The connection between knee pain, sugar, and extra pounds.
Knee pain can be a persistent and debilitating issue, interfering with everything from quality sleep to missing out on a hike with friends. Ongoing pain can affect your mood and seriously dampen your overall quality of life.
Many people with knee pain rely on over-the-counter pain medications such as Advil or Tylenol. You may be one of those people, but if you’re here, I’m guessing you’re wondering if there is something more you can do.
I’ll go ahead and cut to the chase here—chronic knee pain is often a symptom of underlying issues, particularly inflammation.
And you can do something about it. You can reduce your knee pain and even prevent it from returning, something I’ve seen time and time again in my practice.
Before we get into long-term solutions for chronic pain, I want to address some of the underlying causes of knee pain. In this blog, I’ll cover the role of body weight in joint pain and how inflammation fuels the fire. And finally, I will address one of the most common factors I see driving the inflammation that is often behind knee pain—excessive sugar.
Let’s explore the connection between knee pain, sugar, and body weight.
Higher body weight is a risk factor for osteoarthritis and knee pain, but the cause behind this is more complex than you might think.
It makes sense on the surface that more weight would put extra force on the joints and contribute to strain and cartilage breakdown. In fact, the risk of knee osteoarthritis may be up to 7 times greater in those with a BMI* greater than 30 (1).
*I don’t usually rely on BMI as a measure of health in my practice because the height-to-weight ratio can often be misleading (for example, a physically fit or petite and curvy woman may have a high BMI simply because of muscle mass or body type and this doesn’t mean she is “unhealthy”). However, most studies use BMI as a clinical marker of healthy weight.
Weight loss is often the first suggestion your healthcare provider may make when knee pain is a top concern. And losing a few pounds will likely take pressure off your knees and reduce the pain. According to the Johns Hopkins Arthritis Center, ten extra pounds increases the force on the knee by 30-60 pounds each time you take a step (2).
But we also know that there is more at play. For example, higher body weight is also linked to pain in non-weight-bearing joints such as the hands (3), and this may be more pronounced in those with visceral fat (4). Visceral fat is the deepest layer of fat that surrounds your organs. This is different than subcutaneous fat, which is the type that you can easily pinch with your fingers.
(It may be harder to notice visceral fat, although waist circumference can be one indicator. The Luxemburg Institute of Health has a handy calculator that you can use to estimate your level of visceral fat.)
Hmmm…why would body weight affect joint pain in the hands?
Researchers aren’t entirely sure about the mechanism behind this, but it is likely due to inflammation. Fat tissue (also known as adipose tissue) is metabolically active. It contains a vast community of endocrine cells, including immune cells that secrete cytokines (chemical messengers) and hormones like leptin and adiponectin.
Many cytokines and hormones secreted by fat tissue (specifically white adipose tissue) are pro-inflammatory. This means that higher amounts of fat may create more inflammation (5).
Now, it's important to note that not all inflammation is harmful. Your body uses inflammation to heal your tissues and maintain homeostasis. Some inflammation is good, but too much can lead to health issues.
Ideally, fat tissue is mostly confined to certain parts of the body, with larger subcutaneous deposits on the thighs, butt, lower stomach, and hip area. This is the subcutaneous tissue I mentioned before. Carrying fat on your body is normal and protective—fat tissue has many roles in health!
However, when fat deposits accumulate throughout the body, especially around the stomach and organs (visceral fat), this is a cause for concern. Excess fat in these areas increases inflammation, metabolic disease (like diabetes and heart disease), and joint pain.
So, how does the knee pain/sugar connection work?
Higher-sugar diets are associated with chronic inflammation and joint pain severity (6) and are linked to rheumatoid arthritis (7). This means that the more added sugar you eat, the more likely your knees are to hurt!
Excess sugar drives inflammation in several ways, including contributing to dysbiosis (imbalance) of good gut bacteria and increasing the formation of advanced glycation end products (AGEs).
AGEs are chemical compounds that form when protein and sugar combine in the bloodstream. AGEs are present in certain foods, especially when cooked at high temperatures (french fries and potato chips, I’m looking at you).
Eating a high-sugar diet creates AGEs in your bloodstream that can accumulate in various parts of your body (8).
Once in your body, AGEs interact with your cells and influence the creation of inflammatory compounds.
AGEs can even accumulate in the joints, contributing to knee pain and musculoskeletal inflammation (9)!
It's wild to think about sugar affecting your body this way, and it may be hard to visualize. But if you have ever cut back on sugar, you have likely felt the beneficial effects reasonably quickly.
I have seen this firsthand in my RESTART participants.
I remember one student in particular who, at the age of 72 required a cane to walk because her knee pain was so severe! Her weight, inflammation and knee pain was decreased during the 3 weeks of our sugar detox, but not resolved. She went on to maintain her low sugar RESTART lifestyle and after a few months was able to ditch the cane, start comfortably cruising around town, and was on her way to building up her walking stamina for a bucket list, site-seeing tour in Europe! When she repeated the RESTART Program a year later I couldn’t believe her progress! She had lost about 70 pounds and was comfortably walking miles around town every day. RESTART literally changed her life.
In addition to creating inflammation that exacerbates knee pain, sugar contributes to extra pounds and is a driving force behind the creation of visceral body fat. For example, adults who regularly drink sugar-sweetened beverages, such as soda and sweetened coffees, have more visceral fat tissue in their stomach area than those who don’t (10).
And remember, extra weight can contribute to more inflammation and worsen knee pain. This creates a vicious cycle between knee pain, sugar, and excess body fat. Cutting back on added sugar is one of the easiest ways to break this cycle, and I help clients do this every day.
If you’re experiencing chronic knee pain, sugar in high amounts is not your friend, and cutting back will help reduce inflammation and pain. In my professional experience, this holds true for various conditions that cause knee pain, such as osteoarthritis and rheumatoid arthritis, knee injury, and pain due to physical inactivity.
More practical solutions for knee pain
Diet is an integral part of the strategy for healing knee pain and preventing it from returning.
Essential foods to focus on include:
Colorful plant foods provide antioxidants that protect your body from inflammation and support tissue healing. They also support a healthy gut, which helps regulate inflammation. High-antioxidant foods include berries, leafy greens, root vegetables, nuts, and seeds.
High-quality protein supports healing and is essential for maintaining muscle mass. Some observational research shows that women with knee pain eat less protein than those without knee pain (11), and exercise combined with protein supplementation can benefit knee pain and osteoarthritis (12, 13).
Healthy fats, especially omega-3 fatty acids, are vital for calming inflammation that causes tender joints (14). Good sources of omega-3 fats include salmon, sardines, walnuts, and flaxseeds.
Some additional Resources:
Check out this great podcast from Nutritional Weight & Wellness called “Do You Have Sugar Aches?” For more digestible info on this topic.
Here is a good article on supplements that are useful for joint inflammation. My knees have benefited from making the nutritional changes listed above and incorporating additional curcumin (turmeric) as a food and supplement.
I also recommend a visit to a physical therapist or personal trainer who specializes in knee pain. In some cases we have muscular imbalances above or below the knee joint causing pain. Pain in our knee can then lead to pain in the joints above and below (the ankle and hip). It’s all connected, but you can improve it!
Ok, friend, I hope this was helpful for you, and you can begin to apply these simple changes to your life. My goal as a Functional Nutritional Therapy Practitioner is to help you feel your best and live life to the fullest, and it's a lot easier to do that when you aren’t bogged down by chronic pain!
Click here to learn more about my RESTART course, a 5-week sugar reset that focuses on whole foods and a supportive community to feel your absolute best.
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