Weekly Blog

July 31

A decade or so ago, FUEL as a lever against movement-related pain was one of the many "crazy ideas" we rambled on about.  Like so many fundamental shifts in the narrative, this idea was met initially with resistance, which wasn't a huge surprise. In a world rooted in the tradition that mechanics mattered most, the idea that eating healthy foods, especially fruits and veggies, could meaningfully impact physical function (and pain) seemed too far-fetched for many. It was such a hot topic back then that in 2018 I was asked to take part in an "Oxford Style" debate as part of a large conference of physical therapists in Orlando. I still have the trophy presented to the winning captain - a stuffed Mickey Mouse of course. Since that time, and with significant help from an ever-growing mountain of evidence, the idea has become well accepted, if not commonplace. 

Over the years we've discussed this connection. Whether it's the multiple randomized controlled trials showing that blueberry consumption positively impacts knee pain as reviewed here earlier this year or the inverse relationship between fiber and knee osteoarthritis - a 27% decreased risk in those who consumed the most as discussed here last year, the idea that what we eat makes a significant difference in joint health without the negative side-effects common with other treatments is so simple it's compelling. Of course, in our estimation, this was never an "either/or" story; rather, like so many other lifestyle factors, we viewed each as an important layer in the theme of "both/and." Lowering the inflammatory load via FUEL could open a window of opportunity, allowing a strong enough dose of MOVE to achieve the benefits of better mobility and strength without irritating an already cranky joint. How else can we make sense of an umbrella review, published in March of this year, which showed that fruit and vegetable consumption correlated with improvements in walking speed - a functional measure of lower body health that is intimately tied with longevity? Of course, for those who really want to leverage the system's self-healing capacity, layering in a few tactics to improve sleep, especially in cases when poorer sleep coincides with increased pain (as explained here), achieves all three critical legs of the stool. However, in the spirit of efficiency, I suppose it's only natural to wonder which factor is most effective - a question that hasn't been explored until now.

To tease out the answer, researchers from the University of Nottingham in the UK randomly assigned 117 individuals with knee pain from osteoarthritis to one of four groups for 6 weeks: the FUEL group received a 20 gram daily fiber supplement (inulin, aka "prebiotic"), the second (MOVE group) received an online 15 minute exercise prescription developed by a physiotherapist, the third received both MOVE & FUEL protocols; and the last received a placebo. The least surprising finding was, "it worked". Both the MOVE and FUEL groups (separately and combined) improved meaningfully compared to the placebo group; their pain was reduced. However, the important nuance is that below the surface the "why" was fundamentally different; the comparison was not in fact "apples to apples". In addition to reduced overall pain, those who performed the exercise protocol showed signs of improved function - they could get up and moving out of a chair faster (TUG test) and demonstrated better lower body power (30-second sit-to-stand test). Those who consumed the fiber supplement benefitted via a different pathway. They also had reduced overall pain; however, theirs was related to sensitivity - irritated tissues calmed down. Additionally, they showed improvements in blood markers associated with beneficial changes in gut health (SCFA and naturally occurring GLP-1), which have been linked to nervous system efficiency via the gut-brain and possibly the gut-muscle axes. This finding helps explain why those who consumed fiber also improved their grip strength. 

Unfortunately, there weren't enough subjects in the study to reliably understand if the "both/and" protocol was greater than the sum of its parts (synergistic). However, one conclusion seems certain enough to me: While we may feel it most in the heavily used moving parts (knees, shoulders, lower back) - and can even see the "wear and tear" there at the end of the line - arthritis is a complex, whole-system condition, so all inputs, indirect as they may seem, matter. The lifestyle formula for joint pain is simple: ditch the "or". MOVE to stimulate growth AND choose FUEL that provides the building blocks without adding inflammatory gas to the fire AND protect the time needed to RECOVER (especially sleep). Repeat.

We're a third of the way through Summer. Start now, and those achy joints could be feeling better by Fall.

Have a great weekend,

Mike E.