May is National Arthritis Awareness Month. I am writing this month’s blog entry on tips to help arthritis and I’m also working with the director of a yoga studio to make a video showing exercises to do that help arthritis. I hope you find these helpful!
Arthritis is very common in the US, 10 to 20% of adults have it. The symptoms are stiffness and pain in joints, the knees being the most common joint. Other typically affected joints are hips and spine. Stiffness and pain lead to less movement and that makes the muscles around the joint weak. Weak muscles don’t support the joint the way that they should, putting even more stress on it. The arthritis gets progressively worse over time.
Degeneration of cartilage, bone and connective tissue occurs. The most common type of arthritis is osteoarthritis, also known as DJD, or Degenerative Joint Disease. Over time, as you get older, DJD becomes more common. Some doctors consider it a normal “wear and tear” process of aging. I think that’s because it’s so common. But I don’t consider it normal and there are a lot of things that you can do to make it better and improve your quality of life.
Obesity accelerates the rate at which joints degenerate. Losing weight is the best way to start feeling better quickly. Losing as little as 10 pounds has been shown to decrease the progression of knee osteoarthritis by nearly half. The first thing to eliminate from the diet is grains which have high levels of Omega 6. Omega 6 causes insulin resistance. That means that the receptor that removes insulin from your blood stream no longer works. Blood levels of insulin go up and insulin makes sugar in the bloodstream turn into body fat. You can’t store body fat without insulin and lots of insulin means lots of body fat.
Insulin is the most inflammatory hormone in the body. Insulin makes the joints swell. If you have arthritis, you may have a familial propensity towards inflammation, and high insulin levels make this much worse. The goal is to keep your insulin levels down and getting grains out of your diet is the most important way to do this.
Grains don’t have a lot of fiber, not compared to vegetables, anyways. There is no such thing as “whole grains”. Grains in food are all processed, some more than others, but unprocessed grain is like a little rock. You can’t chew it. Well, it would take an hour. So less processed grain is called “whole grain”, but that’s nonsense. To get fiber and nutrients, eat vegetables. Stay away from grains. They have toxic levels of Omega 6. Omega 6 causes insulin resistance which causes obesity, high blood pressure, heart disease, cancer, and
What are examples of grain? Corn, wheat, oats, rice, barley, and other seeds. Weird seeds
are made into oils with super high levels of Omega 6, like grape seed oil. Wow, that should be illegal! The only oil you should ever use is basically olive oil. Foods that are made from grains are breakfast cereal, oatmeal, bread, pasta, corn chips, tortilla or wraps, and crackers.
You already know that sugar is bad. One of the most sugary things is orange juice. Never drink that. Don’t have candy, chips, snacks, and cookies in the house. Nobody should be eating that. Don’t let it come in. For the kids, have fruit on the table. Slice it up and put it on a plate for them. A slice of cantaloupe and a spoonful of plain Greek yogurt is a nice snack. Or strawberries sliced up with a dollop of whipped cream is yummy. Have lots of healthy snacks around so you don’t feel sad or deprived when the cookies are gone.
Foods that help reduce inflammation include fatty fish, dark leafy greens, nuts, olive oil, green tea, berries, garlic and onion. Steer clear of alcohol.
Drink at least 8 glasses of water per day. This will help your body flush out toxins which cause inflammation. It also prevents dehydration which causes water retention. Lifting all that water is a lot of work for those poor joints. Drink at least 8 glasses a day. When you go out, carry one of those fancy water bottles you see everyone carrying.
Once I did a favor for a patient during the pandemic. I had lots of free time and I enjoyed helping the patient. The next week she sent me a present. It was a Soda Stream machine. That thing is fantastic. I recommend everyone get that. I put ice in a big glass, a slice of lemon, and the carbonated water. It tastes great and we joke that we are having our “Pina Colada” Thanks Mrs. J!!
Years ago, Celebrex arthritis medicine had a nice TV commercial about moving, saying “A body in motion stays in motion.” That’s true. I really like that statement! Moving helps arthritis. Sitting around is the worst. Low-impact activities that don’t put stress on the joints are extremely helpful, walking, swimming, cycling, yoga and weight lifting with small weights or elastic resistance bands. Low or no impact movement strengthens the muscles around the joints. When muscles are strong, the joint is more stable, in better alignment, and this improves function and reduces pain.
It’s best to do about 30 minutes of exercise every day. Switch it up. Go to a yoga class once a week, two swimming sessions, two bike rides, and two weight lifting sessions. Walking- you should do every day. Avoid sitting. Get up periodically. Even standing is better than sitting.
The best thing is a class. It’s more fun with other people. You can make your own group, meeting in the rec room, someone’s apartment, or in the park. You can get other people to exercise with you and that’s very satisfying to help other people.
Try to incorporate stretching before and after exercising. This loosens up the muscles and decreases the chance of injury. The muscles work better when they are warm and flexible, and when they work better, they get stronger faster.
Stay away from repetitive, high-impact exercises such as running, jogging, stair climbing, tennis, etc.
Any type of activity is good. Even vacuuming. The worst thing is sitting which makes the arthritis pain worse. Regular exercise will improve mobility and balance, prevent stiffness, and strengthen the muscles.
Go outside every day. Sunshine will activate the Vitamin D that you are taking. This regulates your immune system. Did you notice during the pandemic that there were many studies that showed that a low Vitamin D level was a predictor for a bad case of Covid? Regulating your immune system will help the symptoms of arthritis because inflammation goes down. The best time to go out is at about 4 PM when there is more UV B, which activates Vitamin D. Take Vitamin D3 as well, at least 2,000 units.
You may want to take magnesium as well which helps you absorb Vitamin D. Most multi-vitamins have magnesium in it.
The other benefit to going outside is to see in the far distance. When you walk and see things near and very far away, this prompts the attention of the cerebellum, your coordination center. The more you challenge the cerebellum, the better it functions. You probably have already noticed this- that if you are sick in bed for a few days, laying in bed, and then stand up and walk, that your balance is poor. The cerebellum is lazy. Use it or lose it! So go outside and use it. Good balance means less corrective motion, more efficient motion, and less pain.
Voltaren cream is now over the counter. This is an anti-inflammatory which a lot of patients really like. I still prescribe the high dose version of this, but it’s nice for patients to get something when they need it in the drug store.
Another good product is counter-irritant creams, like Ben Gay, and Zostrix. These creams cause an increase in circulation to the area, which helps reduce pain. Also, the tingling sensation confuses the brain, so it cannot recognize pain. There is a nice patch called Salon Pas. That works well, too.
Recently, I have been prescribing CBD and CBDA cannabis products. They are typically more effective and have less side effects than anti-inflammatory drugs. They have the dual purpose of relieving pain and reducing inflammation that may be causing arthritis. I prescribe the cream in addition to sublingual drops. Many patients have been helped by these products and you can find the over the counter versions of them in many stores.
There is great symptomatic benefit of thermotherapy, the application of heat or cold, for arthritic joints. I recommend that you buy some of those gel ice packs and keep them in the freezer. If you come home from a long day out, go ahead and put one of those ice packs on your knee or hip. A hot bath with Epsom salts is also good. Or you can also use a heating pad. These are very good for back pain. Put the heating pad on low and don’t leave it on for more than 30 minutes at a time.
For anyone with chronic pain, a positive mental attitude is key. Research has shown that fear avoidance and psychosocial factors play a far greater role in the disability associated with osteoarthritis than structural pathology. That doesn’t mean that nothing is physically wrong, but that a good attitude is wonderful medicine.
America’s most famous back pain doctor was Dr. John Sarno, from NYU. He said that pain is in your head. He got a lot of flack from the doctors he worked with there and he had to undergo a chart review. The truth probably lies in the middle, some of the pain is in your head.
I think a beneficial approach is to keep a positive mental attitude and realize that your emotional state can get rid of some of the pain. Staying optimistic will help your motivation to exercise and eat right, and that’s key to feeling better.
Wear good shoes and orthotics
Orthotics are custom made devices that you wear in your shoes. Because they are molded to your foot and fit perfectly, touching every square inch of the bottom of your feet, there is more information going to your cerebellum and finer control of muscles. Orthotics are also wedged and posted for better alignment of the foot to the body. Better position of the foot and leg lowers the shock and stress of each step. Ask for rubbery materials. This will also provide shock absorption.
Wear laced up, rubber soled shoes or sneakers. The laces support the instep and keep the foot aligned with the leg. This will increase the stride length and speed of walking, which is less stressful for the joints. Basically, you will move smoother and more efficiently. When the foot and leg are aligned, muscles are at their optimum length and get stronger faster. Try not to go barefoot. Keep your shoes on, even in the house.
Good luck with all of my arthritis tips! I will also be making an exercise video with the director of Ohana Rising Yoga Studio in Bradley Beach, New Jersey, Lisa Broderick. That will go up on my YouTube channel next week. I hope that you like the exercises and get together with a friend and do them.
Keep moving and walk, walk and be healthy!
Dr. Kristina Janson