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Dr Andrea Robertson is an Osteopath, Naturopath, and Nutritionist. The information shared in this podcast is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your health regimen.

Show Notes

Episode Transcript

Episode 5

Andrea: You wake up in the morning and the first thing you feel is stiffness. Like, you swing your legs over the side of the bed and your knees creak. You stand up and your lower back grumbles. You go to pick up your coffee cup and your fingers feel swollen and tight. And you think, "Is this just getting older?

Is this what life looks like now?" No, it does not have to be. Joint aches and body pain are not an inevitable part of aging. They are a signal, a very specific, very informative signal. And once you understand what your body is trying to tell you, you can start doing something about it. That is exactly what we are doing today

I'm Dr. Andrea Robertson, osteopath, naturopath, and nutritionist. Here we nourish because food is medicine and what you eat changes everything. We heal because the body has an extraordinary capacity to self-repair when we remove what's blocking it. And we rise because feeling well [00:03:00] isn't the destination, it's the foundation for living the life you truly desire.

This is Nourish, Heal, and Rise.

 

Before we begin, a quick and important note. Everything I share on this podcast is for educational purposes only. It's not personal medical advice, and it can't be, because in the context of this podcast, I don't know your health history, your medications, and what else is happening in your body. What I want this podcast to do is give you the knowledge to ask better questions, understand your body more deeply, and make more informed decisions in partnerships with the practitioners who do know you.

If something resonates and you wanna take action, please work with a qualified healthcare provider who knows your full picture

Welcome back. We are now up to episode five in our inflammation series, and we have been building something really substantial together [00:04:00] over the last few episodes. We have talked about what inflammation is, how it works in the body at a fundamental level, and we have started to work through each of the signs that chronic inflammation leaves behind.

Today, we are tackling one of the most common ones I see in clinic, joint aches and body pains. And I want to do this episode a little differently today to the last ones, because this is a topic that sits right at the intersection of everything I do. As an osteopath, a naturopath, and a nutritionist, joint health is one of those areas where I get to bring all three of my disciplines to the table, and I want to share that with you today in a way that is genuinely useful, not just a list of things to try.

Also, I want to share a couple of personal stories with you in this episode, because this is not an area that I'm speaking about purely academically. I have lived this. Both stories are mine, and I think they'll give you something real to hold onto I want to map out what we are covering today so you know what is coming.

We're going to start with the science. I want to explain what is actually [00:05:00] happening inside an inflamed joint. What are the mechanisms? What does inflammation do to tissues at a cellular level? Because once you understand the machinery, everything else will start to make sense. Then we move into the nourish section, food as medicine for joint health, the anti-inflammatory diet, the key nutrients, the foods that drive inflammation and the foods that calm it.

And I will share my first personal story there, which involves perimenopause, calf cramps, paddle, and creatine. Then we go onto the heal section, the naturopathic and lifestyle tools, sleep, stress, gut health, and the targeted supplements with real evidence behind them.

And finally, we move into the rise section, the osteopathic and movement piece, because the way you load and move your body is one of the most powerful anti-inflammatory tools you have. And this is where I will share my second story, the back pain mystery, which took years to solve and what finally turned it around.

Before I get into the inflammatory process, I want to make sure we are all on the [00:06:00] same page about what a joint is and what it is made of, because understanding the anatomy is what makes the rest of this make sense. Okay. A joint, a synovial joint, which is the type we have in our knees and our hips and our shoulders and our fingers and our spine, it's a meeting place between two bones.

The ends of these bones are covered in cartilage, which is smooth, tough, slightly rubbery tissue that allows joint surfaces to glide and slide over each other without much friction. Think of it almost like the, the non-stick coating on a frying pan, though on a side note, please do not use frying pans with non-stick surfaces.

They are toxic, and instead go for stainless steel or cast iron instead. Okay. So that little aside, back to joints. The cartilage surface we've been talking about, it has to be smooth and slippery for things to work properly.

Then around the joint is a capsule, a tough outer sleeve that holds everything together and keeps the joint fluid in. Inside that capsule is the [00:07:00] synovial membrane, which is a thin tissue lining. The synovial membrane does something extraordinary. It produces synovial fluid, which is the lubricating fluid inside the joint.

Almost think of synovial fluid as like the oil in a car engine. When there's plenty of it and it is healthy, the joint moves freely. The cartilage stays nourished

And everything works beautifully. But when the system goes wrong, that oil becomes contaminated, and that can be one reason that you get joint pain. Okay.

This is what happens when chronic inflammation gets into the system. Your immune system produces chemical messages called inflammatory cytokines. You can think of these as like the alarm signals that tells the body something is wrong. The key players in joint inflammation are molecules called TNF-alpha, interleukin 1-beta, interleukin 6, and interleukin 18.

Now, these names are not important for you to remember, but what they do is crucial.

We see these in osteoarthritis and rheumatoid arthritis as [00:08:00] the obvious causes of joint pains. However, and I want to be very clear, you do not need to have a diagnosis of arthritis for these mechanisms to be relevant to you. Chronic low-grade systemic inflammation raises these same molecules. They circulate through your body, they sensitize your joints, and they can contribute to the achiness and stiffness that many women feel every day without anyone being able to tell them why

So when these cytokines flood a joint, three things happen. First, the synovial membrane gets activated, like the synovium starts to become inflamed, and it's a process called synovitis. Instead of quietly producing clean, lubricating fluid, the inflamed synovium starts producing excessive fluid containing inflammatory chemicals.

This is why inflamed joints can swell. The joint literally fills with inflammatory fluid, and that swelling creates pressure, which also creates pain. Second, the cartilage starts to break down. Those same inflammatory cytokines switch on [00:09:00] enzymes

called matrix metalloproteinases, the body's own demolition crew, and these enzymes begin degrading cartilage. Remember that non-stick coating I mentioned? Inflammation is stripping it away, slowly at first, but then progressively. This is how chronic inflammation over years can lead to osteoarthritis. The cartilage erodes, and eventually you have bone rubbing on bone.

Third, your pain system gets sensitized. There is a process called peripheral sensitization, where the nerve endings in the joint become hypersensitive to stimulation. Things that would not normally hurt start to hurt, and over time, if this continues, the brain and spinal cord can also become sensitized, a process called central sensitization.

This is why chronic joint pain is so much more than just a structural problem. There is a neurological component that runs alongside the mechanical one. Now, here is the thing I want you to really understand. Research published in [00:10:00] 2026 in a large Mendelian randomization study, which is particularly robust research design because it uses genetic data to establish cause and effect, well, it demonstrated causal links between specific inflammatory cytokines, particularly interleukin 18, and the risk of joint pain.

This means elevated inflammatory cytokines drives joint pain. So interesting. Now, I want to briefly explain why I find this study particularly convincing, because the research design matters. Many studies can only show us correlation. They cannot prove that one thing actually causes another.

Mendelian randomization is different. It uses genetic data assigned randomly at conception before any lifestyle choices are made to establish cause and effect. Think of it like a natural clinical trial that nature itself ran, and this study used that design to show that elevated interleukin 18 causally increases the risk of joint pain.

I will link to this study in the show notes below

Now, the [00:11:00] prostaglandin piece. There is another inflammatory molecule I want to tell you about because it explains something very practical that I will come back to in the nourish section. When cells are damaged or stressed, the cell membrane releases

a A fatty acid called arachidonic acid. An enzyme called COX-2 then converts arachidonic acid into prostaglandins, particularly a molecule called prostaglandin E2, or PGE2. Prostaglandins are potent anti-inflammatory mediators. They dilate blood vessels, which is why inflamed joints are often red and warm.

They sensitize nerve endings, which is why the joint hurts, and they contribute to the breakdown of cartilage in conditions like osteoarthritis and rheumatoid arthritis. Now, here is why this matters for food.

The fatty acids in your cell membranes determine how much arachidonic acid is available to make prostaglandins. And the type of fat you eat determines the composition of your cell [00:12:00] membranes. This is not theoretical. It is biochemistry. If your diet is high in omega-6 fatty acids found in vegetable oils, processed foods, grain-fed animal products

Well, your cell membranes are loaded with arachidonic acid, and the inflammatory cascade runs hot. However, if your diet is rich in omega-3 fatty acids versus those omega-6 ones, the omega-3s are found in oily fish, flaxseeds, chia seeds, walnuts.

Your cell membranes contain a different type of fatty acid that competes with and reduces arachidonic acid availability. Less arachidonic acid, less PGE2, less inflammation, less pain. This is not alternative medicine. This is fundamental biochemistry, and it is one of the most powerful levers you have

Now, a little bit about perimenopause and joint pain. Before I move on to the nourish section, I wanna briefly address something that is incredibly relevant for the women listening to this podcast. Joint pain is a [00:13:00] common and under-diagnosed symptom of perimenopause. Here is why. Estrogen has direct anti-inflammatory effects on joint tissue.

Estrogen receptors are found in cartilage, in the synovial membrane, in tendons, and ligaments. Estrogen helps maintain collagen synthesis, which is the structural scaffolding of all connective tissue. And estrogen modulates the inflammatory response, helping to keep inflammatory cytokine levels in check.

When estrogen starts to wobble and then decline during perimenopause and the years after into menopause, all of that changes. The anti-inflammatory cushion that estrogen was providing kinda gets smaller. Cartilage synthesis slows, ligaments and tendons become more vulnerable to injury, and the systemic inflammatory load goes up.

This is why so many women in their mid to late 40s suddenly find that their joints are talking to them in ways that they never did before. Joints that were fine before are now [00:14:00] stiff. Old injuries that had settled are making themselves known again. And the morning stiffness that takes, like, half an hour to work through, that's not just tiredness, it's actually an inflammatory response.

Understanding this does not mean you are stuck with it. It means by listening to this podcast, you now know exactly what you're dealing with, and you can start to build a strategy around it

Let's go into talking about inflammation, joint health, and body aches in terms of the name of my podcast. So as you know, this is Nourish, Heal, and Rise, and this is the nourish section, food as medicine for your joints. I want to talk about the anti-inflammatory diet for joint health, and I'm going to start here with the big picture principle and then get specific.

The main thing to think about is having an anti-inflammatory diet and finding the right anti-inflammatory diet for you, filled with foods you love that love you back. This includes avoiding ultra-processed foods, all those foods in packets that have additives, flavors, emulsifiers, and preservatives added.

They are not [00:15:00] real food. They are fake food, and they are doing nothing for your health. Well, actually they are. They're having a very negative effect on your health, bit by bit, making your body and your brain less and less healthy over time. But back to the beautiful anti-inflammatory diet that I want to talk about.

The most studied dietary pattern for joint health and inflammation is the Mediterranean diet. A two thousand twenty-three randomized control called the Madeira Trial looked at a 12-week Mediterranean diet intervention in women with rheumatoid arthritis. They found improvement in disease activity, pain scores, and inflammatory markers.

And a two thousand twenty-five systematic review and meta-analysis in the European Journal of Clinical Nutrition that pooled nine randomized control trials found that dietary interventions, particularly Mediterranean and anti-inflammatory patterns, significantly improve pain in osteoarthritis with a clinically meaningful effect size.

These are not small studies with kind of sketchy methodology. This is good, rigorous science. For [00:16:00] those watching on the video, I'll pop a screenshot of these studies up on the screen

But here's the thing about the Mediterranean diet. It is not really a diet in terms of the restrictive rules-based stuff. It's a way of eating that is built around real, whole, unprocessed food.

It is heavy on plants, so beautifully plant-based, and oily fish, and on good quality olive oil, and on legumes, and on colorful vegetables and fruit. And it is very low in the things that drive inflammation, refined sugar, ultra-processed foods, and excessive refined carbohydrates.

If you are familiar with my approach in the three-week inflammation detox diet or my 12-week whole house solution, you will recognize this framework immediately. This is exactly what we do together in these programs. We are systematically removing the things that are fueling inflammation and adding in the things that calm it down.

The difference with the Mediterranean diet and what I share with my clients is that sometimes there is a food that is healthy on paper but still causing inflammation for that [00:17:00] particular person. That's what I help my clients figure out, the food they love that loves them back. When we do this, the change in how women feel in their joints and their bodies and their brains, mind you, within the first few weeks is often one of the first and most dramatic improvements I see

so that is the big picture focus with avoiding ultra-processed foods and having an anti-inflammatory diet. Let me now go through four key foods and nutrients that I want you to include to support reducing body aches and pains and joint pain

Okay. Omega-3 fatty acids, these are absolutely non-negotiable. We have already talked about the biochemistry. Omega-3s work by shifting the composition of your cell membranes and reducing arachidonic acid availability, which means less of that PGE2 and less inflammatory signaling throughout the body.

The best food sources are oily fish like salmon, sardines, mackerel, anchovies, and herring. I want you eating at least two to three serves of oily fish per week. And if you are [00:18:00] plant-based, you can get ALA, a plant form of omega-3, from flaxseeds, chia seeds, hemp seeds, and walnuts.

But I do want to note that the conversion of plant ALA

to the active forms EPA and DHA that your body uses, that conversion is limited, typically around only 5 to 10%. So if you're not eating fish, a high-quality fish oil supplement or algae-based DHA and EPA supplement is really important. In terms of supplements, when the evidence is reviewed, omega-3 fish oil in therapeutic doses of between two to four grams per day of combined EPA and DHA has shown consistent benefits for reducing joint pain, morning stiffness, and inflammatory markers.

A good fish oil matters. Quality, freshness, and the concentration of EPA and DHA all affect efficacy. This is not a time to reach for the cheapest option on the shelf at the discount chemist stores The second non-negotiable to support your musculoskeletal system is to eat the rainbow.[00:19:00]

All the deeply colored fruits and vegetables, these are really rich and filled with something called polyphenols. Polyphenols are plant compounds with strong anti-inflammatory activity. They work by interfering with that same COX-2 enzyme pathway that I described earlier, the one that makes prostaglandins.

This is essentially the same mechanism as a non-steroidal anti-inflammatory drug, but through food rather than through a pharmaceutical, and without the side effects on the gut lining the anti-inflammatory medications can give. The best sources of anti-inflammatory plant foods are deeply colored. Think berries, cherries, beetroot, red cabbage, purple carrots, dark leafy greens, turmeric, ginger, and green tea.

Curcumin, which is the active compound in turmeric, is one of the most studied natural COX-2 inhibitors we have. I love cooking with turmeric, and I do constantly. I add it to soups, grate it over roast vegetables when I can get the raw turmeric root, and I add it to [00:20:00] smoothies, to my turkey mince scramble that I make every week as well. And then I always combine turmeric with a little black pepper, which contains piperine and dramatically increases the absorption of curcumin.

And all of a sudden with the pepper and the curcumin, you have a potent anti-inflammatory addition to your daily food

Now, I want to talk about protein because I see this underestimated for joint health all the time. Who has osteoarthritis and has ever been told, "Eat more protein to support your joints"? Like, it's not a common message, but you are hearing it from me today. Muscle is not separate from joint health.

It is integral to it. The muscles around a joint are its support system. They absorb load, they stabilize the joint so the cartilage is not taking the full brunt of every impact, of every step, of every movement. When muscle mass declines, which happens with age, with sedentary behavior, and which accelerates unfortunately in perimenopause as estrogen drops,

Well, then joints are left [00:21:00] without adequate support. They take more load, they degrade more quickly, they hurt more. Building and maintaining muscle requires eating enough protein. So I want women in midlife eating between 1.2 and 2 grams of protein per kilogram of ideal body weight per day. Let me say that again.

1.2 to 2 grams of protein per kilogram of ideal body weight per day. So for example, a minimum if you weigh 65 kilograms or if that's your ideal weight, well, that's then between about 105 and 130 grams of protein per day.

You can spread it across the day, like don't just load it up at dinner. But as long as it's kind of evenly spread through the week, it's okay if some meals are more and some are less

Quality sources of protein include eggs, fish, chicken, red meat, hemp, legumes, tempeh, Greek yogurt if you tolerate dairy. And this is a big reason why I designed the protein framework in my 12-week Whole Health Solution [00:22:00] program the way I did, because getting enough protein right is absolutely one of the most helpful things you can do for your body in midlife, not just for your joints, but for everything.

Now, lots of people ask me about collagen. Is it good? Is it a good protein source? Is it helpful for my joints? I've got a little bit to say on this. Collagen's actually the most abundant structural protein in your body. Like, your cartilage is approximately 70% collagen. Your tendons and ligaments are made of collagen.

Your skin is collagen. And as you age, and particularly as estrogen declines in perimenopause and menopause, your body actually produces less of it. Okay, let's have a look at the science. The evidence for hydrolyzed collagen peptides and joint health is kind of promising, and the mechanism makes genuine biological sense.

The research, though, it's still building, and a lot of it has been industry-funded, which I always flag as a bit of a limitation. But what we have is kind of consistent enough, and the safety profile is good enough that I think it's worth including as as part of a broader joint [00:23:00] health strategy.

I would not hang everything on it as the magic miracle cure. But as one piece of the picture alongside your food and your omega-3s and your resistance training, it can definitely have its place

Collagen is not a complete protein source on its own though, and although the evidence is building for taking collagen for joint and cartilage health, it should not be counted towards your daily protein minimum targets. A complete protein contains all nine essential amino acids, the ones your body can't make itself and must get from food.

Collagen is deficient in several of them. It contains virtually no tryptophan, which is actually one of the reasons it's not counted as a complete protein at all, and it's also low in methionine, cysteine, and isoleucine. What collagen is rich in is glycine, proline, hydroxyproline,

and glutamic acid which are the amino acids that make up the structural matrix of connective tissue. These are important, but they are not the full picture of what your body needs for overall protein [00:24:00] synthesis. This is an important point because collagen supplements are heavily marketed as a protein source, sometimes positioned almost as a meal replacement or a way to hit protein targets.

They should not be used that way. 10 grams of collagen peptides does not deliver the same nutritional value as 10 grams of protein from eggs or fish or chicken.

Now, bone broth is a great way to support collagen intake. A slow-cooked bone broth made from quality organic animal bones simmering away for many hours is rich in collagen precursors, glycine, proline, and minerals including calcium and magnesium.

I use bone broth as a cooking base constantly. It's one of those foods that in my view, the traditional food cultures have really got absolutely right. So if you're using a collagen supplement,   Look for hydrolyzed collagen peptides. Around 10 grams per day is a common therapeutic dose used in research. Now, let's talk about the foods to remove to support joint and body aches and [00:25:00] pains.

I'm gonna say this firmly and directly because it is important and you need to listen in. Sugar, refined carbohydrates, industrial seed oils like the sunflower, canola, soy, corn oil, and processed foods. These are not sometimes foods when you are dealing with inflammatory joint pain.

They are the fuel on the fire. Sugar directly activates inflammatory pathways.

Refined carbohydrates spike blood glucose and insulin, both of which promote inflammatory cytokine production. And those vegetable oils high in omega-6 fatty acids shift your cell membrane composition in exactly the wrong direction like we were talking about before. Now, I follow a clean eating, gluten-free, dairy-free approach myself, and this isn't just a personal preference.

I do it because health and longevity, like living a long, healthy life for as long as possible, is a really important value of mine, and I don't want to get joint aches and pains as I get older. This year I turn 50, and it's even more important than [00:26:00] ever. For the majority of women with inflammatory joint conditions, removing gluten and dairy makes a significant difference to joint pain and stiffness.

Gluten can drive intestinal permeability, also known as leaky gut, and when the gut barrier becomes compromised, inflammatory molecules like gluten and dairy for many people can enter the bloodstream and drive a systemic inflammation reaction, including in the joints.

I talk about this in detail in my three-week inflammation detox program and my 12-week program, of course. It's one of the reasons that my programs produce such amazing and consistent results for the ladies who join.

Alcohol also deserves a mention here. Alcohol is directly pro-inflammatory. It disrupts the gut microbiome, it raises inflammatory cytokines, and it interferes with sleep, which we will talk about later in this episode too. So if joint pain is an issue for you, alcohol is not your friend.

Well, I'd say alcohol is not your friend full stop, but especially not if you have any systemic inflammation. Just as I mentioned, I'm turning 50 in a [00:27:00] few months, and I'm navigating through perimenopause and on the edge of menopause with very little symptoms.

Though one of my symptoms in perimenopause has been lower leg and foot cramps. Not just mild foot cramps and mild discomfort. I'm talking about waking up in the middle of the night, like screaming, "Ah," because my lower leg and foot are so cramped up, like front of the leg, back of the leg, like all over, that I literally have to jump out of bed, throw my foot to the floor, and stretch it out as fast as I can.

And sometimes that doesn't even work. Like, thank goodness I can do dry needling because I usually have to get a needle in the middle of the night, stick it into my leg, and that is the only thing that settles it. It is not pleasant, and for anyone who's had this experience with calf cramps, you know exactly what I mean.

Okay. So I play paddle tennis or padel, and I play around five times a week, and the explosive movements, the jumping, the short, sharp changes of direction have made this worse. And I've been working really hard on my court footwork, trying to get that better and all of these [00:28:00] specific little footwork drills to get faster and get more agile so I can win more games.

And all of that repetitive lower limb work was really contributing to the cramping. Now, here's the nutritional piece I wanna highlight. As long as I keep a consistent anti-inflammatory diet, which I do, it's just part of my life, the cramping is mostly manageable. But what has made a dramatic difference on top of the diet is creatine, daily creatine supplementation.

Creatine is a naturally occurring compound found primarily in muscle cells, where it plays a key role in recycling something called ATP. ATP is essentially like the energy currency of every single cell in your body. Think of ATP as, uh, as the battery that powers your muscle contractions.

That's a good way of thinking about it. Creatine allows that battery to recharge faster. When you have adequate creatine stores in the muscle, the muscle can work harder and recover faster

And here is something the research is telling us increasingly clearly. [00:29:00] Creatine is not just for athletes and gym-goers. For perimenopausal and post-menopausal women, creatine is emerging as one of the most evidence-supported supplements for maintaining muscle mass, supporting bone density, supporting cognitive function, and yes, muscular endurance and recovery, which directly affects cramping and joint support.

I came across a 14-week study which found creatine supplementation significantly increased lower body strength in post-menopausal women, and combined with resistance training, the benefits are even stronger. So my recommendation is three to five grams of creatine monohydrate daily. Monohydrate is the most researched and most cost-effective and most well-tolerated form.

You don't need to load it up. You do not need to cycle it in and out, just consistent daily use. So I take mine every morning

I've also had to do significant work strengthening my calf muscles. Now, I will come back to that later in this episode, but the combination of diet and creatine has genuinely changed this for me. Other [00:30:00] supplement non-negotiables for muscle cramping is magnesium.

Magnesium plays a direct role in muscle relaxation. It is essentially the physiological off switch for muscle contraction. When magnesium is low, Muscles stay in a heightened state of tension and are much more prone to cramping. I take 300 to 400 milligrams of magnesium glycinate before bed every night.

It supports muscle relaxation, it supports sleep, and it's one of the most underappreciated minerals for midlife and post-menopausal women.

[00:31:00]

 

Now, as I have said, I wanted to break this podcast into three sections. Nourish was addressing food as medicine. In this next part, we heal, looking at lifestyle tools from my [00:32:00] naturopathic perspective.

So let's start with sleep, the anti-inflammatory medicine you are likely not getting enough of. I want to start the heal section here because I really, really believe that if I could give women one non-negotiable lifestyle intervention for inflammatory joint pain, it might just be sleep

During deep sleep, the body goes

Through its primary tissue repair cycle. Growth hormone is released. That's the hormone that drives the muscle protein synthesis, collagen production, and cartilage repair. The glymphatic system, which is the lymphatic system of your brain, like the brain's waste clearance system,

Well, it runs an overnight cleaning cycle, and inflammatory cytokines are actively suppressed during adequate sleep. Chronic sleep deprivation directly raises TNF-alpha, interleukin-6, and C-reactive protein, the very inflammatory markers that drive joint pain there is also a very direct connection to pain perception.

Sleep deprivation lowers the pain [00:33:00] threshold. You feel pain more acutely when you are tired, and you enter a terrible loop. Pain disrupts sleep. Sleep deprivation makes pain worse. Worse pain disrupts sleep further, and breaking that loop is one of the most important things you can do My minimum target for women managing inflammatory joint pain is seven to eight hours of sleep.

But it's not just that quantity, it's the quality. Deep uninterrupted sleep is when the real repair happens. If you're waking frequently, if you are lying awake for long periods, if you are not feeling rested in the morning, this is something that needs to be addressed directly. Sleep hygiene, screen time management, get off those phones, the sleep hormone melatonin and its relationship to estrogen in perimenopause.

It's all important stuff. I've talked about this in previous episodes, but it's also a topic that deserves its own episode, and we will come back to it in the future Now I want to talk about something I find fascinating clinically, and that is increasingly supported by the research, the [00:34:00] relationship between gut health and joint health.

The gut microbiome, the community of trillions of bacteria, fungi, and other microorganisms living in your digestive tract, it regulates a significant portion of your immune activity

Approximately 70 to 80% of your immune system lives in and around your gut. When the microbiome is healthy and diverse, the immune system is healthy too. It responds when it needs, and it settles down appropriately when it's not needed to respond. When the microbiome is disrupted, which we call dysbiosis, the immune system can become dysregulated, generating inflammatory responses that should not be there or failing to resolve inflammatory responses that need to be switched off.

The connection to joints goes even further.   There is a growing body of research on the gut-joint axis, showing that specific bacterial imbalances in the gut microbiome are associated with conditions including rheumatoid arthritis and ankylosing spondylitis. [00:35:00] Gut bacteria produce something called short-chain fatty acids, particularly butyrate, which has direct anti-inflammatory effects on joint tissue.

When the bacteria producing those compounds are depleted, you lose that anti-inflammatory signal

Now, intestinal permeability, the leaky gut I mentioned earlier. It allows bacterial fragments called lipopolysaccharides, or LPS, to enter the bloodstream. LPS directly activate the immune system and drive systemic inflammation. For women with inflammatory joint pain, healing that gut lining is often one of the most important steps in reducing the inflammatory load on their joints.

Particularly, this means feeding your microbiome with prebiotic fibers, onions, garlic, asparagus, green banana, oats, legumes.

Adding fermented foods if you can tolerate them, like sauerkraut, kimchi, kefir, quality yogurt if you can tolerate dairy, or coconut yogurt if that's okay for you too. And then remove the gut disruptors: sugar, alcohol, [00:36:00] processed foods, unnecessary antibiotics as well. Antibiotics are there for a reason, but if you don't really need to take them, don't take them.

And in clinical practice, I often use targeted probiotics based on an individual-specific pattern. Now, the specific strain matters more than you realize with probiotics. Generic off-the-shelf products are

not the same as targeted therapeutic probiotic strains. For example, look, I know it's not joint health per the topic today, but my mom suffers from osteoporosis, and I have her on a daily probiotic that is specific for bone health. We think she hasn't had any further spinal compression fractures since she started taking this, though it's, it's hard to know, but that's what she tells me.

And I, I don't know, I just wish that I had that research and that product was around a little earlier, so I could have had her on it sooner.

Now, moving on. I cannot talk about inflammation without talking about stress. Cortisol, the primary stress hormone, in acute short bursts is actually good. This is the body's [00:37:00] short-term strategy to deal with a crisis. It mobilizes energy, and it deals with the threat.

This is the body doing exactly what it's supposed to do. But chronic low-level ongoing stress does the opposite, where the inflammation response then kinda just runs unchecked. There is also a direct connection to gut health. Chronic stress increases intestinal permeability, leaky gut. It disrupts the microbiome.

It shifts the immune system into a pro-inflammatory state. And for women in perimenopause, where the HPA axis, hypothalamus pituitary adrenals, the body's stress regulation system, is already being affected by the shifting hormone patterns, well, the cumulative effect can just start to get really strong

And I do not think we can separate joint pain from nervous system state. A body that is living in chronic stress is a body that cannot regulate its inflammatory response properly. Practices that support the nervous system, whether that is movement, time in [00:38:00] nature, breathwork, connection, adequate rest.

These are not just little nice to have extras. They are an important part of any treatment plan. For me, this is why I spend one week in every five weeks working from my house in Port Fairy. This is a house I bought after I sold my clinic in Adelaide, and it's near where I grew up.

It's my recharge place. It's a non-negotiable nervous system reset for me. The slowing down, the sea air, Sunny, my cutest puppy in the world, running on the beach. These are my medicine

Okay, let me give you the key supplements with the strongest clinical rationale for joint health. We have already covered omega-3, creatine, and magnesium. Here are the extra ones that I think are really worth knowing about. Curcumin. As I mentioned earlier in this episode, curcumin comes from turmeric.

It's a natural COX-2 inhibitor. In supplement form, the challenge with curcumin is absorption. It is poorly absorbed on its own, [00:39:00] so look for products that use phospholipid complexes or piperine from black pepper to enhance bioavailability. Doses in research range from about 500 milligrams to 1500 milligrams per day of standardized extract.

Then vitamin D. Vitamin D receptors are found on immune cells, on cartilage cells, and on muscle cells. Low vitamin D is associated with increased inflammatory markers, increased pain sensitivity, and reduced muscle strength, all of which affect joint health. In Australia, despite our beautiful sunshine, deficiency in vitamin D is common, particularly in the southern states of Australia and particularly in women who are indoors a great deal.

Also women who cover up a lot or who have darker skin tones. I check vitamin D levels in every patient I see who has inflammatory pain, and a therapeutic target of around 100 nanomoles per liter is what I'm aiming for

Then we come to B vitamins. The methylation cycle, which is the body's [00:40:00] process for managing inflammation, detoxification, and cellular repair. Well, that cycle, it requires adequate B vitamins, particularly B12, B6, and folate in their active methylated forms. There's something called an MTHFR gene variant, which affects roughly 40 to 60% of the population to some degree.

Well, that defect, it impairs the conversion of folic acid to the active form.

If you have this genetic variant, normal B vitamins don't quite cut it, as the MTHFR gene variant affects the body's ability to metabolize B vitamins and therefore regulate inflammatory processes as well as detoxification and cellular repair. Methylated B supplements bypass this conversion step.

Now, because I have the MTHFR genetic variant, I take these methylated forms of Bs daily. And B vitamins, whether methylated or not, depending on the person, are a standard part of my clinical toolkit. Then we come to [00:41:00] zinc. Zinc is essential for collagen synthesis, for wound healing, and for appropriate immune regulation.

Low zinc shifts the immune system towards a pro-inflammatory state. Food-wise, oysters are the richest food source. But for most women, if you don't like oysters, like me, a targeted zinc supplement of 15 to 25 milligrams per day is a useful insurance policy. Now, I want to be clear, supplements work best on the foundation of good food, good sleep, and good movement.

There is no supplement that can out-supplement a poor diet. Supplements are not a shortcut. However, in the context of a strong nutritional foundation, the right supplements and supplementing for deficiencies can make a big difference

Now we are going on to our rise section of this Nourish, Heal, and Rise podcast. I want to chat about osteopathy, movement, and rebuilding a resilient body. Now, this might be the most counterintuitive piece for anyone in pain,

but it is one of the most [00:42:00] evidence-backed. Movement is anti-inflammatory. Exercise reduces inflammatory cytokines. It supports the gut microbiome. It improves sleep quality. It regulates cortisol. It promotes tissue repair, and crucially, it builds the muscle that supports your joints. When you are in pain, the natural instinct is to rest, to protect, to move less, and I understand that instinct completely.

But in the case of inflammatory joint pain, gentle, progressive movement is almost always a more effective strategy than rest. So here is what happens when joints stop moving. Synovial fluid, remember that lubricating oil I described, it's only distributed through the joint by movement. So when a joint is still, synovial fluid stagnates.

Cartilage, which has no blood supply of its own, relies on the compression and release of movements to pump nutrients in and waste products out. Think of it like a sponge. Squeezing and releasing is how it stays [00:43:00] healthy, and rest almost like starves the cartilage.

Muscles that stop being used rapidly lose strength and mass. This is a process called disuse atrophy. As muscles weaken around an inflamed joint, the joint loses its primary kind of support structure. Load concentrates onto cartilage and bone rather than being distributed through muscle. The mechanical stress on the joint increases, the pain increases, which leads to more rest, more atrophy, more pain.

This is a really important cycle to break. As an osteopath, I am trained to look at the body as an integrated mechanical system. Pain in one area very rarely exists in isolation. The way you move your ankle affects your knee. The way you move your knee affects your hip. The way you move your hip affects your lumbar spine, and the way your spine moves affects everything above and below it.

Osteopathic assessment looks at movement patterns, joint mobility, [00:44:00] muscular balance, and the way load is distributed throughout the body during everyday activities. Very often, joint pain is driven not just by what is happening at the painful joint itself, but by compensatory patterns elsewhere in the body.

A hip that is not moving well will force the knee or the lumbar spine to take excess load. An ankle that has lost range of motion after an old sprain will change the way the entire lower leg and the lower limb moves

One of the most valuable things I do clinically is help people understand the compensatory patterns that are driving their pain, and then work systematically to address them. Often, treating the pain side alone is not enough. We have to address the whole picture. Part of what I recommend, especially for women in midlife, is progressive resistance training.

This is where you lift progressively heavier loads in a structured, controlled way. It is the single most evidence-backed intervention for protecting joints and reducing inflammatory joint pain in the long term. Here is [00:45:00] why.

Your muscle is the primary load-absorbing system for every joint in your body. The more muscle you have surrounding a joint, the less mechanical stress the joint itself has to manage. Building muscle through resistance training also stimulates collagen synthesis in tendons and ligaments, improving joint stability and resistance.

And skeletal muscle is an endocrine organ. It produces anti-inflammatory molecules called myokines when it contracts, including a molecule called interleukin-10, which is a potent anti-inflammatory signal

This is also the strongest argument I know for why women in perimenopause and beyond need to be in the gym lifting weights. Well, not necessarily the gym. It could be at home, but you need to be lifting weights. Not just for body composition, not just for bone density, although that is very critical, but for the protection of their joints against the inflammatory changes that declining estrogen drives.

The key word here is progressive. The body adapts to the demands placed on it, and it only adapts when the [00:46:00] demand is incrementally increased. The same workout done the same way for years will produce kinda diminishing returns. You have to keep increasing the challenge within your own capacity at a rate that your body can manage.

I train at the Iron Viking Gym in Moorabbin here in Melbourne with a progressive overload programming focus.

And so this is not something I recommend just from a theoretical position. It has been life-changing in my own body, which brings me to wanting to tell you about my back injury

Not because I want to dwell on it, but because I think it is one of the most honest stories I can share about how complex joint and muscular pain can be, and how the right understanding, the right guidance, and relentless commitment to rehabilitation can turn things around even when everything else has failed

When I was 38 years old, I had a disc bulge. I was bent over, twisted, getting a big zucchini slice out of the oven, and I sneezed, And it felt like someone had just stabbed a knife in my low back. So it was a full proper disc bulge in my lumbar spine.

It was a pretty big injury. I [00:47:00] had to have 10 weeks off work. But I did everything right. I was like a textbook case, and that 10 weeks later, I was much, much better. I was generally pleased with how I had managed it. As a clinician, I knew the process, I followed it, and it worked. Then, three years later, everything fell apart again.

My back pain became significantly worse than the original injury, and the strange thing was nobody knew what was going on, not even me. And I'm an osteopath. Like, I diagnose and treat backs every day. But when it comes to your own body, your own pain, your own frustration with your body, I kind of believe that the objectivity disappears, and we all need...

even us therapists need therapists of our own. So I tried everything. I did a full year with a personal trainer, no change. I worked with one of the best dance Pilates specialists in Adelaide for a whole year, and every single session made me worse. My Pilates practitioner eventually told me that she thought I had chronic pain, that the pain had become a brain and nervous system issue rather than a structural one.

So I went to see a psychologist, [00:48:00] and the psychologist chatted to me in that session and said, "No, you do not have chronic pain. You have a back injury. Go back to structural treatment." So then I did a year of yoga, and this was interesting. If I did five sun salutations every morning, I would be okay for that day.

That movement was clearly helping. But then the next day, when I woke up, I had to start from zero again. It was like I was constantly just maintaining, like just holding on with a thread, maintaining something rather than actually ever building anything that was sustainable and getting to the root cause.

The breakthrough came from an unexpected place for me. So I had moved to Melbourne after I met my lovely partner, Mike, and one day I received an email from our professional osteopaths association about a course on spinal stability run by an osteopath colleague of mine, a friend of mine called Paul Hermann, whose clinic turned out to be only 15 minutes from where I was living.

So I rang Paul and booked in an appointment to go and see him. Paul had been studying some new research from the US on spinal instability and hypermobility. Which this combination of the [00:49:00] spinal instability and hypermobility is very common in old dancers and gymnasts.

So here is what he explained to me and what changed everything. When you have a hypermobile body, this is a body where joints are naturally more flexible than the average person, which was me for sure. I used to be able to kick my legs way over my head. And which gives dancers and gymnasts their extraordinary range of motion and flexibility.

But then when you stop the high volume exercise that was providing the constant stabilization of these joints, like when I was dancing professionally, the deep stabilizing muscles begin to lose their conditioning, particularly in the lumbar spine. And so the muscle that Paul was focused on was the, was called the lumbar multifidus.

It's a deep segmental stabilizer of the lumbar spine

Its entire job is to hold each vertebra steady against the forces moving through it. When multifidus is strong and firing well, the spine is rock solid. When it is weakened or not activating properly, each vertebrae kind of shifts under load, which is where the pain [00:50:00] comes from. And in a hypermobile body that has stopped high-volume physical training, or not at that level that you were doing when you were, like for me, dancing professionally, the multifidus can become deconditioned and unstable.

The spine loses its segmental control, and no amount of core work or sit-ups or Pilates or yoga or even gym training will fix this if the specific deep stabilizers are not being targeted. I also discovered through an X-ray, prompted by another friend, osteopath friend of mine, Lou Bibby, who noticed that my hips were very crampy and asked the right questions of me.

From the X-ray, I realized and found out that I had a CAM lesion in my hips. So CAM lesions are bony abnormalities at the femoral head. That's the top part of your thigh bone, like the ball in the ball and socket joint. Well, the CAM lesion there alters the way the hip joints move, and these lesions are very common in people who have done a lot of high-range hip movements, former dancers, gymnasts, [00:51:00] athletes.

I call my injury my too many French can-cans injury Because I spent years kicking my legs up over my head doing the can-can two times a night every night in Paris. The CAM lesions meant I could no longer work in that turned-out position of a ballet dancer, in first position, you might have heard of that.

I could only keep my feet in parallel with my toes pointing forwards. Until I started working with Paul, I had just been managing my pain by doing less and then, of course, getting weaker and more restricted with every passing month. So Paul gave me what I can only describe as tiny, precise rehabilitation exercises for the deep spinal stabilizers.

Not impressive-looking exercises, not anything you'd put on, you know, showy, I- Instagram kind of stuff, but slow, deliberate, low-load movements that required very specific muscle activation. And I did them every single day, multiple times a day, for 18 months. It was about 20 to 30 minutes each time, every day, like I said, multiple times without exception.

[00:52:00] Slowly, slowly, slowly things started to improve

And then I could finally get back into the gym. At the start, I had to be super careful. I am not exaggerating when I tell you that I started doing leg presses at 40 kilograms. Teeny tiny little 40 kilograms. That is less than what some people warm up with. And my Romanian deadlift, something called an RDL, which is one of the best exercises for the back part of your muscles and the strength of the back, the glutes, the hamstrings, well, I started that at 15 kilograms.

But now, 18 months later, my leg press is at 145 kilograms. I'm very proud of that. And my Romanian deadlift is at 55 kilograms. I can't seem to quite push above 55 without flaring my back up a little, and I'm working on that progressively and very patiently, even though that goes against who I am.

I'm not a very patient person. But the difference between where I was and where I am now is not just physical. It's the difference between a body that felt fragile and frightening and a body that now feels really capable and [00:53:00] strong. And here is what I want you to take from this story. It's not about the numbers on the weights. It's about the fact that with the right understanding of what was actually going on in my body, the hypermobility, the multifidus instability, the CAM lesions, and the right rehabilitation approach done consistently over time, the body can rebuild, even after years, six years of not knowing what was wrong and even after trying, you know, everything else.

The most important thing I did was not any particular individual exercise. It was the commitment every single day. 18 months of the same specific rehab exercises done without heroics, without rushing, with total consistency and not giving up, even when it felt really slow. Let me bring this back to what is practically useful for you now.

Start where you are, not where you think you should be. This is something I have to say repeatedly in clinic. There is no shame starting with very light loads, very small ranges of motion, very gentle exercise. Starting [00:54:00] is the thing that matters.

The body will tell you what it can handle, so work with it. And prioritize strength over flexibility. I know this might go against what you've heard before, but for most women with joint pain, and particularly for those with hypermobility, adding more flexibility is not the answer. Stability is the answer.

Building muscle is the answer. Controlled, grounded strength training is the answer.

Stretching and flexibility work can be part of your routine, but do not let just that be your primary focus. Honor the difference between pain and discomfort

Now, learn to honor the difference between pain and discomfort. For some muscles, fatigue and mild discomfort during and after exercise is normal and expected. It's a sign that the tissue is being challenged and will adapt. But sharp pain, pain that persists for more than twenty-four hours after exercise, pain that swells a joint, they're the signals to back off and reassess.

I want you to learn to distinguish between the discomfort of effort, called DOMS, it's that [00:55:00] delayed onset muscle soreness that you can feel a day or two afterwards, and then the warning signals of injury. They feel different when you really pay attention to them. And then walk. Walking is free, accessible, it's weight-bearing, and it supports bone density.

And as we mentioned before, it distributes synovial fluid through every joint in the lower body with every step. Thirty minutes of walking daily is a baseline minimum, not a substitute for resistance training, but a non-negotiable addition to it. And then gather your support team, osteopathy, naturopathy, remedial massage, acupuncture, whatever works for you.

For many women, seeing their practitioners for bodywork especially, well, these treatments support bodies that are in the process of rebuilding. I see osteopathic treatment not as a fix, but as a way of keeping the body moving well through the rehabilitation process.

When the joints are moving better, the muscles fire better, and the strength training is more effective

Now, I want to address something here for the women who are active and dealing with joint pain, because I do not want this episode to [00:56:00] feel like a warning to slow down.

I teach barre twice on Friday mornings every week at Club Balance in Hampton. I play paddle tennis about five times a week, and I lift heavy weights at the gym two to three times, and I walk with Sunny most days

Joint pain does not have to mean giving up the activities you love, but it does mean managing your load intelligently, building the strength that supports those activities, and using your nutrition and lifestyle tools consistently to keep the inflammatory load down. For me, the combination of eating really well, gluten-free, dairy-free, anti-inflammatory, no additives, not drinking alcohol, doing my daily creatine and magnesium, consistent resistance training, and the rehabilitation work that I've built into my routine.

This is what allows me to live an active, full life with the body that I have, even though it's a little bit broken. So it's not perfect. My calf still cramps occasionally. My back has its moments. But these are manageable niggles in an otherwise capable and strong body. That is the [00:57:00] goal for all of us.

Actually, this reminds me of a patient I had a few years ago. I'm gonna call her Joanna for privacy reasons

She came to see me in her early 50s. She'd had a long history of what had been labeled as fibromyalgia, widespread joint and muscle pain that moved around in her body and had no clear structural cause. She had been told it was stress. She'd been told it was her age. She'd been on anti-inflammatory medications for years with very little relief.

When I looked at Joanna's full picture, what I saw was a woman whose diet was high in inflammatory drivers without her even realizing it. She was drinking a glass or two of wine most evenings, thinking it was relaxing her. She was eating a lot of convenient packaged food because she was exhausted every night after work, sometimes keeping those light and easy meals in her freezer just to make things easier, and her gut was clearly in trouble.

She had bloating, irregular bowel habits, and reflux. She was sleeping six hours a night, waking multiple times, and she had essentially stopped [00:58:00] exercising because every time she tried, the pain increased, and she assumed she was making things worse. We started with the diet, removed gluten, dairy, sugar, alcohol, and we added oily fish three times a week.

We added bone broth. We added berries and deeply colored vegetables every day. We got her protein up. We added omega-3, vitamin D, magnesium, and curcumin. Within three weeks, her joint pain was about 50% better, like only in three weeks. By eight weeks, she was sleeping through the night for the first time in years, and at three months, she was back at the pool swimming three times a week, something she'd not done for four years Joanna doesn't have the diagnosis of fibromyalgia anymore.

She had a body that was carrying a significant inflammatory load, and when we removed the drivers and added in the tools, it responded quite quickly, really, in the long-term scheme of things. That is how the body works when we give it what it needs. Okay, let me quickly summarize what we've covered today.

To nourish, [00:59:00] build your plate around the anti-inflammatory Mediterranean pattern. Oily fish three times a week, deeply colored vegetables at every meal, quality olive oil, legumes, if you can tolerate them, minimal sugar and refined carbohydrates. Remove gluten, dairy, industrial seed oils, alcohol.

Prioritize protein at one point two to two grams per kilogram daily. Support collagen with bone broth and quality collagen peptides. Daily creatine monohydrate, three to five grams. Daily magnesium glycinate, three hundred to four hundred milligrams before bed. To heal, protect seven to eight hours of sleep quality as a non-negotiable.

Support gut health through prebiotic foods and fermented foods if you can tolerate them. Manage nervous system stress, not as a nice to have, but as a part of your treatment plan. Add omega-3s at two to four grams of EPA/DHA daily. Add vitamin D to maintain levels around one hundred nanomoles per [01:00:00] liter, and add curcumin with enhanced bioavailability formulation and a methylated B vitamin if you need the methylated form.

If not, just a straight B vitamin. Then to rise, start progressive resistance training and start where you're at, not where you think it should be, not where you think you should be. Prioritize stability and strength over flexibility. Walk daily. Work with a skilled manual therapist if you have specific structural problems driving your pain, because understanding what is actually happening in your body is often more important than any individual exercise.

I want to give you a realistic picture of what to expect as you make these changes

In the first two to four weeks, the biggest shift most women notice is morning stiffness. As the inflammatory load starts to drop, that gluey, creaky, takes half an hour to get going kind of feeling in the morning, it begins to ease. Joints start to feel more fluid, more mobile, less like they belong to somebody 20 years older than you.

By six to eight weeks, [01:01:00] pain levels have shifted noticeably. Not necessarily gone, but much better. Sleep is usually improved too. Energy is usually up. Women often tell me that they feel like they have their body back for the first time in years for many of them. The strength training piece takes longer.

You will not build significant muscle in three months, but you will notice around the eight to 12-week mark that your body feels more capable, more supported, more able to do the things you wanna do without the same level of payback Now, some of this work takes 18 months , like mine did. For those of you with complex patterns, with maybe hypermobility like me, with structural issues that have been built up over years, the timeline's longer, the process is more gradual, and the commitment required, well, it's, it's real.

But the improvement is real too, and every woman I have walked through this process has told me that they wish they'd started sooner. Next episode, we are continuing through our inflammation series, and we are moving   to sign number six, gut health. We are gonna talk about gut lining, the gut [01:02:00] microbiome, SIBO, dysbiosis, IBS, all sorts of stuff, and why we really need to support the gut in order to reduce systemic inflammation in the body.

That one is coming next week. So please hit subscribe or follow the show on whatever platform you're listening on right now, because you do not wanna miss a single episode. And if someone in your life needs to hear this, please share it with them too, because the more women who have access to this kind of information, the better.

Just a little note, all of my free resources, my three-week inflammation detox diet, and my 12-week whole health solution can be found at andrearobertson.health. Everything you need is right there waiting for you

If you loved today's episode, please take 30 seconds to leave a review on Apple Podcasts, Spotify, or wherever you listen to your podcasts. It genuinely helps more women find the show so they can nourish, heal, and rise too. Until next week, nourish your body, keep healing, and never stop rising. I'm Dr.

Andrea Robertson, and this has been Nourish, [01:03:00] Heal, and Rise