Leveraging the Body’s Natural Healing Properties…the Right Way

Spring is a time of renewal and regeneration. Trees begin to replace leaves that have fallen long ago, and seedlings begin to poke their first green shoots through the cool, wet ground. Just like the plants we see spring back to life each year, our bodies are designed with natural tendencies to renew and regenerate. This is especially true after injury. However, as we age, the ability to “bounce back” becomes weaker – but it doesn’t have to be this way. 

How to Unknowingly Inhibit Renewal and Regeneration

While the natural cycles of plant life lead to an annual process of regeneration, modern medicine does not always take the same approach. Let’s pick on Dr. Yurth’s original field of Orthopedics. Orthopedists have long taken a hammer and nail approach to fixing a physical system that when healthy, can naturally renew, regenerate, and heal. One of Dr. Yurth’s favorite anecdotes is to quote an old partner she worked with who said, “We don’t do medicine. We do Orthopedics!”

One of the most commonly overlooked areas to leveraging the body’s natural healing properties is joint and back pain. What if we approached joint pain with a renewal and regeneration lens, rather than the same standard of care that has been given for over sixty years?

Despite much research disproving the efficacy (and sometimes even safety) of many common treatment protocols, we continue to see doctors prescribing “standard of care” when it comes to alleviating joint and back pain.

Steroid Injections

While appropriate in limited use, acute pain settings, steroid injections can quickly cause more harm than good. A 2019 study shows patients with mild to moderate osteoarthritis (OA) experience faster progression of arthritic state when on a regimen of repeated corticosteroid injections.

Hyaluronic Acid (HA) Injections

Brands like Euflexxa and Synvisc are injected in a series or sometimes one injection. The injection includes a component of joint fluid (HA), which nourishes cartilage and lubricates the joint. While 66% of patients undergoing HA injections experience 66% improvement, nearly 30% still undergo surgical intervention within 7 months. These products can be helpful when used holistically, as opposed to a one-off “miracle cure.”

Arthroscopic Management

A knee scope, for example, is designed to trim damage and initiate tissue repair. Studies have shown scopes performed in patients with degenerative disease is harmful and may expedite onset of OA.

Joint Replacement

Significant, debilitating OA can make replacement the only option for starting the healing process. Unfortunately, replacement has become a norm out of convenience, especially for older patients who decide they cannot function well enough with their OA. Joint replacement has become so popular that studies now show minimal impact on quality of life because patients are getting them well ahead of when they should be. 

An umbrella review of common elective orthopedic procedures published in the July 2021 British Medical Journal (BMJ) has shown, aside from carpal tunnel release, there is no strong high quality evidence that commonly performed orthopedic procedures are more effective than non-surgical options. We are simply doing too many orthopedic surgeries – in other words we aren’t setting up the body to naturally renew and regenerate. Instead, we are trying to fix the problem with brute force without understanding the underlying issue.

How to Repurpose to Renew and Regenerate

For the body to be in a state conducive to natural healing, it must be able to manage inflammation. Inflammation gets a bad rep, but when it comes to healing, the presence of an acute inflammatory response is critical to sending regenerative signals to the body. It is for this reason that you should actually avoid NSAIDs (like Ibuprofen or Tylenol) immediately after injury! It is when the body remains in the chronic inflammatory state, eventually called inflammaging, where problems arise. Lowering inflammatory cytokines and raising anti-inflammatory cytokines, reducing degradative enzymes, ridding bad mitochondria, increasing autophagy, and initiating repair should be the first standard of care for inflammatory pain and disease.

One way to do this is through repurposing safe and effective pharmaceutical drugs based on their mechanism of action. Certain drugs approved by the FDA for one specific purpose can actually be used “off-label” for the treatment of other conditions. 

Pentosan Polysulfate Sodium (PPS) provides an excellent example of a repurposed drug. First used for bladder pain control, it can be utilized for the protection of joints. It has now received approval as a disease modifying agent for OA by the European Medicines Agency and the American FDA. In clinical trials for OA, PPS reduced pain by 50% and significantly improved function in the joint. It works by reducing inflammatory cytokines, inhibiting MMP3 production, thereby blocking continued cartilage degradation. It also modifies the expression of NGF mRNA, which slows the formation of painful osteocytes in the joint. 

Metformin is another example of a drug proven safe over time that works in multiple clinical settings. Originally a drug for diabetic use, it has shown benefits in patients with cancer, cardiac issues, obesity, renal problems, liver ailments, and now mice studies show it can induce cartilage repair in joints. It appears to work on gene expression of inflammatory proteins and activates AMPK, which has shown preventative, curative, and reversal on pain in various inflammatory processes.

Amlexanox is a small-molecule drug that has anti-inflammatory and anti-allergic properties. It works by inhibiting the production and release of certain chemicals that are involved in the immune response, such as histamine and leukotrienes. Amlexanox has been used to treat a variety of conditions, including oral ulcers, asthma, and allergic rhinitis. It has also been investigated for its potential therapeutic effects on other conditions, such as diabetes and obesity. In some cases, chronic joint pain may actually be the result of a chronic autoimmune condition, such as rheumatoid arthritis.

How to Supplement for Renewal and Regeneration

Beyond pharmaceuticals, we can turn to the work of supplements proving to be quite impactful as treatment for inflammaging. Autophagy and mitophagy (the process of clearing out damaged cells and mitochondria) are integral to keeping the body in a state where it can self-heal and regenerate healthily as allowing bad cells to proliferate will continue the inflammation cycle despite efforts to block it. 

Epigallocatechin (EGCG) is a supplement found in green tea that is packed with antioxidants, vitamins, and polyphenols. It has been found to block inflammatory mediators, oxidative stress, and essentially all parts of the inflammatory process. 

Trehalose is a naturally occurring sugar compound. It has no glycemic impact, making it an ideal sweetener for diabetics. Studies featuring trehalose in mice knees with induced cartilage reduction shows positive impacts on joint space. Trehalose is known to be neurally protective, promote autophagy, and protect mitochondria. Reduced oxidative stress and induced autophagy is exactly what we are looking for in a supplement to treat inflammation. 

Spermidine is also naturally occurring, found in our bodies. We produce less spermidine as we age but it can be found in certain foods like cheese, soybeans, and wheat germ, in addition to supplementary forms (our favorite is spermidineLife from Longevity Labs). Spermidine dampens oxidative stress with boosted mitophagy and a reduction of pro-inflammatory cytokines. This is useful in all age related diseases and in blocking the process of osteoarthritis.

Collagen is well-known for skin, but may be one of the secrets to healthy joints as we age. Fortigel, a certain patented-type of collagen peptide, has shown to be supportive of cartilage repair after three months taken orally. The improvement in joint pain after taking Fortigel for three to four weeks has proven to be better than surgical manageme.

What to Inject to Renew and Regenerate

You hear us talk a lot about peptides. These small chains of amino acids can give the body more of what it already naturally produces for regenerative activities. Body Protection Complex-157 (BPC-157) was able to repair damaged cartilage when injected into the joint. Combined with Thymosin Beta-4 (TB-4), this power healing duo can promote tissue regeneration of all types. AOD-9604 is a fragment of growth hormone that stimulates stem cell production in the joint. When combined with hyaluronic acid, the treatment showed complete cartilage repair after 9 weeks in mouse studies.

Regenerative therapies aim to restore tissue. The key to the success of any regenerative procedure is to first get down the inflammatory state. For example, putting autologous stem cells from an old or sick person back into the body does not bring the same healing punch you might expect since the stem cells themselves were not in a healthy state to begin with. Regenerative techniques such as Platelet Rich Fibrin Matrix (PRFM) or exosomes injected once the inflammatory state has been brought down can have profound effects on kickstarting the body’s own healing abilities. 

At BLI, we prefer PRFM to traditional Platelet-rich plasma (PRP), because with PRFM the sticky fibrin matrix keeps the PRP localized to the injured area for longer. PRP is a biological preparation containing platelet concentration above the whole blood baseline. Owing to the high concentrations of growth factors, this product has been extensively used in musculoskeletal disorders to modulate progression of the inflammatory process and promote healing. 

Osteoarthritis and similar joint conditions involve the breakdown of articular cartilage, inflammation in the synovial tissue, changes in subchondral bone density, and deterioration of the extracellular matrix (ECM). Stem cell therapy has emerged as a promising approach for treating these conditions, with research suggesting that its effectiveness may be linked to the release of extracellular vesicles (EVs) by stem cells. Among these EVs, exosomes (Exos) have garnered attention for their potential therapeutic role in repairing cartilage damage and addressing OA. Recent studies indicate that EVs derived from mesenchymal stem cells (MSCs) can impede the progression of OA. Furthermore, Exosomes hold promise for facilitating tissue regeneration in multiple areas such as limbs, skin, and cardiac tissues

Understanding the significant impact of inflammation on the development of degenerative diseases and chronic pain is essential. When our bodies are not functioning optimally, they struggle to carry out their natural healing processes of renewal and regeneration. This affects not just our joints but also every facet of our health. Embracing this perspective shift helps us understand the both simple and advanced therapies that leverage the body’s inherent ability to regenerate, providing hope and practical solutions to address not only existing pain but also to prevent age-related diseases.

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Published April 17, 2024

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