Knee Pain … How Everything Is Connected — Why Can’t We Treat The Whole Person?

Tim appeared no different than your average middle aged man.  He was complaining of knee pain.  His knee hurt when he woke up and it would be stiff if he sat still for a while and then tried to get up.  He didn’t ask much from his knees … he gave up the activities he loved years ago.

Like many, Tim became “busy”.  Too “busy” to exercise, too busy to walk at lunchtime, too many meetings, too little time for himself.  He wasn’t particularly overweight by todays standards, but he could lose 20 pounds.  He noted that his primary care doctor had just started him on medications for pre-diabetes, and hypertension.  He wasn’t sleeping well… something he blamed on “stress”.  Tim wanted to know what pill he could take to lessen his knee pain.

The physical exam was rather uneventful.  His knee was a little swollen and his X-rays showed the very earliest signs of arthritis.

Our initial discussion about the potential treatments available to alleviate his discomfort didn’t go so well.  Like the lunches he grabbed from a truck outside of work, Tim wanted the quick hit, quick fix so he could move on with his “busy” life.

But we had the talk …

If you don’t make time to be well … you had better plan the time to be a lot sicker.

Tim ate a typical western diet — processed foods, little fiber, lots of meat.  Tim didn’t exercise, had gained 20 pounds over the last few years and was heading down a very predictable path towards a life of pain, further weight gain, heart disease, kidney disease, neuropathy and misery.

“Do you understand how this is all related?” I asked.

No

Well… the contents of the Au Bon Pain bag you are clutching has more sugar in it then you should eat in a month.

Sugar is the enemy. And “Big Food” hides sugar everywhere.

• Sugar raises your insulin levels, which converts the sugar to fat — weight gain.
• Eating processed food that have no fiber causes your blood sugars to spike high.
• The insulin spike actually makes you hungry –> further weight gain.
• No exercise –> poor glucose and insulin control
• sugar spikes, high fat narrows arteries –> heart disease risk factor
• no exercise –> no cardiac reserve
• Poor insulin control due to sugar spikes and fluctuations –> diabetes
• Diabetes leads to a whole slew of conditions you WANT to avoid.
• Glucose spikes, low fiber diets leads to gut leakiness –>metabolic syndrome
• Metabolic syndrome leads to an increase in total body inflammation.
• That inflammation … aside from everything else it causes, will make your knees hurt more (full circle)
• and the cycle repeats.

Many at this point want to run out of the room.  A few perk up and want to learn more. They haven’t heard it all pieced together like this before — especially from an Orthopedic Surgeon.

How could all these things be related?

They are… They are connected in more ways then you can imagine.  The scientific community doesn’t even understand everything about how they are connected.  To add to the confusion, it turns out that your diet also affects your microbiome — the collection of bacteria in your gut.  99% of the DNA in your body is not yours.  Those bugs in your gut make chemicals, hormones and by-products that you absorb.  Those byproducts have been shown to cause heart disease, obesity, arthritis, depression, and on and on.

A high fiber diet, low sugar diet can change your microbiome quite rapidly.

Tim was actually interested … we laid out a plan.

Nearly 6 months to the day, Tim returned to our office out of the blue.  He lost 15 pounds, his knees no longer ached, he walked around at work every 15 minutes.  He had walking meetings if it is possible.  He ate a high fiber diet, and very few processed foods.  He is off of his medications for hypertension and pre-diabetes…. and he just wanted to come in the to the office to say thank you.

We have enough knowledge in medicine today that we can start to truly help our patients change their lifestyle and prevent years of suffering … physical, financial, and emotional.

Sadly, in the rapid, mechanistic, box checking chaos we refer to as a typical physicians office visit that isn’t possible.

I sacrifice a lot to be able to offer people the time they need to understand far more than they thought they were going to hear when they came to the office.

With the current reimbursement models in place, and with Big Pharma and Big Food sitting atop those who throw an endless stream of bureaucratic nonsense our way on a daily basis … the needless suffering is going to continue.