KNEE HEALTH: When WESTERN MEDICINE asks the WRONG QUESTIONS

Better Questions evoke Better Outcomes

A recent article in the Washington Post Knee Health Optionsis a wonderful example of how the current approach to health, here specifically knee health, are inadequate and fail to address the core problems. It is reflective of so many practices in our health care system that center on not asking the right questions.

Yes, there are numerous competing interests at play, but one fundamental feature is that the current system is not asking the right questions. Further, if true innovations have been developed from outside the mainstream approach e.g. natural products, then they are ignored and dismissed, even if they are well validated.

Firstly, let’s define the extent of the knee health problem. Here the article accurately provides the details of how expansive a problem dysfunctional, damaged knees are in the American society. For example:

·      30 million Americans suffer from osteoarthritis.

·      600,000 individuals get metal-based knee replacements each year

·      Knee replacement surgery is the most common inpatient surgery for those over the age of 45 in the USA

One can see that the societal burden is substantial; the problem is endemic and dare I say compounded by the obesity epidemic as well. Before we examine the benefits of the touted solutions (sic innovation) and remind everyone of a better approach, let’s revisit some of the core assumptions and features, that contribute to this poor state of affairs.

Misconceptions that Rule our Thinking

1.        “We are not going to stop arthritis!” UC Davis Sports Medicine

Nonsense, of course we can. Whether it be osteoarthritis or rheumatoid we know what drives the problem and already know of ways to abrogate the damage and activate repair. Indeed, this knowledge has been steadily built over decades. Simply put the scientific literature contains answers.

2.        “Cartilage has no blood supply and therefore it cannot regrow naturally”

It is true that cartilage, like the cornea, has no blood vessels, but that does not mean it cannot repair itself and regrow. Chondrocytes possesses all the genetic tools to do so. With age, we lose epigenetic control of these tools, creating a situation where catabolism dominates over anabolism. Chondrocytes do not need vasculature to execute this. Otherwise, how are we not crippled in childhood with our exuberant antics and miscalculations.

Knowing this is the fundamental issue we can regain control of cellular decision making converting this matrix destruction response to one of growth, repair and maintenance of function.

Surgical Innovations

What was proposed as solutions to the problems were actions that are simply meant to “kick the can down the road”, delaying the full knee replacement surgery. Is this the best we can do? The answer is NO. Certainly, a variety of matrices, gels wraps may alleviate the symptoms of pain and discomfort but are they true solutions?

Always remember that when you ask a surgeon for a solution you get a surgical answer.

The skeptics may say that it is not in the best interest of orthopedic surgeons to truly address the issue of poor knee (joint) health. Rather, it is in their interest to simply offer surrogates that involve varying degrees of invasive interventions. If there were fundamental solutions to the core problems, then their business would suffer. Similar to the fundamental operating feature of the pharmaceutical industry, which is to develop medications that require sustained application and not cure the problem.

Restoring Optimal Cellular Decision Making for Superior Outcomes

A couple of decades ago I addressed joint health using a botanical, cat’s claw, that we found was a potent and effective inhibitor of the NF-kB, the master gene switch for chronic inflammation. The reason why this epigenetic regulator of gene expression is the core driver of poor joint health is that it activates thousands of genes that promote inflammation, and in particular, the enzymes, called MMPs that destroy cartilage (and other forms of matrix). If you suppress the expression of MMPs you shut down the catabolic action of inflammation on the cartilage matrix.

The other benefit of cat’s claw in this scenario in re-establishing a healthy profile of gene expression, is that it activates the genes for production of Type 2 collagen and glucosamine. In other words, this botanical shuts down the processes involved in destroying cartilage matrix, whilst at the same time activating the enzymatic processes that regrow and repair cartilage.

Knowing that in arthritis, the decisions that chondrocytes make drive a loss of cartilage matrix. The forces that damage outduel repair, resulting in a loss of cartilage to the point of bone-on-bone conditions. Correcting this disturbed decision-making addresses the fundamental core problem, leading to a long-lasting solution to joint health.

This is not conjecture, nor is recent. My research team clearly showed these actions on chondrocyte gene expression well over a decade ago and supported the ethnomedical experience with numerous clinical trials, with significant benefits in 7 days. We received an Innovation Award from the NIH for these discoveries back in 2007. Since then, other known botanical inhibitors of NF-kB have displayed similar benefits. If you wish for the details of these publications then please contact me.

Conclusion

The THESIS that we cannot repair cartilage and for many, we face disabling joint health with age in massive numbers is NOT ACCURATE. We CAN repair cartilage, we can maintain health, pain free joints and we achieve this via an approach that is centered on a clear understanding of what the core problem is, and from there ASKING BETTER QUESTIONS followed by searching for solutions even if in my case it took me to endless trips into the Amazon Rainforest.

Further, I am not just the researcher but I’m also the patient. After many decades of triathlons, marathons, martial arts, I ruptured my ACL in my knee. Arthritis was wicked and I was encouraged to have replacement surgery. Instead, I took my research samples of Cat’s claw, and I was pain free in a week. Some 27 years later, I have perfectly healthy cartilage and no joint pain despite not having an ACL.

My advice is that there are solutions out there, we just need to ask better questions.