Osteoarthritis Treatment Options

Osteoarthritis, or degenerative joint disease, is a disorder that ultimately leads to pain in the affected joint, and functional degeneration of the affected joint.  Over 12 million people over the age of 65 are affected by this disease.  The most commonly affected joints are those of the knee, hip and hand.  OA is responsible for 400,000 hospital visits, and up to eight billion dollars for hip and knee replacements annually.  The most common risk factors include advanced age, obesity, past occupation, participation in certain sports, joint trauma, and family history.  Symptoms include joint stiffness in the morning, or after a period of inactivity of thirty minutes or less, limited or reduced range of motion, and joint deformity in later stages.
              The first place where treatment should start include preventive measures including weight loss, quitting smoking, and reducing joint damage by avoiding activities that involve high impact on joints and repetitive motion such as typing, writing, kneeling, squatting, or heavy lifting.  Patient education should be the first step in the treatment of OA.  Education should cover the progression of the disease, the patient prognosis, and appropriate treatment options.  Also, proper resources that the patient can consult for efficient self management information and programs.  The most important modifiable risk factor for the development of OA is obesity.  It is shown that a three to fourfold increase in the risk of joint replacement is associated with increased body weight.  This should be a major focus for individuals with OA in the knee and hip.  An eighteen month program of caloric restriction and exercise resulted in a twenty-four percent improvement in physical function and a thirty percent reduction in knee pain.  Physical and occupational therapy is shown to be beneficial for patients who do not benefit from home exercise programs or need further instruction in range of motion, joint protection, or muscle-strengthening principles.  Exercise programs focused on the quadriceps, adductor, and abductor muscles have be shown to improve knee and hip stabilization.  Surgery is recommended as a last resort effort tom manage OA symptoms in patients whose disease is refractory to less-invasive management methods.  Joint replacement should not be delayed in order to best preserve optimal restorative function.  In terms of pharmacologic treatment options, the first medication that should be used is acetaminophen, which is shown to be effective for mild-to-moderate pain relief.  Non-steroidal anti-inflammatory drugs are shown to be more effective that acetaminophen, but due to the large side effect list of NSAID's,  including nausea, abdominal pain, peptic ulcers, edema, increase in blood pressure, and renal insufficiency, acetaminophen is preferred as the first line of therapy.  If symptoms persist, NSAID's should be used, and the choice of NSAID's should be based on patient comorbidities, cost, and side-effect profile.  Topical analgesics are used for patients unable to tolerate systemic agents.  If symptoms persist, intra-articular glucocorticoid injections are used to bring relief to a localized area.  Then opioid analgesics are used, for a short time period only in order to avoid addiction.  If none of these things help, the last resort is surgery.
              This topic hits particularly close to home as my mom, my dad, and my grandmother are all affected by OA.  My mom has gone through many series of injections, and ultimately a recent surgery to reduce the arthritis in her thumb joint.  My dad will be forced to have a total hip replacement in both of his hips, and his knees are pretty bad.  My grandmother has been dealing with arthritis of the hand and wrist for quite some time now.  Since I have a rare bone disease myself, called fibrous dysplasia, I hope that I am not at a higher risk of developing OA later in my life.


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The Danger of Fad Diets

A fad is defined in the dictionary as "a practice or interest followed for a time with exaggerated zeal."  This can apply to a wide variety of things, such as Pokemon trading cards, toys, hairstyles, and so on.  The focus of this post is on fad diets, and how they turn practices that may have been intended to be beneficial into unhealthy choices.  The first major problem with fad diets is the fact that industries keep a close eye on the current trends and fads, and when they see a particular fad gaining popularity, you can bet that they will start extensive advertising campaigns for that fad.  For example, once it was discovered that people were severely lacking in omega 3 fatty acids, companies began to advertise that their product contained these omega 3's.  This was also heavily advertised through the use of the media, be it on a television show like The Doctors, or in health and fitness magazines.  Another example is the strategy of ketchup producers to place labels on their ketchup that lets people know that lycopene, an antioxidant found in tomatoes, is present in their product.  You just have to walk around a grocery store and you will see all different kinds of products that have advertising on them of why their product is a healthier choice than some other product of a similar nature.
                     The author of the article gives a good example of how a particular fad could come into being.  Take for example vitamin D.  It is a known fact that the sun can provide us with all of the vitamin D that we need.  When our ancestors lived, back in the age of cave dwelling, they were outside the majority of the day, and they got all the vitamin D that they needed from the sun.  Once we learned how to build houses and started to work in factories or offices, we didn't need to go outside as  much.  Eventually someone thought that we were not getting enough vitamin D, so dairy producers started adding vitamin D to milk.  But for whatever reason, this did not catch on with enough people, so the idea of a vitamin D supplement in the form of a capsule was born.  Since people had been getting insufficient amounts of vitamin D over the past decade, health guru's claim that vitamin D deficiency is the "root to a host of health evils."  So some people are going to start to take large amounts of vitamin D capsules, which is a fat soluble vitamin and excess intake can cause liver damage.  This continues in a vicious cycle of people realizing that they are deficient in some nutrient, and then the health industry comes up with an amazing supplement to try and solve our problem.
        The author gives six ways to determine if a particular strategy is a fad or simply a good, common sense idea.  Anything that claims to be capable of "burning away fat" or being a "superfood" is likely to be part of a fad.  In terms of weight loss, a rapid loss of weight is indicative of a fad diet, as what is likely being lost is either muscle mass or water weight, neither of which are particularly desirable effects of a diet.  Any diet that claims it can work without exercise is not only a fad, but is also completely untrue.  Someone could have the healthiest diet ever, and still not be physically fit because of a lack of exercise.  Low carbohydrate/high protein diets such as the Atkins diet are fad diets, because a diet is something that is supposed to be a well balanced amount of all of the essential nutrients that we need.  By eliminating carbohydrates, we remove one of the essential nutrients our bodies need to properly function.  This diet may have worked for our ancestors who relied primarily on hunting and gathering, but it is not suitable for our current lifestyle.
        I am of the opinion that in order to live a healthy life, one must do several things.  First, one has to have a well balanced, healthy diet.  This diet needs to be supplemented with appropriate levels of physical activity, ranging from aerobic fitness, resistance training, strength training, and flexibility training.  Also, proper levels of sleep are required to allow the brain to regenerate and grow.  These are just basic things that one should do, there is much more depth to living a healthy life that what I have said in this post.

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Are Organic Foods Really Better than Commercially Grown Foods?

Organic food has quickly become a major part of the U.S. domestic food sales.  In 1990 sales were at 1 billion dollars.  By 2009 sales had increased to over twenty billion dollars.  The reason for this massive increase in sales is due to the fact that consumers believe that these foods are healthier to eat, and safer for the environment to grow.  In this article, the author examines organic food to determine the actual health benefits of eating organic foods.  Several other factors need to be taken into account, such as the differences in grower tendencies, the yearly weather patterns, and the length of time spent using organic methods to produce the food, as it takes ten years to organically grow tomatoes.  A three-year study done at the University of California found significant differences in the levels of phytochmeicals among different varieties, and from year-to-year.  Organically grown Burbank tomatoes were discovered to have higher levels of ascorbic acid (26%), quercetin (30%), and kaempferol (17%).  Organically grown  Ropreco tomatoes showed 20 % more kaempferol, but had a less robust showing overall in growth.  Over the span of ten years, UC conducted another study on the flavonoid content of conventionally grown tomatoes versus the organically grown variety.  They found that the organic tomatoes had 79% more quercetin and 97% more kaempferol than conventionally grown tomatoes.  Additionally, it was found that the flavonoid levels in the organic plots increased over the period of ten years, while the flavonoid levels in the conventional plots stayed constant.  With the increase in flavonoid levels, the levels of organic material in the soil also increased, making the soil better for continued use.  In regards to vitamin and mineral differences, it was discovered that organic foods have 21% more iron and 29% more magnesium, while on the vitamin side, ascorbic acid was found more frequently in organic fruits and vegetables.  Organic foods also were found to have higher levels of carotenoids, flavonoids, and many other polyphenols.  Flavonoids are known to be potent antioxidants, while carotenoids such as lycopene have been shown to reduce the risk of cancer.  Anthocyanin compounds in berries have been shown to improve neuronal and cognitive brain functions, ocular health, and genomic DNA integrity.  While it is true that organic farming methods prohibit the use of pesticides and herbicides, there is still the possibility of farming on land that is not yet free of insecticide residue, such as DDT.  A review conducted using data collected by the United States Department of Agriculture, and the California Department of Pesticide Regulation, showed that organically grown foods had one-third the amount of chemical residues found in conventionally grown foods.  Additionally, organically grown foods were shown to be far less like to have two or more residues.  Only 2.6% of organically grown foods had detectable multiple residues, compared to 26% of conventionally grown foods.  82% of conventionally grown fruits tested positive for insecticide residue, compared to only 23% of organic fruits.  65% of conventionally grown vegetables tested positive for insecticides, while only 23 of organic vegetables were shown to contain insecticides.  Organically grown vegetables were also shown to be better at suppressing the mutagenicity of several environmental toxins, including benzo (a)pyrene, the main carcinogen found in cigarette smoke and automobile exhaust.  Organic vegetables suppressed 30-57% of the mutagenic action, while conventionally grown vegetables only suppressed this activity by 5-30%.  Against the chemical 4-nitroquinoline oxide, organic vegetables suppressed 37-93% of mutagenic activity, while commercial vegetables suppressed this mutagenicity by 11-65%.  Also, organic strawberries block the proliferation of HT29 colon cancer cells and MCF-7 breast cancer cells.  From all of this information, it seems fairly obvious to me that while organic foods are not better in every single way, they still are far superior to commercially grown foods, and all agriculture companies should be focusing on changing their focus to organic production to make this a healthier nation.    















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