Osteoarthritis is becoming a problem to most. Understanding Nutrition management will be helpful

1. NUTRITION MANAGEMENT FOR
OSTEOARTHRITIS (OA)
Stephen Ayere
Clinical Nutritionist
Smiles Nutrition & Wellness Centre

2.  Identify the roles foods may play in management of
OA
 Understand MNT in Osteoarthritis
 Understand anti-inflammatory diet and how to
recommend it.
Goals

3.  Overview of osteoarthritis (OA)
 What’s OA?
 Risk factors for OA
 Pathophysiology of OA
 Medical Nutrition Therapy for OA
 Anti–inflammatory diet
Outline…

4.  Most prevalent form arthritis.
 Formally known as degenerative arthritis or degenerative
joint disease.
 What do you think is the main difference between OA and
RA?
 RA is systemic autoimmune disorder that results to
symmetrical joint inflammation whereas OA is not systemic or
autoimmune in origin but involves cartilage destructions with
asymmetrical inflammation. It’s caused by joint overuse.
Overview of OA

5.  Risk factors
 Obesity
 Aging
 Female gender
 Ethnicity
 Greater bone density
 Repetitive use injury (load impact)
Overview of OA Cont…

6. Why is female gender more at
risk to develop OA than men?

7.  OA is a chronic joint disease that involves loss of habitually
weight-bearing articular (joint) cartilage.
 Cartilage normally allows bones to glide smoothly over
another.
 The loss of cartilage can results to stiffness, swelling, pain,
↓ in motion and changes in joint shape. In extreme can
result to osteophytes (abnormal bone growth)
Pathophysiology of OA

8. Joints most affected by OA

9. 1. Weight and Adiposity Management
 Excessive weight (obesity) adds burden on the weight-
bearing joints : Knee OA is ↑ in obese population.
 Anti-inflammatory diet combined with moderate exercise
and diet-induced weight loss is effective for OA if the knee.
 Reduced fat mass as a result in weight loss also ↓
inflammatory mediators from adipose tissues.
MNT For Osteoarthritis

10. 2. Vitamins And Minerals
 Cumulative damage to tissues mediated by ROS has been implicated as a
pathway that leads to many of the degenerative changes seen with
aging
 Large doses of dietary antioxidants including vit A,C & D or in
combination has showed no benefit in management of OA.
 OA in many patients was found to consume deficient levels of Ca and Vit
D.
 More studies needed to establish the Role of vit D in pathogenesis of OA
MNT For Osteoarthritis

11. 3. Complementary Integrative Therapy (CIT)
 Meta-analysis studies have found capsaicin gel and S-adenosyl
methionine (SAMe) are useful in treating OA; articulin F
improved pain and function
 Indian Frankincense, Methylsulfonylmethane (MSM) were
somewhat effective
 Collagen, devil’s claw, vitamin K and many more supplements
found to be ineffective for OA.
MNT For Osteoarthritis

12. 4. Glucosamine and Chondroitin
 Glucosamine and Chondroitin are involved in cartilage
production although the mechanism for pain elimination is
not identified.
 Although it’s not effective for all afflicted individuals, the safe
dosage for glucosamine and chondroitin is 1500mg/day and
1200mg/day respectively.
 In contrast, chondroitin is chemically similar to commonly
used blood thinners and could cause excessive bleeding if
used in combination.
MNT For Osteoarthritis

13.  Inflammation is thought to underlie most chronic health conditions
including metabolic syndrome, diabetes, cancer, arthritis etc…
 Various nutrients found and dietary patterns have been shown to
reduce inflammatory markers a.w.a subjective and objective
measures of inflammation.
 Multiple iterations of anti-inflammatory diet exist: DASH,
Mediterranean, MIND, Vegetarian food allergy elimination, calorie
restriction, and low histamine.
 In most cases, overall dietary and lifestyle habits are more
important to consider rather than any single change.
The Anti-Inflammatory Diet

14. Dietary Recommendations:
 Consume abundance of fruits, vegetables, herbs and Spices
 Eat a Low Glycemic Diet
 Have nuts and Seeds or Nut and seed butters every day
 Adjust the quality and quantity of dietary fat and oils
 Get adequate sources of probiotics
 Consider food allergy or sensitivity elimination
 Avoid chemicals
 Stress and sleep
 Drink alcohol in moderation
The Anti-Inflammatory Diet

15.  Phytochemicals and fiber are thought to be the
cornerstone of anti-inflammatory diet due to their ability to
down-regulate markers such as CRP, Nuclear Factor-kappa
Beta (NFkB), and other anti-inflammatory cytokines in vivo
and in vitro
 Cruciferous vegetables, onions, berries, grapes, citrus
fruits, tomatoes, carrots and other colorful veggies.
 Herbs and spices: green tea, turmeric, garlic, ginger, cocoa,
clove, rosemary, oregano etc…
Abundance of fruits, vegetables,
herbs and spices

16.  Diet high in refined CHOs and sugars may be pro-
inflammatory.
 Choosing low Glycemic foods reduces post prandial
glucose and insulin levels, modestly lower concentrations
of insulin-like growth factor; improve the inflammatory
and adipokine
 It’s important to look at GL of food vs GI because the load
is better indicator of actual portion of food.
Eating Low Glycemic Diet

17.  They provide anti-inflammatory and valuable
phenolic compounds
 They also provide beneficial ratio of PUFAs (Omega -6
and Omega-3) which support healthy inflammatory
response in the body
 Examples include: pumpkin, flaxseeds, sesame,
walnuts, almonds, sunflower, chia seeds…
Have nuts and seeds or nuts and seed
butter every day

18.  Increase:
 Unsaturated fats high in omega-3 Fas (ALA)
 MUFAs from extra virgin oil, avocado instead of mayonnaise
or cheese
 Decrease:
 Excessive amounts of animal proteins, high in saturated fats
(arachidonic acid) ↑inflammation.
 Processed foods and oils, vegetable oils
 Avoid hydrogenated fats and trans fats. Mostly in baked and
prepackaged foods.
Adjust the quality and quantity of
dietary fat and oils

19.  Supporting gut ecology helps to keep digestive tract
healthy and balance the immune system
 Fermented and cultured foods are good source of
probiotic bacteria i.e. yogurt
 Getting sufficient prebiotics to feed the good bacteria
is also important i.e. inulin and fructooligosaccharides
from plants i.e. garlic, banana, onions…
Get adequate sources of probiotics

20.  High stress levels and lack of sleep are both associated with
inflammation
 Elevated circulating cortisol levels found under conditions of
psychological stress are associated with elevated inflammatory
cytokines
 Sustained sleep restrictions has also been associated with an
inflammatory state and elevation of TNF-a, IL -1B, etc…
 Intentionally practice stress reduction techniques such as
meditation reduce inflammatory response in human experimental
models.
Sleep and Stress

21.  Food intolerance or sensitivity happens within the gut and
can be as a result of an enzyme deficiency or a reaction to
food additive or naturally occurring chemicals in foods.
 The most common food allergens include milk, eggs, wheat,
tree nuts, peanuts, soybeans and shellfish
 Common food intolerances are non-celiac gluten, lactose, soy,
histamine…
 Common food additives intolerances are sulfites, benzoic
acid, MSG, tartrazine (Yellow 5)
Consider food allergy or sensitivity
elimination

22.  Industrial chemicals such as pesticides disrupt the immune
system.
 Many canned foods contain biosphenol A in their linings.
BPA is an endocrine disruptor and impair insulin actions
 Alcohol has the effect of increasing and decreasing
markers of inflammation. Red wine is most commonly
featured alcoholic beverage with its high anti-inflammatory
polyphenol content.
Avoid Chemicals and Drink alcohol in
Moderation

23.  Cao Y, et al: Association between serum levels of 25-hydroxyvitaminD and
osteoarthritis: a systemic review, Rheumatology 2013.
 De Silva V, et al: Evidence for efficacy of complementary and alternative
medicines in the management of osteoarthritis; a systemic review,
Rheumatology 2011
 Bendsen NT, et al: Effect of industrially produced trans fat on markers of
systemic inflammation, evidence from randomized trial in women, 2011
 Rosenbaum CC, et al: Antioxidants and anti-inflammatory dietary
supplements for osteoarthritis and rheumatoid arthritis, Altern The Health
Med, 2010.
 Shivappa N, et al: Designing and developing a literature derived population
based dietary inflammatory index, Public Health Nutrition, 2013.
 Sears B, et al: Anti-inflammatory nutrition as a pharmacological approach to
treat obesity, journal of obesity 2011.
References