The Functional Medicine Approach to Arthritis

Achy joints become common as we age. There are entire industries devoted to making products to manage and live with arthritis and joint pain, but they rarely if ever make things better in the long run. But what if we didn’t have to just live with arthritis? What if there was an underlying cause and certain things you could do to support your joints?

The Two Main Types of Arthritis
According to the CDC, arthritis is the leading cause of disability, affecting one out of every four adults in the United States. It’s become a 21st-century epidemic, with rates nearly doubling since World War II. 

There are two main types of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA). OA is the most common form and is often referred to as the “wear and tear” of cartilage that happens due to overusing the joint. But there are many other potential causes. OA is most common in the knees, hips, hands, wrists, and spine. 

RA affects about one-tenth as many people as OA and has a very different pathology. RA is an autoimmune condition that occurs when the immune system attacks the tissue and synovial fluid that surrounds the joints. People with RA often have swelling and nodules under the skin that are painful to the touch, and it most commonly affects the knees, feet, and ankles. 

What’s Changed?
What's led to this rise in arthritis over the past 75 years? The radical shift in our diet and lifestyle. 

Our standard American diet (SAD) is responsible for most chronic diseases we see today. Obesity, type 2 diabetes, and heart disease share a common denominator: inflammation. So it’s no coincidence that most people diagnosed with arthritis tend to have one or more of these comorbidities.

Another risk factor for chronic disease is a sedentary lifestyle. Too much time sitting and not enough physical activity leads to the deterioration of our muscles and bones, resulting in unfavorable metabolic changes that increase our disease risk. Regarding arthritis, these metabolic changes affect our cells’ ability to produce and use energy, which causes lactate to build up and inflammation that damages the joints. 

So, a lack of exercise can lead to arthritis, and arthritis leads to a lack of movement. This creates a negative feedback loop that only worsens over time. We can choose to break the cycle, however, by addressing the root cause that’s driving the inflammation. 

Traditional Medicine vs. Functional Medicine Approach 
The traditional medicine approach to OA is to prescribe steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Since RA is an autoimmune condition, immunosuppressants like methotrexate are typically prescribed. These medications can help reduce inflammation and the associated pain but at the cost of potentially harmful side effects. Plus, they don’t resolve why inflammation is there in the first place. 

As a Functional Medicine doctor, I learn as much as I can about my patients on a biological and functional level by ordering lab tests, asking questions, and analyzing their genetic makeup so I can get to the root of what’s causing their inflammation. Inflammation results from an agitated immune system, and about 70 percent of our immune system resides in our gut. Most inflammatory diseases have underlying dysbiosis, an imbalance in gut bacteria caused by eating a bad diet, stress, environmental toxins, food sensitivities, and more. Dysbiosis damages our gut lining so food, bacteria, and endotoxins can readily pass through it and end up in places they don’t belong, like our joints, which confuses our immune system and causes it to attack the surrounding tissue. What’s more, the presence of a specific gut bacteria known as Prevotella copri is associated with an increased risk for RA. 

For my arthritis patients, my focus is to repair the gut, lower inflammation, and rebuild cartilage using targeted supplements and food as medicine. Once inflammation starts to cool off, mobility and strength-training exercises can be introduced to build muscle around the joints. 

So what can you do to reduce your long-term risk of arthritis? I recommend three things:

  • Eat an anti-inflammatory diet. This includes eating a variety of vegetables, berries, citrus, and low-glycemic fruits that are rich in phytochemicals and fiber. Eliminate sugar, refined carbs, vegetable-seed oils, and sources of common food sensitivities like gluten, dairy, and nightshades (eggplants, tomato, and peppers). Get your protein from high-quality sources like organic, pasture-raised eggs, meat, fish, and chicken. You’re also going to want to eat plenty of monounsaturated fats from avocados, nuts, and seeds and omega-3 fats from fatty fish to help keep your joints lubricated. Drink bone broth regularly for its gut-healing amino acids and collagen, and eat probiotic foods like fermented sauerkraut and kimchi to support a healthy gut microbiome. I have a free pdf guide you can access based on my 10 Day Reset. The guide contains helpful tips for adopting an anti-inflammatory diet and lifestyle and continuing it. You can also download my 10 Day Reset Recipe Guide as inspiration for making these nutrient-dense, whole foods into delicious meals for yourself.   

  • Supplements: I always recommend taking a food-first approach, but supplements are great insurance if you’re not getting everything you need from your diet. Vitamin D3 increases calcium absorption and promotes bone health and repair. And if you are supplementing with vitamin D3, you’re also going to want to take vitamin K2, because it helps deposit that newfound calcium into your bones. Curcumin is the botanical version of Advil that can lower inflammation without the risk of ulcers. Vitamin C will also help lower inflammation.

  • Mobility: Repairing the joints isn’t entirely an “inside job.” Using food as medicine is critical for lowering levels of inflammation, but once your inflammation subsides, it's essential to start working on gaining strength in your joints. There are some gentle mobility and strength-training exercises you can do to build up the muscle around your joints. Work with a personal trainer or a physical therapist who can personalize a training program to your physical abilities.

Our body has an innate intelligence and the capacity to heal if it has what it needs to repair itself. If we focus on treating the root cause of arthritis instead of managing symptoms, our mental health and overall quality of life can improve too. There are things we can do to prevent the degeneration of our joints and regain mobility so that we can continue to do the things that bring us joy for the months, years, and decades to come. 

Wishing you health and happiness,

Mark Hyman, MD

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