January 22, 2025 • 44 mins
Is that big toe pain osteoarthritis? Join Dr. Holly Thacker on the Speaking of Women's Health Podcast as she discusses osteoarthritis — a condition that could already be affecting you. Discover how this prevalent form of arthritis often goes unnoticed until later in life and learn about the genetic factors that could place you at higher risk, especially if you're a woman.
Listen for practical tips on how low-impact exercises and proper lifting techniques can contribute to joint health, and why balancing activity with rest is crucial. We’ll address common myths surrounding arthritis and offer evidence-based advice on managing it through diet and supplements.
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
Listen on: Apple Podcasts Spotify
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am glad to be back in the
Sunflower House for a newepisode On this new Speaking of
(00:26):
Women's Health podcast.
I'm going to be talking aboutosteoarthritis.
This affects 80% of us.
Some people have symptoms evenin their 20s.
Even in their 20s and certainlyafter 30, you can see x-ray
(00:47):
evidence of it in joints.
For some people, the x-rays canlook pretty bad, but the person
may not have symptoms, and OAor just arthritis are frequently
used interchangeably, althoughthere are many causes of
(01:07):
arthritis, but osteoarthritis,or degenerative joint disease,
is the most common, andarthritis encompasses over 100
different conditions that causeinflammation, swelling,
potential deformities, lack ofcartilage in the joints.
As of May of 2023, it wasestimated that over 32 million
(01:35):
adults in the United States weresuffering with osteoarthritis
the most common type ofarthritis, arthritis, the most
common type of arthritis, andeven though we can see it even
in the 20s, like in the big toe,the MP, the meadow tarsal joint
of the big toe, like the bunionjoint usually most people don't
(02:01):
start to complain aboutarthritis until about after age
40 to 45.
But you know it's not a normalpart of aging and there are some
things that can be done toprevent or delay it.
So let's just start talkingabout what it is and why is it
(02:21):
more common as people age whatit is and why is it more common
as people age?
Well, certainly, wear and tearand use of the joints can cause
some breakdown, and thecartilage that covers the ends
of the bones help cushion thejoints and reduce impact and it
allows them to glide smoothly.
(02:42):
And it allows them to glidesmoothly.
Now there can be geneticpredispositions.
In fact, many women at midlifecome to me very distressed about
changes in their hands, in thePIP joints, or they become very
knobby and there is an autosomaldominant osteoarthritis of the
(03:05):
hand.
That can be somewhatinflammatory and cause a lot of
changes, particularly ifsomebody is always using the
small joints of the hand.
So I frequently ask women whatdoes your mom's hands look like?
I also like to ask people ifthey had anyone in their family
with a joint replacement, andI've done a previous podcast on
(03:30):
joint supplements and jointreplacements and if you didn't
listen to that one, that's agood one to go back to listen to
.
And, as I mentioned when I wasdoing research for the podcast,
I was surprised to find out thatwomen actually have more joint
replacements than men and Iassumed that, just due to
(03:50):
football and sports injuries andmaybe higher impact physical
labor jobs, that more men wouldhave joint replacements.
But actually it's women andanytime there's inflammation,
and certainly women are muchmore common to experience
(04:11):
inflammatory arthritis,rheumatologic conditions,
rheumatoid arthritis.
There's other types ofarthritis like psoriatic
arthritis, lupus.
Many autoimmune conditions aremuch more common in women than
(04:32):
men because testosterone seemsto have somewhat of a modifying
effect on the immune system.
But if you wear down yourcartilage and you have
inflammation, there can besignificant pain.
So age of course is a big riskfactor and weight gain Of course
(04:55):
.
That's the biggest concern thatwomen at midlife have, and it's
not just for cardiovasculardisease and diabetes and
cosmesis and fitting into yourskinny jeans and all the things
that are important to women.
But for every 10 pounds ofextra weight that you carry
(05:15):
around, it translates up to fivetimes or more the pressure.
So if you're 10 poundsoverweight, that's like 50
pounds every time you walk,slamming on the knee joints and
adipose tissue.
An inflammatory diet cancertainly lead to more
(05:36):
structural damage.
Now overuse and we see thiscertainly in athletes and sports
injuries, and it's not justtrauma or injuries but weak
muscles, and one of the problemsthat women have with their
knees they have more ACL tearsis an imbalance in the strength
(06:01):
of the quadriceps and thehamstrings.
So frequently if you havearthritis complaints, you will
probably be referred to aphysical therapist, in part to
assess your strength, to giveyou advice on stretching and
strengthening, and havingsomeone who is objective and
(06:22):
independent observe you andmeasure your strength can be
very helpful.
Now, sex is a risk in thatfemales tend to have less
cartilage in certain joints likethe knees compared to men, and
post-menopausal women are morelikely to have acceleration of
(06:46):
their knee arthritis as theylose estrogen.
So we, of course, have had somany podcasts in season one and
season two on the benefits ofhormone therapy estrogen, how we
can even use it in much olderwomen, how it's good for
osteoporosis, which is not thesame as osteoarthritis.
(07:07):
In fact, if you have reallydense, strong bones, you're more
likely to wear down yourcartilage and have
osteoarthritis, whereas if youhave very thin, delicate bones
that are more likely to breakand have fractures or fragility,
you're obviously going to haveosteoporosis.
Now I do, unfortunately, havesome patients that have
(07:29):
osteoporosis and osteoarthritis,but it's unusual.
Now, any type of occupation orany type of high impact athletic
activities can certainlyincrease joint strain and injury
, your footwear being on hardconcrete.
(07:51):
In fact, that's one of thethings I regret that I didn't
pay more attention to when I wasyounger.
Even if you don't have symptoms, really good footwear helps to
support your joints and reduceimpacts on your knees and hips
and, just like during pregnancy,I didn't have any trouble with
(08:13):
veins or swelling, but justbased on the added weight that
goes along with a normalpregnancy, I wish I would have
immediately started usingsupport stockings to help
compress the veins and giveextra support to the legs.
And now, if I'm going to bestanding in the kitchen, maybe
(08:34):
making a big, big family meallike at Thanksgiving or
something that might takeseveral hours of me standing
straight in one position, Ialways make sure I have great
footwear on and good supportivestockings.
Now there are other metabolicconditions that can increase
(08:55):
osteoarthritis, and one of themis hemochromatosis, and about
one in every 200 adults actuallyabsorbs too much iron.
Now, one of my first podcastsactually the first one in season
one was on iron andconstipation and the low iron
(09:17):
levels that so many women have.
But some people genetically canabsorb too much iron and that
gets deposited in places likethe liver, which can cause
cirrhosis or scarring, and alsothe joints.
Now there are many nutritionaldeficits that I think accelerate
(09:39):
arthritis.
One of the big ones is vitaminD.
One of the big ones is vitaminD, and anyone who's listened to
me my patients, my fellows, mystaff know that I am a hound on
getting people to have normalvitamin D levels Optimal,
(10:02):
actually, not just normal, andit's not a vitamin, it's a
pro-sterile hormone and beinglow in vitamin D causes a lot
more musculoskeletal symptoms.
Now, certainly, being low inestrogen can, and a lot of women
come back and they don't havejoint pain after starting
menopausal hormones and a lot ofmy patients I see are low in
estrogen and vitamin D.
Another nutrient that is lackingin many American diets is
(10:23):
enough omega-3.
And I've done columns and uhtalked about omega-3s in prior
podcasts and I've alwaysemphasized that it's important
to get enough omega-3s in yourdiet because our body doesn't
make omega-3 and we don't makeomega-6 and we usually get
enough omega-6.
(10:43):
Um so, if you like fatty fishlike salmon and mackerel and cod
and tuna, if you like.
Nuts and seeds, particularlywalnuts and almonds.
Also, chia seeds or ground flaxseed are another good source.
(11:05):
Algae those that are reallystrict vegetarians many times
have to work a little bit harderto get enough omega-3s.
I think that most Americans getway too many inflammatory,
industrially chemically alteredoils, the so-called seed oils,
(11:29):
like corn oil and canola andsafflower and sunflower and palm
and rapeseed.
These are frequently inproducts, like a lot of my
patients tell me.
Oh no, I don't ingest any ofthat, I just use extra virgin
olive oil, or sometimes I useavocado oil and occasionally
(11:49):
coconut oil, and all those threeoils are fine.
But when I check omega-3 levelsin women, which sometimes I do
because of Joint pain, maybe dryeyes, eczema, mood changes In
fact, omega-3s are a treatmentfor postpartum depression and
(12:13):
when you're growing a baby, itsucks a lot of important
nutrients out of you.
In fact, I never understood whyI had this penchant for
Filet-o-fishes with my third son.
Well, after you know, a numberof pregnancies and breastfeeding
the third one, I must have beena little bit depleted in
(12:36):
omega-3s because, oh my goodness, I was always going through the
fast food place and I'm likewhy am I doing this.
Well, I was obviously cravingomega-3s.
The problem is, you know, ifyou're getting a lot of fried
foods, if they're usinginflammatory, cheap seed oils,
(12:57):
that's not such a good thing.
So, being mindful of getting acouple of servings a week and
potentially having levelsassessed Certainly medically,
high doses of omega-3 can beprescribed in patients that have
high triglycerides.
(13:17):
I think it's most important toget your sugar out of your diet,
do intermittent fasting and getthe weight down, because that
many times, will take care ofelevated triglycerides.
Dry eyes and dry eyes can bedue to a number of different
conditions autoimmune conditions, contact lenses, allergies.
Actually, there was justrecently a new eye drop to fight
(13:42):
the causal agent we think ofrosacea demodex, which is a
treatment to eradicate that inthe eye which can cause dry eyes
.
But certainly manyophthalmologists recommend
higher doses of omega-3.
Now it is calories, and youonly have to eat a big apple 300
(14:07):
calories for six months to gain30 pounds and make a baby.
You only need to eat a carrotstick extra a day and be like 20
pounds overweight by the end ofthe year.
So just swallowing, you know,40 or 50 calories of fish oil,
it can add up.
So I think it's best to try toget your nutrients in whole
(14:30):
foods.
Now, vitamin D is the sunshinevitamin.
Many people work inside, livein northern climates, wear
sunscreen to reduce skin aging.
So I just see so much vitamin Ddeficiency that I really think
that most adults with levelsbeing checked may need to be
supplemented, and increasinglyI'm getting more liberal about
(14:55):
omega-3 supplementation,particularly those with a lot of
body pain joint pain, lowlevels, elevated triglycerides,
pain, low levels, elevatedtriglycerides.
Now it's very important for yourphysician or healthcare team to
know about your general healthconditions and if you have other
conditions like rheumatoidarthritis, whether it's
(15:16):
seropositive or seronegative.
Diabetes, a metabolic disorder,and gout can also increase the
risk of having joint pain andjoint problems, and some people
can have two or even three typesof arthritis at a time.
If you've ever had psoriasis,your physician should know about
(15:38):
this.
You have been listening to theSpeaking of Women's Health
podcast and I'm your host, drHolly Thacker in the Sunflower
House talking all thingsosteoarthritis.
So what are some of the signs?
Well, joint pain that getsbetter with rest is a tip off.
(16:01):
Joint stiffness that lasts about10 to maybe 30 minutes in the
beginning of the day with jointuse.
Certainly, the older I'vegotten, the less I can sit still
.
Now I'm sitting for thispodcast, but as soon as I'm done
I'm going to jump up and dosome physical activity, because
when you move you end up movingblood and oxygen and nutrients,
(16:24):
because our cartilage does nothave blood vessels, so it only
gets oxygen and nutritionthrough movement and that's why
a lot of people feel reallystiff when they sit too long,
Like I would have a hard timegoing back to medical school and
sitting in the lecture hall forhours on end at this stage of
(16:46):
my life.
Now, if you have decreasedrange of motion, you can't
totally flex or extend yourjoints.
That is a concern.
If you've got some jointinstability, that's another
concern.
So if you notice when you'rewalking the gait is unstable and
you have pain and you feel likeyour joint may give out, that's
(17:09):
a concerning symptom Crepitusor crackling of the joints, a
grating sound.
Your joint might feel tenderwhen you touch the joint line
and apply mild pressure to it,and some people just notice loss
of flexibility.
And some of flexibility doeshave more to do with your
(17:35):
tendons and just your connectivetissue in general.
So what are some of the thingsthat you should be mindful of if
you have been diagnosed withosteoarthritis.
Well, there's a few things thatgenerally are recommended to
reduce further joint pain andinjury and damage if you have
(17:57):
knee arthritis.
Running or doing high impactexercises, particularly on
uneven surfaces, definitelyaggravate knee osteoarthritis.
Any unnatural twisting orturning of the knee joints Much
better to walk on a track or atreadmill or, even better yet,
(18:17):
an elliptical to take thepressure off the knees and the
hips the pressure off the kneesand the hips.
So it might be time to hang upyour soccer cleats, your hockey
ice skates, your football padsor anything that you've done
maybe in your younger years thatwere super high impact.
(18:38):
Any repetitive motion canfurther damage the knee joints
and it could involve certaintasks, hobbies, exercise or
work-related activities.
If you have to do repetitivephysical activity, it's
important to try to take somebreaks and also use good form
(19:02):
and also make sure that yourmuscles are strong and balance
out those joints.
That being said, we don't wantyou to be a couch potato or a
blob, because exercise does helpand keeping the weight at an
optimal level is also veryimportant.
Lifting heavy objects can putunnecessary strain on your
(19:24):
joints, but if lifting isunavoidable, you must use proper
technique to reduce jointdamage or ask someone for some
extra help.
Now that I have grandchildrenwith more on the way, I'm a lot
more mindful of my joints than Iwas when I was a young mother
(19:45):
carrying two babies around I had.
My two sons were 18 monthsapart and frequently both wanted
to be carried.
They somehow never wanted to bein their double stroller.
I wish I was a little bitfirmer about that, because I've
lugged around a lot of extraweight that wasn't my own body
weight and now I encourage mygrandchildren to walk or get in
(20:09):
the stroller.
Also, just simple things likenot lugging in you know five
bags of groceries at a time,making more frequent trips, not
carrying as much, maybe goingfor a smaller purse or clutch.
I know that's hard for us womenwho carry pretty much
everything in the kitchen sink,in our bags and designer purses
(20:32):
and whatever we're carryingaround with us.
But having a stroll cart ifyou're going to be carrying lots
of things will take off lesspressure of your lower joints.
I do want to talk a little bitmore about knee arthritis,
(20:52):
because 10% of all women will gothrough a knee replacement and
it is one of the top causes ofdisability in American adults
and a study done by theOsteoarthritis Initiative
recently looked to see if thosegrating noises caused by the
knee was indicative of futureosteoarthritis.
And this study looked at peoplebetween the ages of 45 and 79
(21:18):
and found that those that hadnoisy knees or that crepitus
were much more likely todemonstrate findings on x-ray
consistent with osteoarthritis.
So if you have crepitus whenyou flex your knee and you feel
that cracking, crunchingsensation and sound, it may be
predictive.
Also, know what your familyhistory is.
(21:40):
What your family history isSuper young patients.
It doesn't necessarily apply toNow.
The OA initiative, which was amulti-centered 10-year
observational study of both menand women, was sponsored by the
National Health Institute and itaimed to look at resources to
(22:02):
help provide information aboutprevention and treatment of this
very common debilitatingcondition.
Now I will tell you that I havehad patients who thought that
they were going to sign up forbilateral knee replacements and
they got super serious withweight loss.
Maybe they saw a weightmanagement physician.
(22:24):
Most did intermittent fasting,most drastically reduced carbs
and sweets and any unnecessarygratuitous calories from their
diet, and those with significantweight loss many times had
significant improvement of theirsymptoms.
(22:47):
So how do you know if you're atrisk, if you've got these
so-called noisy knees, and whatcan you do about it?
Well, you should talk to yourphysician.
Uh, weight and diet are veryimportant.
I've had several podcasts onhealthy eating.
Uh, I did a column and apodcast on food freedom and the
(23:11):
hundred substances that arebanned, uh, in other countries.
Uh, that we have in our foodsupply.
I think becoming much choosierabout what you're using to fuel
your body is very important andI think understanding a variety
of different physical activities, balancing muscle strength with
(23:33):
some aerobic activity, but notexcessive joint wearing down
activities activities.
Now, treatment of acute flaresor an acute injury is the good
old RICE, rest and icecompression and elevation.
(23:55):
So resting an injured jointhelps prevent future injuries
and gives you some time to heal.
Both hot and cold treatmentscan give some temporary relief.
Ice is usually used if there'sa lot of swelling and there's an
acute injury, or as heatstimulates blood circulation and
(24:16):
helps alter pain perceptions,and since you need blood flow to
the area to help heal, things,that can help.
Cold reduces swelling becauseit constricts your blood vessels
and it can provide some numbing.
In terms of options for heattherapy, obviously the good old
heating pad or warm packs, warmbaths, you know, soaking in a
(24:41):
nice hot tub with Epsom salts,which is magnesium, can help
relax the muscles Using coldpacks of either frozen
vegetables or a frozen waterbottle or frozen packs.
Compression helps reduceswelling and elevation of the
injured part of the body abovethe level of the heart if
(25:02):
possible helps.
And then, after the acuteinjury, undergoing physical
therapy and strengthening of themuscles using pain relief under
the advice of your healthcareclinician.
A lot of things like ibuprofen,acetaminophen, aspirin are over
(25:23):
the counter.
Ibuprofen, acetaminophen,aspirin are over the counter but
it doesn't take very muchacetaminophen, tylenol to damage
your liver and aspirin can, inlow doses, raise uric acid and
make gout worse.
And high doses can help maybereduce uric acid if you've got
that elevated problem, and wehave a nice list of high and low
(25:44):
uric acid foods on ourspeakingofwomenshealthcom site.
But high doses of aspirin canbe bad on the stomach, kidney
bleeding.
So just because something isoff the shelf that you don't
have to get a prescription fordoesn't mean you don't need
appropriate medical advice.
Now that healthy diet that'scolorful, rich in fruits and
(26:07):
vegetables, those omega-3 foodswe talked about, selected
supplements like vitamin D,glucosamine, chondroitin sulfate
for those that are notshellfish allergic does seem to
improve the OA symptoms in atleast 50 to 70% of people with
(26:27):
knee OA, not so much hand OA,unfortunately.
The other area.
I've had some benefit withrecommending glucosamine and
chondroitin sulfate, sometimeswith or without MSM, sometimes
with or without SAMe.
S-adenylmethionine, sometimeswith or without Boswellian
(26:51):
extract, turmeric, which is anIndian spice which many people
find as anti-inflammatory, asMotrin, without some of the side
effects.
But these supplements that areover-the-counter are not
regulated and there was reportsof arsenic poisoning in some
(27:13):
turmeric supplements fromBangladesh.
So whatever you're taking, youshould bring in your bottles
with the lot number, expiration,the dose, don't just wing it or
think, because it's not aprescription that you don't have
to tell your doctor Now.
Referrals to physical therapyand occupational therapy can be
(27:35):
very helpful.
Sometimes cortisone is injected.
There are joint lubricationinjections such as hyaluronic
acid, which gives somecushioning, and increasingly
many athletes and manyperformance-focused people are
seeking out PRP, which isplasma-rich platelets that have
(28:00):
growth factors.
So they draw blood out fromyour own self and it's spinned
down to get those growth factorsthat then are injected into the
site of injury and I hope tohave some anti-aging physicians
or sports medicine and ororthopedic rheumatology
physicians on the podcast,because this is really an
(28:23):
exploding area.
It's usually not covered byinsurance and it can be kind of
pricey, but I'd like to get somemore information out about this
to our listeners Now.
Even just five pounds of weightloss could translate to 25
pounds of less pressure on yourknees and hips, and a lot of
(28:46):
people could tend to lose fivepounds.
Some people need more weightloss than that, um, and if
you're 30 pounds overweight,just think you're stressing your
joints by 180 pounds all daylong walking around.
That's a lot.
Now, um, it's sometimes easiersaid than done to lose weight
(29:10):
and that's why it's excitingthat there are increasing
options.
I think, for many people goinginto ketosis, where they are
really limiting the carbs manytimes this needs to be done
under a physician supervision,because your electrolytes need
to be checked can help burn fatand also reduce hunger.
(29:30):
Now, surgery that's usually oneof the later options.
It's certainly not a first linetreatment, but realigning the
bones, sometimes doing fulljoint replacements, sometimes
partial joint replacements,sometimes doing full joint
replacements, sometimes partialjoint replacements.
Sometimes the joint is fusedlike, particularly in the feet,
(29:55):
and certainly justrun-of-the-mill osteoarthritis
is the most common reason whypeople get either hip
replacements or kneereplacements, but there can be
other confounding factors.
Avascular necrosis from highdose steroids can cause
destruction of the joint.
Women with inflammatoryconnective tissue problems seem
to have more acceleration andneed for joint replacements.
(30:19):
Now, if you have had a jointreplacement, I tell my patients
that are post postmenopausalthat there is research showing
that menopausal hormone therapyafter having had a joint
replacement was associated withalmost a 40% decrease in the
rate of subsequent revisionsurgery compared to menopausal
(30:42):
non-users.
Compared to menopausalnon-users and those women that
were regular users for at leastsix months after surgery had a
40% reduction in the risk forimplant failure.
According to Dr Nigel Arden andcolleagues at the University of
Oxford and I wrote a columnabout this when this research
(31:02):
came out, because it's a bigdeal and we've known for years
that menopausal hormones aregreat for the quality of the
bone and the bone architectureand mineralization reached about
(31:25):
50% for those women whocontinued on menopausal hormone
therapy for at least a year, asreported in the Annals of
Rheumatic Diseases back in 2015.
And the most common cause ofjoint failure within that first
year is because of boneloosening.
You don't want the implant tobe loose, want the implant to be
(31:48):
loose.
That's a bad, bad situation andhaving to have a redo joint
replacement is major surgery.
There's a risk of infection,blood clots and then any type of
problem that you might havewith anesthesia.
So menopausal hormone therapyis bone positive.
So even if you don't haveosteoporosis or hot flashes, it
still be.
May may be something that youwant to consider.
(32:12):
And estrogen is so critical forbone strength.
We've had several podcasts andwe osteoporosis and while I said
that heavier women tend to havedenser, stronger bones with
more degenerative arthritis,whereas thin women tend to have
(32:35):
weaker bones and moreosteoporosis but less
degenerated knees and hips, youcan be heavy and have
osteoporosis.
You can be thin and haveosteoarthritis.
So it's not a direct, completecorrelation by any means and it
(32:55):
is unfortunate for peoplesuffering from both conditions,
although both conditions areimproved with vitamin D and
exercise and especially themenopausal hormone therapy.
Now estrogen is critical inmaintaining bone strength and
obviously strong bones andhealthy joints are important to
(33:16):
maintaining mobility and stayingmobile is one of your best
weapons against aging andnursing home placement.
Fall risk becomes much higheras people progress in age,
especially over age 80 or 85,and there can be corresponding
sarcopenia or loss of muscle.
(33:37):
So, according to researchers,currently we don't have a way to
completely preventosteoarthritis and we don't know
of any medication to reverse orstop the progression.
But eating right, having ahealthy lifestyle, judicious use
of supplements and vitamins,physical therapy and working
(34:01):
with your healthcare team canhelp quite a bit.
And controlling your bloodsugar.
I mean sugar is the root ofmetabolic problems lots of
hypertension, lots of diabetes,fatty liver, osteoarthritis,
cognitive decline.
So there's no such thing as anessential sugar or an essential
(34:22):
carbohydrate.
There's no such thing as anessential sugar or an essential
carbohydrate.
And if you compare the amountof ingestion of plain old sugar
that we Americans ingest nowcompared to, say, a hundred
years ago, it's shocking.
Stay active.
You need at least 30 minutes ofexercise daily.
Make sure you stretch beforeand after exercise.
(34:45):
Be mindful of pain in your body.
Pay attention to what's goingon.
You want to push yourself, butnot to the point of injury.
Practice good posture.
Our assistant, julie, who isour administrative assistant in
the center she was on thatterrific podcast that we did on
(35:07):
how to get an appointment at theclinic.
She gave great tips.
She had a working stand-up deskinstalled, so a lot of times
when I go in the office to talkto her, she's standing up and
moving around, and that, I think, is very important for
sedentary jobs, and be sure toseek medical attention if pain
(35:29):
and swelling do not improve withrice therapy.
Now, other types of arthritis Iwant to just briefly mention
include rheumatoid arthritis.
One of the old-fashionedtreatments for this was estrogen
and vitamin D, and so those arestill important.
Unfortunately, it can reallydamage the synovial linings of
(35:52):
the joint.
It can affect other organs likethe heart and the skin, the
lungs and the kidneys.
It can run in families.
Psoriatic arthritis is also anautoimmune disease and it can
attack the skin and joints andtendons and you could possibly
(36:13):
have psoriatic arthritis withoutthe skin manifestations of
psoriasis.
Interestingly, and I do see alot of patients whose psoriasis
get better when they correcttheir vitamin D and treat their
fatty liver.
And we've got a lot of goodinformation on fatty liver,
including the experience thatour founder and chief strategist
(36:37):
, the wonderful Diane Dunkelman,who's been on our podcast to
talk about clever crazes forchildren, which is her latest
passion, and she details herexperience with having kind of
ignored, untreated fatty liverthat progressed to the point
where she's in completeremission, and I have a lot of
(36:59):
patients in complete remission.
Some of the things that aregood for the fatty liver are
getting the sugars out of thediet, doing intermittent fasting
, black coffee, green tea, sameas a supplement, and
acetylcysteine, which increasesglutathione, which helps protect
the liver and the brain.
(37:19):
Some people will drink milk,thistle tea or boost their
vitamin E intake, and vitamin Cis an antioxidant and can be
helpful for joints.
Now, another type of arthritisto talk about is gout, and we've
talked about uric acid levelsin the past and we have a list
of this on the website.
(37:41):
Typically, the big toe, pedagra,is affected, but it can affect
the ankles, the elbows, thefingers, even the wrist, and
it's very painful.
Hallux rigidus is a common typeof arthritis of that big toe
and usually by changing yourfootwear and avoiding direct
pressure on the joint line canhelp.
Some people do need orthoticdevices done by a podiatrist.
(38:05):
Several types of arthritis canlead to degeneration of the arch
and bone.
Spurs or osteophytes candefinitely affect the nerves of
your feet and cause burning andtingling, and you should seek
out a podiatrist or footspecialist and bring your
footwear to the appointment.
(38:32):
So I want to go over some mythsabout arthritis, and this was
shared by Dr Elaine Husney onour website.
She's in the Cleveland ClinicArthritis and Musculoskeletal
Center in Orthopedics andRheumatology.
Myth number one is all jointpain is arthritis, and that's
not true.
Tendonitis, bursitis, softtissue injury, so you do need to
(38:54):
be evaluated.
Another myth is that rain anddamp weather worsen arthritis.
Many people believe a twinge inthe knee or knuckle predicts
the rain, but we don't reallyhave scientific evidence for
this that humidity intensifiesarthritis.
I think one reason why olderpersons with arthritis like warm
environments is that, um, whenyour body is warmer and you're
(39:21):
getting more blood flow to ajoint, some people feel a little
warmer and looser.
Another myth is to take itcompletely easy if you have a
flare-up and you may need tolimit some joint activity, but
we do want to maintain activity,just like when people throw
their back out.
We don't put them at prolongedbed rest by any means.
(39:44):
If you haven't heard my podcaston sciatica and low back pain,
that was a real popular one.
Another myth is that handicapand loss of function are going
to be inevitable if you haverheumatoid arthritis, and that's
not true.
We have so many advances intreatment, that seeking
(40:05):
treatment sooner rather thanlater is very important.
Another myth I hadn't heardthis one is that rum, soaked
raisins oh gosh, I like rumgrapefruit, eggplant or
nightshades are cures forarthritis.
Oh gosh, too bad.
They're not, because I kind oflike all those foods.
For most people not all dietdoesn't usually have a huge
(40:29):
effect, but I always encouragepeople who are worried about any
association to definitely keepa log.
A lot of people think thatthey're gluten intolerant and
they have a lot moreinflammation, but when they're
tested, they don't have celiacdisease.
I think some of this has to dowith the substances and the
bleaching and some of thesubstances that are added to
(40:53):
bread and pasta, because peoplewill go to Italy and not have
any symptoms.
Another myth is that ice isless helpful than heat, and they
both each have a role, as wediscussed.
Um.
Another myth is that thetreatment for RA is dangerous,
(41:14):
and early treatment for thisprogressive disease does lead to
a better quality of life andimproved outcomes.
So don't be afraid, and don'tbe afraid to seek treatment.
Um.
Another myth is that only oldpeople get arthritis, and that's
not true.
Young, growing children canhave significant arthritic
problems.
Juvenile rheumatoid arthritisis one, and young adults can
(41:41):
develop arthritis as well,because we have 40 different
types in the groups.
Another myth is that glucosaminehelps everyone.
Well, it does help those somepeople, particularly with knee
OA, in terms of helping withregrown cartilage.
You've got to take it for atleast three months to know if
it's going to work and then beon the maintenance.
Uh, you've got to take it forat least three months to know if
(42:02):
it's going to work and then beon the maintenance If it doesn't
work after three months.
Don't, don't waste your money.
That being said, I think isreasonable to try, and I
remember one of the first timesthat I um recommended osteoarth
uh glucosamine to one of mypatients several years ago, and
(42:23):
she said my dog takes it Cause,apparently dogs get a lot of
osteoarthritis.
In fact, my son, emerson, whohas a couple of dogs, was
telling me how, even though helikes to jog and um, when
Shirley Temple his dogs arenamed after drinks, shirley
Temple is his golden doodle anduh, the little yipper is Stella
(42:47):
Artois, the beer.
But he was telling me how hedidn't want to overrun Shirley
as a young puppy, you know, asshe was still developing,
because the vet, you know, saidthat they need exercise, but you
don't really want to damage thejoints.
So I thought that was veryinteresting because there are
(43:09):
certainly some overlays withveterinarian health and and
human health.
But again, seek out your humanhealthcare team team.
(43:30):
So thank you so much forjoining us for another podcast
and we're so grateful for yoursupport.
And certainly give us a fivestar rating.
If you haven't, maybe share thepodcast with others.
Speaker 2 (43:38):
It's free and they may get some helpful information
and be sure to join us againand wherever you subscribe to
podcasts, spotify, tune in.
We don't want you to miss anyfuture episodes.
So thanks for joining us andI'll see you next time in the
(44:02):
Sunflower House.
And remember be strong, behealthy and be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am glad to be back in the
Sunflower House for a newepisode On this new Speaking of
(00:26):
Women's Health podcast.
I'm going to be talking aboutosteoarthritis.
This affects 80% of us.
Some people have symptoms evenin their 20s.
Even in their 20s and certainlyafter 30, you can see x-ray
(00:47):
evidence of it in joints.
For some people, the x-rays canlook pretty bad, but the person
may not have symptoms, and OAor just arthritis are frequently
used interchangeably, althoughthere are many causes of
(01:07):
arthritis, but osteoarthritis,or degenerative joint disease,
is the most common, andarthritis encompasses over 100
different conditions that causeinflammation, swelling,
potential deformities, lack ofcartilage in the joints.
As of May of 2023, it wasestimated that over 32 million
(01:35):
adults in the United States weresuffering with osteoarthritis
the most common type ofarthritis, arthritis, the most
common type of arthritis, andeven though we can see it even
in the 20s, like in the big toe,the MP, the meadow tarsal joint
of the big toe, like the bunionjoint usually most people don't
(02:01):
start to complain aboutarthritis until about after age
40 to 45.
But you know it's not a normalpart of aging and there are some
things that can be done toprevent or delay it.
So let's just start talkingabout what it is and why is it
(02:21):
more common as people age whatit is and why is it more common
as people age?
Well, certainly, wear and tearand use of the joints can cause
some breakdown, and thecartilage that covers the ends
of the bones help cushion thejoints and reduce impact and it
allows them to glide smoothly.
(02:42):
And it allows them to glidesmoothly.
Now there can be geneticpredispositions.
In fact, many women at midlifecome to me very distressed about
changes in their hands, in thePIP joints, or they become very
knobby and there is an autosomaldominant osteoarthritis of the
(03:05):
hand.
That can be somewhatinflammatory and cause a lot of
changes, particularly ifsomebody is always using the
small joints of the hand.
So I frequently ask women whatdoes your mom's hands look like?
I also like to ask people ifthey had anyone in their family
with a joint replacement, andI've done a previous podcast on
(03:30):
joint supplements and jointreplacements and if you didn't
listen to that one, that's agood one to go back to listen to
.
And, as I mentioned when I wasdoing research for the podcast,
I was surprised to find out thatwomen actually have more joint
replacements than men and Iassumed that, just due to
(03:50):
football and sports injuries andmaybe higher impact physical
labor jobs, that more men wouldhave joint replacements.
But actually it's women andanytime there's inflammation,
and certainly women are muchmore common to experience
(04:11):
inflammatory arthritis,rheumatologic conditions,
rheumatoid arthritis.
There's other types ofarthritis like psoriatic
arthritis, lupus.
Many autoimmune conditions aremuch more common in women than
(04:32):
men because testosterone seemsto have somewhat of a modifying
effect on the immune system.
But if you wear down yourcartilage and you have
inflammation, there can besignificant pain.
So age of course is a big riskfactor and weight gain Of course
(04:55):
.
That's the biggest concern thatwomen at midlife have, and it's
not just for cardiovasculardisease and diabetes and
cosmesis and fitting into yourskinny jeans and all the things
that are important to women.
But for every 10 pounds ofextra weight that you carry
(05:15):
around, it translates up to fivetimes or more the pressure.
So if you're 10 poundsoverweight, that's like 50
pounds every time you walk,slamming on the knee joints and
adipose tissue.
An inflammatory diet cancertainly lead to more
(05:36):
structural damage.
Now overuse and we see thiscertainly in athletes and sports
injuries, and it's not justtrauma or injuries but weak
muscles, and one of the problemsthat women have with their
knees they have more ACL tearsis an imbalance in the strength
(06:01):
of the quadriceps and thehamstrings.
So frequently if you havearthritis complaints, you will
probably be referred to aphysical therapist, in part to
assess your strength, to giveyou advice on stretching and
strengthening, and havingsomeone who is objective and
(06:22):
independent observe you andmeasure your strength can be
very helpful.
Now, sex is a risk in thatfemales tend to have less
cartilage in certain joints likethe knees compared to men, and
post-menopausal women are morelikely to have acceleration of
(06:46):
their knee arthritis as theylose estrogen.
So we, of course, have had somany podcasts in season one and
season two on the benefits ofhormone therapy estrogen, how we
can even use it in much olderwomen, how it's good for
osteoporosis, which is not thesame as osteoarthritis.
(07:07):
In fact, if you have reallydense, strong bones, you're more
likely to wear down yourcartilage and have
osteoarthritis, whereas if youhave very thin, delicate bones
that are more likely to breakand have fractures or fragility,
you're obviously going to haveosteoporosis.
Now I do, unfortunately, havesome patients that have
(07:29):
osteoporosis and osteoarthritis,but it's unusual.
Now, any type of occupation orany type of high impact athletic
activities can certainlyincrease joint strain and injury
, your footwear being on hardconcrete.
(07:51):
In fact, that's one of thethings I regret that I didn't
pay more attention to when I wasyounger.
Even if you don't have symptoms, really good footwear helps to
support your joints and reduceimpacts on your knees and hips
and, just like during pregnancy,I didn't have any trouble with
(08:13):
veins or swelling, but justbased on the added weight that
goes along with a normalpregnancy, I wish I would have
immediately started usingsupport stockings to help
compress the veins and giveextra support to the legs.
And now, if I'm going to bestanding in the kitchen, maybe
(08:34):
making a big, big family meallike at Thanksgiving or
something that might takeseveral hours of me standing
straight in one position, Ialways make sure I have great
footwear on and good supportivestockings.
Now there are other metabolicconditions that can increase
(08:55):
osteoarthritis, and one of themis hemochromatosis, and about
one in every 200 adults actuallyabsorbs too much iron.
Now, one of my first podcastsactually the first one in season
one was on iron andconstipation and the low iron
(09:17):
levels that so many women have.
But some people genetically canabsorb too much iron and that
gets deposited in places likethe liver, which can cause
cirrhosis or scarring, and alsothe joints.
Now there are many nutritionaldeficits that I think accelerate
(09:39):
arthritis.
One of the big ones is vitaminD.
One of the big ones is vitaminD, and anyone who's listened to
me my patients, my fellows, mystaff know that I am a hound on
getting people to have normalvitamin D levels Optimal,
(10:02):
actually, not just normal, andit's not a vitamin, it's a
pro-sterile hormone and beinglow in vitamin D causes a lot
more musculoskeletal symptoms.
Now, certainly, being low inestrogen can, and a lot of women
come back and they don't havejoint pain after starting
menopausal hormones and a lot ofmy patients I see are low in
estrogen and vitamin D.
Another nutrient that is lackingin many American diets is
(10:23):
enough omega-3.
And I've done columns and uhtalked about omega-3s in prior
podcasts and I've alwaysemphasized that it's important
to get enough omega-3s in yourdiet because our body doesn't
make omega-3 and we don't makeomega-6 and we usually get
enough omega-6.
(10:43):
Um so, if you like fatty fishlike salmon and mackerel and cod
and tuna, if you like.
Nuts and seeds, particularlywalnuts and almonds.
Also, chia seeds or ground flaxseed are another good source.
(11:05):
Algae those that are reallystrict vegetarians many times
have to work a little bit harderto get enough omega-3s.
I think that most Americans getway too many inflammatory,
industrially chemically alteredoils, the so-called seed oils,
(11:29):
like corn oil and canola andsafflower and sunflower and palm
and rapeseed.
These are frequently inproducts, like a lot of my
patients tell me.
Oh no, I don't ingest any ofthat, I just use extra virgin
olive oil, or sometimes I useavocado oil and occasionally
(11:49):
coconut oil, and all those threeoils are fine.
But when I check omega-3 levelsin women, which sometimes I do
because of Joint pain, maybe dryeyes, eczema, mood changes In
fact, omega-3s are a treatmentfor postpartum depression and
(12:13):
when you're growing a baby, itsucks a lot of important
nutrients out of you.
In fact, I never understood whyI had this penchant for
Filet-o-fishes with my third son.
Well, after you know, a numberof pregnancies and breastfeeding
the third one, I must have beena little bit depleted in
(12:36):
omega-3s because, oh my goodness, I was always going through the
fast food place and I'm likewhy am I doing this.
Well, I was obviously cravingomega-3s.
The problem is, you know, ifyou're getting a lot of fried
foods, if they're usinginflammatory, cheap seed oils,
(12:57):
that's not such a good thing.
So, being mindful of getting acouple of servings a week and
potentially having levelsassessed Certainly medically,
high doses of omega-3 can beprescribed in patients that have
high triglycerides.
(13:17):
I think it's most important toget your sugar out of your diet,
do intermittent fasting and getthe weight down, because that
many times, will take care ofelevated triglycerides.
Dry eyes and dry eyes can bedue to a number of different
conditions autoimmune conditions, contact lenses, allergies.
Actually, there was justrecently a new eye drop to fight
(13:42):
the causal agent we think ofrosacea demodex, which is a
treatment to eradicate that inthe eye which can cause dry eyes
.
But certainly manyophthalmologists recommend
higher doses of omega-3.
Now it is calories, and youonly have to eat a big apple 300
(14:07):
calories for six months to gain30 pounds and make a baby.
You only need to eat a carrotstick extra a day and be like 20
pounds overweight by the end ofthe year.
So just swallowing, you know,40 or 50 calories of fish oil,
it can add up.
So I think it's best to try toget your nutrients in whole
(14:30):
foods.
Now, vitamin D is the sunshinevitamin.
Many people work inside, livein northern climates, wear
sunscreen to reduce skin aging.
So I just see so much vitamin Ddeficiency that I really think
that most adults with levelsbeing checked may need to be
supplemented, and increasinglyI'm getting more liberal about
(14:55):
omega-3 supplementation,particularly those with a lot of
body pain joint pain, lowlevels, elevated triglycerides,
pain, low levels, elevatedtriglycerides.
Now it's very important for yourphysician or healthcare team to
know about your general healthconditions and if you have other
conditions like rheumatoidarthritis, whether it's
(15:16):
seropositive or seronegative.
Diabetes, a metabolic disorder,and gout can also increase the
risk of having joint pain andjoint problems, and some people
can have two or even three typesof arthritis at a time.
If you've ever had psoriasis,your physician should know about
(15:38):
this.
You have been listening to theSpeaking of Women's Health
podcast and I'm your host, drHolly Thacker in the Sunflower
House talking all thingsosteoarthritis.
So what are some of the signs?
Well, joint pain that getsbetter with rest is a tip off.
(16:01):
Joint stiffness that lasts about10 to maybe 30 minutes in the
beginning of the day with jointuse.
Certainly, the older I'vegotten, the less I can sit still
.
Now I'm sitting for thispodcast, but as soon as I'm done
I'm going to jump up and dosome physical activity, because
when you move you end up movingblood and oxygen and nutrients,
(16:24):
because our cartilage does nothave blood vessels, so it only
gets oxygen and nutritionthrough movement and that's why
a lot of people feel reallystiff when they sit too long,
Like I would have a hard timegoing back to medical school and
sitting in the lecture hall forhours on end at this stage of
(16:46):
my life.
Now, if you have decreasedrange of motion, you can't
totally flex or extend yourjoints.
That is a concern.
If you've got some jointinstability, that's another
concern.
So if you notice when you'rewalking the gait is unstable and
you have pain and you feel likeyour joint may give out, that's
(17:09):
a concerning symptom Crepitusor crackling of the joints, a
grating sound.
Your joint might feel tenderwhen you touch the joint line
and apply mild pressure to it,and some people just notice loss
of flexibility.
And some of flexibility doeshave more to do with your
(17:35):
tendons and just your connectivetissue in general.
So what are some of the thingsthat you should be mindful of if
you have been diagnosed withosteoarthritis.
Well, there's a few things thatgenerally are recommended to
reduce further joint pain andinjury and damage if you have
(17:57):
knee arthritis.
Running or doing high impactexercises, particularly on
uneven surfaces, definitelyaggravate knee osteoarthritis.
Any unnatural twisting orturning of the knee joints Much
better to walk on a track or atreadmill or, even better yet,
(18:17):
an elliptical to take thepressure off the knees and the
hips the pressure off the kneesand the hips.
So it might be time to hang upyour soccer cleats, your hockey
ice skates, your football padsor anything that you've done
maybe in your younger years thatwere super high impact.
(18:38):
Any repetitive motion canfurther damage the knee joints
and it could involve certaintasks, hobbies, exercise or
work-related activities.
If you have to do repetitivephysical activity, it's
important to try to take somebreaks and also use good form
(19:02):
and also make sure that yourmuscles are strong and balance
out those joints.
That being said, we don't wantyou to be a couch potato or a
blob, because exercise does helpand keeping the weight at an
optimal level is also veryimportant.
Lifting heavy objects can putunnecessary strain on your
(19:24):
joints, but if lifting isunavoidable, you must use proper
technique to reduce jointdamage or ask someone for some
extra help.
Now that I have grandchildrenwith more on the way, I'm a lot
more mindful of my joints than Iwas when I was a young mother
(19:45):
carrying two babies around I had.
My two sons were 18 monthsapart and frequently both wanted
to be carried.
They somehow never wanted to bein their double stroller.
I wish I was a little bitfirmer about that, because I've
lugged around a lot of extraweight that wasn't my own body
weight and now I encourage mygrandchildren to walk or get in
(20:09):
the stroller.
Also, just simple things likenot lugging in you know five
bags of groceries at a time,making more frequent trips, not
carrying as much, maybe goingfor a smaller purse or clutch.
I know that's hard for us womenwho carry pretty much
everything in the kitchen sink,in our bags and designer purses
(20:32):
and whatever we're carryingaround with us.
But having a stroll cart ifyou're going to be carrying lots
of things will take off lesspressure of your lower joints.
I do want to talk a little bitmore about knee arthritis,
(20:52):
because 10% of all women will gothrough a knee replacement and
it is one of the top causes ofdisability in American adults
and a study done by theOsteoarthritis Initiative
recently looked to see if thosegrating noises caused by the
knee was indicative of futureosteoarthritis.
And this study looked at peoplebetween the ages of 45 and 79
(21:18):
and found that those that hadnoisy knees or that crepitus
were much more likely todemonstrate findings on x-ray
consistent with osteoarthritis.
So if you have crepitus whenyou flex your knee and you feel
that cracking, crunchingsensation and sound, it may be
predictive.
Also, know what your familyhistory is.
(21:40):
What your family history isSuper young patients.
It doesn't necessarily apply toNow.
The OA initiative, which was amulti-centered 10-year
observational study of both menand women, was sponsored by the
National Health Institute and itaimed to look at resources to
(22:02):
help provide information aboutprevention and treatment of this
very common debilitatingcondition.
Now I will tell you that I havehad patients who thought that
they were going to sign up forbilateral knee replacements and
they got super serious withweight loss.
Maybe they saw a weightmanagement physician.
(22:24):
Most did intermittent fasting,most drastically reduced carbs
and sweets and any unnecessarygratuitous calories from their
diet, and those with significantweight loss many times had
significant improvement of theirsymptoms.
(22:47):
So how do you know if you're atrisk, if you've got these
so-called noisy knees, and whatcan you do about it?
Well, you should talk to yourphysician.
Uh, weight and diet are veryimportant.
I've had several podcasts onhealthy eating.
Uh, I did a column and apodcast on food freedom and the
(23:11):
hundred substances that arebanned, uh, in other countries.
Uh, that we have in our foodsupply.
I think becoming much choosierabout what you're using to fuel
your body is very important andI think understanding a variety
of different physical activities, balancing muscle strength with
(23:33):
some aerobic activity, but notexcessive joint wearing down
activities activities.
Now, treatment of acute flaresor an acute injury is the good
old RICE, rest and icecompression and elevation.
(23:55):
So resting an injured jointhelps prevent future injuries
and gives you some time to heal.
Both hot and cold treatmentscan give some temporary relief.
Ice is usually used if there'sa lot of swelling and there's an
acute injury, or as heatstimulates blood circulation and
(24:16):
helps alter pain perceptions,and since you need blood flow to
the area to help heal, things,that can help.
Cold reduces swelling becauseit constricts your blood vessels
and it can provide some numbing.
In terms of options for heattherapy, obviously the good old
heating pad or warm packs, warmbaths, you know, soaking in a
(24:41):
nice hot tub with Epsom salts,which is magnesium, can help
relax the muscles Using coldpacks of either frozen
vegetables or a frozen waterbottle or frozen packs.
Compression helps reduceswelling and elevation of the
injured part of the body abovethe level of the heart if
(25:02):
possible helps.
And then, after the acuteinjury, undergoing physical
therapy and strengthening of themuscles using pain relief under
the advice of your healthcareclinician.
A lot of things like ibuprofen,acetaminophen, aspirin are over
(25:23):
the counter.
Ibuprofen, acetaminophen,aspirin are over the counter but
it doesn't take very muchacetaminophen, tylenol to damage
your liver and aspirin can, inlow doses, raise uric acid and
make gout worse.
And high doses can help maybereduce uric acid if you've got
that elevated problem, and wehave a nice list of high and low
(25:44):
uric acid foods on ourspeakingofwomenshealthcom site.
But high doses of aspirin canbe bad on the stomach, kidney
bleeding.
So just because something isoff the shelf that you don't
have to get a prescription fordoesn't mean you don't need
appropriate medical advice.
Now that healthy diet that'scolorful, rich in fruits and
(26:07):
vegetables, those omega-3 foodswe talked about, selected
supplements like vitamin D,glucosamine, chondroitin sulfate
for those that are notshellfish allergic does seem to
improve the OA symptoms in atleast 50 to 70% of people with
(26:27):
knee OA, not so much hand OA,unfortunately.
The other area.
I've had some benefit withrecommending glucosamine and
chondroitin sulfate, sometimeswith or without MSM, sometimes
with or without SAMe.
S-adenylmethionine, sometimeswith or without Boswellian
(26:51):
extract, turmeric, which is anIndian spice which many people
find as anti-inflammatory, asMotrin, without some of the side
effects.
But these supplements that areover-the-counter are not
regulated and there was reportsof arsenic poisoning in some
(27:13):
turmeric supplements fromBangladesh.
So whatever you're taking, youshould bring in your bottles
with the lot number, expiration,the dose, don't just wing it or
think, because it's not aprescription that you don't have
to tell your doctor Now.
Referrals to physical therapyand occupational therapy can be
(27:35):
very helpful.
Sometimes cortisone is injected.
There are joint lubricationinjections such as hyaluronic
acid, which gives somecushioning, and increasingly
many athletes and manyperformance-focused people are
seeking out PRP, which isplasma-rich platelets that have
(28:00):
growth factors.
So they draw blood out fromyour own self and it's spinned
down to get those growth factorsthat then are injected into the
site of injury and I hope tohave some anti-aging physicians
or sports medicine and ororthopedic rheumatology
physicians on the podcast,because this is really an
(28:23):
exploding area.
It's usually not covered byinsurance and it can be kind of
pricey, but I'd like to get somemore information out about this
to our listeners Now.
Even just five pounds of weightloss could translate to 25
pounds of less pressure on yourknees and hips, and a lot of
(28:46):
people could tend to lose fivepounds.
Some people need more weightloss than that, um, and if
you're 30 pounds overweight,just think you're stressing your
joints by 180 pounds all daylong walking around.
That's a lot.
Now, um, it's sometimes easiersaid than done to lose weight
(29:10):
and that's why it's excitingthat there are increasing
options.
I think, for many people goinginto ketosis, where they are
really limiting the carbs manytimes this needs to be done
under a physician supervision,because your electrolytes need
to be checked can help burn fatand also reduce hunger.
(29:30):
Now, surgery that's usually oneof the later options.
It's certainly not a first linetreatment, but realigning the
bones, sometimes doing fulljoint replacements, sometimes
partial joint replacements,sometimes doing full joint
replacements, sometimes partialjoint replacements.
Sometimes the joint is fusedlike, particularly in the feet,
(29:55):
and certainly justrun-of-the-mill osteoarthritis
is the most common reason whypeople get either hip
replacements or kneereplacements, but there can be
other confounding factors.
Avascular necrosis from highdose steroids can cause
destruction of the joint.
Women with inflammatoryconnective tissue problems seem
to have more acceleration andneed for joint replacements.
(30:19):
Now, if you have had a jointreplacement, I tell my patients
that are post postmenopausalthat there is research showing
that menopausal hormone therapyafter having had a joint
replacement was associated withalmost a 40% decrease in the
rate of subsequent revisionsurgery compared to menopausal
(30:42):
non-users.
Compared to menopausalnon-users and those women that
were regular users for at leastsix months after surgery had a
40% reduction in the risk forimplant failure.
According to Dr Nigel Arden andcolleagues at the University of
Oxford and I wrote a columnabout this when this research
(31:02):
came out, because it's a bigdeal and we've known for years
that menopausal hormones aregreat for the quality of the
bone and the bone architectureand mineralization reached about
(31:25):
50% for those women whocontinued on menopausal hormone
therapy for at least a year, asreported in the Annals of
Rheumatic Diseases back in 2015.
And the most common cause ofjoint failure within that first
year is because of boneloosening.
You don't want the implant tobe loose, want the implant to be
(31:48):
loose.
That's a bad, bad situation andhaving to have a redo joint
replacement is major surgery.
There's a risk of infection,blood clots and then any type of
problem that you might havewith anesthesia.
So menopausal hormone therapyis bone positive.
So even if you don't haveosteoporosis or hot flashes, it
still be.
May may be something that youwant to consider.
(32:12):
And estrogen is so critical forbone strength.
We've had several podcasts andwe osteoporosis and while I said
that heavier women tend to havedenser, stronger bones with
more degenerative arthritis,whereas thin women tend to have
(32:35):
weaker bones and moreosteoporosis but less
degenerated knees and hips, youcan be heavy and have
osteoporosis.
You can be thin and haveosteoarthritis.
So it's not a direct, completecorrelation by any means and it
(32:55):
is unfortunate for peoplesuffering from both conditions,
although both conditions areimproved with vitamin D and
exercise and especially themenopausal hormone therapy.
Now estrogen is critical inmaintaining bone strength and
obviously strong bones andhealthy joints are important to
(33:16):
maintaining mobility and stayingmobile is one of your best
weapons against aging andnursing home placement.
Fall risk becomes much higheras people progress in age,
especially over age 80 or 85,and there can be corresponding
sarcopenia or loss of muscle.
(33:37):
So, according to researchers,currently we don't have a way to
completely preventosteoarthritis and we don't know
of any medication to reverse orstop the progression.
But eating right, having ahealthy lifestyle, judicious use
of supplements and vitamins,physical therapy and working
(34:01):
with your healthcare team canhelp quite a bit.
And controlling your bloodsugar.
I mean sugar is the root ofmetabolic problems lots of
hypertension, lots of diabetes,fatty liver, osteoarthritis,
cognitive decline.
So there's no such thing as anessential sugar or an essential
(34:22):
carbohydrate.
There's no such thing as anessential sugar or an essential
carbohydrate.
And if you compare the amountof ingestion of plain old sugar
that we Americans ingest nowcompared to, say, a hundred
years ago, it's shocking.
Stay active.
You need at least 30 minutes ofexercise daily.
Make sure you stretch beforeand after exercise.
(34:45):
Be mindful of pain in your body.
Pay attention to what's goingon.
You want to push yourself, butnot to the point of injury.
Practice good posture.
Our assistant, julie, who isour administrative assistant in
the center she was on thatterrific podcast that we did on
(35:07):
how to get an appointment at theclinic.
She gave great tips.
She had a working stand-up deskinstalled, so a lot of times
when I go in the office to talkto her, she's standing up and
moving around, and that, I think, is very important for
sedentary jobs, and be sure toseek medical attention if pain
(35:29):
and swelling do not improve withrice therapy.
Now, other types of arthritis Iwant to just briefly mention
include rheumatoid arthritis.
One of the old-fashionedtreatments for this was estrogen
and vitamin D, and so those arestill important.
Unfortunately, it can reallydamage the synovial linings of
(35:52):
the joint.
It can affect other organs likethe heart and the skin, the
lungs and the kidneys.
It can run in families.
Psoriatic arthritis is also anautoimmune disease and it can
attack the skin and joints andtendons and you could possibly
(36:13):
have psoriatic arthritis withoutthe skin manifestations of
psoriasis.
Interestingly, and I do see alot of patients whose psoriasis
get better when they correcttheir vitamin D and treat their
fatty liver.
And we've got a lot of goodinformation on fatty liver,
including the experience thatour founder and chief strategist
(36:37):
, the wonderful Diane Dunkelman,who's been on our podcast to
talk about clever crazes forchildren, which is her latest
passion, and she details herexperience with having kind of
ignored, untreated fatty liverthat progressed to the point
where she's in completeremission, and I have a lot of
(36:59):
patients in complete remission.
Some of the things that aregood for the fatty liver are
getting the sugars out of thediet, doing intermittent fasting
, black coffee, green tea, sameas a supplement, and
acetylcysteine, which increasesglutathione, which helps protect
the liver and the brain.
(37:19):
Some people will drink milk,thistle tea or boost their
vitamin E intake, and vitamin Cis an antioxidant and can be
helpful for joints.
Now, another type of arthritisto talk about is gout, and we've
talked about uric acid levelsin the past and we have a list
of this on the website.
(37:41):
Typically, the big toe, pedagra,is affected, but it can affect
the ankles, the elbows, thefingers, even the wrist, and
it's very painful.
Hallux rigidus is a common typeof arthritis of that big toe
and usually by changing yourfootwear and avoiding direct
pressure on the joint line canhelp.
Some people do need orthoticdevices done by a podiatrist.
(38:05):
Several types of arthritis canlead to degeneration of the arch
and bone.
Spurs or osteophytes candefinitely affect the nerves of
your feet and cause burning andtingling, and you should seek
out a podiatrist or footspecialist and bring your
footwear to the appointment.
(38:32):
So I want to go over some mythsabout arthritis, and this was
shared by Dr Elaine Husney onour website.
She's in the Cleveland ClinicArthritis and Musculoskeletal
Center in Orthopedics andRheumatology.
Myth number one is all jointpain is arthritis, and that's
not true.
Tendonitis, bursitis, softtissue injury, so you do need to
(38:54):
be evaluated.
Another myth is that rain anddamp weather worsen arthritis.
Many people believe a twinge inthe knee or knuckle predicts
the rain, but we don't reallyhave scientific evidence for
this that humidity intensifiesarthritis.
I think one reason why olderpersons with arthritis like warm
environments is that, um, whenyour body is warmer and you're
(39:21):
getting more blood flow to ajoint, some people feel a little
warmer and looser.
Another myth is to take itcompletely easy if you have a
flare-up and you may need tolimit some joint activity, but
we do want to maintain activity,just like when people throw
their back out.
We don't put them at prolongedbed rest by any means.
(39:44):
If you haven't heard my podcaston sciatica and low back pain,
that was a real popular one.
Another myth is that handicapand loss of function are going
to be inevitable if you haverheumatoid arthritis, and that's
not true.
We have so many advances intreatment, that seeking
(40:05):
treatment sooner rather thanlater is very important.
Another myth I hadn't heardthis one is that rum, soaked
raisins oh gosh, I like rumgrapefruit, eggplant or
nightshades are cures forarthritis.
Oh gosh, too bad.
They're not, because I kind oflike all those foods.
For most people not all dietdoesn't usually have a huge
(40:29):
effect, but I always encouragepeople who are worried about any
association to definitely keepa log.
A lot of people think thatthey're gluten intolerant and
they have a lot moreinflammation, but when they're
tested, they don't have celiacdisease.
I think some of this has to dowith the substances and the
bleaching and some of thesubstances that are added to
(40:53):
bread and pasta, because peoplewill go to Italy and not have
any symptoms.
Another myth is that ice isless helpful than heat, and they
both each have a role, as wediscussed.
Um.
Another myth is that thetreatment for RA is dangerous,
(41:14):
and early treatment for thisprogressive disease does lead to
a better quality of life andimproved outcomes.
So don't be afraid, and don'tbe afraid to seek treatment.
Um.
Another myth is that only oldpeople get arthritis, and that's
not true.
Young, growing children canhave significant arthritic
problems.
Juvenile rheumatoid arthritisis one, and young adults can
(41:41):
develop arthritis as well,because we have 40 different
types in the groups.
Another myth is that glucosaminehelps everyone.
Well, it does help those somepeople, particularly with knee
OA, in terms of helping withregrown cartilage.
You've got to take it for atleast three months to know if
it's going to work and then beon the maintenance.
Uh, you've got to take it forat least three months to know if
(42:02):
it's going to work and then beon the maintenance If it doesn't
work after three months.
Don't, don't waste your money.
That being said, I think isreasonable to try, and I
remember one of the first timesthat I um recommended osteoarth
uh glucosamine to one of mypatients several years ago, and
(42:23):
she said my dog takes it Cause,apparently dogs get a lot of
osteoarthritis.
In fact, my son, emerson, whohas a couple of dogs, was
telling me how, even though helikes to jog and um, when
Shirley Temple his dogs arenamed after drinks, shirley
Temple is his golden doodle anduh, the little yipper is Stella
(42:47):
Artois, the beer.
But he was telling me how hedidn't want to overrun Shirley
as a young puppy, you know, asshe was still developing,
because the vet, you know, saidthat they need exercise, but you
don't really want to damage thejoints.
So I thought that was veryinteresting because there are
(43:09):
certainly some overlays withveterinarian health and and
human health.
But again, seek out your humanhealthcare team team.
(43:30):
So thank you so much forjoining us for another podcast
and we're so grateful for yoursupport.
And certainly give us a fivestar rating.
If you haven't, maybe share thepodcast with others.
Speaker 2 (43:38):
It's free and they may get some helpful information
and be sure to join us againand wherever you subscribe to
podcasts, spotify, tune in.
We don't want you to miss anyfuture episodes.
So thanks for joining us andI'll see you next time in the
(44:02):
Sunflower House.
And remember be strong, behealthy and be in charge.
Popular Podcasts
40s and Free Agents: NFL Draft Season
Daniel Jeremiah of Move the Sticks and Gregg Rosenthal of NFL Daily join forces to break down every team's needs this offseason.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.