What is the best anti-inflammatory medicine? It may be weight loss: Obesity, inflammation and joint pain
Marion Hauser, MS, RD
Obesity, inflammation, and joint pain
At Caring Medical, we strive to figure out the underlying cause of our patients’ diseases and injuries. We do not just prescribe drugs, including pain medications. We have stood by this philosophy for over 28 years. This applies not only to prescription pain medications, but medications for other conditions, including high blood pressure, cholesterol, diabetes, depression, anxiety, autoimmune diseases, and the like.
Life is not about “just taking a pill” to obtain a solution. It’s about fixing the underlying problem so that it does not return. In this article, I hope to perhaps provide some small motivation that can show you how you can attack two problems at the same time. Your challenges in losing weight and your challenging dependence on anti-inflammatory medications to get you through your day.
What is the best anti-inflammatory? Not a pill or an injection but weight loss
Cortisone and NSAIDs
Corticosteroids are given as injections or oral medications, which may temporarily reduce pain and inflammation. However, this can be problematic when the pain signal is turned off, yet, a person continues to engage in full sports and activities on an injured joint, accelerating joint damage. Additionally, cortisone itself is degenerative to tissue, including cartilage. If you would like to know more about why we do not offer cortisone injections please see our article Alternatives to Cortisone.
Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, inhibit the body’s repair processes. NSAIDs are among the most commonly used drugs in the world for pain, yet have the potential for significant side effects to the liver, stomach, gastrointestinal tract, and heart. Additionally, they have no beneficial effect on cartilage, rather, they accelerate osteoarthritis, the very disease for which they are most often used. Both cortisone injections and NSAIDs inhibit the healing process, making re-injury much more likely in the future. If you would like to know more about why we do not offer NSAIDs please see our article When NSAIDs make the pain worse.
Weight loss is not easy, we understand that. No lectures here.
Losing weight is difficult especially for someone in chronic pain. Over the years we have found that when someone achieves their weight loss goals, it is usually not a diet plan that made the difference for them, it is usually some type of motivation or inspiration that helped these people achieve their weight goals. Perhaps it is a desire to reduce the burden of medicines they are taking every day. Many patients we see have pills for many different disorders. Fort most people the desire and motivation to lose weight was because of a health scare.
If obesity causes chronic pain through inflammation, is losing weight an anti-inflammatory?
Excessive weight causing inflammation and joint pain
In our clinic, we see a wide variety of patients with a wide variety of problems, included are many patients who have issues of weight and obesity. We understand how difficult it can be for people to lose this excess weight, especially when they are in pain and have limited mobility and function.
When someone comes in for a visit, and they have clear weight concerns, we do not lecture these people on the value of losing weight. These people have usually been to numerous doctors and had numerous treatments and every step of the way they were likely told that they NEED to lose weight. The patient was also likely given numerous nutritional guidelines and dietary recommendations that have not been successful.
Obesity makes inflammation and inflammation makes your chronic pain
A 2017 study from The Ohio State University in the medical journal Pain, (1) tries to explain how and why obesity causes chronic pain through inflammation. In this research, the goal was to evaluate if and how a diet of foods with anti-inflammatory properties affected pain and other problems of inflammation in joints.
Here is what they found:
- Results provide support for (good) dietary intake providing benefit in patients with excessive weight or obesity and their levels of pain.
- Overall, higher body fat was associated with self-reports of greater pain, and dietary practices consistent with better health and anti-inflammatory effects were associated with lower self-reported pain.
- Poorer food choices among individuals with higher body fat may contribute to symptoms of pain.
- Overall, dietary intake of foods with greater anti-inflammatory effects appears to be relevant in the relationship of body fat to pain.
- The researchers found it especially interesting that the primary component of dietary intake driving the beneficial effects was the consumption of seafood and plant protein.
- Given the higher content of omega-3 fatty acids in seafood and the documented anti-inflammatory effects of omega-3 fatty acids, this provides further support for the hypothesis that intake of foods with demonstrated anti-inflammatory effects.
- Plant proteins with demonstrated anti-inflammatory effects (eg, nuts and seeds, soy products) accounted for beneficial effects in respondents following a strictly vegetarian diet
The conclusion of the study presented simple data indicating that dietary intake of foods with anti-inflammatory effects helps control body pain in obese individuals.
Obesity is more than stress from weight load – it creates inflammation without wear and tear
Doctors at the University of Calgary writing in the journal Osteoarthritis and Cartilage (2) examined obese laboratory animals and found that not only does obesity cause osteoarthritis because of weight load, but it also causes osteoarthritis in a “non-mechanical” way – in other words by inflammation without wear and tear.
- What is striking about this research is that the laboratory animal had osteoarthritis in one joint caused by wear and tear, yet in the joint on the other side, the knee for example, where wear and tear were not present, the inflammation was just as great. The inflammation attacking the joints of the animals was caused by a high fat/high sugar diet. This is covered further in our article The evidence that your diet is destroying your joints and will send you to a nursing home.
This type of research is helping doctors get away from the excessive weight load model of thinking, although weight load does cause obvious problems, and helps them look at the inflammation problems.
This was confirmed by French researchers in Current Opinion in Rheumatology, (3) who suggest that the rising prevalence of hand osteoarthritis is from obesity and since the hand does not bear weight, this suggests that the role of systemic inflammatory mediators in fat cells cause inflammation signaling to be sent out and attack joints.
Doctors at the University of Padova in Italy writing in the Journal of Cellular Physiology, (4) citing the above research, suggest obese people have an increased risk to develop not only knee but also hand osteoarthritis, the concept that adipose (fat) tissue might be related to osteoarthritis not only through overloading suggests that obesity induces a low grade systemic inflammatory state characterized by the production and secretion of several adipocytokines (inflammatory mediators) that may have a role in osteoarthritis development.
- Furthermore, hypertension, impaired glucose, and lipid metabolism, which are comorbidities associated with obesity, have been shown to alter joint tissue homeostasis (balance).
- And further still, the infrapatellar fat pad (the cushion-like tissue behind the knee cap) has been demonstrated to be a local source of adipocytokines (a local production of inflammation) and potentially contribute to changing the knee joint towards an osteoarthritic diseased environment.
Heightened pain and severity because of diet.
In February 2021 a paper published in the journal Public Library of Science One (5) offers this explanation as to why a group of South Korean women, over the age of 50, had heightened and more severe knee pain. Their reasoning? The South Korean women were eating the “American Diet” of poor food choices and excess. Here is a brief summary from this study:
Poor diet quality may be associated with increased susceptibility to pain, and poor diet quality can induce thermal (heat associated with an inflamed joint) and mechanical hypersensitivity (pain in the joint many times related to a “nerve” pain) as well as persistent pain following inflammatory provocation (something that causes inflammation like eating food that causes you gastrointestinal distress and joint pain).
The standard American diet is regarded as a poor diet and can cause joint pain
The standard American diet, which is regarded as a poor diet, has been shown to cause an elevation of microglial (cells that start the inflammatory response) activation in the spinal cord, and it might contribute to increased pain and systemic inflammation. (Researchers) reported that poor diet quality is associated with an increase in high sensitivity C-reactive protein (hs-CRP), which is an index of low-grade systemic inflammation.
Among older adults with knee pain, elevated circulating levels of hs-CRP and pro-inflammatory cytokines (the substances that send messages throughout the body to “inflame” in response to injury or immune system attack), such as interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α), have been also found in other previous studies, which may result in the prolonged sensitization and hypersensitivity of C fibers transmitting pain signals from the knee joint to the spinal cord.
Overweight women had more energy than normal range weight women because they were trying to lose weight. Normal weight women with knee pain were depressed.
Meanwhile, recent reports have demonstrated that the association between obesity and body pain can be modulated by the consumption of food with anti-inflammatory effects. . . (These researchers) found that low-fat or high-carbohydrate intakes were associated with knee pain, and this result is in keeping with previous evidence to suggest that a ketogenic diet, a high-fat and low-carbohydrate diet, may alleviate pain. In addition, (their) results showed that energy intake was lower in women with knee pain than in women without, despite a high BMI. This could be because obese women with knee pain tried to lose weight for pain relief.
Otherwise, another possible explanation for the lower intake of energy observed in those with knee pain might be attributed to possible depression or decrease in physical activity, caused by pain, that lead to a loss of appetite among individuals with knee pain.”
Ways doctors can help patients with chronic joint pain alleviate their symptoms by losing weight
Doctors at the University of Florida recently published research (6) in which they attempt to outline ways doctors can help patients with chronic joint pain alleviate their symptoms by losing weight. They focused on exercise and the ability to exercise.
Writing in the Journal of Pain Research, the Florida doctors suggest that in obese patients, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity worsens pain by mechanical loading (weight stress on joints), inflammation (creating a destructive inflammatory environment in the joints, see below), and psychological status.
The researchers continue:
“Pain in obesity contributes to the deterioration of physical ability, health-related quality of life, and functional dependence . . . While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%–71.4% depending on the study design and intervention used.”
What regenerative medicine doctors know is that to benefit from exercise, a patient needs to be able to exercise. Tackling the difficult problem of obesity to many doctors and researchers is the start.
It takes a team to help someone lose weight and lose the pain
There is usually not a single motivation or a single answer that will help the patient with significant knee pain lose significant weight. A June 2021 study in the Journal of Pain Research (7) wrote of the weight loss and pain management challenges patients and their doctors face. Here is a summary of this research.
“It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients who experience significant pain relief after interdisciplinary multimodal pain rehabilitation lose weight.” (Explanatory note) Interdisciplinary multimodal pain rehabilitation is exactly what it sounds like. Interdisciplinary (different health specialists) multimodal pain rehabilitation (each contributing their specialty) to solving the patient’s weight and pain problem.
The researchers of this study investigated whether obese patients with chronic pain lost weight after completing Interdisciplinary multimodal pain rehabilitation in specialist pain units (treatments). The association of pain relief and weight change over time was also examined. (In other words, did this help these patients).
Study results and observations:
- The study has 224 obese patients
- Patients were monitored for body weight and height, pain aspects (pain intensity), physical activity, psychological distress, and health-related quality of life.
- A reduction of at least 5% of initial weight indicates clinically significant weight loss. (A 200-pound person losing 10 pounds for example – initially).
- Patients were classified into three groups based on the pain relief levels after Interdisciplinary multimodal pain rehabilitation:
- pain relief of clinical significance (30% or more reduction of pain intensity);
- pain relief without clinical significance (less than 30% reduction of pain intensity);
- and no pain relief.
Here are some interesting results:
- A significant reduction of pain intensity was found after Interdisciplinary multimodal pain rehabilitation.
- A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss.
- Significant improvements were reported regarding physical activity, psychological distress (happier mood), and better quality of life, but weight change was not associated with changes in pain intensity.
The knees in some of these patients, who had achieved weight loss may be beyond weight losses ability to alleviate their knee pain, BUT, the lifestyle change clearly helped these people get on with their life and manage their pain better as indicated by a better quality of life scores.
Obesity may prevent tissue remodeling, healing, and damage repair
In a recent paper, Duke University researchers noted (8) and speculated that obesity may prevent tissue remodeling. Remodeling is the repair process of healing. In recent years much has been made of stem cell therapy as a non-surgical regenerative medicine staple treatment for cell remodeling. In this research, the investigative team looked at the impact of obesity on adult stem cells as stem cells are closely associated with the remodeling and potential repair of bone and cartilage. These doctors hypothesized that obesity would alter the frequency, proliferation, multipotency, and immunophenotype [healing protein expression] of stem cells from a variety of tissues.
Does this mean stem cell injection therapy will not work for obese patients?
It could, the Duke researchers concluded: “These findings contribute to our understanding of mesenchymal tissue remodeling with obesity, as well as the development of autologous stem cell therapies for obese patients.” In other words, while the impact of obesity is not fully understood, obesity certainly makes healing more challenging but not impossible.
When an obese patient comes into our office seeking non-surgical alternatives to joint replacement we MAY suggest:
- Stronger treatment protocols beyond simple dextrose Prolotherapy. This may include growth factors, platelet-rich plasma, stem cells, or a combination of treatments.
- If so we inform the patient they will likely need more treatments than an ‘average weight’ person.
- Nutritional, exercise, and weight loss guidelines will be suggested.
Research: Sexual dysfunction and cardiac risk are man’s best motivations to lose weight
We know many of our patients have been to other health care providers and they have been browbeaten with the continuing cadence that they “need to lose weight.” These patients understand this, it is still difficult for them to do so. Patients frequently tell us that it is not the lack of knowledge that they need to lose weight but rather the lack of willpower or motivation to keep focused on better and healthier eating and obtaining a more active lifestyle.
This asking for motivational help is a key to achieving their treatment goal. But you still have to find that motivation. For men, that goal may be easy, erectile dysfunction. It is said that nothing will get a man to the doctor faster than erectile dysfunction. This is borne out in the research. In a study from Brown University, (9) doctors writing on erectile dysfunction are cardiac events noted: “As a result of an improved understanding about the pathophysiology of erectile dysfunction and improved treatment options, an increasing number of men are presenting for evaluation than several decades ago. In fact, many of these men are visiting their health care professional for the first time with erectile dysfunction as their primary complaint. ”
The obesity, anxiety, stress connection to inflammation and joint pain
Excess weight is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain.
Swedish doctors have published a new study in the journal of BioMed Central Geriatrics (10). The title of their article is the question they ask: Is excess weight a burden for older adults who suffer chronic pain?
It is common for older patients to have obesity and chronic pain. The researchers in this study wanted to understand how pain and obesity reacted to each other and influenced the severity of the patient’s pain symptoms. To do so, they took:
- A group of patients over the age of 65 were obese. Then the patients in this group who were obese were separated into people with chronic pain and people without chronic pain.
- More obese older adults experienced chronic pain (58%) than those who were low-normal weight (39%) or overweight (41%).
- Obese elderly more frequently had pain in extremities and lower back than their peers.
- Being obese was more greatly associated with chronic pain than being overweight
- Obesity was also significantly related to severe pain.
- However, the researchers also found traumatic history (the loss of a spouse or loved one or other similar events), rheumatic diseases, and depression or anxiety diagnosis showed stronger associations with pain aspects than weight status.
The researchers had to conclude that in older adults, excess weight is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain.
How Obesity, mental distress, and poor sleep equally whole body pain in 51-year-old women
When someone does have obesity and chronic pain, it is easy for other factors to start to have a great negative impact on health.
Norwegian researchers writing in the European Pain Journal paint a grim but accurate picture of the effects of obesity on aging patients. (11) In a group of patients who were mostly females average age 51, obesity was linked to mental distress, poor sleep quality, and poor physical fitness. This leads to a condition of WSP – WideSpread musculoskeletal Pain.
- Simply: obesity + mental distress + poor sleep = Pain. To effectively heal, ALL these issues need to be addressed.
The vicious cycle, lack of sleep causes more pain causes obesity
Doctors at the Norwegian University of Science and Technology wrote in the Journal of Sleep Research (12) that chronic musculoskeletal pain increases the risk of insomnia, particularly among those who report several pain sites. The researchers suggest that a healthy active lifestyle (weight loss and exercise) could reduce the risk of insomnia in people with chronic musculoskeletal pain.
If this article has helped you understand the problems of obesity and joint pain and you would like to explore Prolotherapy as a possible remedy for your joint pain, ask for help and information from our specialists
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This article was updated July 6, 2021