because that is the
first site that
gluten comes into contact with the immune system and can show early
changes.
Nutrition for Arthritis Sufferers

To improve arthritis, first of all avoid common food allergens such as

dairy, eggs, corn, soy, yeast (found in bread, wine and beer), nuts,
nightshades (like tomatoes and eggplant) and
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gluten for at least one month. I recommend that you eliminate gluten
(found in wheat, oats, rye, and barley) for at least three months to see if
you experience less joint discomfort. In addition, I encourage people to
get rid of all processed foods, high processed corn syrup,
and trans fatty acids, all of which trigger inflammation.

Instead enjoy whole foods, like colorful fruits and vegetables, rich in
phytonutrients and antioxidants. I encourage the intake of omega 3 fats
from supplements or fatty fish such as wild salmon, sardines and
herring. These smaller fish do not store heavy metals, as do larger
fish like tuna. Certain foods like cherries contain both anti-inflammatory
properties. Increase your fiber intake from beans, nuts, seed, vegetables
and fruit to normalize the gut function, which is helpful for arthritis.

Exercise

Exercise helps reduce arthritis pain and swelling. In fact in several

studies they have found that people with arthritis who did home
exercise programs had a 23% reduction in pain compared to only 6%
reduction in people who do not exercise. Unfortunately, people with
arthritis may avoid the very exercise that helps lower overall pain by
reducing inflammation.
Try walking or using low impact machines like the elliptical trainer, or
swimming. Yoga and stretching can also help reduce pain and stiffness.

Integrative Therapies

Studies show that acupuncture is affective with arthritis. Yoga can

increase joint flexibility and decrease pain.

Supplements and Herbs

A number of supplements and herbs can help, including the following:

Glucosamine and chondroitin: (1500 mg of glucosamine sulfate
and 1000-1500 mg of chondroitin sulfate a day) work together to help
improve joint function and mobility. In
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numerous studies they have helped actually increase the health of the
joints by building up the cartilage and reducing the destruction of the
joints, which drugs can’t do.
Omega-3 fatty acids: Found in fish oil, as EPA and DHA (1000-2000
gm a day), arthritis sufferers benefit from these fats to control
inflammation.
Food extracts: avocado and soy derivatives, which may help
stimulate the growth of collagen. In a study of 164 people with
osteoarthritis, people who took avocado and soy bean extracts for six
months experienced less pain, increasing mobility and reduced
medication without side effects.
Anti-inflammatory herbs: Ginger, turmeric, which is the yellow spice
in curry, cherry extract, Boswellia or frankincense, and willow are
available as supplements. Capsaicin (used topically) is the main
component in hot chili peppers. Effects are felt three to six or seven
days after applying the capsaicin cream to the skin.
Probiotics, such as acidopholous help normalize gut flora at a dose
of 5-25 billion live organisms a day.
SAM-e (1200 mg a day) has been shown to improve joint pain in 12
weeks or more.
Vitamin D3 (2000 units a day) prevents cartilage breakdown of
cartilage and promotes bone health. Periodically check your vitamin D
levels to keep them between 50 and 75.
Proteolytic enzymes like Wobenzyme or bromelain can help break
down inflammatory proteins and reduce inflammation and pain.
Niacinamide (1500 mg) is a form of B3. In a preliminary study, arthritis
sufferers who took this dose had a 30% improvement in symptoms.
Multi-vitamin and mineral: a high potency vitamin and mineral
supplement provides many of the nutrients needed for proper joint
repair and healing as well as antioxidants.
Antioxidants: many additional antioxidants are available including
plant compounds such
as resveratrol, green tea, cocoa polyphenols, bioflavoinoids and
many others, which have powerful anti-inflammatory effects as well.
Other powerful anti-oxidants can be helpful such as lipoic acid, n-
acetylcysteine and others to help reduce the oxidative damage to
the joints.

Medications and Surgery

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Though helpful for relief of pain short term, medications like aspirin
and the non-steroidal inflammatories, like Ibuprofen and Naprosyn,
have significant downsides. Long term they actually increased joint
destruction and damage the intestinal lining leading to increased risk
of intestinal hemorrhage. The new COX inhibitors such as celecoxcib or
Celebrex may help reduce pain but can have other side effects perhaps
including increased risk of heart attack.

Tylenol may be helpful although this can cause liver stress and
deplete liver reserves for detoxification. Other treatments include
steroid injections or oral steroids, which can provide only short-term
relief and often lead to other complications. Hyaluronic acid is
another treatment that has been available. It can be injected into
joints once per week for three to five weeks and the effects may last
up to a year and can be helpful.

Until arthritis is fairly advanced, surgery has only limited benefits. A

recent study, comparing arthroscopic surgery with the placebo (no
treatment) showed no significant difference in the debridement or
cleaning out of joints. In cases of advanced arthritis, of the hips and
knees,
joint replacement can lead to dramatic increase in activity and reduction
of pain. Usually this joint replacement is reserved for older people
because the joints last only 20 years. Perhaps
new joints may be developed to last longer.

Summary

Arthritis has many causes including diet, lifestyle, food allergies,

nutritional deficiencies and possible infections. I recommend specific
testing to identify the causes that affect you specifically so that your
treatment can be targeted. Since diet plays a huge role in regulating
the inflammatory system in the body, an anti-inflammatory diet is the
first step. Elimination diets to reduce inflammation or avoid allergic
foods are also helpful.

Many supplements can help rebuild joint cartilage or reduce

inflammation naturally without side effects. Acupuncture and
exercise can also reduce pain and inflammation. Medication and
surgery should be reserved as a last resort treatment, only if you are
unsuccessful with
the often more effective lifestyle and supplement and herbal therapies.
A comprehensive
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approach to diagnosis and treatment by getting rid of the underlying

causes is essential to success.

Mark Hyman, M.D.