Hi Everyone! Welcome back to another Friday blog. Osteoarthritis (OA) is on the rise, particularly of the knee. According to the NIH, “knee OA is more important not only for its high prevalence rate compared with other types of OA but also for its presentation at earlier age groups particularly in younger age groups of obese women. The incidence of knee OA increases by age and further increase with longer lifetime and higher average weight of the population.” Today I want to look at what we can do to prevent OA, knee pain and possibly a total knee replacement down the road. So, let’s take a look at what OA really is. 

OA is a disease characterized by localized inflammation of the joint and destruction of articular cartilage that leads to loss of function. It has long been considered a cartilaginous disease, however, OA displays a “much more complex pathology with inflammatory mediators released by bone, cartilage and synovium. Low-grade inflammation induced by metabolic syndrome, innate immunity and chronic inflammation (‘inflammaging’) are some of the more recent arguments in favour of an inflammatory role in OA and, for the link between inflammation and epigenetic regulation in OA.” “Impaired chondrocyte repair mechanisms, due to inflammation, oxidative stress and autophagy, play important roles in the pathogenesis of osteoarthritis.” 

Besides the breakdown of articular cartilage, OA causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone.  Bones have a lot of nerve endings and blood vessels. Direct bone to bone is painful! What causes this breakdown? Most people think of OA as an age-related problem. However, it is happening to us at younger ages due to obesity, chronic low-grade inflammation, low physical activity and poor diet.  According to the CDC, OA is the 6th leading cause of debility. It affects your health in a number of ways. 

Knee cartilage bears approximately 3 times the body’s weight while performing daily activities,10 times the body’s weight during running and roughly 20 times the body’s weight when participating in jumping. Think of the millions of cycles of mechanical loads our chondrocytes are subjected to in a year! Now, think about adding an abnormal mechanical load that can be caused by factors such as obesity, joint instability, and excessive load increase in the activities of daily life may cause cumulative micro-injuries or trauma to the joints, and induce the conversion of healthy cartilage to degenerative joint disease and OA.

A recent study looked at muscle weakness and knee OA. They found that women with weak quadriceps strength resulted in a 47% increase in developing OA of the knee, while weak hamstrings resulted in a 41% increase. “Without strong quadriceps muscles, more stress is placed on the cartilage within the knee, and this has been suggested to induce a degenerative process, wearing down of the cartilage and ultimately osteoarthritis.” The quadriceps muscle in the thigh is able to act as a shock absorber and stabilizer of the knee, relieving stress at the articular surface. Researchers did not find the same results for men, likely due to muscle response to higher body mass index (BMI). When we look at the impact of OA on our lives, it is no surprise that it affects multiple facets. 

Obesity is a significant risk factor on its own. According to Johns Hopkins - Overweight women have nearly 4 times the risk of knee OA; for overweight men the risk is 5 times greater.

As we can see from the map, we Texans tend toward obesity. Can we blame it on the 100 degree summer heat?….😂 I can’t go outside right now. Too hot. 

What can we do to prevent knee OA?

• Lose weight - According to the CDC, “a woman of normal height, for every 11 lb weight loss (approximately 2 BMI units), the risk of knee OA dropped > 50%. Conversely, a comparable weight gain was associated with an increased risk of later developing knee OA (odds ratio 1.28 for a 2 BMI weight gain).” 

• Exercise - Increasing strength around the knee with the appropriate exercises decreases stress to the articular cartilage. High intensity running, plyometrics and high impact aerobic exercise can be damaging to the articular cartilage. Also, it is of utmost importance to understand that maintaining full range of motion of your joints is imperative to the health of your cartilage. It is through movement that your articular cartilage gets oxygen and gets rid of waste to help prevent deterioration. This is one reason YOGA is so good for us. Recent studies “confirm the importance of the physical activity in conjunction with extra-virgin olive oil diet in medical therapy to prevent osteoarthritis disease in order to preserve the articular cartilage and then the entire joint.” In mice, studies demonstrate that it is the combination of light/moderate treadmill exercise + EVOO offer the best protection to our articular cartilage to date!!!

• Diet - Enter EVOO…“diets based on olive oil have reduced postprandial oxidative stress and inflammation in human studies. These findings suggest that olive oil and its derivatives are potential therapeutic agents for inflammatory diseases like OA.” Multiple polyphenols in EVOO have shown chondroprotective (chondrocytes are cartilage cells) properties. A study in 2017 showed Oleuropein (polyphenol in EVOO) supplementation reduced the level of PGE₂(inflammation marker) and collagen-2 (cartilage degradation marker) for OA. They also showed that the combination of treadmill training combined with EVOO-enriched diet prevented cartilage damage in mice.

Okay guys! The polyphenols in EVOO help protect our articular cartilage in multiple ways. Lubricin, an important chondroprotective glycoprotein that serves as a critical boundary lubricant between opposing cartilage surfaces, is protected. A joint injury initiates an initial flare of inflammatory molecules such as cytokines and interlukins that can lead to OA. In the 2017 study with mice, they transected the ACL in the knee to create injury, which significantly decreased lubricin expression and set off inflammatory markers. The combination of treadmill training along with EVOO supplementation reversed this by normalizing the lubricin and interlukin-1 levels! WHAT?!!! The powerful polyphenols in EVOO halt the progression toward OA. To top it all off, Oleocanthal (polyphenol in EVOO) is a powerful pain reliever that acts similar to ibuprofen to relieve pain in the body, but without any side effects. It mitigates pain so profoundly, many MDs are prescribing it to their patients!! We don’t have to kill ourselves at the gym to get these benefits. Take your EVOO shot and go for a walk!! Done.

So, until next time my friends, drink, drizzle, digest high polyphenol EVOO, eat fatty fish rich in Omega 3s, eat foods high in lutein, drink lots of water, brush and floss your teeth, get a good pre/probiotic to balance your gut microbiome, exercise your body and mind, get plenty of sleep…and turn off the light!  #EVOO