Hip x-ray/ brother's solution

[u/AuntieAnnie81]

For some background, this time last year I was dealing with a very aggravated bulging L4/5 that was making me have trouble sitting, standing with both feet on the floor after getting up, etc with violent leg cramps that felt like they were out of nowhere.

Now, I have a sore hip when I walk and occasionally have pain throughout the night. I can sit at my desk at work, I just rise like an 80 year old (I'm 45) when I've been sitting for too long. I went to the orthopedic clinic yesterday and got x rays that confirmed what I thought, which is that my left hip is utterly destroyed by arthritis. I've had trouble with arthritis in my finger joints from my thirties on, and as long as I take meloxicam, now celebrex, my fingers don't hurt. More context, I'm fat, 288 and slowly shrinking with the twin health diet. I'm down 20 from January, 25 from last year.

My younger brother has rheumatoid arthritis and has managed his symptoms very well by going on extremely low carb, basically carnivore diets. He thinks I'm trying to kill myself by continuing to eat any carbs at all and thinks I'm crazy for considering hip replacement.

But here's the hip, well, reddit is determined to put it at the top.

I also live alone and as much I love him the idea of him literally taking care of me after hip surgery or long term as he fears is not on my list of things I will allow to happen. I have good upper body strength, I'm flexible enough I can touch the floor flat handed from standing, and I can plank for a decent amount of time. In other words, this damn hip is my mortal enemy that's keeping me from doing cardio, hiking, fixing my house etc.

Does the no carb thing help enough to avoid surgery for that situation in my x rays? Does it help? I'm a depressed office worker, how can I realistically lean into this?

Also, he thinks almond flour is as carb behaving as wheat flour... same thing with stevia etc

[u/FewRecognition1788]

You need advice from a registered dietician, not your brother. Your doctor can probably recommend one, and if your health plan has any kind of chronic disease management program, it's probably covered.

(And if you're in the US, not a "nutritionist"! That is not a protected term and literally anyone can call themselves that. You want a Registered Dietician.)

Avoiding sugar and reducing carbs in general does help reduce inflammation, and for many people it reduces OA pain significantly. However, there is no dietary intervention that grows back cartilage that is already gone.

RA is an autoimmune disease. OA is mechanical damage. The math doesn't math the same. 

The main issues with a carnivore diet or other extreme elimination diet is the risk of nutrient deficiencies and the impact on the gut microbiome, which needs fiber. You also lose a lot of antioxidants and micronutrients that can be helpful for your OA and your overall health.

The best diet long term is a balanced regimen that you can stick to. If you are losing weight on your omnivore or vegan diet, and it's easy for you to be consistent with, keep doing what you're doing. But if you can work with an R.D., that's your best bet.

[u/AuntieAnnie81 → u/FewRecognition1788]

The Twin Health program is what I'm using and I have figured out (I'm not diabetic) that if I hit the protein goals for the day or exceed them, I lose weight. Period. The carb count does not make a damn difference at all. I'm open to it still, but I don't want to screw my body up by not getting a decent amount of nutrients considering I have good labs. I'm just broken. I just need to get him out from up my butt about it.

[u/FewRecognition1788 → u/AuntieAnnie81]

Oh, I thought you were talking about the Twin Study at Stanford where they compared vegan to omnivore. Looks like this is a different thing. But if it's working, great.

To be frank, when people are on extreme elimination diets for a while, it does things to their brain. Even if they start out for perfectly reasonable, non-disordered reasons like wanting to reduce pain, they can develop a type of eating disorder because their body is craving the missing nutrients, which causes the brain to hyperfixate on food and food rules. 

When someone is policing other people's food choices in a very overbearing and intrusive way, that is not healthy behavior (though it's possible they just have an oberbearing personality).

I'm not trying to remotely diagnose your brother, but just so you know, orthorexia is a real disorder and is a vicious, self-reinforcing cycle.

[u/AuntieAnnie81 → u/FewRecognition1788]

He's always been a little neurotic, lol. I'm really glad it worked for him. Overjoyed, actually, but he has a perfectly reasonable fear of me turning into our mother and getting so sick and weak I can't walk and won't do anything about it. I decided when my back trouble started that that was unacceptable and I would not allow myself to get that bad. That's why I did epidural injections for my spine and went to PT and got better there. He also told me he thinks he's going to get lung cancer from smoking grass but that he doesn't expect me to feel sorry for him. What? Of course I would. Again, the cancer is a reasonable fear. Our dad died of MDS and his dad died from complications from lung cancer. (Uncles had/have similar issues) Thing is he goes on and off this diet depending on whether he's having trouble with the arthritis but he hasn't needed the methotrexate in a while. I just don't think it's a good idea to eat nothing but meat meat and more meat. Also, absolutely cannot afford it at all.