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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A new government inquiry will examine women’s pain and treatment. How and why is it different?
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The Victorian government has announced an inquiry into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue.
The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.
The gender pain gap
Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic pain.
Approximately half of chronic pain conditions have a higher prevalence in women compared to men, including low back pain and osteoarthritis. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as chronic prostatitis/chronic pelvic pain syndrome.
These statistics are seen across the lifespan, with higher rates of chronic pain being reported in females as young as two years old. This discrepancy increases with age, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men.
It feels worse
Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report higher pain scores than men.
Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to both women and men.
Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain than men with chronic pain. Women are also more likely to report more health care use and be hospitalised due to their pain than men.
Women seem to feel pain more acutely and often feel ignored by doctors.
ShutterstockMedical misogyny
Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as not being real or “all in their head”.
Hollywood actor Selma Blair recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018.
It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. Our research has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life.
Misogyny exists in research too
Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive functions. As a result, most pre-clinical pain research has used male rodents as the default research subject. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also influence research findings.
The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in pain prevalence and sensitivity. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process potentially painful stimuli through entirely different immune cells.
These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents.
When women seek care, their pain is also treated differently. Studies show women receive less pain medication after surgery compared to men. In fact, one study found while men were prescribed opioids after joint surgery, women were more likely to be prescribed antidepressants. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were more likely to receive pain medication.
So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this.
What will the inquiry involve?
Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future.
Inquiry submissions are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.
The state has an excellent track record of improving women’s health in many areas, including heart, sexual, and reproductive health, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.
Jane Chalmers, Senior Lecturer in Pain Sciences, University of South Australia and Amelia Mardon, PhD Candidate, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cannabis & Heart Attacks
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For many, cannabis use has taken the place that alcohol used to have when it comes to wanting a “downer”, that is to say, a drug that relaxes us as opposed to stimulating us.
Indeed, it is generally considered safer than alcohol ← however this is not a strong claim, because alcohol is much more dangerous than one would think given its ubiquity and (in many places, at least) social acceptability.
We’ve talked a bit about cannabis use before, in its various forms, for example:
Cannabis Myths vs Reality ← a very good starting point for the curious
And one specifically about the use of THC gummies (THC is the psychoactive compound in cannabis, i.e. it’s the chemical that gets people high, as opposed to CBD, which is not psychoactive) as a sleep aid:
Sweet Dreams Are Made of THC (Or Are They?)
And for those skipping the THC, we’ve also written about CBD use, including:
CBD Oil: What Does The Science Say? and Do CBD Gummies Work?
So, about cannabis and heart attacks
Alcohol is a relaxant, and yet it can contribute to heart disease (amongst many other things, of course):
Can We Drink To Good Health? ← this is mostly about red wine’s putative heart health benefits, how the idea got popularized, and how it doesn’t stand up to scrutiny when actually looking at the evidence.
And cannabis, another relaxant? Not so good either!
New research has shown that cannabis users have a higher risk of heart attacks, even among younger and otherwise healthy individuals. This is based on analyzing data from 4,636,628 relatively healthy adults.
Specifically, the data showed that even young healthy cannabis users get:
- Sixfold increased risk of heart attack
- Fourfold increased risk of ischemic stroke
- Threefold increased risk of cardiovascular death, heart attack, or stroke
We mention the otherwise “relatively healthy” nature of the participants, because it’s important to note that less healthy people (who were perhaps using cannabis to self-medicate for some serious condition) were not included in the dataset, as it’d skew the data unhelpfully and it’d make the risk look a lot higher than the risk levels we mentioned above.
The mechanisms by which cannabis affects heart health are not fully understood, but hypotheses include:
- Disrupting heart rhythm regulation
- Increasing oxygen demand in the heart muscle
- Causing endothelial dysfunction, which affects blood vessel function
Further, heart attack risk peaked one hour after cannabis use, and while this doesn’t prove causality, it certainly doesn’t make cannabis look safe.
You can read the paper in its entirety here:
Want a safer way to relax?
We recommend:
- No-Frills, Evidence-Based Mindfulness
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- Which Style Of Yoga Is Best For You?
- 7 Kinds Of Rest When Sleep Is Not Enough
- Better Sex = Longer Life (Here’s How)
Enjoy!
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Hope Not Nope – by Dr. Dillon Caswell
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The author a Doctor of Physical Therapy, writes from both professional expertise and personal experience, when it comes to the treatment of long term injury / disability / chronic illness.
His position here is that while suffering is unavoidable, we don’t have to suffer as much or as long as many might tell us. We can do things to crawl and claw our way to a better position, and we do not have to settle for any outcome we don’t want. That doesn’t mean there’s always a miracle cure—we don’t get to decide that—but we do get to decide whether we keep trying.
Dr. Caswell’s advice is based mostly in psychology—a lot of it in sports psychology, which is no surprise given his long history as an athlete as well as his medical career.
The style is very easy-reading, and a combination of explanation, illustrative (often funny) anecdotes, and a backbone of actual research to keep everything within the realms of science rather than mere wishful thinking—he strikes a good balance.
Bottom line: if your current health outlook is more of an uphill marathon, then this book can give you the tools to carry yourself through the healthcare system that’s been made for numbers, not people.
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Brazil Nuts vs Cashews – Which is Healthier?
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Our Verdict
When comparing Brazil nuts to cashews, we picked the cashews.
Why?
Looking at the macros first, Brazil nuts have more fat and fiber, while cashews have more carbs and protein. So, it really comes down to what you want to prioritize. We’d generally consider fiber the tie-breaker, making this category a subjective marginal win for Brazil nuts—and especially marginal since they are both low glycemic index foods in any case.
When it comes to vitamins, Brazil nuts have more of vitamins C, E, and choline, while cashews have more of vitamins B2, B3, B5, B6, B7, B9, and K, so while both are great, this category is a clear by-the-numbers win for cashews.
The category of minerals is an interesting one. Brazil nuts have more calcium, magnesium, phosphorus, and selenium, while cashews have more copper, iron, manganese, and zinc. That would be a 4:4 tie, but let’s take a closer look at those selenium levels:
- A cup of cashews contains 109% of the RDA of selenium. Your hair will be luscious and shiny.
- A cup of Brazil nuts contains 10,456% of the RDA of selenium. This is way past the point of selenium toxicity, and your (luscious, shiny) hair will fall out.
For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.
We consider that a point against Brazil nuts.
Adding up the section makes for a win for cashews. Of course, enjoy Brazil nuts too if you will, but in careful moderation please!
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Treat Your Own Hip – by Robin McKenzie
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We previously reviewed another book by this author in this series, “Treat Your Own Knee”, and today it’s the same deal, but for the hip.
A quick note about the author first: a physiotherapist and not a doctor, but with over 40 years of practice to his name and 33 letters after his name (CNZM OBE FCSP (Hon) FNZSP (Hon) Dip MDT Dip MT), he seems to know his stuff.
He takes the reader through first diagnosing the nature of the pain (and how to rule out, for example, a back problem manifesting as hip pain, rather than a hip problem per se—and points to his own “Treat Your Own Back” manual if it turns out that that’s your problem instead), and then treating it. A bold claim, the kind that many people’s lawyers don’t let them make, but once again, this guy is pretty much the expert when it comes to this. Ask any other physiotherapist, and they probably have several of his books on their shelf.
The treatments recommend are tailored to the results of various diagnostic flowcharts; essentially troubleshooting your hip. However, they mainly consist of exercises (perhaps the greatest value of the book), and lifestyle adjustments (these ones, 10almonds readers probably know already, but a reminder never hurts).
The explanations are thorough while still being comprehensible, and there is zero sensationalization or fluff. It is straight to the point, and clearly illustrated too with diagrams and photographs.
Bottom line: if you’re looking for a “one-stop shop” for diagnosing and treating your bad hip, then this is it.
Click here to check out Treat Your Own Hip, and indeed Treat Your Own Hip!
PS: if you have musculoskeletal problems elsewhere in your body, you might want to check out the rest of his body parts series (neck, back, shoulder, wrist, knee, ankle) for the one that’s tailored to your specific problem.
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Even small diet tweaks can lead to sustainable weight loss
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It’s a well-known fact that to lose weight, you either need to eat less or move more. But how many calories do you really need to cut out of your diet each day to lose weight? It may be less than you think.
To determine how much energy (calories) your body requires, you need to calculate your total daily energy expenditure (TDEE). This is comprised of your basal metabolic rate (BMR) – the energy needed to sustain your body’s metabolic processes at rest – and your physical activity level. Many online calculators can help determine your daily calorie needs.
If you reduce your energy intake (or increase the amount you burn through exercise) by 500-1,000 calories per day, you’ll see a weekly weight loss of around one pound (0.45kg).
But studies show that even small calorie deficits (of 100-200 calories daily) can lead to long-term, sustainable weight-loss success. And although you might not lose as much weight in the short-term by only decreasing calories slightly each day, these gradual reductions are more effective than drastic cuts as they tend to be easier to stick with.
Small diet changes can still lead to weight loss in the long run. Monkey Business Images/ Shutterstock Hormonal changes
When you decrease your calorie intake, the body’s BMR often decreases. This phenomenon is known as adaptive thermogenesis. This adaptation slows down weight loss so the body can conserve energy in response to what it perceives as starvation. This can lead to a weight-loss plateau – even when calorie intake remains reduced.
Caloric restriction can also lead to hormonal changes that influence metabolism and appetite. For instance, thyroid hormones, which regulate metabolism, can decrease – leading to a slower metabolic rate. Additionally, leptin levels drop, reducing satiety, increasing hunger and decreasing metabolic rate.
Ghrelin, known as the “hunger hormone”, also increases when caloric intake is reduced, signalling the brain to stimulate appetite and increase food intake. Higher ghrelin levels make it challenging to maintain a reduced calorie diet, as the body constantly feels hungrier.
Insulin, which helps regulate blood sugar levels and fat storage, can improve in sensitivity when we reduce calorie intake. But sometimes, insulin levels decrease instead, affecting metabolism and leading to a reduction in daily energy expenditure. Cortisol, the stress hormone, can also spike – especially when we’re in a significant caloric deficit. This may break down muscles and lead to fat retention, particularly in the stomach.
Lastly, hormones such as peptide YY and cholecystokinin, which make us feel full when we’ve eaten, can decrease when we lower calorie intake. This may make us feel hungrier.
Fortunately, there are many things we can do to address these metabolic adaptations so we can continue losing weight.
Weight loss strategies
Maintaining muscle mass (either through resistance training or eating plenty of protein) is essential to counteract the physiological adaptations that slow weight loss down. This is because muscle burns more calories at rest compared to fat tissue – which may help mitigate decreased metabolic rate.
Portion control is one way of decreasing your daily calorie intake. Fevziie/ Shutterstock Gradual caloric restriction (reducing daily calories by only around 200-300 a day), focusing on nutrient-dense foods (particularly those high in protein and fibre), and eating regular meals can all also help to mitigate these hormonal challenges.
But if you aren’t someone who wants to track calories each day, here are some easy strategies that can help you decrease daily calorie intake without thinking too much about it:
1. Portion control: reducing portion sizes is a straightforward way of reducing calorie intake. Use smaller plates or measure serving sizes to help reduce daily calorie intake.
2. Healthy swaps: substituting high-calorie foods with lower-calorie alternatives can help reduce overall caloric intake without feeling deprived. For example, replacing sugary snacks with fruits or swapping soda with water can make a substantial difference to your calorie intake. Fibre-rich foods can also reduce the calorie density of your meal.
3. Mindful eating: practising mindful eating involves paying attention to hunger and fullness cues, eating slowly, and avoiding distractions during meals. This approach helps prevent overeating and promotes better control over food intake.
4. Have some water: having a drink with your meal can increase satiety and reduce total food intake at a given meal. In addition, replacing sugary beverages with water has been shown to reduce calorie intake from sugars.
4. Intermittent fasting: restricting eating to specific windows can reduce your caloric intake and have positive effects on your metabolism. There are different types of intermittent fasting you can do, but one of the easiest types is restricting your mealtimes to a specific window of time (such as only eating between 12 noon and 8pm). This reduces night-time snacking, so is particularly helpful if you tend to get the snacks out late in the evening.
Long-term behavioural changes are crucial for maintaining weight loss. Successful strategies include regular physical activity, continued mindful eating, and periodically being diligent about your weight and food intake. Having a support system to help you stay on track can also play a big role in helping you maintain weight loss.
Modest weight loss of 5-10% body weight in people who are overweight or obese offers significant health benefits, including improved metabolic health and reduced risk of chronic diseases. But it can be hard to lose weight – especially given all the adaptations our body has to prevent it from happening.
Thankfully, small, sustainable changes that lead to gradual weight loss appear to be more effective in the long run, compared with more drastic lifestyle changes.
Alexandra Cremona, Lecturer, Human Nutrition and Dietetics, University of Limerick
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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