New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link
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The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was originally developed to help people with type 2 diabetes manage their blood sugar levels.
However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for weight loss, and hundreds of thousands of people around the world are using it for this purpose.
Evidence has also shown the drug can help manage heart failure and chronic kidney disease in people with obesity and type 2 diabetes.
Now, a study published in the New England Journal of Medicine has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked?
Osteoarthritis and obesity
Osteoarthritis is a common joint disease, affecting 2.1 million Australians. Most people with osteoarthritis have pain and find it difficult to perform common daily activities such as walking. The knee is the joint most commonly affected by osteoarthritis.
Being overweight or obese is a major risk factor for osteoarthritis in the knee. The link between the two conditions is complex. It involves a combination of increased load on the knee, metabolic factors such as high cholesterol and high blood sugar, and inflammation.
For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the development of osteoarthritis.
Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. International and Australian guidelines suggest losing as little as 5% of body weight can help.
But losing weight with just diet and exercise can be difficult for many people. One study from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten.
Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness.
Semaglutide for osteoarthritis?
The rationale for the recent study was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight.
They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight.
As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group.
The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group.
This is much greater than the pain reduction in another recent study among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale.
The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as anti-inflammatories, opioids and antidepressants.
Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test.
How could semaglutide reduce knee pain?
It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain.
But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have anti-inflammatory properties, and could even protect against cartilage wear and tear.
While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not.
The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis are prescribed opioids. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity.
It’s also important to consider semaglutide can have a range of side effects, including gastrointestinal symptoms and fatigue.
There are some concerns that semaglutide could reduce muscle mass and bone density, though we’re still learning more about this.
Further, it can be difficult to access.
I have knee osteoarthritis, what should I do?
Osteoarthritis is a disease caused by multiple factors, and it’s important to take a multifaceted approach to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of self-management. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.
Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney and Christina Abdel Shaheed, Associate Professor, School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Oranges vs Lemons – Which is Healthier?
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Our Verdict
When comparing oranges to lemons, we picked the oranges.
Why?
In the battle of these popular citrus fruits, there is a clear winner on the nutritional front.
Things were initially promising for lemons when looking at the macros—lemons have a little more fiber while oranges are slightly higher in carbs, but the differences are small and both are very healthy in this regard.
However, alas for this writer who prefers sour fruits to sweet ones (I’m sweet enough already), the micronutrient profiles tell a different story:
In terms of vitamins, oranges have more of vitamins A, B1, B2, B3, B5, B9, E, and choline. In contrast, lemons have a (very) little more vitamin B6. You might be wondering about vitamin C, since both fruits are famous for that—they’re equal on vitamin C. But, with that stack we listed above, oranges clearly win the vitamin category easily.
As for minerals, oranges boast more calcium, copper, magnesium, potassium, selenium, and zinc, while lemons have more iron, manganese, and phosphorus.
Technically lemons also have more sodium, but the numbers are truly miniscule (by coincidence, we discover upon grabbing a calculator, you’d need to eat approximately your own bodyweight in whole lemons to get to the RDA of sodium—and that’s to reach the RDA, not the upper healthy limit) so we’ll overlook the tiny sodium difference as irrelevant. Which means, while closer than the vitamins category, oranges win on minerals with a 6:3 lead over lemons.
Both fruits offer generous helpings of flavonoids and other polyphenols such as naringenin and hesperidin, which have anti-inflammatory properties and more specifically can also reduce allergy symptoms (unless, of course, you are allergic to citrus fruits, which is a relatively rare but extant allergy).
In short: as ever, enjoy both; diversity is great for the health. But if you want to maximize the nutrients you get, it’s oranges.
Want to learn more?
You might like to read:
Lemons vs Limes – Which is Healthier?
Take care!
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Why We Get Sick – by Dr. Benjamin Bikman
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There’s a slightly buried lede here in that the title doesn’t offer this spoiler, but we will: the book is about insulin resistance.
However, unlike the books we’ve reviewed about blood sugar management, this time the focus is really and truly on insulin itself—and that makes some important differences:
Dr. Bikman makes the case that while indeed hyper- or hypoglycemia bring their problems, mostly these are symptoms rather than causes, and the real culprit is insulin resistance, and this is important for two main reasons:
- Insulin resistance occurs well before the other symptoms set in (which means: it is the thing that truly needs to be nipped in the bud; if your fasting blood sugars are rising, then you missed “nipping it in the bud” likely by a decade or more)
- Insulin resistance causes more problems than “mere” hyperglycemia (the most commonly-known result of insulin resistance) does, so again, it really needs to be considered separately from blood sugar management.
This latter, Dr. Bikman goes into in great detail, linking insulin resistance (even if blood sugar levels are normal) to all manner of diseases (hence the title).
You may be wondering: how can blood sugar levels be normal, if we have insulin resistance?
And the answer is that for as long as it is still able, your pancreas will just faithfully crank out more and more insulin to deal with the blood sugar levels that would otherwise be steadily rising. Since people measure blood sugar levels much more regularly than anyone checks for actual insulin levels, this means that one can be insulin resistant for years without knowing it, until finally the pancreas is no longer able to keep up with the demand—then that’s when people finally notice.
The book is divided into sections:
- The Problem: What Is Insulin Resistance
- The Cause: What Makes Us Insulin Resistant
- How We Can Fight Insulin Resistance
The first two parts are essential for the reader’s understanding, but the third part is the practical part, with appropriately practical advice on the most insulin-friendly ways to exercise, eat, fast, and more. He also talks drugs, and discusses the pros and cons of various interventions—but of course, far better is the lifestyle management of insulin.
The style is mostly very pop-science in overall presentation, and then occasionally gets very dense at times, but when that happens, he will then tend to follow it with an easier-to-understand explanation, to ensure that nothing remains opaque.
Bottom line: if you care about your metabolic health and don’t mind reading a book where you may have to read a paragraph or two twice sometimes, then this is a top-tier book on insulin resistance and how to prevent/reverse it.
Click here to check out Why We Get Sick, and stay well instead!
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The 7 Approaches To Pain Management
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More Than One Way To Kill Pain
This is Dr. Deepak Ravindran (MD, FRCA. FFPMRCA, EDRA. FIPP, DMSMed). He has decades of experience and is a specialist in acute and chronic pain management, anesthesia, musculoskeletal medicine, and lifestyle medicine.
A quick catch-up, first:
We’ve written about chronic pain management before:
Managing Chronic Pain (Realistically!)
As well as:
Science-Based Alternative Pain Relief
Dr. Ravindran’s approach
Dr. Ravindran takes a “trauma-informed care” approach to his professional practice, and recommends the same for others.
In a nutshell, this means starting from a position of not “what’s wrong with you?”, but rather “what happened to you?”.
This seemingly subtle shift is important, because it means actually dealing with a person’s issues, instead of “take one of these and call my secretary next month”. Read more:
Pain itself can be something of a many-headed hydra. Dr. Ravindran’s approach is equally many-headed; specifically, he has a 7-point plan:
Medications
Dr. Ravindran sees painkillers (and a collection of other drugs, like antidepressants and muscle relaxants) as a potential means to an end worth exploring, but he doesn’t expect them to be the best choice for everyone, and nor does he expect them to be a cure-all. Neither should we. He also advises being mindful of the drawbacks and potential complications of these drugs, too.
Interventions
Sometimes, surgery is the right choice. Sometimes it isn’t. Often, it will change a life—one way or the other. Similar to with medications, Dr. Ravindran is very averse to a “one size fits all” approach here. See also:
The Insider’s Guide To Making Hospital As Comfortable As Possible
Neuroscience and stress management
Often a lot of the distress of pain is not just the pain itself, but the fear associated with it. Will it get worse if I move wrong or eat the wrong thing? How long will it last? Will it ever get better? Will it get worse if I do nothing?. Dr. Ravindran advises tackling this, with the same level of importance as the pain itself. Here’s a good start:
Stress, And Building Psychological Resilience
Diet and the microbiome
Many chronic illnesses are heavily influenced by this, and Dr. Ravindran’s respect for lifestyle medicine comes into play here. While diet might not fix all our ills, it certainly can stop things from being a lot worse. Beyond the obvious “eat healthily” (Mediterranean diet being a good starting point for most people), he also advises doing elimination tests where appropriate, to screen out potential flare-up triggers. You also might consider:
Four Ways To Upgrade The Mediterranean Diet
Sleep
“Get good sleep” is easy advice for those who are not in agonizing pain that sometimes gets worse from staying in the same position for too long. Nevertheless, it is important, and foundational to good health. So it’s important to explore—whatever limitations one might realistically have—what can be done to improve it.
If you can only sleep for a short while at a time, you may get benefit from this previous main feature of ours:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Exercise and movement
The trick here is to move little and often; without overdoing it, but without permitting loss of mobility either. See also:
The Doctor Who Wants Us To Exercise Less, And Move More
Therapies of the mind and body
This is about taking a holistic approach to one’s wellness. In Dr. Ravindran’s words:
❝Mind-body therapies are often an extremely sensitive topic about which people hold very strong opinions and sometimes irrational beliefs.
Some, like reiki and spiritual therapy and homeopathy, have hardly any scientific evidence to back them up, while others like yoga, hypnosis, and meditation/mindfulness are mainstream techniques with many studies showing the benefits, but they all work for certain patients.❞
In other words: evidence-based is surely the best starting point, but if you feel inclined to try something else and it works for you, then it works for you. And that’s a win.
Want to know more?
You might like his book…
The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain
He also has a blog and a podcast.
Take care!
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Calisthenics for Beginners – by Matt Schifferle
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For those who are curious to take up calisthenics, for its famed benefit to many kinds of health, this is a great starter-book.
First, what kind of benefits can we expect? Lots, but most critically:
- Greater mobility (as a wide range of movements is practiced, some of them stretchy)
- Cardiovascular fitness (calisthenics can be performed as a form of High Intensity Impact Training, HIIT)
- Improved muscle-tone (because these are bodyweight strength-training exercises—have you seen a gymnast’s body?)
- Denser bones (strong muscles can’t be built on weak bones, so the body compensates by strengthening them)
A lot of the other benefits stem from those, ranging from reduced risk of stroke, diabetes, heart disease, osteoporosis, etc, to improved mood, more energy, better sleep, and generally all things that come with a decent, rounded, exercise regime.
Schifferle explains not just the exercises, but also the principles, so that we understand what we’re doing and why. Understanding improves motivation, adherence, and—often—form. Exercise diagrams are clear, and have active muscle-groups highlighted and color-coded for extra clarity.
As well as explaining exercises individually, he includes three programs, increasing in intensity. He also offers adjustments to make exercises easier or more challenging, depending on the current condition of your body.
The book’s not without its limitations—it may be a little male-centric for some readers, for instance—but all in all, it’s a very strong introduction to calisthenics… Enough to get anyone up and running, so to speak!
Get started with “Calisthenics for Beginners” from Amazon today!
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The Best Mobility Exercises For Each Joint
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Stiff joints and tight muscles limit movement, performance, and daily activities. They also increase the risk of injury, and increase recovery time if the injury happens. So, it’s pretty important to take care of that!
Here’s how
Key to joint health involves understanding mobility, flexibility, and stability:
- Mobility: active joint movement through a range of motion.
- Flexibility: muscle lengthening passively through a range of motion.
- Stability: body’s ability to return to position after disturbance.
Different body parts have different needs when it comes to prioritizing mobility, flexibility, and stability exercises. So, with that in mind, here’s what to do for your…
- Wrists: flexibility and stability (e.g., wrist circles, loaded flexions/extensions).
- Elbows: Stability is key; exercises like wrist and shoulder movements benefit elbows indirectly.
- Shoulders: mobility and stability; exercises include prone arm circles, passive hangs, active prone raises, easy bridges, and stick-supported movements.
- Spine: mobility and stability; recommended exercises include cat-cow and quadruped reach.
- Hips: mobility and flexibility through deep squat hip rotations; beginners can use hands for support.
- Knees: stability; exercises include elevated pistols, Bulgarian split squats, lunges, and single-leg balancing.
- Ankles: flexibility and stability; exercises include lunges, prying goblet squats, and deep squats with support if necessary.
For more on all of these, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Building & Maintaining Mobility
Take care!
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The Connection Cure – by Julia Hotz
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You may recognize some of the things in the subtitle as being notable elements of the Blue Zones supercentenarians’ lifestyles, but this book looks at numerous quite diverse countries, and people from many walks of life.
What they have in common—and this is mostly a very person-centered book, relying a lot on case studies, with additional references coming from wider sociological data—is social prescribing.
What is social prescribing? That’s what the author (a journalist by general profession) answers comprehensively here, and it’s about looking at the ways medical problems can often have nonmedical solutions. It doesn’t necessarily mean that walking will cure your cancer or art will cure your diabetes, but it does mean that very often a key part of an unhealthy lifestyle is fundamentally something that can be fixed by one or more of: movement, nature, art, service, and belonging.
She looks at social prescribing in its birthplace (the UK, where cheap solutions that are nevertheless evidence-based are very much prioritized), in big countries like Canada and Australia, in aging countries like Singapore and South Korea, and yes, also in the #1 country of pill prescribing, the US.
The structure of the book is interesting, we first have 5 person-centered chapters addressing each of the social prescribing aspects and how they helped in two example case studies for each one, then 5 country-by-country epidemiological chapters looking at the big picture, then 5 person-centered chapters again, this time looking at personalizing social prescribing for oneself (this section of the book being headed “Social Prescribing For You And Me”), looking at what is going on in one’s life and health, which of the 5 elements might be missing, and what tangible goal-oriented benefits can—according to the evidence—be obtained by tending to what one actually needs in terms of social prescribing.
The style is narrative and journalistic, with very little hard science, but very little that’s wishy-washy either. It is, in short, a pleasant and informative read that helps the reader really understand social prescribing, the better to implement it in our own lives.
Bottom line: if you like having extra nonmedical approaches to avoid or alleviate medical problems, then this book will really help you achieve that.
Click here to check out The Connection Cure, and get social prescribing!
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