Does Obesity Cause Arthritis?

Obesity is defined by a marked accumulation of excess fat. Generally, those suffering from obesity are at higher risk for developing potentially life-threatening complications and chronic diseases. Recent statistics from the U.S. Centers for Disease Control and Prevention (CDC) indicate more than 630,000 people were diagnosed with obesity related-cancer in the U.S. alone. 1

Although the terms overweight and obese are often used interchangeably, they do not have the same meaning. The body mass index (BMI) classification lists overweight as having a BMI between 25 and 29.9, and obesity with a BMI greater than 30.

Nearly 40 percent of adults in the U.S. are obese, not just overweight. 2 These rising numbers are alarming as the condition is associated with an increased risk of cardiovascular disease, Type 2 diabetes and cancer.

An increased load on your joints may also have a detrimental effect on your knees, hips and hands. These are areas most affected by osteoarthritis (OA) and used repeatedly in performing a task or playing sports.

Obesity, inactivity, increasing age, muscle weakness and poor posture are all risk factors associated with the development of OA. Recent research demonstrates the inflammation and pain associated with OA may also be related to poor gut health. 3

Healing Your Gut May Reduce Joint Damage

Arthritis and joint pain is common in individuals who are overweight or obese. Researchers now find bodywide inflammation driven by your gut microbiome maybe a root cause for the pain associated with OA. 4 Fundamentally, this may be caused by an unbalanced diet, which subsequently imbalances your gut microbiome.

The connection between your gut and obesity-associated OA was examined by researchers from the University of Rochester Medical Center using an animal model. At 5 weeks of age, half the mice were given access to a low-fat diet and the other half to a high-fat diet. Those on the high-fat diet gained more weight and became obese.

On a side note, I want to stress that diets high in healthy fats are not associated with weight gain provided they’re low in net carbohydrates. The theory that low-fat diets promote weight loss or less weight gain has been soundly disproven, as discussed in numerous previous articles, such as "Fat Versus Carbs — Higher Amounts of Dietary Fat Actually Improve Your Metabolic Health."

Research has also demonstrated that diets high in healthy fats, i.e., a ketogenic diet, actually improves the gut microbiome. On the other hand, research has confirmed that obese individuals have greater amounts of harmful gut bacteria than lean individuals, and this is precisely what they found in this study as well.

The researchers were able to alter the microbiome of the obese mice using oligofructose, a prebiotic supplement, which subsequently reduced the inflammation and completely reversed the OA symptoms.

The prebiotic made the gut microbiome and joints of the obese mice indistinguishable from the lean mice, leading the researchers to conclude prebiotics may have a place in the treatment of OA in obese individuals. They explained their findings, saying: 5

"Here, we report that — compared with the lean murine gut — obesity is associated with loss of beneficial Bifidobacteria, while key proinflammatory species gain in abundance. A downstream systemic inflammatory signature culminates with macrophage migration to the synovium and accelerated knee OA.

Oligofructose supplementation restores the lean gut microbiome in obese mice, in part, by supporting key commensal microflora, particularly Bifidobacterium pseudolongum. This is associated with reduced inflammation in the colon, circulation and knee and protection from OA."

Bifidobacteria Lacking in Gut of Obese Mice

The researchers were surprised to find the effects of obesity on gut bacteria, inflammation and OA were prevented when the high-fat diet was supplemented with oligofructose. Colonies of Bifidobacteria grew and crowded out proinflammatory bacteria. In turn, this decreased systemic inflammation and slowed cartilage breakdown. 6

However, while oligofructose reduced insulin resistance in the obese mice, it did not change their body weight. The joints continued to bear the same load, but appeared healthier and without as much degeneration. The researchers believe this supports the hypothesis that inflammation, not biomechanical forces, trigger OA and joint degeneration.

The researchers are now collaborating with those at the Military and Veteran Microbiome: Consortium for Research and Education at the U.S. Department of Veterans Affairs to evaluate veterans who have obesity-related OA to further identify connections between gut microbiome and joint health. 7

What Is Oligofructose?

Researchers used oligofructose as the prebiotic to impact the gut microbiome of the obese mice. Oligofructose is a subgroup of inulin, a soluble fiber from plant material made of fructose molecules linked together in such a way they can’t be digested. 8

Prebiotics are the food required by many of the microorganisms living in your gut. They support digestive health by nourishing beneficial bacteria, which in turn convert inulin and oligofructose into short-chain fatty acids that nourish your colon cells and provide a variety of other health benefits. 9

Neither oligofructose nor inulin are digested in the upper gastrointestinal tract and have very little caloric value. However, both stimulate the growth of intestinal Bifidobacteria, a key beneficial bacterial player in your microbiome. 10 Natural sources of inulin can be found in asparagus, chicory root, garlic, jicama and onions.

Oligofructose is made by removing a longer molecule from inulin and is also known as fructooligosaccharide, an insoluble fiber. While inulin is a relatively flavorless fiber, oligofructose is slightly sweet. The product is 30 percent to 50 percent as sweet as sucrose. 11

While used as a fiber supplement, its best known nutritional effect is the action to stimulate Bifidobacteria growth in the intestines. Human studies have demonstrated dramatic positive shifts in the composition of microflora at supplemental doses of between 5 and 20 grams of inulin or oligofructose per day for 15 days. 12

Osteoarthritis Unlikely Due to Wear and Tear

In a study 13 , 14 evaluating the remains of over 2,500 people spanning more than 6,000 years, researchers analyzed large joints at the hip and knees for OA-related changes. This collected data was then combined with information from other research teams, covering prehistoric times, early industrial times and the modern postindustrial era.

According to senior study author Daniel Lieberman, Ph.D., a paleontologist and professor of biological sciences at Harvard University, "Using careful statistical methods, we are able to say that if you were born after World War II you have approximately twice the likelihood of getting knee OA at a given age or BMI than if you were born earlier." 15

The researchers were not able to account for this rise based on an increase in life expectancy or the meteoric rise in obesity. 16 Even after controlling for age and BMI, they found a significant increase in the number who suffered from OA.

They evaluated remains from individuals over the age of 50, analyzing over 1,500 who died between 1905 and 1940, and an additional 819 who died between 1976 and 2015.

OA in the knee was 2.5 times more common if you were born in the post-industrial age than if you were born in the late 1800s. They also found the rate of having OA in both knees in the postindustrial era was 1.4 times higher than in the preindustrial era. 17

The researchers were only able to theorize about the lifestyle differences that may have created such a variability in their results. Lieberman speculates that one of the primary factors may be inactivity. Based on the results of his team’s analysis, he posits: 18

"The most important message here is that we shouldn't consider arthritis a wear-and-tear disease of age. Arthritis is a disease that becomes more common as you age, but it's not caused by 'wear and tear'; if anything, it might be caused by the absence of physical activity."

Lack of Activity Affects Joint Strength and Gut Health

The increase in joint degeneration in sedentary individuals may be triggered by weaker leg muscles and cartilage, causing the joint to break down more quickly than expected. Lieberman now believes OA may be added to the list of health conditions for which you're at greater risk when you spend hours sitting.

In previous animal and human experiments, researchers have also found that physical activity, independent of diet, alters the composition of your gut microbiome. 19 The results demonstrated exercise was associated with an increase in the production of short-chain fatty acids that are beneficial for colon health.

In one animal study, researchers were surprised to find mice that exercised experienced a reduction in inflammation and an increase in the regenerative molecules when a chemical that triggers inflammation of the colon was injected. 20

Based on these findings, they concluded that exercise-induced modifications in the gut microbiome could mediate interactions with potentially beneficial outcomes. In other words, inactivity may trigger OA both because muscles and tendons weaken and don't support the large joints, and as inactivity does not support a strong gut microbiome and thus increases the inflammatory response.

Balancing Omega Fats May Reduce Symptoms

Another factor important in the development of damaged cartilage is a deficiency of omega-3 fats. Animal models using arthritis-prone guinea pigs have demonstrated diets high in omega-3 not only help prevent the condition, but may also reduce the symptoms in those already affected. 21

In other human experiments, there was a reduction in inflammation and symptoms when animal-based omega-3 supplement krill oil was administered. 22 Both animal and plants may contain omega-3 fats, but only animal-based sources provide the omega-3 fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are crucial components of all cells in your body.

As general guidance, you only need around 1 to 2 grams of omega-6 linoleic acid per day, ideally from plant seeds and tree nuts, whereas optimal levels of marine omega-3 fats are around 3 to 4 grams per day.

However, a standard Western diet often provides far more omega-6 fats than omega-3s. The easiest way to balance these two fats is to limit processed foods and add more foods rich in animal-based omega-3 such as anchovies, sardines, herring and wild caught Alaskan salmon. I also recommend getting an omega-3 index test on an annual basis to ensure you're not deficient. For optimal health, your index should be over 8 percent.

Benefits of a Strong Gut Microbiome

Balancing your gut microbiome is important to your mental and physical health. Your microbiome profile is impacted by the foods you eat, your environment and exercise. Other factors that change your gut health include stress, exposure to antibiotics and other drugs and alcohol consumption. 23 Aging is the only factor impacting your gut over which you have no control.

Your gut health can impact everything from your energy level and cognitive function to muscle strength and immunity. 24 A healthy gut microbiome can even impact the way you age. While an overabundance of some bacteria have been linked to disease, others appear to actively be involved in preventing disease states. 25

Your gut microbiome has an influence on reducing inflammation and may be an underlying factor in the initiation and progression of some cancers. 26 Your gut bacteria may also help improve the effectiveness of treatment for cancer by activating your immune system and allowing it to function more efficiently.

As mentioned earlier, research has also linked certain gut bacteria to an increased risk of obesity. By eradicating four species of bacteria in lab animals, researchers were able to trigger metabolic changes that led to obesity. 27

The foods known to produce metabolic dysfunction and insulin resistance, such as processed foods, fructose, sugar and artificial sweeteners, also decimate beneficial gut bacteria and may be the mechanism by which these foods promote weight gain. Exposure to chemicals found in foods may also alter gut microbiome and contribute to the development of metabolic dysfunction and weight gain. 28

Seek Out Natural Pain Relief

As the featured study demonstrates, your gut microbiome plays a significant role in the inflammatory process in your body, contributing to pain and discomfort. Taking care of your gut through appropriate dietary measures to reduce inflammation and support your microbiome helps provide natural pain relief.

Consider the strategies discussed in my previous article, "How to Develop a New Gut for the New Year." It is possible to manage OA with natural supplements and achieving a healthy gut before turning to pharmaceutical choices that may do far more harm than good in the long run. Aside from addressing your gut health — which is a more long-term strategy — the following can also help control the pain associated with OA:

Astaxanthin — One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required and one may need 8 milligrams (mg) or more per day to achieve this benefit.

Arnica — This popular homeopathic remedy is used for pain management. It's available orally and topically, but there are important precautions to consider before using it, which you'll find discussed in my previous article, "Arnica: This Powerful Herb Promotes Various Kinds of Healing."

Boswellia — Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties. The herb has been prized for thousands of years and has achieved good results in studies. 29 , 30 , 31

Bromelain — This enzyme is found in pineapples and is a natural anti-inflammatory that may be taken as a supplement, but is also found in enough quantity in pineapples that eating the fresh fruit may also be helpful. 32 , 33 It is available as an oral supplement or as a cream.

Cayenne cream — Also called capsaicin, this cream is derived from dried hot peppers. It alleviates pain by reducing your supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.

Curcumin — Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added only 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. 34

In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.

Diet — The foods you eat are primary keys in the reduction of inflammation that triggers pain and disease. Diet can either prevent or trigger inflammation so, while adding some foods to your daily diet, you’ll want to remove others.

Processed foods often contain soy, sugar, high fructose corn syrup and trans fats that trigger inflammation. Foods cooked at high temperatures, especially with vegetable oil, increase inflammation, as do sugar, grains and lectin-rich foods. I strongly suggest avoiding these foods to reduce inflammation.

Emotional Freedom Techniques (EFT) — EFT is a noninvasive therapeutic tool that may help reduce the toll that pain takes on your emotional health. As stress also increases inflammation and your perception of pain, EFT may help you to manage your pain without pharmaceutical intervention throughout the day.

Ginger — This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.