Found on Ironman.com and written by Heather Rodgers, Experience Life
Are you experiencing hip, knee, or other joint pain? Eating strategically can ease pain and minimize future damage.
On an icy Colorado ski slope in 1986, Jan Patenaude crash-landed after taking a jump. In the tumble, she badly twisted her right knee, rupturing her anterior cruciate ligament (ACL), which runs under the front of the kneecap and provides stability to the joint.
Doctors told her that she had two options: have surgery to rebuild the ligament using tissue from a cadaver — a new and risky option 30 years ago — or strengthen the leg muscles with exercise to support her knee, and live without the ligament. Patenaude chose the latter.
In the years since, her pain has come and gone, but now, for the Hawaii-based dietitian, it’s mostly gone. Patenaude attributes this to exercise and, crucially, joint-friendly foods and supplements.
Twelve years ago, Patenaude decided to try an elimination diet — avoiding certain foods for a set time to watch her body’s reaction. In doing so, she discovered that tomatoes, refined wheat, grapes, soy, and sugar aggravated the pain in her knee. So she stopped eating them altogether.
Around the same time, she started giving glucosamine to her dog in hopes that it would help his aging hips. Within a few weeks, he went from limping to jumping into the back of her truck. So she started taking glucosamine supplements, too, and soon felt the difference.
Patenaude is certainly not alone in her joint troubles, or in seeking an alternative approach to treating her pain. As she and a growing number of joint-pain sufferers are experiencing firsthand, nutrition can play a vital role in alleviating inflammation and managing joint pain.
“Without this diet and glucosamine, my knee would probably be hurting all the time,” says Patenaude, who’s now in her 50s. “I’d probably be on my way to knee-replacement surgery.”
The inflammatory response
An estimated 63 million Americans suffer chronic joint pain, aching, or stiffness, according to the Centers for Disease Control and Prevention (CDC). Joint pain from an old injury is common and can lead to arthritis — inflammation in the joints that can in turn cause cartilage to break down. Arthritis can also result from wear and tear over time, which is why so many older people have it: Nearly half of Americans over 65 are afflicted with the disease, the CDC reports.
Include those who suffer from acute joint injuries and the painful swelling associated with autoimmune conditions like rheumatoid arthritis, and you’ve got a whole lot of people in pain, much of it persistent.
A common hallmark of joint pain is chronic inflammation in the joint and the surrounding tissue.
“Inflammation is chemical war on the joints,” says Vonda Wright, MD, an orthopedic surgeon and spokesperson for the American Academy of Orthopaedic Surgeons.
Of course, inflammation is a vital part of good health: It’s the first stage of healing, the result of the immune system defending the body against invaders like bacteria and viruses or repairing damaged tissue. It is also a process that can go awry.
The cells in damaged tissue release a bevy of chemicals to respond to the assault, including prostaglandin, a lipid, and two types of proteins: nuclear factor kappa beta (NF-kB) and cytokines. These substances send signals to the body’s immune system, causing white blood cells to rush to the scene, directly triggering inflammation.
Once a wound has healed, the inflammatory response is supposed to cease. But in the joints, the off switch often doesn’t get hit, leaving residual swelling that wreaks havoc on elbows, ankles, and knees.
“Some tissues, like bones and muscles, heal really well, but joints, for whatever reason, just don’t sometimes,” says Farshid Guilak, PhD, vice chair of orthopedic surgery and director of orthopedic research at Duke University.
With ongoing swelling, joint tissue continuously sends distress signals, one substance cyclically igniting the next. White blood cells attack healthy tissue, changing cartilage from smooth and rubbery to rough and cracked. (Chondrocytes, the cells in cartilage, can even release prostaglandins that tell the immune system to attack that very cartilage.) The continued release of NF-kB, cytokines, and prostaglandins summons yet more white blood cells, which causes further inflammation. Joint experts refer to this process as an “inflammatory cascade.”
Halting this ongoing inflammation is essential not only for relieving pain, but also for protecting joints from further cartilage loss.
While reaching for a bottle of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be a natural instinct, these meds can trigger a host of problems, including further degradation of the joints over time.
Adding and subtracting foods
On a recent family visit, Patenaude ate pizza and cake at her niece’s birthday party. The next morning her right knee throbbed. “I knew right away I’d eaten my trigger foods,” she says — refined wheat in the crust, plus tomatoes and sugar. So Patenaude went back to fresh produce and wheat-free whole grains, and within a few days the pain was gone.
Physicians and clinicians looking to combat patients’ inflammatory cycles are increasingly prescribing a change in menu.
One of the key ideas behind their recommendations is that the anti-inflammatory properties of many foods — particularly those high in omega-3 fatty acids — may reduce swelling in the joints, easing pain and slowing further cartilage damage.
A 2002 study found that patients with controlled, but active, rheumatoid arthritis who followed a Mediterranean diet (fish, whole grains, fruits, vegetables, healthy fats like olive oil) experienced reduced inflammation and increased physical function.
An often-unintended benefit of modifying your nutrition is weight loss. Keeping off excess pounds is indisputably beneficial for your joints: Obesity is a significant nutritional risk factor in osteoarthritis.
“If you’re overweight, you have at least three times the chance of developing knee osteoarthritis, and up to twice the chance of getting arthritis in your hip,” says Rowland W. Chang, MD, a rheumatologist, epidemiologist, and director of the Institute for Public Health and Medicine at Northwestern University.
Know your body
Taking a nutrition-based approach to managing joint health requires a willingness to experiment, as well as a certain amount of patience. The anti-inflammatory compounds in foods occur in lower doses than prescription drugs, so nutritional treatments act more slowly than medications.
“If people take some kind of analgesic, they feel better pretty quickly,” says Leslie Bonci, RD, director of sports nutrition at the University of Pittsburgh Medical Center’s Center for Sports Medicine. “It’s not like that with nutrition. They have to build up to a therapeutic dose in the body — it might take two weeks.”
A nutritional approach also requires a healthy dose of self-awareness. Medical research on the effects of certain foods on joint inflammation specifically — versus on the body globally — is limited and preliminary. (The National Institutes of Health is funding further research into nutritional supplements, but most demonstrated results remain in the lab so far.)
In the meantime, you can start with an elimination diet, keeping a food journal to note when and how things change in your body.
“It’s most important to pay attention to what you eat and how you feel,” says Chang. Ultimately, it comes down to what works for you.
What to eat
1. Omega-3 Fatty Acids
“What you want to do is create an anti-inflammatory milieu in the body,” advises orthopedic surgeon Vonda Wright, MD. Omega-3 fatty acids are particularly good for this: They change the fatty-acid composition of cells, tamping down those inflammation-instigating cytokines.
- Coldwater fish, particularly salmon, mackerel, and herring. A good daily dose of omega-3 is 1,000 mg: “That’s equivalent to an iPhone-size piece of fish,” says Leslie Bonci, RD, of the University of Pittsburgh Medical Center.
- Flaxseed oil. This omega-3 is a plant-based alpha-linolenic acid (ALA) that the body must convert to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) to reap anti-inflammatory benefits.
- A tablespoon of flaxseed oil delivers 700 mg. Mix into food — or slurp it straight if you’re up for it.
- Eggs and pastured eggs enriched with omega-3s. Hens lay eggs with more of the healthy fatty acid if they’re fed flaxseeds, fish oil, or algae.
This naturally occurring mineral is the cellular scaffolding on which connective tissue is built, including cartilage, tendons, and ligaments.
- Eggs, poultry, fish, and legumes. These protein-rich foods are good sources of amino acids that contain sulfur.
- Garlic, onions, and leeks. Alliums contain the flavonoid quercetin, an antioxidant with anti-inflammatory properties.
- Cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts. Experts recommend a daily serving of these sulfur-rich veggies.
3. Calcium and Vitamin D
You need calcium for strong bones and teeth, but this mineral also assists in muscular contractions. Without enough calcium, you could be putting yourself at risk for bone loss, diminished bone density, and ultimately osteoporosis. Vitamin D is crucial to your body’s ability to absorb calcium.
- Dairy products, including milk, yogurt, and cheese (unless you have a sensitivity or allergy), are rich in calcium. Choose organic to limit your exposure to antibiotics and hormones.
- Collard greens, kale, turnip greens, arugula, and mustard greens. These and other dark leafy greens are packed with calcium.
- Egg yolks, and fatty fish like salmon and mackerel. Complement your calcium intake with these excellent whole-food sources of vitamin D.
An antioxidant that gives fruits red, blue, and dark-purple hues, anthocyanin has been shown to stop production of cytokines.
- Stone fruits such as plums and cherries. Note that sweet cherries contain the powerful pigment, but in lower amounts than their tart cousins. Bonci suggests her patients drink 8 to 16 ounces of tart cherry juice daily in place of other calories, determined by how much pain they’re trying to treat. Since tart cherry juice also contains melatonin, it might cause drowsiness. “You may not want to take it midday right before a big presentation,” she says. “It’s better at the end of the day.”
- Blueberries, strawberries, raspberries, bilberries, cranberries, and black currants. Indulge in these delicious anthocyanin sources to your heart’s — and your joints’ — content.
Richard Diana, MD, an orthopedic surgeon and clinical instructor at the Yale School of Medicine, recommends eating fiber-rich foods to slow carbohydrate absorption. In Healthy Joints for Life, he explains that fiber helps control blood-sugar levels, which keeps glucose and insulin in check, restraining inflammation.
- Whole-kernel grains like oatmeal, brown rice, and quinoa.
- Legumes, including black beans, split peas, and lentils, which contain about eight times more fiber than whole-grain bread.
- Artichokes, green peas, kale, and spinach. As a general rule, the darker the color of the vegetable, the higher the fiber content.
What to avoid
1. Refined sugars
Wright advises her patients to stop eating all refined sugars. White sugar and high-fructose corn syrup are found in a wide range of prepackaged foods and drinks. The digestive system breaks down processed sugars into basic sugars, including glucose; in response, the pancreas releases insulin. Glucose is considered an inflammatory agent, and research has shown that high levels kick-start the release of NF-kB and cytokines.
2. Simple Carbs
Bonci recommends being mindful of carb intake and opting for whole-kernel grains. While many fruits and dairy products (like milk) fall into the “simple carb” category, the most problematic are highly processed foods: white bread and white rice, cakes, cookies, crackers, and breakfast cereals. These carbs are “simple” because, unlike fiber, their chemical structure is weak — just one or two sugar molecules. They quickly break down into glucose once ingested. As with refined sugars, this rush of glucose summons the body’s inflammatory response.
3. Unhealthy fats
While the body needs omega-6 fatty acids, they are beneficial in far smaller amounts than what’s typical in the Western diet. Many omega-6 fatty acids trigger a pro-inflammatory release of cytokines. Partially hydrogenated oils, known as trans fats, can also stoke swelling. A study published in the American Journal of Clinical Nutrition found that the intake of trans fats is positively associated with global inflammation in women. Avoid excess omega-6s by steering clear of refined vegetable oils like soy, corn, safflower, and cottonseed. Bonci advises avoiding commercial fried foods because of the low-quality oils that are typically used. Diana lays out an entire dietary program in Healthy Joints for Life that recommends ditching all prepackaged, processed, and refined foods.
4. Food sensitivity triggers
Like Jan Patenaude, many people have “trigger foods” that set off inflammation in their bodies. An elimination diet can help you determine whether certain foods trigger joint pain. Common culprits include gluten and casein (proteins found in wheat and dairy, respectively) and additives like aspartame and MSG.
Healthy joint supplements
In addition to a change in diet, supplements can help reduce pain and inflammation. Work with your healthcare practitioner to determine dosage, efficacy, and potential drug interactions and side effects.
Omega-3 fatty acids: Fish-oil supplements rich in omega-3 fatty acids come in liquid or capsule form. Taking them with a meal can help mask the fishy aftertaste.
Glucosamine: A major National Institutes of Health study concluded that glucosamine, which comes from the exoskeletons of shellfish, in combination with chondroitin sulfate, improved symptoms in people suffering moderate-to-severe levels of pain.
Gingerroot: The anti-swelling components in this root are called gingerols. These strong antioxidants can help halt cytokine production.
Turmeric: The anti-inflammatory agent in turmeric is curcumin. This compound interrupts NF-kB activity and heads off the release of cytokines. Only 3 percent of turmeric spice is curcumin, so most clinicians advise supplements.
Boswellia: For millennia, this tree’s resin, frankincense, has been used to treat inflammation. Current-day studies reaffirm its ability to inhibit swelling. Boswellia is available as a capsule, tablet, or in topical creams.
Green tea: The phytochemical epigallocatechin-3-gallate, or EGCG, in green tea is a potent antioxidant that holds NF-kB at bay. Not all sources of EGCG are equal: Prepared green-tea drinks usually do not contain as much of the phytochemical as a cup you brew yourself.
5 reasons your joints might ache
Acute injury. Painful joints can result from injuries that cause biomechanical stresses. Acute injuries can happen from a direct blow to a joint, a rough landing, or a crooked step off a high curb. More serious injuries, like a damaged anterior cruciate ligament (ACL), can undermine the joint and subsequently lead to yet more acute problems, such as a rip in the knee’s meniscus.
Mild injuries. Even if an injury isn’t severe, it can compromise a joint and, over time, lead to uneven cartilage wear and premature weakening. If a joint is destabilized, a person might compensate by shifting her weight slightly while walking. Because the joint is no longer aligned, and the pressure isn’t distributed evenly, the cartilage will wear more quickly at the points of greatest stress.
Wear and tear. Also known as osteoarthritis, this is caused by the thinning of the cartilage in the joint. It is the most common form of arthritis, occurring most frequently in hands, knees, and hips.
Autoimmune disorders. The most common autoimmune disorder to cause joint pain is rheumatoid arthritis, in which the immune system attacks healthy cells in the synovium, the soft tissue lining the joints. This triggers inflammation that causes further degradation and, often, debilitating pain.
Excess body weight. Obesity is a major source of joint problems. The overload puts significant pressure on cartilage, particularly in the knees and hips. According to Vonda Wright, MD, an orthopedic surgeon and spokesperson for the American Academy of Orthopaedic Surgeons, load-bearing joints experience an impact seven times the weight of a person’s body. If someone gains 10 pounds, the knees are burdened with 70 additional pounds of pressure. Under such stress, cartilage can become damaged and begin to break down.
Heather Rogers is a Brooklyn, N.Y.–based journalist and the author of Green Gone Wrong.