 Osteoarthritis is the most frequent cause of physical disability among older adults in the world, affecting more than 20 million Americans, with 20% of us destined to be affected in coming decades and becoming more and more widespread among younger people as well. Osteoarthritis is characterized by loss of cartilage in the joint. We used to think it was just mechanical wear and tear, but it is now generally accepted as an active joint disease with a prominent inflammatory component, as evidenced by, for example, significantly higher production of inflammatory prostaglandins from tissue samples obtained from the knees of people suffering from the disease. If the loss of cartilage is caused in part by inflammation, might an anti-inflammatory diet help, like it does with rheumatoid arthritis. Using optimal nutrition and exercise as the first-line intervention in the management of chronic osteoarthritis could well constitute the best medical practice. Whereas the best science on what optimal nutrition might look like, the China study is a prime example showing the serious health consequences of high consumption of pro-inflammatory foods, meat, dairy, fat, and junk, and low consumption of anti-inflammatory plant foods, whole grains, vegetables, and fruits, and beans, and split peas, chickpeas, and lentils. The unnatural Western diet contributes to low-grade systemic inflammation and oxidative tissue stress and irritation, placing the immune system in an overactive state, a common denominator of conditions such as arthritis. There are phytonutrients in plants that appear to help decrease the degradation of the joint cartilage, the inflammatory activity, the cell death, and oxidative damage. This is based largely on in vitro studies, suggesting protective benefits of soy, pomegranates, and citrus, and grapes, and green tea, and the curry powder-spiced turmeric. But my patients are people, not petri dishes. What role might the yellow pigment curcumin and turmeric play in the treatment of osteoarthritis? Well, obesity doesn't just put stress on our joints, the fatty tissue inside our joints, like in the kneecap itself, is a source of pro-inflammatory chemicals that have been shown to increase cartilage degradation. Curcumin may not only help prevent the release of inflammatory chemicals, but slow the formation of the fat pad in the first place. But enough with test tubes. There have been two clinical studies published to date. The latest took 50 patients suffering from moderate to mild, knee osteoarthritis, and gave them either the best available medical treatment, which included control with anti-inflammatory drugs and painkillers, or the best available treatment along with some proprietary curcumin supplement. They looked at a number of different outcome measures, including the Karnovsky scale, which goes up to 100, which is normal, no complaints, no evidence of disease, down to zero, at which you're dead. The group with the added curcumin did significantly better, and were able to double their walking distance. This is the best medicine I had to offer, so Mother Nature made a counter-offer. The curcumin group was able to significantly decrease their drug use, significantly fewer side effects, less swelling, hospitalizations, and other treatments. But it doesn't have to be some fancy proprietary formula. Here's the other study. The efficacy of turmeric extracts in patients with knee osteoarthritis. About 100 sufferers were randomized to ibuprofen, or concentrated turmeric extracts, for six weeks, and the curcumin group did as good or better than the ibuprofen. Even though ibuprofen is over-the-counter, it can cause ulceration, bleeding, and porforation of the stomach and intestines. It can eat right through our stomach wall, and in fact that happened to someone in the study. Is one of the side effects of curcumin potentially protecting against a long list of diseases?