Is There a Link Between Diet and OA Knee Pain?

If you are anything like the average car owner, the last time you got your vehicle back from the repair shop the technician likely shook his or her head and said, "No more cheap motor oil and low-grade gasoline!" We listen to the mechanic's chiding and promise to do better… because we love our cars, and because we need them to get around.

But just how much do we love our bodies… those other important things that help us get around?

Are we using the right kinds of fuel for our bodies, or are we running on the typical American diet that is high in salts, fats, and sugar? It's an especially important question for those of us experiencing chronic joint pain and reduced functioning due to osteoarthritis (OA). Many if not all of us wonder how to relieve OA knee pain. 

For people with OA, loving the body doesn't just mean keeping up with regular doctor's appointments, or treating ourselves to those comfortable shoes we've been yearning for. It also means considering the quality of the fuel we choose to get us from one place to another. And it turns out that the precise kinds of food may matter, even more than we might think.

Yes-No-Maybe: Eating for Inflammation

Strictly speaking, no diet can cure OA. However, medical professionals, including dieticians and nutritionists, say some types of foods might actually improve the symptoms of the disease, while others appear to have the opposite effect by increasing pain and inflammation within the body. In general, they encourage eating a balanced, nutritious diet that includes the following: 

"Yes" Foods

1. Fish— Oily fish with high Omega 3 content, such as salmon, tuna, mackerel, herring, and sardines may be most helpful. A 2016 study found that both low and high doses of fish oil provided improvements in pain and functioning. Omega 3s are fatty acids that help lower levels of C-reactive protein (CRP) and interleukin-6, proteins that cause inflammation within the body.
   
2. Vegetables—Dark, leafy greens like spinach, kale, chard, bok choy, and collard greens contain antioxidants like vitamins A, C and K, which protect cells from free-radicals and deliver a high dose of calcium. Brussels sprouts, cabbage, bok choy and cauliflower contain a substance known as sulforaphane. Research on mice shows sulforaphane blocks the inflammatory process and might slow cartilage damage in osteoarthritis (OA), although this is yet to be proven in humans.
   
3. Healthy fats—A 2017 study that included more than 2,000 patients with OA, found that people who ate the most fat, especially the saturated kind, showed increasing joint damage, whereas those who ate healthy fats like olive oil and avocados had little disease progression.
   
4. Anthocyanins—These naturally occurring compounds are found in many foods, including cherries, blueberries, strawberries, raspberries, and blackberries. Anthocyanins are the pigments that give red, purple, and blue plants their coloring. They serve as antioxidants, fight free radicals, andmay offer anti-inflammatory, as well as other health benefits.
   
5. Vitamin C— has been found to help preserve bone and protect cartilage cells. Vitamin C is easily found in a variety of fruits and vegetables, including citrus, kiwis, kale, strawberries, and more.
   
6. Plants and Fiber—There is evidence that people who ate a whole-food, plant-based diet experienced decreases in OA pain. After just six weeks, they reported more energy and better physical functioning. Another study found that a high-fiber diet may lower the risk for knee osteoarthritis by up to 61%. 
   
7. Nuts, Seeds, and Legumes—Certain nuts and seeds, including walnuts, almonds and pistachios, and flax seeds and chia seeds are rich in magnesium, l-arginine and vitamin E, which may play a role in helping with inflammation. Beans, including black, pinto and kidney varieties also have been found to contain anti-inflammatory and antioxidant compounds. 
   

"No" Foods

Barry Sears, Ph.D., a former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, is a longtime advocate for all things anti-inflammatory. Dr. Sears says that eating sugar, refined carbs, red meat, processed food and corn and soybean oils is "like throwing a match into a vat of gasoline." Among the foods he discourages people from eating when trying to reduce inflammation:

1. Sugar—Whether it's an obvious sugar (a cube) or a sneaky sugar (that delicious flavored latte your barista just prepared), consuming processed sugars can trigger the release of inflammatory cytokines within the body, resulting in increased pain and inflammation. 
   
2. Meat—Because some forms, particularly red meat, are high in saturated fat, they may encourage inflammatory response in people who eat excessive quantities. Whether grilled, fried, broiled or microwaved, meat and processed meat products that are subject to high heats may also encourage the creation of advanced glycation end (AGE) products, which can increase inflammation.
   
3. Omega 6s—Although a certain amount of these fatty acids is necessary in a balanced diet, an excess can set of a cascade of pro-inflammatory chemicals, so people should be mindful of not eating too much of these. Omega 6s are found in oils such as corn, safflower, sunflower, grapeseed, soy, peanut, and vegetable, as well as in mayonnaise and many salad dressings.
   
4. Refined carbohydrates—Products made of white flour, as well as potatoes and rice, also have been found to drive the production of advanced glycation end (AGE) products within the body, leading to increased inflammation.
   

"Maybe" Foods

1. Dairy—As kids, we were all encouraged to drink tall glasses of cold milk every day. But does milk still "do a body good?" One review of 52 clinical studies concluded that dairy generally had anti-inflammatory effects, except in people who were allergic to cow's milk. The most convincing evidence so far centers on yogurt, which researchers at the Harvard T. H. Chan School of Public Health say was associated with decreased inflammation. However, this is yet to be confirmed via rigorous clinical trials. In general, experts recommend an elimination diet to determine whether a person's OA symptoms improve or worsen after eating dairy products.
   
2. Nightshade Vegetables—Another whole category of vegetables from the "nightshade" family may also be getting mixed reviews, at least when it comes to causing inflammation. Nightshade foods, which include white potatoes, eggplant, tomatoes, and some peppers, contain solanine, a chemical that some people believe may aggravate arthritis-related pain or inflammation. However, no research has ever concluded that solanine is the contributing factor to              inflammation.
   
3. Supplements—Both Turmeric, formally known as Curcuma longa, and Green Tea have been evaluated to determine whether they might be beneficial for helping with OA symptoms. Initial results have been somewhat promising: a2016 study found that patients with knee OA who took Curcuma longa experienced clinical improvements in their symptoms. Green Tea also was beneficial in reducing inflammation and joint damage, although the study was conducted on people with rheumatoid arthritis rather than OA, which is a different condition. 
   

Adding Exercise to the Mix

Another benefit of eating more of the so-called "Yes" foods could be weight loss, which is also typically recommended for people exploring how to relieve OA knee pain. That's because carrying extra weight makes physical activity harder on the joints, and unintentionally creates added stress on the knees. 

Unfortunately, many people with knee OA find physical activity painful or difficult due to their condition. The result can be a vicious cycle: it hurts to be physically active, so they become less active, resulting in increased weight gain, leading to more stress on the knees. It becomes even more painful to move around, leading to even less activity and more weight gain... and the cycle continues.

To avoid this dreaded cycle, your doctor may recommend the use of assistive devices including off-loader braces, which can assist with stability and function in people with knee OA. One popular off-loader brace is the Unloader One® from Össur, which was designed to reduce pain and improve functioning by shifting weight away from the affected portion of the knee. In clinical trials, 25% of people with knee OA who wore the Unloader One reported a reduction in their overall pain medication use, and an astounding 35% reported a reduction in their prescription anti-inflammatory medication use. 

Your Journey Starts Today

As a whole, medical processionals usually recommend a combination of better food choices and regular exercise to help people reduce their body mass and maintain a healthier weight overall. 

The good news? A massive transformation in weight and physical fitness is not required to reap the benefits of improved OA symptoms. Dropping as few as 10 pounds can be the equivalent of losing 30 pounds, in terms of reduced pressure on the knees.

If you are among the millions of people struggling with knee OA ready to start loving your body again, ask your doctor whether a specific eating plan and an off-loader knee brace might help accelerate your journey toward healthier and happier adventures.