Can strawberries help with joint pain?

Marion Hauser, MS, RD

When people come into our clinics with significant joint pain, they will often ask our clinicians about nutrition. Nutrition, of course, is a very important element in healing. The right food can stimulate healing, the wrong food can cause inflammatory reactions and hinder healing. A realistic expectation one may have with food choice change is that you will probably look a little better, feel a little better, have a little more energy, and your joints will hurt less. To what degree depends on how aggressive you are with a change of diet and healing. What type of foods can help? Some researchers think strawberries for one.

Let’s look at some of the new research surrounding strawberries and its ability to help to alleviate joint pain.

Are strawberries a good anti-inflammatory?

Doctors at the University of Nevada at Las Vegas published research (December 2018) in the journal Food & Function (1) 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.

What they found was strawberries lowered TNF-α, and lipid peroxidation byproducts (toxic fatty acid production and inflammation) in obese adults with knee osteoarthritis.

• Tumor-Necrosis factor (TNF‑α) is cell signaling protein (cytokine), which communicates the commands to create inflammation in arthritis joint swelling. The medical thinking is if you can block TNF and other inflammatory factor production or at least inhibit it, joint swelling will be reduced and hopefully, the amount of articular cartilage breakdown resulting from a toxic, over inflamed joint environment will be slowed. Many studies have identified elevated TNF-α in synovial fluid, synovial membrane, subchondral bone and cartilage of osteoarthritis patients. TNF-α is the stuff of joint erosion.

An August 2017 study from researchers at multiple universities led by doctors at Oklahoma State University and the University of Oklahoma Health Sciences Center appearing in the medical journal Nutrients also examined the role of strawberries in improving pain and inflammation in obese adults with knee osteoarthritis.(2) The learning points and study highlights are provided below:

• The Oklahoma State University lead study tested earlier research suggesting dietary polyphenols (micronutrients) and other bioactive compounds found in berries (including strawberries), curcumin, and tea have shown effects in relieving pain and reducing inflammation in osteoarthritis.

In a randomized, double-blind cross-over trial, 17 adults with radiographic evidence of knee osteoarthritis, whose body mass index scaled in the obese range, with an average age of 57 years old,  were randomized into two groups:

• Group one drank a reconstituted freeze-dried strawberry beverage (50 g/day)
• Group two drank a control beverage daily
• Each group drank the beverages for 12 weeks, separated by a 2-week washout phase (total duration, 26 weeks).

The researchers then took blood draws and assessments of pain and quality of life indicators using tradition pain and quality of life scoring system questionnaires. The questionnaires were completed at baseline and at weeks 12, 14, and 26 of the study.

• Among the serum biomarkers of inflammation and cartilage degradation, (inflammatory agents) interleukin (IL)-6, IL-1β, and matrix metalloproteinase (MMP)-3 were significantly decreased after strawberry vs. control treatment.
• Strawberry supplementation also significantly reduced constant, intermittent, and total pain as evaluated by the questionnaires.

The researchers concluded their study by saying:

• Dietary strawberries may have significant analgesic and anti-inflammatory effects in obese adults with established knee osteoarthritis.

Strawberries and wine share a common ingredient in reducing chronic inflammation

An international team of researchers writing in the May 2018 edition of Food chemistry focused on the strawberry’s high concentration of anthocyanins. Anthocyanins give strawberries their color as pigment but they also act to reduce chronic inflammation in the body. A particular anthocyanin, Pelargonidin-3-O-glucoside (P3G) was cited in this research. The study revealed that the P3G in strawberries have important anti-inflammatory proprieties that can act as an adjuvant (secondary) in the treatment of inflammatory conditions. (3) In other words, eat more strawberries to combat your inflammation if your doctor and diet allow.

P3G is also found in red wine. It comes from the pigment in the grapes.  I cover the red wine / resveratrol – Mediterranean diet connections in these articles:

• Resveratrol and osteoarthritis
• The Mediterranean diet and osteoarthritis

The hard science of the amazing healing potential of strawberries

Strawberries are serious science. Another 2017 study in the Annals of the New York Academy of Sciences comes from an international team of researchers in Italy, Mexico, and Spain. Here are their findings:

• The consumption of strawberries has been related to the maintenance of well-being and the prevention of several chronic diseases, owing to the high contents of antioxidants and phytochemicals (plant chemicals) present in the fruit.
• Strawberry phenolics (chemical compounds) are able to exert anti-inflammatory, anticarcinogenic (fights cancer), antiproliferative (stop cancer cells from spreading and multiplying), and antiatherosclerotic (beneficial effects in helping to prevent heart disease and stroke) activities.(4)

Strawberries as super anti-inflammatory, anti-oxidant, even antibiotic

In the journal Food and Chemical Toxicology, (5) the same 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 is the involvement of oxidative stress, related to ROS production.
• Comment: Simply Reactive oxygen species (ROS) is a chemical reaction that leads to oxidant damage. To prevent oxidant damage you take anti-oxidants. As the researchers point out “Dietary antioxidants from plant foods represent an efficient strategy to counteract this condition.”

In this stud,y the researchers took E. Coli LPS (E. Coli is a bacterial toxin, LPS is the Lipopolysaccharides, the outer protective layer of the bacteria that helps defend the bacteria againt anti-bacterial agents), and pretreated the toxins with strawberry extract before introducing them to healthy cells.

Typically the E.Coli LPS would be expected to cause bacterial infection, significant enough that antibiotics would need to be introduced to reverse the infection.

The researchers found that strawberry extracts  pre-treatment on the cells exposed to the E. Coli  counteracted LPS-induced oxidative stress reducing the amount of ROS and nitrite production, stimulating endogenous antioxidant enzyme activities and enhancing protection against lipid, protein and DNA damage.

What does all this mean? The oxidative stress and its components were halted by the strawberry’s anti-oxidant effect and, in fact, was reversed.

The researchers concluded: The results obtained in this work highlight the health benefit of strawberries against inflammation and oxidative stress.

By this time you should have an awareness that strawberries maybe good for you. Here is another argument and it is from the same researchers as the previous two cited studies:

In a third journal Critical Reviews in Food Science and Nutrition, (6) these researchers wrote:

“Current evidence indicates that the consumption of strawberries, a natural source of a wide range of nutritive and bioactive compounds, is associated with the prevention and improvement of chronic-degenerative diseases. Studies involving cells and animals provide evidence on the anti-inflammatory, anticarcinogenic and antiproliferative activity of the strawberry.

• Epidemiological and clinical studies demonstrate that its acute consumption:
  • increases plasma antioxidant capacity,
  • improves circulating inflammatory markers and ameliorates postprandial glycemic response (This means strawberries help regulate your glycemic respoins after your meal).
  • Strawberry intake reduces chronic inflammation and improves plasma lipid profile, supporting cardiovascular health, especially in individuals with increased risk for metabolic syndrome.”

Strawberries do a lot of good things but they are not the single answer to obesity, chronic inflammation and joint pain

We often tell patients who come in for our comprehensive Prolotherapy treatment program to regenerate the damaged tissue of their painful joints, that years of degenerative damage cannot be reversed by a single “magic bullet,” treatment. Regeneration and restoration of advanced degenerative joint disease needs to have an aggressive and realistic program if they wish to avoid joint replacement.

Strawberries, while a great super food for many, is not a “magic bullet,” food. Where it can help is by planting seed (no pun intended) to help you turn a more positive page in your health care by creating awareness.

• Replace sugary desert with strawberries after meals, you just read about the research that says strawberries help you regulate glycemic response.
• Drink natural strawberry beverages when you can
• Natural, no-sugar added strawberry yogurt can go a long way in helping rebuild your immune and inflammatory defense systems.

Better health, losing weight, it all requires desire and motivation and more importantly results. Small changes, such as strawberries as dessert, when added to other changes to your diet, add up.

If you have questions about chronic pain, you can get help from our Caring Medical staff.

1 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]
2 Schell J, Scofield RH, Barrett JR, Kurien BT, Betts N, Lyons TJ, Zhao YD, Basu A. Strawberries Improve Pain and Inflammation in Obese Adults with Radiographic Evidence of Knee Osteoarthritis. Nutrients. 2017 Aug 28;9(9):949. [Google Scholar]
3 Duarte LJ, Chaves VC, dos Santos Nascimento MV, Calvete E, Li M, Ciraolo E, Ghigo A, Hirsch E, Simões CM, Reginatto FH, Dalmarco EM. Molecular mechanism of action of Pelargonidin-3-O-glucoside, the main anthocyanin responsible for the anti-inflammatory effect of strawberry fruits. Food chemistry. 2018 May 1;247:56-65. [Google Scholar]
4 Giampieri F, Forbes‐Hernandez TY, Gasparrini M, Afrin S, Cianciosi D, Reboredo‐Rodriguez P, Varela‐Lopez A, Quiles JL, Mezzetti B, Battino M. The healthy effects of strawberry bioactive compounds on molecular pathways related to chronic diseases. Annals of the New York Academy of Sciences. 2017 Jun 15.  [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 Forbes-Hernandez TY, Gasparrini M, Afrin S, Bompadre S, Mezzetti B, Quiles JL, Giampieri F, Battino M. The healthy effects of strawberry polyphenols: which strategy behind antioxidant capacity?. Critical reviews in food science and nutrition. 2016 Jul 29;56(sup1):S46-59. [Google Scholar]

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