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Osteoarthritis: Preventing and Healing Without Drugs

Osteoarthritis: Preventing and Healing Without Drugs

by Peter Bales

Osteoarthritis affects over 20 million Americans and is the most common degenerative disorder in the United States. It causes more disability than any other degenerative disease and is occurring in epidemic proportions in our country.

In this novel approach to understanding and treating osteoarthritis, orthopedic surgeon Peter Bales highlights the nutritional


Osteoarthritis affects over 20 million Americans and is the most common degenerative disorder in the United States. It causes more disability than any other degenerative disease and is occurring in epidemic proportions in our country.

In this novel approach to understanding and treating osteoarthritis, orthopedic surgeon Peter Bales highlights the nutritional connection to this painful and debilitating condition. Dr. Bales focuses on new genetic research, which shows that the same poor nutrition responsible for causing increased inflammation in our bodies, along with epidemic rates of obesity, diabetes, and heart disease, is also fueling the development of osteoarthritis. Among the topics discussed are the following:

*The mechanisms by which our joints become destroyed. The culprits are increased inflammation, increased oxygen free radicals causing our joints to "rust" from chronically elevated blood sugar levels, and hormonal imbalance.

*Dietary strategies to decrease the production of oxygen free radicals and to turn off genes that lead to cartilage breakdown.

*Joint nutrients that can combat osteoarthritis and specific dietary recommendations for the treatment and reversal of osteoarthritis based on the most current genetic and nutritional research.

*The disadvantages of treating osteoarthritis with drugs and the exciting promise of using nutritional intervention that directly affects the expression of our genes.

The only book to emphasize the link between poor nutrition and this often-disabling disease, Osteoarthritis: Preventing and Healing without Drugs offers hope for arthritis sufferers and will be of interest to anyone concerned about good health.

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Prometheus Books
Copyright © 2008

Peter Bales
All right reserved.

ISBN: 978-1-59102-615-0

Chapter One Cartilage and Its Role in Osteoarthritis

The major role of the cartilage in the joints is to act as the cushion that absorbs the stresses of walking, running, and other activities. It is useful to think of cartilage as being similar to the brakes in a car. When they are of proper thickness, the brake pads allow for smooth braking and stopping. As they become worn out, braking becomes harder, there is more grinding when the brakes are applied, and the car does not stop smoothly. Similarly, when joints with deteriorated cartilage are moved, there is grinding, popping, and a lack of smooth motion. This is very painful. But why do we lose the cartilage in our joints? Is this an inevitable part of growing older? The answer to the second question is "no!" Although osteoarthritis has traditionally occurred in older people, we are now seeing an epidemic of it in younger people as a result of their unhealthy diets. In answer to the first question, the loss of cartilage in the joints is a complex and poorly understood problem, which I will address in the following chapters. Osteoarthritis refers to the deterioration of cartilage in the joints and can be distinguished from other forms of arthritis, such as rheumatoid arthritis, which is an autoimmune disease in which the body attacks a number of other organs (lungs and heart) besides the joints. While much is known about autoimmune diseases, until recently the causes of osteoarthritis, other than those resulting from injuries, have been poorly understood.

Normal cartilage is able to absorb the stresses of everyday use of the joints and properly distribute them to the surrounding bone. Cartilage can be thought of as a snowcap covering a mountain: the bone is the mountain and the cartilage is the snowcap. A major part of cartilage is collagen, a protein that twists around itself in a helix and makes up the three-dimensional structure of cartilage. Collagen is the backbone of cartilage and forms the bulk of the "snow cap" described above. In this framework are dispersed the cells that build cartilage. Factories within the cells build the proteins that form cartilage, much like building a house from individual beams of wood. The genes in cartilage cells code for the proteins that are used to build collagen and the cartilage framework. The genes are the basic units of the "master plan" called the DNA, which contains the genetic information needed to create a human being. These cartilage cell genes are a major topic of this book. They are very sensitive to environmental signals such as the food we eat, the air we breathe, and other environmental conditions we come in contact with. When we eat the wrong types of foods, genes become activated in cells that code for proteins that break down the surrounding cartilage. Some of these genes are called "suicide genes"; they will be discussed in chapter 8.

In osteoarthritis, the cartilage that cushions our joints deteriorates. As it breaks down, the joint surface becomes irregular and does not glide smoothly. This causes the joint to become painful and swollen during movement, resulting in the typical stiffness and swelling seen in arthritis. When the cartilage is destroyed completely, a condition develops in which the two adjoining bones that make up the joint start grinding together (commonly referred to as bone-on-bone). This is very painful because bone, unlike cartilage, has many nerve endings and is able to perceive this abnormal contact. By this stage, however, it is too late to reverse the processes that set the whole deterioration in motion. Through proper nutrition and the use of key supplements and other nutrients, we can help preserve our joints and prevent the deterioration from occurring in the first place.

Cartilage is a complex three-dimensional structure made up of cartilage cells, water, aggrecan, and collagen proteins.

Proteoglycans form the basic subunits of cartilage that bind to and interact with collagen to form the 3-D cushion of our joints. Collagen is not found only in cartilage; it is also present in many other places including the ears, nose, and blood vessels. It is an important component of the structure of the body. It is a unique structure in that it does not have the ability to effectively clear waste and ward off disease. Cartilage is bathed in a fluid called synovial fluid, which delivers most of the nutrients to the cartilage cells. This is because cartilage does not have good blood flow, which is necessary to bring in oxygen and nutrients. It also has a poor lymphatic flow, which makes it inefficient in removing waste products that can accumulate in the cells. These characteristics create a perfect environment for the accumulation of toxins. Aggrecan is a major protein component of the cartilage framework whose normal function is critical to cartilage's ability to withstand the load of daily activities. Joints also contain fat, which is an important actor in osteoarthritis and will be explained more in chapter 10.


The cartilage cell is no different than heart cells, stomach cells, or any other cells in the body. A cell is the basic unit of life, surrounded by a wall, called the cell membrane, which separates it from the outside environment. Inside the cartilage cell, all the instructions needed to build a human being are found in the DNA, which is located in a central compartment of the cell called the nucleus. While every cell in the body has all the DNA needed to build a whole person, only a certain portion of the DNA is active in a given cell, depending on what type of cell it is. These DNA instructions are coded for by individual sections of the DNA called genes. Each gene codes for a unique protein, such as the collagen that forms the framework of cartilage.

The part of the cell outside the nucleus, called the cytoplasm, contains the chemical factories that decode the messages sent by the genes to form the proteins necessary to sustain life. These chemical factories, called the mitochondria, play a major role in the development of osteoarthritis. The mitochondria take the nutrients that are absorbed by the cells from the bloodstream and use them to generate a unique substance known as adenosine triphosphate (ATP). All the food one eats is ultimately converted to ATP, which is the chemical cells use to power all their activities and to grow and regenerate. ATP acts as the energy currency of the cell, in the same way that money is the currency used to conduct our daily business affairs. In the process of creating energy from food, mitochondria create a by-product known as oxygen free radicals (cell smog). This is analogous to the smog that comes out of the tailpipe of a car as gasoline is burned to move the car. These oxygen free radicals damage cartilage cells if they are allowed to accumulate. The body has unique chemical pathways to process and neutralize this cell smog (which includes the compound nitric oxide), but when one's nutrition is poor, these chemical-detoxifying pathways do not work properly, leading to the accumulation of toxic smog inside the cell. This is deadly for the cell: its own waste products accumulate, poisoning and eventually killing it. In osteoarthritis, toxic waste products accumulate in cartilage cells, leading to the destruction of our cartilage. This occurs because the wrong types of genes are turned on in arthritic cartilage. The research outlined in this book points to poor nutrition as an important cause of this malfunction of the cartilage cell. It also points to nutritional strategies as important tools for the treatment and prevention of osteoarthritis. Proper nutrition optimizes the function of the mitochondria, keeps the "right" genes turned on, and prevents the accumulation of toxic oxygen free radicals in our cartilage cells.


The cartilage found in our joints is a unique organ in that it lacks the normal blood flow, the rich nerve endings, and the lymphatic flow that is found in most of our other organs. This means cartilage is slow to heal when damaged because inadequate blood flow does not bring nutrients and other reinforcements necessary to rebuild and regenerate. The lymphatic system filters waste and carries it away to be disposed by the kidneys or colon. Because cartilage has poor lymphatic flow, it is prone in accumulating waste products and other toxins that circulate in the bloodstream. The toxins are stored in cartilage, and because of its poor nerve supply, extensive damage can occur in cartilage without any symptoms of pain and dysfunction. This is a dangerous set of circumstances that leads to the late detection of osteoarthritis by both patients and their doctors. These chemical characteristics of cartilage make it ideal for the development of degenerative disease such as osteoarthritis.

The body's hormonal state also has a direct effect on joint health. Our nutritional state, hormonal state, and overall health are connected at the chemical level. If we eat foods high in toxic trans fats, saturated fats, and sugar and white flour, as well as other unhealthy chemicals, our hormones, produced by such organs as our thyroid gland, start to malfunction. Hormones produce chemical signals that influence the proper functioning of cartilage cells and many other cells in the body. For example, when large amounts of unhealthy saturated and trans fats are consumed, cells start producing increased amounts of unhealthy compounds called prostaglandins. There are "good" and "bad" prostaglandins, but unhealthy diets overproduce the bad ones. Prostaglandins are the chemical compounds responsible for increasing inflammation in the body. When these prostaglandins are formed excessively, they contribute to an unhealthy joint environment, which leads to cartilage breakdown in osteoarthritis. These unhealthy prostaglandins are overly produced by the fat cells in the oversized waists (i.e., abdominal obesity) of obese people.

Our genes interact with the environment around us, and they are highly adaptable to the surrounding environment of each person. In osteoarthritis, certain genes are turned off and others become overactive, leading to the development of this disease. New research has shown that diet can control the expressions of genes. An unhealthy diet can trigger genes that break down cartilage and lead to the development of osteoarthritis. Nutrition is very powerful in determining which genes are turned on and how they function. Each individual has a unique genetic makeup. It is interesting to note that the DNA makeup of human beings is 99.99 percent identical. It is the 0.01 percent difference that is important in coding for the individual characteristics that make each of us unique from one another. This 0.01 percent difference in our genes is what gives each individual a predisposition to certain diseases. Our genetic predisposition for disease-such as the development of osteoarthritis-runs in our family. What is important to realize, though, is that this predisposition is not etched in stone. We are not destined to always develop the same diseases our parents and grandparents had. Our environment, including the food we eat and the chemicals we come in contact with, influences the expression of these genes.

Cartilage cell genes code for three important substances involved in the development of osteoarthritis. First there is the production of cytokines, which are chemical messengers that influence which genes are turned on. Second, cartilage produces proteases, which are proteins that break down and remove old cartilage as it becomes damaged over time. This is part of the body's normal "housekeeping," but in the case of osteoarthritis, proteases are overproduced and damage healthy cartilage. As noted earlier, DNA is made of short segments called genes. Each gene codes for a specific protein that has a distinct function in the cell. Proteases are normally produced in small amounts and function to break down old, worn-out cartilage as it is replaced by new cartilage. As we know, the body constantly replenishes our tissues with new ones-for instance, old skin flakes off as new skin forms. In this way, the body constantly regenerates itself. The problem in osteoarthritis is that these breakdown processes overwhelm the rebuilding processes: cartilage is broken down more quickly than the body is able to make new cartilage, resulting in an overall negative balance in the amount of cartilage remaining and the development of osteoarthritis. This occurs because increased oxidative damage and free radical production turns on genes that overproduce the proteases that break down cartilage. Thus, the whole delicate balance of new cartilage production and old cartilage removal is disrupted. Proteases are part of a class of compounds in the body also known enzymes. An enzyme is a protein coded for by a single gene that carries out some important chemical reaction in the cell. A third, very important substance is nitric oxide (NO), a toxic agent for our joints that accumulates in joint cartilage as a result of poor nutrition. These three chemical, cytokines, proteases, and NO, are at the heart of the development of osteoarthritis.

Poor nutrition leads to the activation of "cartilage breakdown genes" and the suppression of "cartilage formation genes." In contrast, a healthy diet and the use of nutritional supplements that have been shown to support cartilage health can turn on genes that maintain the proper health of cartilage. Nutritional supplements are an important adjunct to a healthy diet and can be used to keep our joints healthy and to combat osteoarthritis. I will be discussing these in great detail in chapters 15 and 16, but some important ones include glucosamine; chondroitin; SAMe; EPA and DHA omega-3 fats found in fish oils; vitamins B, C, D, and E; alpha lipoic acid; and coenzyme Q10.


As mentioned earlier, cartilage is a tissue that has poor blood supply. This prevents cartilage from healing well after injuries, and also makes it unable to ward off disease or to neutralize well toxins that enter the joint. In the case of osteoarthritis, as the three-dimensional cartilage structure becomes fragmented and dysfunctional, it becomes even more difficult for the proper nutrients to reach the cells. A cartilage- destroying cycle is thus propagated in the joint. Interestingly, some of the most common drugs used to treat osteoarthritis, such as Indocin and aspirin, have been found by researchers to significantly decrease the production of the 3-D framework of cartilage known as the ECM or extracellular matrix. Please see chapter 12 for a more in-depth discussion.

One clinical research study in which 105 patients with osteoarthritis of the hip were given either Indocin or another anti-inflammatory drug, Azapropazone, found that the Indocin group showed a more rapid loss of joint space and had a lower concentration of the beneficial prostaglandins in their joint fluid that increase the blood flow and blood supply of the organ. Loss of joint space is an indication of worsening of the arthritis condition. The decrease of prostaglandins in the joint fluid, which are needed to allow for adequate blood flow to the joint, can inhibit nutrients and oxygen from getting to the joint bone and other joint structures, such as the nourishing and lubricating layer that covers the joints, called the syovium.

In another study, researchers showed that salicylates, the chemicals referred to as aspirin accelerated artilage destruction and damage in animals with osteoarthritis. Other researchers have shown that certain nonsteroidal anti-inflammatory drugs exacerbate osteoarthritis by inhibiting prostaglandin synthesis. These studies seem to indicate that certain anti-inflammatory drugs accelerate the progression of osteoarthritis by reducing the manufacturing of important chemicals that increase the blood flow to joints. Presumably the prostaglandins blocked are those responsible for allowing adequate nutrients and oxygen to reach the joint.

As stated previously, the joint cartilage sits on the bone much like snowcaps that cover mountain peaks. The ends of the two long bones that form a joint are called subchondral bone. For example, in the case of the knee, it is formed by thighbone, called the femur, and the shin bone, called the tibia. The end of each bone is capped by a thick layer of joint cartilage. This subchondral bone also plays an important role in the development of osteoarthritis. Early in the course of the disease, subchondral bone thickens and shows increased chemical activity. In the later stages of the disease, the bone actually starts to fragment as its fibers become narrower and weaker. As bone weakens it starts to deform. This is the reason people with knee arthritis develop bowlegs or knock-knees as the disease becomes more advanced.


Excerpted from OSTEOARTHRITIS by PETER BALES Copyright © 2008 by Peter Bales. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Meet the Author

Peter Bales, MD, MHSA (Roseville, CA), is an orthopedic surgeon in private practice, a member of the clinical staff at UC Davis Medical Center Department of Orthopaedics, a fellow of the American Academy of Orthopedic Surgeons, and a member and research advocate of the Arthritis Foundation.

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