HIV Foundation Health Osteoarthritis in the knee: How stem cells can repair damaged cartilage

Osteoarthritis in the knee: How stem cells can repair damaged cartilage

It crunches and cracks, and some movements during exercise are really painful. When the knee shows signs of wear and tear, those affected want a miracle cure that rebuilds the cartilage. Hope rests on stem cells.

  • The body’s own stem cells have a positive effect on osteoarthritis-related inflammation in the knee.
  • A study now wants to clarify whether they actually build up permanent cartilage.
  • A transplant can repair minor cartilage damage in young patients.

After a certain age, signs of wear and tear become noticeable in the knee . After the age of 30, the risk increases linearly. The painful, inflammatory breakdown of cartilage in the operating room and with an artificial knee ends 150,000 times a year. Then smooth metal has to replace the cartilage layer, which allows round, painless movements in a healthy knee.

The idea frightens many people suffering from osteoarthritis. They hope for new methods to rebuild lost cartilage: stem cells should help.

Belly fat provides the best stem cell material

The doctor uses the patient’s belly fat as a starting material. The idea behind it: stem cells can be obtained particularly easily and in relatively large numbers from vascular fat tissue. Injected at the location of the defect, they learn from the microenvironment into which cell type they should develop.

According to this principle, the doctor and stem cell researcher Eckhard Alt uses the undifferentiated cells : Stem cells from the patient’s fat tissue are processed in the operating room within an hour and injected into the patient where he needs them – for example into the osteoarthritis knee.

The founder of the “Interdisciplinary Stem Cells Research Center” in Houston and a private clinic in Munich sees stem cells as the future therapy for chronic inflammatory diseases of the musculoskeletal system – among other things.

The cell extract in the knee does not guarantee success

Some orthopedic practices that offer the procedure honestly state that it is a not generally recognized attempt at healing with no guarantee of success. Rather, it is a final experimental attempt to remedy knee problems without a joint replacement.

“In this so-called ‘point-of-care’ application, a cell extract is injected that not only consists of stem cells,” explains Oliver Pullig from the Fraunhofer Translational Center for Regenerative Medicine in Würzburg. How many stem cells that are supposed to develop into cartilage material actually get into the knee is just as little regulated as the preparation of the suctioned off belly fat.

Development of osteoarthritis

Osteoarthritis most commonly occurs on the fingers, thumbs, knees, hips and big toes.

Arthrosis is always preceded by cartilage damage. Cartilage is considered to be a “shock absorber” for the joints. Initially, the damage to the cartilage is often superficial and limited to a small area. In the advanced stage, the symptoms worsen. Tension pain occurs and the joints change.

The joints react to the cartilage damage with pain, swelling or inflammation.

Stem cells instead of knee prostheses

A Europe-wide study is currently looking for scientific evidence of the anti-osteoarthritis potential of the body’s own stem cells.

A small one with six patients in Würzburg and twelve in Montpellier, France, led to success in 2013: Almost all participants canceled their previously unavoidable operation for a knee prosthesis. “Your complaints had improved throughout,” explains Oliver Pullig. “A reconstruction of cartilage was unlikely with such a large damage.”

The follow-up study that has just begun with 153 participants at ten European locations therefore fulfills a requirement that the German study director Ulrich Nöth from the Evangelical Forest Hospital Berlin-Spandau formulated back then: Stem cell therapy is best suited for patients with middle and middle-aged osteoarthritis. You are no longer eligible for a cartilage transplant, but you are too young to have an artificial joint.

New cartilage from stem cells? A study should show it

Like the pilot study, the ADIPOA2 study uses so-called mesenchymal stem cells from the abdominal fat of each subject. These precursor cells of the connective tissue have the ability to develop into cartilage, bone or fat cells.

Biologist Oliver Pullig explains: “We take 100 milliliters of belly fat from each participant. The stem cells obtained from this are multiplied millions of times in special laboratories. That takes a good two weeks. 51 patients then receive two million of these pure stem cells injected into the joint, 51 patients receive an injection with 10 million cells and 51 patients receive a placebo. “

Results should be available by the end of 2018, and thus scientific proof of whether stem cells fulfill the hope of permanently building cartilage. The scientist is optimistic: “If successful, the therapy with stem cells as a drug could be ready for the market at the next study level. It doesn’t take five years. “

Cartilage transplant only helps to a limited extent

Another method to restore lost cartilage is transplantation, which has been tried and tested for 20 years. So far, however, it has only been successful in the case of centimeter damage in an otherwise intact knee. The operation is laborious and the healing process long.

In the first keyhole surgery, the doctor removes a small piece of healthy cartilage, hardly larger than a grain of rice. These cartilage cells are propagated in the laboratory in three to four weeks. In a second operation, the surgeon places these cells or the cartilage patch on the defective area in the knee.

After that, the knee must not be subjected to any load for six weeks, then only lightly for another six weeks. Only after a year is the joint stable enough for sport to be possible.

Cartilage from the laboratory is expensive

The transplant is only suitable for younger knee patients whose cartilage and joints are free from osteoarthritis. If this therapy is successful, it can prevent further cartilage damage and a later threatened knee prosthesis.

Then, in the long term, the costs of several thousand euros for cells grown in a laboratory will pay off.

Hyaluronic acid can at least relieve pain

If these methods are out of the question, another remedy can help: synthetic hyaluronic acid is often misunderstood as a substance for building up cartilage. However, it cannot produce worn cartilage, but serves as a lubricant and for joint care.

Orthopedic surgeons inject the moisture-retaining gel three to five times at weekly intervals. Hyaluronic acid relieves pain and promotes mobility – permanently for some patients, at least for a year or two for others. Then the treatment can be repeated.

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Magnesium is vital – you need to look out for it to stay healthyMagnesium is vital – you need to look out for it to stay healthy

Magnesium is involved in hundreds of different processes in the body. Therefore, the symptoms of a magnesium deficiency can be different. What surprising signs are possible, who is particularly at risk and how you can intelligently compensate for a magnesium deficiency.

Magnesium is particularly well known in connection with magnesium deficiency and cramps. This applies to nocturnal calf cramps, but also massive cramps in athletes. But this important role that magnesium takes on for well-functioning muscles, only reflects a tiny aspect of its very broad spectrum of activity with diverse, vital functions.

What is magnesium

Magnesium is a mineral and belongs to the group of metals. This mineral is essential. This means that the body cannot produce magnesium itself, but the mineral is vital and must therefore be supplied with the diet. It is then absorbed through the intestinal walls and gets into the blood. Any excess is excreted through the kidneys with the urine. High fat foods, oxalates and phosphates can slow down the absorption of magnesium in the intestine.

Around 25 grams of magnesium are present in the organism (in a person weighing 70 kilograms). A good half is in the bones, a little less in the muscles and only one percent in the blood. The bones also act as magnesium stores. However, the magnesium content in bones decreases over the course of life.

In addition, minerals are divided into bulk and trace elements. Magnesium is one of the bulk elements because the body needs relatively large amounts of it, unlike trace elements such as iodine and copper.

Why Magnesium is Vital

Magnesium is involved in the activation of over 300 enzymes in the body, including in the protein structure. The mineral takes on decisive tasks for energy and cell metabolism and regulates many vital functions, including:

  • Impulse transmission in muscle and nerve cells, magnesium ensures normal conduction of excitation in nerves and muscles. In connection with nerves, magnesium also supports brain functions and via the muscles, for example, the heart muscle. Adequate magnesium intake even seems to reduce the risk of sudden cardiac death, a study suggests.
  • Magnesium influences the heart rhythm and blood pressure.
  • It relaxes muscles, nerves and blood vessels and can reduce the production of stress hormones. This normalization of the excitability of nerves and the vascular tension is probably responsible for the fact that with an adequate supply of magnesium, among other things, the number of migraine attacks demonstrably decreases, as the analysis of several studies showed.
  • Magnesium can reduce the clumping of blood platelets, so it can support normal blood clotting. The risk of having a stroke decreases when the body receives enough magnesium, further research shows .
  • It is involved in the utilization of glucose and in blood sugar control. The risk of type 2 diabetes has been shown to decrease if the mineral is taken in sufficiently.
  • Magnesium is an important antagonist of calcium, prevents too much calcium from being stored, for example in muscles, but also vessels and organs. Magnesium can prevent the formation of kidney stones, which often consist of calcium oxalate.
  • In addition, magnesium can neutralize too much stomach acid somewhat and thus reduce the risk of heartburn.
  • In conjunction with calcium and vitamin D, magnesium controls the bone metabolism. Among other things, magnesium supports the activation of vitamin D in the kidneys. Magnesium is therefore an important factor in preventing osteoporosis. Already existing osteoporosis could be slowed down somewhat by adequate intake, as a study suggests.
  • The mineral regulates important messenger substances that also play a role in the mental mood. Studies show that magnesium can have a similar effect on mild depression as certain antidepressants , the selective serotonin reuptake inhibitors (SSRIs). 

Overall, these and similar studies provide strong indications that an adequate supply of magnesium, including through dietary supplements, is associated with a lower risk of numerous common diseases.

These tricks help against the bellyThese tricks help against the belly

From the age of 30, German men are growing rapidly. It doesn’t look good and is a health hazard. Nevertheless, the stronger sex has difficulties with weight loss programs. FOCUS Online explains why this is so and which diet works best for men.

Surveys by the Federal Statistical Office show that Germany’s men are getting fatter year after year: If the body mass index is used as a benchmark, 62 percent of men are currently overweight (BMI over 25) and 18 percent are obese (BMI over 30) . And while only a third of the 20 to 25 year olds are overweight, the proportion among the over 50 year olds rises to more than 70 percent. Among women, 43 percent carry too many pounds around – but the proportion of people who are overweight shrinks slightly every year.

Visceral belly fat is a health risk

But while many of the overweight women have the word “lose weight” at least in the back of their minds, the term “diet” bounces off most men. Somehow, around 30, they gradually lose their firm body, but they feel comfortable with their figure, which they do not find too fat at all. Men seem to be more tolerant of their paunch than women of their love handles.

This has nothing to do with reason, because it is now known that so-called visceral belly fat in particular poses a health risk. The metabolically active tissue releases inflammatory substances and increases the risk of cardiovascular diseases, diabetes and erectile dysfunction.

The traditional image of the man promotes obesity

Papa gets the biggest piece of meat because a man has to eat properly – this age-old belief persists in Germany. And so men eat an average of 1.1 kilograms of meat every week. That is twice as much as for women and twice as much as recommended for a healthy diet. In addition, there are plenty of carbohydrates in the form of pasta, potatoes or white bread, sausage, butter and cheese – and the plates are often scooped up on the “all-you-can-eat” principle.

Many men get fat because they eat and drink too much of the wrong things, for example six times as much beer as women. And they stay fat because it is very difficult to change established eating habits.

Men need a lot of motivation to diet

Doctors and nutritionists find time and again that men rarely lose weight because they find themselves too fat. It almost always takes an external spark for the average man to change something in his lifestyle, for example when the doctor diagnoses diabetes or a heart problem, or when a relationship breaks up.

This was also the result of an evaluation of two major diet programs by the British health authority NHS. And there were even more men-specific issues on the subjectLose weight:

  • Only ten percent of men had received a referral from their doctor for the programs.
  • But: Once men start with such a measure, they develop ambition to lose weight and get out less often than women.
  • Men are more likely to respond to programs that avoid the word “diet” and place great emphasis on exercise.

Proper diet and exercise

Weight loss results mainly from diet changes. However, if men also expand their muscle cushion in the process, the effect is increased because of the high energy requirements of the muscles. Men should exercise all muscle groups in the body and not just squint at the fast-growing biceps.

A sporting program that includes a mix of strength and endurance is often better accepted by men than women. Sport should be fun in any case, because after actively losing weight, exercise can stabilize the desired weight – without the man having to constantly watch the calories.

What men should eat for weight loss is no different from a diet for women:

1. less red / fatty meat, sausage and animal fat

2. more vegetables

3. less white flour and sugar (carbohydrates)

4. more white / lean meat, tofu, or legumes (protein)

5. no alcohol

Intermittent fasting – as invented for men

Intermittent fasting is a suitable diet method for those who like it simple and uncomplicated. With the simple principle, there are time windows for food intake, which alternate with fasting episodes. The fat metabolism is activated, excess pounds can melt – especially if you keep an eye on the calories.

  • The popular “16: 8” method is suitable as a permanent nutritional principle: During the day, people eat in an 8-hour window, two to three meals without snacks in between. The nocturnal eating break is extended to 16 hours – ideal for men who do not like breakfast.
  • The “5: 2” interval fasting allows you to eat normally on five days, then there are a maximum of 500 calories on two days.
  • The “1: 1” method is considered to be the most difficult to stick to: alternately eat one day and one fast.

For men (and women), the combination of two protein shakes and a normal meal a day is a good start to losing weight. US presenter and comedian Jimmy Kimmel lost over twelve kilos before he switched to intermittent fasting “5: 2”.

The man’s body is the best weapon against obesity

Once men have decided to lose weight, they enjoy a great advantage over women. Men are taller, heavier and have more muscles – as a result, their bodies burn more energy even when they are resting.

If they also save calories, they lose more weight and lose weight faster than women. This was shown by a study with 2000 male and female participants who had exactly the same general conditions. After eight weeks, the men saw 16 percent more weight loss. Their bodies cling less to fat deposits, which in women are a stubborn reservoir for pregnancy and breastfeeding.

“Cancer cells are fed” – underestimated health risks lurk in meat and sausage“Cancer cells are fed” – underestimated health risks lurk in meat and sausage

Iron deficiency is often discussed. There is hardly any talk about the opposite, the frequent overloading with heme iron, the iron form made from red meat and sausage. It promotes the common diseases of diabetes, cancer and arteriosclerosis. FOCUS Online shows how you can meet your iron needs in a healthy way.

The trace element iron is indispensable for a number of vital metabolic functions in the body. As a component of hemoglobin in the red blood cells, it supplies every body cell with oxygen. Iron deficiency, which manifests itself in anemia, exhaustion, susceptibility to infection, affects around 20 percent of women and ten percent of men in Germany. The higher risk for women is explained by menstruation and decreases accordingly when the childbearing phase of life is over.

Many people have an excess of iron – and know nothing about it

Iron deficiency is known and many nutrition-conscious people pay attention to adequate iron intake. However, significantly more people could have anything but an iron deficiency, namely too much of this trace element. Probably very few people know about it, although it carries a high risk of disease.

Heme iron and non-heme iron: these are the differences

First and foremost, it is important for these relationships – there are the two known, different forms of iron, only one of which can be hazardous to health:

1. Heme iron , i.e. bivalent iron (Fe), mainly found in red meat and sausage. Heme iron has a high bioavailability, the body can use at least 20 percent from food.

2. Non-heme iron , trivalent iron (Fe3), from plant-based nutrient suppliers such as legumes, whole grains, nuts, oil seeds and various types of vegetables. Non-heme iron must first be oxidized to some form of Fe in the small intestine in order for the body to use it. In this way, only around five percent of the iron from food comes into play.

The iron requirement per day is 15 milligrams for women and 10 milligrams for men.

Underestimated health risk heme iron

What is certain is that most people in industrialized nations have at least a sufficient supply of the trace element. Due to our meat and sausage-heavy diet, a large part is even oversupplied with heme iron, and thus risks diseases. Various studies indicate these relationships .

“We assume that too much heme iron can have negative health consequences through eating meat,” explains Matthias Riedl, board member of the Association of German Nutritionists (BDEM) and diabetologist, nutritionist, internist, managing director and medical director at Medicum Hamburg.

The human organism is not prepared for high meat consumption

Normally, a complex mechanism of substances in the liver and intestines controls the iron level. If too much iron storage protein ferritin is measured, the body slows down absorption. “This does not work adequately with large amounts of heme iron, the body continues to absorb it, simply because this form of iron is extremely easy to use,” says the expert.

The nutritionist explains that the cause lies in our evolutionary history. Up until two million years ago, humans were purely plant-eaters, only then did they add animal consumption. That was sometimes more, mostly less meat – definitely a lot less than is regularly eaten today. The human organism is not prepared for this.

High consumption of heme iron feeds cancer cells

The excess iron is then deposited in the pancreas, liver and spleen, which can put stress on the organs. But that’s not all. “Heme iron can promote mutations via certain chemical compounds – for example in intestinal cells, but also in other cells,” warns the internist.

In addition, these compounds have a cytotoxic effect, so they can not only change cells, but also damage them. “And cancer cells, on the other hand, are properly fed by heme iron, so to speak,” says the expert. Malignant cells have a high demand for this trace element. A high consumption of heme iron means that existing cancer cells grow better and are stronger against the immune system.

Meat lovers are more likely to develop diabetes and arteriosclerosis

In addition to the connection between heme iron and cancer, many nutritional studies have shown two other negative effects of the “meat iron”:

1. Numerous studies show that people who consume a lot of sausage and meat are particularly likely to have type 2 diabetes .

2. In addition, this dietary preference often leads to arteriosclerosis , with the well-known secondary diseases of high blood pressure, heart attack and stroke.

“If people don’t eat ‘appropriately’, they get sick”

The higher the meat consumption, the higher the risks for cancer, diabetes and arteriosclerosis. What actually stands behind it: “If people do not eat ‘species-appropriate’, i.e. eat too much red meat and sausage and thus too much heme iron, they will get sick,” warns Matthias Riedl. It is well known that primitive peoples who still eat originally – eat very little meat and no sausage – do not have arteriosclerosis at all, for example.

Trivalent iron from plants is converted into bivalent iron

So heme iron has a rather negative effect on the body. Non-heme iron, on the other hand, does not pose these health risks – but is converted into bivalent iron in the body in order to make it available. Doesn’t it then become as unfavorable as bivalent heme iron? “No, because the trivalent iron from plants is converted into a bivalent iron, but not into heme iron,” explains the expert.

Providing the body with healthy iron – vegetables and fruits with non-heme iron

In order to provide the body with sufficient iron without meat, there are a number of plant-based foods that have a high content of non-heme iron, such as:

  • Lentils around 2.7mg / 100gr
  • Chickpeas around 2.7mg / 100gr
  • Peas 1,5mg / 100gr
  • Spinach 3,6mg / 100gr
  • Chanterelles 6.5mg / 100gr
  • Elderberry 1.6mg / 100gr
  • Pine nuts 9.2mg / 100gr
  • Millet 6.9mg / 100gr
  • Flaxseed, ground 8,4mg / 100gr
  • Amaranth 8.9mg / 100gr

Spinach contains a comparatively high amount of iron for a plant-based food, but at the same time the substances it contains can prevent it from being absorbed by the body. Beans or lentils are therefore better suited as a vegetarian source of iron.

Intelligently upgrade the bioavailability of iron from vegetables and fruits

Sure, none of these foods provide as much iron as meat. “The availability of iron from plant-based foods can be increased by cleverly combining the ingredients in a meal,” says Matthias Riedl. Vitamin C, for example, improves absorption. Suggestion for a corresponding daily plan:

  • In the morning: oatmeal / muesli with fruit, a glass of orange or lemon juice for breakfast,
  • Lunch: millet salad with paprika (the pods are extremely rich in vitamin C),
  • In the evening: whole wheat pasta with broccoli or parsley pesto

Coffee and tea inhibit iron availability

However, there are also plant substances that have an inhibiting effect on iron absorption. These are phytates and polyphenols, for example, these plant substances are contained in coffee and tea. So avoid these drinks during, immediately before and after a meal containing iron. In wholemeal products, on the other hand, the phytate content plays a lesser role, as they convince with their high iron content.

Cover your iron requirement healthily, certain meats are also allowed

“Those who follow a purely vegetarian / vegan diet can still get too little iron, especially women are at risk here,” says the expert.

Pregnant and breastfeeding women in particular should take preparations if they have a proven iron deficiency. Otherwise there is a ‘species-appropriate’ solution for everyone: That means a small, moderate meat meal per week, preferably poultry meat, because white meat is not statistically associated with the disease risks mentioned.