The whole process of osteoarthritis involves wearing down of the cartilage, or the cartilage not building up or not generating as it should do. As promised we’ve got Dr David Nye and we’re going to break down the different management protocols of osteoarthritis, arthritis and rheumatism. Welcome, David. Thank you. Can you start with osteoarthritis? And let’s look at a comprehensive, natural management programme. Yes. I think there are quite a lot of things that one can do to manage osteoarthritis and I think one of the important things to be said right at the outset is that the conventional management of osteoarthritis involves nonsteroidal anti-inflammatory drugs like aspirin, Ibuprofen and many of these others and I think it’s been shown quite conclusively in many trials that although they might give you quick pain relief they actually seem to aggravate or cause further deterioration in the joints. Oh, not just the stomach problems and the other side effects? Not just the stomach problems and the other side effects. Right. But they actually cause, they did a study where they watched people with osteoarthritis without any aspirin or anti-inflammatories and a lot of them even recovered on their own. Whereas the ones who were taking aspirin or anti-inflammatories actually got worse and worse even though they got quicker pain relief. What would you then recommend a patient use? Yes, we want to avoid the use of long-term anti-inflammatories. They can be useful for a few days, just for a crisis, a flare-up. Okay, so just for acute management you would still prescribe a short dose? Absolutely. If somebody needs to perform for a weekend or something, give them some anti-inflammatories for a few days just to help them get on the move but long term would be a problem. Would you add cortisone to that, corticosteroids with the anti-inflammatory? In extreme circumstances. Right. Also in short dosages? Yes. Okay. But I think long term it causes a lot of problems and as I said causes deterioration. So we want to look at what can be done. As far as the diet goes there’s been a lot of anecdotal evidence showing that the nightshade group of vegetables do seem to have problems with causing degeneration of the joints. You’re talking about eggplant, tomatoes… Eggplant, tomatoes, peppers, bell peppers, chillies – that whole family. Potatoes include in that family too, the white potatoes. And a lot of people do get a lot of benefit from avoiding nightshade plants for that reason. It hasn’t been proven clinically as far as I know but people do get relief from it. And you experience that in your practice otherwise you wouldn’t be saying it? Yes, it doesn’t work for everybody but I always tell people to try it because if it does work for them then it’s a fairly-easy thing to look at. We need to look also at antioxidants, things like vitamin C, vitamin E they both work very well together, they both have very positive effects on the joint. Then if we look more specific treatments like things to build up the cartilage and to regenerate the cartilage we come to products like glucosamine which is a natural product, very simple, made up of glucose and a protein together but it actually stimulates a production of glycosaminoglycans. So you don’t make that in your body, glucosamine? You have to supplement it? You don’t make glucosamine in your body, but you make the glycosaminoglycans in your body. Right. And these are abbreviated to GAGs, much easier to remember. And GAGs are also an end product of sulphur metabolism in the body so you need sulphur to make these products so there’s complicated metabolic pathways. But if you don’t get enough meat in the diet, you don’t generate enough sulphur and that means that you also don’t build up enough GAGs to regenerate the cartilage. Are you talking specifically about glucosamine-sulphate? Yes, glucosamine-sulphate is the form of glucosamine which seems to be the best/most therapeutic. There are other forms of glucosamine, which I don’t think are generally used or certainly not as effective. And would you use it on its own or would you combine it with something like chondroitin? It comes in many different forms. You could get glucosamine on its own, which has an effect of rebuilding and nourishing the cartilage. And then it often is combined with chondroitin, which is also a cartilaginous kind of product – bigger molecules so it doesn’t get absorbed as well but it has a very important function in drawing water into the joint and increasing the hydration of the joint. So quite a lot of products combine the glucosamine and the chondroitin together with other pain-relieving things like MSM, antioxidants like vitamin C/ vitamin E, sometimes they’ll include some of the herbs that we’ve mentioned like boswellia and so on to make a very comprehensive product that covers quite a few of the treatment modalities that we’ve talked about separately. What other herbs would you recommend in the treatment of osteoarthritis? Some notable ones would be harpago, which is known as Devil’s claw and yucca. Both which work on a similar mechanism and I think part of their mechanism involves the bacterial microbiome in the gut and by preventing the absorption of the bacteria through the gut it has an effect on preventing the reabsorption of cartilage in the joints. Okay. So it can have a positive effect that way. And boswellia has a very positive effect on the joints too. So those are three that work very well. Then there’s also green-lipped mussel, which is an extract from mussels grown particularly in New Zealand which they don’t really know how it works but it does seem to have some very important omega 3 oils in it and some antioxidants and various other proteins which all have a very good anti-inflammatory effect. So then the only concern that I would then have is if somebody is allergic or sensitive to shellfish, that they then avoid the chondroitin and green-lipped mussels. We don’t know how sensitive the person might be but anybody suspects that they have a seafood allergy or shellfish allergy particularly, shouldn’t have anything with chondroitin in it and shouldn’t have anything from the green-lipped mussel. So in that case it would be better for them to stick to things like glucosamine and some of the other herbs separately. And where would hyaluronic acid fit in the picture? Hyaluronic acid is actually composed of these glucosaminoglycans so it’s actually like an ingredient that’s already there and by giving the hyaluronic acid which is very expensive but can be given directly into the joints by injection, it can be rubbed on as a cream, it can be taken orally. It’s not something that I have much practice with in my practice largely because of the cost but I believe it may work quite well. So there’s some merit to it but you would still look at antioxidants and potentially fish oil supplements and glucosamine and chondroitin combination – so a nice product that has a couple of these ingredients in probably would be like a bonus, if you could get that. Yes, quite a few of these products glucosamine, chondroitin, they would have some antioxidants in it and they would have a good composite of things in there that would be good for good health. How realistic is it to actually restore cartilage, rebuild cartilage? It’s what we would like to do because the whole process of osteoarthritis involves wearing down of the cartilage, or the cartilage not building up or not generating as it should do. So that’s certainly what we try and do and I think it certainly is achievable with things like glucosamine and hyaluronic acid. But I think we would probably look at lots of other tools in your arsenal that you can use for example, acupuncture and hot and cold compresses. A lot of the physical modalities like diathermy, hot and cold, ultrasound, laser, these kinds of things all help to improve circulation and perfusion of the joint which allows the joint to heal itself. So they’re all useful. Acupuncture is certainly of great benefit in osteoarthritis but I think more for relieving pain. I’m not sure that acupuncture will really, because it’s such a slow thing to develop and it’s also such a slow thing to heal, I’m not sure maybe acupuncture over a long period of time would have a great benefit in healing the joint. But most people are impatient they want just a few treatments of acupuncture to relieve the pain and that’s where it certainly is where it’s very effective. So it’s almost like there is different levels to treating it. I mean you’ve got the rebuilding of the cartilage, you’ve got the increase of fluid and blood flow and hopefully increase of the fluid in the joint as well to get rid of all the toxic build up. And then you know you’re looking at other alternative treatments for pain management, so that you restore mobility and get someone moving again. So after covering osteoarthritis and the management protocol, how does that differ from the management of rheumatoid arthritis? In many different ways, rheumatoid arthritis is a very different kettle of fish, being a more inflammatory condition, a very strong hereditary factor, I’m sure you know many people have parents with rheumatoid arthritis and it can be a very crippling disease if the inflammation in those joints causes such deformity that the person can’t function anymore. Sure. So we need to look at what’s causing the inflammation. We need to know are there foods that might be irritating the immune system and causing inflammation. We need to look at other things that could be irritating the immune system, things like stress, radiation, electromagnetic (EMF), pollutants, toxins like mercury, toxic environment in general. There are so many things that can be aggravating the immune system. And here we’re dealing with an immune disease, and autoimmune diseases can be difficult to manage at the best of times so we need to try and eliminate all the obstacles to a functioning immune system. And this is a where a product like low-dose naltrexone, which is a prescription medication. But a lot conventional doctors don’t even know about it is a fantastic aid to regulating immune systems. It doesn’t boost the immune system, it doesn’t suppress the immune system but with an autoimmune condition like rheumatoid arthritis can get a lot of benefit from going on to low-dose naltrexone over a long period of time. What’s inside there? Naltrexone. What is it derived from? It’s a chemical, it’s not a natural substance. Right. It is a chemical, it was actually originally discovered when they used it in high doses as an antidote for heroin addicts. And we now use it in a very low dose because they found that serendipitously that it has a wonderful effect on the immune system and reducing inflammation. Which would then reduce pain? Yes. So maybe you can then get away from having pain medication? Well, it works slowly so you’ll need to be on it for a month or three before you really get relief so you can certainly use all the other pain-relieving medications. And there’s some anti-inflammatory herbs as well like ginger and turmeric which are very good anti-inflammatory herbs which would be more appropriate here as opposed to the boswellia and yucca which would be for the cartilage-based arthritis. So you also wouldn’t go into glucosamine and chondroitin necessarily? Or would you consider that? No, not necessarily. Glucosamine is really more for osteoarthritis. But how long would you need to be on naltrexone, can you wean off of that quite quickly? You can stop and start as like. Okay. But generally, I would put somebody on it for a month or two before we decide to continue or to stop. Wow. David, this is valuable. Thank you so much. You’re very welcome. It’s a lot of information to absorb. It is, so take notes. So press the pause button a lot. Thanks, David.