The Strong Connection Between Metabolic Health and Joint Health
Your joints are a framework of bones, cartilage, ligaments, and tendons that work together to support your movement. Cartilage acts as a cushion for the bone ends, while ligaments provide stability to your joints, and tendons connect muscles to bones.
However, osteoarthritis (OA) is a common condition today. The number of people living with OA worldwide has more than doubled since 1990, show data from the Global Burden of Disease (GBD) study 2019 and it affects more than 527.81 million people globally and 32.5 million adults in the U.S alone. 1.8 million Australians (8%) reported having osteoarthritis. It is more common in women (10.2%) than men (5.6%).
It is often referred to as "degenerative" or "wear and tear" arthritis, but this label is misleading.
OA as a Metabolic Disease
OA is better understood as a metabolic disease that impairs the tissue's ability to produce and use energy. There is a significant overlap in the mechanisms involved in metabolic issues and joint problems, such as chronic inflammation, blood flow issues, and mitochondrial dysfunction.
People who are obese and experience low-grade chronic inflammation are at a five times greater risk for both metabolic syndrome and OA. Type 2 diabetes and OA are among the most prevalent chronic conditions we face today, and their interconnection is deep and complex. Here are five ways in which they are linked.
High glucose (blood sugar) levels can damage tendon collagen. The collagen fibres in our tendons are designed to withstand force and adapt to stress. However, high blood glucose levels can lead to the build-up of advanced glycation end-products (AGEs) on collagen fibres over time, causing cross-linking and stiffness. Animal studies have shown that AGEs can limit the ability of tendon fibres to unkink and slide, leading to degenerative rotator cuff changes.
Insulin resistance leads to cartilage degradation. Insulin resistance, which is a hallmark of metabolic dysfunction, has been linked to cartilage degradation in people with arthritis. Hyperglycemia, mitochondrial dysfunction, decreased AMPK activation (an enzyme that plays a role in cellular energy homeostasis), and chronic inflammation—all key features of insulin resistance—are associated with osteoarthritis. Strategies to increase insulin sensitivity, such as calorie restriction, physical activity, and certain medications, may help protect against OA.
Cholesterol deposits may weaken tendons. High cholesterol levels may cause lipid deposits to degrade tendon structure and drive inflammation, potentially leading to injury. Dyslipidemia (the imbalance of lipids such as cholesterol) has also been associated with rotator cuff tears, and rotator cuff tendinopathy is linked to higher cardiovascular risk scores.
Worsening metabolic health causes inflammation. Metabolic dysfunction, including high levels of uric acid in the synovial fluid surrounding joints, can lead to inflammation and tissue damage. Oxidative stress caused by an imbalance in reactive oxygen species production also contributes to inflammation and cytokine production, leading to OA progression.
Reduced blood flow to tissues, like joints, tendons, and muscles, increases the likelihood of pain and damage. Metabolic health and insulin sensitivity play a crucial role in how well our blood vessels function and deliver oxygen to our tissues. Good blood flow delivers essential nutrients, hormones, signalling factors, and immune elements that support tissue health and resilience. On the other hand, poor blood flow can lead to tissue dysfunction, and weak muscles, tendons, and ligaments.
Can Surgery Help?
Board-certified Orthopedic Surgeon Dr Howard Luks says surgery may be necessary in some cases for treating musculoskeletal conditions and injuries, but it should not be the first option.
Many of the findings seen in imaging studies are normal for a person's age and do not require surgery. It is important to optimize the body prior to surgery to support good surgical outcomes, such as controlling blood sugar levels around the time of surgery to reduce infections and improve wound healing.
In some cases, surgery may even be more harmful than beneficial, and non-invasive treatments can be just as effective. Recovery from surgery can also affect movement and potentially have negative effects on a person's metabolic health and well-being.
For example, meniscus surgery is a common treatment for people with cartilage tears, but it may increase the risk of developing osteoarthritis and cartilage loss. A study found that all 31 knees that had meniscus surgery developed OA within a year, compared to only 59% of the 280 knees with meniscal damage that did not undergo surgery. Additionally, cartilage loss occurred in nearly 81% of the surgery knees, while it occurred in about 40% of those that were not operated on. Dr Luks warns that cutting into the knee joint can be the fastest way to generate OA.
How About Non-invasive Options?
A randomized controlled trial published in the New England Journal of Medicine compared meniscus surgery outcomes to physical therapy outcomes. The researchers randomly assigned 351 patients with a meniscus tear and mild-to-moderate OA, who were 45 years or older, to either undergo surgery or physical therapy. At the six-month follow-up, the researchers assessed the patients' physical function scores and found that surgery patients improved by an average of 21 points on the scale, while those in the physical therapy group improved by an average of 18.5 points.
The takeaway here is that surgery didn’t provide significantly enhanced function over physical therapy. At the 12-month follow-up, improvement scores were still similar. The study authors concluded that an initial non-operative strategy provides considerable reassurance.
Conclusion
We should always take a multimodal and holistic approach to healing and be our own health advocates. Optimizing metabolic health to support all aspects of health, including joint and musculoskeletal health, and to support healing and regenerative capabilities, is crucial.
Even in cases where pharmaceutical or surgical intervention is required, a healthier and more metabolically functional body due to optimized daily habits such as unprocessed food, exercise, sleep, stress management, light exposure, and toxin avoidance will do better.
Part of healing, however, with or without surgery, is believing that the body can heal. While taking a pill or undergoing surgery can seem like a silver bullet, a non-invasive approach with an unknown endpoint for healing can feel uncertain. It is worth considering whether opting for a quick fix can ultimately undermine the body's ability to activate innate healing paths that benefit the entire system.
If there are ways to encourage the body to heal itself, it is always preferable to opt for those methods first or in conjunction with more aggressive therapies.
Source and further reading:
Levels Newsletter
https://www.levelshealth.com/blog/how-diet-affects-joint-health-arthritis-and-longevity