Healthy Joints

Welcome to Nutrition Facts.  I’m your host, Dr. Michael Greger, and I’m here to ask you, what is the most important decision you’ll make today, is it how you’ll get to work, who you’ll set up a meeting with, what friend you’ll call for lunch?  Well, as it turns out, probably the most important decision you’ll make today is what to eat.  What we eat on a day-to-day basis is the number one determinant of our health and longevity—literally.  Most premature deaths in the United States are preventable and related to nutrition.  So, we’re going to explore some smart nutrition choices based, naturally, on facts.  Here, we refer to the science, the research, the available data published in the peer-reviewed medical literature right now.  That’s why I wrote my book, How Not to Die, and why I created my nonprofit site NutritionFacts.org and, now, this podcast.

Maintaining joint health means stopping the chain of events that causes joint disease. Joint disease has many triggers, including injury, infection, and inflammation, often leading to a painful arthritis. 

A key to joint health is minimizing inflammation.  Many studies show an anti-inflammatory effect of a more plant-based diet, whereas many animal and junk foods appear to have proinflammatory effects.  Certain meats in particular can lead to high concentrations of uric acid in the blood that can end up crystalizing in our joints, causing a painful condition called gout. 

Rheumatoid arthritis may be triggered by autoimmune friendly fire against a urinary tract infection bacteria called Proteus mirabilis, which could help explain why sufferers randomized to a more plant-based diet experience such remarkable benefit.  Here’s the research.

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions, characterized by persistent pain and stiffness, and progressive joint destruction—particularly in the hands and feet, leading to crippling deformities.  What can we do to prevent it and to treat it?

In a famous 13-month-long randomized controlled trial of plant-based diets for rheumatoid arthritis, patients were put on a vegan diet for three and a half months, and then switched to an egg-free lactovegetarian diet for the remainder of the study.  Compared to the control group, that didn’t change their diet at all, the plant-based group had a significant improvement in morning stiffness within the first month, cutting the number of hours they suffered from joint stiffness in half.  Pain dropped from five out of ten down to less than three out of ten.  A drop in disability; they reported subjectively feeling better, significant improvements in their grip strength in their hands, fewer tender joints, less tenderness per joint, and less swelling, with the added benefit of losing about 13 pounds and keeping most of that weight off throughout the year.  They also had a drop in inflammatory markers in their blood, sed rate, C-reactive protein, and white count.  The question is, why?  What does diet have to do with inflammatory joint disease?

Well, rheumatoid arthritis is an autoimmune disease in which your body attacks the lining of your own joints.  Why would it do that?  Well, there’s a different autoimmune disease called rheumatic fever, in which your body attacks your own heart.  Again, why would it do that?  Well, it appears to be a matter of friendly fire.  Rheumatic fever is caused by strep throat, which is caused by a bacteria that has a protein that looks an awful lot like a protein in our heart.  So, when our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by “molecular mimicry”.  The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both.  That’s why it’s critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

So, researchers thought maybe rheumatoid arthritis might be triggered by an infection as well.  A clue to where to start looking was the fact that women seem to get rheumatoid arthritis three times more frequently than men.  What type of infection do women get more than men?  Urinary tract infections.  So, researchers started testing the urine of rheumatoid arthritis sufferers and lo and behold found this bacteria called Proteus mirabilis–not enough to cause symptoms of a UTI, but enough to trigger an immune response and, indeed, there’s a molecule in that bacteria that looks an awful lot like one of our own molecules in our joints.  So, anti-Proteus antibodies against the bacteria may inadvertently damage our own joint tissues, leading eventually to the joint destruction.  Therefore, therapeutic interventions aimed at the removal of this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

Well, as we saw before, urinary tract infections originate from the fecal flora–the bugs crawl up from the rectum into the bladder and so, how might one change the bugs in one’s colon?  By changing our diet.  Some of the first studies over 20 years ago on trying to fundamentally shift people’s gut flora were done using raw vegan diets, figuring that’s about as fundamental a shift from the standard Western diet as one can get and, indeed, within days one could significantly shift someone’s gut flora.  And you put rheumatoid arthritis sufferers on that kind of diet and they experience relief and the greater improvements were linked to greater changes in their gut flora.  But the diet was considered so intolerable that half the patients couldn’t take it and dropped out–perhaps because they were trying to feed people things like buckwheat-beetroot cutlets buttered with a spread made out of almonds and fermented coconut juice—excuse me, not coconut—that might have been good—cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis, but we didn’t specifically have confirmation that plant-based diets brought down anti-Proteus antibodies, until now.  Those that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group.  Maybe it just dropped immune responses across the board?  No, antibody levels against other bugs remained the same.  So, the assumption is that the veg diet reduced urinary or gut levels of the bug.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of our urine–for example, higher levels of lignans in the urine of those eating vegetarian.  Up until now, it was just thought that they protected people eating more plant-based from getting cancer, but now we know lignans can also have antimicrobial properties as well, so may be helping to clear Proteus from our system.  Either way, this suggests a new type of therapy for the management of rheumatoid arthritis.  This new treatment includes anti-Proteus measures such as dietary manipulations in the forms of vegetarian diets.

Can the consumption of sesame seeds improve the clinical signs and symptoms of arthritis?  Here are some answers.

Ever since the 1920s, doctors have been injecting arthritis patients with gold.  Evidently, “gold-based medicines have been in use for thousands of years,” and remarkably, are still in clinical use as so-called disease-modifying antirheumatic drugs—meaning they can slow the progression of rheumatoid arthritis. 

Unfortunately, such drugs can be toxic, even fatal, causing conditions such as gold lung, a gold-induced lung disease.  “Although its use can be limited by the incidence of serious toxicity,” injectable gold has been shown to be beneficial but maybe, some researchers suspected, some of that benefit is the sesame oil that’s injected, which is used as the liquid carrier for the gold.

Sesame seeds contain anti-inflammatory compounds, with names like sesamin and sesamol, which researchers suspect “may serve as a potential treatment for various inflammatory diseases.”  But, these were in vitro studies.  First, we have to see if it has an anti-inflammatory effect in people, not just cells in a Petri dish.  But, there haven’t been any studies on the effects of sesame seeds on inflammatory markers in people with arthritis, for example—until now.

“Considering the high prevalence of osteoarthritis and since, until now, there hasn’t been any human studies to evaluate the effect of sesame on osteoarthritis patients, this study was designed to assess the effect of administration of sesame seeds on inflammation” and, they found a significant drop in inflammatory markers.  But, what effect did it have on their actual disease?

Fifty patients with osteoarthritis of the knee were split into two groups: standard treatment, or standard treatment plus about a quarter-cup of sesame seeds a day for two months.  Before they started, they described their pain as about 9 out of 10—where zero is no pain, and 10 is the maximum pain tolerable.  After two months, the control group felt a little better—pain down to 7 but, the sesame group dropped down to 3.5—significantly lower than the control group. 

The researchers conclude that sesame appeared to have a “positive effect,” “improving clinical signs and symptoms in patients with knee osteoarthritis.”  But, the main problem with this study is that the control group wasn’t given a placebo.  It’s hard to come up with a kind of fake sesame seed.  But, without a placebo, they basically compared doing nothing to doing something and, any time you have patients do something special, you can’t discount the placebo effect. 

But, what are the downsides?  I mean that’s the nice thing about using food as medicine—only good side effects.  Though the results are mixed, there have been studies using placebo controls that found that adding sesame seeds to one’s diet may improve our cholesterol and antioxidant status and, the amount of sesamin found in as little as about one tablespoon of sesame seeds can modestly lower blood pressure a few points within a month—enough, perhaps, to lower fatal stroke and heart attack risk by about 5%, potentially saving thousands of lives. 

The yellow pigment curcumin in the spice turmeric may work as well as, or better than, anti-inflammatory drugs and painkillers for the treatment of knee osteoarthritis.

Osteoarthritis is “the most frequent cause of physical disability among older adults” in the world, affecting more than 20 million Americans, with 20% of us destined to be affected in coming decades, and “becoming more and more widespread among younger people,” as well.

Osteoarthritis is characterized by loss of cartilage in the joint.  We used to think it was just mechanical wear and tear, but it’s now generally accepted as “an active joint disease with a prominent inflammatory component” as evidenced by, for example, significantly higher production of inflammatory prostaglandins from tissue samples obtained from the knees of people suffering from the disease.

If the loss of cartilage is caused in part by inflammation, might an anti-inflammatory diet help, like it does with rheumatoid arthritis?  Using optimal nutrition and exercise as the “’first-line’ intervention in the management of chronic osteoarthritis could well constitute the best medical practice.”

Where’s the best science on what optimal nutrition might look like?  The China Study is a prime example, showing “the serious health consequences of high consumption of proinflammatory foods, meat, dairy, fat, and junk, and low consumption of anti-inflammatory plant foods, whole grains, vegetables and fruits,” and beans, split peas, chickpeas, and lentils.  The unnatural Western diet “contributes to low-grade systemic inflammation and oxidative tissue stress and irritation, placing the immune system in an overactive state, a common denominator of conditions such as arthritis.”

There are phytonutrients in plants that appear to help decrease the degradation of the joint cartilage, the inflammatory activity, the cell death, and oxidative damage.  This is based largely on in vitro studies suggesting protective benefits of soy, pomegranates, citrus, grapes, green tea, and the curry powder spice turmeric.  But, my patients are people, not Petri dishes.  What role might the yellow pigment curcumin in turmeric play in the treatment of osteoarthritis? 

Well, obesity doesn’t just put stress on our joints; fatty tissue inside our joints, like in the kneecap itself, is a “source of proinflammatory chemicals that have been shown to increase cartilage degradation.”  Curcumin may not only help prevent the release of inflammatory chemicals, but slow the formation of the fat pad in the first place.  But, enough with test tubes–there have been two clinical studies published to date.

The latest took “50 patients suffering from moderate-to-mild knee osteoarthritis,” and gave them either the best available medical treatment, which included control with anti-inflammatory drugs and painkillers, or the best available treatment along with some proprietary curcumin supplement.  They looked at a number of different outcome measures, including the Karnosfsky scale, which goes up to 100—which is normal, no complaints, no evidence of disease—down to zero, at which you’re dead.  The group with the added curcumin did significantly better, and were able to double their walking distance.  This is the best medicine had to offer; so, Mother Nature made a counteroffer.  The curcumin group was able to significantly decrease their drug use, significantly fewer side-effects, less swelling, hospitalizations, and other treatments. 

But it doesn’t have to be some fancy proprietary formula.  Here’s the other study:  The Efficacy of Turmeric Extracts in Patients with Knee Osteoarthritis.  About a hundred sufferers were randomized to ibuprofen or concentrated turmeric extracts for six weeks and the curcumin group did as good or better than the ibuprofen.  Even though ibuprofen is over the counter, it can cause ulceration, bleeding, and perforation of the stomach and intestines—can eat right through our stomach wall and, in fact, that happened to someone in the study.  Whereas, what are the side effects of curcumin?  Potentially protecting against a long list of diseases.

To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page.  There, you’ll find all the detailed information you need plus links to all the sources we cite for each of these topics.

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Thanks for listening to Nutrition Facts.  I’m Dr. Michael Greger.

This is an approximation of the audio content, contributed by Allyson Burnett.