What You Can Do About Arthritis Arthritis pain is on the rise and science says popular supplements cant help. But eating right and exercising might.

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A rthritis is increasingly affecting our daily lives-and new research fnd- ings seem to dash any hopes that the most popular supplements thought to combat arthritis do any good. Yet amidst this gloomy picture, scientists are discovering clues to how you might make a difference against arthritis by smart choices in your diet.Such answers cant come any too soon for the more than one in fve American adults who have been diagnosed with arthritis. According to a new Centers for Disease Control and Prevention (CDC) report, 22.2% of US adults-about 50 million people-have arthritis or a related condition such as gout or lupus. Although that fgure has increased only slightly since 2007, the percentage whose symptoms limit their daily activities jumped from 8.3% to a record 9.4%.That increase was more than we expected, commented John Klippel, MD, president of the Arthritis Founda- tion. He suggested that more Ameri- cans may be hobbled by arthritis in part because of the aging Baby Boomer population-plus the fact that so many aging Boomers are overweight or obese. In the latest CDC survey, people who were obese or physically inactive were most likely to report arthritis-related activity limitations.Glucosamine & Chondroitin Flunk T he CDC report came on the heels of a landmark meta-analysis of 10 placebo-controlled trials of glucos- amine and chondroitin that research- ers said should close the book on whether those popular supplements actually help arthritis sufferers. Peter Juni, MD, of the University of Bern in Switzerland, and colleagues concluded, Our fndings indicate that glucos- amine, chondroitin and their combina- tion do not result in a relevant reduc- tion of joint pain nor affect joint-space narrowing compared with placebo.… We believe it unlikely that future trials will show a clinically relevant beneft of any of the evaluated preparations. DDr. Juni and colleagues pooled data from prior trials totaling 3,803 pa- tients; fve of the studies, totaling 1,558 participants, lasted at least two years. Neither supplement nor a combina- tion was associated with a clinically signifcant improvement in joint pain compared to a placebo. Seven trials funded by supplement makers did show greater benefts in pain relief, research- ers noted, than the three trials without industry funding.The analysis also combined data from six trials totaling more than 1,800 patients that reported results on joint-space narrowing, a more objec- tive measure of arthritis than joint pain. Only chondroitin by itself was associ- ated with any apparent improvement in joint-space narrowing, and Dr. Juni and colleagues characterized this possible effect as minute.Despite the researchers suggestion that their meta-analysis might be the last word on glucosamine and chondroitin, a possibly even more defnitive trial is already underway: Results are expected late next year from the Long-Term Eval- uation of Glucosamine Sulphate (LEGS) study, which will also test chondroitin in combination with glucosamine among 600 arthritis patients.In the meantime, Dr. Juni and his team conceded in the journal BMJ, We see no harm in having patients con- tinue these preparations as long as they perceive a beneft and cover the costs of treatments themselves. Given that the cost of such supplements can top $100 a year, however, arthritis sufferers may want to frst consider options-such as dietary changes and exercise-that sci- ence has not debunked.

    Tai Chi Eases Fibromyalgia T he ancient Chinese martial art of tai chi may be the latest weapon against the chronic pain of fbromyalgia. A recent clinical trial at Tufts New England Medical Center found that patients receiving train- ing in tai chi showed signifcantly greater improvement in measurements of pain, fatigue, physical function, sleeplessness and depression than those in a control group.Chenchen Wang, MD, MSc, and her colleagues split 66 fbromyalgia sufferers into two groups for the 12-week trial. Half attended twice-weekly, 60-minute classes with Boston tai chi master Ramel Rones and got his DVD to practice with for 20 minutes at home on the other days. The rest did stretching exercises and got well- ness education. All were assessed using the standardized Fibromyalgia Impact Question- naire (FIQ) at the end of the trial and again 12 weeks after the study was over.The 33 in the tai chi group had clini- cally important improvements in the FIQ total scores and quality of life, Dr. Wang and colleagues reported in the New England Journal of Medicine. A third of patients in the tai chi group improved enough to stop taking medication for their condition, compared to one-sixth of the control group. Even after three months, benefts persisted for the tai chi participants.Although originally developed as a martial art, tai chi today is primarily taught as a gentle, low-impact exercise. Tai chi has multiple components-physical, psychological, social and spiritual, said Dr. Wang. It com- bines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation to move vital energy (called qi by the Chinese) throughout the body. New England Journal of Medicine, August 19, 2010; abstract at <www.nejm.org/doi/ full/10.1056/NEJMoa0912611> Sunrise Tai Chi: Sim- plifed Tai Chi for Health & Longevity (YMAA Publication Center, $16.95) by Ramel Rones, one of the authors of the study, and David Silver; available at <www. tuftsbooks.com>

Shed Pounds, Get MovingT he frst scientifcally proven thing you can do to ease arthritis pain, as the CDC survey suggests, is simply to lose weight. An editorial accompany- ing that report in the CDCs Mortality and Morbidity Weekly Report pointed out, Obesity is associated with onset of knee osteoarthritis (the most com- mon type of arthritis), disease progres- sion, disability, total knee joint replace- ment, and poor clinical outcomes after knee joint replacement, and likely has a critical role in the increasing impact of arthritis on disability, health-related quality of life, and health-care costs.Among people who are obese, the lifetime risk for symptomatic knee ar- thritis alone is 60.5%-double the risk for those who are normal/underweight. Even a modest weight loss-about 11 pounds-can reduce the risk of arthritic knees among women by 50%, the CDC said.Staying physically active from regular exercise to simply moving around to keep joints from stiffening- is also important to protect your joints and manage arthritis pain. Exercise strengthens the muscles around your joints; strong muscles keep joints from rubbing against one another, which wears down cartilage.Your Arthritis and What You EatI ncreasingly, according to the Arthritis Foundation, dietary changes are also being investigated as possible coun- ters to arthritis. These are among the tantalizing research fndings about how what you eat might affect your joints:

  • Dietary fiber: Scientists already know that fiber from foods can help protect your heart. One of the ways f- ber might do that is by reducing infam- mation, as measured by an indicator called C-reactive protein (CRP). And less infammation might beneft your joints as well as your heart.A study by Dana E. King, MD, of the Medical University of South Caro- lina found that people who ate a diet high in fber-about 28 grams daily, either from food or supplements-re- duced their CRP levels. Surprisingly, the effect was most pronounced in thinner people, who saw CRP reductions of about 40%, compared to just 10% in overweight participants.The fndings on fber echo a study at the Federal Research Center for Nu- trition in Germany, in which men who boosted their consumption of fruits and vegetables-a good source of dietary fber-from two to eight daily servings lowered their CRP levels. Foods rich in carotenoids, such as carrots, peppers and other red and orange produce, were most strongly associated with CRP reductions.

  • Healthy fats: Regular readers of this newsletter already know that, when it comes to your health, all fats are not the same. But the healthy omega-3 fatty acids found in fsh may also play a role in reducing infammation related to arthritis.Charles Serhan, PhD, of Harvard Medical School, and colleagues have investigated compounds called resolvins that the body derives from the omega- 3s found in fsh oil. Resolvins seem to function as a sort of off switch for the bodys overactive immune response, which causes the tissue damage seen in arthritis and other infammatory diseases.It may also be important to con- sume omega-3s in greater proportions than the omega-6 fatty acids found in vegetable oils. According to the Arthri- tis Foundation, when you take in more omega-6s than omega-3s, the COX-2 enzymes responsible for joint infam- mation become more active. (That term COX-2 may sound familiar, as pain medications such as non-steroidal anti-infammatory drugs-NSAIDs for short-and COX-2 inhibitors work by blocking these enzymes.) While liquid vegetable oils are still a smarter choice than saturated fats such as butter, this omega-6 concern is an- other good reason to avoid fried foods and other junk food. The Arthritis Foundation notes, Many of the foods people overindulge in during snack attacks are linked to increasing joint infammation and obesity.Olive oil,which is high in mono- unsaturated fatty acids and lower in omega-6s than other vegetable oils, may actually combat infammation much the way NSAIDs painkillers do. Research by Gary Beauchamp, PhD, director of the Monell Chemical Senses Center in Phila- delphia, and colleagues found that a compound in olive oil called oleocanthal blocks the production of COX-1 and COX-2 enzymes. Stronger-flavored olive oils contain more of the oleocanthal. Youd have to consume about 3 1/2 tablespoons of olive oil (con- taining about 400 calories), though, to get the anti-in- fammatory beneft of a 200-milligram ibuprofen pill.

  • Cooking low and slow:Advanced- glycation end products (AGEs), formed when sugars combine with proteins, fats and other ingredients in food- such as in the high-heat browning of grilled or fried foods-can increase infammation in the body. In addition to boosting your risk of heart disease and diabetes, AGEs may contribute to arthritis.You can cut down on AGEs in your diet by lowering cooking temperatures- cooking meats low and slow instead of quickly and at high heat-and opting for moist cooking methods such as steaming, braising and poaching. Prepare fresh foods from scratch at home rather than relying as heavily on processed and packaged foods or eating out. And rear- range your typical dinner plate to shrink the portion devoted to meat and increase the allotment of vegetables, fruits and whole grains, which contain antioxidants that may help combat the oxidative dam- age from AGEs.For more on AGEs, see our March 2010 Special Report.

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