Prolozone and Nutritional Therapy for Osteoarthritis with Dr. George Papanicolaou

It's oxygen ozone therapy, because part of the benefit comes from getting oxygen into the joint. And then the ozone plays another role.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you suffer from arthritis, this is an important conversation to listen to, or you have chronic pain, this is a conversation you need to listen to because it's a special episode of the Doctor's Pharmacy called House Call. And today my guest is Dr. George Papam: one of our physicians here at the Ultra Wellness Center in Lenox, Massachusetts. Welcome, George. Thank you, Mark. Glad to be here. So, George, you're doing an incredible new kind of therapy that is helping patients with osteoarthritis when other things often aren't working. So let's talk about this epidemic of osteoarthritis we have in America.

How common is this?

How big of a problem is it and what do we do traditionally to deal with it?

So Mark, 27 million Americans over the age of 25 have osteoarthritis and the joint that is most commonly affected is the knee. It creates a great deal of morbidity, meaning that- Suffering. Suffering.

I think that's a fancy medical word for suffering. Pain in the ass.

Right, so yeah, and our traditional therapies basically help you control the symptoms but might not necessarily do anything to reverse it. So using Motrin or Advil or Tylenol are common things people will use. And then your orthopedic surgeon may inject it with a steroid or they may use something like a lubricant.

Like hyaluronic acid.

Yeah, hyaluronic acid. And so it's only a lubricant effect.

And then you need a knee replacement.

Right, and then you're getting towards a knee replacement. And then we know that 40% of people that have their knee replaced still continue to have pain and loss of motion. So we don't have a lot of real successful treatments out there that are really changing people's lives.

Yeah, right. It's true. And I think, you know, we often used to think about osteoarthritis as a wear and tear problem. You just beat up your joints too much. But it turns out it's really an inflammatory problem as well.

So what's interesting, it certainly increases with age and trauma to the knee is certainly part of what creates that inflammation. And that trauma can be repetitive use. It doesn't have to be an ACL tear, you know, from a, you know, football injury. It can just be repetitive use on a person who's carrying too much weight on their body. So obesity is a risk factor for arthritis.

But obesity also is a generally inflamed state.

Right?

So when you're obese, your fat cells are not just there holding up your pants. They're producing tons of inflammatory compounds that are making your whole system inflamed.

Right, and so if you have an inflamed system and you're creating micro trauma to your joints, you're going to have an overreactive response in the joint. And joints, I think we should understand and know about them is that the cartilage and the ligamentous structures of the joint have lower oxygen tension than the rest of your body, meaning that they don't have an enormous oxygen supply. It's a little bit different than the rest of the body and that plays a big role into why as we age that oxygen supply actually decreases. Blood flow to those vital areas of the cartilage and ligaments decrease so that when you injure them, they're less likely to repair, more likely to have an inflammatory response that leads to degeneration. Yeah, interesting.

So, what we're also learning about osteoarthritis and fasting to me was that when they're doing like biopsies and do analysis, they're finding microbes in the joints. Not an infection, but just dislocated microbes from the gut. So we're seeing the microbiome in the gut and the knee, which is crazy. So that's maybe also triggering an inflammatory response, right?

Yeah, yeah. We are really only 10% human. We understand that because we have 100 trillion bacteria living in and on us and they're only 10 trillion human cells.

So conventional medicine, basically, your knee hurts, you go to the doctor, and you get an x-ray and they go, you have osteoarthritis, here take some Advil, you know, maybe do some strengthening exercises for your legs, maybe if it gets really bad you get a couple of shots in your knee of steroids, that doesn't work anymore, you need a knee replacement. It's kind of a bad trajectory. There's no way to really sort of recover from this. And from a functional medicine perspective, we.

Do a different approach. We do. and, you know, we are going to talk about that approach, but exercise does help, nutrition does help, losing weight does help. So there are definitely things that we can do with a person's lifestyle and help them intervene. I worked with a patient that was 45 pounds overweight, was eating a totally processed food diet, was drinking too much, and was scheduled for knee replacement in september. I saw them in early july, and I said, hey, look, If you do these things I'm about to tell you, I bet you you could be playing golf in January in Miami with your friends instead of recovering from knee replacement. And he said, okay, I'll take you on. I said, okay, if you win any money in Miami, I get 10%. So guess what?

Did you get the 10%?

He got what he wanted. I didn't get what I wanted. Okay? So he lost 45 pounds.

Amazing.

I put him in physical therapy with a really good functional physical therapist, his knee, he canceled the knee replacement and came into an appointment, like walking, right? And he opened up an envelope with his tickets to Miami.

Oh, right. That's amazing. But just to be clear, it wasn't just like eat less, exercise more. No. You put him on an anti-inflammatory diet, which is speaking to the point that osteoarthritis is not just a mechanical wear and tear breakdown. It's a chronic inflammatory process.

Multiple things.

From a functional medicine perspective, we deal with chronic inflammation holistically. So what are the things that you did diet-wise and supplement-wise that actually helped with his chronic inflammation that helped his knees and the weight loss?

The really key thing was to get him to decrease his alcohol and also to decrease his intake of processed foods. These processed foods are fast carbs that go into your body, they have toxins in them, and they also create an inflammatory response driven by insulin.

So sugar and starch are inflammatory foods.

Right, and so we took that right out. So we just basically put them on a Mediterranean diet. But not gluten and dairy free. Gluten and dairy, yeah, absolutely gluten and dairy free. Why is that important? Because as we've talked about before, multiple times, they're both inflammatory, and so gluten can actually trigger leaky gut, which again triggers that whole process of inflammation in the body, and then if you have any micro trauma to your knee, that inflammation, that cytokine response, is going to lead to degeneration of cartilage and even bony structures in the knee.

So here's the deal, not everybody needs to be gluten and dairy free. But if you were inflamed, you gotta be. If you have a chronic problem, it's number one, two and three on the list, right?

Gluten and dairy sugar.

Gluten and dairy sugar gone. And inflammatory foods as the first step. And then you say, well, is it better? Is it not? Is it something else? Because it's sometimes something else. But it's really powerful when you put people on an anti-inflammatory diet. So if you have osteoarthritis, It's diet is one, two, and three, and it's really getting on a whole foods, plant-rich, good fats, lots of anti-inflammatory foods, getting.

Off gluten, getting off grains, getting off starch, processed foods. Yeah, so yeah, and you put them on really good healthy fats, because fats are a really important part of the anti-inflammatory process. I put him actually, one of my favorite things to do when I'm dealing with inflammation is high dose omega-3s. So lots of omega-3s, right? Yeah, so I use, you know, 4,000 or more. so I put them on Omega-3s. I use an anti-inflammatory botanical called curcumin. And so, it's sort of like a botanical Advil. So, I put them on that. I also use something like it's a supercharged Omega-3. It's refined from Omega-3s called Specialized Pro Resolving Factors, Mediators. And they are very potent. SPMs. So, they're very potent anti-inflammatories. So, between his diet.

It's sort of like taking all the, the good juju out of the Omega-3s and concentrating them. And, there's a lot of research done at Harvard on this.

Oh, yeah.

And, your body has this ability to resolve inflammation. It has an auto built-in system. It's called resolvins. So, resolvins are molecules in your body that resolve inflammation. So, these are called specific pro-resolving mediators. So, they're really effective. They are. There's a lot of research on these.

And a lot of research with particularly post-surgical recovery, post-trauma recovery, that these will actually enhance recovery and you'll have a shorter recovery time when you're using SPMs.

Yeah, so they can be very effective. So, diet, supplements, and targeted supplements. Yeah, even vitamin D may be helpful because it strengthens the immune system.

Oh, yeah, absolutely. Yeah, vitamin D and omega and omegas are pretty much standard for me when I'm dealing with anybody with any amount of inflammation because of the impact that vitamin D has on the immune system, inflammatory system, mood, it just does so many things. In addition, physical therapy is very important because we do know that the muscular strength around a joint will protect that joint and keep it from the constant damage that it can get from repetitive use.

So, I never had any knee problems, knock wood. But I have very big thighs because I was a runner most most of my life and bikers. I have really big thighs and my knees, my leg thighs are strong. My knees always were protected.

Right, yeah. So, I could tell a personal story. I had my right hip replaced, had no pain and then I fell, I injured it, it got inflamed and within four months I had to get a hip replacement. I asked the surgeon, why did I have end-stage arthritis and not know it? Well, I had been running and I had been racing a bike for 10 years. I mean, I had really strong legs. And he said, there are a couple things, George. you have so much strength in the leg and you may have been a person because of your diet, you're not very inflamed. And so your cytokine response at the joint limited the pain you were going to feel. So strength and anti-inflammatory living can actually keep you from even knowing you have arthritis.

It's amazing. I had a lecture I did recently and there was this woman who's like, I did your 10-day reset and basically it's a anti-inflammatory detox from sugar and starch and gluten dairy sugar. It's a really nice program and you can go to getpharmacywithanf.com and you can learn about it. You can download the program free. You can get the extra version if you want. But she did this and not seeing me as a patient, just as on her own, and she said I was scheduled for a bilateral knee replacement. I did this program and I did it for more than 10 days, obviously. and I canceled them because my knees are fine now, which is pretty amazing story. I've heard this over and over. So I think if you're facing that level of surgery, I mean, a knee replacement is not easy. Hip replacement, you get the hip, you're up and going pretty quick. Knee replacement, you're out for a long time, a lot of hard work, physical therapy, you don't really get back to perfect. I mean, it can be great for people who need it, but there's some other intermediate steps before you get there, even if you know your diet great and everything's great. You've done all these things and it's still not working. There's another therapy that is merged that is really powerful.

Yeah, and this is, this is, yeah, this is very powerful stuff. And, you know, I wanted to make sure we talked about that the lifestyle and those important things.

Yes.

But what we really wanted to talk about was ozone. Yeah. And prolozone and, and what it can do for the, the joints.

Now, beautiful. To take us through this because, you know, most of your ozone, they the ozone layer and it's bad for you and what, what?

Right. So, so ozone. oxygen is a gas. We know that there's oxygen and oxygen is actually two oxygen atoms that come together and they have to be together because they're very stable together. Oxygen by itself, it needs another electron so it shares it with a partner. So you have O2, they're married and they're very happy together. But if they get any solar activity placed upon them or any electrical activity, they'll split and that's happening constantly all the time. But they'll come back very quickly together But sometimes they come back and there's a third person there. There's another extra oxygen molecule that's latched on because you couldn't find a partner. So now you have this what we call tri-atomic oxygen or O3. And now there's not enough electrons for all three to share. So the two oxygens have got to find a way to get rid of this third wheel. So that becomes a very unstable molecule. and it's that very thing that makes it so effective.

Tell us how it works. So how would you use that with arthritis?

So the way it works is, is that we can actually, we have an ozone machine. We have a machine.

Ozone generator.

Ozone generator.

It takes oxygen and runs it through this machine that was invented by Nikolai Tesla.

I was just, he did it again.

I need to say stuff too. It's my podcast.

So Nikolai Tesla in 1890, I think it was like 1893 or so, he patented the first, ozone machine, which is a really cool thing. So now we have ozone machines and we have an ozone machine that we hook up to medical grade oxygen and in that machine it will take that oxygen, it will hit it with electricity and create ozone and it can be modulated as to how much ozone you can actually make. And you can make anywhere from 1 to 5% oxygen ozone mixture. in different concentrations and we can adjust that concentration.

So we picked- so it's mostly oxygen with a little ozone.

Yeah, mostly oxygen, a little ozone. And that's really critical because part of the, it's ozone, it's oxygen ozone therapy because part of the benefit comes from getting oxygen into the joint. And then the ozone plays another role. So we then take this ozone and we inject it directly into the joint. It can be the shoulder joint, it can be the knee, it can be the hip, it can be the ankle. Any joint you can put ozone in. Hey everybody, it's Dr. Hyman.

Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introduce to you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode.

The way ozone works is pretty interesting. Because it's unstable, it actually has what we call a hermetic effect. It actually, by the fact that it stimulates the body to do something better by irritating it. Yeah, so it's a little bit like.

If you're lifting weights, you tear some muscles and you get bigger, stronger muscles.

Right. So what happens inside the joint is that it will actually modulate the cytokine response. So when you have that damage to your knee and you're constantly moving it, you're constantly creating that inflammatory response and there are cytokines. And those cytokines will then, this inflammation will lead to the breakdown of cartilage and eventually even bone and it also mediates pain. Ozone has been shown to modulate that response so that it will actually produce more of the anti-inflammatory cytokines versus the pro-inflammatory cytokines.

So that's also it activates your antioxidant system. So it's like an antioxidant for your knee and anti-inflammatory directly in there.

Exactly. So you get anti-inflammatory, it stimulates antioxidant and an antioxidant effect. But remember what I said earlier, that the knee and the cartilage anywhere and ligamentous structures don't have a great oxygen supply. And when you have that much inflammation in an older person and that oxygen supply and circulation has been diminished, now you don't have any of the healing capacity that you would have had without inflammation or if you were younger. What does ozone do? Ozone actually increases blood flow, it increases oxygen delivery and oxygen utilization. Wow, that's good. And it stimulates chondroblast and fibroblastic activity so that you can actually build up cartilage and build up the soft tissues around the knee. It's amazing. It's pretty amazing stuff.

I just got to tell a personal anecdote. So I also have been trained in ozone and we do this here at the Ultra Wellness Center, prolozone and other forms of ozone therapy for chronic illness, which are really effective. for so many things and definitely on the margins of medicine, but very, very powerful. And I had a broken arm a number of years ago and went to get training on how to do this. And my arm wasn't healing. And then I had a frozen shoulder. I could not move my arm above, like, you know, like 45 degrees from my body. It was so painful. And he's like, yeah, I can inject your shoulder. the guy who was training us, and he took ozone and injected it into my shoulder joint. And literally within five minutes, I was like doing this. I was completely mobile, moved my arm everywhere. There was another doctor in the training as well who had a frozen shoulder, not just for six months, but for years. Same thing. Injected his shoulder.

Yeah. Well, it's a miracle. Seen it over and over again. Yeah.

It's amazing. And I remember a patient, not that was mine, but when I was in training, there was a guy who had been on NHL. Hockey player and he'd won five Stanley Cups, part of the New York Islanders and his knees were shot. He couldn't walk. And he'd come in for a number of treatments to his doctor and after the ozone treatments in his knee, which I saw him administer, he just literally was up and walking. And I've seen people come in with.

Canes and dance their way out.

It's pretty amazing.

I know it sounds, you know, it sounds wacky, right?

But it sounds sensational, but it is. I mean, I was, I mean, I, that convinced me. I literally could not move. I don't know, I was, I had to go to physical therapy for a year and I had to maybe go under anesthesia to mobilize my shoulder and all these things I was getting recommended.

And I'm like, it was like five minutes.

And it was painless. Yeah, it is.

It is. It was a little needle poke, but that was it. And when we do it, we not only inject the ozone in, but because we know what's happening and that the joint hasn't been getting the blood supply it needs, the nutrients it needs, we'll add in some nutrients that are part of the healing process. So we'll add in some methylcobalamin, some magnesium and procaine. We use procaine also because it actually changes the action potential of the cell and membrane, which has been disrupted by the inflammation and it allows for the cells to become healthier. So the procaine actually is not just for the anesthesia, but it's also to help the cells heal.

That's amazing. So tell us about this patient you had who you treated with ozone here at the Ultra Wellness Center using prolozone, which is a form of ozone that you inject into joints or soft tissues to help with pain.

Yeah, so this is a woman who just two years ago went on a pilgrimage and hiked through these very high mountains in Spain. And on that hike, she had been having pain in her knee on and off, but nothing that ever inhibited her from doing anything she wanted. but on this hike, suddenly it blew up and she couldn't finish her pilgrimage. So she came home to her doctor, x-rays were done, and she had pretty much bone on bone in her knee.

Wow.

And so over the past two years, she has had steroid injections and she's had a lubricant injection with hyaluronic acid, and she had some benefit, but she still wasn't able to hike. So, she asked if I would treat her and I evaluated her and I treated her with ozone. And after her second injection, just three days ago, we had her second injection almost two and a half weeks ago. Three days ago, she went on her first hike in two years. She hiked six miles and went over mountains that were very high and she didn't have a problem. And the day after, she said, I didn't have any swelling.

That's amazing. That is amazing. And, you know, so how many treatments.

Do people often need? It doesn't sound like that. Usually, so, you know, usually I tell people between three to maybe eight injections, usually somewhere between three and six is a sweet spot.

And then you can come in for a tune up if you need it. Absolutely.

Is it painful? Not at all. Not at all. I mean, you'll feel the needle going in initially, but once I'm in the joint, it's not painful. You may feel the pressure of the ozone going in, but I monitor that very closely when I'm doing it and I can actually feel it.

You can feel the knee fill up with gas. Yeah, you can. And, it's basically a disinfectant, so there's microbes in there that shouldn't be there. It activates the anti-inflammatory system.

It's a powerful antioxidant. And, it's like an imagine and it manages a cytokine response which, you know.

Causes the inflammation and the pain. It's pretty remarkable. I mean, if I hadn't experienced it myself like that, I would be like, oh, this sounds really quacky. and actually it's a real procedure that's being used all over the world for years. For years. For many countries, for years. It's used here to some degree, but in many other countries like Cuba and South America and Spain, Italy, Russia. I mean, they're doing it extensively. It's extremely inexpensive. It's super effective. It's probably more effective than most traditional treatments for osteoarthritis. Absolutely. And it's got very low downside and very low cost. You inject steroids into knee over time. it's going to degrade the cartilage. It's going to degrade the knee. It's going to make things worse. You get a temporary benefit, but then.

You end up with worse. 10%. This actually helps restore cartilage. Yeah, that study that came out in 2019, 10% of the people that get steroid injections, actually their arthritis gets worse. Yes.

And they end up with unexplained fractures.

Yes.

Because it weakens their tissues. Yeah, so we know that.

And with prolozone, we've seen cartilage regeneration. Right, and that's the difference. That's what I wanted to make sure we made that point because it stimulates chondroblasts. Chondroblasts are the cells that rebuild cartilage. It can rebuild the cartilage and again, what we love in functional medicine is to find those modalities that just don't maintain disease but will actually reverse it and Prolozone fits the bill.

And you were saying this patient, she's hiked six miles and she was told.

She needed a knee replacement. Yep. Okay. I'm telling you, it's pretty amazing. She's pretty near bone on bone.

That's incredible. Well, it'd be interesting to see her follow up X-rays. I'm interested. And to continue to do this and track it. But, I think people out there suffering from osteoarthritis, the focus really should be on lifestyle. And, I think people need to understand they have a lot of power to transform the inflammatory state of their body. And, what often is considered diseases of aging are often inflammatory diseases. We call it inflammaging. and I think the arthritis is part of that. It's not just a bone on bone, you know, mechanical issue. It's an inflammatory issue. So using an aggressive lifestyle approach, 10-day reset, for example, using prolozone as an adjunct can be incredibly helpful for those people who need it. And I think it works for all kinds of joints, all kinds of orthopedic and soft tissue issues, back problems. And I think it's really such a.

Great service we offer here at the Ultra Wellness Center. It is great, and it's safe.

And it's safe.

The same thing, they did this study in 1980 in Germany where they looked at 650,000 treatments that were provided by 644 docs to 300 and some, I think, 50,000 patients. And their complication rate, there was only 40 complications reported, which was .00007% complication rate.

Seven in a hundred thousand.

Yeah.

That's not too bad.

Yeah, you're pretty good at math. So yeah, that's a great safety record. And it's been used in Europe for at least half a century for treating viruses, infections, wounds.

Yeah, and this was not prolotherapy, but this was other forms of other forms of other. But it is very safe and I think We're so excited to be able to introduce this here, not just for orthopedic issues, but we have different forms of ozone we give intravenously and through other methods that help people with all sorts of chronic issues. So, I encourage you all to check it out, learn more about it. Go to ultrawellnesscenter.com, check out the Get Started page, learn how to become a patient. We'd love to see you here. We can do all virtual consults, although you can't do prolo ozone over Zoom, which is a problem. But we are offering the service still. We're open, our clinic is open. We'd love to see you. And if you have loved this podcast, please share with your friends and family on social media. Leave a comment, we'd love to hear from you. Subscribe wherever you get your podcasts. And we'll see you next time on the Doctor's Pharmacy.

Come on, Mark.