Joint is the connection between two bones structure that allows you to bend and being flexible. Part of the structure are also, smooth tissue called cartilage, synovium and synovial. Synovial is fluid that act as lubricator in the joint area (1,2).

Below are few tips for healthy joint:

Maintaining healthy weight

Joint pain usually occurs as a result of the normal wear and tear thus it is no surprise that the heavier the person the more load joint must carry, thus,  in the long run this will develop pain in the joint. Study found out that, just by being obese an individual has four- to five-fold increase in the risk of developing osteoarthritis (1, 2).

So, now go and weigh your body and find out your healthy weight
(psssttttt you may talk to us as well)!

Exercise regularly

We always know that by being physically active it can lower the risk of getting diseases. However, what if one already has the joint problem? How can one exercise and be physically active?

Many do not know that by performing correct exercise and do it with correct technique, it can alleviate joint pain and/or numbness that usually people with osteoarthritis or rheumatoid arthritis have.  Aerobic exercise (Exercise that can increase heart rate) such as swimming can improve joint health (2,3).

If you already experiencing joint pain and would like to alleviate the pain using exercise method in combination with trying to get healthy weight, bear in mind to apply heat, because heat can relax your joint and muscle, you can also try to use warm towel or hot pack. Always go for slow movement and warm up your body with stretching first for about 10minutes to 15 minutes. If you feel pain, take a break or slow down.

Another easy tip is that, do not be a couch potato! By not moving your joint it increases the tendency for your joint to become stiff hence in the long run you will experience joint pain (2, 3).

What about food?

Eat food that is high with Calcium and Vitamin D

Food plays a huge role in our daily life, not only that it nourishes our body with nutrient, vitamins and minerals but it also at the same time prevent us from getting diseases. Deficiency of minerals and vitamin such as Vitamin D and Calcium can lead to many problems such as joint problem (1,4,5).

Calcium is the healthy bone mineral. About 99% of the calcium in the body is stored in bones and teeth. It is mineral that makes them hard strong. Study found out that, adequate amount of calcium intake lead to better bone and joint health.  In older adults, especially in post-menopausal women, bone is broken down at a faster rate than it is built. If calcium intake is too low, this can contribute to osteoporosis. Thus, consumption of food high with calcium content is very crucial since young (1,4,5).

Apart from dairy product, there are various other food that is close to Malaysians but people do not know that is high with calcium such as fish with edible bones (sardines and anchovies), beans and bean products such as yellow dhal, tofu, and tempeh, or locally processed food such as cencaluk, budu, vegetables like spinach, cekur manis, tapioca leaves, kailan and brocolli. In fact the bioavailability of calcium in broccoli is just about the same in milk!

Check this out…

Whilst for Vitamin D, usually we can get it from the exposure to sunlight, however, since nowadays we often stay indoors and use products with SPF when we are outside thus lesser vitamin D is able to absorb by our body. Vitamin D is important for the absorption of calcium, even when there is enough calcium intake, when vitamin D is not enough in the body, calcium will then become a waste (1,4,5).

Thus, it is very important to consume calcium and vitamin D rich foods in order to take care of our bone and joint health. Since in most countries currently the ‘lockdown’ phase is still ongoing, thus if you notice that you may be suffer from not getting enough vitamin D, thus start consume vitamin D rich foods like the above. Read food labels and consume food that is fortified with vitamin D such as breakfast cereals and milk.

References

1. Kristin L. Clarke. (2007). Nutritional Consideration in Joint Health. Vol 26. Issue 1 (1010-108). : https://doi.org/10.1016/j.csm.2006.11.006
2. WebMd (n.d). Tips for Taking Care of your Joints. https://www.webmd.com/arthritis/caring-your-joints#1
3. WebMd (n.d). Tips to Keep Joint Healthy. https://www.webmd.com/rheumatoid-arthritis/better-living-ra-17/active/slideshow-keep-joints-healthy
4. Healthline (n.d). Is there are connection between Vitamin D and Joint Pain? https://www.healthline.com/health/vitamin-d-and-joint-pain
5. Cleveland Clinic (2015). Osteoporosis Prevention with Calcium Treatmenthttps://my.clevelandclinic.org/health/articles/15049-osteoporosis-prevention-with-calcium-treatment

Normally, uric acid dissolves in the blood and passes through kidneys and excreted in urine.  But when there is too much uric acid in the body, uric acid crystals (monosodium urate) will build up in joints, fluids, and tissues within the body. The build up will become sharp needle like crystal compound in joint or in the surrounding tissue that will cause pain, inflammation and swelling in the affected joint area.

Sometimes hyperuricemia does not cause gout, which also refer to as asymptomatic hyperuricemia. This condition does not need to be treated but efforts should be made to lower the uric acid levels by encourage individuals to make changes in their diet or lifestyle.

What are the sign and symptoms for gout? (1,4)

Sign and symptoms for gout occur when there is appearance of inflammation and swelling in the joint are, this condition usually refers to as acute gout attack. Usually during this condition symptoms below can be seen:

Intense joint pain. Usually it affects the large joint in the big toe area, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists, and fingers. The pain is likely to be most severe within the first 4 to 12 hours after its presence.

Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks.

Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.

Limited range of motion. As gout progresses, individuals may not be able to move joints normally, as it will becoming stiff.

For gout there will be times when symptoms get worse, known as flares, and times when there are no symptoms at all, known as remission. Repeated attack of gout can lead to gouty arthritis, a worsening form of arthritis.

What are the risk factors for gout (5)?

There are factors which makes individuals are more susceptible to gout as compared to others:

• Male

• Being Obese

• Have certain health condition such as hypertension, diabetes, and poor kidney function

• Using certain medication such as diuretic pills

• Excessive drinking of alcohol

• Frequently have diet that is high with purine

How gout is diagnosed? (1,5)

 Doctor usually diagnose gout based a review of your medical history, physical examination, and the symptoms. However, as for gout as people in Malaysia rarely do blood test thus the only time, they found out that they have gout is when their big toe is already at stake. Usually when you meet doctor with presence of tophi or podagra, the doctor usually will manage or treat the condition as gout until proven otherwise. Doctor will usually further confirm this via X-ray to see if there is any stone, or through your blood result where your uric acid level will be measure. Sometimes doctor can also take fluid sample from your joint to confirm whether it contains uric acid (4).

How gout is treated? (1,5)

Gout is usually treated by managing the pain of flare. Treatment of flare consists of non-steroidal anti-inflammatory (NSAID), like ibuprofen, steroids, and the anti – inflammatory drug colchicine.

However as to prevent from the future flare, changes in lifestyles is a must. Losing weight, eat less purine-rich food (like red meat or organ meat), limit alcohol consumption, and drinking plenty of water will help to prevent future attack.

 In order to prevent gout from happening, it is none other than to live a healthy lifestyle, eat diet in balance, variety, and moderation manner. Exercise frequently. Always make sure your weight is in the healthy range of weight for your height and frequently conduct medical check up to see if there is any changes in your blood result as our age increases.

References

1. Centre of Disease Control (CDC). Gout. https://www.cdc.gov/arthritis/basics/gout.html (Accessed on November 26, 2020).
2. What is gout? https://www.webmd.com/arthritis/arthritis-gout (Accessed on November 26, 2020).
3. American Family Physician Foundation (AAFP). Gout and Hyperuricemia. https://www.aafp.org/afp/1999/0215/p925.html#:~:text=The%20peak%20incidence%20occurs%20in,changes%20in%20diet%20or%20lifestyle. (Accessed on November 26, 2020).
4. Mayo Clinic. Gout. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897 (Accessed on November 26, 2020).
5. Clinical Practice Guideline (CPG). Gout. Ministry of Health Malaysia (MOH).

Have you heard of low purine diet? Low purine diet is diet that is prescribed to individuals who have gout, or have symptoms of gout, or have high or borderline uric acid in their blood results. Low purine diet is not a first line mechanism in treating gout or hyperuricemia (a condition of high uric acid level). Usually in the condition of gout attack, or when individual have swollen joint (usually in the big toe area), doctor or pharmacist will prescribe medication to ease the inflammation and diuretic medication to help with the retention of uric acid crystal.

These two prescription usually will be accompanied with pain killer to ease the pain. Depending on severity, condition, and individuals’ level of uric acid, the acute attack will slowly resolve in few days or week. However, if individuals fail to be cautious on food that they consume, gout may attack again (1,5). So here in this article, we are going to explain on diet that is suitable for individual with gout. Some said that it can be used for people who have kidney stone as well, but it is best to seek medical advise on what kind of stone itself, such as sometimes it can be calcium stone, oxalate stone, and many more thus avoidance of food must be made according to what kind of stone in the individuals body. Again, in this article we focus on gout.

Purine is found on many types of food, the only different is the amount of purine in a particular food. Certain food has high amount of purine while the other have low amount of purine. Food that is high in purine is the kind of food that has to be avoided by individuals with gout since it will be broken down into uric acid which for individual with gout it will be a huge problem (1,5,3).

Carbohydrate

Most carbohydrate does not have high amount of purine; thus, it is okay for individual to consume carbohydrate within recommended intake. However, as for people who have gout and diabetic, it is very tricky since wholegrain product has high amount of purine but has low glycemic index and high fiber, which is meant for individuals with diabetes but not gout, thus for individual with both problems, they need to balance in the amount of carbohydrates taken from these two source, meaning to say, let’s take rice as an example, certain days individual has to consume white rice while other days it can be brown rice. The same thing works for bread and pasta etc (carbohydrate-based food) (2,3,6).

Protein

Most of gout individuals must be cautious when it comes to protein-based food. Fish such as anchovies, sardines, scallops, tuna, codfish, herring, and haddock has high level of purine thus need to be avoided. Meat such as from goose and duck and organ meat such as brain, heart, liver, and kidney also have high amount of purine thus must be avoided or limit it intake. Gravies that is made from meat, like red meat broth or soup or stocks also has high purine (2,4,6).

For individual with gout, protein rich food can be consumed from source such as chicken, lean meat, and prawn. However, the consumption of meat also must be limited to 2-3 ounces only per day. For individuals with gout it is best to consume protein from legumes and eggs since most of it does not has high purine, but for individuals with gout and high cholesterol level consumption of eggs need to be limit  as well. If for normal and gout individual consumption of egg is up to two eggs per day while for gout and high cholesterol need to limit to one only or better do not consume egg yolk for it can elevate your cholesterol level. You sure don’t want your cholesterol level rising while managing your uric acid level, don’t you ?

Vegetables and fruits

Most of the vegetables and fruits has low amount of purine except for asparagus, cauliflower, spinach, and mushroom. Thus, individuals with gout may consume vegetable without concern that it may elevate level of uric acid in the blood. As for individuals who has diabetes and gout, consuming a lot of vegetables also will help in the management of blood glucose level as well, but you need to consume fruits that has low glycemic index such as apple, strawberry, kiwi, and peach (2,3,7).

Milk and dairy products

Milk and dairy products are mostly low in purine. However, in consuming milk and dairy products, individuals need to be aware on the amount of fat they are ingesting. It is also not suitable for individual who has high cholesterol. Thus, always choose milk and dairy product that is low trans-fat, low saturated fat, and low sugar (2,3,7).

In conclusion,

Other than category of food mentioned above or in the picture above, alcohol consumption also must be taking in cautious, for gout individuals, wine is better than beer. And, if you are considering supplementation consumption, it is best to avoid supplement that contained yeast. Consumption of low purine diet also must be together with drinking plenty of water and exercise which can help you to maintain or lose weight, which is one of the risks for gout (2,3,6). You may follow the low purine diet table below to understand diet for gout individuals better!

References

1. 7 Tips following a low-purine diet. https://www.healthline.com/health/tips-for-following-low-purine-diet (Accessed on December 1, 2020).
2. com. Low Purine Diet. https://www.drugs.com/cg/low-purine-diet.html (Accessed on December 1, 2020).
3. Mayo Clinic. Gout: What’s allowed what’s not. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524 (Accessed on December 1, 2020).
4. sg. Gout Diet: Top Carbohydrate, Dairy, Fruits, and Vegetables to eat. https://www.healthxchange.sg/food-nutrition/food-tips/gout-diet-carbohydrate-dairy-fruit-vegetable (Accessed on December 1, 2020).
5. My Health Portal. Ministry of Health Malaysia (MOH). Gout. http://www.myhealth.gov.my/en/gout-5/ (Accessed on December 1, 2020).
6. My Health Portal. Ministry of Health Malaysia (MOH). Diet Management for Gout. http://www.myhealth.gov.my/en/diet-management-for-gout/ (Accessed on December 1, 2020).
7. Clinical Practice Guideline (CPG). Ministry of Health Malaysia (MOH). Gout.

Collagen is a fiber-like structure that is used to make connective tissue, which connects other tissue together. It is a major component of bone, skin, muscles, tendons, and cartilage. Collagen is a component that help to make tissue strong, resilient, and able to withstand stretching (1).

Although the saying that our bodies make less collagen as we age is true, but the production of collagen drops most not only because of this but also due to excessive exposure to sun, smoking including second hand smoke, excessive consumption of alcohol, lack of sleep and lack of exercise. As the collagen level in our skin diminish, the deep skin layers change from a tightly organized network of fibers to an unorganized maze. Environmental exposure to skin such as harsh weather can also damage collagen fibers by reducing their thickness and strength which can lead to wrinkles on the skin surface (1).

Research on collagen supplementation are mostly on joint and skin health. Although studies pertaining to this using human subjects are still lacking, but some randomized controlled trials have found that collagen supplementation improve skin elasticity. In one study, women who took a supplement containing 2.5 – 5 grams of collagen for 8 weeks experienced less skin dryness and a significant increase in skin elasticity as compared to those who did not. Another study found out that women who consume it for 12 weeks experienced increased skin hydration and a significant reduction in wrinkle depth as compared with a control group (1,2, 3,4). 

Trials on collagen supplement and  joint health also found that it can improve joint mobility and decrease joint pain for people with osteoarthritis or in athletes (5). Collagen comprises about 60% of cartilage, a very firm tissue that surrounds bones and cushions them from the shock of high-impact movements; so a breakdown in collagen could lead to a loss of cartilage and joint problems.

Other than consumption of collagen based supplement, there are also foods that is rich with collagen, or that encourage collagen production other than lifestyles modification mentioned above. Food such as  tough cuts of meat full of connective tissue like pot roast, brisket, and chuck steak. However, a high intake of red meat is not recommended as part of a long-term healthy diet. Collagen is also found in the bones and skin of fresh and saltwater fish. Bone broth which require animal bones to simmer in water with small amount of vinegar for 4 – 24hours also is said to have high collagen properties. However, the amount of amino acids will vary among batches, depending on types of bones used, cooking period, and many more. Other foods that can help to with production of collagen are foods that is rich with zinc such as legumes, nuts, seeds, whole grains, and vitamin c rich food such as citrus fruits, bell peppers and tomatoes.

Although studies on the effectiveness of collagen to health is still  not in the solid, but many available research has not shown negative side effects in individuals given collagen supplements (6). Thus, it is worth to try for its said benefits especially if the benefits is your health concerns! But be sure to talk to your healthcare professionals on this based on your medication intake and your health issues before consuming any health supplement.

References

1. Harvard T.H. Chan. School of Public Health. Collagen.https://www.hsph.harvard.edu/nutritionsource/collagen/
2. Healthline. Top 6 Benefits of Taking Collagen Supplements. https://www.healthline.com/nutrition/collagen-benefits
3. Proksch E, Segger D, Degwert J, Schunck M, Zague V, Oesser S. Oral supplementation of specific collagen peptides has beneficial effects on human skin physiology: a double-blind, placebo-controlled study. Skin Pharmacol Physiol. 2014;27(1):47-55. doi: 10.1159/000351376. Epub 2013 Aug 14. PMID: 23949208.https://pubmed.ncbi.nlm.nih.gov/23949208/
4. Borumand, M., & Sibilla, S. (2015). Effects of a nutritional supplement containing collagen peptides on skin elasticity, hydration and wrinkles. Journal of Medical Nutrition and Nutraceuticals, 4(1), 47.https://www.jmnn.org/article.asp?aulast=Borumand&epage=53&issn=2278-1870&issue=1&spage=47&volume=4&year=2015
5. Bello AE, Oesser S. Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature. Current medical research and opinion. 2006 Nov 1;22(11):2221-32.
6. Kim DU, Chung HC, Choi J, Sakai Y, Lee BY. Oral intake of low-molecular-weight collagen peptide improves hydration, elasticity, and wrinkling in human skin: a randomized, double-blind, placebo-controlled study. Nutrients. 2018 Jul;10(7):826.