Category: Health

How does osteoarthritis affect people who do endurance sports, including running? What is the difference between osteoarthritis and rheumatoid arthritis? Should you be exercising with osteoarthritis? In this article, we look at what osteoarthritis is, and how diet and supplements can play a role.

Osteoarthritis results from the breakdown of the cushioning tissue (cartilage) inside the joints. It is the most common form of arthritis and can occur in any joint and it is thought to be due to past load impact injuries or constant friction. It is therefore common in runners and people who engage in heavy-impact exercise (e.g. rugby) for long periods.

Once the cartilage wears away, the bones rub together, causing pain, inflammation and stiffness (especially in the mornings). Pain is the earliest symptom and is worsened by exercise and relieved by rest.

Arthritis (or joint inflammation) refers to a set of diseases affecting the area in or around joints such as knee, hip, and finger joints, and is quite common in middle and older aged people. Generally, arthritic diseases fall into two major categories: Osteoarthritis and rheumatoid arthritis.

Rheumatoid arthritis results from inflammation (redness, warmth, and swelling) inside of the joints – a disease in which the immune system turns on itself and attacks the joints – causing the breakdown of the cartilage instead of healing or protecting it.

It is three times more likely to affect women than men and often lasts for many years with alternate attacks and remissions (absence of symptoms). Arthritis is usually chronic but may present as acute episodes. Though the disease tends to stop by itself in periods of remission, any joint damage that occurs during the inflammatory phase will be permanent, sometimes causing much disability.

The prevalence of osteoarthritis is higher among overweight persons as compared with those of normal body weight. Obesity and injury are the two greatest risk factors for osteoarthritis. The severity of arthritic symptoms varies from person to person, and even daily.

Should you be doing Exercise?
Though excessive high-impact exercise may exacerbate arthritis, regular exercise, especially non- or light weight-bearing exercise (swimming, cycling or walking) in combination with a low-fat diet will help prevent weight gain, reduce the chance of osteoarthritis and minimise the symptoms if you already have the condition.

Non-jarring aerobic exercise has been shown to reduce symptoms, increase mobility and lessen continuous damage from the condition. The exercise must be adapted around the individual’s capability – for the most part, any exercise session should be pain-free.

Exercise can also improve sleep and can promote a greater sense of well-being. Increased muscle tone and strength as well as general conditioning can also help to protect the affected joints during exercise.

Can diet play a role?
Arthritis does not only occur in elderly people, it can afflict anyone, at any age. Scientists are still unsure what influence food has on the illness, but they are looking into the role diet may play with increased interest.

Diet may indirectly increase your chances of developing certain arthritis. For example, being overweight increases the risk of osteoarthritis as it increases weight on the joints and therefore increases wear and tear. This process can be exacerbated with long-term participation in high-impact sports.

Diet may also have an impact on the body’s immune system and may modulate the way the body’s immune system reacts to certain kinds of arthritis that involve inflammation (the inflammatory process is a part of the body’s immune system).

There is no evidence to suggest that certain diets may prevent arthritis altogether. Some very early studies in animals or in small numbers of people with certain types of arthritis suggest but do not prove, that dietary changes may help relieve some of the symptoms of arthritis. Presently, there is not enough scientific evidence to recommend that people with arthritis change their diets radically, except for losing weight if overweight.

However, the following dietary changes may provide some symptomatic relief from arthritis:
Overall, the basic guidelines are for a healthy, balanced diet:

1. Eat a variety of foods – a good diet includes choices from each of the five different groups of foods. Eating various foods helps provide the estimated 40 nutrients (vitamins and minerals) your body needs daily. Unfortunately, arthritis can make it harder to get variety in the diet. Fatigue and pain can lower one’s appetite, and swollen joints and loss of movement may lead to avoidance of foods that need more time or effort to prepare and cook.

Certain kinds of arthritis and some medications can also affect how well your body uses what you eat; it may decrease your appetite; increase the risk of stomach upset etc. This will mean you have to be even more diligent in following a balanced intake. For most people, following a balanced diet will help keep up the levels of the nutrients that may be affected by medication.

2. Ensure an adequate Calcium and Vitamin D intake. Many persons with osteoarthritis do not consume sufficient calcium. One should aim to ingest at least 2 servings (cups) of dairy per day (e.g. milk, yoghurt, buttermilk, cheese, soymilk or other soy products).

Vitamin D status is generally fine in individuals who receive sufficient sunlight exposure (~10 minutes per day), but might be impaired in the elderly, who tend to confine themselves indoors, bed-ridden individuals or those who, for religious reasons, cover most body surfaces with clothes. It has been reported that the risk for progression of the disease is increased three-fold in those individuals with a poor Vitamin D status.

3. Ensure adequate antioxidant vitamin intake – evidence shows that a diet low in antioxidants, especially the trace mineral selenium and vitamins A, C and E, may predispose some people to joint problems. Selenium is found in all fish and shellfish, meat, whole grains and cereals, and eggs. Include foods rich in beta-carotene, which the body converts to vitamin A (e.g. carrots, mangoes, apricots, sweet potato, spanspek), vitamin C (e.g. red and yellow peppers, kiwi fruit, oranges, Brussels sprouts and cabbage), vitamin E (e.g. avocado, nuts, sunflower seeds and olive oil).
4. If you suffer from suppressed appetite or know that your diet is imbalanced (if you exclude certain food groups, skip meals, no time to prepare proper meals or snacks) then a general multi-vitamin and mineral supplement would be advisable – choose one that provides these nutrients in no more than 1.5 – 2 x RDA (or 150-200% of RDA). Avoid supplementing with large doses of single vitamins or minerals as this may cause imbalances and detrimental side effects.
5. Maintain ideal weight – while normal joints can handle and support a vast amount of use, the mechanical abnormality of a joint makes it susceptible to degeneration. As mentioned, being overweight or obese increases your risk of developing osteoarthritis in the knees, since these joints bear the weight of your body. Even a small weight loss can make a big difference.

Avoid too much fat and cholesterol – many older adults with arthritis also have high blood pressure or heart disease.

6. Eat foods high in fibre – it is generally more nutritious (more vitamins and minerals), more filling and low in fat; it may even help reduce high cholesterol levels. They are also helpful if you are having problems with diarrhoea or constipation, which can be precipitated by some of the arthritis drugs.
7. Avoid too much sodium (salt), especially if you already suffer from high blood pressure as well. Some arthritis drugs, such as corticosteroids, may also cause the body to retain too much sodium. Sodium causes your body to retain water, this can affect your blood pressure.
8. Drink alcohol in moderation – alcohol can interfere with the working of arthritis drugs. Alcohol also has a toxic effect on bones = can weaken the bones, and can contribute to unfavourable weight (fat) gain. Drinking alcohol does not mix with certain drugs for arthritis. For example, stomach problems are more likely if you drink alcohol together with nonsteroidal anti-inflammatory drugs or aspirin (consult your doctor or pharmacist).
9. Drink lots of water – water is a key component of both cartilage and synovial fluid that lubricates the joints. Drink at least 8-10 glasses of water daily – always ensure that your urine is pale yellow (the colour of lemon juice).
10. Avoid food that you find is aggravating your condition. Certain foods produce chemicals in the body which aggravate arthritis in some people. Some people are also allergic to certain foods. This is highly individual and varies from person to person.

Eliminating certain fruits and vegetables (tomatoes, potatoes, eggplant, green peppers, red peppers, chilli) has been reported to reduce stiffness and pain in rheumatoid arthritis. It is the solanine in these foods that causes the morning stiffness. Solanine is thought to inhibit nerve impulses. There is not yet enough research to support the connection between arthritis and eating foods high in solanine. However, if you feel better eliminating them, then continue. If you include a variety of other vegetables and grains in your diet, you should not be too concerned about losing out on any nutrients.

Several studies have found that following a vegetarian diet helps relieve some of the symptoms of rheumatoid arthritis, however, more evidence is needed before definite conclusions and recommendations can be drawn.

Supplements that may provide symptomatic relief from arthritis:

Omega 3 (fish oil) supplements:
Omega-3 fatty acids can have an anti-inflammatory effect on the joints of some arthritis sufferers. Found in oily fish such as salmon, trout, snoek, mackerel, sardines, cob and pilchards. One should try to eat oily fish two to three times a week. These fatty acids are also found in flaxseed, soya beans and tofu. Ginger and celery contain anti-inflammatory agents, which may help alleviate symptoms, while sunflower seeds are rich in vitamins D and E.

Glucosamine and Chondroitin supplements:
Glucosamine is a primary building block of cartilage. The theory (yet unproven) behind glucosamine and chondroitin supplementation is that it may stimulate cartilage synthesis, and decrease its breakdown. Though there is no direct evidence that such repair or protection occurs, supplementation has been shown to provide symptomatic relief and improve functional capacity and mobility in patients with osteoarthritis. It seems as though these favourable effects only take place after at least 3 months of supplementation.

Some studies have indicated that patients on chondroitin supplementation needed less anti-inflammatory drug treatment for pain relief, though most of these studies injected the chondroitin directly into the joint. There is debate whether glucosamine and chondroitin are absorbed from the gut in sufficient amounts after oral ingestion.

There is no evidence that these supplements will prevent the development of osteoarthritis, or that they can reduce joint pain in athletes, and it also does not seem to be effective for people who have joint (cartilage) operations and who wish to recover faster.

Despite that lack of evidence of enhanced benefit of combining glucosamine and chondroitin, many over-the-counter preparations do combine the two in dosages of 500mg glucosamine and 400 mg chondroitin to be taken 3x daily (for a total dose of 1500mg glucosamine and 1200mg chondroitin daily).

Consultation with a doctor is always recommended before using any alternative therapies.

Some unproven claims …
Some claim that special diets, foods or supplements can cause or even cure arthritis – usually publicised in magazine articles, books and TV infomercials. Most claims for such diets have not been scientifically tested to prove that they work and are safe, and are health frauds. These diets may be detrimental to health, especially if they promote the exclusion of major food groups, or stress the intake of only a limited choice of foods. Before making major changes to your diet (excluding major food groups) in the belief that it may better your condition, first discuss it with a dietician and doctor. If you are on medication, it is probably best to continue your regular medical care even if you decide to try a diet change.

Conclusion
Although researchers are looking at the role diet may play in arthritis, there is not yet enough evidence to clearly show how diet might affect certain types of arthritis. Food affects people in different ways and some people do find that the pains can be kept at bay by avoiding or including certain foods.

Good nutrition can, at the least, help alleviate symptoms.

Hyponatremia is a condition of low sodium concentration in the blood. Prolonged overhydration during exercise is the primary cause of all forms of exercise-associated hyponatremia (EAH) and should be avoided. The updated EAH clinical practice guidelines issued by the Wilderness Medical Society stress that individuals engaged in physical and endurance activities should drink to satisfy their thirst (known as “drink to thirst”) to avoid overhydration. The guidelines appear in Wilderness & Environmental Medicine, published by Elsevier.

Review articles and international consensus statements have mainly focused on the incidence of EAH in organized endurance events that are conducted in the frontcountry, where medical tents and local emergency medical services are typically available on site and transport to a local hospital is readily available. However, many prolonged individual exertional activities such as backpacking, ultramarathons, and multiple-day endurance events take place in the backcountry with limited or no medical support and expectations of delayed medical evacuation.

Appropriated management of EAH depends first on correctly diagnosing the condition. The guidelines address the assessment of patients with overlapping or nonspecific signs that can make differential diagnosis challenging, for example, with heat exhaustion or exertional heat stroke.

The guidelines recommend that:

• Appropriate education and coordination among participants, event directors, support crews, park rangers, first responders, and EMS transport personnel are essential in both prevention and management of EAH.
• Prolonged overhydration during exercise, which is the primary risk factor in the development of all forms of EAH, should be avoided.
• Sodium and/or salty snacks should be freely available for consumption along with the appropriate fluids, particularly in long, hot events in non-heat acclimatized persons.
• Participants should drink enough to satisfy their thirst but avoid overdrinking.
• Point-of-care testing should be done on at-risk, symptomatic patients, when available.
• Oral fluids should be restricted if EAH from fluid overload is associated with mild symptoms.
• Hypotonic fluids are contraindicated with suspected EAH.
• The use of oral salt or hypertonic fluids may be effective in reversing moderate to severe symptoms of EAH when no IV hypertonic saline (3 percent) is available.
• Patients should be observed for at least 60 minutes after exercise to ensure no decompensation from delayed symptomatic EAH.
• Receiving caregivers should be alerted to the potential diagnosis of EAH and fluid management restrictions when transferring care.

EAH is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe EAH being below 120 mEq/L. Symptoms may include nausea and vomiting, headache, short-term memory loss, confusion, and lethargy, altered mental status, coma, seizures, and/or respiratory distress, some of which can be confused with other medical conditions.