It is not uncommon for patients to report that their joint pain becomes exacerbated during stressful times. There are many known, and probably many to be discovered, different reasons for this. For now I’ll focus on one aspect of the stress response which may seem like minutia, however, if it’s your missing link you’ll want to continue reading.
I use the word minutia because I’m going to focus on a particular molecule (really its depletion), sulfate. You may have heard of glucosamine sulfate and even chondroitin sulfate. Add keratan and dermatan sulfate to the list as well – the list of compounds involved (and contained) in the cartilage that cushions your joints. As you may know, one reason for musculoskeletal pain is “wear and tear” to this cartilage. This is especially true in the case of osteoarthritis. However, whether or not you are diagnosed with osteoarthritis, joint pain from cartilage damage and loss – or is it really joint pain from lack of repair – occurs frequently.
Now, back to the stress response. One of the major hormones secreted during stressful times is cortisol. And one of the hallmarks of this hormone is to help stimulate the production of glucose by breaking down fat and protein in order to ready the body to respond to the stressful situation. By the way, this “stressful situation” has been found to be anything from lack of sleep, a food sensitivity or allergy, chronic infections, blood sugar imbalances, musculoskeletal imbalances, and certainly mental/emotional stress as well. Regardless of the source, it’s well known that stress of any kind leads to an increase in cortisol. [In cases of severely depleted individuals with chronic stress, cortisol can get eventually become depleted] In this article I’m not concerned much with the production of cortisol, but rather its clearance or breakdown from the body that may have unpleasant side effects.
Cortisol is a steroid hormone (along with DHEA, testosterone, estrogen, progesterone, etc.) that gets detoxified through specific pathways in the liver. These pathways are known as glucuronidation and sulfation. (That’s about as fancy as I’ll get with words, so no worries from here on.) Note the name of the second detox pathway I mentioned. It’s derived from the word sulfate, because it is the sulfate molecule that is used in this type of detoxification. Now recall those substances mentioned earlier that are components of cartilage. They all end with the word “sulfate” as they also require the sulfate molecule for their structure and function. So, if your body is busy burning through its sulfate to detox the excess cortisol that’s running through your bloodstream; where is the sulfate that helps repair cartilage going to come from? That’s certainly the issue, isn’t it?
Fortunately there are several options. Starting with dietary choices, you can consume foods rich in sulfur. These include garlic, onions, eggs, cauliflower, broccoli, and many others. This may be helpful, though sometimes not sufficient. One major reason (aside from quantity) that relying on food alone may not cut it is if high levels of circulating cortisol has compromised your digestive tract, which it typically does. This may lead to malabsorption of any nutrient(s), and not just sulfur. Another option is to supplement with sulfur, typically in the form known as methyl-sulphonyl-methane (MSM). Whether or not research supports the use of MSM in joint pain and cartilage repair/synthesis, you’re still an individual and may experience varying results (certainly related to your sulfate-dependent detox pathways). Lastly, sulfate can be had from the appropriate metabolism of homocysteine. If you’re unfamiliar with homocysteine, click here to learn more. In order to metabolize homocysteine into sulfate, the body requires certain nutrients especially vitamin B6 and molybdenum.
Please be aware that even though sulfate is critical in relation to stress and joint repair, chances are that your sulfur intake is not the only thing that need adjusting. In order to combat the stress response, I find it critical to support the structural (bones, muscles, etc.), chemical (nutrients, toxins, etc.), and mental/emotional components of a person. A “big picture” (well, truly holistic) approach is often preferred, if not necessary, to overcome the problems associated with any stressors, not the least of which is joint damage and repair. As a generally observed, several other (than sulfate) nutritional factors come to mind: proper collagen formation, healthy blood sugar metabolism, and last but certainly not least, stress management.
Hopefully this helped you to understand a bit of how the pathophysiology of the stress response may be affecting your body; and how to help it. Click here to read more on adrenal stress syndrome.
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology
source – “Degeneration Intervention – Gut, Liver, & Joints” seminar by Walter Schmitt, Jr., DC, DIBAK, DABCN
Thanks for this post. After 15 years of on / off symptoms, I have started taking SSRIs which have had a remarkable effect on my physical joint pain symptoms (which were always the dominant feature along with low mood/fatigue). I would now like to find a way of controlling the symptoms without SSRI drugs and a sulfer based supplement looks like a good place to start, along with other areas. I just wish I lived in NY to be able to talk further with you.
Thanks
Adrian, Dublin
Hi Adrian,
I’m glad you finally got relief after 15 years of on/off symptoms. You should definitely seek the help of the prescribing physician if you plan on stopping the SSRI’s.
As far as sulfur (MSM), I’ve truly never seen a huge difference in using it with patients, but that doesn’t mean it won’t help you. I know all the miracles it’s supposed to offer. My patients who’ve tried MSM with no relief simply needed something else. So again, it’s hard to say if it will help you.
It sounds like the best thing that may help you are supplements that increase serotonin and help the serotonin receptors function better. I say this because you said an SSRI did the trick.
Good luck,
Dr. Rob D’Aquila
hi – I am recovering from Cushing’s Disease due to pituitary microadenoma. I have had a loss of strength, muscle weakness and joint pain, including achilles tendon problems and knees – cartilages are very noisy! The many years that my body endured very high levels of cortisol has left me with ongoing problems, especially my knees, but also back and hips. Any suggestions?
thanks
Annie
Canberra Australia
Hi Anne,
If it were me, I’d get a 4-sample adrenal salivary profile done to see where my cortisol levels were; and then treat accordingly. If the pathology was taken care of, I’d look to functionality.
Hope this helps,
Dr. Rob D’Aquila
Hi Dr. D’Aquila,
My mom had been diagnosed with having RA many years ago, even though her blood levels were not ‘text book’. Her joints affected are not tyical of RA either. She has the most problems with the large joints of her knees and hips. About 2 – 3 years ago, she had an injury of some kind to something in her hip….her pain is felt in the crook of her groin (I guess that’s the best way to describe it). She was also having muscle aches and a heaviness in her legs that the MD finally stated was due to her statins. She stopped the statins and her leg symptoms went away. She finally had some relief with her hip as well-coincidence, we don’t know. Unfortunately, about 3 months ago, she started having the same pain in her other hip-same place. The biggest thing she notices is that her pain and stiffness will flair with emotional stress-to the point of barely being able to get around. Heat will help her pain a bit for a short time. She is 70 years old. I am 37 and I am following along the same path with knee pain/swelling and now my hips, as well (I am 6’2″ and have played many years of volleyball, basketball and softball so I have some other things going on in one of my knees for sure – torn meniscus and some osteoarthritis). We both deal with terribe bouts of fatigue and stomach issues. Her doctors have sent her to all kinds of specialists and for all kinds of testing and no one seems to know what is causing her problems. She is a very active person and I hate to see her lifestyle being affected by pain and an inability to get around. We are both overweight…..she, however, eats well. Her only ‘vice’ would be pop and she drinks it for the caffeine so she has no problem drinking diet but she can’t seem to lose weight. I don’t eat as well as her but I don’t eat a lot and am still overweight. I’m curious about the possible link to all of this and cortisol. Can you suggest any further reading or tips or testing we can have done to see if there is something she or I (or both) might both deficient in?
Thank you so much from ColumbusOhio,
Beth K.
Hi Beth,
I’d recommend you work with a competent applied kinesiologist and/or medical doctor who can put all the pieces together. It doesn’t sound as if there is one thing you (and your mother) may be deficient in that is causing the issues. You need to look at the whole picture.
Take care,
Dr. Rob D’Aquila
This is fantastic information. I am currently suffering from protracted acute withdrawal from klonopin and have been in a state of constant anxiety for 3 months now. I’m experiencing pain in both of my knees and shoulders to the point where it is difficult to walk. I think sulfate depletion is a good possibility and I look forward to seeing what sulfate supplementation can do for me. Thank You
Hi. I’m 34 and almost two years ago my hand joints began hurting. It flared up during a stressful time at work and ever since then the soreness and annoying pain has been there as well as every joint in my body. Some times worse than others and I can’t figure out what triggers it. I saw a neurologist (nothing), endocrinology (because I have a hypothyroidism, but he said joint pain is unrelated), rheumatologist (who rulled out arthritis). Now I don’t know what to think. Any ideas?
Hi Irina,
My first impression would be some type of systemic arthritide, so hopefully that’s been truly ruled out. You may have to run the tests again…
Otherwise, you may have GI issues, microbial imbalances, toxic metals/chemicals, food sensitivities, etc. causing a systemic inflammatory response. And I would think that the thyroid is a possible culprit, that should be looking into.
Best in luck with figuring this out,
Dr. Rob D’Aquila