If you like mnemonics, here is a COVID tip: MASTERSTRESS. M-Maintain healthy eating. A-avoid isolation. S-Stay informed but not obsessed (watch the news only once a day). T-talk with others. E-engage any and all help you need (e.g. ask people to shop for you). R-relax and play. S-step outside. T- take a deep breath. R-remember to wash your hands. E-engage in gratitude. S-sustain routines. S-sleep. Shared by Dr. Okereke, director of geriatric psychiatry, Mass General Hospital. And I will add. Wear your face coverings, please. Stay 6 feet apart.
Q I have osteoarthritis and my doctor has told me to lose weight and exercise. I can’t exercise enough to lose weight. What should I do? — KM, Greenville
A Dr. Tovah Wolf from Western Carolina and I are presenting a free, 30-minute Lunch and Learn ZOOM, Oct. 21 at noon for the Osteoarthritis Action Alliance on that topic. Register at https://zoom.us/meeting/register/tJYqc--oqTIoGNAubrOhErzGsqbQB_Mcm2xf
The experts agree that people who are overweight and have osteoarthritis in their knee, hip or hand may reduce their pain and/or improve their function with weight loss and physical activity. Doctors use clinical guidelines to help them make decisions on prevention and treatment of chronic conditions.
There are several sets of guidelines for the prevention and treatment of osteoarthritis. It makes sense that losing some weight would provide some mechanical benefit to the knee and hip. I was taught that that being overweight by 10 pounds increases the force on the knee 30-60 pounds per step for every step you take. And, that if a person lost 15 pounds, they could reduce their symptoms by 50 percent.
How does that work for the hand? We now know there are metabolic effects of weight loss, but the experts don’t think there are enough data to include diet in the guidelines. We can expect more research in the future as the opioid epidemic has increased interest in non-pharmaceutical approaches to pain relief. So here is what looks promising and not harmful.
Restricting your calorie intake remains the primary non-surgical way to achieve weight loss. There are studies that show that leads to less pain and better function. A registered dietitian nutritionist can help you find the right diet for you. Studies confirm that it is safe and effective to do this with commercially produced meal replacements that help control portion size.
There are lots of products on the web, in the pharmacy and grocery store to choose from depending on your other nutrition goals. I typically suggest ones that give you fewer than 400 calories; at least 3 grams of dietary fiber; at least 10 grams of protein (animal or plant); less than 4 grams of saturated fat; and less than 750 grams of sodium. The products vary in price; added sugars or artificial sweeteners; amount of carbs; additions of “superfoods or ingredients” and probiotics.
There are two eating approaches that appear to be helpful — the Mediterranean and the DASH —with or without weight loss. If you aren’t overweight, you might have less pain and/or improved function by following one of these anti-inflammatory approaches to eating. Send me an email I will send you a handout. If you are overweight and follow DASH or Mediterranean, eat about 250 calories fewer than you might normally.
There could be some benefit in limiting certain nutrients. There are studies that suggest eating saturated fat — found in animal foods — increases pain and decreases function. The advice for heart health is likely to be good for joint health. Getting omega 3 fatty acids from food but not supplements also has been shown to give symptom relief. The use of olive oil instead of other fats has been found to reduce pain and retard cartilage destruction. I found one study that showed consuming a low carb diet for at least 12 weeks “reduced pain intensity, unpleasantness in some functional pain tasks, self-reported pain, reduced oxidative stress and adipokine leptin.”
So, obviously, people do respond to diets differently. Officially the experts say that glucosamine and chondroitin supplements don’t work. Yet, in studies where most people found no benefit, a few people did. There have been some small studies on turmeric/curcumin, oral hyaluronan and avocado soybean unsaponifiables (ASU), and vitamins C and D supplements, but it’s not known what dosage might work. If you can afford these supplements, talk with your doctor about the risks and possible benefits for you before you start taking any supplement. And, buy a good quality brand.
By the way, Hannah Verrilli, who did such a fine job researching and writing the column on the leaky gut last week — is a fourth year Brody medical student.