Navigating Menopause and Joint Health: A Rheumatologist's Approach to Arthritis with Dr Neha Bhanusali

Are you struggling with joint pain, feeling the effects of inflammation, or navigating the complex landscape of midlife health? This episode is your roadmap to understanding how lifestyle choices can transform your well-being.

Join Dr. Orlena and renowned rheumatologist Dr. Neha Bhanusali as they unpack the mysteries of inflammation and joint health. You'll discover:

• How your diet can be a powerful tool in fighting chronic inflammation
• Surprising foods that can help protect your joints and reduce pain
• Why movement is more important than ever as you age
• The crucial connection between gut health and overall inflammation

Whether you're experiencing joint stiffness, concerned about arthritis, or simply want to optimize your health, this conversation offers practical, evidence-based insights that can change how you approach wellness. 

Get ready to learn from an expert who believes in the power of lifestyle medicine and empowering your body's natural healing potential.

Connect with Dr Neha Bhanusali :

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Youtube: https://www.youtube.com/@PlantForwardMD 

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Transcript

Dr Orlena (00:01.353)
Hello, hello, welcome to Fit and Fabulous with me, Dr. Orlina. Today, exciting, we have an amazing guest. We are talking about inflammation, which is a super exciting topic, and we are talking about arthritis, and we're talking about the connection between the two of them. Dr. Neha Banusali, welcome, welcome.

Neha Bhanusali (00:19.263)
Hi, thank you for having me.

Dr Orlena (00:21.459)
Would you like to start just by introducing yourself and telling people a little bit about you and what you do?

Neha Bhanusali (00:27.878)
Sure. So I'm a rheumatologist, which is an autoimmune specialist, and I've worked in an academic setting for the last 12 years. So I do research. I also teach the doctors of tomorrow and I see patients. And I'm also board certified in lifestyle medicine. a lot of what we're going to talk about today is actually approaches to rheumatology or autoimmune diseases or arthritis or inflammation, but kind of with the lens of

lifestyle approaches.

Dr Orlena (00:59.539)
Perfect, I love it. We're all about lifestyle approaches here and how to make them easy so that we don't feel deprived and we don't feel restricted and we actually just enjoy our lives. So let's start with inflammation because it is, I don't know, the word of the decade, I think. Everyone's talking about inflammation. So what is inflammation and what does it really mean for women over 40?

Neha Bhanusali (01:22.444)
Okay, so actually inflammation itself inherently is not bad. If you fall down and you hurt your arm, you're gonna have inflammation in that area and you want it, right? Because you want all the little blood cells to go there, you want it to heal properly. So that's a good thing. You're gonna have some pain, you're gonna have some redness, gonna be some swelling, but you want it to heal. So the inflammation in that case is actually a good thing. When it's bad is when it becomes kind of a chronic inflammation. And that chronic inflammation, you may not even have that much pain, right? It's kind of like a very low level.

but it's simmering the whole time and with that inflammation, you know, it becomes chronic. You can get chronic diseases because of that like arthritis, heart disease, cancer, even cognitive decline, right? So you're just not thinking as sharply as you were before.

Dr Orlena (02:07.389)
And so thinking about things that contribute to inflammation, you've talked about like normal things that happen, like you cut your finger or you get an infection, but what about some other things that contribute to inflammation?

Neha Bhanusali (02:20.142)
So because we're talking specifically about women who are in their 40s and 50s, if we focus on that, right? So we're talking about the trauma, we know, heart disease, cancer, all these risks, but women specifically kind of in their 40s and 50s are going through a big change, right? They're going through different hormonal changes, things are going up and down, maybe they have other issues in life like poor sleep, stress, and all of this stuff. While you may have been able to handle it better

or younger years, during this time as your body is changing, kind of, you know, this inflammation really can be influenced by all of these changes.

Dr Orlena (02:58.921)
So all of the pillars, all of the things. Let's just, sweet.

Neha Bhanusali (03:02.284)
Yes, yes. I mean, the good news is, is you can use lifestyle, right, to improve this now that if you can, if you know what the problem is, the good news is you can target it.

Dr Orlena (03:11.207)
Yeah, perfect, perfect. I like your thinking there. So just changing tracks a little bit and like bringing in arthritis. And people think that arthritis is really about aging or genetics. So like, do we have any control over it or is it just, you know, a fait accompli?

Neha Bhanusali (03:27.466)
No, we actually have a fair amount of control over it. Like you can look at it in two ways. You're looking at the wear and tear arthritis, right, that a lot of us assume that we're gonna get as we get older. By the time you hit 80 or 90, I mean you might have some creaky joints and they may hurt, but not everybody actually. And then what about autoimmune arthritis, right? So there's two different, I would say there's different buckets, and if you look at it, let's take the autoimmune arthritis first, right? Whether it's rheumatoid arthritis, psoriatic arthritis, lupus arthritis, there's so many different

different ones out there, autoimmune disease is on the rise, can you prevent it? Well, yeah, I mean, I don't see that like somebody who has it that their sister or brother necessarily has it or that their kids have it. You definitely have an increase because of your genetics, but it doesn't mean it's necessarily gonna happen. And lifestyle, changing kind of your lifestyle could maybe help you prevent it. And I'll just give a quick example. There was a study recently in lupus and you know, so patients will ask me, you I have lupus, I also have maybe

two daughters and I'm hoping they don't get it. Is there anything I can do or that they can do to prevent it? And there was a study recently that said especially if they carried a very specific blood marker

and they avoided eating ultra processed foods that may reduce the chance. Because if you look at it the other way, if they carried that blood marker and they had a lot of ultra processed foods like chips and crackers, granola bars that are full of stuff that we don't know what they are, all these foods where we read the ingredient label and we have no clue what they're actually saying, if they ate that and they ate a lot of it, they were more than 50 % likely a developing lupus. So I thought that was pretty scary numbers, right? And that's an autoimmune disease.

And maybe if we change things, we can help prevent it. Now if we shift focus to kind of more the wear and tear arthritis. I definitely have people who are in their, I would say early 40s and above who have that kind of wear and tear osteo degenerative arthritis. So yeah, there's lots of ways that we can kind of target that. Number one thing I would say is weight. Kind of keeping a stable weight as you're going through the years. Right? Because we know after the age of 30, we're losing muscle

Neha Bhanusali (05:39.4)
mass every decade, right? Three to five percent. So as we kind of go up, our muscle is going down, the amount of muscle, but the amount of fat is going up. And in general, every decade, you people gain weight. Now, when people think, hey, I have gained, you know, 10 pounds, that doesn't mean an extra 10 pounds of pressure on your knees. The ratio is about four to five. So if you gain one pound of weight, that's about that's about four to five pounds of extra pressure on your knees.

Dr Orlena (05:56.713)
you

Neha Bhanusali (06:09.824)
So if you gain 10 pounds, that's 40 to 50 pounds of extra pressure on your knees. So yes, your knees can hurt because they're carrying your load. But the good news here is that even if you lose five pounds, you're not losing 10, 20 pounds. Even if you lose five pounds, that's actually taking a lot of pressure off those little knees of yours. So yeah, it can help and there are definitely modifiable things that you can change.

Dr Orlena (06:32.851)
Wow, and I guess it's one of those circular things as well, that if you've got, if you reduce the pressure on your knees, then suddenly it's easier for you to walk and to do more exercise and then you can potentially lose more weight. And just coming back to rheumatoid arthritis or inflammatory arthritis, I guess what you're saying is that because it's a process that's driven by inflammation, it doesn't really matter whether the inflammation is coming from...

the disease process or you're adding extra inflammation into your life by eating lots of processed foods and not doing things healthily, it's still gonna impact your joints. Is that what you're saying?

Neha Bhanusali (07:11.138)
Yeah, yeah, absolutely. is gonna, so if we talk about an autoimmune arthritis like rheumatoid arthritis, absolutely. Could you avoid it in the first place? There are studies going on about that. But what if you have it already, right? And you're like, you look at the commercials, there's all these commercials out there. Half of those commercials are rheumatic medications, even though this field is so tiny actually of autoimmune disease. A lot of people have no idea what I do in life, but yet if you look at the commercials, a lot of those medications are rheumatology

medications. Why? Because they make so much money, right? Like pharmaceutical company-wise they make so much money. So it's really in the best interest of know pharmaceuticals to produce these medications and to have people take them. And I will tell you being that I have been practicing for 15 years these drugs are life-changing. mean amazing to go from not being able to walk or wheelchair-bound to just you know being able to live life.

But the problem is how many people actually get 100 % improvement? I mean, very few, like very few. Every time somebody tells me, I love this medication, I don't even remember that I have RA half the time. I love hearing that, but it's not every day and it's not every patient. So then you wonder like all these other drivers of inflammation, what can you do to kind of impact them? Like food, like you're saying, diet is definitely one of them that they're doing more and more studies on. Like if you had met me like a decade ago, 15 years ago, I would have been like, no, just take your

Medications and there's really nothing else that we have that can help you but now we've got all these studies You know that are saying yeah, maybe if you do this, maybe if you eat this certainly like processed foods I don't think anyone can say that they're good for you and when you have these foods and you have this inflammatory process It's not helping you by any means

Dr Orlena (08:39.699)
Yeah.

Dr Orlena (08:57.331)
Yeah, definitely. you know, as I was saying before we started recording, I had a client who had arthritis and she said that sugar really impacted her. So she would eat sugar and the next day she could feel it in her joints. It was almost like she was hung over, except she had a bit of a sugar addiction. So it was really difficult for her. And that's why she worked with me to get her off the sugar. But that was totally life-changing for her as well, because then she can navigate food.

without feeling deprived and have all the energy and not feel this like awful, know, unwellness every single day. So coming back to food and anti-inflammatory foods, in your opinion, anti-inflammatory foods for women in middle life, which ones do you recommend? And are there any surprising ones?

Neha Bhanusali (09:29.764)
absolutely. Yeah.

Neha Bhanusali (09:43.246)
So what do I recommend is kind of, if you're gonna do food, and I'm not talking supplements, right, because I'm not super keen on supplements, I like things that you can get in your own diet. Do the best you can, right? We can't get everything. But things like turmeric. I do like turmeric. I think you do have to be careful when you have it because it can often be cut with lead or people use different, yeah, people use different flowers.

Dr Orlena (10:06.107)
How can you tell?

Neha Bhanusali (10:09.378)
So you have to rely on the company that's selling it, honestly. Because unless you're going to go out and have it tested, how are you going to know? So generally when I tell people, I don't necessarily believe in organic everything. But I would say something like turmeric, where we know there's been a lot of contamination, depending on who is supplying it. I would suggest more, I guess, well-known stores like maybe Whole Foods, even Costco, places that they tend to do a little bit more research. Or if you're going on Amazon and you're getting your

Turmeric, that's totally fine. But I would go with the company that's got like, you know, the 10,000 reviews and not the one that has two reviews, right? Because we want to make sure this is okay. I would say worldwide. mean, if you, like, I'm of Indian background. So if I want Turmeric, I'll tell my mom, who'll tell my uncle in India, who will only go to certain stores and get it from there. Because even there, they know it's not always pure.

Dr Orlena (10:47.487)
And is that specific to the US or is that worldwide?

Dr Orlena (11:02.589)
No, no, but I meant the lead because I know that in Europe we have much better food regulation than in other places. So I don't, like I've heard about the lead in turmeric in the US, but I don't know if that extends to places like Australia and Europe and other places.

Neha Bhanusali (11:20.878)
I don't know, yeah, I don't know if the contamination levels are high in the other countries. I know in America, we just don't have the regulation, right? Like anything that's kind of a powder, a supplement, vitamin, we don't have that regulation. So I'd be careful.

Dr Orlena (11:28.713)
Yeah.

Dr Orlena (11:33.363)
And how much, as long as you can get good turmeric, because I would probably say not having turmeric is better than having putting a teaspoon of lead in your food. So as long as you've got good quality turmeric, how much would you recommend eating a day?

Neha Bhanusali (11:41.708)
Yes, that is true. Yeah.

Neha Bhanusali (11:50.36)
So it kind of depends what your goal is, right? So if you, it's not really turmeric that you want, you want the curcumin, right? That's the active component in it. And so let's say you're super liberal in your food and you're sprinkling it on your morning eggs, you're putting it in your afternoon soup, you're putting it in your nighttime meal. You're still not getting that much curcumin. You're probably getting, if you're super liberal, maybe 60 to 100 milligrams, and there's nothing wrong with that. But let's say you

actually have joint pain, joint aches, and you want to use kind of more for anti-inflammatory purposes, you're probably going to need a little bit more. You're probably going to need anywhere from 500 to 1,000 milligrams of curcumin, you know, that active component to help really with those pains and that anti-inflammatory purpose. So if you don't have any issues and you just want to have a healthy lifestyle, you can just add it to your foods. Like I would say, you can even shave it to your salads. But if you really are having pain, you're having active inflammation and you want to use it, you may want to use a supplement and that's

what I'm saying. You kind of really have to be careful where you get your supplements from.

Dr Orlena (12:53.427)
Yeah, okay. Yeah, I actually often add it to my breakfast and I put a reel of my breakfast on Instagram with my turmeric in it. And someone went, you can't put turmeric in your breakfast, it's disgusting. I was like, well, I quite like it and it's my breakfast. So I don't see what the problem is.

Neha Bhanusali (13:11.112)
Exactly, yeah. mean, everybody has their own things, right? Whichever they want to get it in. Somebody recently was telling me, you know, she loves chia seeds for their Omega-3, right? And I'm a big proponent of chia seeds. She's like, if I do it later in the day, I have to add sugar to it. And I don't want to do that, right, for anti-inflammatory purposes. So instead, she puts it in her coffee. And, you know, she puts a little bit of vegan creamer in there. And she's like, that way I have the sweetness. I have this coffee that tastes great, but it's got the chia seeds in it. I got my chia seeds in for the day. And I was like, that's interesting. I was like, I haven't tried that yet.

but hey, if it works for you, So crunchy coffee, right? that's also my inspiration to try it next too.

Dr Orlena (13:41.983)
I'm tempted, a sort of crunchy coffee.

Dr Orlena (13:50.749)
And you did also, just as you were talking about shaving it, you brought up a point that it doesn't have to be in powder, you can get turmeric root. I mean, here in Spain where we are, it's not widely available, but it is available in some places. And that's another option as well to grate it into your food.

Neha Bhanusali (13:58.349)
Yes.

Neha Bhanusali (14:08.77)
Yes, absolutely. We don't have it available everywhere either. mean, certain stores will have it and at least it's safer in that way. But the taste is very interesting and not everybody I think can handle it also. yes. Yeah, you can. And it's easiest I think in soups and stews. I think that's probably one of your easiest ways to get it in.

Dr Orlena (14:20.489)
Presumably you can cook it as well. Perfect. Any other?

Dr Orlena (14:28.861)
Okay, and any other foods that are surprising that we should be aware of?

Neha Bhanusali (14:34.444)
Well, you know, aside from like walnuts and flax seeds, think legumes are a big part of it just because of the fiber content. You know, I'm a big proponent of that to help your gut microbiome, that pre-fiber, right, that you want to the prebiotics. That's helpful for everything, including for inflammation. But I would say also prunes, which I used to hate as a kid. I have a new respect for. So prunes and then also like figs. And these are also sources of calcium because as I

said before, supplements also, you're getting into your 40s and 50s, you're starting to worry about bone health and are you getting enough calcium? And yes, you can get it in a tablet form, but there are studies that are coming out that are saying that people are probably, a lot of people are getting too much calcium, you know, because you're taking the supplements. So in general, when you're taking something in your food, it's usually a little safer for you than taking it by supplements, unless you really need it.

Dr Orlena (15:27.187)
so what was the purpose of taking the prunes? And does it have to be prunes or can it be plums?

Neha Bhanusali (15:31.95)
It could be plums and prunes. These are also great foods for fiber. Especially with figs and all that stuff, can get calcium in it, which will help in so many different ways.

Dr Orlena (15:36.062)
Yeah.

Dr Orlena (15:41.705)
What about berries? I buy berries because my children have a genetic eye problem, which is like inflammation driven. And so our ophthalmologist said, get berries. And so my kids, like I buy them in the freezer because blueberries are extortionately expensive here in Spain. They're expensive, even frozen, to be honest, but we have started having berries, raspberries and blueberries with a little bit of yogurt, which makes a nice and easy dessert.

Neha Bhanusali (16:08.878)
Absolutely. actually blueberries are like awesome, know, like as a powerful, I think antioxidant that the blue in their skin is actually the really good part for you, right? So you're going to get your antioxidants or polyphenols. So berry wise, super powerhouse. And in fact, you know, we're talking about rheumatoid arthritis earlier. There's actually studies that show that people who are eating these berries, like they actually tested this, felt better subjectively in terms of their symptoms. So absolutely there's something for it. I love raspberries. A cup of raspberries is like eight grams

of fiber. yes, I'm a big fan of those. And you want those different colors, right? So whether it's blackberries, blueberries, strawberries, raspberries, the berries in general have just so much antioxidant. So I'm not surprised with eye inflammation that they're suggesting that.

Dr Orlena (16:52.467)
Perfect, and you bring a good point. I presume everyone always talks about blueberries because I suspect they're more commercially available than other things, but we have a mulberry tree here and it's a dwarf mulberry tree, but it just goes, it just has so many mulberries in June that I can't pick them all, well I do, and then I freeze them. But you know, things like mulberries and blackcurrants that have got that black skin, I presume they're just the same and that they have the same benefits as blueberries.

Neha Bhanusali (17:18.542)
I if it's the exact same or not, but I bet you they have their own benefits. You're right, we don't have as many of those here, and I think it might be more regional. But yeah, absolutely.

Dr Orlena (17:27.273)
Perfect. And what do you see people making as the biggest mistakes in diet, in terms of diet and arthritis?

Neha Bhanusali (17:35.854)
So I would say in diet in general, processed foods are really kind one of the worst things, right? Now people think that they're getting this very healthy granola bar. But take a look, turn it over, and be like, what is exactly in that? And is it all of that stuff, pronounceable, do you know where it all comes from? Or is it really just another processed food that's packaged well in a small candy bar? Like it's really a candy bar, not a granola bar. So yeah.

Dr Orlena (17:58.973)
Yes, yes, real food, real food, I was saying.

Neha Bhanusali (18:01.484)
Real food, yes, cereal too. Cereal is a big one, I'd say. You go to the whole shelves and they look so pretty and the marketing is amazing. But really, what's in it? I would say that's one of the biggest things to, and I don't know how it is for you in Spain, but people, it's hard. It's hard to make your own food. It takes a long time. So you buy all these things in the stores, but when you buy it, there are definitely foods that have less ingredients. And if you can stick to something that has the least amount, five or six ingredients that you know what they are, then

I think overall it's better for you.

Dr Orlena (18:33.779)
Yeah, no, I totally agree. personally, so in Spain, we have much less packaged foods actually than for example, in the United Kingdom. Obviously it does exist, but we are also lucky that we have good fresh produce, fruit and vegetables. And I eat most of my food as unprocessed food. But the way I can do that, I think is a mindset shift of thinking...

Well, it's food. doesn't have to be this amazing meal. Do you know what mean? Like sometimes I do make meals, but sometimes it's just like, well, I'm just going to chop up some fruits and some vegetables and eat them. It doesn't have to be my favorite food the whole time. It's just actually, I would rather have food that nourishes my body than eat the processed food, which I think is doing kind of the opposite, nourishing my body.

Neha Bhanusali (19:18.304)
Exactly, exactly. You know, I teach all these med students. I mentor medical students too. And the other day when I was telling them about my background, I met a new class of them. And several of them had these frozen burritos in front of them. And they were like trying to hide them on the side. I was like, listen, I was like, you guys are medical students. Life is so hard right now. You're just so busy with all your studying, your exams and all that. And I would say that to any student out there, right? They're just trying to survive and get through school, whichever school. And they're going for the fast.

Dr Orlena (19:33.543)
I'm

Neha Bhanusali (19:48.16)
the processed foods because you don't have time. But I would say something like a burrito, right? You can make it on your own. You can freeze it. You can pull it out when you have to go to class. So if you could, even just one meal of the day, least make it like a homemade meal. Make it on Sundays. Do your batch prep. And throughout the week, I think you need to do things like that because we have to, we don't always have time. And I'd say that's the biggest, biggest problem out there. We just don't have the time or we don't utilize it.

Dr Orlena (20:03.476)
Yeah.

Dr Orlena (20:11.785)
Well, I think there are some easy, easy recipes like scrambled eggs. So easy, you know, and my 16 year old son can make scrambled eggs. In fact, I think all of my children can make scrambled eggs. And another thing I would say is I, so my breakfast is like basically one of my biggest meals and I have oats and fruit and nuts and seeds. And I was working on this reel that I'm doing for Instagram and I get like 18 grams of fiber in my breakfast. I was like, really? Is that correct? Like, can that possibly be correct? And I had to go and buy a scale to make sure.

it was right and it was right.

Neha Bhanusali (20:44.044)
Yeah, no, I mean, you can get so much in that first meal of the day. I agree.

Dr Orlena (20:48.019)
Yeah, if you can set yourself up with that meal, if you've got like the bulk of your fiber in that meal and obviously antioxidants and things like that, then it doesn't matter so much the rest of the day. You know, there's a little bit more leniency if you, you know, do all of your meals less processed, fabulous. But if you've got one, which is, you know, you just do the same all the time, it makes life so much easier.

Neha Bhanusali (21:11.694)
I make a bread, so one of my twins will only eat my bread. And it is full of like, you I do have some all purpose flour in there, but it's mostly wheat flour, oatmeal flour, quinoa flour, you know, some hemp. And I think the key is I have so much garlic in there and he just loves garlic and it tastes like garlic bread to him. But he gets, like, I know that he's getting like this massive amount of fiber, whole grains, you know, right from the beginning of the day. And I agree with you, like, it really sets the day.

Dr Orlena (21:37.311)
Perfect, I didn't know you have twins. I have twins as well. Anyhow, moving on to menopause, that lovely M word and that change that we all go through. How does menopause and joints, how does it affect them?

Neha Bhanusali (21:40.111)
yes.

Neha Bhanusali (21:53.102)
Well, excellent question. So menopause is being more talked about and I think that's great because there's just not enough out there and I would say even with my field, which treats joint pain, joint aches, arthritis?

say it's pretty lax in terms of the menopause data, but what we do know is that estrogen has more, know, estrogen is good for us, right? And it has more of an anti-inflammatory effect. So when it goes down, which is what happens in menopause, then you have different issues with joint stiffness, joint pain, you know, all of that can increase. And you have less collagen production, you have more bone loss, right? That's when we start worrying about osteoporosis, osteopenia, usually

just after menopause, unless you have some other condition before. And you know, we're just increasing arthritis risk, all from that level of your hormones just going down. And you wonder, know, people who are given these diagnoses of rheumatoid arthritis, osteoarthritis, really, is it really arthritis or is it all of this hormonal fluctuation that's happening that's causing these pains and stiffness?

Dr Orlena (22:58.941)
And do you see when women in their 40s or early 50s, if they're presenting with sort menopause or arthritis, does it affect certain joints or can it affect any of them? Does it follow a pattern?

Neha Bhanusali (23:11.758)
So it, no, it can affect any of them. Like from what I've seen, like with my patients, with people coming through, everybody's a little bit different and sometimes, you know, it is more like hands and kind of like the smaller joints. But there's a lot more, I would say, more larger joints, more tissue pain that we're seeing when people are kind of undergoing this transition phase. Could be anywhere.

Dr Orlena (23:32.819)
And often people don't really know what's happening and they put it down to being unwell or depression or something like that.

Neha Bhanusali (23:40.16)
Absolutely, yeah, yeah. And then somebody will throw a blood test in there. you go to your primary physician, they put in this blood test, which has a high amount of positivity, false positivity. So now you're worried that you have this condition, which you may not have, which just may be all part of this transition of menopause. So yeah.

Dr Orlena (23:59.259)
Interesting, interesting. Okay, what about gut joint connection? How does our digestive impact inflammation and arthritis?

Neha Bhanusali (24:10.222)
So I think everything stems from the gut. If your gut is not balanced, things are going to happen. So basically, if you don't provide the good nutrition for the good bacteria in your gut, then you're going to have problems. And it's manifesting in different ways, right? For example, autoimmune disease. When you have something like rheumatoid arthritis, we call it an arthritis. But it's actually a state of inflammation, right? Because you can get features in your eyes. You can get inflammation in your eyes from rheumatoid arthritis, something like it's called scleritis.

You can get it in your skin. You can get vasculitis. You can get it in your voice box, right? People don't know that rheumatoid arthritis can go there. So there's so many different areas and yet we're calling it an arthritis, but it's all from inflammation that's kind of in your body. Same with things like psoriatic arthritis.

That also is more inflammation, right? It's psoriasis, a skin disease, and yet it's all coming from inside. Where is it coming from? So there's a lot of theories going on with the gut, with leaky gut, gut dysbiosis, right? That your gut is just not.

in a good state right now. And maybe it's during those times where your gut is not in a good state that you're having all this extra inflammation, extra symptoms. So what can we do? The best thing we can do is try to keep our gut balanced, right? And going back to the sugary foods, the ultra-processed foods, none of that is helping our gut, right? We don't want to feed the bad bacteria, we want to feed the good bacteria. So we want to go to the prebiotics. Things like bananas, onions, all of that stuff is a prebiotic. When you eat a banana though, and this

I like the sweet bananas. I enjoy those. However, the ones that are better for you as a prebiotic is really more the greenish ones, right? A little bit not so ripe and sweet yet. But you want to do all those things. You want to have the berries. You want to feed all the good stuff because otherwise we're more worried about inflammation.

Dr Orlena (25:59.763)
Perfect. Sorry, I have a sneeze at my nose. It's what I call swimming pool nose. The chlorine makes my nose sneeze. Okay, perfect. So we want to be looking after our gut. What about supplements for joint health? Do they actually work or not?

Neha Bhanusali (26:02.774)
No. So you lose. No problem.

Neha Bhanusali (26:18.542)
So there's a lot of stuff out there on I would say glucosamine, chondroitin sulfate, those medications to kind of help with.

and I'll say the studies are positive half the years and the studies are negative the other half the years. So I cannot say that I am very excited about any of the studies. Actually there was one in Europe where they had a prescription grade supplement of the chondroitin glucosamine and that looked like it did a little better. We don't have that available in America.

So it's kind of like if you want to take them, the downsides are very minimal. Maybe it'll help you, maybe not. You can give it two to three months, see if it does anything for you. And if not, it's expensive. So why continue it? So yeah, I wouldn't say. And the collagen data is still out. There are some people that say it helps, but more people are saying that it's not helpful, at least to a degree. Because you have to remember, everything you take, the placebo effect can be quite high, sometimes as high as like 30%. And so you're taking these supplements, you're paying all this money, and you're like, but

Dr Orlena (27:00.265)
Yeah.

Neha Bhanusali (27:19.002)
Is it really helping or is it really just more of a placebo effect? So everybody's different, they have to go. And that's why I say the one thing you can control is what you put in your body. And supplements could be one of them, but I would say food is another big one. And something I didn't touch on that I love for the gut is more fermented foods. You know, whether it's like kefir and kimchi, sauerkraut, those are fermented foods, miso. But people who have arthritis, may try these foods and you may be like, I don't

Dr Orlena (27:22.045)
Yeah, yeah.

Dr Orlena (27:28.093)
Yeah.

Neha Bhanusali (27:48.894)
feel so good because you might have some gas and bloating, it may be that your body is not quite ready for it because you already have some gut dysbiosis, right? Your gut is not quite where you want it to be and you may need to kind of take a step back and see what can you handle in all these good foods, foods that are good for your gut and you may need to kind of introduce them little bits at a time to kind of get your body used to it because you also, they are good for you. It's just that you may not be able to tolerate it right then.

Dr Orlena (28:15.288)
Yeah, perfect. I think the same comes with lentils and legumes and beans and people always say, my goodness, I can't eat them. And actually it's because they haven't got the bio that's adapted to it. And so they have to build up little by little until they can process it and then obviously reap all those amazing benefits. So if you had one thing, one big recommendation for people to avoid arthritis, what would it be?

or rather than to avoid arthritis, more look at it in general for your joint health, how to look after our joints.

Neha Bhanusali (28:51.884)
The one thing you can do for yourself is move. Just get up and move. Because we have a very sedentary society. Maybe it's the same in Spain. I know in America that's a big problem we're facing with all the remote work, the different types of jobs out there. just, you know, sitting for eight to nine hours a day is not natural to us. And so whether it's every hour, and I've written, I have written notes for my patients, you know, to get up every hour, please move for three to five minutes at least, you know, and because they get in trouble for doing this. You can't do

Dr Orlena (29:09.407)
Yeah.

Neha Bhanusali (29:21.808)
at some jobs, right? You're constantly, you have your thing on and you cannot leave your keyboard. It's terrible because you really need to move and if you're not happy, if your body's not happy, your workplace is not gonna be happy either. So you kind of have to work around this. So for your joint help, would say move. I'm a big fan of weight training. You don't have to go for a run and I know people when they think of that, they're like, I can't run anymore and this hurts and that hurts. You don't have to do that. Weight training is excellent and speed walking is also good.

to whatever your ability, throw on some ankle weights if you want to get a little more bang for your buck, but there's so much you can do with movement that I think we all can improve on.

Dr Orlena (30:00.927)
Perfect. I love it. I love it. Thank you so much. Thank you so much for spending some time with us. Where can people find out more about you?

Neha Bhanusali (30:08.238)
So I actually have a YouTube channel that I created, yeah, I created last year after I did a study on diet and autoimmune diseases. And a lot of my colleagues were like, you now our patients are asking about all this, can you just give them a handout? And I was like, I don't know, do people use handouts anymore? So I decided, you know, let me just make a video. And it's been a lot of fun kind of trying to teach in a different way. So I made one for this condition and that condition and I'm of going through. And you have to have evidence behind this. You can't just say it, you have to have.

Dr Orlena (30:10.91)
Yay!

Neha Bhanusali (30:38.218)
something, the research behind it to say, you know, things are helping or not. And just like you, have an Insta channel also where put all these recipes. I actually cook with my twins, you know, so I have three kids and I don't know about you, but it's it's hard, right? Trying to raise kids today and not have them go straight for all the food that they're that they want to have in the supermarket. Right. So we have to be able to be creative and make food tasty, because if food is not tasty, nobody's going to eat it. So we actually do have an Insta channel that I do with them.

Dr Orlena (31:06.995)
Perfect, perfect. And I will definitely connect with you. And yeah, I think with kids, I always think of kids as glucose seeking missiles. And if we have that as like, that's the norm and they want any kind of carbohydrates. And my daughter loves, I hate these things. They're instant noodles. And I'm like, my goodness, these things are so bad for you. But instead of just saying, I'm never gonna buy them again, which is sometimes what I do when I just get across with her. It's more about teaching her how to have them, but put other bits like protein and fiber in.

Neha Bhanusali (31:21.346)
Yes.

Dr Orlena (31:36.989)
them so she's not just eating those horrible horrible data balls.

Neha Bhanusali (31:42.294)
No, I hear you actually. So yeah, my boys also they they love that. And I told my son, know, you can eat all the ramen you want. OK, but you have to make it. So he has had to learn how to make his own broth. And he's you puts his protein and his fiber and stuff in it. So he still loves his noodles. But yeah, it's a little more you have to make it yourself versus heat it up one minute in the microwave, which he does sometimes to write for in a hurry. But overall, I agree. You have to change it. And so, yeah, so it's plant forward MD. Yeah.

Dr Orlena (32:07.635)
Perfect. Well, I will definitely look out for that ramen recipe because my daughter will, that will be on her list of things to make next.

Neha Bhanusali (32:15.746)
yeah, yeah. But I think I forgot to tell you also, so my handle is Plant Forward MD, in case you can't pronounce my name. So it's a little bit harder to pronounce, you know.

Dr Orlena (32:21.129)
Perfect, perfect. I will grab the links and I will put them in the show notes as well. Perfect. Fabulous, thank you so much.

Neha Bhanusali (32:30.104)
Yes, it was great meeting you and being on the show. Thank you, Arlena.