Despite these big numbers arthritis gets little press. This is partly because the general conception is that osteoarthritis, the most common kind, is inevitable ‘wear and tear’ and there’s not much you can do about it except take pain-killers and that rheumatoid arthritis, classified as an auto-immune disease and suffered by close to half a million people, is irreversible. (I’ll be covering rheumatoid arthritis in detail in a future newsletter.) Both of these assumptions are untrue. In most cases people just manage pain and wait until degeneration is so bad that, if possible, they have a hip or knee replacement and start again. But none of this addresses what caused the problem in the first place.
While calming down inflammation and hence reducing pain is key to preventing further damage to joints the critical question is what’s driving all this inflammation and joint damage?
The answer, for most people, is a gradual breakdown in four processes.These are:
- Lipidation – excess omega-6, lack of omega-3 and too many oxidised fats
- Glycation – the loss of proper blood sugar control with too high blood glucose levels, too much insulin, lack of sensitivity to insulin and consequent pure ‘fuel’ delivery to the cells that keep your joints healthy. That’s the subject of this article.
- Oxidation – too much damaging oxidative activity as a consequence of a lack of antioxidants and an excess of oxidants.
- Methylation – this is indicated by a high homocysteine level, a consequence of insufficient B vitamins often brought on by gradually worsening absorption of vitamin B12. Methylation is critical for making healthy bones.
Of these four glycation is the most important and the subject of this article. Losing resilience in these four fundamental processes is both the main underlying causes of ‘inflammaging’ but also the hallmarks of ‘metabolic syndrome’ which refers to a pattern of changes seen in most people with weight gain, diabetes, heart disease, dementia and also osteoarthritis. Metabolic syndrome is diagnosed by the presence of a few common attributes – high blood fats (triglycerides), high cholesterol, high blood sugar and/or insulin, weight gain especially around the middle and inflammation and high homocysteine.
This is both bad news and good news. The bad news is the standard diet and lifestyle of the 21st century tips one’s metabolism into an inflammatory state that leads to a progression of diseases often starting with weight gain, then diabetes then heart disease, then arthritis then dementia. (Not everyone does it in this order so don’t think, just because you’re not overweight none of this applies to you.) This is what inflammaging is all about. The good news is that the very same changes that will reverse arthritis also protect you from these other common diseases.
Feeding Your Joints Slow Carbs
The cells in your joints that make cartilage and keep everything healthy are called chondrocytes. Their main fuel, as for almost all cells in your body, is glucose (sugar). But this glucose has to be slowly fed into cells together with oxygen and other nutrients, mainly anti-oxidants. The combustion of glucose with oxygen within the cell’s energy factory results in energy to do vital joint repair and rejuvenation, and ‘exhaust fumes’ called oxidants which antioxidants mop up.
But what happens in the chondrocytes of people with arthritis is that this normal sugar metabolism is so messed up that the cell reverts to an earlier, and less efficient evolutionary means to make energy (called glycolysis) which generates less energy and more oxidants. You also get a build up of lactic acid which makes muscles stiff. As a result you end up with stiff and achy joints that gradually degenerate. This is very similar to what happens to cells that ultimately switch into cancer cells. That’s what happens close up in joint cells but pan back to your bloodstream and you’ll see a loss of blood sugar control resulting in craving for carbohydrates and sweet, sugary foods. This is how it works:
You eat some carbohydrate food, which gets digested down into glucose. Your blood sugar(glucose) level goes up. In pours insulin (from the pancreas) to get this fuel out of your blood and into the energy factories in cells. All is good.
You eat too many carbohydrate-laden or sugary foods. Your blood sugar level goes to high. In pours too much insulin and, by now, this has happened so many times your insulin receptors are blunted and less responsive. It takes longer to get your blood sugar down which, meanwhile, is damaging your arteries and joints. Eventually the insulin kicks in and, with too much glucose – beyond the need of your cells – your liver now has to work double time to store the excess glucose as fats called ‘triglycerides’. You then get high blood fats. Your poor chondrocytes, ironically starved of a good, clean even supply of glucose, together with other energy nutrients such as B vitamins and antioxidants, switch to ‘glycolysis’ a less efficient way to make energy that makes even more oxidants which damage the joints even more. Those overworked and underpaid chondrocytes can’t cope and joint degeneration occurs, along with inflammation and pain. Eventually everything starts to break down - cartilage, synovial membrane, bone ends, the meniscus in the knee and even the ligaments that support the joint.
Of course there’s a bit of chicken and egg here in that a drift towards metabolic syndrome, primarily brought on by an increasing penchant for carbohydrates, leads to weight gain and with weight gain the chances are you feel less inclined and eventually less able to exercise, which cranks up the weight gain which further stresses the joints.
WHY KEEPING YOUR BLOOD SUGAR BALANCED IS KEY
Knowing all this you can now see why keeping your blood sugar level even is critical not only in order to combat arthritis but also to maintain overall health. Insulin, the major hormone released by your body to control blood sugar, stimulates the production and assembly of proteoglycans into cartilage. But this isn’t going to happen if you are ‘insulin resistant’. Diabetics, who are either deficient in insulin or insensitive to it (known as ‘insulin resistance’), have more severe arthritis than non-diabetic arthritics. Osteoarthritis predicts diabetes  and diabetes predicts osteoarthritis.
This is because one of the main causes of inflammation and damage to joints is glycation, which means damage caused by sugar. Glycation is inflammation caused by glucose imbalance and insulin resistance. Glucose can damage joints in the same way it damages arteries, which is one of the mechanisms that link diabetes and arthritis. While ordinarily the adrenal hormone cortisol – the body’s best anti-inflammatory agent – can handle such problems, out-of-control blood sugar results in adrenal exhaustion. So it’s far better to restore blood sugar balance to avoid the damage in the first place.
Having an uneven blood sugar level also upsets how calcium is used to help create healthy bones. In addition, keeping your blood sugar balanced is probably the most important factor in weight control thus taking the weight off your joints.
That’s why a foundation of preventing and reversing osteoarthritis (and rheumatoid arthritis) is to follow a low glycemic load (GL) such as the one I advocate in my books The Low GL Diet Bible and the Low GL Diet Cookbook. That, plus natural anti-inflammatories such as curcumin and omega-3, is the place to start.
3. Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol. 2012;8(12):729-737. doi:10.1038/nrrheum.2012.135; see also Gierman, L. M. et al. Metabolic stress-induced inflammation plays a major role in the development of osteoarthritis in mice. Arthritis Rheum. 64, 1172–1181 (2012); see also Sellam J, Berenbaum F. Is osteoarthritis a metabolic disease?. Joint Bone Spine. 2013;80(6):568-573. doi:10.1016/j.jbspin.2013.09.007
4. J. H. Bland and S. M. Cooper, ‘Osteoarthritis: a review of the cell biology involved and evidence for reversibility. Management rationally related to known genesis and pathophysiology’, Seminars in Arthritis and Rheumatism, vol 14 (2), 1984, pp. 106–33
5. L. Sokoloff, ‘Endemic forms of osteoarthritis’, Clinics in Rheumatic Diseases, vol. 11 (2), 1985, pp. 187-202.
6. Rahman MM, Cibere J, Anis AH, Goldsmith CH, Kopec JA. Risk of Type 2 Diabetes among Osteoarthritis Patients in a Prospective Longitudinal Study. Int J Rheumatol. 2014;2014:620920. doi:10.1155/2014/620920
7. Courties A, Sellam J. Osteoarthritis and type 2 diabetes mellitus: What are the links?. Diabetes Res Clin Pract. 2016;122:198-206. doi:10.1016/j.diabres.2016.10.021; see also Veronese N, Cooper C, Reginster JY, et al. Type 2 diabetes mellitus and osteoarthritis. Semin Arthritis Rheum. 2019;49(1):9-19. doi:10.1016/j.semarthrit.2019.01.005