The Relationship Between Diet, Osteoarthritis and Pain: UPDATE

Conventional wisdom suggests that osteoarthritis (OA) is a “wear and tear” disease.

It’s a mechanistic view as if your body is more like a car or some other machine than a dynamic biologic organism. Cars, machines fall apart with use and, yes, if you have the right parts, you can fix them, up to a point, but cars/machines have no ability to fix themselves..at least not yet.

Our bodies, however, are not some sort of machine with flesh. Unlike machines, we have a number of mechanisms that self-regulate and repair. We don’t need an expert to fix a scratch or cut nor help for even some sprains and strains. Fractures generally heal and even your liver can take a lot of abuse and heal itself. There’s a limit though. Significant injuries or surgeries often require professional help but most of the time, the things we run into in life are things we can manage.

For our bodies to function optimally and self-regulate we need at least three basic physical things: physical stress/movement, sleep, and adequate nutrition (we need people, have fun, have a purpose too but that’s another day).

Our joints run into trouble when one or more of these things are either lacking, sleep is a major one in this department, or are in excess or imbalance such as too much physical load with inadequate recovery.

OA features a deterioration of the articular surface of a joint – the cartilage that covers the end of the bones. The function of the cartilage is to attenuate the transmission of forces and provide a nearly friction-free surface for easy motion.

In OA, the cartilage becomes softer and is more easily damaged. And, because of the softness, the physical loads are then transferred into other structures such as the underlying bone.

While exposure to repetitive, high loads can damage the joint surface and lead to OA, it’s not a guarantee.

Runners have no increased risk of OA if they have been consistent, recreational runners over their lifetime.^[1] Konradsen, L., et al. (1990). “Long distance running and osteoarthrosis.” Am J Sports Med 18(4): 379-381. And we know that the loads the body receives from running are multiple times body weight.^[2]Nilsson, J. and A. Thorstensson (1989). “Ground reaction forces at different speeds of human walking and running.” Acta Physiol Scand 136(2): 217-227.

Yet, the common theory of how people develop OA is driven by the notion that the accumulation of excessive and abnormal joint forces disrupts the cartilage and wears it down.^[3]Felson DT. Osteoarthritis as a disease of mechanics. Osteoarthritis Cartilage. 2013 Jan;21(1):10-5. doi: 10.1016/j.joca.2012.09.012. Epub 2012 Oct 4. Review. PubMed PMID: 23041436; PubMed Central … Continue reading

Articular cartilage responds to physical stress as other biologic tissues do – remodeling and refortifying itself to withstand the loads.^[4]Roos, E. M. and L. Dahlberg (2005). “Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of … Continue reading This is part of our body’s self-regulation mechanism and it does this by the action of a special cell – a chondrocyte.

A chondrocyte does for cartilage what an osteoblast does for bone. Chondrocytes produce the matrix that keeps the tissue together and are constantly producing and breaking down cartilage.

The problem with OA is that this balance of producing and breaking down cartilage gets out of balance. The breaking down of cartilage begins to exceed production.

Once this cycle starts, it becomes difficult to reverse it partly due to the lack of blood supply to the cartilage tissue. Cartilage has a sluggish metabolism so any changes you try to make take a long time.

But, why do some people who have not had a traumatic event, have not accumulated a lot of loads over their lifetime or done a lot of exercising, develop OA? Is it just the everyday life loads – walking around, moving from place to place, picking up and putting things down – that wears down the cartilage?

Or, perhaps there’s something else in the mix? Something that disrupts the self-regulation mechanism?

Diet, OA and Pain

The cause of OA is more than one thing but something that’s not often discussed is the relationship between diet and osteoarthritis.

I now have first hand experience with this.

I wrote about an injury I sustained in November 2021 the result of which was an autoimmune disorder.

Part of the treatment included changing my diet.

A lot.

More specifically, removing gluten, dairy, legumes, nightshades (bell pepper, tomatoes, zucchini among others) and alcohol.

I also removed “seed oils” – things like vegetable, soybean, canola, safflower, sunflower, and corn oil (for a more in-depth discussion on seed oils read “The Hateful Eight” by Dr. Kate Shanahan). We cook with olive oil and avocado oil now.

The thing about seed oils is these products are in a LOT of foods and for some people can weaken the immune system and create inflammation.

And of course joint pain is often from an inflammatory reaction.

The Skinny on Gluten

Gluten is a protein found in wheat and there’s some evidence that people with sensitivity to gluten can develop joint pain ^[5]Volta U, Bardella MT, Calabrò A, Troncone R, Corazza GR. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med. 2014;12:85. 2) Slot O, … Continue reading

Today’s gluten is the product of multiple hybridizations by plant geneticists to make wheat easier to produce and convert into foods we consume (although I’m not sure I would consider a doughnut food).

Because of the hybridization, modern-day wheat has new proteins and it’s these proteins that seem to cause systemic inflammation and gluten sensitivity. Additionally, gluten has become more difficult to digest at least for some people.

When you consume gluten (and it’s surprising how many foods contain gluten), if you have a sensitivity to it, your body reacts with an inflammatory response in part because of how gluten causes an increase in permeability of the intestinal wall. Undigested fragments and food particles can leak into the bloodstream (and although gluten can cause gut problems, it’s not alone as there are a number of other “foods” people eat that can disrupt the gut environment).  The body sees this as an attack and unleashes anti-inflammatory weapons.

The inflammation can then cause joint pain and also disrupt the absorption of nutrients in the gut but it might also disturb the delicate balance between cartilage production and destruction since all tissues depend on adequate nutrition.

If this is the case, then it might explain why some people develop OA without any history of excessive load. Yes, there is some evidence that OA may have a genetic link but this work is still in the early stages.^[6]Eleni Zengini et al. Genome-wide analyses using UK Biobank data provide insights into the genetic architecture of osteoarthritis. Nature Genetics, 2018 DOI: 10.1038/s41588-018-0079-y

No one knows yet if consuming gluten causes osteoarthritis. There’s no causal relationship between the consumption of gluten and the onset of osteoarthritis. There is enough evidence though to be concerned especially if you’re scratching your head wondering why your joints hurt when your activity level has remained relatively constant. But a correlation – when you remove gluten, your joint pain improves – is not the same thing as causation. The joint pain could stem from systemic inflammation but that doesn’t mean you have arthritis. There is plenty of info on the Web suggesting that gluten causes arthritis yet when you read the articles, in most cases, there’s no data, no science, no references.

Until I see proof, I’ll refrain from proclaiming gluten causes osteoarthritis but it seems that there is some relationship between the two and it’s worth exploring.

But it might cause joint pain or joint related symptoms (just because you have joint pain doesn’t mean you have OA).

What To Do

I’ve written before about the importance of managing body weight with OA. Removing gluten often creates a natural weight loss – the details go beyond the scope of this article but a good resource on the topic is “Wheat Belly” by William Davis – and weight loss can only help your joints.

A relatively easy experiment to run is to remove gluten from your diet for at least a month. Keep track of your symptoms over this time period and try not to change other variables like your activity. Your individual sensitivity to gluten can vary. If you have a positive response to removing gluten, you can try adding it back in small amounts and note the effect. Some people just cannot have any gluten while others can find a balance that works for them.

In my case, I removed much more than gluten (another good resource is “The Plant Paradox” by Stephen Gundry, MD). After a couple of months many of my symptoms had resolved – the bilateral knee aching, Achilles tendon pain and stiffness, pain and stiffness in both hands.

As a fringe benefit, I lost almost 4o lbs. And it’s stayed off now for a little over a year.

If you have unexplained knee joint pain, no history of excessive loads or accumulated loads, and are wondering why this is so, it might be worth your time for a trial run of a gluten-free diet (and removing seed oils is another good idea). Understanding the relationship between diet and osteoarthritis is an important part of combatting symptoms and improving your function.

And you haven’t even added joint strengthening exercise yet.

Thanks for reading.

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Doug Kelsey has been a physical therapist and human movement expert since 1981. He is formerly Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Sciences Center and the author of several books. He has conducted over 250 educational seminars for therapists, trainers, physicians, and the public and has presented lectures at national and international scientific and professional conferences. His professional CV is here.