How too much weight and a bad diet hurts your knees
Marion Hauser, MS, RD
One of the most obvious ways to help a patient with degenerative knee pain and metabolic syndrome (abdominal obesity, hypertension, and diabetes) is to help them understand that a healthy lifestyle can be extraordinarily beneficial to their joint pain, especially knees and spines.
One of the hardest things to convince a patient of is that they need to examine their food choices and lifestyle choices and make immediate and meaningful changes to help try to save their knee or to help with their back pain.
It is very likely that if you are reading this article, you have:
- high blood pressure that is being controlled by medication,
- you are constantly challenging yourself to get rid of your “gut,”
- and you have type-2 diabetes.
Every 1% weight loss was associated with a 2% reduced risk of knee replacement
You also have moderate to severe knee and/or back pain and are losing your mobility and ability to work or function. Your adult children may be talking to you about considering assisted living one day in the future. Why? Because you are having difficulty moving and you may be on the verge of “Locomotion Syndrome.”
Let’s start our article with an April 2022 study in the International journal of obesity (10). In this paper from medical university researchers in Australia, doctors described the impact of weight loss on helping people avoid a knee and hip replacement. What the researchers found was: “In people with or at risk of clinically significant knee osteoarthritis, every 1% weight loss was associated with a 2% reduced risk of knee replacement and – in those people who also had one or more persistently painful hips – a 3% reduced risk of hip replacement, regardless of (how overweight they were).
In other words, if you are a 180 pound person and are 36 pounds over weight and you lost that 36 pounds – you would reduce your chances of needing a knee replacement by 72%
Your inability to move pain-free, without frailty and instability is related to body mass index
Your inability to move pain-free, without frailty and instability, is called “Locomotion Syndrome.” There are some obvious causes of “Locomotion Syndrome.” These include progressive degenerative disorders such as degenerative joint disease, hip osteoarthritis, knee osteoarthritis, degenerative diseases of the ankle and foot, and osteoporosis. Obviously disorders that would make it very difficult for someone to walk. But what if you did not have a significantly degenerated spine and joint disease and you have problems walking, or maintaining your balance, or even standing? What else could it be?
Let’s look at a November 2019 study in the medical journal Geriatrics & Gerontology International (1) that looks at aging patients to see what is causing aging patients their locomotion problems. The researchers state: The objective of the present study was to identify the factors related to onset and progression of Locomotion Syndrome in the absence of degenerative joint and spine disorders.
So they gathered and examined 1034 volunteers (444 men, 590 women, average age 63.5 years).
They divided the volunteers into two groups:
- Those who had degenerative joint and spine disease
- Those who did not
Then the grouped these people by age, sex, body mass index, muscle strength, gait ability, pain, body balance, spinal sagittal alignment, geriatric syndrome (locomotive syndrome, frailty and sarcopenia or bone loss) and Quality of Life scores.
The somewhat obvious findings were in patients without degenerative disease.
- If you can keep body mass index (weight and obesity) low, the faster you can walk, the greater the grip and back muscle strength you will have. You will also have more stable body balance; better sagittal spinal alignment (straight spine); and lower rates of locomotive syndrome, frailty, and sarcopenia.
A look at Locomotive Syndrome – reduced mobility requiring nursing care
In January 2019, researchers at Nara Medical University in Japan published a study in the journal Modern Rheumatology (2). What they wanted to observe and assess was the impact of musculoskeletal diseases, depressive mental state, and hypertension on locomotive syndrome.
Learning points of this research:
- Aging, osteoporosis, and low back pain significantly increased the risk of locomotive syndrome, followed by knee osteoarthritis and lumbar spinal stenosis.
- Locomotive syndrome was significantly related to depressive mental state and hypertension and led to functional “inconvenience” in daily chores such as cleaning, shopping, and strolling.
- The risk of locomotive syndrome may be decreased by treating comorbid osteoporosis and instituting exercise and diet-related modifications.
In November 2018 another Japanese research team lead by Tokai University Oiso Hospital researchers looked at people with reduced muscle strength to measure the relationship with muscle frailty and metabolic syndrome leading to locomotive syndrome and required nursing care. This was published in the Journal of Orthopaedic Science.(3)
A problem for women
Here are the leaning points of this study:
- In women, body weight, body mass index, and abdominal circumference were significantly lower in the non-Locomotive Syndrome risk group than in the Locomotive Syndrome higher risk group.
- In women, the ratio of lower limb muscular strength to body weight was significantly lower in the double-risk group ( Locomotive Syndrome and Metabolic Syndrome higher risk groups). In simpler terms, the muscles of the women at risk had a difficult time supporting their weight
Abdominal obesity, hypertension, and diabetes accelerates knee pain and osteoarthritis and Locomotion Syndrome
In October 2018, researchers in the journal Clinical Rheumatology (4) reinforced these findings.
The goal of the study was to take patients who had metabolic syndrome (abdominal obesity, hypertension, and diabetes), and knee osteoarthritis and examine the patient’s clinical history, functional capabilities, and match that with scans and MRIs of their knees.
- This study examined 60 patients – 55 being women
- Every patient had been diagnosed with metabolic syndrome (abdominal obesity, hypertension, and diabetes).
- All patients had knee osteoarthritis documented by MRIs and scans
- All patients were tested for pain, stiffness, and disability assessments
- The findings:
- If you have the components of metabolic syndrome, abdominal obesity, hypertension, and diabetes, your knee pain was worse, your degeneration was worse, your functionality was worse.
The obvious conclusion? You will probably walk a lot better and feel a lot better if the issues of Abdominal obesity, hypertension, and diabetes are confronted.
If you have a big belly. Look down. You are looking at an inflammation processing plant. Your fat cells are pumping out inflammation to your joints
Dr. Karel Pavelka of the Czech Republic has published findings in the Fall 2017 issue of the Czech language journal Internal Medicine. (5) Here are his bullet points:
- It remains problematic that one of the main components of metabolic syndrome is obesity which in itself is a risk factor for osteoarthritis development in the weight-bearing joints.
- Note: Research is now showing that obesity also causes osteoarthritis inflammation in non-weight bearing joints such as the hands.
- It had been thought obesity caused joint degeneration because of weight load.
- In research on patients with hand osteoarthritis and obesity, it was found that obesity cause inflammation leading to osteoarthritis, weight-bearing had nothing to do with it. This is covered in our companion article Excessive weight and joint pain – the inflammation connection.
- “Meta-inflammation.” Inflammation caused by metabolic syndrome.
- Over the last decade, evidence has been shown that adipose (fat) tissue is a source for growing inflammation. Inflammatory cells in the fat: cytokines (small proteins that send pro-inflammatory and anti-inflammatory messages to damaged joints) and adipokines, which are also cell signaling messenger proteins secreted by fat cells which may cause inflammation of low-activity synovial tissue, sometimes also called “meta-inflammation,” go into high production in the presence of obesity.
- “Adipose tissue-associated inflammation.” The changed secretion profile of pro-inflammatory adipokines is present in obese individuals, an older population and postmenopausal women, the populations at high risk for both metabolic syndrome and osteoarthritis.
In other words, your fat cells are pumping out inflammation.
The message again: Your fat cells are pumping out inflammation
State Medical University researchers in Russia (6) have published their observations on 164 patients with osteoarthritis. Eighty-two patients were diagnosed with Metabolic Syndrome, Eighty-two were not and used as controls.
In the 82 patients with Metabolic Syndrome, clear indications of the negative impact of the disorder were seen:
- the frequency of joint injuries and multiple joint injuries.
- the prevalence of synovitis (synovial inflammation of the knee),
- and the intensity of joint pain and inflammation were significantly higher than in the non-Metabolic Syndrome group.
Doctors in France cited these same findings in their research on factors affecting joint healing and metabolic syndrome in Current Opinion in Rheumatology: (7)
- Recent advances in the study of metabolic syndrome-associated osteoarthritis have focused on a better understanding of the role of metabolic diseases in inducing or aggravating joint damage.
- This research gives emerging evidence that, beyond the role of common pathogenic mechanisms for metabolic diseases and osteoarthritis (i.e., low-grade inflammation and oxidative stress), metabolic diseases have a direct systemic effect on joints.
In other words -abdominal obesity, hypertension, and diabetes are destroying your joints as if it were a wear and tear disease.
Research: Your big belly is causing your joint swelling
University researchers in Australia write in the journal PLoS One (Public Library of Science one) (8) of the established risks obesity plays in osteoarthritis.
The researchers fed Wistar rats a high-carbohydrate, high-fat diet for a period of 8 and 16 weeks. The study showed that obesity-induced by this diet is associated with spontaneous and local inflammation of the synovial membranes in the rats even before the cartilage degradation.
- In other words, there was no joint damage, but the diet caused inflammation
This was followed by increased synovitis and increased macrophage infiltration (immune cells are now invading the areas causing swelling and edema) into the synovium and a predominant elevation of pro-inflammatory M1 macrophages (A specific type of immune cell).
- In other words, obesity is causing the swelling
This study demonstrates a strong association between obesity and a dynamic immune response locally within synovial tissues before cartilage degradation.
- In other words, the joint environment is eroding
Researchers identify a gene causing inflammation in the knees – it gets stimulated in obesity
A March 2022 paper published in the Journal of orthopaedic translation (x) looked for a way to provide drug manufacturers information on producing better anti-inflammatory medications for people with joint pain. What they found was a protein gene (ADCY7 ) that was being stimulated by obesity to help create inflammation. What the researchers did was to take synovial fluid samples from osteoarthritis patients. In some of these patients, there was a ADCY7 (gene) expression. The researchers write that “this may represent a currently undefined osteoarthritis subtype and explain the clinical phenomenon of more severe synovial inflammation in obese osteoarthritis patients. . . ” Further, they confirm that the inhibition (stopping the gene expression) of ADCY7 could effectively stop high-fat diet-induced degenerative changes as well as the inflammatory (break down of lipid or fatty acids) lipolysis and fibroblast-like synoviocytes dysfunction (a dysfunction that causes chronic inflammation and eventual breakdown of cartilage) as they had observed in an animal study.
What does this suggest in simpler terms? High fat diet stimulates chronic inflammation and eventual breakdown of cartilage
The problems of managing insulin
Doctors writing in the journal Medical Hypotheses (9) offered evidence making a connection between insulin, inflammation, and joint pain here are the bullet points of their findings.
- High levels of insulin in obesity and metabolic syndrome can induce numerous complications.
- Insulin can increase proliferation of chondrocytes (Cartilage building blocks) but can also simultaneously prevents their differentiation into a specific type of cells. In other words, the building blocks of cartilage multiple but do not differentiate – that is, become cartilage. They become duds.
- Decreasing insulin levels can prevent osteoarthritis progression and/or improve the treatment process.
Reducing circulation insulin levels can be achieved in many cases with health-professional guided lifestyle and dietary changes.
Eating foods that maximize healing
The same researching team cited above also examined the recent advances in the knowledge of osteoarthritis and its association with obesity and metabolic syndrome through systemic mechanisms.
“Type 2 diabetes has been described in two (studies) as an independent risk factor for osteoarthritis.” In these animal studies, diabetic rodents display spontaneous and more severe osteoarthritis than their non-diabetic counterparts.
The negative impact of diabetes on joints could be explained by the induction of oxidative stress and pro-inflammatory cytokines (systemic low-grade inflammation) and by joint tissues exposed to chronic high glucose concentration.
The message here is simple: Abdominal obesity, hypertension, and diabetes = knee pain and accelerated knee osteoarthritis. The choice to do something about it is yours.
Weight causes post-knee replacement complications
Despite the efforts to avoid knee replacement, some people will still need to have it. Some people in fact demand the surgery thinking that the knee replacement will help their quality of life. For many people knee replacement is in fact a life changer and can offer many benefits for the patient. However an August 2022 (12) paper from doctors at the University of Auckland, New Zealand wrote the following: “Persistent pain following knee arthroplasty occurs in up to 20% of patients and may require ongoing analgesia, including extended opioid administration.” Who was at rick for extended opioid administration? Predictors of increased opioid use more than six months after surgery included increased body mass index and three or more other joint pain sites.
If you have questions about metabolic syndrome and osteoarthritis joint pain, get help and information from our Caring Medical staff
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This article was updated July 11, 2022