My Osteoarthritis Recovery Protocol

I've turned up some really interesting aspects to osteoarthritis recently that's got me thinking - what if my osteoarthritis is not an end state, but instead can be resolved and recovered from? Wouldn't that be worth pursuing instead of merely resigning myself to surgery as the only option? As Dr Bernard Presser says in this article:

OA is not simply a matter of wear and tear; it's also a failure of the cartilage to repair itself.

Putting two and two together, I think I now have a clue what caused my acute episode of arthritis and I have put together this protocol to see if I can not only contain the decline but perhaps even reverse the disease and defer the need for hip replacement surgery.

Why did my arthritis get bad

Clue 1: The Paleo Solution podcast

During this podcast with Robb Wolf and Paul Jaminet [transcript here] they discussed how very low carbohydrate diets can impact the production of mucus. I'd previously heard of this causing, for instance, dry eyes and sinuses and even problems with destruction of the gut lining leading to leaky gut problems. Robb and Paul's discussion mentioned:

Paul Jaminet: When you're on a low carb diet, you excrete more things and it’s very easy to become dehydrated. It’s very easy to lose electrolytes and you’re not quite as robust because your body has to allocate the protein to make milk for the carbs. It lets go of some of the you know, building up extracellular matrix that it would have done if it had more carbs. You know, you don’t make quite as much mucus. Mucus is mostly glucose. 

Robb Wolf: And synovial fluids and all that like for your joints and all that stuff.

Paul Jaminet: Yeah that’s right.

I have been following a Paleo-style diet for the past couple of years. I have experienced great improvements in health, vitality and have achieved great weight loss. All of the information regarding Paleo and arthritis has been positive because of the high nutrient density plus low inflammatory load of the diet. Often Paleo is discussed along with high fat, low carb, very low carb and even nutritional ketosis (where the body switches to using fat molecules called ketones for fuel instead of carbohydrates). I am well fat-adapted and go in and out of ketosis, and have been enjoying improved mental performance plus weight loss as a consequence. I avoid gluten and bread, and if I eat carbs, I eat them in the evening - a few potatoes or sweet potatoes, a little rice, plenty of veggies. But not much carb.

So this discussion by Robb and Paul is the first I had heard that a low carb diet may lead to problems with joints.

Clue 2: A question to Paleohacks.com

My next stop was to ask this question on paleohacks.com. One answer said:

there's some speculation that VLC can "dry things out" 

Hmm, so there might be something in this worth following up. Could a low carb diet can impact the production of proteoglycans which are important for cartilage health, synovial fluid health etc.? If so, would it be possible to reverse the decline and even reverse some of the disease condition?

Next step, post a question to the forums of Dr Jack Kruse. Dr Kruse discusses dehydration at length although to me it sounds like he likes to use lots of fancy physics words out of context. Nonetheless, there could be something in it. 

Next step: stop the decline, reverse the damage

Perceived wisdom is that osteoarthritis is a progressive downhill decline; that there is no cure. I don't think that's accurate. I think it's fairer to say that OA is  a failure of the cartilage to repair itself. Now that puts a different spin on things.
What's the impact of a Paleo diet on OA? On its own a standard Paleo may help by reducing weight (reducing the pressure on the joints) and reducing systemic inflammation. But what I've learnt about Paleo is that with the *right* approach that many diseases can be addressed, for example Dr Terry Wahls recovery from Multiple Sclerosis, type-1 diabetics no longer requiring insulin etc. So is osteoarthritis really just a one-way downhill slide or can I figure out a protocol to arrest the decline and start healing? Well, I figure I've got 5 months before my scheduled hip replacement surgery to try my hardest. Let food be thy medicine.

So here it is - my recovery protocol. Some of it makes total sense, some of it is pretty far out. I got nothing to lose and everything to gain! 

Recovery protocol

The recovery protocol that I've put together as a consequence intends to:

• address the dehydration of the hip joint;
• minimise inflammation;
• prevent further damage from occurring;
• promote healing of the injury;
• be practical.

It is a combination of the following factors:

• nutrition;
• supplementation and medication;
• exercise and physical therapy;
• lifestyle factors.

Nutrition

Bulletproof Paleo, meaning:

• real food;
• gluten-free; no bread, flour, pastry etc
• minimal sugar, including limiting fruit intake;
• no 'vegetable oils' (sunflower, canola, soy bean oils etc);
• saturated fats (butter, coconut oil, lard, animal fats) from free-range, grass-fed animals;
• eggs from free-range pasture-raised chickens;
• fish and oysters; try to eat oysters a couple of times a week, fish regularly during the week;
• low inflammatory starches such as rice, potatoes, sweet potatoes; 
• minimal nuts (nuts are generally high in omega-6 fats), so Macadamia nuts mainly;
• liver once or twice a week;
• lots of vegetables;
• limited amounts of fruit but including berries.

But I've been following essentially this diet for the past couple of years, so what's different? The key difference that I'm experimenting with is increasing my carbohydrates. This means rice, potatoes, sweet potatoes, pumpkin or other starchy vegetables with lunch and dinner. Proteoglycans are essential for forming cartilage and bone and are a combination of protein and glucose. So starch and protein are essential for good bone formation.

Oysters are another thing I'm concentrating on eating a couple of times a week since they're full of zinc, iodine, omega-3 fats and all the cofactors to make these little nuggets of pure nutrition. And per Dr Presser's article, you need to eat some uncooked food sources.

Supplementation and medication

• Cod liver oil - 1 teaspoon morning and evening; EPA and DHA plus vitamin D, vitamin A. I don't take additional vitamin D but I do try to get as much sunlight as I can. I note that high intake of fish oil can be inflammatory (due to oxidation of polyunsaturated fats) but I don't think this is to excess given my current state;
• 1x aspirin in the morning to enhance the production of resolvins, could also use apple cider vinegar (1 teaspoon);
• Glucosamine 1500 with chondroitin and proline - 1 or 2 per day;
• MSM - 2 per day (morning and evening);
• Magnesium with Zinc and Selenium; 1 tablet per day in the evening;
• Vitamin C - regular dosing from multivitamins, fresh food and tablets (especially after swimming in a chlorinated pool);
• Bovine collagen powder or gelatin. I mix it into my morning coffee. Give your body the building blocks to repair the damaged tissues!
• Vitamin K2, appears to be something of a miracle cure, especially for strong bones. Weston A Price described "Activator X" as a missing nutrient in modern diets, linked with poor dental and bone health. But you can't get it easily in Australia (I've got some on order from iHerb.com). Alternative sources include hard cheese, especially Gouda and Edam (presumably there's a particular bacteria culture used in the production) and butter. That's what I'm eating at the moment;
• Vitamin E [20-Oct-2014].

Things I don't use or avoid:

• Avoid non-steroidal anti-inflammatories. If you need them then your diet is wrong. I have found that if I have chips or Doritos one day, I'll have stiff hips 2 days later. Vegetable oils are bad!!!
• Curcumin supplements - basically concentrated Turmeric. I haven't found these to help particularly and they're expensive.

Exercise and physical therapy

• Sunlight - I try to get outside every day and I go to the outdoor pool a couple of times a week, even during winter.
• Cold water immersion - currently doing about 10 minutes per day in 6'C water - very cold! This has several beneficial effects:
• It increases the production of glutathione (the master anti-oxidant) in the body;
• It shunts blood away from the extremities into the core, flushing capillaries with highly oxygenated blood;
• It improves cardiovascular elasticity, encouraging blood flow through parts of the body that may not otherwise receive good blood flow, such as bones and cartilage;
• It stimulates the mitochondria, a process called cold thermogenesis. With repeated exposure to cold, the body creates more mitochondria and improves the efficiency of existing mitochondria, which end up causing energy release and heat generation;
• Coverts white fat to Brown Adipose Tissue.
• Saunas - a couple of times per week until my heart rate has reached at least 130 bpm (resting heart rate < 60 bpm). Releases BDNF, Heat Stress Hormone, increase blood plasma volume, sensitises to endorphin (makes you feel good!) and all manner of other goodies - listen here;
• Red light therapy - using a red LED array, shine red light onto the hip area, again to try to stimulate mitochondrial function in the area and improve water circulation (increase the energy available to the molecules);
• Standing up straight. I have a desk job, meaning that I sit most of the day. My hip flexors (which connect the top of the thigh into the deep core stomach and lower back) were tight. I now focus on making sure I stand up 'properly' tall (straight through the hips) and stretch my hip flexors. There's videos on youtube for this.
• Walking, standing; again with good posture;
• Using a resistance band to do a deadlift like this. This has worked really well for me. The trick is to make sure you're doing this exercise with good form. Straight back, neutral head and neck, no strain in the arm, weight on your heels.If I find that I'm feeling stiff or that things are out of place, I have found this exercise to get everything back in line and ease things off.
• Chiropractor - you need every other part of your body properly aligned so that you're minimising undue stress on your musculo-skeletal system. A good chiropractor is a must.
• Swimming - I'm in my backyard pool every day and go to the local pool a couple of times a week.
• I can highly recommend the book "Heal Your Hips" by Robert Klapper. I've been doing the stretching exercises for about 3 weeks and feel great! Most interesting has been working on hip abduction (side-to-side opening) that has been hard for me for a while, as has leg circling to increase range of motion.[20-Oct-2014]
• Body-weight squats.[20-Oct-2014]

Things to avoid:

• Stretching the injured joint where it doesn't want to go. I think this is what caused my acute problem.
  [20-Oct-2014] See above - the 'Heal Your Hips' protocol has been great in this respect, so stretching is back on the positive list.
• Sudden impact or shock through the joint;
• Twisting or torsion in the joint;
• Sitting down for too long;
• Walking on rough or uneven surfaces;
• Cycling - I have heard good things but I'm find the traffic on the road intimidating.
  [20-Oct-2014] Last weekend I tried cycling on both days. It was nice to get out on the road and I could feel the lack of cardiovascular fitness as I tried to slog up the hill but the crouched over position didn't feel very good, .

Lifestyle factors

Water

This is an essential component to my protocol. Avoid fluoridated water. I haven't (yet) installed a Reverse Osmosis water filter, so instead I drink spring water at work and filtered rain water at home. 

This will sound woo-woo pseudo-science but... Cellular water is not just sloshing around, it is structured. Check out this mind-boggling presentation on structured water. Did you see those blood cells moving through tight capillaries? That's what you want to happen in your bones and cartilage. So drink the best, purest water.

Grounding or earthing

This also sounds like woo-woo pseudo-science, but I'm sure you've heard people talk about grounding or earthing. Standing barefoot on wet grass or sand is one way.

The body is an electromagnetic entity and so is the earth. In fact the earth resonates at 7.83Hz - the Schumann resonance - but we usually insulate ourselves from the earth with rubber-soled shoes, car tyres, carpets etc.

I am now grounding myself every night while I sleep by running a wire from a stake in the garden, via a 1Mohm resistor and a switch, to a strip of metal tape on my sheet. I included the switch because the first time I tried it, I woke up in the middle of the night tingling. Powerful stuff.

EMF exposure

Dr Jack Kruse is insistent that EMF exposure is highly dehydrating. So don't walk around with your cell phone in your hip pocket! 

The EMF sources to be aware of include:

• Smart meters - use WiMAX technology; very strong pulsed microwave emissions;
• Microwave ovens - just see what happens to that steak you left in there too long - it dries out. Microwave ovens tend to 'leak' somewhat;
• Cell phones - the worse the reception, the higher the radiation from that phone. Don't walk around with it in your pocket if you can avoid it. Turn it onto Airplane mode if you need to carry it with you - they can always leave a voicemail;
• Wifi - everything has wifi yet the French have banned wifi in schools due to health impact concerns. Make sure your router is not near your bedroom, don't take gadgets into your bedroom, if you do, turn them to Airplane mode.
• Bluetooth - this is pretty low-power energy and I'm not too concerned about it. Be aware that some health sensors use bluetooth though, and they're attached continuously to your body. Avoid that.

Circadian light exposure

Sleep in a properly dark room. Cover any LEDs or glowing lamps.

Minimise blue light at night like computers, laptops. Give yourself an hour or so before bedtime without a screen. Install F.Lux on your computers.

Metal detox

I've just completed a few weeks using Metal Free, a peptide metal chelator. Do this once a year.

Medical interventions

Hip replacement surgery

I am currently viewing hip replacement surgery as a final option if my plan doesn't work out. I have a date with a surgeon in a few months time. Let's see if we go ahead.

Stem cell therapy

This sounds interesting. One option available is by Regenexx where they extract bone marrow, isolate the stems cells via centrifuge and inject back directly into the joint capsule.

Another option is to isolate stem cells from adipose tissue.

Yet another option mentioned in info from the Mayo Clinic shows stem cells being delivered to the femur head by drilling from the outside of the femur [find reference...]

The problem I have with these therapies is that it's expensive and I'm not sure if it's effective or not. But maybe with everything else I'm doing, I stand a better chance than others (who aren't actively supporting repair and recovery)? I'll need to think about this some more.