Dear Prof. Cordain,
I am an orthopaedic surgeon specializing in hip and knee arthroplasty for the treatment of symptomatic osteoarthritis. I am currently coming to the end of a clinical fellowship in Toronto and will be returning to the UK to take up a post as a consultant (attending) in a NHS hospital and I would be grateful if you could give me any information on the use of Paleo diet and evolutionary fitness principles in the treatment of my patients.
I first read about the Paleo diet on Art de Vaney’s website, then read Rob Wolff’s The Paleo Solution and am now reading through your book The Paleo Diet. I already give many of the patients I see dietary advice because very often they are overweight (in fact, more often than not) and have radiographically mild disease but considerable pain. It is an observation many surgeons have made anecdotally that patients who are of normal weight and are active seem to be able to tolerate far more severe disease (in terms of joint destruction observable on X-radiographs) than those who are overweight and sedentary.
Many patients can be educated that weight loss may improve their symptoms and are willing to try but conventional diets are difficult to follow, so I advise them to follow Paleo principles because I think it is a much easier diet to follow consistently. However, I wonder if there is anything specific I should be advising that may help their symptoms. Also, exercise is important for joint function, symptom control and general health, but of course it is very difficult to exercise when one has a painful joint. Do you have any advice that I can pass on to them, or do you know of anyone doing clinical work in this field who I could get in contact with?
Many thanks for your time in reading this.
— Julian Gilbody MSc, FRCS (Tr & Orth)
Lower limb arthroplasty fellow, Toronto Western Hospital
Dr. Cordain’s Response:
Thanks for your support of the Paleo diet. I believe that arthritis, particularly RA (rheumatoid arthritis) is driven by inflammation emanating from the gut. See our group’s paper “Modulation of immune function by dietary lectins in rheumatoid arthritis.” Hence, inflammation of the gut and inflammation of the joints (particularly in RA) appear to be linked by a number of dietary mechanisms we have proposed in this paper. Clearly arthritis can result from purely mechanical factors independent of the gut immune response. Nevertheless, arthritis of mechanical origin is also driven via systemic inflammation, and any environmental factor (pharmaceutical, dietary or otherwise) that reduces inflammation will also tend to reduce symptoms of arthritis (mechanical or otherwise). This therapeutic response in all arthritis patients who adopt the Paleo Diet may help to explain your anecdotal observations why contemporary Paleo diets are therapeutic for your arthritis patients. Keep up the good work, and keep me posted on any case studies you may encounter.
Loren Cordain, Ph.D., Professor Emeritus