Chronic joint and muscle pain can be debilitating. While there are medications that can reduce the inflammation and allow for continued mobility, these sometimes come with significant side effects, especially is autoimmunity is a root cause.
Over the last two decades I have seen may nutrition related connections to joint pain that are rarely if ever explored in the standard of care. From osteoarthritis to rheumatoid arthritis to idiopathic joint pain, what we put into our bodies or what we neglect to include can have a significant difference in our pain levels and ability to enjoy life. I want to share with you some of the causes for joint pain that you may not have explored, and if you do suffer from chronic joint or muscle pain, I encourage you to implement some of the tips in todays episode to begin making improvements. Lets dive in and see what possibilities there are that might be influencing your pain!
Foods which can exacerbate Inflammation
Nightshades – Nightshades are a family of vegetables that include tomatoes, potatoes, goji berris, ashwaghanda, tobacco, eggplant, tomatillos, groudn cherries (aka cape gooseberries) and all bell and spicy peppers, but not peppercorns. For some, an intolerance to them shows up as joint pain. This is common enough it is one of the top suspects when a client has joint pain.
In my practice I have also seen nuts lead to joint pain, although this is less common.
Eggs, gluten, and dairy are among the top foods people are intolerant to worldwide, and joint pain may be linked to these commonly consumed foods.
It is worth noting in cases of nuts and nightshades that sometime someone is only reactive to one or two of the foods in the family, and not the entire class of foods. The best way to assess whether or not one of these foods is problematic for you is to eliminate all of them for 3-6 weeks to see if pain subsides. While joint pain often takes longer to dissipate than many other symptoms, I have found in my practice that going beyond 6 weeks of elimination is unnecessary. If you find your pain resolves before that time, you can begin introducing foods one at a time for 2-3 days to see if that food triggers pain, followed by a wash-out period for 3 days, or until pain subsides again if you find you are reactive. While most people find the elimination part of such a plan easy, they really struggle with reintroductions without support, because of the emotions around restriction, confusion about how to reintroduce in a successful way, and difficulty in finding a strong enough dose and duration to really test out a food. This is one of the places where an experienced coach can be really, really helpful to walk you through the process of reintroductions and give you real time feedback about the process so that you can customize it to yourself.
Aside from food intolerances, there are some classes of foods and nutrients that can lead to joint pain when we neglect to consume enough of them.
Micronutrients:
Low Vitamin D status has been linked to increased back and joint pain. Studies do support that supplementation of Vitamin D at doses of 4000 IUs reduced pain after 13 weeks. Still higher doses of Vitamin D are shown to reduce pain in those with rheumatoid arthritis and other nutrient deficiencies such as selenium, zinc, magnesium, are associated with rheumatoid arthritis pain. Selenium is a key player in the enzyme glutathione peroxidase, which shields our cells from oxidative damage. It’s got some impressive benefits, including anti-inflammatory, and immune-modulating effects, making it useful in conditions like autoimmune disease, and is noted to be impactful in rheumatoid arthritis (RA). Zinc is another essential mineral, crucial for various biological processes like growth, development, repair, and maintaining cell integrity. It’s vital for immune system balance, and low zinc intake is often seen in RA, multiple sclerosis, and type 1 diabetes (T1D). Lastly, magnesium plays a significant role in inflammatory and immune responses, and low magnesium is one that is often linked to both muscle and joint pain. Of note – various seafoods are among the most potent sources of dietary vitamin D, zinc, and selenium in the diet. I do recommend increased intake of fatty fish, oysters, clams, and other seafood as part of an autoimmune plan so seeing these nutrients linked with reduced joint pain in RA doesn’t come as a surprise.
Low omega-3 intake is also linked to chronic join pain. Osteoarthritis prone guinea pigs have less disease development, with half the disease progression scores of those not fed omega-3 supplemented feed. Additionally, the quality of cartilage in the guinea pigs remained healthier than those not fed omega-3 fatty acids. Mechanistic studies point to the role of omega-3 fats inhibiting inflammation pathways and enzymes, effectively acting as nature’s Celebrex by reducing Cox-2 enzyme expression, among other markers that contribute to inflammation.
A meta-analysis of 17 RCTs showed those taking 2.7 grams of omega-3 fats daily for more than 3 months reported significant reduction in joint pain intensity, morning stiffness, and NSAID use while on omega-3 fatty acids, so it’s not just the family guinea pig that can benefit from fish oil supplementation. Additionally, a systematic review of the impact on omega-3 fats and rheumatoid arthritis indicated that at doses of 3 grams a day or higher, joint swelling and joint pain was reduced, with significance increasing as doses increased.
If you are not consuming high omega-3 fatty fish at least 3 times a week, you may want to consider supplementing with omega-3 fatty acids. Doses of 3 grams a day or more are what I see clinically being impactful, with researching supporting this. With high degrees of inflammation I will often dose higher and then taper to a more modest dose after a few months. That said, omega-3 fatty acids are potent enough that they can interfere with some medications, so don’t play around with dosing without 1) informing your doctor and asking if there are contraindications and 2) speaking with a knowledgable health professional about appropriate dosing in your circumstances.
You may be wondering about plant-based omega-3 supplementation, and whether or not these are equally as effective.
The short answer is no. Substituting flax oil will not have the same impact due to how plant-based omega-3s are structured and the piss-poor conversation rate we humans have in converting them to the desired EPA and DHA form that is responsible for the anti-inflammatory activity.
I was unable to find any research on the impact of algae oil on osteoarthritis, but one small study on women in their 30s showed 3 grams taken the week before an intense weight workout did reduce pain and inflammation following that workout. They also continued supplementation 2 days post-exercise. If you are looking for a more environmentally sustainable option than fish oil, krill oil is shown to be effective in reducing osteoarthritis pain in mild to moderate cases and reduces cartilage damage in osteoarthritic rats, so if you want to use krill instead of fish I think that is probably a fine choice to begin with.
Lack of these foods also sets you up to be in pain:
Low produce intake is another cause of chronic joint pain. I first observed this in clinical practice with individual clients, and then among multiple people in my veggie-focused groups that I hold a couple times a year. This was one of those situations where I saw it, I was like, “WTF, is this real?” and then I went to PubMed to confirm my findings after a group participant reported a chronic knee injury she’d been having began to clear up a couple weeks into a veggie challenge — lo and behold, the research had been sitting there all along!
Upon even modest reflection, it is easy to see how this would be the case. Our vegetables are chock full of all sorts of sexy antioxidants that protect the cells and tissues from damage and inflammation, and what is joint pain but tissue inflammation and subsequent damage? What is a chronic, nagging injury but damaged tissue that doesn’t have what it needs to repair itself?
There are multitudes of studies showing associations between high produce consumption and lack of chronic pain, but many of these are observational, or rely on self-reporting as their foundation. These are not nearly as strong and robust as something like a randomized controlled trial, but they are much easier and less expensive to do. Here the bulk of research shows a very strong signal, with several key components at play.
The research points to multiple components in plants which reduce inflammation and prevent tissue damage. Vitamin C is a well-known and well-researched vitamin that is connected to reduced joint pain, and it is also a key component of cartilage and tendons.
Lutein and zeaxanthin, found in tomatoes, watermelon, and carrots; was associated with a decreased risk of cartilage defects in healthy adults, and those who consume the most fruits, green veggies, and omega-3s from diet had the least likelihood of developing arthritis in the future.
A review of several randomized controlled trials, and therefore higher quality data, showed that interventions which were as broad as a Mediterranean diet or a vegan diet and as specific as including blueberry powder, freeze dried strawberries, broccoli soup, turmeric, olive oil, can reduce joint pain in individuals. These foods are all rich in various polyphenols which demonstrate really kick-ass impacts on cell health, inflammation and chronic disease. Among the polyphenols; flavonoids in a wide variety of green and red and purple and blue fruits and veggies, lignans found in chia, flax and whole grains, proteolytic enzymes (think papaya, pineapple) all contribute to reducing inflammation in the body and promoting a more balanced immune response overall.
So the long and the short of it is that a high produce diet with an abundance of fish oil and olive oil can make massive headway in reducing your chronic pain. If you find you still struggle, you may have an intolerance to a food I have mentioned that is irritating your joints despite your healthy diet.
One more thing….
One last factor that is associated with chronic joint pain that is now showing up in research is breast implants. This association is not robust, nor very strong and the collection of data has not been very precise in some studies, but as a clinician I have seen and heard of various cases over the years so do not feel it can be wholly dismissed. The FDA encourages ultrasound screening to see if there is a leak or other issues with implants after surgery if you experience joint pain, so they recognize that Breast Implant Illness does exist. If you have breast implants and have taken all the steps above with no relief, it is worth having a conversation with a specialist about this connection and whether or not implant removal may be helpful for you.
ACTION STEPS:
Even 6 weeks on a Mediterranean diet has been shown to reduce pain and mornings stiffness in women with rheumatoid arthritis so start here, focusing on those veggies, olive oil and that fish part of the Mediterranean diet as your foundation if you cant stomach the thought of an elimination diet or if your personal history makes that a unreasonable choice, such as a history of disordered eating.
Adding more red and dark blue fruits, as well as vegetables, spices, and complex food like quinoa, amaranth or chia seeds, will boost your intake of many different polyphenols. A daily cup of green tea, and including tasty spices like curcumin, ginger, pepper, or cinnamon in their daily meals can also be impactful over time. An easy way to have fruits and vegetables in a green morning smoothie with spinach, berries, or enzymatic fruits like papaya, mango, and pineapple and even add some turmeric or cinnamon in there to kick it up a notch, as Emeril would say. Smoothies are a good and easy way to eat more vegetables and fruits and get to the minimum 5 a day recommended by nearly all governing bodies.
If you learned something of use today please restack this page to share it on your feed! If you know someone with chronic joint pain who is suffering, sharing this episode to them can change their lives.
have you observed certain foods as exacerbating or alleviating your chronic pain? Was there anything you’ve noted that I have failed to mention? Comment below and share your own experiences!
RESOURCES:
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