Diet and Exercise Reduce Pain in Osteoarthritis
From the American College of Rheumatology (ACR) 2011 Annual Meeting: Abstract 722. Presented November 6, 2011.
November 7, 2011 (Chicago, Illinois) — Intensive diet and exercise can slash the amount of pain in older adults with osteoarthritis of the knees and improve function and walking speed, according to a study from researchers at Wake Forest University in Winston-Salem, North Carolina.
The 18-month Intensive Diet and Exercise for Arthritis (IDEA) trial was designed to evaluate the impact of intensive weight loss with or without exercise on disease progression. The results presented here at the American College of Rheumatology 2011 Annual Meeting are the first from the trial, and focus on pain and function only.
Investigators randomized 454 overweight and obese individuals (72% women), with a mean body mass index of 33.6 kg/m2 and an average age of 65.6 years, to 1 of 3 groups: intensive diet designed to achieve weight loss of 10% or more; moderate exercise only (two 15-minute walks and 20 minutes of weight training 3 times a week); or both. Participants met weekly for the first 6 months, and biweekly thereafter. Eighty-eight percent of participants completed the 18-month study.
At the end of the study, participants in the diet-only group lost an average of 9.5% of their baseline weight, and those in the exercise-only group lost an average of 2.2%. The combined diet/exercise group, however, lost an average of 11.4%. None of the participants regressed to baseline levels, even after 18 months.
Although all groups reported less pain at 6 months, the difference between groups was not significant. However, at 18 months, the combined diet/exercise group experienced a 51% reduction in pain, compared with 27% and 28% in the diet-only and exercise-only groups, respectively (P < .0004), said lead author Stephen P. Messier, PhD, director of the J.B. Snow Biomechanics Laboratory at Wake Forest University. Forty percent of those in the combined group rated their pain at 0 or 1 at 18 months, he said, compared with 20% in the exercise-only and diet-only groups.
In addition, participants in the diet/exercise group improved their functional status by 47%, compared with 30% in the diet-only group and 26% in the exercise-only group. The combination group also increased walking speed by 12%, compared with 10% and 6% in the diet-only and exercise-only groups, respectively (P = .004).
“Clearly, our cohort has reversed the trend of declining mobility that is seen in older adults,” Dr. Messier said. In fact, the combination group had a faster walking speed than healthy middle-aged women aged 40 to 62, and one equivalent to that of healthy middle-aged men, he said.
Eric L. Matteson, MD, chair of the Department of Rheumatology at the Mayo Clinic in Rochester, Minnesota, said that the most intriguing finding of the trial is that even patients who did not exercise experienced less pain.
“Both exercise and diet are a great way to improve pain and function,” he said, “but what was really unique in this study was the observation that patients who lost weight had less pain associated with just the weight loss, not even any exercise.” This could be the result of a lower load on the joints, he said, and might enable patients to postpone joint replacement surgery.
It is also possible that patients will be able to reduce the amount of pain medication they take if they lose weight, noted Dr. Messier, something his group hopes to show with additional analysis. “We are hoping from a public health standpoint that medication use goes down,” he said, “and we expect it will.”
The take-home message, he said, is that “clinicians can tell their patients that they will see marked improvement [in pain and function] in 6 months or less.” The fact that significant differences did not appear between the groups until 18 months, however, “underscores the need for long-term studies to detect clinically and statistically meaningful results.”
Dr. Messier and Dr. Matteson have disclosed no relevant financial relationships.
100% Fruit Juice Supports A Healthy Overall Diet
WHOLE FRUIT JUICE LINKED TO BETTER DIET
100% fruit juice is viewed by many as a sweetened beverage with a potentially negative effect on weight; however, a research team has concluded that individuals aged two years and up who drink one hundred percent whole fruit juice daily have better overall diet quality, as measured by the Healthy Eating Index-2005, than those who do not consume whole juice daily.
Consumption was associated with greater daily calorie intake among those over age five. But the consumption of both overall fruit, and whole fruit, was higher among the one hundred percent fruit juice-drinkers; and their intake of added sugars was lower. The researchers recommended that consumption in moderation be encouraged. (Other studies have shown a decline in consumption over the past five years. The link between daily consumption of one hundred percent fruit juice and better overall diet quality is not necessarily a cause-and-effect association.) This study was released February 13, 2011 and will appear in a future issue of Nutrition Journal. It is available online now at http://bit.ly/i4X0bz without charge.
How Betulin May Help You
BIRCH BARK INGREDIENT HAS STRONG METABOLIC BENEFITS
According to a new study, a component in the bark of birch trees may lower cholesterol, suppress diet-induced obesity, improve insulin sensitivity and slow the development of atherosclerosis (hardening of the arteries). Although the research was conducted on mice, the benefits would be substantial if further work finds the effects hold for humans. For example, betulin decreased cholesterol in the liver, blood and fat to a greater extent than lovastatin, a widely prescribed drug class for treating high cholesterol.
The birch ingredient also made the mice more sensitive to insulin, which may help prevent diabetes, and caused them to burn more calories and lose weight. It also reduced plaque build-up in the arteries. Betulin alters the expression of genes involved in the biosynthesis of cholesterol, triglycerides and fatty acids.
Although not sold as a supplement, betulin appears to have low toxicity and is a readily available compound already in use as a precursor in the manufacture of some drugs. This study was published in the January 5, 2011 issue of the journal, Cell Metabolism. The full study is available online now at http://bit.ly/hYelkF without charge.
Why is Eating Healthy Synonymous with “Not So Great Taste?”
by Meera Vasudevan
Why is it foods that taste so good are often termed “not good for you”? Why is eating healthy is considered synonymous with “not so great” taste? This is the conundrum facing Americans who are hearing from the media, health organizations and even the First Lady that we are dangerously obese and need to reexamine the foods we eat.
Americans have, for the past couple of decades, been consuming absurdly large quantities of foods that are laden with fat and sodium. One argument places a chunk of the blame for this consumption pattern with fast-food restaurants and processed foods manufacturers, which have tended to use fat and sodium as the principal “taste makers.” The sheer convenience of these foods for time-poor Americans has led to high levels of consumption.
According to a study from the Centers for Diseases Control and Prevention (CDC), in 2007 to 2008, the prevalence of obesity in the United States was 32.2 percent among adult men and 35.5 percent among adult women. What’s worse—future generations will be affected as well by this “obesity epidemic.” CDC also projected one in three children born after the year 2000 will develop type II Diabetes as a result of obesity.
Fortunately, an increasing number of Americans are re-evaluating their diets and lifestyle in an effort to become healthier. Low-fat and low-sodium diets, exercise and increasing the ratio of fruits and vegetables in an average meal are becoming part of the everyday lexicon of Americans. This is great news for retailers of natural foods and healthy products.
Diet obviously plays a key role in weight management, and today’s consumers have access to many more dietary choices than ever before. Restaurants offer a variety of global cuisines, packaged ready-to-eat foods provide amazing innovation in nutrition and convenience, and a diverse range of new immigrants bring ancient, healthy cuisine influences with them. As a result, dietary choices are easier for Americans to make.
One of the rising trends in eating across America is the inclusion of ethnic foods and flavors. According to a 2009 Mintel study, ethnic food sales hit $2.2 billion and were expected to increase 20 percent from 2010 to 2014. Indian and Asian foods are among the fastest growing offerings. These cuisines are not only delicious, but also relatively healthy, since they are based in centuries-old medicinal systems that hinge around diet. Indian cuisine, for instance, has evolved over thousands of years with strong roots in Ayurveda (which means “science of life”)—an ancient medicinal system that combines spices and herbs, specific foods and yoga as the cornerstones of a healthy life. Similarly, Thai and Chinese cuisines are based in traditional medicinal systems that incorporate spices and herbs.
Indian and Asian foods use an amazing variety of spices for two simple reasons. First, spices add sheer pleasure to food and transform the ordinary into something exotic. And second, spices are nature’s “super foods,” with intrinsic proven health properties. Even obesity or daily weight management can be affected by the regular use of spices.
Ayurvedic documentation over the centuries, as well as modern American medical and clinical studies, has proven some simple facts about spices. Here a few examples:
Chilies: A great reason to spice up the standard meal. A compound in chilies called capsaicin has a thermogenic effect, meaning it causes the body to burn extra calories after consumption, bolstering metabolism.
Turmeric: Another popular spice in Indian and Thai cuisine, turmeric may help reduce the absorption of fat by the body. A Columbia University of Medical Research study found curcumin, the major polyphenol found in turmeric, reduced weight gain in mice and suppressed the growth of fat tissue.
Cinnamon: This spice is thought to boost weight loss by promoting healthier processing of carbohydrates by the body. Because of this effect, it may help to prevent development of metabolic syndrome. The benefits of cinnamon can be achieved with just one teaspoon a day. It mimics insulin to lower blood glucose, as well as helps reduce bad cholesterol (LDL) and triglycerides.
Black Pepper: Black pepper has great healing properties and can help with weight loss. It improves digestion, frees nutrients for absorption and can help stimulate the metabolism to burn more calories. The component in black pepper that makes it taste pungent is called piperine; it stimulates receptors in the brain and nervous system. Researchers suggest this effect increases food’s thermogenic effect (the amount of energy it takes to digest food) and results in a greater number of calories burned.
These are just some examples of the spices researchers are studying to understand how they help in the fight against obesity. Adding spices to the daily diet not only enhances the flavor of meals, but also works toward maintaining health.
Meera Vasudevan is the executive vice president for product development and marketing at Preferred Brands International (PBI), which markets the Tasty Bite (TastyBite.com) line of all natural, ready to eat Indian and Pan Asian foods.
