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:

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:

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.

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:

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:

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.

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:

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:

Doctors in France cited these same findings in their research on factors affecting joint healing and metabolic syndrome in Current Opinion in Rheumatology: (7)

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.

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).

This study demonstrates a strong association between obesity and a dynamic immune response locally within synovial tissues before cartilage degradation.

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.

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

1 Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Inoue T, Seki T, Ishizuka S. Multivariate analysis of factors related to the absence of musculoskeletal degenerative disease in middle‐aged and older people. Geriatrics & Gerontology International. 2019 Nov 1;19(11):1141-6. [Google Scholar]
2 Akahane M, Maeyashiki A, Tanaka Y, Imamura T. The impact of musculoskeletal diseases on the presence of locomotive syndrome. Modern rheumatology. 2019 Jan 2;29(1):151-6. [Google Scholar]
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9 Askari A, Ehrampoush E, Homayounfar R, Bahramali E, Farjam M. Serum insulin in pathogenesis and treatment of osteoarthritis. Med Hypotheses. 2017 Feb;99:45-46. [Google Scholar]
10 Salis Z, Sainsbury A, I Keen H, Gallego B, Jin X. Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data. International Journal of Obesity. 2022 Jan 11:1-1. [Google Scholar]
11 Cao X, Cui Z, Ding Z, Chen Y, Wu S, Wang X, Huang J. An osteoarthritis subtype characterized by synovial lipid metabolism disorder and fibroblast-like synoviocyte dysfunction. Journal of orthopaedic translation. 2022 Mar 1;33:142-52. [Google Scholar]
12 Kluger MT, Rice DA, Borotkanics R, Lewis GN, Somogyi AA, Barratt DT, Walker M, McNair PJ. Factors associated with persistent opioid use 6–12 months after primary total knee arthroplasty. Anaesthesia. 2022 Jun 27. [Google Scholar]

This article was updated July 11, 2022


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