A Healthy Diet First
If we want to have a rational strategy for managing osteoarthritis, OA, in relationship to cardiovascular disease, then the earliest place to intervene is to get our patients eating a healthy diet so as to decrease the production of the advanced glycation endproducts. We always like to start by recommending to our patients the Page Fundamental Diet
For a review of Part I
For a review of Part II
India Celery Seed
Targets for herbal therapy involve various steps along the way and the research is very compelling on how herbs and certain nutrients play a roll in this particular inflammatory cascade. If patients have elevated blood glucose, a very likely reason for that is insulin resistance. We know that insulin resistance increases the production of advanced glycation endproducts. The current information that is available to us suggests that OA shares a very similar biochemical and inflammatory profile to patients with metabolic syndrome.
National Health and Nutrition Exam Surveys
The U.S. government conducts on a very regular basis things called the National Health and Nutrition Exam Surveys. These surveys collect health data from U.S. citizens and then researchers can crunch the numbers in any way that they like and a recent study of 8000 persons revealed a very strong association between OA and an increased prevalence in metabolic syndrome. The worrisome thing is that this study showed that there was an increase in this association particularly in younger people. This association between OA and metabolic syndrome also speaks to a cardio-vascular link to OA, so we need to go down that track as well in this discussion, which takes us into the circulatory system.
Insulin Resistance and Cardio-Vascular Health Links
One of the issues between insulin resistance and cardio-vascular health is obviously elevated blood pressure. Insulin resistance predisposes the patient to increased arterial wall thickness, so when we are insulin resistant we are not insulin resistant in every tissue in our body. One of the tissues that is not affected in insulin resistance and still retains insulin sensitivity is the tissue of the arterial wall. When insulin is increased it acts like a growth signal and this causes an increase in the thickness in the arterial wall. Studies in the last few years show that there is a relationship between arterial wall thickness and the development of OA.
When MRI’s are being done on patients with OA of the knee it is observed that the popliteal artery posterior to the knee is thickened. There is growing evidence now from epidemiology, looking at large population studies, to suggest that OA is linked to primary cardio-vascular disease. A high prevalence of cardio-vascular risk factors and vascular comorbidity have been commonly described in the current literature. Factors that strongly associated cardio-vascular disease with OA are increased lipids in the blood and also hypertension. More importantly, when we are talking about elevated lipids and subchondral bone, what has been observed is that fat particles can actually block up the venules in that subchondral bone, which can lead to changes in subchondral bone integrity.
Cardiovascular Issues Linked to OA
There is a higher risk of cardiovascular death associated with widespread OA in the body. In Finland there was a very large study conducted, which showed that men with OA in any finger joint were 40% more likely to die from cardiovascular disease. These researchers, when drilling into the detail came to the conclusion that if you have an atherosclerotic vascular disease then that is more important to the progression of the OA then it is to the initiation of the OA. So, in the wellness world as clinicians, we are focused on helping these issues before they become a problem. If we see a patient with OA and they have a vascular disease going on such as atherosclerosis, then we need to be much more focused in dealing with both of these conditions and it increases the significance in terms of the therapy.
Micro Vascular Involvement
There is a microvascular involvement in terms of a disruption to microvascular flow. Lipid clogged venules in the subchondral bone is a very relevant feature in the metabolic aspects of OA. If the nutrient flow through the subchondral bone is reduced by having it blocked up by those fat particles then there can be little ischemic events in that subchondral bone due to the microthrombi that are produced. That causes some osteocyte death and it causes a little bone resorption and a bit of necrosis.
In an environment where you haven’t got good blood flow and good levels of oxygenation, the wound healing event doesn’t proceed very well and over time these microthrombi caused necrotic spots start to coalesce. This is really the way that bone marrow lesions develop, particularly in knee OA. As well as having reduced nutrients flowing through that subchondral bone so that the overlying cartilage is starved of its nutrients and its oxygen there is a metabolic state inside the bone being created, which is aberrant.
Some of the growth factors being produced by the bone to repair the damaged bone actually leak into the articular cartilage, which is one of the reasons that the articular cartilage becomes mineralized and starts to behave like bone. What has been observed are microcracks in the bone and those microcracks fissure into the underlying articular cartilage. All of the growth factors and the repair mechanisms that are being developed by the bone to repair what has gone on because of those ischemic events can leak into the underlying cartilage. This creates a scenario where the cartilage starts to falter.
Synovial Joint as an Organ
If we tie all of these threads together, we really have to focus on the synovial joint as an organ. We have to consider OA as not simply mechanical wear and tear. We have to take into account all of the possibilities. We have to be looking at the synovial membrane and the health of the cartilage. We have to be looking at the health of the underlying bone. We have to look at circulation. We have to deal the metabolic syndrome that is present and we have to reduce the fasting and after meal blood glucose levels.
Complex Therapy for OA Treatment
If we want to have a rational approach to managing OA then we have to see it as a very active and very complex biological process where we have matrix degradation that is mediated by the cells within the joint and also in the cells adjacent to the joint. There is a range of inflammatory mediators and there is a range of inflammatory and pathological processes that need to be tackled. Therefor, therapy needs to be quite complex and we need to target the therapy for the individual patient. If we are treating pain, then we have to realize that pain can be quite a challenging thing to locate and deal with and we’ve got to be very mindful of the fact that insulin resistance and compromised circulation, particularly the microvascular circulation are predisposing factors to the syndrome. Rational therapy for OA should target the underlying process that’s driving this matrix degradation and the true sources of the pain and inflammation.
Therapies We Use at Seaside Wellness Center
Some of the herbals that we recommend include MediHerb’s Boswellia Complex which is a mixture of herbs namely Boswellia serrata, India Celery Seed, Ginger and Turmeric. When we explore the various actions that these herbs have in combination we will arrive at a therapy which takes into account much of the discussion that we have just had. Along with MediHerb’s Boswellia Complex we will consider the chiropractic approach of joint manipulation to free fixation, improve the nerve supply and the vascular supply. We will also discuss the benefit of Reflexology and the use of the Young Living Essential Oils to balance homeostasis and promote general wellness within the various systems involved in the syndrome of OA.
In Part IV we will discuss all of this at length including Young Living Essential Oil: http://daryl.marketingscents.com/ Ginger, Abundance (Myrrh, Frankincense, Patchouli, Orange, Clove, Ginger, Spruce), PanAway (Wintergreen, Clove, Helichrysum, Peppermint), Frankincense, Valor (Spruce, Blue Tansy, Frankincense, Rosewood), Lavender.