Leptin, Osteoarthritis & Rheumatoid Arthritis

Leptin is more than just a hormone that regulates weight & metabolism. It is also a hormone involved in inflammation and autoimmunity. 

Leptin & Osteoarthritis

  • Leptin increases nitric oxide in joint cartilage. Nitric oxide is pro-inflammatory, leading to the death of cartilage cells.
  • Leptin increases metalloproteinases which degrade joints
  • Leptin increases the recruitment of immune cells to inflamed joints.

Bottomline, more leptin means more joint inflammation and more degradation of cartilage. 

Leptin & Rheumatoid Arthritis

  • Possible correlation between leptin levels and how aggressive RA is
  • Correlation between leptin levels and duration of RA
  • Leptin prevents the activation and proliferation of T regulatory cells that keep the immune system in check

Bottomline, more leptin may mean more severe RA with longer flares and impaired immune activity to keep the immune system in check from attacking your joints. Also, the biologics that are primarily used to treat RA do not affect leptin levels.

Assessing & Addressing High Leptin

This information suggests that we view rheumatology through a broader lens. Instead of just focusing on what is happening in the joint space, we need to look at hormones, metabolism, and nutrition. This integrative view is common sense for many of us, but it is exciting to see the research supporting this idea.

Now, for the most part, the research only looks at leptin in obesity. So an erroneous conclusion would be to believe that leptin-arthritis connection only applies if you are obese. This is wrong for many reasons. First, obesity is defined by your body mass index, a calculation based on your weight and height. It factors in no physiology and therefore has very little meaning (other than to make people feel bad about themselves). BMI tells us nothing about your leptin levels.

So regardless on your BMI, the first step is to evaluate your fasting leptin levels through a simple blood test. An optimal fasting leptin level is less than 12. Most people I test for leptin have levels in the 30s or 40s.  

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Once you have established that you have elevated leptin, the next step is to lower it. This is simpler that it sounds because many factors influence leptin levels including:

  • inflammation
  • glucose
  • insulin
  • cortisol
  • estrogen
  • increased fat mass
  • overeating

For most people, the place to start is nutrition. A higher fat diet that has moderate levels of carbs and protein tends to be the best at lowering leptin levels. To learn more about the leptin diet, read this blog post and be sure to check out my Leptin Diet Meal Plan. It is 28 days of meal planning and nutrition calculations done for you so all you have to do is shop, cook, eat and lower your leptin levels. 

References

  • https://onlinelibrary.wiley.com/doi/full/10.1111/bcpt.12109#bcpt12109-bib-0013