By Ayo Bankole, ND 

Osteoarthritis (OA) is a painful degenerative and inflammatory condition that commonly affects large, weight-bearing joints, such as the hips and knees. According to the Centers for Disease Control and Prevention, OA is the most common cause of disability in the United States, affecting 30 million people and resulting in one million knee and hip replacements annually. 

While there are treatment options to help relieve symptoms, there is no known cure for osteoarthritis. First-line pharmacotherapy with both non-steroidal or steroidal anti-inflammatories has not been shown to stabilize or reverse the ongoing cartilage deterioration characteristic of osteoarthritis—often leading patients down a road devoid of treatment options other than steroid injections and finally total joint replacement.

On account of treatment limitations, the best hope for improved outcome should include efforts aimed at prevention. Therapy should start early on and involve lifestyle methods, based on a regenerative paradigm. Specifically, a regenerative paradigm entails therapies with the potential to restore, repair, and regenerate function and structure to both cells and tissue. Here are some of the most promising strategies to help prevent or minimize the pain and deterioration of osteoarthritis based on the best available evidence.

Glycosaminoglycans 

Glycosaminoglycans (GAGs) are molecular compounds that are the major structural components of connective tissue. They include but are not limited to hyaluronan, chondroitin, and glucosamine. 

Glucosamine is often recommended as first-line therapy for arthritis in Europe due to its ability to control pain, improve function, and delay structural changes in the joints.¹ Both glucosamine and chondroitin exert arthritis-modifying benefits, including:

Increasing the production of cartilage-forming cells, type II collagen, and proteoglycan—the major protein GAGs subunits that make up our cartilage and stabilize the extracellular matrix (ECM).

Reduce death of connective tissue cells.

Decrease inflammatory mediators that hasten joint pain and deterioration. 

Of note, ECM contains GAGs and other components that provide connective tissue structure and support to withstand compressive forces. Glucosamine and chondroitin can slow cartilage deterioration enough to clinically improve joint function and decrease joint pain. Additionally, chondroitin has been shown to improve stiffness of arthritis joints. According to Henrotin et al, these substances demonstrate a “small but significant reduction in the rate of joint space narrowing.”²

Glucosamine typically requires a minimum of four to six weeks to see changes. Although not all studies have yielded positive results, individuals should consider GAGs because of their high safety profile and low rate of side effects. 

Fruit Polyphenols

Polyphenols and other nutritional compounds are shown to enhance joint function by virtue of their anti-inflammatory and antioxidant properties. Polyphenols include a variety of compounds such as genistein found in soybeans, hydroxytyrosol from olives, and epigallocatechin gallate in green tea. Others include flavonoids (the most studied type of polyphenol), flavonols, and anthocyanidins—all subclasses of polyphenols from fruits and berries. 

According to both animal and human studies, these fruit and berry-derived compounds are shown to reduce arthritis symptoms. Pomegranates especially, but also bilberries, blueberries, and black raspberries are credited with anti-inflammatory properties due to the high polyphenol content. These molecules are known to decrease the expression of matrix metalloproteinases (MMPs)—a group of enzymes responsible for cartilage degradation and associated with the progression of OA.

Along with suppressing MMPs, polyphenols are also known to decrease levels of inflammatory signals and prostaglandins in joint fluid and plasma in animals. Human studies using fruit polyphenols in arthritis confirm these findings.³ In a recent study involving individuals with knee OA, consumption of pomegranate juice (200ml/day) for six weeks improved stiffness and physical function scores, and decreased serum MMP levels. 

Similarly, a strawberry beverage providing approximately 1,500 mg total polyphenols and 66mg anthocyanins per day significantly decreased inflammatory markers, such as interleukin-6, interleukin-1-?, and MMP, and reduced knee pain scores.⁴

Exercise and Healthy Weight Maintenance

Obesity and type 2 diabetes are both long-established risks for OA. Conversely, exercise and weight loss have been independently shown to decrease the risk of arthritis and improve function, particularly of larger weight-bearing joints. According to a 2016 study, not only is pain and function improved in middle-aged women who exercise and achieve moderate weight loss, but they also enjoyed “significantly reduced risk of arthritis” as confirmed by radiographic images.⁵

Physical activity has also been shown to reduce arthritis-associated medical visits and costs after twelve months. In fact, studies have found that the benefits of exercise in those with osteoarthritis can be maintained for up to six months after exercise has stopped.⁶ Both exercise and weight loss have been shown to decrease inflammatory signals associated with the inflammation and deterioration of arthritis, as well as reduce joint pain, improve physical function, and minimize obesity-associated arthritis risks to joints.⁷

Mediterranean Diet

The benefits of the Mediterranean diet (MD) for arthritis are supported by nearly ten studies, three or more of which are systematic reviews. Notwithstanding some regional variances, the Mediterranean diet emphasizes vegetables, fruits, legumes, olives, nuts, seeds, and cereals; fish and seafood; and moderate consumption of poultry, eggs, and dairy products. The moderate intake of red wine and reliance on olive oil as the main source of dietary fats are also key features.

One small study of 100 participants in England showed improved knee flexion and hip rotation, decreased levels of the inflammatory signal IL-1-alpha, and decreases in a specific cartilage degradation byproduct. Even more compelling is a study of the relationship between the MD and cartilage thickness in 800 osteoarthritis sufferers. The investigators determined that “significant improvement” in cartilage thickness was highly correlated with adherence to the MD.⁸

While hydroxytyrosol—a major flavanol found in olives—has been associated with many health benefits, including antioxidant, anti-inflammatory, and anti-diabetic effects, it is also shown to alleviate arthritis in animal models and humans as part of a Mediterranean diet.⁹

Summary of 4 Regenerative Strategies for Osteoarthritis

Evidence shows that osteoarthritis and its related pain and dysfunction is best addressed early and that health interventions like adopting a Mediterranean diet, proper blood sugar control, exercising regularly, and maintaining appropriate body weight can play a key role in treatment and prevention. 

Consuming foods rich in flavonoids, anthocyanins, hydroxytyrosol, and other polyphenols are not only shown to decrease pro-inflammatory mediators like MMP and some interleukins involved in pain and osteoarthritis but are also shown to improve joint function and pain scores. 

Finally, glycosaminoglycans like glucosamine are the major structural components of connective tissue and are known to increase the production of cartilage-forming cells, slow down deterioration, and decrease destructive inflammatory mediators. Together, these methods represent key components of a regenerative approach to chronic joint pain and osteoarthritis.

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Ayo Bankole, ND, is a California licensed naturopathic doctor and physician assistant. He founded the Inland Naturopathic Wellness Center where he and his team focus on providing comprehensive wellness and Regenerative Medicine to those suffering from chronic disease and pain. He has advanced training in Prolotherapy and is a member of the American Osteopathic Association of Prolotherapy Regenerative Medicine, American College for Advancement in Medicine, and the California Association of Naturopathic Doctors. More about Bankole and his practice’s approach to care is found at www.inlandnaturalmedicine.com.

References

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2. Henrotin Y, Marty M, Mobasheri A. “What is the current status of chondroitin sulfate and glucosamine for the treatment of knee osteoarthritis?” 2014 Dec;79(4):487.
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6. Arthritis Care Res (Hoboken). 2016 Oct;68(10):1428-33. doi: 10.1002/acr.22854. Epub 2016 Aug.
7. Vincent HK, Heywood K, Connelly J, Hurley RW. “Obesity and weight loss in the treatment prevention of osteoarthritis.” PM R. 2012 May;4(5 Suppl):S59-67. doi: 10.1016/j.pmrj.2012.01.005.
8. Kraus VB, Sprow K, Powell KE, Buchner D, Bloodgood B. “Effects of Physical Activity in Knee and Hip Osteoarthritis: A Systematic Umbrella Review.” 2018 Physical Activity Guidelines Advisory Committee
9. Veronese N, La Tegola L, Crepaldi G, Maggi S, Rogoli D Clin Rheumatol. “The association between the Mediterranean diet and magnetic resonance parameters for knee osteoarthritis: data from the Osteoarthritis Initiative.” 2018 Aug;37(8):2187-2193. doi: 10.1007/s10067-018-4075-5. Epub 2018 Apr 3.