Research tells us some individuals are genetically predisposed to develop type II diabetes.[1-4] .This does not mean that they will but that prevention is an important factor in preventing the cascade that leads this metabolic disorder. As individuals age the body is less effective at metabolizing sugars, in addition we become less physically active. The unfortunate thing is that sugar and fat release brain chemicals that make us feel better short term so the worse we feel or the more stressed we are the more we want food that we would be better off without.
One type of sugar, Glucose, is critical to brain functioning and we need it to live and think .When we eat sugar or starches in our diet, these are broken down to glucose. This glucose has to get into cells to be used effectively it acts like a started in a car to initiate energy production. A hormone called insulin is the key that unlocks the door for the glucose to enter all of your cells and be used as energy. Some people produce too much insulin in response to sugars in the diet. This has been tagged Metabolic Syndrome.[5-9] Over time, these massive amounts of secreted insulin cause the cells to become less sensitive to insulin and we can develop insulin resistance.
Cortisol is also released during stressful times and binds with another neuro-chemical to increase cravings for sweet and fatty foods. Stress and pain can disrupt glucose levels even though individuals often have normal or near normal fasting glucose levels, so they are rarely diagnosed with anything at this point. These people mostly become overweight in middle age, triglycerides and blood lipids levels rise and often high blood pressure ensues. They are tired most of the time, as their blood sugar levels drop substantially after a high glycemic meal (lots of carbs and/or sugar).
What does all of this have to do with pain? Its all about the inflammation. In last 5 years, hundreds s of studies have been completed finding strong links between heart disease and inflammation. One measure of total body levels of inflammation is C-reactive protein or CRP. Patients with the Metabolic Syndrome or diabetics in training have elevated CRP levels.[8, 10-13] While not much study has been focused on how diet can impact osteoarthritis, elevated inflammatory markers have been found in several studies of patients with hip, knee, and erosive hand osteoarthritis.[14-17] It would seem logical then that patients who have early insulin resistance may be able to control both onset of diabetes and inflammation by dietary changes. In other words you have the power to stop the negative cascade no matter what your phenotype.
Many individuals on the South Beach, the Zone or even the Pritikin diet report feeling less pain and increased energy. Most of us do not pay attention to what we eat. I remember listening in amazement as a doctor berated the AMA about heart healthy guidelines and low fat diets. The anguish was evident as the individual felt they had obeyed the rules and the AMA was fraudulent but in actuality this person like most others had no idea what they actually consumed on a daily basis! None of us is immune…a researcher colleague found out the little pastry he had with coffee was 600 calories and loaded with sugar and fat. It was so few bites he had dismissed it as inconsequential until his ‘diet’ plan proved useless.
Some guidelines below were posted on the former Spinal Injury Foundation website and amended to include more recent research:
1. Avoid white flour. This also means that you significantly limit bread intake to small amounts of true whole grain bread or some of the low carb breads on the market. This is as little as 2-4 slices of bread (or the equivalent) per day. This means no cakes, pastries, or other concoctions made with white flour. Your intake of any of these types of sweets (even if made with whole wheat flour) should be significantly limited.
2.Avoid all candy.
3.The best sweetener to use is natural honey (not processed big company brands that add sugar, but old fashioned small farm honey from real bees). Several studies have shown that small amount of natural honey have a stabilizing effect on blood sugar and also contains anti-inflammatory properties.[18, 19] Depending on how you feel about artificial sweeteners, you can also use small amounts of Equal, Stevia or Splenda (but these can also elevate blood sugar and in susceptible individuals can increase cravings).
4. Caffeine will drop your blood sugar by triggering insulin release, avoid this as much as possible.. This also means that teas and diet colas are also off limits. Green teas seem to be a little easier on blood sugar levels, in moderation. In order to accomplish this part of the diet in our busy world, you have to take care of yourself and rest when you are tired. We've gotten into the habit of tanking up on caffeine when we are tired and not resting, this is bad for your pain, blood sugar, and your health.
5. Avoid potatoes and other very high carbohydrate fruits and vegetables (such as carrots, peas, yams bananas), enjoy lots of all other kinds of fruits and vegetables.
6. Pasta made with semolina, rice noodles and white rice are best to avoid.
7. Limited amounts of fat and olive oil are helpful to stabilize blood sugar, however the Dana Foundation has found that fat sets off cravings (like we needed scientists to tell us this!) Our hormones can betray us. This link is an excellent article and shows clearly why most diets don't work long-term. The largest funded dietary study (WHI or Women's Health Initiative) failed to show any benefits to avoiding saturated fats but these women were not carefully watched and there is no way to tell if they were able to stick to the guidelines. It is best not to avoid natural fats but to use them in moderation.
8. Years ago cake or cookies went bad after a week. In my house they are lucky to last a full day! In the 1950s the food industry fixed that by superheating the oils (Trans fats). It extended the shelf life of foods so that you could keep crackers on the shelves for years without them going bad. However, it also introduced a completely foreign substance into the food supply. For general health, avoid trans fats like the plague! These are hydrogenated or partially hydrogenated oils. They are found in most foods that have a substantial shelf life, so read the labels! Artificial whipped toppings and coffee creamers are loaded with these and other harmful chemicals. While this may not have much to do with pain, these types of fats are a substantial heart health risk among just about all studies. To get an idea of how to avoid these fats, go into your cabinets and spend 10 minutes reading labels, you will be surprised at how these fats are in almost everything.
9. If you feel tired after a meal or are ravenously hungry before a meal or when you wake up, you have exceeded your glycemic load. This means that you ate more starchy or sugary carbs than your body can handle. Avoid these foods and/or cut back severely on them and increase your protein and fresh fruit and vegetable intake. It is best to limit fruit juices though as these are high in sugar and can raise insulin levels.True hunger is a deep gnawing realization that you should probably eat. An insulin overload from eating the wrong foods is the realization that you will eat anything as long as you get it right now! You should study yourself after meals and in the mornings to learn the difference between these two sensations.
10. Like everything you've heard, exercise will help you control weight and will also help you control blood sugar. How do you exercise when you hurt all the time? Warm water pool therapy, walking, stretching, gentle yoga and even pilates is a great start for many people.
For more information google under glycemic index. Many great articles will come up. Eating this way will help you lose weight, feel better with less fatigue, and may just help your joint pain!
Joint pain can sometimes be helped by taking glycosamine, vitamin C, fish oil, and vitamin D and eat foods rich in magnesium. 20 minutes of sunshine daily can help lower pain levels for some people.
1. Fernandez-Real, J.M., Genetic predispositions to low-grade inflammation and type 2 diabetes. Diabetes Technol Ther, 2006. 8(1): p. 55-66.
2. Herbert, A., et al., A common genetic variant is associated with adult and childhood obesity. Science, 2006. 312(5771): p. 279-83.
3. Horikoshi, M., et al., A polymorphism in the AMPKalpha2 subunit gene is associated with insulin resistance and type 2 diabetes in the Japanese population. Diabetes, 2006. 55
4. p. 919-23. 4. Li, Y., et al., Association between functional FABP2 promoter haplotype and type 2 diabetes. Horm Metab Res, 2006. 38(5): p. 300-7.
5. Baxter, A.J., T. Coyne, and C. McClintock, Dietary patterns and metabolic syndrome--a review of epidemiologic evidence. Asia Pac J Clin Nutr, 2006. 15(2): p. 134-42. 6. Caballero, A.E., Metabolic and vascular abnormalities in subjects at risk for type 2 diabetes: the early start of a dangerous situation. Arch Med Res, 2005. 36(3): p. 241-9.
7. Haffner, S.M., Risk constellations in patients with the metabolic syndrome: epidemiology, diagnosis, and treatment patterns. Am J Med, 2006. 119(5 Suppl 1): p. S3-9.
8. Hanley, A.J., et al., Metabolic and inflammation variable clusters and prediction of type 2 diabetes: factor analysis using directly measured insulin sensitivity. Diabetes, 2004. 53(7): p. 1773-81.
9. Reynolds, K. and J. He, Epidemiology of the metabolic syndrome. Am J Med Sci, 2005. 330(6): p. 273-9.
10. Bo, S., et al., Does C-reactive protein identify a subclinical metabolic disease in healthy subjects? Eur J Clin Invest, 2005. 35(4): p. 265-70.
11. Florez, H., et al., C-reactive protein is elevated in obese patients with the metabolic syndrome. Diabetes Res Clin Pract, 2006. 71(1): p. 92-100.
12. Gonzalez, A.S., et al., Metabolic syndrome, insulin resistance and the inflammation markers C-reactive protein and ferritin. Eur J Clin Nutr, 2006. 60(6): p. 802-9.
13. Temelkova-Kurktschiev, T., et al., Subclinical inflammation is strongly related to insulin resistance but not to impaired insulin secretion in a high risk population for diabetes. Metabolism, 2002. 51(6): p. 743-9.
14. Garnero, P., et al., Cross-sectional association of 10 molecular markers of bone, cartilage, and synovium with disease activity and radiological joint damage in patients with hip osteoarthritis: the ECHODIAH cohort. J Rheumatol, 2005. 32(4): p. 697-703.
15. Punzi, L., et al., Value of C reactive protein in the assessment of erosive osteoarthritis of the hand. Ann Rheum Dis, 2005. 64(6): p. 955-7.
16. Penninx, B.W., et al., Inflammatory markers and physical function among older adults with knee osteoarthritis. J Rheumatol, 2004. 31(10): p. 2027-31.
17. Takahashi, M., et al., Relationship between radiographic grading of osteoarthritis and the biochemical markers for arthritis in knee osteoarthritis. Arthritis Res Ther, 2004. 6(3): p. R208-12.
18. Al-Waili, N.S., Natural honey lowers plasma glucose, C-reactive protein, homocysteine, and blood lipids in healthy, diabetic, and hyperlipidemic subjects: comparison with dextrose and sucrose. J Med Food, 2004. 7(1): p. 100-7.
19. Shambaugh, P., V. Worthington, and J.H. Herbert, Differential effects of honey, sucrose, and fructose on blood sugar levels. J Manipulative Physiol Ther, 1990. 3
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