In this episode, Dr. Scott and Tommy discuss the ways that fasting can improve clinical outcomes for people suffering with knee osteoarthritis, as well as many other bone and joint ailments. Excess body fat puts an immediate physical overload on our joints, but the metabolic inflammation that is seen in osteoarthritis can also be greatly improved through fasting. They discuss how to make significant improvements in quality of life and mobility through fasting, which is just starting to gain support in the orthopedic world.
Leyland KM, Judge A, Javaid MK, et al. Obesity and the Relative Risk of Knee Replacement Surgery in Patients With Knee Osteoarthritis: A Prospective Cohort Study. Arthritis Rheumatol. 2016;68(4):817-825. doi:10.1002/art.39486
Messier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005;52(7):2026-2032. doi:10.1002/art.21139
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Fasting For Life Ep. 67
[00:00:01] Hello, I'm Dr. Scott Watier,
[00:00:03] And I'm Tommy Welling, and you're listening to the Fasting for Life podcast, and
[00:00:08] This podcast is about using fasting as a tool to regain your health, achieve ultimate wellness and the life you truly deserve.
[00:00:15] Each episode is a short conversation on a single topic with immediate, actionable steps. We cover everything from fat loss on health and wellness to the science of lifestyle design.
[00:00:25] We started fasting for life because of how fasting has transformed our lives, and we hope to share the tools that we have learned
[00:00:30] Along the way.
[00:00:40] Everyone, welcome to the Fasting for Life podcast. My name is Dr. Scott Watier. I'm here, as always, a good friend and colleague, Tommy Welling. Good afternoon to you, sir.
[00:00:48] Hey, Scott. How are you?
[00:00:49] Rock and roll, man. Let's do it. I'm doing great. Today's conversation is one that I can relate to personally, also professionally. And it is a subset of something that I don't think we've ever directly talked about. But it is incredibly encouraging that fasting is going to be able to benefit kind of the the overall population that suffers with knee osteoarthritis. So if you're coming to the fasting podcast, you're new to our podcast. You listen to some of the episodes maybe, and you're like, wait a minute. So today they're going to talk about osteoarthritis of the knee. And we are and we're going to back it up with some statistics and most definitely some action steps or something that we can do a big take away in the fact that fasting can be helpful and it's going to be weight related. There'll be some metabolic conversations about the overall health of the individuals, et cetera. So it's going to be really cool. This is a brand new study in twenty 20. Correct me. OK, cool. And a 20 twenty. And it came out of the research center in India, a research center in India.
[00:02:09] I'm not going to attempt to pronounce that name. Just go. Go. Maybe I will go. Caldas Hospital and Research Center in India. Apologies if I did not pronounce that correctly, but Journal of Clinical Orthopedics and Trauma, and it's this is literally the title of the article. Can intermittent fasting be helpful for knee osteoarthritis? And the answer is drum roll. Yes, yes, it can. We could have done better there. That's fine. So it absolutely can be. So I want to start to unpack this, Tommy, with the end goal in mind, which is, you know, improving one's health to improve the quality of life, to regain control, to be healthy. And, you know, there's just so many different places we want to take this. I want to hone in and focus in on kind of really an it in a way that makes sure that. There's insulation here in terms of you knowing that you have an option or a choice when it comes to something like osteoarthritis, and you don't end up as one of those statistics that ends up in a surgery.
[00:03:20] Yeah, and I'm excited to talk
[00:03:23] About this, too, because we just haven't gone down this path before. And when we saw this article, I was I was pretty excited to see it because that was definitely the first time I've seen an intermittent fasting article linked up with something in the orthopedic realm. And I've worked with different patient populations in the orthopedic and clinical settings. And it's it's something where the the the healthier you you are, the better your outcomes are going to be the surgical outcome or physical therapy, whatever it is that you're going through, if it's an issue or another joint. Every every pound less seems to help with your clinical outcome. And so whether it was a skiing accident or something more, something like that, or if it was more of a degenerative issue that happened over time, maybe you're getting a little older and the creaky Rindy kind of feeling in your knee is getting worse. Those are all exacerbated heavily by each additional pound. So I think this is really relevant for everybody.
[00:04:36] Yeah, and it's the statistics on knee pain is incredible, but if we look at just osteoarthritis as a whole, it is the number one cause of disability in this country. So we're talking about knee surgeries over six hundred and sixty thousand knee surgeries every single year. And if you look at some of the outcome measures for those surgeries, people expect the pain level to be like a zero or a one. And a lot of times you end up in that three to four to five range. You've got decreased range of motion, you've got instability. And I cannot believe we haven't talked about this before because I used literally the clinic that I owned and ran for almost a decade. One of the main things, like half our patient base was knee pain patients. And there was a really cool mechanical side, not the metabolic side. So I want to make sure we kind of hit both the metabolic side and the mechanical side of this in terms of how fasting can help and how we can help this huge population of people that kind of deal with the pain from an osteoarthritic condition, knee pain, hip pain, et cetera. So one of the first things is if you're going in to see your provider and you have knee pain and you're overweight, they're going to tell you to do what first is lose weight.
[00:05:58] Have you ever actually get an actionable plan to do so? Typically, the answer's no. In doing thousands and thousands of console's people would say, yeah, my doctor said I need to lose weight. And my follow up question was always, and how's that going? And what was that? Oh, it was always something. Right? And it was never great. It was this. I tried this. I lost 10 pounds. I did this. So, you know, just looking at the overall statistics, I want to break down the study's two main drivers of why the main outcome of the study was obesity is a significant factor in knee osteoarthritis. Right. So it's a significant factor in furthering some of the stats that we're talking about. And weight loss is now been shown and proven as a tested strategy to be a management of obesity, which then decreases your chance of ending up in that surgical state or having advanced osteoarthritis. Right. So from those two driver points, I'll just outline it and then we can dive into them. One is, you know, when you have the weight, you have a component of a metabolic syndrome typically, and then you have an adipose or a fat tissue induced inflammatory response.
[00:07:21] So your fat cells are literally causing an inflammatory response in the body, which then directly leads to cartilage damage. So like the meniscus or the cushion in the knee, right? Yeah. So the second part is the the the more of the mechanical piece. So that was more of the metabolic piece. Right. The mechanical piece is the increased weight puts an additional load. And I want you to share the stand on what that is in just a second. Right. The increased poundage. So you have an increased load on the knee, you have an increased chance of injury, and then you're also accelerating those degenerative changes which lead to the late stages of osteoarthritis. And one of the first symptoms of osteoarthritis is intermittent knee pain. Right. So we're talking about, you know, knee pain that comes and goes in the beginning. But as the decades progress and you have this extra weight in terms of these two components, the metabolic component or the actual just mechanical component, it's something that fasting can absolutely help with in getting that weight off.
[00:08:27] Yeah. On both sides of that equation. Because, I mean, what you just described there sounded like the perfect storm for for knee pain and the degeneration. So it's it's it's degenerating from the inside out, beginning with with the meniscus and the connective tissue. And then an increased load is being pushed on on top of it as well. And so what what gravity does is it actually multiplies that increased load. So if we put on one additional pound for each stride that we take, we actually feel over four pounds of additional force. So if we have an extra 10 pounds to lose, that's not just ten additional pounds on the knee, because if we're if we're walking or jogging, we're actually going to feel 40 pounds worth of additional force on the knee. So this it gets it gets serious really quickly. And that knee pain that was just kind of nagging, we start to feel it exponentially grow as we put on a few pounds.
[00:09:28] So this is one of the things to you know, I like the way you were. We could also look at it in terms of like step. So, you know, this ten thousand step thing, right, right. Like, eat less, move more, get out and move burns more calories. Right. So, you know, if you're looking at a weight loss of one pound, that's going to be forty eight hundred pounds per one mile. Oh, wow. If you've lost 10 pounds, that's forty eight thousand pounds less in compressive load per mile walked. Wow, so personal story. We brought regenerative medicine into my previous clinic because of a nagging shoulder injury that just was not responding, and months and months and months and months and months later, nothing was happening. I had a colleague, a mentor who told me about regenerative medicine. PRP, had it done, had never had a problem since. So we started working with shoulders, knees and some hips. And I was the guinea pig. I'm like, OK, I'm going to try this before we put it in the clinic. So I'm like, I want to make sure this works right. And I took an x ray, my knees, and I was like. Oh, no. So I had a grade two situation in my right knee and a grade one situation on my left, and what I'm talking about is the cartilage or the cushion in between the joint, and that is called the Carlgren Lowrance grading system for knee osteoarthritis. And this is from the World Health, straight from the World Health Organization.
[00:11:06] Right. That's how you categorize the knee. And I'm sitting there going, wait, I don't have any knee pain. Right, I have no no pain, but I did have 20 to 30 extra pounds of weight that I was carrying around with me. And I was insulin resistant, and we're going to kind of transition into the metabolic side of this right. And how fasting can help with the metabolic side in that adipose induced inflammation. And I would have intermittent knee pain every now and then. But I'm sitting there going, OK, well, OK. So if I took my situation and I looked at my knees and I was like, oh, crap, I don't know what. So imagine keeping that weight on for the next three decades just with those numbers. I just said, right. A ten pound increase or they used it in the other way. A 10 pound reduction was forty eight thousand pounds less load on the knee joint for every mile. What I would have just been on my way to accelerating my process or my path into having severe degenerative change, which is then what a lot of most people end up finding out about them having arthritis is you've got severe knee pain or knee pain that won't go away for a few months and you go get an x ray and the doctor like, well, yeah, you got 50 percent loss of cartilage and you're like, well, wait a minute, what the heck?
[00:12:20] Yeah, it's not exactly a great early warning system. So you know what you just described your your knee pain was you were knocking at the door of your knee pain like it was coming for you three decades later maybe. But put on top of that, maybe two to five to 10 pounds of additional weight per year. And you're accelerating that that curve.
[00:12:47] Yeah, right. So just simply to put it, one pound of additional weight on your torso is four pounds per knee. Right. You can play with the math, however. Weight, however, anyways, we just did it. But that's one of the things in this research article that was really clear, was that physical or mechanical component of being able to get the weight off. And that was one of the beautiful things about fasting and intermittent fasting is that which is the title of the article. And Kinnamon fasting behave helpful for Niasse arthritis. You know, this is the basis of the fun stuff is when we get in the metabolic side of what's happening, which is why I go into now. But from the physical standpoint, I mean it's just math, right. So if we can help you and there was one study that was referenced and I pulled it up here, Tommy, it was a one hundred and eighteen month study. It was a clinical trial of diet and exercise. Right. And we were just going back and forth about this ahead of time. And I said I couldn't find it. I did end up finding it as you were talking full kind of peek behind the curtain there. This so 18 month clinical trial, diet, exercise. And there was one hundred and forty two sedentary, overweight and obese adults. Right. So at the end of those 18 months, they had a three percent reduction, average of three percent reduction in their body weight. And this is the study that showed that if you lost one pound, you would reduce you would have a four fold reduction in the load exerted per knee. Right. So we're kind of looking at it from the opposite side. But my point I bring this up is so these people lost three percent over 18 months. The average weight loss in our challenges. I don't we don't have the metric. We're kind of getting to the point where we're putting enough people through the challenges that we're going to have some. But what would you say the average would be? Six, eight?
[00:14:34] Yeah, yeah, probably about six, seven percent, something like that
[00:14:40] In 10 days. So from a physical aspect, huge.
[00:14:47] Yeah. The protocol that they were using was very slow going and they still saw a decrease in their risk of needing knee replacement surgery and osteoarthritis treatments because, you know, each pound, like we're saying, is very, very significant. So getting a few pounds off and getting them off quickly, using a powerful tool like intermittent fasting can can really start to to change that direction very, very quickly. Know up to the point that that we know overweight individuals have a 40 percent increased risk of needing total knee replacement and other related osteoarthritis surgeries and obese individuals have a a one hundred percent higher risk of needing total knee replacement and other related surgeries. So just getting those those pounds off and knowing how to do it and using the right method is can be life changing, literally.
[00:15:51] I was so hoping you were just going to go there with those statistics. So I want to make sure that that landed. So. Seventy three percent of our population is overweight and right now about forty two or forty three percent is obese in the United States. If you guys are listening because we know we have listeners across across the pond, so to speak, and we've got people halfway across the world in Australia. So if you guys are listening here in the States, we have seventy three percent of the population overweight. Forty to forty three percent of the population is obese, we're we're trending towards 50 percent obesity with by 20, 30. So a lot of numbers here. So seventy three percent of the population has a greater than 40 percent chance of having a knee replacement. Not a discectomy, not a scope, not a clean up, but an actual full blown replacement. And if you're obese, if you're in that 43 percent category, which I was not too long ago, give me one hundred percent increased risk of replacement surgery compared to people with a normal weight. So the association actually goes up even the younger and stronger that you are. So it's crazy. You know, it's just like, OK, how do we what's what's that thing? Occam's razor. The simplest answer is usually the one or I'm so bad paraphrasing and that kind of stuff that's sitting out there. Yeah. Please just bear with me. That is not my strong suit weight reduction strategies. They could reduce that requirement by up to thirty one percent of people that had arthritis. This was a huge study over two and a half to two and a half years. You know, where you reference those numbers in like one hundred and six thousand people in it. So just some really clear things of like let's get the weight off as quickly as possible before you start doing ten thousand steps to nowhere.
[00:17:47] Yeah, absolutely, and just to just to add to that your risk of injury, if you're an active individual or you'd like to be, your risk of injury goes up exponentially with those additional pounds as well. And the recovery from any surgery. But orthopedic surgery definitely included in that gets gets much, much more difficult and more prolonged with each additional pound. So if. If you're looking forward to an active lifestyle and a long, healthy, active life, focus on getting that weight to where it needs to be using the right methods, and you're going to empower yourself for years and years and years to come. And if something does happen and you do have to undergo any sort of surgery, you're going to have a much, much quicker recovery time and you'll be much better off as you recover from it.
[00:18:47] So I want to I want to make sure we we we come back to to the to the square one to the starting point. So we had these two and I totally forgot about the injury component to Tommy. We just talked about the the additional load component, which then accelerates the degenerative change right. Over time. So thank you for bringing that back, because that's that's that mechanical component. Right. That that stuff's fun. It's applicable. What I really love with this study is. The other side of it, the metabolics of the right, so the adipose induced inflammation that proliferates cartilage damage, which is the cushioning or the meniscus tissues in the knee surrounding ligaments and support structures as a component of metabolic syndrome. So I love that this study just in the intro where it says this review article would help sensitize the orthopedic surgeons about fasting and weight reduction in assisting in knee osteoarthritis. Right. So they're saying that this choice of if or fasting should be offered to obese patients with knee osteoarthritis, not just because it's going to reduce the weight, but it's going to have what we're going to go into now, which is all of these other metabolic effects on overall health.
[00:20:04] Yeah, and these are extremely important because this is where all the comorbidities come into play. Where we have we have one problem at the core, which is insulin resistance and all the things that that leads to in the body and how it changes blood markers, every and every level of of testing, we're going to start seeing an effect thereof. And and the. The chemical component of the blood in the interstitial, fluid in the synovial fluid, everything that's going to be important to our our knees and our joint health is going to be affected. So you're almost with insulin resistance, you're almost kind of poisoning the pool that that all of these important bodily structures are are actually sitting in. And that's going to lead to just a compounding effect of what we've what we're discussing.
[00:21:08] I really wish I would have known this because, you know, we work with, you know, part of my other portion of my career that is not around fasting is in clinical settings, working with multidisciplinary clinics or working with M.D. and Deo's and PTS and apples and Fops and all these different medical professionals. And we have a collaboration or collaborative approach to getting people out of knee pain using different techniques inside of the clinics. I wish I would have had this component in my own clinic when I ran it because it would have been so OK. Patient comes to a knee pain. They've been to five different doctors have had cortisone injections or at the last resort for a knee replacement. OK, well, let's take you through our process. Let's try to help help get the pain and inflammation down. But then let's talk about a long term picture, which would be getting that weight off as quickly as possible. And we had a weight loss program. Remember, I've talked about this dozens of times in different different variations of, you know, the reason why none of the weight loss programs stuck in our clinic was because I was doing them and they weren't working for me. Right. So it's like, OK, I wish we would have had this.
[00:22:12] So I love this article because it talk specifically about the 16 eight method, which is really the most basic, most basic, most common, you know, intermittent fasting technique. They talk about the eat, stop, eat, which is, you know, two twenty four hour fast or one meal a day fast, a couple of times a week. And then the five two diet, which is very well known as well, which is, you know, five days of of normal eating and then two days of restricted eating, which is either personally, we think of the five two diet as not eating on those two days, but also the five two really is like five hundred calories or less. So a severe caloric restriction on those days. And the benefits that you were just talking about, alluding to or just in terms of weight loss. Yes, we've talked we've pretty much probably kind of talked too much about I don't want to say too much, but we've we've been down into the ground. Right. We've got it. Like the weight loss benefit is there. But the effect on type two diabetes, cardiovascular disease and even cancers was shown in this review to be a direct benefit of the fasting techniques.
[00:23:22] Yeah, I mean, as as as blood sugar remains elevated, as insulin remains elevated, you have problems that result in in circulation in the immune system. Everything starts to to kind of degrade and take a hit. And I mean, that's that's that's affecting these things from the inside out as far as our our inflammatory response goes.
[00:23:47] Yeah. And that was that second component, the metabolic component. So we've said it a few times, that adipose induced inflammation. So the regimens that we mentioned, the benefits were obviously the weight, the protects against neurodegenerative disease or diabetes, type three. So Alzheimer's and dementia is family. If you're not familiar with that, go ahead and get on your favorite search engine and go down a rabbit hole. Bruce, the metabolism for fat loss or don't. That's fine, too. You laughed those again, so that might not land with some people. Insulin drops, glucose levels drop. So then you're going to have your effect on blood sugar growth hormone increases, which is going to be protecting that lean body mass or that that healthy tissue you're going to have reducing the oxidative stress. So that's going to be cardio related to cardiovascular diseases. Right. You're going to be decreasing your chance of of having cardiovascular symptoms and cardiovascular events because of the reduced reduction in oxidative stress. You've mentioned we've mentioned a couple of times now the reduction in inflammation. You're going to be promoting autophagy, which is just by caloric restriction alone. You can get some autophagy to take place, which is the regeneration of the old dead tissues and cells and making them healthy and new again. Right. That regenerative property and then the effects of having lower insulin, never mind the weight loss again. Right. Like we keep saying that, but a direct reduction in blood pressure which takes pressure off the cardiovascular system. So just an incredible, like systemic review of why, you know, never mind the effects directly on the pain level of osteoarthritis, but the metabolic effect of promoting health as we progress through the later decades in life.
[00:25:34] Yeah, absolutely, I think the value here is just understanding that what what you talked about at the beginning of this episode was I don't remember.
[00:25:45] So please remind me, I feel like I'm I'm like flying I'm flying all over the place. And this and I'm super excited about I can't believe like this what we used to do and I missed it. So if you guys are listening, your next client, please just thank you for your Grace and this like I wish I would have known this a decade ago. All right. Sorry, I just totally.
[00:26:03] Yeah. You know, and we always do the best we can with the tools that are available right now and that we understand. And so, I mean, it's just just but regaining that control and that that ability to, you know, to to live and to to remain, to do have your mobility and how important that that is. And it becomes more and more important as it becomes a little more limited, you know, as we age. So understanding the the effects of how we can prolong the longevity of our joints and our mobility and thus have the physical freedom that we enjoy means we're just going to be able to to to maintain a longer, happier life for that much longer. So protecting the joints and and prioritizing health and the weight and the the inflammation and everything else that goes along with this, we have the tools. So I just I just love that that we're kind of seeing those field come along and that we have a group of of orthopedics who are putting this out there in this frame so that we can start gaining more traction in the words the world and start benefiting a lot more people.
[00:27:20] All right. So to to wrap up, my favorite thing about this article is the last sentence. And I think it's a perfect bridge into what it is that we do and where what people can do now is intermittent fasting is to be considered in weight loss programs and its benefits extended for the nonsurgical management of osteoarthritis, but more so for the metabolic knee osteoarthritis. So that inflammatory component. So let's get the weight off as quickly as we can. You know, thinking in terms of how to have this conversation with your doc, you know, your doctor might not know this, your orthopedist might not know this. You might be already had a meniscus surgery or a clean up or a scope of some sort. And now you can see that a surgery based on the statistics that we shared, is in your future. So with that, let's think about what it is that we can control in the short term. And that is literally going to be the window in which you eat and you will be getting all of those additional benefits from a metabolic side of things and the decrease inflammation, decreased chance of diabetes, decreased cardiovascular risks, et cetera. So the best thing you can do is get started. Now, go to our website, the Fasting for Life Dotcom, the fasting month for Life Dotcom, download the Fast Start guide and get started today. As always, Tommy, thank you so much. And we'll talk soon. Thank you.
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