Together we can stop your pain!
The treatment of Osteoarthritis Pain is controlled by you. Your health is your responsibility. We will give you all the guidance and help that we can so that you can achieve control. This is a long journey. It has taken many years for your arthritis to get this bad. Getting you better will not happen overnight. There is no magic bullet but there are some things that you can do that will seem wonderful and you will wonder why you didn’t do them a lot earlier. Usually you haven’t done them not because you didn’t know about them. Usually it is because you didn’t know how to fit them into your life and why. This is not just non surgical treatment of osteoarthritis related pain in the elderly, but for sportsmen and young victims of trauma. Read below to learn how to treat osteoarthritis.
Risk, Benefit Analysis
Why do you need to do it and how much difference will it make. In medicine we call this a “Risk, benefit” analysis. The “Risk” is how much you will have to give up. The “Benefit” is how much better will I feel. We will not give up on you.
The Key Components
- Measurement If you measure how bad your OA is before any change you make and measure again after the change you will know if the change is worth making. Many small improvements add up to a big improvement.
- Diet. Diet underlines everything. Improve your diet = improve your health. Eating inflammatory food directly makes your OA worse.
- Movement
- Physical Therapy
- Drugs
- Stem Cells, Cytokines (SVF) and PRP
- Surgery
Motivation
I will tell you about a patient who needed to stop smoking. He didn’t stop because it was “too hard”. One day he rang me to say that his leg had gone cold. I immediately went to his home. He had no pulse in the leg. I admitted him to hospital and they amputated his leg. Three months later he rang me again to say that his other leg was going cold. I immediately went to his home. The pulses were very weak but not absent. He had called me earlier this time. I admitted him to hospital and they were able to save his leg. As soon as he was admitted he stopped smoking. He had no withdrawals. He never smoked again.
To lose one leg was not good enough reason to stop smoking, but to lose two legs was. What reason do you need to make a change. If you haven’t made the change you may not know that you have to, or you may not know how, or you haven’t found a good enough reason to change. We will help you with all of these steps. You may have to repeat some of these steps. You may need to break them down into little steps that match your motivation. We will help you with all of this until you have tried everything you can and then we will help you some more. You are not alone in this journey. There are many people who can help you with each step. The people around you can help you with support and motivation but they need guidance and support too.
Movement
Muscle Pumps
Veins have valves inside which only allow the blood to flow in one direction back toward the heart. When we use our muscles these veins are squeezed and the blood moves toward the heart. This is called a “muscle pump”. Muscle pumps start in our feet and move blood up into our calves. This is the next pump which then sends it up into our thigh muscles and so on up to the heart.
Lymph channels collect the fluid that has leaked out of the blood vessels and pooled under the skin and around all our tissues. This is known as extra cellular fluid and is the fluid that we see as swelling and feel as stiffness. It impedes movement. As we move less and less so the swelling gets worse. The good thing is that it improves with movement. At first movement is difficult but as we move our tissues start to loosen up as we pump this excess fluid out. This works for lymph channels exactly as it does for veins. Lymph channels have one way valves and as muscles contract they squeeze the lymph up toward the heart. The same muscle pump moving all the fluid.
If you lie down in bed or sit all day you will not be using your muscle pumps and everything will start to swell up.
When your tissues swell and stiffen they are more likely to become inflamed. Inflammation in the tissues irritates the nerves and we feel pain.
How much movement do we need?
We need enough movement to move all our excess fluid and take away the swelling. This means regular movement through out the day.
If our joints are really painful then we may have to opt for non weight bearing movement. Doing stretches before getting out of bed is a good example. Floating in the water allows us to be non weight bearing all over
This can be a very useful option. If we have access to a heated pool this can be even more soothing.
Preventing muscle loss.
If we cannot use our muscles they will fade away. As we get older it becomes more difficult to get that muscle back. This muscle loss reduces our ability to move. Swelling, stiffness and pain get worse. Sarcopenia is the medical condition that describes loss of body tissues including muscle. People with sarcopenia are literally “fading away “.
Pain may limit our movement and restrict muscle use but we need to do as much as we can.
Exercise is good for osteoarthritis
We hear this phrase all the time. It is true. Exercise is essential for health. But it can be a little daunting. Exercise sounds like hard work and can be very painful. Motivation is difficult when you are in pain.
Don’t think about it as “exercise “. What you need is movement. Any movement.
If you can’t dance and have no sense of music or rhythm pretend no one is watching. Just move. Hopefully music will help.
And remember. You don’t have to be good at “exercise “ you just have to move.
Muscle
As we get older the stem cells in our muscles age and are not as fast or virulent as they used to be. This is not bad. They are still strong enough to repair damaged muscle and grow new muscle cells when needed. The down side is that it takes longer and needs more support. Some of that support comes from our hormones. Testosterone is by far the most significant hormone for muscle growth and strength for males and females. Unfortunately this starts to decline after age 35 and by 55 is less than a third of what it used to be. Less testosterone also means less energy and less activity, less movement. As our muscles are not working as much they will shrink in size.
Diet for Arthritic Pain
Appetite also declines with age. Any mother with an 18yr old son playing sport will tell you that he and his friends each eat as much as three grown men. A big part of this appetite decline may be simply because we are not as active but studies are also showing us that our bodies do not use nutrients as efficiently and that as we age it takes more protein to maximally stimulate muscle growth. If we don’t eat enough protein we will be starving our muscles and they will fade even more quickly.
Protein
So how much protein do we need?
Baum and his group published a very good review of the available science on behalf of the Food and Nutrition Board. One of their key messages was that as we lose muscle mass (Sarcopenia) with age we then accumulate fat (Obesity). This is double trouble for disease development.
The problem with Dietary Protein Recommendations is that they are expressed as DRI for macronutrients, RDI, and EAR.
The Estimated Average Requirement (EAR) is how much we think the average body will need. The Recommended Dietary Allowance (RDA) is how much we think you will need to eat to get that EAR. The Acceptable Macronutrient Distribution Range (AMDR) is how much of your diet should be protein. The Food and Nutrition Board recognise that RDA is enough but that the level of protein needed for optimal health may be more. Therefore the board recommends a range of 10% to 35% of daily energy needs to come from protein.
What does all this mean for your Arthritis?
0.8g/kg/day is what you will need to not starve your muscles. Take your weight in kg and multiply by 0.8. That is your daily target in grams of protein.
Protein satisfies your hunger (satiety) more effectively than carbs and fats. So eat your proteins first. This effect is maximal at around 20% of daily energy needs. So means getting up to 1.2g/kg/day protein for non-weight training people.
If you want not just to maintain your muscle but to get back some of what you have lost then you will need 50% more protein on average. And you will have to work your muscles.
Leidy’s team reinforce this need for more protein. Higher protein diets between 1.2 and 1.6g/kg/day divided into 25-30 G protein per meal provide improvements in appetite and body composition. They also note that those who adhered to the diet gained muscle and lost fat. But, Non-compliance saw no marked improvements. Their closing statement is “further strategies to increase dietary compliance are warranted.” How do we increase compliance. We increase motivation. Make it easy and understand why you are doing it.
Motivation
All the numbers, all the research, all the planning achieves nothing unless you can carry through with it and keep doing it long term.
Little Steps
Wanting to it is like wishing, hoping to win the lottery. Deciding to do it is the start. Matching your goals to your motivation and planning the journey will help. Decide what you can achieve and maintain permanently. What change can I make that will last for the rest of my life. Small motivation, small steps. But be honest. If it looks too uncomfortable reduce it down to something that will be a permanent change. For example. If you can’t stop bread altogether stop white bread and only eat pale brown or darker. One year from now you can celebrate the success of changing your diet.
Elimination diet For Arthritic Pain.
Measure to improve motivation
Another thing that boosts motivation tremendously is having a good enough reason for doing it. If we truly believe then the change will be easier.
If you can see a clear improvement in your symptoms making permanent changes to your diet will be easier. Measuring your osteoarthritis symptoms, recording your level of function, before and after your changes will give you a clear percentage improvement. WOMAC was designed to do exactly this. It has been proven to be accurate, repeatable and reliable. Before you start make sure you understand the WOMAC and how to use it.
Likert
If you are going to do an elimination diet it is very likely that other things will change not just what is being measured in the WOMAC. If you have the interest you can measure all of these other symptoms as well. Do you have low energy, poor sleep, sadness, poor skin, bloating, constipation, “Allergies”. Have you ever wondered if you might have “Brain Fog“. Is you brain not as quick as it used to be? Do you have headaches? Make a list of all your symptoms and build your own personalised Likert scale to measure your symptoms.
The idea of the elimination diet is to remove everything that might be adding to your inflammation. The diet is extreme but you need to choose a time when you can do it without interruption. No looming parties, celebrations or events where you have to eat other peoples cooking. If you can do this for three weeks then you will have completed a good test.
So why three weeks
Antibodies, which are the proteins that your immune system makes when it reacts to foods, take around 21 to 23 days to turn over. So, if you don’t quit those foods you’re sensitive to for at least that time frame, you won’t experience the true effects of elimination.
Alcohol when treating the Pain of Osteoarthritis
Alcohol is a mixed blessing. It contains sugar that contributes to inflammation and may help yeast to grow in our gut. Having a balanced bowel flora is critical for health. It can interfere with sleep and has a depressant action on the brain. A little depressant action on the brain can be useful to reduce anxiety and take the edge off stress but an excess can contribute to depression and interfere with social interactions.
7 Elimination Diets
There are many “Elimination Diets”. Here are 7 elimination diets