What is the best diet for my knee pain?
Marion Hauser, MS, RD
What is the best diet for my knee pain?
You probably do not need a lot of science to convince you that obesity can cause advanced degenerative damage in your knee. Many patients come into our office with knee pain and a bit of a belly. They tell us that they need to lose some weight but it is hard with their knee pain limiting their activities. We understand and we do not lecture patients on this. We try to offer suggestive help. So, when these people come into our clinics with significant knee pain, and they ask our clinicians about what type of diet they should be on. The answer is usually, the one that helps you to a healthy body weight.
Avoid foods that cause weight gain AND inflammation. As the research will show you below, you eat this stuff, it is very likely you will have knee swelling and knee pain from both excess weight and these foods producing their own inflammation.
The best diet is one that does not cause weight gain and does not cause inflammation independent of the degenerative inflammatory response. There is a list of “wrong foods,” that would be incredibly long. So I will simplify this list down to the following foods noted on the Dietary Inflammatory Index Scale, this is a scale that measure which foods cause the most and least inflammation and is used in making food choice recommendations for heart disease and cancer prevention.
The list is somewhat obvious:
- Foods that contain excess sugar
- Processed carbohydrate foods, white flour, white bread, white rice, and of course the sugars.
- Fried foods
- Red and processed meats such as deli meats.
As the research will show you below, you eat this stuff, it is very likely you will have knee swelling and knee pain from both excess weight and these foods producing their own inflammation. This is why you get a C-Reactive Protein test to screen for heart disease. The test is checking for the inflammation in your body independent of joint damage.
So as the right food stimulates healing, the wrong food can cause inflammatory reactions and make your knees feel worse.
What are the right foods?
Here are my articles on this website. They list the scientific benefits of certain foods.
- Green tea and joint pain In this article I show how Green Tea shuts down chronic inflammation.
- Vitamin D and knee osteoarthritis As research points out, vitamin D does have a place in helping a patient with knee osteoarthritis. Vitamin D supplements are readily available and food rich in vitamin D are plentiful. These include Salmon, herring and sardines, for non-fish lovers spinach and kale. Of course, sunshine helps a lot too.
- Metabolic syndrome and osteoarthritis joint pain
- Olives and osteoarthritis
- Ginger and joint pain | Research says it does help
- What is obesity-induced osteoarthritis?
- Type 2 diabetes in osteoarthritis joint healing
- Curcumin and osteoarthritis
- Celiac disease and difficult to treat joint pain
According to medical studies, dieting will help some people with knee pain, dieting will not help some people with knee pain. Will it help you? That depends, according to researchers, on the type of diet you are on.
- Lo-Carb diets will help some people with knee pain, low-carb diets will not help some people with knee pain.
- Fruit and vegetable/ and or high fiber diets will help some people with knee pain, Fruit and vegetable/ and or high fiber diets will not help some people with knee pain.
- The Mediterranean Diet will help some people with knee pain, The Mediterranean Diet will not help some people with knee pain.
- Some people, despite their best intentions, will not maintain a diet and will think knee replacement is the answer.
Where do we begin with all of this? With research.
Low Carb Diet works for some
At the University of Alabama at Birmingham, a research team published their findings that diet may offer a an alternative to opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs. This research appears in the journal Pain Medicine.(1)
Study learning points:
- Who: Adults 65-75 years of age with knee osteoarthritis studied for 12 weeks on different diets.
- How: These adults were divided into three groups
- low-carbohydrate diet group
- low-fat diet group
- or continue to eat as usual
- What were the researchers looking for:
- Functional pain, self-reported pain, quality of life, and depression were assessed every three weeks.
- Serum from before and after the diet intervention was analyzed for oxidative stress.
- A quick word about oxidative stress / Inflammation
- Oxidative stress is damage from inflammation. In other articles, we have noted that Nature’s way for trying to heal a joint in a state of degeneration is to try to rebuild damaged tissue. To do this our body’s immune system must try to shut down certain types of inflammation by producing its own anti-inflammatory protection system for the new cartilage it is building. When chondrocytes (cells that build cartilage) can neither complete repair or shut off the inflammation, the inflammatory loop creates a toxic environment in the joint filled with cells and chemicals that contribute to oxidative stress.
- The researchers in this study are looking to see if diet impacts this type of oxidative stress activity.
RESULTS: Over a period of 12 weeks, the low-carbohydrate diet group reduced pain intensity and unpleasantness in some functional pain tasks, as well as self-reported pain, compared with the low-fat diet group and the people acting as a control group who continued to eat as usual.
- The low-carbohydrate diet group also significantly reduced oxidative stress and the adipokine leptin (fat cells) compared with the low-fat diet group and the people acting as a control group. Reduction in oxidative stress was related to reduced functional pain.
- The researchers concluded that evidence suggesting that oxidative stress may be related to functional pain, and lowering it through low-carbohydrate diet intervention could provide relief from pain and be an opioid alternative.
Quick comment: A word about fat cells and inflammation
- There is no magic pathway to successful dieting or change of lifestyle. Successful dieting comes from within and from a good support system.
- This is particularly true for men. Please see my article Why do men fail to lose weight on diets aimed to reduce knee and joint pain?
In the above study, the researchers measured the adipokine leptin or fat cells. Fat cells cause inflammation. In my article Is losing weight an anti-inflammatory? I showed research that obesity is more than weight load – it causes inflammation without wear and tear. I shared with the readers research from doctors at the University of Calgary who wrote in the journal Osteoarthritis and Cartilage (2) that when they examined obese laboratory animals, they found that not only does obesity cause osteoarthritis because of weight load (such as in a knee), but it also causes osteoarthritis in a “non-mechanical” way – in other words by inflammation without wear and tear. The inflammation attacking the joints of the animals was caused by a high fat/high sugar diet. This is covered further in our article Abdominal obesity, hypertension, and diabetes is destroying your knee.
Will a diet of fruits, vegetables, and fiber help my knee pain?
The different types of foods that could help knee osteoarthritis is something that I cover in many articles on this website. Let’s get to some introductory research that will help us understand the role of fruits, vegetables, and fiber.
In the April 2019 issue of the European medical journal Maturitas (3) which deals with the subject of Menopause, research led by the University of Wollongong in Australia examined the effect of dietary phytochemical intake from foods on osteoarthritis.
- A phytochemical is a compound that plants have that protect them from fungus or insects or anything that may harm the plant. In humans, this is a term given to the chemicals in certain plant foods that may be beneficial to us. Examples are below.
- Among the phytochemicals are a group called the polyphenols. Examples of these plant chemicals are listed below.
The researchers of this study, while warning that there is not enough research to make a strong recommendation on what types of phytochemicals may be beneficial, did suggest that:
- Dietary polyphenol intake from foods (e.g., freeze-dried strawberries and tart cherry juice) may slow the progression of osteoarthritis via decreased inflammation and reduced cartilage degradation.
Let’s take a quick look at strawberries with a summary from my article Can strawberries help with joint pain?
- Doctors at the University of Nevada at Las Vegas published research (December 2018) in the journal Food & Function (4) which investigated knee osteoarthritis in obese people with high cardio-metabolic risk factors (high blood pressure, high blood sugar, abnormal blood cholesterol). They noted that eating strawberries have been shown in clinical research to alleviate some arthritis symptoms in obese patients and to also impact problems of chronic inflammation by reducing inflammatory markers.
Above we also discussed oxidative stress
- In the journal Food and Chemical Toxicology, (5) the researchers from Italy, Mexico, Spain, and Ecuador’s leading universities published their findings on the health benefits of strawberries even in the most toxic environment. Here is what they wrote:
- A common denominator in the pathogenesis of most chronic inflammatory diseases (knee osteoarthritis included) is the involvement of oxidative stress. The researchers found Oxidative stress and its components were halted by the strawberry’s anti-oxidant effect and, in fact, was reversed.
Research: Fruits and vegetables do help knee pain, but how?
A 2017 study from The Journal of Nutrition, Health & Aging (6) did make a positive connection between the consumption of fruits and vegetables. The question was how? The answer it may all be in your mind.
The research team hypothesized that higher fruit and vegetable consumption might be associated with the severity of knee pain lower prevalence of severe knee pain by affecting pain perception in the knee joint. So they investigated the relationship between self-reported knee pain and the consumption of fruits vegetables, carotenoids, and vitamin C and self-reported knee pain.
In this study, the patients told the doctors how much their knee(s) hurt on a standardized scoring system. Then they ate a diet rich in food and vegetables. Here are the results:
- Standardized pain scored of knee pain decreased significantly with increasing fruit and vegetable intake.
- The longer the people of the study stayed on the diet, the better their knees felt.
What the researchers questioned was the question, did these people knees hurt less because of the diet’s specific impact on their knees or did the people of this study, because they were eating better, simply feel better overall? To the person the diet is helping, it does not matter.
Will a cholesterol-lowering diet help my knee pain?
In my article My doctor says that my knee pain is being made worse by my elevated cholesterol, I looked at a study in the influential journal Scientific Reports.(7)
- In this study of nearly 14,000 participants, the researchers found that hyperlipidemia (elevated cholesterol) elevated risks of knee pain and clinical knee osteoarthritis in middle-aged or older adults.
- The also found that lipid-lowering drugs impact on knee pain and clinical knee osteoarthritis was limited.
- A better way to control knee pain thought related to high cholesterol is diet and exercise.
- What is the best diet for your knee pain?
It is very likely that you have been on numerous diets and have not done as well as you would have liked, else wise you would still not be looking for help. Generally, the best diets for people are the ones that tend to show some success at the onset is not just losing weight but in overall health. Above we spoke about researchers who could not distinguish whether the diet was helping the knee pain or the idea of the diet and eating health was helping the knee pain. One thing for sure, something was helping the knee pain and this lead people to stay on the diet.
Do you have questions about joint pain and diet?
You can get help and information from our Caring Medical Staff.
1 Strath LJ, Jones CD, Philip George A, Lukens SL, Morrison SA, Soleymani T, Locher JL, Gower BA, Sorge RE. The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis. Pain Med. 2019 Mar 13. pii: pnz022. doi: 10.1093/pm/pnz022. [Epub ahead of print] PubMed PMID: 30865775.
2 Collins KH, Reimer RA, Seerattan RA, Leonard TR, Herzog W. Using diet-induced obesity to understand a metabolic subtype of osteoarthritis in rats. Osteoarthritis Cartilage. 2015 Feb 3. pii: S1063-4584(15)00028-X. doi: 10.1016/j.joca.2015.01.015. [Google Scholar]
3 Guan VX, Mobasheri A, Probst YC. A systematic review of osteoarthritis prevention and management with dietary phytochemicals from foods. Maturitas. 2019 Jan 11.
4 Basu A, Kurien BT, Tran H, Maher J, Schell J, Masek E, Barrett JR, Lyons TJ, Betts NM, Scofield RH. Strawberries decrease circulating levels of tumor necrosis factor and lipid peroxides in obese adults with knee osteoarthritis. Food & function. 2018;9(12):6218-26. [Google Scholar]
5 Gasparrini M, Forbes-Hernandez TY, Giampieri F, Afrin S, Alvarez-Suarez JM, Mazzoni L, Mezzetti B, Quiles JL, Battino M. Anti-inflammatory effect of strawberry extract against LPS-induced stress in RAW 264.7 macrophages. Food and Chemical Toxicology. 2017 Apr 30;102:1-0. [Google Scholar]
6 Han HS, Chang CB, Lee DC, Lee JY. Relationship between total fruit and vegetable intake and self-reported knee pain in older adults. The journal of nutrition, health & aging. 2017 Jul 1;21(7):750-8. [Google Scholar]
7 Zhou M, Guo Y, Wang D, Shi D, Li W, Liu Y, Yuan J, He M, Zhang X, Guo H, Wu T. The cross-sectional and longitudinal effect of hyperlipidemia on knee osteoarthritis: Results from the Dongfeng-Tongji cohort in China. Scientific Reports. 2017 Aug 29;7(1):9739. [Google Scholar]