Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH

Integrating Nutrition into Regenerative Orthopedics:

An Interview with Kenneth Cintron MD, MBA

Regenerative orthopedics is an emerging specialty that is changing the practice of orthopedics and sports medicine at a very fast pace. This month’s Townsend Letter focuses on alternative therapies for inflammation and arthritis. Regenerative therapies such as platelet rich plasma (PRP) and stem cells offer new treatments to patients with arthritis. When introduced early, these treatments can end disability, reduce the need for pain medications, and prevent surgery altogether. How do regenerative therapies work? They tap into the body’s innate healing processes, the metabolic pathways well-known to Townsend Letter readers.

To traverse this exciting bridge from orthopedic surgery to integrative therapies, I spoke with Dr. Kenneth Cintron. Dr. Cintron is a foot and ankle surgeon who now specializes in regenerative therapies for his patients. He observed that the therapies are more successful, requiring fewer treatments and more full recovery, when a patient’s metabolism is functioning properly. Dr. Cintron guides patients through the needed metabolic corrections. He’s the only doctor I know who is board certified in both orthopedics and integrative medicine.

Here I highlight my discussion with Dr. Cintron.

IK

: What sparked your interest in integrative medicine?

KC

: My daughter developed type 1 diabetes, and I was looking for the best therapies for her. [Now his daughter is thriving!] I had hypothyroidism which was undertreated and had led to adrenal fatigue. I was too tired to exercise and eat right. But in two months of integrating functional medicine strategies into my care, I was like a new person and I was finally able to do the lifestyle approaches. That’s why I decided to train in integrative medicine, and the way it applied to orthopedics was very clear to me.

IK

: What conditions do foot and ankle surgeons commonly treat?

KC

: Achilles tendon tears, fractures, and sports injuries. Foot and ankle injuries are common among athletes, so common that I was the team physician for Puerto Rico’s national sports teams. Bunions are also very common, especially in middle-aged women.

IK

: Most practitioners of medicine assess the health of their patient’s musculoskeletal system with physical exam and diagnostic testing. During surgery, you visualize the tissues directly. What do you learn from this “insider” view?

KC

: Very often we can readily determine if the patient has osteoporosis or even osteopenia. Patients may not have been evaluated for bone loss or they may have had a false negative test. (Bone strength is not the same as bone density.) By placing screws or other hardware in bone, we are making a very direct assessment of bone strength.

Healthy tissue bleeds well. By looking at the tissue, we can determine if the patient has peripheral vascular disease or other reasons for reduced bleeding. The blood vessels to the feet are the longest and thinnest in the body.

Nonunions (fractures that don’t heal) may be a clear indication that the patient has metabolic imbalances. [As the interviewer I could think of only one exception to Dr. Cintron’s rule, a perfectly healthy patient at South Pole Station, Antarctica.]

IK

: Who are the best candidates for regenerative therapies?

KC

: As an orthopedist, I can recognize what conditions could work. Most successful are early stages of osteoarthritis, partial tears of ligaments and tendons, and synovitis. What regenerative therapies can’t do is correct mechanical problems. Complete or displaced meniscal tears and complete rotator cuff tears should be treated surgically because of mechanical dysfunction. And once bone is rubbing on bone and osteophytes have developed in the joint the condition is too advanced for long term relief from regenerative therapy.

Dr. Cintron emphasized inflammation’s causal role in arthritis and synovitis. The growth factors in PRP are strongly anti-inflammatory.

There are many factors that influence how effective any single PRP treatment will be. These include the time of day the plasma was drawn, the patient’s metabolism as mentioned, and even the brand of centrifuge. Unfortunately these variables are usually omitted from clinical research papers, making it difficult to generalize the findings and advance the science.

IK

: What have you learned from your foot and ankle patients that made you interested in regenerative therapies?

KC

: My orthopedics patients overall want to be more active. They are in a dilemma. They are limited by joint pain. But they want to avoid surgery. Now I can give them what they want, hopefully at low enough cost to them. From the Centers for Medicare and Medicaid Services perspective, this is value-based medicine. It’s great outcome at low cost.

Summary

Optimizing our patients’ metabolism can benefit them in yet another way. By improving our patients’ metabolism their regenerative therapies are more likely to result in long-term healing. We heard from a foot and ankle surgeon who somewhat literally “got a foot in the door” in this emerging field of regenerative orthopedics.

Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Faculty Associate, Johns Hopkins Bloomberg School of Public Health

Executive Director, NutriBee National Nutrition Competition Inc.

Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)