You cannot reverse sarcopenia. You can mitigate its decline and you can build muscle mass. So I tell people to push and pull heavy things. We need to do resistance exercises. You need to eat well.

You need to get yourself to go outside. You need to make your day a little harder. You need to try and sleep better. Try not to stress-eat as much. Try to find that little win, right? You put that cream in the coffee, have a donut in the morning, or a few Oreos at night.

Just find that little win. It matters and it works in the end. So am I. Luks points out that there are varying degrees of how osteoarthritis will affect a patient. For the vast majority, the case will be mild and can be managed with non-surgical treatments such as weight training, negating the misconception that osteoarthritis is a life sentence.

We focus on the fact that osteoarthritis, the ideology or the cause of osteoarthritis is more often than not biological, and that cartilage, nutrition, and health [are] based upon this repetitive loading.

As we also discussed, we had runners who were less commonly resorting to knee replacements as opposed to non-runners with the same degree of arthritis. And if you can play two sets of tennis instead of three before you get sore, do it.

Weight training is not going to destroy your joints. If the pain is mostly in the front of your knee, weight training is going to alleviate the pain in the vast majority of circumstances.

And the more active that you stay, the happier your knee is gonna be. The stronger you keep your leg, the longer you keep your knee.

Casey Means goes into factors influencing the issue, such as consumerism and the western concepts of impatience and instant gratification.

Part of the equation in facing physical challenges like this is actually just tapping into a sense of patience and tapping into a sense of healthy coping because we are an instant gratification culture and in a sense, surgery does feed into both consumerism and also instant gratification.

We have difficulty sitting with discomfort because of just our general western culture of thinking that discomfort is actually a bad thing versus a growth opportunity. I think a lot of this probably does come down to mindset. So really, it gets down to a lot of like fundamental framing issues or [the] kind of modern [cultural] things that we struggle with in the western world like impatience and consumerism and lack of ability [to trust] the body.

Voila, four months later, [and I feel] better [but that might not] be the case for everyone. Howard Luks :. The longer that you suffer from high cholesterol, the higher your A1C is and your glucoses over the longer period of time, the worst the downstream consequences are going to be for you, not only for your eyes, not only your risk of dementia, your risk of kidney failure, hypertension, NAFLD or fatty liver, but in my world, the higher the risk of tendon related issues, more severe pain, tendon tears and more significant pain with arthritis and other maladies.

This is A Whole New Level. Casey Means :. Hello, and welcome to A Whole New Level. This is Dr. Casey Means, co-founder and chief medical officer of Levels, and I am so thrilled to introduce our guests today, Dr.

Howard Luks, who is a world renowned orthopedic surgeon. In his personal life, he has an avid trail runner, a cyclist, you can even find him on Strava. So look him up. And really help us understand that a lot of the things that we think about that are inevitable with aging like pain and reduced mobility and surgeries and injuries, they may not be inevitable.

A lot of is modifiable and a lot of it comes down to our metabolic health so much of which we can control. So this is a very empowering episode and may just help us all live a healthier and more functional life of mobility and freedom.

So excited to share this episode. Okay, well, same with me. Please call me Casey. I was telling you before we started, I am really one of your biggest fans.

I love what you are doing to change the way we think about a subspecialty like orthopedics or orthopedic surgery and really broadening understanding of joint health and musculoskeletal health. And I went to the doctor, to the orthopedic surgeon and he told me with a strong recommendation that I should do this two stage very invasive surgery called a Macy procedure that would have me harvesting cartilage, growing it in a lab, putting it back in my knee.

And it just did not feel right to me. It felt like a very turbo decision for a young person who was not actually in that much pain. How do you approach something like that? Yeah, great question. We are so much more than a simple finding on an MRI.

And what we fail to understand as well is what are findings very typical of active people who are squatting heavyweights, running distances in an orthopedic practice. Is it unusual to have a small lateral condo cartilage defect? It turns out, no. As I shared with you, I got MRIs of both knees long ago just because I wanted to see them.

I was interested. I have meniscus tears and cartilage defects and bone marrow edema in both knees, yet I was actively running 30 to 40 miles a week and I still am. So we dove into your process and the fact that you had little to no pain and were ready to go back out and start working out and moving.

And we realized that this may have been the day that you realized that you had a defect, but it may not have been the day the defect came about. And look, you are feeling fine. And it will generate a little just because of that. And I shared with you, I think that I was part of the original research done in New York City at the hospital for joint diseases on this cartilage based procedure.

And we found a lot of these defects recurred, so if we were doing them on degenerative defects or defects that were coming about, not because of an acute trauma, but just over time that they would come back again a few years later. I really hate the idea of trying to do something now because we might affect something in the future because we might not.

Yeah, it was an amazing conversation because you shared with me what you said that you can take a lot of patients who are older or even young and do MRIs of their knees and some people may have structural architectural defects in the knee or in any joint. It turns out that cartilage issues and early osteoarthritis is often the result of a failure of the innate repair mechanisms that cartilage has.

And where does that give us room to intervene in a different way? Great question. And that these horrible things are happening inside our knee when we run or when we move or when we work out.

And it turns out that osteoarthritis in the majority of situations is a failure of a biological repair mechanism. I do follow it closely though. And it appears that there are WNT, this is the WNT pathway, as one of the pathways involved in repair. Of course, because I was thinking, okay, I want to do anything non-operative that I could possibly do before having someone cut into my knee, which is ironic as I trained as a surgeon, as you did.

And there are some papers, not strong research showing, okay, maybe fish oil or anti-inflammatory strategies can help with joint health. So how do you think about the various behavioral modulators of a healthy joint biology? And is there anything that you recommend for patients to essentially create conditions within the joint that lead to the more regenerative capabilities of our tissues?

So what I try to get through to patients is our joints are no different than our liver, our heart, our brain, our pancreas, our eyes, our kidneys, et cetera.

A year-old woman, a year-old woman is going to spend more time in the hospital because of osteoporosis than heart disease and breast cancer combined. One in three is going to suffer an osteoporotic fracture. One in five men is going to suffer an osteoporotic fracture, so men are going to suffer too.

We are more prone to having tendon tears, ligament tears in situations where we have poor metabolic health. So you have an increased risk of rupture because those tissues are weaker. And this may be why osteoarthritis and other conditions which are inflammatory in nature worsen a little more in people with poor metabolic conditioning and health.

So poor metabolic conditioning. I actually bring a lactate meter to my office sometimes. Do I have this? I am not going to stop their exercise. It is.

You said you do not tell people to stop exercising even if they have a joint issue. I need to have surgery to cut off whatever is causing that clicking. And there was a little bit of pain, maybe two out of And that might be a bad thing.

Yeah, sure. First of all, throw this out there. Not going to feel better in six weeks. They may regret having the surgery in six or eight months. We just do not respond fast.

Now, there are very few reasons to stop exercising. It is a common misconception that with osteoarthritis, you are causing more harm if you remain active. Yet the exact opposite is the case.

Osteoarthritis by definition is less common by evidence, is less common in runners. However, they did a study where they had a bunch of runners and non-runners, same degree of osteoarthritis on x-rays. The sedentary people remain sedentary.

It has a very slow metabolism, but it is capable of repair. There is a nourishment process that is going on, that nourishment comes not from blood flow but from substances in your joint fluid.

So the cyclical loading actually helps to get that nourishment and energy source into the cartilage. So maintaining a level of activity is super important.

So there are very few reasons to stop people from exercising. Their primary care might have said the same thing. So doctors are guilty of this too.

If the pain ever gets to the point where it is the reason why you need to stop, then we need to talk. That makes a lot of sense.

And based on your complaints, right? We often get it to confirm a diagnosis based on our suspicion. Very little in my world is an emergency, period. I want to know if you have a large rotator cuff tear.

But again, these are not life and death struggles in the orthopedic world. So you do have options and choices. Knee injuries, right? Not only not to confirm the ACL tear, because my exam will tell me that, but to look for concomitant injuries to other structures that may need us to address them.

But the vast majority of joint pains and aches, they do not require surgery. They require us to listen to you, to examine you, and to come up with an appropriate plan.

Not blowing you off. I remember reading, when I hurt my knee about chondrocytes, the cartilage cells. Do they have mitochondria? Do they respond to regenerative or anti-inflammatory factors that might be circulating in the fluid around them?

And it also just reminds me of how I think we were taught in medical school a lot of these things that are very black and white around brain cells.

Once they die, they never regenerate. And once you have a heart blockage, it never changes. I should be all the way up on the right somewhere. It changes every day. We used to just think of cartilage as this smooth, rubbery substance, than, right, it was dead like a sloth.

It really is a wonderful tissue. Three years you may have a cartilage injury, it may show up on an MRI. It was because of that injury three years ago because it took so long for the ramifications of that injury to reveal themselves. And they secrete this matrix. In a non-arthritic knee they do not have a nerve supply.

So it has no source of nutrition coming from the underlying bone or from blood vessels, through the bone into the cartilage.

Same with IL-6 levels. We are completely connected. So, so, so interesting. And then on the flip side of that, how does improving or having optimal metabolic health change our outcomes for having pain throughout our lifetimes?

The reason why we see people with pain in the office is often two major groups, bony and soft tissue. The majority of bony issues, joint issues, are arthritic in nature. And the majority of soft tissue issues are tendons, ligaments. So a lot of shoulder pain is tendinous, a lot of hip pain is tendinous.

You may have heard the term bursitis. We suffer from tendinopathies. So painful tendons, changes within the tendon. Shoulder pain, that awful pain on the side of your shoulder when you reach up or at night when you roll over.

Why does everyone between the age of 15 and 65 get tennis elbow? So tendinopathies, some of it may be pre-programmed into us.

As I said, everyone gets tennis elbow. It was a short course. Maybe my fitness had something to do with that because it can last nine to 12 months in many people. Tendon is made of collagen.

In other words, take a box of spaghetti, take the spaghetti out. If you overload a tendon, you will develop an overuse tendinopathy. And a week later our tendon hurts. Take allopurinol and decrease your glucose? These are all area under the curve issues. I had to say that. The higher your A1C is and your glucose is over the longer period of time, again, area under the curve, the worst the downstream consequences are going to be for you.

Not only for your eyes, not only your risk of dementia, your risk of kidney failure, hypertension, NAFLD or fatty liver. But in my world, the higher the risk of tendon-related issues, more severe pain, tendon tears, overuse injuries, and more significant pain with arthritis and other maladies.

Beautifully said. And if you start adding a bunch of excess uric acid, cholesterol deposits, glycation through excess glucose sticking to things, you start cross-linking all these things and causing problems in the structure that can make it basically more vulnerable to injury.

But bottom line, we want to get rid of these excess metabolic byproducts that ultimately disturb our tissue, and therefore create symptom and disease.

And I love that framing. And then another one that I … I went to a conference a couple years ago where there was an orthopedic person.

This was actually when I was plant-based and I was fully planted-based. I still love plants, but I was hardcore and it was a plant-based physician nutrition conference. And one of the things that is so vivid that sticks out in my mind is he basically said that rotator cuff injuries are heart attacks of the shoulder.

And so he was talking a lot about blood vessel, blood flow as part of these … The link between metabolism and our predisposition for basically injuries. The downsides of excess glycation affects every tissue. No tissue gets a pass in this. And our cardiovascular system or our blood vessels, are terribly affected by the presence of Type 2 diabetes, high glucose levels, high inflammation, the hypertension.

We have many areas in the orthopedic world that already have very limited blood flow, like parts of the Achilles tendon. So if in the best of circumstances you have a marginal blood supply, because there are watersheds. In the perfect situation they overlap a little.

Where there is no blood flow, there is no cell turnover. I get this. So what happens to stick with men a lot, why they want to focus on their metabolic health, is impotence, boom. I immediately get their attention because the incidents of impotence is huge.

And so yes, the same issues can be reflected in our tendons and various areas of our body, and absolute will have a role. Because every time you exercise, run, walk, do things, we get these micro injuries.

I mean, blood vessels are there. Love those visuals, so impactful. I just think this framing of the body is such a dynamic entity. You can limit blood flow to the area.

You can create blocks in communication by having all this deposits of debris. The blood vessel narrowing or lack of elasticity, the glycation and too much glucose sticking to things, too much oxidative stress, too much chronic inflammation, which we know can be driven by metabolic dysfunction, uric acid buildup, et cetera.

Do you find in your practice that when you dig into the metabolic issues with patients and they do have their light bulb moment and they make changes, do you tend to find better outcomes? What has your patient experience been like with some of this messaging and patients who have really adopted this?

Or I know on the flip side, for your patients who are just super metabolically healthy, do you find that they tend to do better over time? For me, these are my biggest wins in the office. They just are. Look, can I convince everyone?

I can. And it does work, and it takes time. You see your cardiologist is going to adjust your blood pressure medicine, so your endocrinologist is going to increase your metformin. I have some handouts in the office of outtakes from the book.

I guess the take-home message of that statement is, be your best advocate. You have to look deeper and think in a more complex manner. And I can imagine that as a physician, burnout is at all-time high right now.

Suicide is super high, da, da, da. But also, you see people getting better and you see their whole bodies getting better. Because I see it as quite revolutionary. We have common pathways that are affecting all over the body. Maybe even prevent surgery. One, so this will be a big answer I think.

How did you become that way? But economically speaking, the economics of building and training a surgeon is you should keep them operating all day long.

So get an MRI with a positive findings, have them see the PA. The PA will tell them of that and they need an operation. They say hi to the surgeon. I get that. I understand the economics.

I was never the busiest surgeon. I could have been. I was very smart in terms of my saving, investing. I founded a company with two wonderful guys and we sold it.

I was involved with others and had a few exits. However, the analogy falls short when it comes to solving the problem of wear and tear. Your automatic garage door may last longer if you push the button less frequently, but your joints thrive on movement to keep them lubricated and healthy. Here, Dr.

Neil Ghodadra discusses the symbiotic connection between your muscles and your joints, and explains how more movement, not less, is the key to health and longevity.

Osteoarthritis OA is the most common type of arthritis , and the main driver behind it is wear and tear. Over time, the protective cartilage thins out and disappears until your bones rub against one another painfully.

In addition to inflammation and stiffness, your joints may develop bone spurs, which are hard protrusions that hinder movement, irritate nearby nerves, and exacerbate the problem. It may seem logical that reducing usage would preserve your joints and prevent OA, but the opposite is true.

Movement promotes lubrication and flexibility, while a sedentary lifestyle leads to a long list of health problems, including achy joints. Strong muscles go hand in hand with healthy joints. When your muscles function properly, they absorb shock around your joints and protect them from the effects of daily usage.

Regular exercise, especially weight-bearing activities, develops muscle tissue and allows your joints to focus on what they do best — movement. Lack of exercise leads to muscle atrophy and balance problems. This accelerates the onset of OA and triggers a cycle of pain, stiffness, inactivity, and joint deterioration.

Strong muscles act like bodyguards for your joints, so we encourage all our patients to maintain a good exercise routine. You know strength training can help maintain bone density, but it also can strengthen tendons and muscles, which, along with ligaments, form the support system for your joints.

For joint health, aim for two full-body strength workouts every week, focusing on compound exercises that use multiple muscle groups.

As crazy as this sounds, sleep really can impact your joints. Yet painful joints can actually affect your sleep, leading to a vicious cycle. Bottom line? Getting enough sleep will help you maintain an active lifestyle, which will keep those joints healthy. The Sleep Foundation recommends logging seven to nine hours every night.