The Top Ten Causes of Cartilage Loss
We’re often asked what patients can do to help their cartilage. I thought discussing why we lose cartilage may be a good way to explain how you can keep more cartilage as you age.
1. Obesity-Mechanical-being heavier places more wear and tear forces on cartilage. SOLUTION-This one is simple, but often tough to accomplish-lose weight.
2. Obesity-Biochemical-Metabolic syndrome-As I’ve blogged before, obesity not only breaks down cartilage by wear and tear, but also causes changes in the patient’s insulin response system that breaks down cartilage. This is called a “Metabolic Syndrome” which is defined by obesity (apple or pear body), high blood pressure, and early diabetes. This syndrome itself dramatically destabilizes the chemical matrix (structure) of cartilage. SOLUTION-Not only lose weight, but reduce your carbohydrate and sugar load to reduce spikes in blood sugar and insulin release. This means if you have the genes that create the risk for metabolic syndrome you need a strict low glycemic diet (you likely have the genes if you have that middle aged paunch, muffin top, or belly). This means no sodas, no added sugar, limited whole grains, no caffeine (it will spike your blood sugar), no fruit drinks, no baked goods, etc… Some low glycemic diet sites: Zone , Atkins, SouthBeach.
3. Trauma-Injuring the cartilage surface in a sudden traumatic event can lead to a weak spot in the cartilage that can cause that area to break down easier with normal forces. Think of a strong fabric with a rent. The damage may be small, but the fabric will wear faster due to the rent. SOLUTION-Look for cell based solutions for cartilage repair before the problem becomes bigger. This might include platelet rich plasma or stem cell injections.
4. Joint Instability-Think of ligaments as duct tape that hold a joint together. An unstable joint means that ligaments have been injured which will cause the joint move around too much. All of this extra motion can further slowly injure the cartilage in the joint. Signs of instability include soreness or swelling after activity and if the instability is severe you might notice sudden shifting, popping, or cracking. Realize that without a physician who will spend the time to look for small amounts of instability, your joint instability may be missed. SOLUTION-Injections like prolotherapy, PRP, and stem cells in our clinical experience can help reduce instability. Click here for an example of how stem cell injections improved the symptoms and MRI appearance of one patient’s loose ACL ligament. If the instability is more severe, you may need to have it surgically corrected.
5. Nutrition-You are what you eat. 1,500 mg of Glucosamine has been shown in MRI studies to protect cartilage. The same cartilage protection holds true for 1,200 mg of Chondroitin a day. Vitamin C also has a protective effect. Resveratrol also seems to help stabilize cartilage matrix breakdown caused by Metabolic Syndrome. Vitamin E may also be able to protect against premature cell death due to excessive wear due to obesity or chemical insults such as medication. If you are overweight with high blood pressure, you likely have a metabolic syndrome, see dietary advice above.
6. Medications-The most common medications injected into arthritic joints are also likely the most toxic to cartilage-local anesthetics and steroid medications cause cartilage cell death (called apoptosis). Local anesthetics that contain epinephrine (a common medication used to prolong the effects of anestheics for injections) are even more toxic due to their low pH and a preservative used to prolong the shelf life of the medication. In addition, commonly used NSAID medications like Ibuprofen (Motrin, Alleve), Naproxen (Naprosyn), and Celebrex (Celecoxib) may also have adverse impacts on normal cartilage cells. In one study, Celebrex hurt the production of good protective chemicals by cartilage cells and increased the production of bad chemicals. In some drug company sponsored trials, some researchers have suggested NSAID’s might protect cartilage, however one large real world patient study found no such protective effect. SOLUTION-Stay away from “cortisone shots” and consider using natural anti-inflammatories like fish oil.
7. Hormonal changes-The most important hormone related to cartilage breakdown is Leptin. Leptin is the hormonal switch that tells you when you’re full. In patients who chronically overeat (usually due to the right genes combined with a sugary or carbohydrate loaded diet-see Metabolic syndrome above) too much Leptin is produced. The body looses it’s sensitivity to Leptin and a Metabolic syndrome sets in. Lack of response to Leptin has been associated with more arthritis. SOLUTION-See above for Metabolic syndrome, also eat smaller portions. You can reset your Leptin switch to better turn off your impulse to eat with a fast or steep reduction in food intake for day or two.
8. Repetitive trauma-If your joints are normal, then running should help your cartilage. If you’ve already had joint surgery, then activities such as running or other impact sports combined with cartilage damage can worsen cartilage loss. Moderate loading activities like walking tend to protect cartilage, whereas higher levels of loading like running may breakdown cartilage in some patients. SOLUTION-If you have cartilage loss, switching from high impact to mid or low impact activities may help protect your existing cartilage. If you have normal joints, keep running, it seems to help protect joints from damage.
9. Poor alignment and biomechanics-We’d all accept at face value that if our car alignment was off, your car’s tires would wear unevenly. The same laws of physics apply to the human body. If you have asymmetrical cartilage loss (i.e. one knee and not the other), you may have a body alignment problem that’s wearing down certain joints faster. SOLUTION-Best to see the alignment section in our medical practice’s book: Orthopedics 2.0 where there are many different types of care systems recommended to fix alignment issues.
10. Age and Genes-Older patients seem to have less cartilage and certain people have genes for weaker cartilage. There may not be anything you can do about this one, so I put it last on the list!