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Can sugar really worsen your joint pain? It’s a question commonly contemplated by arthritis and fibromyalgia sufferers.  

One survey found sugary foods and drinks are the most commonly reported culprits for increased joint pain in arthritis sufferers.1 

There was a study showing that women who drink only one soft drink per day had a 63% higher risk of positive rheumatoid arthritis blood markers.2

In another study, young adults who drank sugary drinks (soft drinks, apple juice, and fruit drinks) more than 5 times per week are 3 times more likely to develop inflammatory arthritis!3

My own husband notices a flare in his joint pain and heartburn when he eats too much sugar a few days in a row. Many of my clients have had the same experience.

Yes, sugar can worsen joint pain and we’ll talk about seven interesting ways. Plus, tips to reduce your sugar intake to improve joint pain.

Inflammation

Chronic inflammation is what causes pain, swelling, and stiffness in your joints when you have arthritis. When you eat sugar, pro-inflammatory chemicals like cytokines are released which increase overall inflammation, pain, and swelling. 

A low sugar diet can definitely lead to less inflammation through many mechanisms.

Advanced Glycation End Products (AGEs)

Sugar molecules can bind with proteins to form inflammatory compounds called advanced glycation end products or AGEs. Eating sugary foods, especially high fructose corn syrup (HFCS), produces much more AGEs to gather in and damage your joints, skin and blood vessels.4,5

AGEs are found in higher amounts in people with chronic diseases (such as rheumatoid arthritis, diabetes, renal disease, cardiovascular disease, and Alzheimer’s disease).4 AGEs were even found to make osteoarthritis joint pain worse in one study.5

How to reduce AGEs in your joints and body 4

  • Read the labels on everything you eat (and drink!) for the next week. The Nutrition Facts will tell you how much “Added Sugars” are in your foods. Keep these to less than 25 grams per day for women and children or less than 36 grams per day for men. 
  • Also, read the ingredient lists and avoid anything with high fructose corn syrup (HFCS).
  • Avoid the “unhealthy” fats like vegetable, corn, soybean, and canola oils. Avoid trans fats. Instead opt for olive oil, avocado oil, coconut oil, and real butter. High fat diets are thought to result in more AGEs. 
  • Choose 80% real, unprocessed food with ingredients you can recognize and pronounce. 
  • Avoid too many foods fried or grilled at high temperatures. Low and slow cooking methods will have the lowest AGE content.
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Insulin Resistance

Eating too much sugar too frequently (a characteristic of most American diets) leads to insulin resistance. More than 50% of us have some degree of insulin resistance and we don’t even know it.

Insulin is the hormone that helps control your blood sugar levels whenever you eat sugar. Eating a lot of sugar causes insulin to be released often, eventually causing your cells to stop responding to insulin. In turn, your pancreas releases more and more insulin to keep blood sugar levels normal. Your insulin levels will be high for years before your blood sugars ever begin to look elevated, but doctors rarely test insulin levels so you’ll probably never know.

At the point when your blood sugars begin to creep above 100 while fasting, you can be sure you’ve had significant amounts of insulin circulating in your blood for a long time. A lot of belly fat is another reliable sign of insulin resistance. 

If insulin’s only job was to control blood sugars, this might not be a problem. However, insulin has other roles. 

For one, insulin tells your body to store more fat around your belly, organs, and muscles. This is an especially harmful type of fat that releases inflammatory chemicals like TNF-alpha and interleukin 6. It also prods the liver to release more CRP- a common marker of inflammation your doctor might test for.6 It puts your body in a pro-inflammatory state that leads to more insulin resistance, more weight gain, more joint pain and stiffness, heart disease, diabetes… and the list goes on!

Too much insulin can also impact other hormone levels, eventually throwing everything out of whack, from your thyroid to your sex hormones. It’s connected with infertility, low testosterone, polycystic ovary syndrome (PCOS), heart disease, cancers, and of course arthritis and fibromyalgia.7–9 

Insulin resistance is an often overlooked key root cause that many fail to address when treating arthritis and other chronic conditions. You bet we cover it in my 12 Week Thrive with Arthritis program though! 

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To reverse insulin resistance:

  • Eat a low “added sugar” diet- less than 25 grams/day for women and children, and less than 36 grams/day for men. As we talked about before, read labels on everything you eat to get a feel for how much added sugar you are eating. Naturally occurring sugars in fruit and milk don’t count, but limit fruit juice to 4 ounces or less per day.
  • Eat a very low carbohydrate diet, especially if your blood sugars or insulin levels are already high. 
  • Include a whole food source of protein and fat at every meal to slow the absorption of sugars from carbohydrates. 
  • Cut out sugary drinks except on very rare occasions. One can of soda contains roughly 40 grams of sugar, and many people are drinking much more than one can a day. Anything you drink that tastes sweet has ample amounts of sugar or artificial sweeteners (which carry their own health risks). Learn to love water!

Altered Gut Microbiome

The microbiome is the thriving metropolis of bacteria and other microbes living on your skin and within your digestive tract and other places. They are actually so important to your health you could almost consider them another organ.

Many studies show the connection between an unhealthy microbiome and inflammatory arthritis conditions of all types.8,10–14

Dysbiosis, or the dominance of the wrong types of bacteria, can also lead to a condition called “leaky gut” or increased intestinal permeability, which leads to food sensitivity reactions and major inflammation in arthritis and fibromyalgia. We will discuss leaky gut and food sensitivity below. 

How to Balance Your Microbiome

Diets too high in sugar, processed foods, additives, meat, and fat promote the growth of harmful bacteria that increase inflammation, autoimmunity, and undermine our health in many ways.

Diets that balance healthy fat and protein with low sugar and lots of vegetables, fruits, beans, whole grains (especially soaked, sprouted, and sourdough grains), nuts and seeds (again, sprouted are best) encourage really good probiotic bacteria to flourish in our bodies. 

Frequent antibiotic use can also destroy the good bacteria along with the bad and lead to harsh imbalances. Serious overgrowth or infections like H. Pylori, SIBO, Candida albicans, or parasites may require heavy herbal or prescription antimicrobials combined with probiotics and a healthy diet over a long period to restore balance. 

Adequate sleep, exercise, and reducing chronic stress can also help improve your microbiome.

Also, be sure that you have a healthy amount of stomach acid. If you’ve been on acid-lowering medications for a long time or have frequent heartburn, you may actually have too little stomach acid. Stomach acid kills harmful bacteria and prevents overgrowth in your intestines. Learn how to test for low stomach acid here. If you have to come off PPIs, do so very slowly, or you will have a rebound effect that could make heartburn worse. 

Check out my microbiome-balancing protocol on Fullscript for supplements that might be helpful. Of course, talk to your doctor or dietitian first.

Fullscript

Leaky Gut & Food Sensitivities

We now know that sugar can induce “leaky gut” or increased intestinal permeability, which basically means you get tiny holes in the lining of your digestive system.15 

These holes allow partially digested proteins, bacteria, viruses, and more to “leak” through the lining and enter your circulation. They are seen as threats by your immune system, which can lead to a hyperactive immune response, tons of inflammation, pain, unexpected symptoms all over your body, and autoimmunity, as seen in most forms of arthritis. 
It seems that all inflammatory arthritis and fibromyalgia are preceded by leaky gut. Therefore, healing leaky gut is an important target for treating and reversing these diseases and many others.15 We cover this thoroughly in my Thrive with Arthritis 12 Week Program.

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How to Heal a Leaky Gut

A diet rich in vitamins, minerals, and amino acids is also essential for repairing the gut lining. 

Many supplements (like probiotics, prebiotics, zinc carnosine, and l-glutamine) can aid in restoring the gut microbiome. Check out this article: Best Gut-Healing Supplements for ideas and links to specific protocols.

Also, temporarily removing foods your immune system is reacting to (food sensitivities) helps my clients quickly reduce inflammation and have a chance to heal. My favorite tool for this is the Mediator Release Test (MRT). Clients see an average of 70% improvement in symptoms in the first 2 weeks when using MRT and working with a Certified LEAP Therapist like myself.

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Dental Health

It’s probably no coincidence that both gum disease and inflammatory arthritis started appearing in the late 1800’s, right as sugar was becoming more widely available. 

Gum disease is associated with many forms of arthritis including rheumatoid arthritis, psoriatic arthritis, lupus, and idiopathic juvenile arthritis.16 

In fact, those with gum disease are TWICE as likely to get RA, and 50% LESS likely to go into remission with treatment.16 

Eating sugar encourages “bad” bacteria like Aggregatibacter actinomycetemcomitans (Aa), which may trigger BOTH rheumatoid arthritis and periodontal disease!17 

Good dental hygiene, including a diet low in sugary foods and drinks, probably plays an important role in preventing and improving arthritis. 

Fructose and Gout

There is a clear link between consuming fructose sugar and a type of arthritis called gout. 

Incidence of gout has doubled as the intake of fructose-laden soda has increased.18

One study showed men who drink more than 2 sodas a day had an 85% higher risk of gout than those who drink it occasionally!19 

As fructose is broken down, purines are released and uric acid is formed. Uric acid crystals can settle in your joints and cause redness, swelling, pain, and inflammation. Uric acid is formed within minutes of eating fructose.19 

How to Reduce Fructose Intake

High fructose corn syrup (HFCS) is more concerning than natural sources of fructose, like fruit and milk. Fruit juice may still be high in fructose. I avoid fruit juice and choose whole fruits instead. 

Many sodas contain lots of HFCS. Fake maple syrup, sweet drinks, and other processed foods are common sources of HFCS. 

Read your ingredient lists and opt for products that do not include HFCS.

Tips to Reduce Sugar Intake

  1. Read the food labels on everything you eat and drink. Become more aware. The Nutrition Facts panel will list “added sugars”, which is what you are most worried about. Also, scan the ingredient list to see what types of sugars are present. High fructose corn syrup is especially important to avoid. Don’t be fooled into “sugar-free” foods and drinks. If it tastes sweet, it either has sugar or artificial sweeteners. Neither are good for you.
  2. You don’t need to cut sugar entirely. For most, there is no need to completely cut sugar from your life. As you become more aware of where you are getting your sugar from, you can decide where it really counts. Aim for less than 25 grams/day for women and children, and 36 grams/day for men.
  3. Ditch soft drinks. Sodas, fruit drinks, etc. are the biggest source of sugar for Americans. Save soda for rare occasions. This might seem really hard at first, but don’t worry! My clients across the board report that they don’t miss them anymore after several weeks, and they feel so much better. Learn to love water!
  4. Use Stevia. Small amounts of Stevia to sweeten smoothies, plain yogurt, hot chocolate, or other foods that you can easily swap sugar for is great. Stevia doesn’t work great for baked goods where the texture makes a difference. Be sure it is pure Stevia, not mixed with other artificial sweeteners. Stevia is extremely sweet. A tiny bit goes a very long way. 
  5. Balance blood sugars. Eating plenty of healthy fats and quality protein with every meal will help you avoid energy crashes that can make you crave sugar.

Summary

Reducing sugar intake is one important way to improve joint pain and stiffness, as it will reduce your inflammation, AGEs, dysbiosis, insulin resistance, leaky gut, gum disease, and gout. 

Other important strategies include identifying food sensitivities, healing leaky gut, and enhancing detox. 

Utilizing support and guidance to identify your root causes and then reversing them with food and lifestyle can make you so much more successful on your journey to healing!

If you’d love lots of support, resources, and guidance, join us in my Thrive with Arthritis 12 Week Program!

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References

  1. Tedeschi SK, Frits M, Cui J, et al. Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry. Arthritis Care Res. 2017;69(12):1920-1925. doi:https://doi.org/10.1002/acr.23225

2. Hu Y, Costenbader KH, Gao X, et al. Sugar-sweetened soda consumption and risk of developing rheumatoid arthritis in women. Am J Clin Nutr. 2014;100(3):959-967. doi:10.3945/ajcn.114.086918

3. DeChristopher LR, Uribarri J, Tucker KL. Intake of high-fructose corn syrup sweetened soft drinks, fruit drinks and apple juice is associated with prevalent arthritis in US adults, aged 20–30 years. Nutr Diabetes. 2016;6(3):e199. doi:10.1038/nutd.2016.7

4. DeGroot J, Verzijl N, Wenting-van Wijk MJG, et al. Accumulation of advanced glycation end products as a molecular mechanism for aging as a risk factor in osteoarthritis. Arthritis Rheum. 2004;50(4):1207-1215. doi:10.1002/art.20170

5. Braun M, Hulejová H, Gatterová J, et al. Pentosidine, an advanced glycation end-product, may reflect clinical and morphological features of hand osteoarthritis. Open Rheumatol J. 2012;6:64-69. doi:10.2174/1874312901206010064

6. Ellulu MS, Patimah I, Khaza’ai H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci AMS. 2017;13(4):851-863. doi:10.5114/aoms.2016.58928

7. Bissell L-A, Hensor EMA, Kozera L, et al. Improvement in insulin resistance is greater when infliximab is added to methotrexate during intensive treatment of early rheumatoid arthritis-results from the IDEA study. Rheumatol Oxf Engl. 2016;55(12):2181-2190. doi:10.1093/rheumatology/kew306

8. Zamani B, Farshbaf S, Golkar HR, Bahmani F, Asemi Z. Synbiotic supplementation and the effects on clinical and metabolic responses in patients with rheumatoid arthritis: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2017;117(8):1095-1102. doi:10.1017/S000711451700085X

9. Johnson A. The dangers of elevated insulin levels. The Daily Universe. Published July 17, 2018. Accessed July 6, 2021. https://universe.byu.edu/2018/07/17/the-dangers-of-elevated-insulin-levels/

10. Zamani B, Farshbaf S, Golkar HR, Bahmani F, Asemi Z. Synbiotic supplementation and the effects on clinical and metabolic responses in patients with rheumatoid arthritis: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2017;117(8):1095-1102. doi:10.1017/S000711451700085X

11. Paul AK, Paul A, Jahan R, et al. Probiotics and Amelioration of Rheumatoid Arthritis: Significant Roles of Lactobacillus casei and Lactobacillus acidophilus. Microorganisms. 2021;9(5):1070. doi:10.3390/microorganisms9051070

12. Wang P, Tao J-H, Pan H-F. Probiotic bacteria: a viable adjuvant therapy for relieving symptoms of rheumatoid arthritis. Inflammopharmacology. 2016;24(5):189-196. doi:10.1007/s10787-016-0277-0

13. Sredkova P, Batsalova T, Moten D, Dzhambazov B. Prebiotics can change immunomodulatory properties of probiotics. Cent-Eur J Immunol. 2020;45(3):248-255. doi:10.5114/ceji.2020.101237

14. Horta-Baas G, Sandoval-Cabrera A, Romero-Figueroa MDS. Modification of Gut Microbiota in Inflammatory Arthritis: Highlights and Future Challenges. Curr Rheumatol Rep. 2021;23(8):67. doi:10.1007/s11926-021-01031-9

15. Bischoff SC. “Gut health”: a new objective in medicine? BMC Med. 2011;9:24. doi:10.1186/1741-7015-9-24

16. Gum Disease and Arthritis | Arthritis Foundation. Accessed July 6, 2021. https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/mouth-bacteria

17. Konig MF, Abusleme L, Reinholdt J, et al. Aggregatibacter actinomycetemcomitans-induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Sci Transl Med. 2016;8(369):369ra176. doi:10.1126/scitranslmed.aaj1921

18. Rho YH, Zhu Y, Choi HK. The Epidemiology of Uric Acid and Fructose. Semin Nephrol. 2011;31(5):410-419. doi:10.1016/j.semnephrol.2011.08.00419. Fructose and Gout: What’s the Link? Gout. Published February 15, 2016. Accessed July 6, 2021. http://blog.arthritis.org/gout/fructose-sugar-gout/

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