episode 19: Igor Klibanov : The Natural Approach to Osteoarthritis

Igor's latest book can be found at amazon.ca. You can also follow this link.
https://a.co/d/1p0YJiI

For further information regarding his services or to learn about the other books he has authored check www.fitnesssolutionsplus.ca/

Be sure to follow me on Instagram @drcliffworldwidevet.com
Listener questions, episode suggestions, or if you have a good idea for a guest, email me at dr.redford@vet905.com
Additional information can be found at drcliff.ca

Transcript

Dr. Cliff Redford (00:08)

My next boxing match, three weeks today. October 18th in Toronto. Yeah. Some sort of charity event. Yeah. I don't know what charity yet. The coach whose gym is running it reached out to my coach.

and basically said that his fighter wants a rematch. is this the guy you showed me earlier? I'm not sure, but it was the guy I beat in Brampton. Yes, okay. Yeah, it was my first, my first, what's it called? Like sanctioned match, non -exhibition. This one technically is exhibition, but you know, unless it's a really close fight, we'll put it down on our own mental scoreboard.

When you win by TKO, it's not even competitive. What's the point of a rematch? Well, I mean, yeah, I don't know. I don't know, but I'm not going at it like that. I'm going at it as if this guy has been training like a beast. And, you know, he wants to knock my block off in front of all of his friends. Maybe he thinks you've improved enough that it makes sense to do rematch. be. And look, the reality is, so at that time, I got a bye. There were only three in our division. I got a bye.

So I went right into the finals. So I only had to make weight once. And then I could just pig out. Whereas he had to make weight on the Saturday, fight, make weight again Sunday, fight me. And yeah, maybe he was tired. His first division, his first match went the distance. It's only three minute and a half rounds though. So there might be things like that. I don't even know if we're fighting 71 kilo. Because we both cut down a bit.

So usually in this sorts of things I've asked my coach to find out like are we doing 71 which is fine. Yeah, or are we just gonna be like 73 ish. Yeah 74 Usually for these gym events whether they're sanctioned or not or exhibition I guess they're both sanctioned but it whether it goes on it's official or exhibition, right? They allow a couple of kilos, okay, you know

Difference? they just don't want one guy to be giant. they'll usually do like three kilo difference kind of thing. Sort of like a 5%, a little bit under 5%. But as soon as I know, I'll let you know, man. Come out, buy some tickets, give money going to this charity, whatever it is. Sounds good. And we'll see.

Anyways, let's get this going although we already are recording. So everyone welcome to vet life with dr. Cliff blah blah blah Igor is a good buddy of mine. I have known you for I think since 2010 13 years Yeah, when we did Fit talk fitness twice 360 health wise what am I saying fit talk because there was you talk pet talk health wise

360, one of the talk shows on the AC media network. Man, if we had have kept going with those, we were like the beginning of podcasts. Like it would be huge. It'd be huge. It'd be us and Joe, you know, back to back maybe. Maybe we'd be above them, who knows. And you are from Fitness Solutions Plus? Exactly. Excellent.

But the big thing is you are like a crazy author. How many have you written including this latest one? Written 16 published so far 15. There's one more to be published in about two months. And that's the cholesterol one? That's the one. We're definitely going to have you back on that and I'm going to... My cholesterol has been at the edge of like the doctor saying, know, it goes much higher. We're going to put you on medicine. Right. I said, well, I'm not going to go on medicine. And you know...

And there was a lot that I could do to drop it. But yeah, both cholesterol and my sugar are right in the edge and it's genetic. I eat very, very well. You exercise a ton. I exercise a ton, but it's genetic. today you have this book, The Natural Approach to Osteoarthritis, Workouts, Diets and Supplements for Less Joint Pain Without Medications or Surgery. I've already had one surgery, one total hip replacement, but I got another one.

probably coming up in a year. Maybe you can save me. So let's talk about this book. How'd you get into this? Arthritis? Well, I've been in personal training for 18 years so far. And general personal training school, including my kinesiology degree as well as my certification, didn't really prepare me for chronic conditions. They talked about general fitness, how to lose body fat, how to gain muscle, how to be generally fit, but not specifically the best way to actually get rid arthritis. Or my previous books, Diabetes, High Blood Pressure, Osteoporosis, et cetera.

But I wasn't satisfied with just good enough, I wanted to see the best. Because you can spend an hour doing a good thing, or you can spend an hour doing the best thing. Still an hour, but you might as well do the best thing that you can for whatever condition you're working with, in this case, arthritis. So there was no certification that existed at the time, and now the only certification that exists in chronic conditions is actually my certification, the one I created.

in terms of what is the best way to exercise to work chronic conditions. But sometimes there is more to it than exercise. In some conditions, nutrition makes a big difference. As we might talk about, arthritis nutrition doesn't make a heck of a big difference, but in diabetes makes a huge difference, in hypertension, in osteoporosis makes a huge difference, as well as supplementation. So I was interested in what can I do as a personal trainer? As a personal trainer, medication, surgery, there are also my school of practice, so I didn't even dive into that. I say, if you want medication, surgery, talk to a pharmacist, talk to a doctor, talk to a surgeon.

But I can't help you there. What I can't help you with is exercise and nutrition supplementation. So that's where I did the deep dive in, first of all, for my clients to figure out what's the best way to do it for them. Once I started, like that one client who came to me with a chronic condition, once they got good results with what I learned in the medical literature, I started using it with other clients. And then I wrote blogs about it I got even more clients with more conditions like that. Then I taught, once I've had enough case studies under my belt, I taught that to my staff.

members who started using it with their clients who had those conditions. Once they get to writing a book, we have a few dozen success stories in person and a bunch more success stories through my blogs and newsletters. So that's how I of get to writing a book and working with Chronic Reduction and kind of specializing in that. Gotcha. And this can be, we can get it at Amazon. Yeah, exactly. Amazon, anywhere else? Amazon .ca, Amazon .com. Amazon's the big one. somebody lives in the GTA, they can pick it up in person. Perfect. No, Amazon works. Well, let's talk about this.

What are the main takeaways? mean, there's going to be a bunch of ones. And obviously, weight control's got to be huge. Yes. That's probably the first thing. There is a ton of myth busting. Weight control is a good one, but it's not necessarily the biggest one. Weight loss is a good way to improve your joint health, but it's not the fastest way. It's not necessarily the best way. You can do two things. It's also not as fun. It's not as fun. If you want to stay at your weight, you can be overweight and you can do certain things that keep you overweight.

But from an exercise and supplementation perspective, you can still improve your joint health without weight loss. I want to talk about the nutrition side of things, the myth -busting around nutrition extensively. But with that's the way to do it. actually classify the exercise. So I go through seven different types of exercise in my book, including strength training, cardio, stretching, yoga, proprioception exercises, and a couple others. And they're all classified based on three different parameters.

One is speed. How long does it take to see results? Two, magnitude. By how much does each type of exercise reduce pain? And three, durability. If you stop that exercise, how long before your pain returns? And so in terms of speed, there are a couple of forms of exercise that work fast in a matter of hours to days. And that's cardio. It reduces pain very, very quickly. Stretching, it reduces it quickly, but not by a large extent and the durability is not good. And proprioception.

those in interaction How does cardio reduce pain? I would think if I got a sore knee Yeah, let's say and if it is arthritic Yes, because I recognize, you know, I'm dealing with a sore right knee right now, but it is sort of compensation Myocytosis inflamed muscle and inflamed soft tissue because of my bad hip, right?

So when I run, it kind of feels a bit better because it's loosening things up. But if I had a janky knee, if I had an arthritic knee, how would cardio help? Yeah. if the knee is the issue, I'm definitely not talking about jogging. But there are, can swim, you can cycle, et cetera. But there's other cardio than jogging? Yes, exactly. Or boxing? That's it. Absolutely. But the way that cardio helps is systemically. One, endorphins. Once you cross a certain intensity threshold, your brain releases endorphins.

They block pain everywhere, including your knee. If have a bad shoulder, it'll also help your shoulder. Unless your choice of cardio is swimming, it's not gonna help your shoulder. So the effects are systemic. And the greater the intensity, the greater the pain reduction from cardio. Now you don't have to do high intensity, but the trade off is high duration. If you're gonna do moderate intensity, you have to it for over about an hour to get the pain reducing effects. That's one. The other one is psychologically. It seems like, people often have

I have this conception or misconception rather that psychology and physiology are totally separate, but they're not. There's an entire chapter in my book on how positive psychology and using strategies from positive psychology actually improve joint pain without any mechanical interventions, without manual therapy, without surgery, without acupuncture or anything like that even exercise. We can dive into that later if you want. But the way it helps you improve is...

You you challenge yourself with cardio so you think this is difficult This is painful, but I'm overcoming it and then that kind of transfers over to other areas of your life including joint pain It also for in one of my previous books called the fit executive I asked a lot of executives who are exercising four plus hours per week Why do you exercise they say if I do something difficult early in my day? It makes my the rest of my day go better even stuff that's not fitness related So it has that effect as well So a the endorphins and be just the psychological aspect of overcoming something

difficult. Yeah, okay. What about like blood flow to the the area? Is that benefit? Like, okay, so again, I'm gonna say knee arthritis. Yeah, I'm gonna avoid running. Maybe I'll do some spin cycling, you know, I'll do some bike riding. Does that almost zero impact repetitive motion going through the range of motion, improve blood flow and therefore reduce

pain and improve synovial fluid and all those things as well or is that just a myth? Somewhat. On the one hand, if there's no cartilage, there's no synovial fluid either. If there's cartilage remaining, there's going to be some synovial fluid. the reason that a lot of people, a lot of arthritis sufferers need surgery is because cartilage is avascular, like no blood flow goes to it. Blood flow goes around it. It goes to the muscles, goes to the skin, but things like tendons, ligaments, cartilage, they get next to no circulation.

Because of that, training is great, cardio is great, but not because it brings blood flow to those areas. Gotcha. Okay. So, so a fact, a fast way of reducing pain, cardio, appropriate cardio, stretching and proprioceptive type. And traction. And traction. Okay. For listeners who don't know, and I'll give you an example for knee arthritis specifically, traction comes from the word distraction, which means pulling one bone from another. So if we're talking about knee arthritis, you're going to pull the shin bone.

away from the thigh bone. You can do that manually or there are all kinds of traction devices. You can get them on Amazon or your local drug store. Just ask the pharmacist what's a traction device for, name the joint arthritis, hip arthritis, knee arthritis, shoulder arthritis, et cetera. You can find it easily now. Yeah, they're everywhere. All right. What about long -term benefits? What can you do? Strength training. Strength training has the highest magnitude and the highest durability. So in terms of magnitude, we're always working with percentages.

strength training helps reduce joint pain by anywhere between 40 and 60 percent if you do it properly and the durability is really really high. Once you stop strength training and hopefully you never do but if you do the benefits last for three to six months beyond the cessation of strength training. That's the only thing that has that kind of durability. Nothing else lasts that long. Appropriate reception is the next best one which lasts for about one and a half to two and a half months. Cardio you lose the effects in a matter of a few weeks and stretching lose the effects in a matter of minutes to hours. So different forms of

of exercise have different levels of durability on pain reduction. Right. And we're not just talking about like typical, you know, weightlifting exercises that any Jane or Joe would do in the gym, three sets, 10 reps, know, three exercises kind of thing. We're talking about very specific.

activating muscles that maybe are not firing or like, it's not just about building up a strong muscle around the joint as a protection. So what's interesting is that the protocol for strengthening is very different than the protocol for joint pain reduction. Whenever it comes to extra stress prescription, we want to know a few things. It's the FIT principle, F I T T, frequency, intensity, time and type. In terms of frequency, how many days per week? In terms of intensity, when it comes to strength training, it's how much weight are you lifting?

Time doesn't apply to strength training, that applies more to cardio, but in strength training we talk about sets and reps instead. And type, well, strength training. Because type could be one of the other ones. Could be foam rolling, could be proprioception, could be cardio, cetera. So the type is strength training. For building strength, which I differentiate from building muscle, the intensity needs to be pretty high, like over 70 % of your one rep max. Whereas for joint pain reduction, it seems like the intensity doesn't matter at all.

So there are a number of studies that I talk about in my book where one group of people actually has with only 10 % of their one rep max. That's never going to strengthen you. The intensity is just not sufficient. And then one group of people actually has with 70 % of their one rep max. At the end of the study, the 70 % group increases their strength a lot more, but both groups reduce their pain by an identical amount. So seems like intensity is a much less important variable for pain reduction as compared to strength building. What the two main factors that

matter when it comes to joint pain reduction with strength training is one, progression. No matter what level you start at, 10 % or 70%, try to make it a little bit harder next time. You can do that by adding a rep, can do that by adding a set, you can do that by adding a pound, lengthening the range of motion. There's many ways to progress, but just find some very small way to make it ever so slightly harder the next time. So that's the protocol for strength training. And the other element is just consistency. And that goes for any goal.

whether that's building strength, building muscle, building endurance, pain reduction, you just need to do it two days per week minimum, three to four days per week optimum. It looks like one day per week will build strength, but will not reduce joint pain. Four days per week will reduce joint pain, will build strength, but it's not superior to three days per week. So there is a sweet spot. Two days per week is minimum, three to four days is optimum. Five days per week will build strength better, but it won't reduce pain any better. So there is a sweet spot there. And we really have to our eyes on the prize. What are we really trying to accomplish? Is it

more strength or is it pain reduction? We can do both but you have to figure out what's your top priority.

Yeah, okay. And I would assume if they're in pain, that should be the top priority. Reduce the pain first. Worry about your mirror muscles and looking good later or lifting heavy weights later. The only exception I would make is if somebody is in pain but at the same time they're frail, then ignore the pain, build strength enough so that you're not frail, you're mobile, you can ambulate, and then focus on pain relief as well. Now, if you're already mobile, you're functional, et cetera, you're just in pain, yeah, exactly.

about pay reduction first and then building strength in multiple seconds. Especially because that pain can go away quickly. Yes. Like some of the exercises my athletic therapist had me do once she very quickly said, your problem is not your knee, which was the knee that I had my cruciate rebuilt like 12 years ago. She said the problem is the hip above it. Yes. So we're just going to do some foam rolling, a little bit of traction actually now that you're saying it, a little bit of traction on my patella.

And then she got me doing these like one -legged push the treadmill to activate my glute and all that sort of stuff Two or three sessions. I was like 90 % better. Yeah now I go do the consistency Yes, I've had to literally write it down or type it into my phone as a warm -up for my boxing Yeah, because I'll do the boxing every single day. I love it. I put on my Metallica or AC DC

weird Euro trash music you listen to. What's that band? Modern Talking. Modern Talking. No, that's not good for boxing, I don't think. And, you know, have it as part of my warm up and, you know, hopefully I can keep this thing feeling good for a long time. Okay, so we got exercise, like weightlifting, we've got cardio, proprioception, like range of motion stuff, traction.

I gotta do my yoga and stretching once a week, like active, like 75 minutes at the hot yoga place. What about nutrition? What do we do? Nutrition, is really one thing you can do and that is weight loss. that's it. If somebody has no weight to lose, nutrition is not gonna do anything for them, for their arthritis. Okay, well when I say nutrition, I think supplements. Okay. Also. Yeah, so I separate those two. Okay, so there's no, before we get into supplements, let's say, there's no...

Macro or micronutrients, I'm throwing this out there calcium phosphorus vitamin K, know vitamin D There's none of these things that are beneficial Omega omega fatty acids is that nutritional or supplemental? That's probably supplemental. Yeah There's none of that stuff. That's nutrition. That's really useful. No, the only thing that works is weight loss And so actually my book I go through all of these so we use you say vitamin C So I looked at dietary vitamin C like orange and kiwis no difference

We talk about things like gluten. Does it make a difference or does it not make a difference? So it makes no difference. The only thing that makes a difference... What about sugar? Not a difference. Sugar doesn't cause pain though? Sugar does not cause pain. Sugar makes pain worse once you already have it and not that kind of pain. For rheumatoid arthritis, which is a world of difference than osteoarthritis, yes, sugar worsens that. For osteoarthritis, no difference whatsoever. A lot of people, a lot of nutritional guidelines for osteoarthritis come from what I call

bad science. They come from either mechanistic evidence. So for example, they look at stuff in petri dishes. They come from evidence in mice, rats, monkeys, et cetera. That doesn't apply to people. They come from people who don't have osteoarthritis. They come from research on rheumatoid arthritis. But in science, very basic law, if you take an undergrad, any undergrad science course will tell you you can only apply from the, what they found in the study to the, towards the population study. You have to study people with osteoarthritis, specifically.

Not people with rheumatoid arthritis, have to study people with osteoarthritis. So don't go talking to your veterinarian asking for health advice. Correct. Unless he's read this book. Yes. Or talked to his buddy Igor. Because my dad, who's going to be listening to this? Hi dad, love you.

going to get you this book. we, us Redfords, do suffer from rheumatoid arthritis as well. so I was very pleasantly surprised when you talked about that regarding sugar because when I'm very good at cutting out simple sugar, which is very regular.

I kind of joke that I feel greasy. Like everything feels good. The pain is gone. it's actually the, and it's not that the arthritis pain is gone. It's the rheumatoid arthritis pain that's gone. only difference, the only similarity between rheumatoid arthritis and osteoarthritis is the name arthritis. But the, but everything else about it the two diseases is vastly different. The word osteoarthritis, anything, any anitis is inflammatory. Arthritis, bursitis, plantar fasciitis, tendonitis, that's inflammatory. So

They both have inflammation. However, in osteoarthritis, inflammation is a consequence of the condition. In rheumatoid arthritis, inflammation is a cause of the condition. And so the treatment is vastly different. For osteoarthritis, treatment, the large part of the treatment is exercise and to a lesser extent, supplementation. Nutrition has very little it can do. For rheumatoid arthritis, nutrition plays a world of difference and exercise plays a smaller difference. So it's just vastly different. So get the diagnosis first.

and then you know, then that's that whole fit, F -I -T -T, you gotta know what you're treating. All right, so nutrition, that's an easy chapter. Then to read, lose some weight. Well, if you have more than 10 % weight to lose, objectively, not vanity pounds, because a lot of people have more of a body image issue than they do an actual body fat issue. If you objectively speaking have more than 10 % of your body weight to lose, weight loss will make a significant enough difference. How do you tell that though?

If

doesn't do so for maximum muscle. And so the percent of people for whom BMI doesn't work on a population basis because they're so muscular is less than 1%. So on a population basis, BMI is pretty good. On an individual basis, it might not be good because for that exact reason. The other reason BMI might not be great on an individual basis is a far larger part of the population who actually has good BMI, but especially seniors, frailty. They have low muscle mass, low bone mass, but high fat mass. So for them,

DMI also isn't great. But for the middle part of the population who's not super athletic or super frail, it's perfectly fine. So that's how you can tell if you're at your ideal weight or above or below your ideal weight on a population basis. Gotcha. So if you're a guy who weighs 200 pounds and your ideal weight is 180. Yes.

Let's say your ideal weight is 181, so that's just under 10%, then weight loss is not a key factor in arthritis pain. You're better served doing other things like exercise or supplements. Okay, but if you're 30 pounds overweight, if you're 210 and you should be 180, and there's a lot of people like that, and they probably still look good in suits, depending on how the fat is distributed. Right.

gets into stress and smoking and you know.

again, is it just calorie excess or is it what kind of calories? What exactly are you eating? Like some of this stuff goes in different parts of the body. Genetics plays a big role. Some people look different at 10 % overweight than other people do. But if you're 10 % overweight, if you're more than 10 % overweight, man or woman weight loss will be beneficial. But that's a long term thing. And better for your heart, better for your overall

probably your sleep, better for so many things, but it takes a long time to do that. The funny thing is, the two most recommended diets for osteoarthritis are the Mediterranean diet and the anti -inflammatory diet.

Okay. Now, first of all, nobody has a clue of what the anti -inflammatory diet is. They just say, cut out what's bad for you. So let's define it. The anti -inflammatory diet is high in three things. Antioxidants, a specific type of antioxidant called anthocyanidins. Anthocyanidins, okay. Yeah, and omega -3s. That's it. That's the anti -inflammatory diet, officially. Okay? Because a lot of people have no definition, so that's the definition. And between the reasons that I don't like to look at research on specific diets is because I like research that isolates

variable.

When you change an entire diet, there's a million variables. For example, the Mediterranean diet is high in omega -3, it's high monounsaturated fatty acids, it's moderate in poultry, it's low in red meat, it's high in vegetables. So if that's drastically different than what you're currently eating, what's the one thing or the multiple things that cause the change? We don't know. So that's why I researchers that isolate variables so can pinpoint to one thing. And so people are asking, well, why is it that the Mediterranean diet and the anti -inflammatory diets are so effective for osteoarthritis?

antioxidants, it's the omega -3s, it's way simpler than that. It's calories. Lower your calories low enough to be at your ideal weight. Because you're, it's that whole joke of if you want abs like this, do three sets of 10 reps of stop eating so much crap. Yes. So my favorite exercise for abs is table pushaways. That's right. Shut your mouth. Yeah, exactly. Yes. Yes. Shut your mouth. Stop eating.

Yeah, mean, we, North American society, we're usually in a calorie surplus. And you had a nutritional deficit, right? Like garbage. It's garbage, the stuff that so much of the stuff. Nutritionally avoid food. So it's got a lot of calories without a lot of nutrients. Yeah, I go to, you know, I go to Greece every year, go and visit my in -laws and...

Like we go ham, man. We pig out and we eat and we drink Uzo and you know, they got so much good desserts based out of, based with honey and you know, obviously Mediterranean diet, but like we stuff ourselves and I come back 10 days later and I'm lighter. Yeah. You more nutrient dense food, more nutrient dense. And, and you know, it's sort of

You wouldn't like it because it's very non -scientific. It's not specific, but it's it's cleaner. There's got to be something about you know, the body's processing it better and and I don't remember ever seeing a McDonald's in Athens. I'm sure there's one right maybe but you don't see you don't see a McDonald's there and I mean, yeah and the lifestyle is different. They probably move around more. yeah. Yeah, they definitely move around more

Yeah, there's so much, mean, heck, just the arguing that they do. exactly. calories. That probably doesn't. But yeah, so I mean, cut, do the pushaways. the table pushaways. It's such a good idea. All right, then supplements. That was easy for nutrition. What do we do for supplements? I mean, I know of glucosamine and chondroitin sulfate and omega fatty acids. For animals, we don't know if...

So theoretically, we understand that the physiology of the joint of a dog is similar to that of a human. so theoretically, chondroitin sulfate and glucosamine should help. Should help build up the cartilage. It should help improve synovial fluid, so lubrication.

But we don't know if dogs can absorb it. We worry that, at least this is my understanding, that the molecule of glucosamine might be too big and so that the dog's body sort of rejects it and passes it and doesn't absorb it. We don't know and no one's going to do the studies because none of the pharmaceutical companies are going to make any money if they, so they don't do that. What we have seen and I think it's a lot anecdotal, but we've seen benefits of things like green lipid muscle.

as very effective. most of our treatment... What is green lipid muscle? Green lipid muscle is like... muscle is in -U -S -S -E -L. So shellfish. Gotcha. I mean, it smells like turtle food. It smells like little shrimp. But the shellfish... You might be able to tell me better. I don't know what's in it anymore. But this is product called Forsyte. We've seen some really good...

effects in the early stages. We don't know about preventative, but in the early stages and certainly mega doses of omega fatty acids can help, but we end up having to rely more on like pharmaceutical treatments, injectables, things of that nature, and obviously painkillers, but there's very little research for animals.

where it's actually been proven and the money's been put into to show that these supplements, over -the -counter supplements can help. So any of my animal -loving friends listening to this, take this with a grain of salt because this is for people. as you said, the mice studies aren't good enough. You wanna do studies on people. That doesn't mean it's bad. Talk to your veterinarian, but...

It'll be interesting one day we'll figure out how similar they are.

So what can I do? I'm thinking I don't have as much, I mean my hips got bad arthritis from the acetabular impingement, but that's structurally F'd. That's really, really bad. know, supplements aren't going to rebuild or reconstruct the pinched acetabulum, the pinched joint socket. But as far as reducing arthritis, what can I do? If I start something right now, what can I do? Yeah. So the, I just want to bust one myth out there is that

You cannot rebuild cartilage. exercise and supplements. Maybe you can do it with stem cells, maybe you can do it with other but you can't do it Can you thicken it? No. Really? Yeah. So we're always told, we're always told, I mean, I'm a little bit older than you. I remember 25 years ago, 27 years ago now in vet school, being told that the studies in people for glucosamine specifically showed that people on glucosamine

had a noticeably thicker cartilage based on, I'm going to assume, x -rays. And you're saying that's not the case. Well, so.

I think it's usually glucose in combination. Okay. Condroitin and MSM. Okay. And so you can't regrow cartilage. Okay. you can do is so that what they say about glucose, condroitin and MSM, and those are like the trio of arthritis supplements is that they can maintain cartilage. Okay. So first of all, if you have end stage arthritis, in other words, it's bone to bone, there's no cartilage, there's not going to do anything for you. However, if you have some cartilage remaining, it's going to just want to slow down the progression of arthritis. It's not going to relieve pain. Okay.

So I mean and they've been studied forever and they've been studied in Rasmussen and Peter Dishon since the 50s and then people since the 80s. They've got a ton of research on them and the research is very consistent. They don't relieve pain. Unless you believe they're gonna relieve pain then you have the placebo effect working for you. Which is very powerful. Pain is really subjective so if you believe it's gonna reduce your pain it's probably gonna reduce your pain. However I want things that work even if you don't believe they're gonna work and there's only two supplements that do that.

One is type two collagen, the other one is fish oil, omega -3s. by the way, I distinguish those two, fish oil and omega -3s. There are omega -3s that are not fish oil, like alpha lipoic acid. Alpha lipoic acid is great for many things. However, improving joint pain is not one of those things. So specifically omega -3s, EPA and DHA. Those are the only two. And those are the only two supplements that I'm aware of. And I've listed a bunch of supplements in my book and analog.

works or doesn't work and no other supplement works except for those two. There's a ton of myths out there then. Yes. So can you get enough fish oils from eating fish? Yes, if you're eating at least about 300 grams per week of fatty fish. things like sardines, anchovies, trout, things like that, they will help. Not salmon? Salmon, yeah. mean there's any type of fish that's a fatty fish. Salmon, herring, etc. How much is 300 grams? 300 grams would be...

of air quotes steaks, like a couple of salmon steaks. Even one salmon steak will do it. Even one salmon steak is about 300 grams. Close to 300 grams. Okay, so you only need 300 grams once a week to get the benefits of fish oils in reducing pain. Correct, and that's split across them. If you want to do smaller portions more frequently, that's fine too. Is there a benefit between sort of...

getting it in a capsule versus getting it in its food, in its natural source? Good question. It hasn't really been studied for arthritis. It has been studied extensively for cholesterol, which there's a world of difference between fish and omega -3 supplements. But in arthritis, it hasn't been studied. So we don't really know. We don't really know. Yeah. OK. Tastes a better in the salmon. A little bit of oregano and lemon.

course being Greek. That's staple. Okay, so fish oils, like omega fatty acid fish oils, chondroitin,

MSM Glucosamine don't work don't work don't don't work for pain reduction, right? They work for maintenance of the cartilage you have now for slowing down the reduction cartilage, but not pay reduction Okay, if we're specifically talking about pain reduction just call it type 2 collagen and Omega -3s. Would you recommend like the average? active

35 40 year old who yet has been diagnosed with osteoarthritis to be on Glucosamine chondroitin and MSM for prevention probably. Yeah. Yeah, just are you on it? No, why not? Well, I don't really have a family history of it. My grandma didn't have it. My dad you're not doing any crazy sports. I mean, you're very very fit. You're not doing any Collision sports. Yeah. Yeah, I'm in combat sports anymore. My dad doesn't have any 72. My mom doesn't have it. She's 58 My grandma never had it. My grandparents didn't have it

not in the family history. You're lucky. Because of that, don't think, for my case, it doesn't make sense. Right. It's not dangerous, though. There's no harm in it. For most people, are some who will shellfish allergies, so they probably shouldn't take glucosamine contrarianosine. Diabetics should really talk to their doctor or better yet, their pharmacist about glucosamine because glucose... Why did you say better yet? Your pharmacist. Pharmacists are way better at supplements than doctors are, especially drug nutrient interactions. Doctors, no offense, no

little about supplements. They're very good at many other things, but they're not good at There's just too much knowledge. Yeah. It's just their head space is limited. Right. And just like that, pharmacists are great at supplements and they're bad at other things, right? They're not going to do surgery. Yeah, exactly. So speak to a pharmacist about drug use and interactions. Don't speak to your doctor. Most doctors are too conservative. They have too much on their hands. So just to be conservative, they're going to say, don't take it, even though what they really mean is, I don't know how it works. Right. Gotcha. They're too shy to say that. Yeah. Okay. Yeah, that's true.

Alright, so we've talked about supplements, we've talked about nutrition, or pushing away from the table and exercise and all that sort of stuff. There's also the huge component, very, very underrated component of psychology. Okay. So there's an entire chapter there about positive psychology. And so there's an interesting field of research about why is it that some people with objective evidence of mechanical damage experience no pain?

And yet other people with the same degree of a mechanical damage experience tremendous pain. So if you look at an x -ray of two knees of two different people, you would think they're both in the same amount of pain based on the amount of cartilage or absence of cartilage. And yet it's the variation in subjective pain based on objective evidence is so wide. You have to conclude that sometimes pain does not equal damage. Right. And likewise, damage does not equal pain. And it's not that the person who's not feeling pain is tough.

Correct. It's it's different. Yeah, different a different brain. Yeah a different upbringing a different, you know

Just psychology of it. Exactly. Psychology is the right word. There are two personality traits specifically that distinguish the people who will feel pain from damage and people who will not feel pain from damage. And that is a bit of a simplified. Those two personality traits, one is self -efficacy. The other one is called catastrophizing. Self -efficacy means how in control do you feel of your pain? And catastrophizing is what do you think are the consequences of your pain? In other words, are you a person who thinks of worst case scenario immediately or are you

more of an optimist and you're like, it's going to be okay. And I tell a tale of two different clients that I've had without mentioning their names. So I had one client, I have one client, he's 84 years old. And about 20 years ago, he had an arthroscopic surgery.

He believes nowadays, 20 years later, that his knee is still swollen. When I look at his knees, I see no difference. And to prove to him that I don't think it's swollen, I asked 10 random people in my gym telling them one of his knees had a surgery 20 years ago. Which one do you think it is? Five people said one knee, five people said the other knee. And that wasn't good enough for him because in his eyes, he still saw more swelling than it actually was. There was no swelling.

it defines a great part of his personality. self -identity is rooted in the history of this surgery. so everything he does, objectively speaking, when I do strength testing, I do range motion testing, it's perfect. It's as functional as a knee who's never had a surgery. And yet, in his mind, this had a surgery, this has damaged me forever.

And so for him to actually acknowledge that this knee is perfectly functional, he's got all the strength of the other knee, he's got all the range of motion of the other knee, all the proprioception and everything, it would be, he would actually have to change his self identity. It's very, very difficult to do. And so every morning he wakes up and he looks for problems where there are no problems. So those problems are created in his mind only. I have another client to contrast that. He had a shoulder injury, he got rehabilitation for it, he restored strength, range of motion. Three weeks later I asked him, how's your shoulder? He asked, what do mean?

He forgot he ever had the injury right it didn't define him He likes that. Well, I mean maybe he's 84 years old. He forgot about it, but the other kind of thing for as well So yeah, but nonetheless he forgot he ever had the injury. It didn't define him and it didn't hurt anymore He didn't dwell on it. So that is catastrophizing gotcha Do you think it's gonna be effective for life? Do you think it's it's bad now But it's not gonna be bad if I treat it and then it's gonna go away. Yeah, so that's catastrophizing, huh? Yeah, but there's no supplements for that. There's no

for catastrophizing or self -efficacy. However, there are tests for it and they're obviously subjective tests because they're personality tests just on a 0 to 5 scale rate how true you think this statement is and there's 10 different statements that you can go through. You can just go on Google and type in self catastrophizing test or self -efficacy test. I would imagine if

a doctor, let's say a doctor was a psychotherapist was presented with a patient who was in pain due to a real serious injury in the past, surgery, that sort of thing. And they're in a lot of pain and it's really affecting them. And they did this test and they said, no, Mr. Jones, you're just catastrophizing. It's all in your head.

No, the person's not gonna be like, you don't know type of truck that pain is real. And the pain is real. It is in your head, it's in the brain. In other words, the brain is in your head, that is true. But we used to think there was one pain center in the brain. We now know better. There is no pain center in the brain. There are multiple pain centers. Not to get too deep into the neurology and neuroscience of it, but there are something like 11 to 19 different pain centers in the brain. So injury to injury from person That we know of. That we know of. Yeah, there's gonna be more later on.

So in one person of the way

the same injury in another person will bounce around different parts of the brain. Furthermore, in the same person, the same injury a few years apart will activate different parts of the brain. One of the areas activated is called the hippocampus, which is responsible for memory, especially converting short -term to long -term memory. If this is a brand new injury, the hippocampus will get activated and think, have I experienced this pain in the past? Yes, no, no, okay, move on to the next area of the brain. Or if they experience this injury, the hippocampus gets activated and asks,

Again, did I experience this pain before? Yes, no, yes, okay. How was it back then? Was it bad? Was it good? How did it affect me, etc. And so again, the same injury can activate different parts of the brain in the same person if it happens a few years apart. That's one example. Another part is called the amygdala, which is responsible for emotions, especially anger. In other words, some people get injured and they're upset. Others are angry. Another area activated is called the prefrontal cortex. So there's different areas of the brain activated in the same person

with the same injury in the same person with different injuries in different people with the same injury in different people with this with with different injuries And so there's no pain center of the brain So it is in your head, but it's in your brain And so the pain might be real even if the mechanical damage is not okay pain the the The official definition of pain is it's an experience and experience is personal. It's not like an x -ray We can measure and can see things like like an MRI we can measure and see things you can pull out a ruler and say set X number of

centimeters, loss of cartilage, et cetera.

So it's a subjective experience. again, the pain is real. I don't doubt that. But the mechanical damage is not real. And again, what is it that differentiates people who feel pain in response to mechanical damage and those who don't? There's a number of different factors, from a personality perspective, it's self -efficacy and catastrophizing. Now, just because they are personality traits doesn't mean they're not changeable. There are ways to change those personality traits. But that's difficult. It's not difficult. So there's an entire area of psychology

called positive psychology. Before I looked into it, I thought that just means think happy thoughts, don't worry, be happy. But no, positive psychology is actually more like do good behaviors and as a result you'll feel good things. So it's not just about thinking happy thoughts, it's about doing good things. So in one of the studies that I talked about in my book, there was a six -week program of positive psychology and it was compared to a six -week program of...

placebo. What people thought was positive psychology, but was, but actually wasn't. For example, in the positive psychology group, the researchers asked them in week number one, list five positive things that happened to you today. In the control group, just said list five things that happened to you today, not necessarily positive. The next week, week number two, it said in one day, do three nice things for somebody else. Like hold the door open for them, give them a compliment, et cetera, et cetera. In the other group, it says interact with three people today. Doesn't have to be positive.

or negative just contract through people. So that's how they compared positive psychology to control group. And again, there's no mechanical interventions. They didn't manipulate any joints. There's no biochemical intervention. They didn't take medications or supplements, no nutrition, just psychology. And at the end of the study, the positive psychology group dropped by an equivalent amount to exercise without exercise. And the effects were long lasting. After the six weeks of positive psychology were done, the researchers followed up with them at a certain period of

And like months afterwards and the benefits still held. Hmm So it's not a physical exercise, but it is like psychological exercise and it's not very difficult How how hard is it to do something nice for somebody like holding the door open for them? How hard is it to give a compliment to somebody? It's not very difficult and yet the effects on the subjective perceptions of pain are very large so that's that's part of psychology and self -efficacy Which is one of the personality traits could be improved by think about what that word means You think that you can be effective for yourself

So think about what can you do that relieves your pain? Can you exercise? Well, yeah, there's a bunch of exercises you can do. Can you put an ice pack on it? That can relieve the pain. Can you take a painkiller? That can relieve your pain. If you think you are in control of your pain or at least you have some kind of influence over it, that's going to improve your self -efficacy. Catastrophizing is, first of all, understanding the difference between damage and pain. The first step towards reducing catastrophizing is understanding what the literature calls therapeutic neuroscience.

Education or that means in simple terms is just what I explained pain does not equal damage damage is not like well It does not equal pain just because it hurts doesn't mean it's damaged That's just because even if it is damaged doesn't mean it's gonna be further damage. There are there are things you can do about it and those are the low -tech ways the the more involved ways are actually to see a therapist like a cognitive behavior behavioral therapist or DBT dialectical behavioral therapy But even without a therapist there are there's lots you can do to improve your own personality traits personality

is not permanent. right. But it is, you know, when I said it was complicated, what I meant is, you know, the average person would have to...

read a book to learn what those steps are to do that therapy, that positive therapy on their own. And they're not necessarily, what if they don't do it right? What if they don't follow through? Whereas, you know, taking a supplement is easier. Mind you, learning an exercise, I mean, you have to learn the proper techniques and then you go back to your trainer or your physiotherapist or your AT and then they do a new exercise. you know, so there is some work involved.

than that, but at least you have that coach putting you through it, right? We have a saying, and it's obviously not just in the vet world, that we don't treat the x -rays, we treat the patients. And a physician client of mine said, yeah, we don't treat numbers, we treat the disease. And then I was like, well, what about cholesterol? And she was like, that's different. She's like, because that's a hidden problem if you got a high cholesterol, let's say.

Then before we quickly talk about your next book for five minutes, what, there's gotta be some bad things that people do other than eating garbage food, being too heavy. Are there supplements or?

medications that are commonly taken like NSAIDs that can speed up or worsen osteoarthritis. So as a personal trainer, I'm not allowed to comment on medications. supplements, is nothing that's bad. There's just stuff that's ineffective. There's nothing that's really going to harm you unless you take a crazy dose of juice. if you believe something is going to work, even in the absence of evidence, the placebo effect is a real effect. Go ahead and give it a shot. Give it a shot. See. Well, in animals, and we do

know the very big similarity between cats, dogs, and people, non -steroidal anti -inflammatories, NSAIDs, aspirin, Advil, which is ibuprofen, Tylenol is different, those sort of cyclooxygenase inhibitors, so aspirins and whatnot, they over time can be...

damaging to the bones to a certain degree. There's a level of chondral protection because it does reduce inflammation and inflammation can cause damage, But over long term, can cause issues. Cortisone shots, obviously. When I had my first hip...

diagnosed that I was going to need surgery. I wanted to avoid it for as long as I could. And I went through two cortisone shots. The first one worked great. Second one didn't really help at all. And I knew I was damaging the joint. But I also knew eventually they're replacing it with a titanium joint. So who cares?

wish I had done the surgery much sooner because you know two -thirds of my body improved as far as function as soon as that hip was replaced so I'm kind of looking forward to when the next one gets done yeah but not right now because of boxing and surfing season right here so I don't want to do it and it's not that bad yet but okay so there's really nothing that that other than you know bad exercise where you're injuring yourself or

let's say obesity, high BMI, that sort of thing. The ultimate guideline in terms of exercise is just pain. If an exercise hurts, either don't do it or better yet, I talk about an indicator exercise, which is make that your indicator exercise to test how is your progress with your exercise. So if it hurts, find a way to do the same exercise pain free, either shortening the range of motion or reducing the weight. especially with knee or hip osteoarthritis, I use the example of step ups.

I want something to actually carry over to their everyday life. One mistake that think that professionals make, people who treat osteoarthritis, is they want it to look good on a therapy table. But then you get off the therapy table and it hurts. You're climbing stairs, still hurts. You get off your chair, couch, or toilet, your hip hurts. So I want it to actually be good when you get out of the gym. So the indicator test is something that actually hurts you in real life, not in a contrived environment of a therapy table. So for example, step ups, going up the stairs. A standard stair is eight inches.

hurts try six inches. So you're going to have to use something smaller. Or if that hurts try putting your more weight into the banister to take some of your weight. So figure out ways to make the pain full pain free and use that to train yourself across time. What you want to do is you want to do as many pain free repetitions as you can or 10 whatever comes first. If you can do that rest two to five minutes and then repeat the same exercise. If your number of pain free repetitions stays the same or increases keep doing the same exercise.

However, your first set with number of pain free repetitions decreases. That's the end of that exercise for you for that day Okay, okay, and then try it again the next day, right? Eventually you'll find that you can get ten consistent reps pain free for two three consecutive workouts at that point find a way to make it harder If you've been stepping on if you've been stepping onto a six inch step try stepping onto an eight inch step now See if it's that pain free now if you've been putting your weight into your hands into a bad ester Try not doing that or try putting it into just one hand. So just find ways

to make the pain full, pain free. And over time progress that in range of motion and the amount of weight that it bears. All righty. And your next book comes out when? It's cholesterol, right? That's actually in two books. I got into a book writing group. my goodness. three books in two months. OK. So this one is The Natural Approach to Osteoarthritis. Yes. I'm going to do a link on this episode's sort of info thing. The Amazon link.

What is the one that's coming out next? It's actually already out, but I haven't started a promo for it. It's a book about PCOS, Polycystic Ovarian Syndrome, which is a condition only in females, obviously, because men don't have ovaries. And it's when women have high testosterone, high insulin, and irregular periods, unless they're postmenopausal. So it's...

Like if you have a 25 year old with PCOS, it's a testosterone and or insulin issue. Often both, yeah. Really? Yeah. Well, I the ultimate diagnosis is polycystic ovarian. So many cysts on the ovaries. Right, right. But it's characterized by excessive, well, I shouldn't say testosterone, shouldn't say androgens in general, because it also includes others, androcyndiol, DHEA, DHT, et cetera. OK. But also high testosterone, high in some other hormones.

hallmarks and some women also high estrogen and some women also subclinical hypothyroidism and some women also high cortisol. But the two hallmarks are high insulin and high testosterone. High androgens. Okay. Wow. Okay. So PCOS is the book that's out as well. Yes.

And then the next one is the one I'm looking for, cholesterol. Correct. Okay. And when does that launch? So the writing is finished and the editing is finished. So it's now in the illustration stage. So it should be out, let's say mid to late November. Very cool. my goodness. There's a lot of myth busting. I'm very excited about that one as well. Yeah. Yeah. I'm,

hit me up for like editing it, to help you edit it. Sounds good. I'd be happy to and then it'll give me a chance to read up on it. Yeah, you got it. Because I want to avoid Lipitor and all those drugs as much as possible. I'm 51. I would like to see if I can get at least to 60 without taking any sort of pharmaceuticals. Yeah, totally. And I mean, at that point, I'll decide if I can go longer.

Obviously I'll do what is right for my health, but if I can do it the natural way, that would be great for everything. nutrition plays a huge role. there's exercise, and there's a lot of myths about exercise for cholesterol. Cardio doesn't actually lower your cholesterol, even though it's tremendously positive for heart health. Right, right, right. Yeah. Well, I mean, that would explain why my cholesterol is borderline. Yeah. Like, you know, I'm an ex -marathoner. Heck, I went to ultra -marathons, right? know, 100 kilometers.

racist. cardio was my thing and still is.

All right, that's that's exciting. Yeah, anything else going on? Where can people find you? Amazon look up my name on Amazon. It's a very difficult last name, but if you just okay, but like you you Social media linked in like how if they want to follow you if they want to come get some of your advice hire you What how do they find you? I'm very bad with social media, but my website is www .fitnesssolutionsplus .ca Perfect. Yeah. Okay. Excellent, man. Thanks for coming on my pleasure. Thanks for having

and I love talking about this kind of stuff. Excellent. As always, be kind to animals, be kind to yourself, be kind to others, be kind to your joints. Yes. For the women out there, be kind to your ovaries. Yes, absolutely. And if you guys like this episode, I just read that I'm supposed to be not only just saying share and comment and etc. etc. which I don't never really talk about. I'm gonna ask everyone who enjoyed this episode and stuck around to the end.

Send, share this episode specifically to one person. Text it to a family member, a friend, a coworker and say, hey, this guy, Igor, knows what he's talking about. Check it out and this guy, Dr. Cliff's not too bad. All right, man, thanks for coming on. Thanks for having me. This was a lot of fun. All right, cheers.