For those people who are living with a higher BMI, this is a long time thing. In the same way that osteoarthritis is this generally very slow burning long-term progressive condition so if we can start to intervene at some point along there and help support patients to reduce and get down to a more healthy BMI reduce some unwanted body fat then that stands them in really good favor at first reducing their risk of osteoarthritic flare-ups or worsening and then if they are experiencing OA symptoms it becomes a really good way of helping to manage that and reduce long-term symptoms.
SPEAKER_01:Weight management is a core area of treatment for many patients with osteoarthritis and on top of this our patients are bombarded by a minefield of information and marketing on supplementation and nutrition. In today's episode we're joined by Ben Steele-Turner to talk about why weight management is so important, how to have these conversations and the key foods, nutrients and supplementation we can discuss with our OA patients. Ben started off his career as a physiotherapist, but on completion of his physiotherapy degree, he decided he wanted to go into more detail in and around nutrition. So he went back to university and completed an MSc in human nutrition, allowing him to become a registered associate nutritionist. He now brings together these two valuable skills to deliver a physiotherapy assessment and treatment combined with nutritional advice and support. Ben now also produces high quality content on his social media platform at Physiotrition, and we are pleased to announce that he has produced a whole masterclass for the physio network where he goes into a lot more detail on how nutrition can really boost your treatment of patients in msk clinics click the link in the show notes to watch his masterclass for free with our seven day trial enjoy this podcast as there are some very important points that you'll want to cover with your future oa patients i'm james armstrong and this is physio explained Ben, it's great to have you on the podcast. Thank you so much for joining us.
SPEAKER_02:Thanks so much, James, and a real pleasure and honour to be invited on.
SPEAKER_01:Brilliant. So we are going to be talking around the topic that you've done for a masterclass with the Physio Network. And today we're going to be talking around osteoarthritis and nutrition. Obviously, nutrition is what most people know you well for on social media, combining that nutrition information with the physiotherapy background and expertise. So we're going to kickstart today's episode, pulling out a small chunk of a topic you've done for the masterclass, and that's going to be looking So we're going to start with weight loss and why weight loss is recommended as kind of a big part of the treatment for these patients. Can you talk us through
SPEAKER_02:that then? With a lot of osteoarthritis guidelines, both in the UK and throughout the globe, weight loss is consistently one of these three core frontline treatments. So the model that I like the best is the NICE model from the UK, which is this treatment target. So imagine like a bow and arrow target where you can do any of the treatments on the target, but the three in the middle are the core ones. And that's education, reassurance and support, both localized and global exercise, and then weight loss. for when patients have got an elevated BMI and I'm really passionate about for physios we do the first two really well but the third one is one that generally as physios we can prove in it's so important we know that the higher your BMI so the greater level of obesity a patient's living with the greater your risk of developing symptomatic osteoarthritis and it's most prominent at the knee so at the knee there's a really strong dose response curve just like two lines going up, where the greater level of obesity you are, the higher your risk of onset of arthritis is. And it's the same at the hip, interestingly, at the hand as well, although dose-response relationship's not quite so clear, whereas the knee's a little bit more structured. So we know those people who are living with a higher level of obesity are at increased risk. And obviously, for those people who are living with a higher BMI, this is a long-time thing. In the same way that osteoarthritis is this generally... very slow-burning, long-term, progressive condition. So if we can start to intervene at some point along there and help support patients to reduce and get down to a more healthy BMI, reduce some unwanted body fat, then that stands them in really good favour at first, reducing their risk of osteoarthritic flare-ups or worsening, and then if they are experiencing OA symptoms, it becomes a really good way of helping to manage that and reduce long-term symptoms.
SPEAKER_01:So you touched on there, Ben, around Weight loss is key, is important. Just kind of just to touch on that a little bit, we talk about weight loss and patients will often describe to us, oh, I know it'll take the load out of my joints. But can you give us a bit of an idea as to why else might weight loss be important for osteoarthritis in terms of the management of it? What else does it do to help these patients rather than just take load off the joints?
SPEAKER_02:I think this is crucial because the load one is evident, but then we then sound a little bit odd if in one sentence we say, oh, it's good if you lose weight to reduce the load. And then in the very next sentence we say, here's some exercises which increase the load. Patients are probably understandably quite confused about that. So it's the altered load associated with unhealthy weight, but far more prominently and what links to the association with hand osteoarthritis is the inflammatory aspect So healthy subcutaneous body fat is generally slightly anti-inflammatory actually. So it's a healthy thing and obviously a little bit of visceral, so intra-abdominal adipose tissue. But when you are consistently in a place where you're eating too much, so you get taking too many calories in, what happens with these adipocytes and the fat cells is they start to grow and increase and they basically, to put it simply, they're kind of crowding each other out. And then this causes a switch in the metabolic activity of the fat cells. So these adipocytes stop creating the more healthy hormones and start giving off the more pro-inflammatory, unhealthy cytokines, adipokines. These then create this low-level systemic inflammatory environment that's kind of almost ticking away in the background, but just slowly flicking that switch towards an unhealthy environment where it's negative impact for synovial joint health. Yeah,
SPEAKER_01:I wanted to touch on that because I think it's a really, really important one, especially from the point of view of education of our patients. So how can we as physios include weight management advice in our osteoarthritis treatment?
SPEAKER_02:Yeah, a really good conversation because we aren't dietitians and nutritionists and we shouldn't be trying to be. But how I think of it is if you meet a patient who has knee osteoarthritis and you just say to them, oh, you should do some exercises and then you leave the room. We would all agree that's quite poor physio. We haven't told them how many to do, what to do, when to do them. You know, this is giving some proper support in the exact same way that just saying to a patient, oh, you should lose some weight and then walking out the room, they probably go, oh yeah, I know. So we have to respect it's not our main avenue, but we need to do it well to support that. The main thing everyone's worried about is that patients are going to be offended or not want to speak about it. Sometimes patients bring it up and that's great. They then say, oh, I know I need to lose a little bit of weight. And that's a time to pause, go a little bit slow into the conversation and then discuss it. If not, the first tip I always say is ask patients. Probably it's not one normally to discuss in the first appointment if you're meeting a patient in a musculoskeletal setting, but maybe an appointment two or three, if it is someone that you feel would benefit from improving their overall health and losing weight, then ask and say, is it okay if we discuss weight loss? Because they are well within their right to say no. If they say no, then say, oh, well, the reason I ask is because I know we're here for physio. But actually, if I can do my part to give you some support and some guidance and some signposting towards weight loss, then that's only going to be helpful for what we're doing. Hopefully, of course, they are open to the conversation. In which case, the first thing is, if there is anything else clinically, e.g. diabetes, cancer, stuff like that, probably welcome. We give advice that losing weight is good, but they might need referral to a dietician or nutritionist or via their GP, right? But for giving overall health eating advice, how I look at it is that we can provide the support, the accountability, basic health eating weight loss advice, and they're going to be coming back and checking in with you with their progress with exercises. So we can always add on to that. Well, let's check in on a weight loss goal or something like that. So ask if it's okay. Make sure it's safe for you to discuss. I like to discuss some form of metric in the same way that we'll test the patient's strength with our dynamometer. It's quite nice. We might say, oh, well, if you want to lose this, let's set a goal. Or how often do you do your body weight so you're getting some kind of metric? I think it's probably outside a physiotherapist scope to physically, right, or get on the scales and let's measure you. Maybe some physios could do that, but if you could just say to a patient you know i could be your check-in point so we're going to focus on the exercises and it's great that you're going to the gym and everything but let's make the goal for the exercises is we're going to get to this on the dynamometer when i next see you in a four weeks time and how about we also set a goal that we're also going to get that number down by two kilograms and then you've got a little bit of accountability that i'm going to speak to you about that and generally i found that gives patients really good buy-in because they're understanding that we're not trying to force it to them but give them that little bit of backup
SPEAKER_00:This podcast is sponsored by Cliniko.
SPEAKER_01:No, that's great. It's a really good way of just involving it in part of our musculoskeletal assessment, but also the treatment, as you say, just being that pillar for that patient to come back to you each time and discuss their progress, whether it be good, bad or indifferent, I suppose. So going on to our final point, and one that I'm really keen to chat to you about, actually is some of these key foods, the nutrients that we might be looking at with our O8 patients and also talking about supplementations. I think this is another topic that there's an awful lot of information out there that I know my patients quite often come in and tell me that they think they should be doing or are already doing. Talk us through some of these key foods, nutrients and supplements, Ben.
SPEAKER_02:Sure. So we'll come to the supplements last. As you said, you're most interested in that. So keep your interest for the next couple of minutes. With kind of key nutrients, the main overall thing is it's promoting healthy eating, but then we can just apply the aspects of that to osteoarthritis. So hitting protein goal is important because we are asking these patients to probably do an exercise plan, which involves some kind of strengthening. We all know if we're going to the gym that we probably need some dietary protein to support that muscle growth. So getting their protein goal is important. With carbohydrates and we can modify this a little bit. So the carbohydrates are the energy sources. We want to promote this overall health eating. So we might try and encourage patients to avoid the classically unhealthy processed sugars, sodas, sugary drinks, things like that. Dietary fats are really important. And that's because dietary fats have got a key role in your metabolic profile. So saturated fats, this is red meats, animal fats, butters, cheeses, saturated fats generally want to be limited. And the Rough guidance is 11% of your total daily energy come from that. We really, really want to prioritize omega-3s. So omega-3s are a polyunsaturated fat and they're really well known for their anti-inflammatory effects. Most well known being olive oil, lots and lots of extra virgin olive oil, obviously olives as well. Oily fish, mackerel, sardines, trout, salmon would be really good. Flax seeds and chia seeds really high. So they would be the key fats that I'd want to be promoting. Then with the micronutrients, vitamin K is super important. It's also my favorite vitamin because I think every nutritionist should have a favorite vitamin. Vitamin K, super important. Basically, rich, green, leafy vegetables. And vitamin K is very, very important in bone health. There's VKDPs, which are vitamin K-dependent proteins, which require the presence of vitamin K. So green, leafy veg, lots and lots of that. Vitamin D... I'm not sure there's ever been a nutrition podcast where vitamin D hasn't been mentioned, but vitamin D is also really important. And then, as you've requested, supplements. Supplements, I think this, from my personal, only my personal experience, and from clinicians who have asked me, everyone's always really interested in what supplements they can take for OA. And the kind of brief overview, albeit we discuss it a little bit more, well, a lot more, in the masterclass is glucosamine and controitin, which is the poster child. really really mixed don't recommend it so do not say to somebody oh you should take glucosamine and chondroitin but a lot of people swear by it and you could have you could have one person sat on one side of me and say i've got 10 studies that support that you should take glucosamine chondroitin for vitamin for osteoarthritis sorry and then the person on the other side could say well i've got 10 studies that say you shouldn't take it and they are both correct and But the overall balance is that the higher quality ones don't support it. If it's not harmful and someone says, oh, I'm taking glucosamine and chondroitin and I find it really helpful, I don't then use that as an opportunity to be all obnoxious and butt in and say, well, actually, you shouldn't take it. Then you, as a therapist, are then actively taking away something that the patient finds beneficial. But I would never recommend it to patients. Omega-3s is obviously cod liver oil, fish oil as a supplement, regularly taken one gram or 1,000 milligrams, like a standard capsule per day. If you're not eating much oily fish, there's probably going to be a healthy choice. And then turmeric, curcumin, turmeric. So curcumin is just the active ingredient, active in compounds within turmeric. A lot of emerging evidence so far seems pretty positive. It's been used for thousands of years as an anti-inflammatory substance. I think some people, if you take it as a supplement, or you can get turmeric root and add it to your food, I think some people, if you take a lot, have mild gastrointestinal side effects, but other than that, it's pretty safe. So I always recommend to patients, take some turmeric, 12 weeks is the rough guidelines. Take a turmeric supplement. If you're happy to pay for turmeric supplements for 12 weeks, it might help, and you might feel it's beneficial and something to continue, or it might not, in which case, you haven't lost. That would be kind of my quick three or four minute overview.
SPEAKER_01:It's really interesting. You touched on a few things there. I had a patient myself just the other week who came in and said they kind of referred for osteoarthritic pain in their knees. And after doing the referral, they started taking costal congritin and glucosamine and on arrival said, well, since I've been taking it, I've hardly had any pain. And it really got me thinking about, well, who am I to say it doesn't work in that patient? And You hit the nail on the head with your answer to that.
SPEAKER_02:Yeah. And anecdotally, you read where it says in bold, we shouldn't be recommending this. Then a lot of people say it's really useful. Even more anecdotally, our family dog has joint health supplement, which we grind up and put in his food, which contains glucosamine and chondroitin. And our whole family are pretty convinced if we forget to give it to him for a couple of days, you can see his walking's not as good. And I'm like, hang on. This must be doing something. It's interesting, but the balances don't routinely recommend. But as for so many things within musculoskeletal care, actually, there are some people where it's going to be a relatively cheap, very safe adjunct to the therapy. So why not?
SPEAKER_01:Brilliant, Ben. Well, I mean, that's just a little bit of a snippet of the things you're going to cover in the masterclass. So a big thank you for your time today, Ben, and also a massive thank you for the masterclass that you've done for us. It's going to be really helpful from a physiotherapy point of view, but just touching much more on that nutrition. And I think the masterclass will give clinicians watching it a much better understanding of how they can include some nutrition advice without going out of their scope. but information that will be really helpful and beneficial to their patients and increase our confidence in that conversation with patients. So Ben, thank you so much for your time today. Thank you so much, James. Really appreciate it. Brilliant. So for everyone listening to this, if you're a little bit interested, which I'm sure you are in finding out more about how nutrition can benefit your patients, there is a link in the show notes below of how you can access the masterclass that Ben's done and many more. So highly recommend clicking on that and finding out more. So Ben, thank you much again and enjoy the rest of the evening. I'm sure we'll have you on again to talk about other things and all things nutrition and physiotherapy. Thanks, Ben.
SPEAKER_02:Thanks, James.