What if treatment would be more integrative, earlier and more human for osteoarthritis?

What if treatment would be more integrative, earlier and more human for osteoarthritis?

by | Jun 2, 2025 | Joint Health

What if treatment would be more integrative, earlier and more human?

By Marc Dellière

All too often regarded as an age-related inevitability, osteoarthritis now affects more than 10 million French people. Yet there are many complementary, scientifically-validated strategies available to improve patients’ quality of life.

Articular cartilage is an incredibly resistant tissue, capable of withstanding loads far greater than our body weight. The problem is that this tissue, however efficient, is very difficult to repair. Devoid of blood vessels, it depends on a slow process of nutrient diffusion to survive. And since chondrocytes live in an oxygen-poor environment, their ability to regenerate the matrix is limited.

Hence the importance of protecting this joint capital from the very first signs.

Every kilo lost relieves 4 to 6 kilos of pressure on the hips or knees… a good reason to promote appropriate physical activity and a balanced diet.

What if, in the face of osteoarthritis, we dared to take a more comprehensive, more humane and earlier approach?

Get moving.

Yoga, walking, cycling and tai chi all help to lighten joints, activate muscles and limit degeneration.

Manage pain and stress.

Hypnosis, meditation, sophrology and cardiac coherence can really improve symptom management.

 

Eat well.

The plate is a well-known Hippocratic therapy. Fewer fast sugars, more antioxidant-rich foods and a plant-based diet similar to the Mediterranean diet for less inflammation.

 

Good referral.

Acupuncture, derived from traditional Chinese medicine, is becoming an increasingly popular treatment option for osteoarthritis patients. Its effectiveness is neither magic nor a simple placebo effect. Several studies have demonstrated its effectiveness in reducing chronic pain, improving joint mobility and limiting the use of analgesics. By acting on nerve pathways and inflammation mediators, acupuncture offers a valuable complementary approach.

 

Supplement well.

  • Turmeric (curcumin): well-documented anti-inflammatory effect.
  • Boswellia serrata: supports joint flexibility.
  • Harpagophytum: reduces perceived pain.
  • Omega-3: modulation of chronic inflammation.
  • Glucosamine & chondroitin: slow cartilage wear and improve joint comfort in certain patients, notably in cases of mild to moderate knee osteoarthritis.
  • Type II collagen and hyaluronic acid: structural support for cartilage, promoting suppleness and elasticity.

 

Far from pitting conventional treatments against natural approaches, integrative medicine invites us to combine them intelligently. As healthcare professionals, we have a key role to play in this dynamic, offering personalized, evidence-based support… with an emphasis on prevention.

 

Sources :

Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts. Coppola C, Greco M, Munir A, Musarò D, Quarta S, Massaro M, Lionetto MG, Maffia M. Curr Issues Mol Biol. 2024 Apr 29;46(5):4063-4105. doi: 10.3390/cimb46050251.

Comparative efficacy of mind-body exercise for pain, function, quality of life in knee osteoarthritis: a systematic review and network meta-analysis.Gao K, Tao J, Liang G, Gong C, Wang L, Wang Y.J Orthop Surg Res. 2025 Apr 17;20(1):384. doi: 10.1186/s13018-025-05682-7.

Mind-body exercises for osteoarthritis: an overview of systematic reviews including 32 meta-analyses.de-la-Casa-Almeida M, Villar-Alises O, Rodríguez Sánchez-Laulhé P, Martinez-Calderon J, Matias-Soto J.Disabil Rehabil. 2024 May;46(9):1699-1707. doi: 10.1080/09638288.2023.2203951.

Short-term manual acupuncture decreased markers of systemic inflammation and altered articular cartilage transcripts in the Dunkin-Hartley model of osteoarthritis. Spittler AP, Bukovec KE, Afzali MF, Leavell SE, Bork SB, Seebart CA, Santangelo KS, Story MR. Am J Vet Res. 2025 Feb 7;86(4):ajvr.24.11.0341. doi: 10.2460/ajvr.24.11.0341. 

Bioactive Compounds in Osteoarthritis: Molecular Mechanisms and Therapeutic Roles. Maouche A, Boumediene K, Baugé C. Int J Mol Sci. 2024 Oct 30;25(21):11656. doi: 10.3390/ijms252111656.

Role of Plant Materials with Anti-inflammatory Effects in Phytotherapy of Osteoarthritis. Geszke-Moritz M, Nowak G, Moritz M, Feist B, Nycz JE. Curr Top Med Chem. 2025;25(1):35-46. doi: 10.2174/0115680266297662240527105450.

 

Stress: the invisible enemy of fertility?

Stress: the invisible enemy of fertility?

by | May 26, 2025 | Stress Management

Fertility problems: what if Stress was the invisible enemy?

By Marc Dellière

Under stress, the brain perceives the environment as unsuitable for reproduction.

It then naturally slows down fertility-related processes, as a protective mechanism.

Added to this is a significant psychological impact: the difficulty of conceiving itself becomes a major source of anxiety… which reinforces the blockage.

Chronic stress activates the HPA (hypothalamic-pituitary-adrenal) axis, increasing cortisol, which inhibits the HPG (hypothalamic-pituitary-gonadal) axis, key to reproduction. This disrupts sexual hormone production, reducing fertility and impairing ovulation in women and spermatogenesis in men.

In periods of prolonged stress, the body also mobilizes more cholesterol to produce cortisol via the hypothalamic-pituitary-adrenal (HPA) axis. This biological priority mechanism can redirect resources away from the synthesis of other steroid hormones such as DHEA, estrogen, progesterone and testosterone.

Fewer resources are therefore available for fertility, which can contribute to hormonal disorders, reduced libido and irregular cycles in women.

In women

It can lead to ovulation disorders, irregular cycles or even amenorrhea.

Studies have shown that stress can suppress the HPG axis, leading to ovulatory dysfunctions, reduced sexual steroidogenesis (synthesis of steroid hormones, i.e. those originating from cholesterol: gynecological hormones, estrogen, progesterone, and male hormones, testosterone) and reduced fertility in women of childbearing age.

In men

It can reduce sperm quality and quantity.

Psychological stress is associated with reduced sperm concentration, altered sperm morphology and reduced sperm motility. Oxidative stress, linked to an excess of free radicals, also alters gametes DNA, compromising their quality.

Chronic stress also alters sleep quality, disrupting the secretion of leptin (satiety hormone) and ghrelin (hunger hormone), thus contributing to caloric overconsumption. These metabolic disturbances may influence fertility, although the precise mechanisms remain to be elucidated.

“During our first IVF (in vitro fertilization) attempt, I was overwhelmed by anxiety. I felt like everything depended on this cycle. I controlled everything: the dates, the hormones, the results… But inside, I was in a panic. I couldn’t sleep because of the stress, I often cried for no reason and I took refuge in food. The result was negative. For the second attempt, I started hypnosis coaching to better manage my emotions. I felt calmer, more aligned… and this time, it worked. Today, I’m pregnant. I’m convinced that my psychological state has made a real difference.”

Sophie M., 35

As caregivers, we have a key role to play in breaking the vicious circle between stress and infertility.

Incorporating a holistic approach, focusing on body and mind, not only improves the chances of conception, but also reduces the psychological suffering of patients and those around them.

  • Psychological support
  • Stress management techniques (hypnosis, meditation, CBT)
  • Regular physical activity
  • Appropriate nutrition
  • Support for family and friends or discussion groups

Sources:

Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018 Mar;20(1):41-47. doi:10.31887/DCNS.2018.20.1/klrooney. 

Kim J, Whitcomb BW, Kwan B, Zava D, Sluss PM, Dietz A, Shliakhtsitsava K, Romero SAD, Natarajan L, Su HI. Psychosocial stress and ovarian function in adolescent and young adult cancer survivors. Hum Reprod. 2021 Jan 25;36(2):405-414. doi: 10.1093/humrep/deaa313. 

Aitken RJ. Impact of oxidative stress on male and female germ cells: implications for fertility. Reproduction. 2020 Apr;159(4):R189-R201. doi: 10.1530/REP-19-0452. 

Nikolaeva M, Arefieva A, Babayan A, Chagovets V, Kitsilovskaya N, Starodubtseva N, Frankevich V, Kalinina E, Krechetova L, Sukhikh G. Immunoendocrine Markers of Stress in Seminal Plasma at IVF/ICSI Failure: a Preliminary Study. Reprod Sci. 2021 Jan;28(1):144-158. doi: 10.1007/s43032-020-00253-z.

Scollo A, Cotticelli A, Peric T, Perrucci A, Prandi A, Ferrari P. Hair Dehydroepiandrosterone Sulfate (DHEA(S)) and Cortisol/DHEA(S) Ratio as Long-Lasting Biomarkers of Clinical Syndromes Exhibited by Piglets Early in Life. Animals (Basel). 2025 Apr 3;15(7):1032. doi: 10.3390/ani15071032.

Gleicher N, Seier K, Kushnir VA, Weghofer A, Wu YG, Wang Q, Albertini DF, Barad DH. Associations between peripheral androgens and cortisol in infertile women. J Steroid Biochem Mol Biol. 2016 Apr;158:82-89. doi: 10.1016/j.jsbmb.2016.01.004.

Chimote BN, Chimote NM. Dehydroepiandrosterone (DHEA) and Its Sulfate (DHEA-S) in Mammalian Reproduction: Known Roles and Novel Paradigms. Vitam Horm. 2018;108:223-250. doi: 10.1016/bs.vh.2018.02.001.

Type 5 diabetes: all you have to know

Type 5 diabetes: all you have to know

by | May 16, 2025 | Blood Sugar Management

What is type 5 diabetes?

By Marc Dellière

At the International Diabetes Federation (IDF) World Diabetes Congress 2025 in Bangkok, type 5 diabetes – also known as malnutrition-related diabetes – was officially recognized as a distinct entity. This form of diabetes affects between 20 and 25 million people worldwide, mainly in South Asia and sub-Saharan Africa, where chronic malnutrition during childhood or adolescence remains common.

Unlike types 1 and 2, this diabetes is neither autoimmune, nor linked to overweight or insulin resistance. It reflects altered metabolic development due to prolonged deficiency of energy and essential micronutrients, which has a lasting effect on pancreatic function. This particular metabolic profile is marked by severe insulin deficiency, reduced hepatic glucose production, preserved muscular glucose uptake, little or no insulin resistance, and low visceral fat mass.

Until recently, this form of diabetes was often misclassified as type 1 or type 2 diabetes, and therefore poorly managed. Official recognition by the IDF marks a decisive turning point in the global approach to diabetes.

An international working group, co-led by Dr Meredith Hawkins (Albert Einstein College of Medicine, New York) and Prof Nihal Thomas (Christian Medical College, Vellore, India), has been mandated to develop formal diagnostic criteria, therapeutic guidelines, an international research registry and training modules for healthcare professionals.

As a reminder:

  • Type 1: autoimmune destruction of pancreatic β-cells.
  • Type 2: insulin resistance and progressive decompensation.
  • Type 3: secondary forms (genetic, drug-induced, pancreatic).
  • Type 4: gestational diabetes.
  • Type 5: undernutrition diabetes, now defined by specific clinical, metabolic and social criteria.

What about MODY?

MODY diabetes (Maturity-Onset Diabetes of the Young) is one of the genetic forms grouped under type 3. This hereditary, monogenic form of diabetes occurs at an early age, but without autoimmunity or obesity. It requires precise molecular diagnosis.
This classification enables us to better adapt diagnosis and management to profiles that have hitherto been poorly understood

Official recognition by the International Diabetes Federation (IDF) has several aims:

  • Improve early detection of cases, which are often misdiagnosed today.
  • Adapt treatment protocols: this type of diabetes responds poorly to conventional oral antidiabetics.
  • Guide nutritional policies in the countries concerned, with a focus on vulnerable populations.

In practice: recognition of type 5 diabetes avoids confusion with type 2 diabetes in skinny, young patients who are often inaccessible to standard care.

Therapeutic approaches focus on progressive reconstitution of metabolic reserves, with particular attention paid to :

  • a protein-enriched diet,
  • a moderate reduction in fast carbohydrates,
  • correction of micro nutritional deficiencies (zinc, iron, B vitamins, etc.).

According to Dr. Meredith Hawkins (Albert Einstein College of Medicine):

“We now need to define a specific nutritional strategy for these patients, while respecting their social and economic context.”

Dr Meredith Hawkins

Sources:

IDF launches new type 5 diabetes working group

IDF Diabetes Atlas (2025 edition) 

Malnutrition-Related Diabetes Officially Named ‘Type 5’
Miriam E. Tucker
April 11, 2025

Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019.
Chong B, Jayabaskaran J, Kong G, Chan YH, Chin YH, Goh R, Kannan S, Ng CH, Loong S, Kueh MTW, Lin C, Anand VV, Lee ECZ, Chew HSJ, Tan DJH, Chan KE, Wang JW, Muthiah M, Dimitriadis GK, Hausenloy DJ, Mehta AJ, Foo R, Lip G, Chan MY, Mamas MA, le Roux CW, Chew NWS.
EClinicalMedicine. 2023 Feb 16;57:101850. 
doi: 10.1016/j.eclinm.2023.101850.

We Need to Better Understand Malnutrition-Related Diabetes

Subgroups of adult-onset diabetes: a data-driven cluster analysis in a Ghanaian population.
Danquah I, Mank I, Hampe CS, Meeks KAC, Agyemang C, Owusu-Dabo E, Smeeth L, Klipstein-Grobusch K, Bahendeka S, Spranger J, Mockenhaupt FP, Schulze MB, Rolandsson O.
Sci Rep. 2023 Jul 4;13(1):10756. 
doi: 10.1038/s41598-023-37494-2.

An Atypical Form of Diabetes Among Individuals With Low BMI.
Lontchi-Yimagou E, Dasgupta R, Anoop S, Kehlenbrink S, Koppaka S, Goyal A, Venkatesan P, Livingstone R, Ye K, Chapla A, Carey M, Jose A, Rebekah G, Wickramanayake A, Joseph M, Mathias P, Manavalan A, Kurian ME, Inbakumari M, Christina F, Stein D, Thomas N, Hawkins M.
Diabetes Care. 2022 Jun 2;45(6):1428-1437. 
doi: 10.2337/dc21-1957.

Severe malnutrition as a cause of transient carbohydrate metabolism disorders which evolved into hyperosmolar hyperglycaemic state.
Sokołowska-Gadoux M, Pietrusik A, Chobot A, Jarosz-Chobot P.
Pediatr Endocrinol Diabetes Metab. 2022;28(2):162-167. 
doi: 10.5114/pedm.2022.114668.

Qu’est-ce que le diabète de type 5 ?