Vitamin K, Leptin, AGEs, and Arthritis

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Vitamin K, Leptin, AGEs, and Arthritis
What do the lack of vitamin K, leptin resistance, high levels of nitric oxide and high levels of Advanced Glycation End Products (AGEs) have in common? They are all involved with the development of osteoarthritis. Just when you thought the topic of osteoarthritis couldn’t get any more complicated, you now see even more factors influencing the process of degenerative joint disease.

Vitamin K



An excellent study published last year in the American Journal of Medicine showed that lack of vitamin K caused an increase in the development of osteoarthritis. We understand that Vitamin K plays a powerful role in regulating bone mineralization and has many other health benefits. What has not been known is the link between lack of vitamin K and osteoarthritis. This has serious implications for the more than two million individuals who are on Coumadin or Warfarin for blood thinning either as prevention or treatment of blood clots. Individuals on the most common anticoagulant drug Coumadin are often on diets that severely restrict vitamin K intake and the drug itself damages vitamin K uptake. If you are on this drug, know that you have to be even more diligent than the average patient with osteoarthritis. If you have to use the prescription, focus on using the smallest dose or use other approaches to reduce inflammation and support healthy blood viscosity.

Lack of vitamin K also occurs as a result of antibiotic use. The Journal of American Medical Association reported this back in 1957. How many millions have been given antibiotics since that time? How has this impacted gut health and created vitamin K deficiencies? How has this deficiency gnawed away at joint and bone health? It is scary to think about the impact these drugs have had on our children’s joint development. Think of the millions of 30-40 year olds who grew up on antibiotics for ear aches and acne, and now have arthritis. Rather than calling osteoarthritis a result of wear and tear and old age, we have to take our head out of the sand and wonder why so many young people are developing bad joints. Healthy digestive function and gut flora is vital for normal vitamin K production and critical for reducing the risk for arthritis.

Leptin



The implications of leptin imbalance and deteriorating health continue to show. Problems with abnormally elevated levels of leptin play a key role in the pathophysiology of osteoarthritis. Just like with high levels of arachidonic acid and too much Omega 6 oils, the higher the level of leptin found in the joint, the higher the level of osteoarthritis. Research shows that bone building cells, osteoblasts, and cartilage building cells, chondrocytes, are capable of leptin synthesis and secretion. This means that there is a local site of leptin production as opposed to only adipose cells producing leptin. Researchers have determined that obesity or high levels of body fat in and of itself may not be a risk factor for joint degeneration, but rather it is leptin that influences the skeletal and immune systems and causes inflammation and deterioration. So far, 2013 researchwith leptin and osteoarthritis shows that leptin levels in synovial fluid are increased in obese patients, leptin receptors are present in cartilage, and leptin induces the production of matrix metalloproteinases (MMPs), pro-inflammatory mediators and nitric oxide (NO) in cartilage cells. This would also potentially explain the development of osteoarthritis in non-weight bearing joints. So while researchers are figuring out more about the nuts and bolts of leptin and osteoarthritis physiology, know that there are some basic principles that go a long way in reducing leptin resistance and high levels of leptin. Read more about leptin.

Nitric Oxide



Nitric oxide (NO) is a tiny cellular signaling molecule. There are three basic types of NO, i.e. eNOS (endothelial) NOS), iNOS (inducible NOS), and nNOS (neuronal NOS). It has a number of purposes in the body and is frequently discussed with concerns such as blood pressure, cardiovascular, insulin, and nervous system function. iNOS often is seen as the most damaging of NO and is involved with inflammatory signaling and free radicals. iNOS is produced in diseased joints and may be a key mediator of inflammatory immune cells that affect cartilage. While there are a number of nutritional compounds known to support healthy NO function, research now shows that Coenzyme Q 10 plays a key role in osteoarthritis support. CoQ 10 was shown to positively regulate iNOS and several other inflammatory compounds including receptors for Advanced Glycation End Products. This means that CoEnzyme Q 10 was able to reduce pain and cartilage breakdown.

Advanced Glycation End Products



Advanced Glycation End Products or AGEs is what happens when inflammation and poor blood sugar management meet in the body. When blood sugar metabolism is poor, sugar in the blood attaches to proteins, i.e. your muscles or cells. The end result is that these tissues become stiffer and more susceptible to damage or breaking down. In cartilage, this causes structural breakdown. It also creates a high level of oxidative stress. This effect can happen even with a hemoglobin A1C (HbA1C) within the “normal” range of 5.5 – 6.0 and definitely happens with higher levels. The AGE and inefficient blood sugar response can come from consuming high glycemic index foods or more ingrained problems from Metabolic Syndrome, prediabetes, diabetes, and/or leptin resistance. If you have ever noticed that after consuming a meal high in carbs or sugar a few hours or the next day, you feel stiffer. You just experienced first hand of what AGEs does to your body – it ages it!

Here are some basic steps to help reduce AGEs.

1. Consume foods low on the glycemic index. Note that wheat and most grain products have a higher glycemic index than table sugar and contribute substantially to AGEs.

2. Follow the Leptin Diet.

3. Food preparation also determines the amounts of AGEs. Microwaved, well done or burnt foods including Cajun style have higher amounts of AGEs. Reduce or avoid them. The crispy burnt foods that you like so well are proteins and sugar burned together and made stiff via AGEs and oxidation.

4. Consume a diet rich in colorful fresh vegetables and fruits to counteract external stressors. Eat vegetables and fruit from the rainbow (yellow, orange, red, blue, green, purple, and white (i.e. cauliflower, onion, garlic, not white sugar, rice, or potatoes) and that doesn’t mean eating the candy Skittles. Specific nutrients include vitamin B1, B6, and B12 (particularly methylcobalamin) along with tocotrienols, fisetin, grape seed extract, lipoic acid, resveratrol, and many others.

5. Stay active. Physical activity plays a substantial role in reducing pro-inflammatory effects of AGEs and osteoarthritis.

Other factors



Celiac disease or gluten intolerance and Leaky Gut Syndrome or increased gut permeability are also common concerns linked with osteoarthritis. Know that digestive health and gluten intolerance are significant every day concerns plaguing individuals with chronic health problems including osteoarthritis.

Summary



Rather than calling osteoarthritis a result of old age and be resigned to futility, use this information to empower you to take charge of your health. No matter what your age and status of degenerative joint disease, address these and other known risk factors, like smoking and inactivity. Start with the basics and build on top of that depending on how difficult and extensive your concerns are. As you can see from this newsletter and the previous three, joint health, prevention and management of the number one leading cause of disability are multi-factorial. Aging well with joint health is more than resignation to just live with it. The solution is not powerful medications with life threatening adverse effects or joint replacement surgery and recovery that is anything but simple. Take charge of your health now by making good choices and being proactive.

1. Make sure that good oils balance out the bad. Consider using fish oils if you have high levels of pain and inflammation.

2. Use some basic cartilage and synovial support nutrients such as hyaluronic acid, chondroitin, glucosamine, curcumin, and boswellia.

3. Reduce or avoid using NSAIDS and other medications such as Warfarin and antibiotics that interfere with cartilage. If you need to be on these medications, take proactive steps to counteract the breakdown of joints and other adverse effects. Always support digestive health when using these types of medications.

4. Get leptin back in balance. Follow the Leptin Diet. Use nutritional support if needed to get leptin working better.

5. Work on blood sugar management. Get your hemoglobin A1C measured. It is a simple blood test. If it is higher than 5.4, it is out of the optimal range. Eat foods that have a low glycemic index. Eat at least one serving of vegetables and fruits from each color of the rainbow – every day!

6. Use other nutrients to help support healthy vitamin K levels, nitric oxide, and antioxidant status. These include probiotics, resveratrol, tocotrienols, fisetin, grape seed extract, coenzyme q 10, lipoic acid, and B vitamins.

7. Be physically active every day. If you don’t use it, you will lose it.

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