By Dr. Mercola
Arthritis is a general term for over 100 different conditions1 that affect your joints and surrounding tissues. Any joint in the body may be affected, but the most common are the knees, hips, hands and wrists.2 The two most common forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). Both forms of the disease cause significant pain and discomfort in the joints, but the triggers behind the conditions are different.
RA is an autoimmune disease where your body’s immune system mistakenly attacks the joints3 by releasing enzymes that damage the lining. The disease is chronic and progressive, causing inflammation that results in painful deformity and immobility. It usually occurs in the fingers, thumb, wrists, elbows, shoulders, knees, feet and ankles.4 RA may also trigger other systemic symptoms such as inflammation in the lungs and eyes, nodules under the skin, fatigue, fever and weight loss.
About 1.5 million people in the U.S. have RA; nearly three times more women than men have the disease. On the other hand, over 30 million U.S. adults suffer from OA, which is the most common form of arthritis and sometimes called degenerative joint disease.5 Unfortunately, researchers have found the number of people suffering from OA is rising and your risk of suffering from the condition may be higher than the one your grandparents experienced.
What Is Osteoarthritis?
OA more commonly affects the weight-bearing joints in your body, such as your knees, hips, lower back, neck and the small bones in your hands. The joints more often affected are those repeatedly used performing a task or playing a favorite sport. Your hips, knees, bones in your hands and lower back may be affected from carrying excess weight.6
Injury or repeated wear on the joint may cause the cartilage between the bones to wear, resulting in bone rubbing on bone. As a result, you lose joint flexibility, bony spurs develop and you experience joint swelling and pain. Nearly 10 percent of men and 30 percent of women age 60 and older will suffer from OA.7 The condition appears to have multifactorial etiology and may be a product of interaction between environmental and systemic factors. Factors that appear to increase your risk of developing OA include:8,9
✓ Increasing age
✓ Repeated knee injuries
✓ Muscle weakness
✓ Repetitive joint use
✓ High bone density10
✓ Joint laxity
✓ Poor posture
✓ Occupations that require repeated squatting and lifting
✓ Congenital joint or cartilage deformity
In addition, suffering from other types of arthritis earlier in life, such as septic arthritis, gout and RA, may also increase your risk of developing OA as you age.11 Other medical conditions may also affect your joint health and either increase your risk of developing OA or hasten the degeneration you are already experiencing. Some of those conditions include an underactive thyroid, diabetes, gout, osteonecrosis and Paget’s disease of the bone.
Oftentimes, the first symptom of OA is an unexpected increase in pain or swelling in a joint that doesn’t correlate with your activity level. The reference standard for diagnosis of OA has long been changes noted on radiographic images, such as X-rays, in the joint spaces.
The severity of the disease is graded zero to four depending on evidence of specific changes in the joints, such as bony spurs, deformity of the joint or joint space narrowing. However, not all people with radiographic changes that define OA have clinical symptoms, and not all people who have classic symptoms of the condition demonstrate radiographic changes.12
Your Risk of Osteoarthritis Is Higher Than Your Grandparents’ Risk
As a result of degeneration in the joint spaces, eventually the bones begin to rub against each other and produce a distinctive glass-like polish that is readily identifiable in skeletal remains. This was the indicator researchers used as they searched through the remains of over 2,500 people spanning more than 6,000 years.13
Researchers evaluated remains from archeological and cadaveric collections across the U.S. and found the average American is more than twice as likely to be diagnosed with OA in the knee today as they were before 1940.
The researchers chose to evaluate skeletal remains as there were no set criteria for diagnosing OA prior to 1950. Ian Wallace, Ph.D., a research fellow in the Skeletal Biology and Biomechanics Lab at Harvard University’s Department of Human Evolutionary Biology, commented on the criteria they used when evaluating the skeletons:14
“When your cartilage erodes away and two bones that comprise a joint come into direct contact, they rub against each other causing a glass-like polish to develop. That polish, called eburnation, is so clear and obvious that we can use it to very accurately diagnose osteoarthritis in skeletal remains.”
Interestingly, the researchers could not account for this rise in disease based on an increase in life expectancy or the meteoric rise in rates of obesity since 1940.15 Even after controlling for age and body mass index, researchers found a significant rise in the number of people suffering from OA. According to Wallace:16
“Although knee OA [osteoarthritis] prevalence has increased over time, today’s high levels of the disease are not, as commonly assumed, simply an inevitable consequence of people living longer and more often having a high BMI. Instead, our analyses indicate the presence of additional independent risk factors that seem to be either unique to or amplified in the postindustrial era.”
The rise in incidence of OA was staggering. All of the remains were from people over the age of 50. Researchers analyzed over 1,500 who died between 1905 and 1940, and 819 who died between 1976 and 2015. They found that knee OA was 2.5 times more common when you were born in the post-industrial age as when you were born in the late 1800s. They also found the rate of having OA in both knees in the post-industrial era was 1.4 times higher.
Inactivity May Play a Leading Role
The No. 1 cause of disability in the U.S. is arthritis.17 Senior study author Daniel Lieberman, Ph.D., paleoanthropologist at Harvard University, hopes the results of this study, demonstrating a rising number of people suffering from OA in the knees, will lead to a change in perception about the condition. Lieberman says:18
“Understanding the origins of knee osteoarthritis is an urgent challenge because the disease is almost entirely untreatable apart from joint replacement, and once someone has knee osteoarthritis, it creates a vicious circle. People become less active, which can lead to a host of other problems, and their health ends up declining at a more rapid rate.”
Although the study looked at the difference in numbers of individuals who suffered from OA over thousands of years, the researchers could only theorize what the lifestyle differences were that created such variability. They speculate that one of the primary factors is inactivity. Lieberman posits:
"The most important message here is that we shouldn't consider arthritis a wear-and-tear disease of age. Arthritis is a disease that becomes more common as you age, but it's not caused by 'wear and tear'; if anything, it might be caused by the absence of physical activity."
Thus, one of the greatest tools you may have to prevent the most common type of arthritic condition is to just keep moving. It is important to differentiate between movement and exercise as it pertains to reducing your risk of OA. Your body was designed to move and not sit for long hours.
Unfortunately, Western societies have become more sedentary with each passing decade as digital devices are used for work, entertainment and communication. What once required movement to achieve, you may now accomplish with the push of a button.
This inactivity has led to a significant increase in associated health conditions, such as heart disease, depression, cancers and hypertension. Dr. James Levine, endocrinologist at the Mayo Clinic whose research jumpstarted the field of “sitting science,”19 calls this “chair-living.”20 Wallace and Lieberman now believe that OA can be added to the list of health conditions for which you are at greater risk when you spend hours sitting.
This may be triggered by a reduction in strength in leg muscles and weaker cartilage, causing the joint to break down more quickly than expected.21 The team is testing this theory by studying guinea pigs (the only lab animal that naturally develop knee arthritis) and long-distance runners from the Tarahumara tribe of northern Mexico,22 famous for running long distances well into their senior years.
Omega-3 Fats May Help Prevent Osteoarthritis
Another factor in the development of damaged cartilage leading to OA is a deficiency in omega-3 fats. Animal models using arthritis-prone guinea pigs have demonstrated that diets high in omega-3 fats not only help prevent the condition, but also help reduce the symptoms in animals already affected by OA.23 Other research with humans demonstrated a reduction in inflammation and symptoms when animal-based omega-3 fat supplemental krill oil was administered.24,25
Your body requires a balance between omega-3 and omega-6 fats. It’s believed a 1-to-1 ratio is ideal. However, a standard Western diet often provides far more omega-6 fats than omega-3s, often resulting in a 20-to-1 ratio. The omega-6/omega-3 ratio test is a cost-effective way of finding out how much change needs to occur in your diet to balance your omega-3 and omega-6 fats. Ideally the results should be below 1, and optimally below 0.4 percent.
To balance your ratios, you need to increase your omega-3 intake and reduce your omega-6. The easiest way to do this is to limit processed foods and add in more omega-3-rich foods, such as anchovies, sardines and wild-caught Alaskan salmon. I recommend getting an omega-3 index test on an annual basis to make sure you’re not deficient. Ideally, it should be over 8 percent.
Until recently, scientists were unsure why omega-3 fats were so beneficial and how they worked to reduce inflammation. A recent study26 at Brigham and Women’s Hospital in Boston found that once ingested, these fats were converted into compounds 10,000 times more powerful in reducing the inflammatory response.
In inflammatory types of diseases, an overactive immune response leads to tissue destruction. This research demonstrated the powerful compounds produced from omega-3 fats effectively stop this active process.
There are both plant and animal-based omega-3 fats, but only the animal-based foods provide EPA and DHA fats in bioavailable forms. To avoid toxic sources of animal-based omega-3, I suggest eating small, cold-water, fatty fish that have a lower risk of contamination than larger predator fish such as tuna. The healthiest fish to consider are anchovies, sardines, herring, mackerel and wild-caught Alaskan salmon.
There are several ways of incorporating these fish into your weekly menu. Try experimenting with sardines or anchovies in your salad, or pureed into a homemade Caesar salad dressing. Wild-caught salmon is healthy, delicious and versatile. Try my recipes where salmon is sesame-crusted with coconut kale or almond crusted.
Importance of Vitamin D and Astaxanthin
Vitamin D is another important component as it stimulates up to 300 antimicrobial peptides that are more powerful than antibiotics, and help regulate your immune system, a potent factor in maintaining good health while fighting inflammation.
For most people living in the Northern Hemisphere your vitamin D levels drop dramatically January through April when sun exposure is at its lowest level. Testing your vitamin D level is the only way to really know how much supplemental vitamin D you might need to maintain a clinically relevant level of 40 to 60 ng/mL year-round.
Astaxanthin may be an even more powerful factor in reducing inflammation as it has very strong free radical scavenging activity to protect your cells from oxidative damage. Following absorption, it’s distributed in your bloodstream on lipid molecules, where it works to significantly reduce inflammation and metabolic disease markers.27 It also positively affects oxidative stress and has shown to decrease tumor necrosis factor in humans. In animal models, astaxanthin has the same effects as corticosteroids, without immunosuppression.
Astaxanthin has a demonstrable effect on cell membranes, fighting DNA-related age damage. Studies show this antioxidant is more potent than vitamin C or E and may have dozens more benefits.28 It’s produced only by microalgae as a survival mechanism when the water supply dries up.29 The two known sources of astaxanthin are microalgae and the sea life that eats them, such as krill and salmon. Astaxanthin can also be purchased in supplement form.
Using Hyaluronic Acid and Bone Broth to Reduce Pain and Inflammation
Hyaluronic acid (HA) is a key component in the development of cartilage, and is responsible for movement of nutrients in and waste products out in an area with little blood supply. It is one of the components that gives your tissues and cartilage flexibility, and makes your cartilage smooth and friction free in a way that no man-made product has yet to achieve. HA also works in the fluid inside your joint, inhibiting natural chemicals that may trigger inflammation.
When there isn’t enough HA in your diet, high-quality supplementation may help reduce inflammation and pain. However, many of these are manufactured in a lab and not as bioavailable as HA found in nature. Homemade organic bone broth is an excellent dietary addition that may increase your HA and is also full of glucosamine and chondroitin sulfate that help keep your cartilage healthy and reduce inflammation and pain.30
Bone broth is made from animal bones. Your homemade version will differ greatly from the commercial canned variety that is often no more than water, bouillon cubes and chemical flavors and preservatives.
Traditionally, bone broth is simmered for 12 to 72 hours using animal bones, vinegar and spices. The longer the broth cooks, the more gelatin, minerals and other nutrients from the bones are released. These are the keys to the health benefits and restorative properties of the broth. You’ll find complete directions using my Bone Broth Recipe.
Although bone broth seems to have appeared in the past couple of years, it’s actually a healthy recipe that’s been passed down from generation to generation for centuries.31 It’s not only good for your joints, but also helps heal your gut, supports weight loss, fights inflammation and improves sleep and brain function.32
Natural Pain Relievers and Anti-Inflammatory Supplements
It is possible to manage your osteoarthritis with natural supplements and remedies before ever turning to pharmaceutical choices that may do far more harm than good in the long run.
As you consider the strategies outlined below to relieve pain, remember to include omega-3 fats, astaxanthin, vitamin D and bone broth to reduce inflammation and help your body repair minor damage. Incorporate movement into your hourly routine to reduce the potential you’ll develop OA and to keep your joints flexible and strong, thus reducing the need for pain control.
The foods you eat are primary keys in the reduction of inflammation that results in pain and disease. Diet can either prevent or trigger inflammation, so while adding some foods to your daily diet, you’ll want to remove others.
Processed foods often contain soy, sugar, high fructose corn syrup and trans fats that trigger inflammation. Foods cooked at high temperatures, especially with vegetable oil, increase inflammation, as do sugar, grains and lectin-rich foods. I strongly suggest avoiding these foods to reduce inflammation.
This is the yellow pigment in turmeric, a spice commonly used in curry. It has an excellent safety profile and there is strong evidence to suggest it is potent against inflammatory diseases.33 Studies have found it provides strong pain relief and demonstrates long-term improvement in function in OA.34
Curcumin also helps stabilize your blood sugar, which plays a role in the inflammatory process. In fact, the spice plays a significant role protecting your health and reducing inflammation. However, achieving optimum therapeutic doses requires supplementation, as in its natural state the bioavailability of curcumin is poor.
Commonly known for stomach-settling properties, ginger also offers anti-inflammatory pain relief. Fresh ginger root may be steeped in boiling water and served as tea, or grated into your vegetable juice. Although powder capsules are available, I recommend using the fresh root.
This herb has specific anti-inflammatory ingredients and is one of my personal favorites as I have seen it work well for many rheumatoid arthritis patients, and it achieves good results in studies.35,36,37
This enzyme is found in pineapples and is a natural anti-inflammatory that may be taken as a supplement, but is also found in enough quantity in pineapples that eating the fresh fruit may also be helpful.38,39 It is available as an oral supplement or as a cream.
✓ Cayenne Cream
Also called capsaicin, this cream is derived from dried hot peppers. It alleviates pain by reducing your supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.
✓ Emotional Freedom Techniques (EFT)
EFT is a noninvasive therapeutic tool that may help reduce the toll that pain takes on your emotional health. As stress also increases inflammation and your perception of pain, EFT may help you to manage your pain without pharmaceutical intervention throughout the day.