Category Archives: Joints

Lack of Vitamin D a worry for the frail

Vitamin D has received a lot of attention both in research and in the media recently, and I recently wrote about the importance of this vitamin for expectant mothers and their children. It is becoming clear that adequate levels of vitamin D are critical at all stages of life. A new study published in the European Journal of Clinical Nutrition suggests that low levels of Vitamin D can increase the risk of death in frail, older adults (1).

Sunshine
Sunshine is one of the best sources of Vitamin D

The study, which analysed data on 4300 adults over the age of 60, found that inadequate Vitamin D levels increased risk of death from all causes by 30 percent.

‘Frailty’ is defined as a decrease in physical function, marked by symptoms such as slow walking, muscle weakness, low physical activity and unintentional weight loss.

The study found that those who had lower vitamin D levels were more likely to be frail. It also found that frail adults with low levels of vitamin D also had triple the risk of death over people who were not frail and who had higher levels of vitamin D.

The effect of Vitamin D on muscles and bones has indeed been known for some time. When Vitamin D receptors are activated within the cell, this stimulates new protein synthesis which affects muscle growth (2). In fact a prospective study found that Vitamin D supplementation increased the number of fast-twitch muscle fibres and improved muscle function in elderly women with osteoporosis (3). This is particularly interesting as it suggests that the protective effect of Vitamin D on fracture risk is not solely a result of its effect on bone mineral density. It may also be a result of improved muscle strength leading to better physical function and lower numbers of falls.

The study does not prove whether Vitamin D plays a causative role. In other words, it is not clear whether Vitamin D deficiency contributed to frailty, or whether frail adults were more likely to develop the vitamin deficiency because of health problems.

“If you have both, it may not really matter which came first because you are worse off and at greater risk of dying than other older people who are frail and who don’t have low vitamin D,” says study leader Ellen Smit. “This is an important finding because we already know there is a biological basis for this. Vitamin D impacts muscle function and bones, so it makes sense that it plays a big role in frailty.”

The researchers suggest that older adults should be screened for Vitamin D levels, and that they should spend more active time in the sun. A carefully managed diet can also help to boost levels. For example, oily fish such as salmon or mackerel can provide 350iu per serving, so try to include this a couple of times each week. Eggs can help too, with a single egg supplying 20iu of Vitamin D. For elderly people who spend little time outdoors it may be wise to supplement Vitamin D in order to ensure adequate levels, especially during the winter months. Sunlight is of course the best source, and just 20 minutes outdoors between the hours of 10am and 2pm will provide around 400iu of the vitamin.

Written by Nadia Mason, BSc MBANT NTCC CNHC

 References

1. E Smit, C J Crespo, Y Michael, F A Ramirez-Marrero, G R Brodowicz, S Bartlett, R E Andersen (2012) The effect of vitamin D and frailty on mortality among non-institutionalized US older adults. European Journal of Clinical Nutrition

2. Boland R. (1986) Role of vitamin D in skeletal muscle function. Endocr Rev 7:434-48.

3. Sorensen OH, Lund B, Saltin B, et al. (1979) Myopathy in bone loss of ageing: Improvement by treatment with 1 alpha-hydroxycholecalciferol and calcium. Clin Sci (Lond) 56:157-61.

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Optimising supplements for managing joint pain and inflammation

Osteoarthritis is the most common cause of musculo-skeletal disability in the elderly and, within the secondary care system, its management is primarily focused on palliative relief using pharmaceutical drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. As with many pharmaceutical drugs, there are potential side effects, with treatment regimens also failing to address the progressive and complex nature of the condition.

The potential role of pharmaconutrients
Not surprisingly, given the safety profile of the majority of nutritional interventions, practitioners are continually striving to identify disease-modifying pharmaconutrients that are capable of both improving symptoms and preventing, slowing, or even reversing the degenerative process. Clinically, osteoarthritis is characterised by joint pain, crepitus (grating or cracking sounds on movement), stiffness after immobility and general limited movement. Identifying nutrients that can aid and support these symptoms are crucial to providing both relief from pain and treating the condition itself [1, 2].

Fatty acids as immunomodulators
Marine omega-3 fatty acids such as eicosapentaenoic acid (EPA) and the omega-6 fatty acid gamma-linolenic acid (GLA) exhibit anti-inflammatory effects through the production of eicosanoids – substances with both anti-inflammatory and immunoregulatory properties. As such, both are well documented as useful natural agents to help treat inflammatory diseases, alone and in combination.

Gamma-linolenic acid
GLA is found in certain plant-seed oils, including evening primrose seed oil, and is metabolised to dihomo-gamma-linolenic acid (DGLA) the direct precursor to anti-inflammatory and immunoregulatory products. Supplemental GLA has been shown to suppress acute and chronic inflammation in several conditions, including arthritis [3].

Omegaflex Duo
Omegaflex Duo is one supplement that combines glucosamine, calcium and EPA which is beneficial for bone health.

Eicosapentaenoic acid
The specific ratio of the principal omega-3 and omega-6 fatty acids AA (arachidonic acid) and EPA provides valuable information on the measure of the body’s eicosanoid balance and the AA:EPA ratio provides a direct indication of the inflammatory state of the body. Developing an anti-inflammatory treatment regime means preventing or reducing the accumulation of AA from the diet. By reducing AA through EPA supplementation, we reduce the substrate for the formation of inflammatory eicosanoids and increase the production of anti-inflammatory eicosanoids directly from EPA. Interestingly, whilst the benefits of EPA as a potent anti-inflammatory and immune-regulating fatty acid are well established, [4] these benefits are significantly superior for osteoarthritis sufferers when combined with glucosamine [5].

Glucosamine
As well as pain and joint degeneration, osteoarthritis also involves progressive loss of cartilage. Glucosamine is an amino monosaccharide believed to stimulate production of compounds called glycosaminoglycans and proteoglycans, the ‘building blocks’ of cartilage. Whilst glucosamine is important as a structural component, it is also known to exert specific pharmacologic effects by decreasing the production of inflammatory products. Glucosamine does this by regulating their production at the genetic level, by switching off genes that are directly involved in their production, thereby interfering with the inflammatory signalling cascade. When administered exogenously, it is used for the treatment of osteoarthritis as a prescription drug or a dietary supplement [6].

Calcium
The synovial fluid within joints contains calcium, as does the cartilage lining the joints. When that calcium crystallises, the resulting tiny shards wear away the joint surface and spur the release of enzymes that further break down cartilage. Not surprisingly, it is sometimes thought that because osteoarthritis is aggravated by calcium deposition in joints, osteoarthritis patients should avoid taking calcium. Formation of calcium crystals can, however, result in calcium deficiency and, whilst calcium serves to maintain healthy bones and teeth, it is also essential for the normal functioning of muscles, blood vessels and nerves. If proper management of calcium is not carried out, this could be harmful for osteoarthritis patients, who may be at a higher risk of also developing osteoporosis, especially if they are long-term users of NSAIDs [7].

 

Written by Dr Nina Bailey

References
1. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S145-154.
2. Lopez HL: Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals. PM & R : the journal of injury, function, and rehabilitation 2012, 4:S155-168.
3. Dawczynski C, Hackermeier U, Viehweger M, Stange R, Springer M, Jahreis G: Incorporation of n-3 PUFA and gamma-linolenic acid in blood lipids and red blood cell lipids together with their influence on disease activity in patients with chronic inflammatory arthritis–a randomized controlled human intervention trial. Lipids in health and disease 2011, 10:130.
4. Calder PC: Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? British journal of clinical pharmacology 2012.
5. Gruenwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ: Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in therapy 2009, 26:858-871.
6. Rovati LC, Girolami F, Persiani S: Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties. Therapeutic advances in musculoskeletal disease 2012, 4:167-180.
7. Vestergaard P, Rejnmark L, Mosekilde L: Fracture risk associated with use of nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, and acetaminophen and the effects of rheumatoid arthritis and osteoarthritis. Calcified tissue international 2006, 79:84-94.

 

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