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

Research in medicine does not stand still. Frequently we update our articles because a wave of new studies appear on a specific subject, such is the case in the relationship between obesity and inflammation. Before we get into the science of inflammation, let’s have a quick review of food choices and inflammation.

Our daily food choices fall into either “pro-inflammatory” or “anti-inflammatory” categories. Researchers have found links between eating a pro-inflammatory (bad inflammation) diet and increased fractures in women, as well as an increase in osteoarthritis in both men and women. As we age, pain and fractures are very real concerns, and smarter dietary decisions can help us stay strong and pain-free!

Salmon, for example, is a well-known source of omega-3 fatty acids. These essential fats are often labeled as “anti-inflammatory,” since they decrease systemic inflammation. The fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can improve functional ability and reduce pain in a myriad of conditions, including osteoarthritis.

Onions and garlic both possess anti-inflammatory agents that help with chronic pain. Onions also have the antioxidant quercetin that aids in inflammation. Since both onions and garlic are the basis of so many recipes, the fact that they are so good for us is a great bonus.

A May 2022 study in the European Journal of Pain (21) suggests garlic has shown promising effects in treating knee osteoarthritis, rheumatoid arthritis and peripheral arterial occlusive disease stage II. The most common garlic products are garlic powder (dried garlic), steam distilled garlic oils, garlic oil macerate and aged garlic extract.

Berries are excellent sources of antioxidants. The popular blueberry contains a strong antioxidant called anthocyanin. Strawberries can help with inflammation in some people because they contain high concentrations of anthocyanins as well. A major anthocyanin in strawberries, pelargonidin-3-O-glucoside (P3G), can help in inflammatory conditions. According to a 2018 edition of Food Chemistryoxidative stress and its components were halted and reduced by P3G.The benefit of strawberries doesn’t stop there. Resveratrol is found in high concentrations in strawberry seeds. Resveratrol has shown anti-inflammatory, cardiovascular-protective properties as well as anti-cancer properties.

What are pro-inflammatory foods?

Sugar is one of the top inflammatory foods to eliminate much as possible. Others include trans and saturated fats, fried foods, processed meat, refined carbohydrates, and artificial sweeteners/additives. Choosing fresh, whole foods instead of pro-inflammatory foods as often as possible has far-reaching effects on our health, including our joints.

An excellent summary to the challenges of pain, inflammation and diet

Let’s start here with a December 2020 paper from the Department of Psychology, University of Alabama at Birmingham published in the journal Pain therapy.(13) The introduction to this paper provides an excellent summary to the challenges of pain, inflammation and diet.

“Chronic pain is often associated with anxiety, depression, and restrictions in mobility and daily activities, substantially reducing quality of life. Analgesics, especially opioids, are one of the primary pharmaceutical treatment methods for chronic pain. However, prescription opioid misuse and abuse has become increasingly prevalent and concerning, prompting the need for research into alternative treatment methods which avoid the side effects of traditional treatments. Chronic pain is, in part, thought to be the result of oxidative stress and inflammation, and clinical research has indicated links between these conditions and diet. Thus, dietary interventions are a particularly promising therapeutic treatment for chronic pain, with numerous studies suggesting that diet has a noticeable effect on pain as far down as the cellular level.”

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.

Research: Doctors do not want to talk weight loss because people understand that they need to lose weight. Where is the disconnect?

Let’s look at a September 2021 paper focused on helping doctors understand their overweight patients. This paper was published in the journal Postgraduate medicine. (15)

“Obesity is a major risk factor for development and worsening of osteoarthritis. Managing obesity with effective weight loss strategies can improve patients’ osteoarthritis symptoms, functionality, and quality of life. However, little is known about the clinical journey of patients with both osteoarthritis and obesity. This study aimed to map the medical journey of patients with osteoarthritis and obesity by characterizing the roles of health care providers, influential factors, and how treatment decisions are made.”

What did the researchers find? (90%) patients have/are currently trying to lose weight.

Let’s state the obvious – people desiring weight loss are not being help. What can be done?

For many people, weight loss comes from within. These people find the right motivational factors and are able to make their way towards their weight goals. There is no magic formula for weight loss. You need to find something that works for you. Some simple tips are:

1. Set realistic goals to lose weight slowly (1 or 2 lbs per week). Losing too much too quickly may result in health problems, as well as cause you to regain quickly after resume eating the way you used to eat. Try to make lifestyle changes in your diet for life – not just to lose weight.

2. Consistency. This applies not only to eating, but to exercising as well. The older we get, the more we realize that we must be consistent with our eating patterns and with our exercise. When we feel like we are gaining weight, it is often because we lost our consistency. Your weight and general health will reflect what you do and eat most of the time.

3. Exercise burns fat quickly and gives you energy. There seem to be many different opinions about whether you need to exercise to lose weight or just change your diet.

4. Work on Muscle building.. Just doing small amounts of weight training and/or CORE training can make a big difference (especially for women). Muscle burns more than fat.

5. Metabolic rate. Raising your metabolic rate will use energy which either burns fat or stops fat being stored. Exercise will raise you metabolic rate. We have also found that spicy/hot foods can also contribute.

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.

Mismanagement of diet. Weight loss can make problems worse in the aging person.

In some people, weight loss would be a recommended strategy to help alleviate joint point related to osteoarthritis. As is pointed out in this article, obesity plays a greater role than just weight load and stress on your joints, the fat you accumulate is creating its own inflammation. Where you have fat, you have inflammatory factors.

Let’s quickly look at a September 2021 paper in the medical journal Experimental gerontology (16). It comes from doctors at the Baylor College of Medicine.

“The number of adults 65 years and older is increasing worldwide and will represent the 20% of the population by 2030. Half of them will suffer from obesity. The decline in muscle mass and strength, known as sarcopenia, is very common among older adults with obesity (sarcopenic obesity). Sarcopenic obesity is strongly associated with frailty, cardiometabolic dysfunction, physical disability, and mortality.

Importantly, diet-induced weight loss is associated with fat, muscle, and bone mass losses, and may further exacerbate age-related sarcopenia and frailty outcomes in older adults.

Successful approaches to induce fat mass loss while preserving lean and bone mass are critical to reduce the aging- and obesity-related physical and metabolic complications and at the same time ameliorate frailty.”

What is “inflammaging”?

“Inflammaging,” is a combination word consisting of “inflammation” and “aging.” Doctors now regularly use this term to describe the harmful aspects of chronic low grade inflammation in aging people. A December 2017 paper  in the medical journal Frontiers in immunology, published by doctors at the University of Miami and University of Chieti-Pescara, helps explain this problem.(17)

Here is what the researchers said:

While this paper focuses on many disorders of aging including type-2 diabetes, rheumatoid arthritis, cognitive impairment, and dementia, where obesity plays a significant role, we will focus on the aspects of obesity and osteoarthritis.

A quick point though, as stated in this research and another study from university research teams in Italy published in Clinical and molecular allergy, (18) the increase of obesity inspired pro-inflammatory cytokines (small proteins that send pro-inflammatory and anti-inflammatory messages through out the body) is associated with dementia, Parkinson’s disease, atherosclerosis, diabetes type 2, sarcopenia (bone loss) and a high risk of morbidity (disease) and mortality (death). Coming up with a treatment for inflammaging is obvious paramount to the patient’s health.

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:

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.

Obese people have an increased risk to develop not only knee but also hand osteoarthritis

The idea that doctors should get away from the excessive weight load model of thinking 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.

In May 2022 doctors wrote in the journal Arthritis & rheumatology (14), that in obese people with hand osteoarthritis, higher BMI is associated with greater pain severity in the hands, feet, and knees/hips. Systemic effects of obesity . . . may play a larger mediating role for pain in the hands than in the lower extremities.

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:

Here are some interesting results:

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:

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.

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.

Obesity accelerates progression of osteoarthritis – Exercise and loss of at least 10% of body weight can effectively lead to improvement in symptoms, pain relief, and physical function.

Study highlights from the University of Miami and University of Chieti-Pescara team:

The last statement warrants a few articles on its own, and we have them. These articles will help you understand how physical activity and weight loss help heal damaged joints even advanced joint degeneration. Please see How stem cells heal degenerative joint disease after years of cortisone and painkillers, and Excessive weight and joint pain – the inflammation connection.

Doctors working with nutrition and metabolism are among those researchers who are bringing attention to osteoarthritis as a whole joint disease and in fact a whole body disease.

This is a title of an 2017 study: (19)“Obesity-associated metabolic syndrome spontaneously induces infiltration of pro-inflammatory macrophage in synovium and promotes osteoarthritis.” Before we go onto to discuss this research these are the keywords that should stick out: spontaneously, pro-inflammatory, promotes osteoarthritis.

This study lead by researchers at the Queensland University of Technology, the University of Southern Queensland, and The Prince Charles Hospital in Australia begins with acknowledging that obesity is an important risk factor for osteoarthritis however how obesity causes osteoarthritis remains largely unknown.

Before you read on you may think that the answer is obvious, excessive weight is causing pressure and load on joints. Studies as we have shown in companion articles on this website, are actually looking at how obesity causes inflammation without weight load being a factor. We are going to pull in that research here later in this article.

Back to the Australian researchers: obesity is creating a toxic inflammatory environment spontaneously

The researchers fed Wistar rats a high-carbohydrate, high-fat diet for 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.

The researchers noted increased synovitis and increased macrophage infiltration (immune cells are now invading the areas causing swelling and edema) into the synovium (the protective joint membrane) and a predominant elevation of pro-inflammatory M1 macrophages (A specific type of immune cell) is occurring.

This study concludes that future therapeutic strategies targeted at the synovial macrophage phenotype (an obesity causing classification of inflammation) may be the key to break the link between obesity and osteoarthritis.

When we write our articles, we like to “connect the dots,” this means looking at multiple studies and finding the common thread. This line of thinking takes us over to the Netherlands who one week earlier published their article “Metabolic dysregulation accelerates injury-induced joint degeneration, driven by local inflammation; an in vivo rat study.” The keywords we will be looking at here are accelerates injury-induced joint degeneration.

The growing evidence for the existence of an obesity causing type of osteoarthritis

In this study from researchers at  the University Medical Center Utrecht, (20) the doctors wrote of the growing evidence for the existence of an obesity-related phenotype of osteoarthritis in which low-grade inflammation and a disturbed metabolic profile play a role. (A phenotype is a classification, what these doctors are trying to show is that osteoarthritis caused by obesity is a special type of osteoarthritis, caused by inflammation, not wear and tear or rheumatoid factors.)

In a Rat model study, the scientists were able to link together a devastating progression of quick and rapid joint degeneration.

If you have cartilage damage from wear and tear – obesity accelerates that damage to osteoarthritis

What else can you say? If you have cartilage damage from wear and tear – obesity accelerates that damage to osteoarthritis and more so and the need for knee replacement. If you have somehow been spared wear and tear damage in your joints, the obesity induced inflammation will damage it on its own. Researchers cannot make a more powerful statement.

Other articles on this obesity, inflammation and joint disease

Here is more research from our other articles:

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

Research citations:

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This article was updated July 14, 2022

 

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