Arthritis | Prediabetes Diet and Exercise | Part 1
What is Arthritis? To put it simply, osteoarthritis – commonly just called arthritis – is a damaged joint. The more challenging part of the question is what causes osteoarthritis, and what can you do about it? Don’t let joint pain and stiffness keep you from fixing your metabolism, losing weight and improving your blood sugar levels to stop prediabetes and avoid full type 2 diabetes with all its potential complications including foot and leg problems that could prevent you from living a functionally active and independent life into your senior years. You do not want to end up in a nursing home.
We used to think osteoarthritis was simply caused by wear and tear of cartilage in the joint, or from a sudden injury involving a joint. Cartilage is the white covering at the ends of bones. When it is healthy, it is very slippery and allows your bones to move against one another with very little friction. When it becomes damaged, the bones tend to scrape together causing pain and stiffness – think about what happens when the Teflon on a frying pan becomes damaged and worn (by the way Teflon is a nasty chemical, but that’s a post for another day). The wearing out of car tires is another visual analogy to help you understand “wear and tear” of your joints. In the feet and legs, one can easily think about tires on a car – things just wear out over years of use – but it isn’t quite that simple.
In this article, I will first discuss arthritis, and then tell you what you can do as far as exercise-movement and food-diet to help arthritis. In Part Two, I will discuss nutritional diet supplements and natural remedies that have evidence-based support for helping arthritis…so let’s get started with Part One.
The cause of arthritis in the feet, legs, and elsewhere, involves more than simple wear and tear.
So-called “wear and tear arthritis” also involves an inflammation in and around the joint that plays a major role in the worsening of the arthritis and the resultant pain that often develops. (1, 2) Early on in a joint that is becoming damaged by arthritis, before the arthritis actually becomes noticeable and start to hurt, inflammation is brewing. Research into how arthritis comes about has historically focused on the cartilage in the joint, but we now have a fuller understanding that arthritis affects many parts of the joint, including the synovial lining which is mostly responsible for making joint fluid for lubrication. This inflammation is a major factor – as opposed to a secondary consequence – of the arthritis disease process. This has lead to a new perspective on this age old disease enabling you to do something about this problem.
This fuller understanding of arthritis offers some possibility that by focusing on and addressing the inflammation that happens over time as arthritis progresses, we may be able to limit its effect and extent – perhaps even stop it before it has a chance to do too much damage leading to stiffness and pain. Although you may not see the inflammation that is playing a role in worsening of the problem, it’s there.
Arthritic joints have an extra amount of inflammation producing cells putting out their inflammatory substances. This is where your food, movement and lifestyle come in. Strive for an “anti-inflammation lifestyle.” You can suppress inflammation producing cells and minimize arthritis damage to your joints along with all the other health benefits.
What Can You Do About Arthritis?
Arthritic feet, ankles, knees and hips may not only result in decreased functional movement, but also in chronic discomfort, stiffness, and outright pain. This can be lessened by an early diagnosis and care of the injured joint. If you believe you have arthritis there are things you can do now to keep yourself moving and functional. You can’t significantly reverse the changes that have occurred with aging or injury, but there are things you can do to keep yourself mobile and functional well into your senior years.
What does that mean? Well for one, contrary to common belief, exercising or moving the arthritic joint is generally advised. Guidelines for arthritis management actually encourage movement of the arthritic joint. If you think this sounds crazy, you are not alone, but stay with me. Most people don’t realize that movement of an arthritic joint can be helpful. One study found that less than half of people with mild arthritis believe it is helpful to move and exercise their arthritic joint. Most people believe even moderate intensity physical activity will make their arthritis worse.
If you don’t know exercise-movement can be helpful for arthritis, you may be more likely to rely on medications. Medications are not without side effects. Podiatrists who manage arthritis of the feet, and orthopedic specialists who manage arthritic joints throughout the body, will use anti-inflammatory medicines such as ibuprofen or other anti-inflammatory drugs by mouth, cortisone and other joint injections, or topical medicines that can be rubbed onto the area to act locally to help alleviate symptoms in hopes of having you move more freely. Perhaps with proper exercise-movement of your arthritic joint(s), medications can be reduced. They may still be needed depending on your individual situation – talk to your doctor.
Exercise-movement of an arthritic joint can:
- reduce joint pain
- improve quality of life
- potentially reduce the progression of joint damage (3)
It does this by:
- Improving the nerve signal to the muscles that move the arthritic joint. This allows for better stability and control of the joint whether you are aware of it or not.
- Improving the structures around the joint that hold it together, such as ligaments.
- Benefitting the structures inside the joint, including the cartilage.
- General improving your sense of well-being.
- Improving your overall health & improving joint health in general. (4)
Joint movement has a rehabilitative effect because we are designed to move. Most people are aware of movement for rehab after heart attack or joint surgery. In the old days, if you had a heart attack, it was advised that you “take it easy.” Now there are cardiac rehab programs that use exercise to help people recover after many heart problems. Exercise is medicine.
Types of Exercise Movements for Arthritis
This depends on the joint involved. For the joints of the feet and legs it is usually best to start with non-weight bearing movements.
Endurance activity and arthritis – Researchers looking at the benefits of using a stationary bike for knee arthritis found that biking participants had reduced pain, stiffness and increased ability to walk after only 3 months of cycling. Some of you may be thinking, “only 3 months?” This is not a long time for not only the health of your joints, but your body as a whole.
For those who may be a bit intimidated by using a regular bicycle, stationary bikes are a great alternative. Recumbent bikes are best if you are older or have low back discomfort. You should incorporate some form of cardiovascular exercise into your life. And I don’t mean walking on a treadmill or riding a bike for an hour a day. For many of you, that would be counter-productive whether you have arthritis, or not. You will benefit from just 20 minutes of endurance activity, or even better – 10 minutes at a time 2-3 times per day. It has been shown repeatedly that short episodes of activity throughout the day are better than one long episode. As we get older this becomes more relevant since the body often doesn’t tolerate prolonged activity. If you become sedentary as you age your risk of disease will rise, including your risk of prediabetes and eventual diabetes.
Resistance activity and arthritis – Aging inactive adults undergo an increased steady loss of muscle mass each decade. This especially begins after 40 years of age and is accompanied by a slowing metabolism and increased body fat. So what do you do about it? Answer: Keep moving and lift weights (or do some form of resistance movement). Yes, I said it, “lift weights!” The positive results of weight training exercise are well-known although most people do not take advantage of these health benefits. It has been shown that just ten weeks of resistance weight lifting training increased muscle weight by 1.4 kg, increased resting metabolism by 7%, and reduced fat weight by 1.8 kg. Resistance weight lifting exercise is medicine.
The benefits of resistance training also include improved:
- Neuromuscular control
- Walking speed
- Functional independence
- Cognitive abilities – otherwise known as “brainpower,” or ability to think
- Self-esteem – kind of follows along as a natural outcome of the other benefits. But don’t get too cocky, you’ll end up hurting yourself
Resistance training may assist in stopping prediabetes and preventing or managing type 2 diabetes by:
- Decreasing inflammation producing abdominal fat – “beer belly” mid-body fat
- Lowering HbA1C
- Increasing the amount of glucose transporter type 4 – helps insulin pull blood sugar out of the bloodstream
- Improving insulin sensitivity
Resistance training “weight lifting” may enhance cardiovascular health by:
- Lowering blood pressure
- Decreasing low-density lipoprotein cholesterol (LDL) and triglycerides
- Increasing high-density lipoprotein cholesterol (HDL)
Resistance training may also promote:
- Bone development.
- Relief of low back pain and easing discomfort associated with arthritis and fibromyalgia
- Reversal of specific aging factors in skeletal muscle (5)
If weightlifting intimidates you, consider exercise bands, or simple movements against your own body weight – a deep knee bend is an example of a body weight resistance exercise. If that still doesn’t suit your fancy, consider the mindful approach to exercise-movement in theform of Tai Chi or yoga. These forms of movement can incorporate an endurance element, a resistance element as well as balance and mindfulness benefits. Because of this, Tai Chi has been shown to benefit metabolism leading to healthier blood sugar levels and improved blood circulation. This is an excellent option for all ages, in addition to someone who may be getting a little older and needing to modify their approach to exercise-movement.
Keep Your Feet and Legs Functional
One of the keys to a healthy metabolism that will keep you functionally active and independent into your senior years without the complications of diabetes arestrong feet and legs. Joints that are surrounded by strong muscles are less vulnerable to arthritis. The joints of the lower limbs – including the hip, knee, ankle and multiple foot joints – are all prone to arthritis as we age. Our feet are especially prone to trauma. There are 33 joints in your foot that could be affected. Many of them are small and arthritis in these joints certainly won’t limit you, but remember the last time you stubbed your big toe? The damage to the cartilage in the big toe joint can cause pain and limitation of functional movement.
Although the “tires on a car” analogy may not be a perfect one to explain arthritis in the feet, it does have a place in thinking about your feet from a functional point of view. As we age, the tissues in the feet and ankles change and become less protective and supportive. Just like tires need to be aligned well, and have good tread, your feet need proper alignment and healthy shock absorbing tissues to function well. This becomes more important as we age, and the body becomes less forgiving of abnormalities. When there is an alignment problem or compromised shock absorption, there are ways to help counter the negative effects that can develop. The foot and ankle are areas that podiatrist foot specialists work to keep functional and walking. This is especially important for people who have unhealthy blood sugar levels and a poor metabolism from pre-diabetes or metabolic syndrome. Movement is an integral part of your health, including the health of your joints. Without movement, your metabolism, bones and joints, along with your overall health will, deteriorate rapidly. Strong legs are one of the keys to successful aging.
Food, Diet and Metabolism Effects Arthritis
Your metabolism is greatly influenced by the food you eat, and can influence your bones and joints for good or for bad. Some have referred to the negative effect of a poor metabolism as “metabolic arthritis.”
The readers of Nutrientolgy know the components of metabolic syndrome all too well. These components can affect your joints in the following ways:
1. High blood pressure affects the blood flow under the cartilage at the ends of the bones. It is the health of this cartilage that deteriorates with arthritis. This affects the ability of the cartilage to get nutrition from your bloodstream.
2. When you do not have healthy levels of “the different types of cholesterol” this can lead to fat being deposited in the cartilage cells and/or affecting the cartilage cells’ fat metabolism, and therefore their health.
3. High blood sugar levels affect your joints both locally by increased advanced glycation end products in the joint itself, and throughout your body as a whole through the increased inflammation that exists in the face of increased blood sugar levels.
4. The metabolism of people who are obese and overweight is a factor. This is probably easiest to understand once you grasp the idea that abdominal body fat is an active tissue that is secreting nasty stuff causing inflammation throughout the body. These substances, known as “adipokines,” contribute to arthritis because of these inflammation producing substances from fat. (6)
Being heavy has more of an impact on joints than just the simple physical stress on joints from increased body weight. In other words, there is more to arthritis in the feet and legs than simple physical body weight stress – the ”more” is damaging inflammation. Studies have shown that overweight people have a higher incidence of arthritis in their hands. Overweight people are not walking on their hands. So, what’s going on?
The higher amount of internal inflammation present in overweight people is a factor. Many people with prediabetes and metabolic syndrome are overweight with excess “mid-body fat.” The substances (adipokines) released by this fat instigate inflammation and insulin resistance leading to prediabetes and eventual diabetes with all its life-changing complications.
By definition, people with this excess “stomach fat” have increased inflammation and a “bad metabolism.” If you have excess fat in your stomach area, how do you expect to reduce inflammation in a single arthritic painful joint when you are essentially bathing in mild inflammation throughout your body as a result of the excess mid-body fat? You need to deal with this if you want to be able to keep moving as you age. Otherwise you will be in a nursing home next to a snoring roommate with dementia.
So, now you know there is more to arthritis in overweight people than physical stress. The chronic inflammation that is produced by “stomach fat,” can aggravate the inflammation of a damaged arthritic joint making it worse. You now know the inflammation of arthritis can be instigated, and aggravated, by your metabolism in addition to the stress of weight bearing. If you are overweight and have some degree of prediabetes, borderline diabetes or metabolic syndrome, you most likely have low-grade inflammation throughout your body, not just at your arthritic joints.
One of the most significant things you can do to alleviate arthritis in the feet and legs is to improve your metabolism and lose weight. In that case, not only will you reduce the physical stress, but the “inflammation stress” that is being applied to the joint(s) will also become reduced. Have I convinced you to take at least some action? I know what you are thinking, if you are like most overweight or obese people, at this point in your reading you are thinking (yelling?), “how can I lose weight when I can’t walk because of my sore, stiff joint from arthritis?”
I have written above about some ways you can participate in at least some movement-exercise for a healthy metabolism and all its benefits, including weight loss and healthier blood sugar levels. Just do something. If it means spending just 5 minutes on a stationary bike, or elliptical machine, do it. If you can’t use this equipment, get some exercise bands, and use them for upper body resistance movement while sitting in a chair if you have to. Where there’s a will there’s a way. They actually make a workout exercise chair with attached exercise bands.
Resistance Chair Exercise System
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Anti-inflammation Food for a Healthy Metabolism
Guess what, the same approach to food that you should take to stop pre-diabetes and prevent diabetes is the same one you should use to help arthritis. This is not a coincidence. Both problems are associated with too much inflammation in the body. While some inflammation is normal, inflammation is not something you want in excess. Inflammation serves a useful and helpful purpose, but when it is excessive and/or chronic, it can lead to ill health.
Two types of food nutrients that have shown significant benefit for prediabetics with a sick metabolism, as well as having strong anti-inflammatory support, are polyphenolsfound in fruits and vegetables and omega-3 fats found in seafood and nuts. (8, 9)
Polyphenols are a vast and interesting family of nutrients that belong to several different groups. They should be a regular part of your diet due to their antioxidant, anti-inflammatory, and beneficial cardiovascular properties.
For readers with a science background, a good complete review article on the various biological properties of polyphenols – including their anti-inflammatory benefits – can be found here.
Many people simply do not like to eat vegetables. I can’t say that I blame you, but now that you know they can help decrease inflammation, help you improve your metabolism to lose weight, stop prediabetes and avoid diabetes, find a way to prepare them in a way that suits you. There is a way, you just need to put in some time and creativity to figure out what you like. Add butter and spices. With the addition of spice, not only will you be making them more palatable, you will be adding more healthful polyphenol compounds in the form of spices. Many of the spices you are familiar with are polyphenols and are known to have positive antioxidant effects and other biological properties beneficial to health.
You may even find yourself eating vegetables regularly if you come up with different combinations of spices with different vegetables. Spices can play an important role as anti-inflammatory agents in your diet, helping you burn fat, improve insulin sensitivity as well as counteract abnormal cholesterol and body weight.
The ancestral and Mediterranean approaches to eating are especially high in polyphenols and omega-3. This is one of the reasons why multiple studies have shown these dietary approaches to be so beneficial. Find the version of the ancestral or Mediterranean diet that works for you and remember they also involve regular movement.
Omega-3 is a healthy fat found in high concentration in fish, other seafood, nuts and seeds (flax seed is a popular plant source). Some are concerned about fish as a source of omega-3 because of possible mercury contamination. The amount of farm raised fish used these days is also a concern. Look for “wild caught” fish at the supermarket and a quality omega-3 supplement. Most of the literature that I have read on the subject of mercury in our fish states that the amount is exceedingly low, and the benefits outweigh the risks. Having said that, no mercury is better that any amount of mercury. If you are concerned about mercury, an Arctic krill oil supplement can be considered. *Pure Encapsulations has a quality Arctic Krill supplement.*
Increased Blood Sugar of Prediabetes Can Contribute to Arthritis
The other aspect of an improved prediabetes diet is the healthier blood sugar levels that it will bring about. By reducing the amount of non-vegetable and non-fruit carbohydrates that you eat, you will improve your blood sugar levels and stop prediabetes.
Readers that are already part of the Nutrientology family know unhealthy increased blood sugar leads to the formation of advanced glycation end products (AGEs). They form as the result of excess sugar in the blood sticking on to proteins and other parts of the body. Well, it appears that AGEs are at it again in the development of arthritis.
Medical research has shown that people with arthritis have a higher amount of AGEs in their joints. It appears they play a role in the arthritis process. Regular readers know that a high amount of AGEs are typically the result of high levels of blood sugar. It is this unhealthy increased blood sugar in the prediabetic, and especially in the diabetic, that leads to many of the nasty complications of prediabetes and diabetes.
We are not sure if AGEs contribute to joint damage, or if they are the result of the damage. Either way, advanced glycation end products have been seen in higher amounts in arthritic joints due to inflammatory and/or degenerative changes in the cartilage. Not only do AGEs interfere with the structural integrity of the joint tissues, they are also associated with higher levels of inflammation-related substances in the joint. (10, 11)
Thinking out loud – I wonder if some AGEs may play a role in the reparative process of the joint? Increased AGEs have been found in young people with injured joints; people who presumably have not had unhealthy blood sugar levels. This is a question that still needs to be answered, but for now, we know too many AGEs, like too much inflammation, is not a plus for good health. Maintain a healthy blood sugar level by eating real food – “food with parents” – and control how much non-veggie and non-fruit carbohydrates you eat.
You now know healthy omega-3 fats and polyphenols found in plants have positive anti-inflammation benefits. If you cannot get enough of these important nutrients in your diet, consider a quality supplement to fill the gaps. Most people are aware of the omega-3 or “fish oil” supplement. There are many polyphenol supplements that you are also likely aware of, but do not know them as “polyphenols.”