Do We Have Any Control Over Joint Pain?

I commonly meet with clients who are experiencing multiple forms of pain, including that which resides in the joints. Conditions and diseases that affect the joints include bursitis, tendonitis, cartilage tears and injuries, gout, osteoarthritis, rheumatoid arthritis, psoriatic arthritis, lupus, ankylosing spondylitis, amyloidosis, fibromyalgia, carpal tunnel syndrome, and Paget’s disease, among others. At the root of each of these is inflammation. What do I mean by inflammation? Think redness, heat, swelling, pain, and loss of function.

The Immune System & Joint Pain

The immune system is the source of inflammation. It determines how much inflammation is present at any given time, and factors within our eating patterns, lifestyle, and genetics can increase or decrease inflammation. Of these factors, what we eat and drink will have the single most significant effect.

The immune system accomplishes its work by manufacturing and sending out “messengers” that are either inflammatory or anti-inflammatory. Different types of messengers include cytokines, prostaglandins, and leukotrienes, and the body’s inflammatory status will largely depend on their inflammatory status. The joints have proteins that receive these messengers, aptly called “receptors.” Binding inflammatory messengers to these receptors increases inflammation locally in the joint and can lead to cartilage destruction and pain.

Don’t get me wrong – sometimes, the immune system must send these messengers to recruit immune cells to a specific spot in the body for repair. This is a natural process and one of the immune system’s most significant roles. With an acute, short-lived injury to the joint, these messengers will enlist immune cells, such as fibroblasts and macrophages, to repair connective and soft tissues and regulate inflammation. To a limited extent, cartilage can be repaired as well. However, as we will see, having multiple inflammatory factors present can increase “systemic” or body-wide inflammation and lead to chronic pain, especially in the joint.

Inflammatory Factors that Influence Joint Pain

Besides acute or chronic injuries, factors that can influence inflammatory status and increase joint pain include eating a large number of inflammatory foods, drinking a lot of sugary or heavy chemical-laden beverages, over-using alcohol, being overweight or obese, having one or more chronic health conditions, experiencing a great deal of stress, and being sedentary.

Inflammatory Eating Patterns and Weight

As mentioned, what we eat and drink will have the greatest impact on the body’s inflammatory status. A dietary pattern that contains a moderate to significant number of inflammatory foods and beverages, including alcohol, will increase the production of inflammatory messengers from the immune system. Additionally, eating excess amounts of inflammatory, high-calorie foods and drinks can lead to overweight and obesity, which increases the production of inflammatory messengers as well.

Being overweight or obese can increase inflammation in the joints through two different mechanisms. First, more fat accumulation around the abdomen, known as “visceral” fat, creates an inflammatory environment where many immune messengers and hormones are produced and secreted. These travel throughout the body and can bind to joints, the brain, and all organs, wreaking havoc. Second, when we are overweight or obese, shear force on weight-bearing joints, such as the knees, hips, and ankles, can increase significantly. An additional 4 to 6 pounds of force is estimated to be placed on the joints for every pound of excess weight. This added pressure can wear down cartilage and lead to increased inflammation, osteoarthritis, and other forms of degenerative disease.

Chronic Health Conditions

Chronic inflammation typically causes the emergence of chronic medical conditions such as autoimmune disease, type-2 diabetes, high blood pressure, high cholesterol, liver disease, and many others. Each of these conditions can increase inflammation even further. Thus, inflammation triggers, drives, and maintains chronic disease.

Sometimes, we may have a hereditary predisposition for a particular disease, but thankfully, our genetics do not always get the last word. Once again, what we eat and drink can have a profound effect. We can’t change our genetics, but we can certainly change how they are expressed by adopting anti-inflammatory eating and living patterns.

Chronic Stress

Chronic stress has an interesting effect on the body. Acute, short-lived stress leads to a rise in the stress hormone cortisol, which signals the body to undergo many changes system-wide to endure the stressor, for instance, outrunning a tiger. When we experience chronic stress, the immune system begins to function abnormally, increasing the production of inflammatory messengers. These can change the function of every cell, joint, and organ, predisposing to disease. Note that this effect is independent of diet.

Lack of Exercise

Being chronically sedentary increases and maintains inflammation, as regular exercise is one of the most potent and available anti-inflammatory therapies we have at our disposal.

When we do not consistently exercise and cause our muscles to contract, they produce fewer anti-inflammatory messengers called myokines. These immune system messengers communicate with all organs, reduce inflammation, regulate metabolism, and may improve chronic disease.

Inflammatory Eating Patterns

I’ve mentioned inflammatory foods and drinks; at this point, you may be wondering which are inflammatory. That’s a great question!

Most processed, ultra-processed, and sugary foods and beverages will elevate immune system activity and raise inflammation. But why are these foods inflammatory? Many, if not most, have few nutrients and contain artificial ingredients, dyes, trans fats, adverse saturated fats, harmful omega-6 fats, increased salt, certain artificial sweeteners, and high amounts of added sugar.

Added sugar deserves special attention because consistent, regular intake of foods and beverages high in added sugar puts us at risk for developing insulin resistance, prediabetes, and type-2 diabetes. Frequent blood sugar spikes and chronic high blood sugar directly activate the immune system and damage blood vessels, joints, and all organs.

For some, foods that contain gluten, dairy, or other sensitive or allergic components can be problematic. And let’s not forget about alcohol. Regular, chronic intake can raise inflammation body-wide, and this effect is independent of diet.

The Power of Anti-Inflammatory Eating & Living

In contrast, an eating pattern that includes many anti-inflammatory foods reduces immune system activation and increases the production of anti-inflammatory messengers. These foods are rich in vitamins, minerals, protein, healthy fats, fiber, and antioxidants.

Generally, anti-inflammatory foods include fresh vegetables and fruits, whole grains, beans and legumes, lean meats, fatty fish, nuts, seeds, fresh herbs, and healthy fat sources. Also, “eating the rainbow” and including as many colors as possible of veggies, fruits, spices, beans, and whole grains boost antioxidants, thus reducing inflammation even further. Replacing sugar-sweetened and chemical-heavy beverages with plenty of water and green, white, black, and herbal teas can add to anti-inflammatory effects.

Many of my clients find that reducing or eliminating their intake of inflammatory foods and drinks and replacing them with more anti-inflammatory offerings significantly improves their weight, joint pain, and chronic disease. Even a 10% loss of total weight can be considerably beneficial. Identifying specific foods and ingredients that drive food allergies or sensitivities can be helpful, too. By far, the most potent “therapies” for joint pain are improved eating and weight loss, if needed.

Having said all this, sometimes significant dietary changes and weight loss fail to resolve joint pain completely. In these cases, adding specific, targeted supplements may be beneficial. Molecules like curcumin, boswellia serrata, quercetin, omega-3 fish oils, niacinamide, glucosamine, chondroitin, collagen, and avocado-soybean unsaponifiables may provide some relief.

Anti-inflammatory Supplements

Curcumin, one of the active components of turmeric root, is a powerful antioxidant that tells our cells to make fewer inflammatory messengers. It can also reduce the production of inflammatory prostaglandins in the joints by limiting the activity of the cyclooxygenase-2 enzyme. However, curcumin has poor bioavailability, so specific, optimized forms will work best.

Boswellia serrata, an extract of Indian frankincense, reduces inflammation by limiting the activity of the 5-lipoxygenase enzyme, which in turn, can restrict the production of inflammatory leukotrienes in the joints.

Quercetin, a bioflavonoid found in many plant-based foods, may reduce the production of inflammatory messengers and the recruitment of inflammatory immune cells to sites in the joints.

Omega-3 fish oils, particularly eicosapentaenoic acid (EPA), reduce the production of inflammatory prostaglandins and leukotrienes in the joints. They also are an integral component of cell membranes in the joints, providing proper structure, flexibility, and improved inflammatory signaling.

Interestingly, niacinamide, a specific form of vitamin B 3 , can reduce inflammatory messaging and joint pain. It is also believed to restructure the joint through improved collagen synthesis.

Other common molecules, such as glucosamine, chondroitin, and collagen, as well as the lesser-known avocado-soybean unsaponifiables (ASUs) can potentially reduce inflammatory messengers, protect and maintain cartilage, and stimulate new cartilage production. Keep in mind that some forms of these molecules will be more bioavailable and better absorbed than others.

Exercise

Most forms of exercise, including aerobic and anaerobic, encourage the production of anti-inflammatory messengers and hormones. Brisk walking, swimming, cycling, yoga, pilates, high-intensity interval training (HIIT), and resistance training can all reduce inflammation and strengthen joints if performed regularly, 3-5 times per week.

More intense forms of exercise, such as CrossFit, marathoning, ultra-marathoning, and heavier weight training, tend to increase inflammatory messaging and joint pain, especially if performed without proper form and scheduled rest periods.

Chiropractic

Working with an effective chiropractor can relieve stubborn acute or chronic joint pain. Chiropractic can improve pain through several mechanisms. First, it can correct spinal misalignment, reduce joint and nerve pressure, and optimize related functions. Second, proper alignment can improve blood flow to the joints and nerves, bringing oxygen and nutrients to the sites for proper repair. Third, specific chiropractors are trained in soft tissue therapy and will use massage to release muscle tension and break up scar tissue. Each of these therapies can help reduce the production of inflammatory messengers and joint pain and improve function.

The Takeaway

In many cases, there are several things we can do to control our inflammatory status in general and joint pain in particular. As mentioned, what we regularly eat and drink will have the most powerful impact, but weight loss, targeted supplements, stress reduction, proper exercise, and effective chiropractic care can all play a role. The professionals at Nelms Nutrition and Main Street Chiropractic would love to show you how.