Advanced Mediterranean Diet

Photo credit: Steven Paul Parker II

Dr Ken Berry published at YouTube a 4-minute video on a diet he believes will lessen the effects and incidence of knee osteoarthritis. For men, the lifetime risk of developing knee osteoarthritis is 40%. For women, 47%. The effects of arthritis are pain and impaired functional status. The title of the video even mentions reversing arthritis. I suppose improved pain and functional ability would be at least a partial reversal.

In short, Dr Berry suggests a diet free of all sugar (no mention of fruits), all grains, and all vegetable oils.

Dr Berry refers to a study done at University of Alabama at Birmingham.  The research was published in Pain Medicine.

Dr Berry also referred to a study of cadavers that found a doubling of knee osteoarthritis from around 1850 to 2000. The researchers don’t think aging and obesity are related to the increase. Maybe diet has some thing to do with it.

How was the UAB study done?

The twenty-one study participants were folks with knee osteoarthritis between 65 and 75-years-old. Nine men, 12 women. Average baseline weight was 194 lb (88 kg). The 21 participants were randomly assigned to one of three diets they would follow for 12 weeks:

1. L0w-carb diet group (8 participants). Restricted daily total carbohydrates (not net carbs) to 20 grams or less for the first three weeks. Then could go up to 40 grams “if required” (not explained). No fat or protein or calorie restriction. Limited amount of vegetables were OK (e.g., 2 cups/day of leafy greens, 1 cup of non-starchy vegetables). Carb-free sweeteners (stevia, sucralose) were allowed but maltodextrin-containing sweeteners were limited (stevia, sucralose, aspartame, saccharin). This group had no drop-outs.
2. Low-fat diet group (6 participants). 800–1,200 calories/day. It looks like the men were put on reduced calorie diets—500 cals under estimated baseline or maintenance calories. Women’s calories were reduced by 250-300/day from baseline. Calories were reduced mainly through reduction of fats. They ate veggies, fruit, low-fat foods, whole grains, low-fat dairy, and limited cholesterol and saturated fats. Macronutrient distribution: 60% of calories from carb, 20% from protein, 20% from fat. (Yet Table 1 indicates 50–67 g of fat/day. Twenty percent of 1,200 of calories is only 27 g of fat. So misprint in table 1?) This group had one drop-out.
3. Control group (N=7), eating as per their usual routine although given documents on portion control. Two drop-outs.

The authors indicate that groups 1 and 2 ate about 100 g of protein/day.

All participants filled out surveys documenting knee pain levels and were put through periodic supervised tests like a timed walk and repeatedly arising from a chair with their hands placed on opposite shoulders.

Results

The low-carb diet group is the only one that demonstrated decreased pain intensity and unpleasantness in some functional pain tasks. In other words, improved quality of life.

The low-carb group lost an average of 20 lb (9 kg) compared to the low-fat weight loss of 14 lb (6.5 kg), not a statistically significant difference. Even the control group lost 4 lb (1.8 kg).

A blood test—thiobarbituric acid reactive substances or TBARS—indicated reduced oxidative stress in the low-carb dieters.

The authors hypothesize that the improvement in arthritis pain in the low-carb group was related to the reduction in oxidative stress, which reduces pain and inflammation.

Will these old knees make it up Humprheys Peak one more time?

Implications

With so few participants, you know this was a pilot study that ultimately may not be entirely valid or replicable. But it’s promising. Next, we need a study with 150 participants.

Dr Berry is getting a bit ahead the the science here. He gives a powerful personal testimony in his video. And perhaps he’s seen many of his patients improve their arthritis with a very low-carb diet.

The carb consumption of the low-carb dieters would be ketogenic in most folks. Yet I didn’t even see “ketogenic” in their report. Perhaps because they didn’t measure ketone levels?

The authors of the report mention other studies finding improvement of osteoarthritis  pain and inflammation by the Mediterranean diet. The Mediterranean diet even helps rheumatoid arthritis.

How about combining a very low-carb and Mediterranean diet? As in my Ketogenic Mediterranean Diet. If you have the funds to run the study, I can probably get you a nice discount on books. Have your people contact my people.

Given the safety of very low-carb diets, I can’t argue against a 12-week trial if you have bothersome knee osteoarthritis. Get your doctor’s clearance first.

Steve Parker, M.D.

References:

Strath LJ, et al. The effect of low-carbohydrate and low-fat diets in individuals with knee osteoarthritis. Pain Medicine, 21(1), 2020, pp 150-160.

Oliviero, F, et al. How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Swiss Med Wkly, 2015; 145; w14190.

Veronese, N, et al. Adherence to the Mediterranean diet is associated with better quality of life: Data from the Osteoarthritis Initiative. American Journal of Clinical Nutrition 2016: 104(5): 1403-9.

McKellar, G. et al. A pilot study of a Mediterranean-like diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis 2007;66(9):1239-43.

Slöldstam, LB, et al. Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets. Nutr J 2005;4(15).

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