Friday Favorites: Benefits of Cabbage Leaves on the Knee for Osteoarthritis

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In a section of the British Medical Journal called Minerva, where they compile interesting little snippets, they published a picture of a woman who they found had taped a cabbage leaf to her knee. She said that this was the only measure that provided relief from the symptoms of her osteoarthritis. Some doctors responded with bemusement; others were “like, duh”—amazed to see the photograph, not because “a cabbage leaf was used, but that this was considered newsworthy.” The doctor disclosed she may be a little biased, though, as she admits to being a cabbage leaf user herself.

“There is nothing new about this ancient remedy,” wrote another reader, “used to help reduce all [kinds] of painful swelling.” “Freshly washed cabbage leaves are known in European folk medicine as the poor man’s poultice.” “So there is nothing freakish or stupid about” putting cabbage leaves on your knees! Okay. I didn’t realize it was such a touchy topic.

Of course, we’ll never really know if it actually works. There’s never been a randomized controlled trial of “topical cabbage leaves for osteoarthritis,” and, there never will be…until, now:

“Efficacy of Cabbage Leaf Wraps in the Treatment of Symptomatic Osteoarthritis of the Knee: A Randomized Controlled Trial.” Wait, how did this study even get funded? A family foundation just stepped forward and paid for it. I love that. In fact, it’s the former president and first lady of Germany’s foundation. After all, “[o]steoarthritis…of the knee is one of the most common chronic diseases among older adults.” So, let’s “test the effects of cabbage leaf wraps.” Why not?

Patients with confirmed osteoarthritis of the knees were randomly assigned to four weeks of treatment with a cabbage leaf on their knees every day, or a topical pain gel containing an anti-inflammatory drug, or neither. Even better would have been a fourth group applying like iceberg lettuce leaves, but I’ll take what I can get.

Here’s a graph of pain intensity over the 28-day experiment. Here’s how the drug worked: not much better than doing nothing. But, the cabbage worked better. Overall, the study “found that a 4-week application of [cabbage leaves] was more effective than [usual care] with respect to pain, functional disability, and quality of life. It was, however, not [in the final analysis] superior to a 4-week application of topical medication.” But, hey, cabbage leaves are safe, “can be used in the longer term.” So, why not give them a try?

It also wouldn’t hurt if you ate some as well, as cabbage may have internal anti-inflammatory potential as well. The anti-inflammatory effects may explain the health benefits of cabbage family vegetables. Not just potent anti-inflammatory effects in petri dishes, but in people. Ten days of broccoli consumption in smokers cut CRP levels 40%! Okay, but what about for arthritis?

In vitro, sulforaphane, the magic cabbage chemical, “protects cartilage from destruction,” suggesting that a high-cabbage or -broccoli family vegetable diet “may be a useful measure either to prevent or to slow the progression of [osteoarthritis].” But, even if sulforaphane can protect cartilage cells in a petri dish, how do we even know the compound makes it into the joint when we eat it? I mean, no one’s ever done a study where you like have people eat broccoli, and then stick a needle in their knee joint to check. No one, that is… until, now.

And, sulforaphane was indeed detected in the synovial fluid of 40 patients with osteoarthritis “following broccoli consumption,” followed by significant epigenetic changes of gene expression within the joint. The next step is to see if it can actually improve the disease.

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• Utting MR, Currall V. Minerva. BMJ. 2003:326:1406.
• Lauche R, Gräf N, Cramer H, Al-Abtah J, Dobos G, Saha FJ. Efficacy of Cabbage Leaf Wraps in the Treatment of Symptomatic Osteoarthritis of the Knee: A Randomized Controlled Trial. Clin J Pain. 2016;32(11):961-971.
• Munns A. Cabbage leaves can help inflammation of any body part. BMJ. 2003;327:451.
• Rokayya S, Li CJ, Zhao Y, Li Y, Sun CH. Cabbage (Brassica oleracea L. var. capitata) phytochemicals with antioxidant and anti-inflammatory potential. Asian Pac J Cancer Prev. 2014;14(11):6657-6662.
• Jiang Y, Wu SH, Shu XO, et al. Cruciferous vegetable intake is inversely correlated with circulating levels of proinflammatory markers in women. J Acad Nutr Diet. 2014;114(5):700-708.e2.
• Hwang JH, Lim SB. Antioxidant and Anti-inflammatory Activities of Broccoli Florets in LPS-stimulated RAW 264.7 Cells. Prev Nutr Food Sci. 2014;19(2):89-97.
• Riso P, Vendrame S, Del Bo' C, et al. Effect of 10-day broccoli consumption on inflammatory status of young healthy smokers. Int J Food Sci Nutr. 2014;65(1):106-111.
• Davidson RK, Jupp O, de Ferrars R, et al. Sulforaphane represses matrix-degrading proteases and protects cartilage from destruction in vitro and in vivo. Arthritis Rheum. 2013;65(12):3130-3140.
• Facchini A, Stanic I, Cetrullo S, Borzì RM, Filardo G, Flamigni F. Sulforaphane protects human chondrocytes against cell death induced by various stimuli. J Cell Physiol. 2011;226(7):1771-1779.
• Davidson R, Gardner S, Jupp O, et al. Isothiocyanates are detected in human synovial fluid following broccoli consumption and can affect the tissues of the knee joint. Sci Rep. 2017;7(1):3398.

Image credit: josealbafotos via Pixabay. Image has been modified.

Motion graphics by Avocado Video.