The Role of Diet in Chronic Pain

Our food choices often play a major part in the development of chronic pain. All of the ways our diet affects our internal chemistry is too big a topic for this forum, but there are some key elements I want to discuss. Just making a few changes may produce a dramatic improvement in longstanding cases of pain.

Inflammation is a condition present in almost all chronic pain. Certain foods have a tendency to contribute to inflammation, others are relatively neutral, and some special edibles actually help reduce inflammation.

Foods that tend to promote inflammation include sugars (sucrose, corn syrup, evaporated cane juice, agave nectar, etc.); wheat flour (bread, muffins, bagels, cake, cookies, pasta, etc.); fried foods and trans fats (margarine, hydrogenated oil, shortening); junk food and fast food (pretzels, chips, beef jerky, french fries, etc.); most polyunsaturated oils (corn, sunflower, cottonseed, and others); and fatty meats (chicken with the skin, bacon, ribs).

If you experience chronic pain, it is worth avoiding these foods. Also, go easy on dairy products, poultry, and red meat. Regarding red meat, wild game (venison, elk, bison, rabbit, etc.) tends to be less problematic than farmed meat, and meat from grass fed animals is significantly better than grain fed.

There is a wide range of human variation, so I am usually hesitant to say “such-and-such is good for everyone” and “such-and-such is bad for everyone.” It’s possible that your body manages the above foods better than average. But everyone could do without them, and most will feel better. Even if eliminating these foods doesn’t affect your pain, you are likely to experience other health improvements by kicking them to the curb.

If there are any foods you have a sensitivity to, these should be avoided as well, since their consumption may provoke an inflammatory response – even if they’re not foods that are intrinsically pro-inflammatory. The most common culprits are wheat products, corn products, soy products, dairy products, and eggs.

One method for determining whether you have any food sensitivities is through lab tests. A naturopathic physician is usually your best bet if you’d like to have this testing done. Lab tests do vary in their accuracy, however. I have had patients bring in lab results that stated they were sensitive to foods they seemed to handle just fine, and failed to identify foods they had glaring difficulties with. So, I think the lab results may highlight some problematic foods, but there should be follow through to determine whether the results are accurate.

The most accurate method for determining food sensitivities is going on an elimination diet. This means limiting your diet to just a few foods that are almost never problematic for anyone (such as salmon, rice, and certain bland vegetables). If your symptoms improve while on the elimination diet, after about two weeks you can start systematically reintroducing suspected foods, one at a time, and carefully monitoring your body’s response. Against the “clean canvas” of the elimination diet, problematic foods often cause glaring responses, which makes them easier to identify. In contrast, when you consume foods that you’re sensitive to on a daily basis, it’s often difficult to perceive any difference in how you feel after one more serving of this food. You can find more details by searching for “elimination diet” online, and by working with a natural healthcare provider.

An interesting mechanism is at play in certain cases of food sensitivity-provoked pain. It’s called Leaky Gut Syndrome (LGS). In LGS, the intestinal lining loses its integrity and ends up leaking food particles and bacterial toxins directly into the blood stream. (This should not happen normally; bacteria and their excretions should stay in the gut, and intact food particles must be more thoroughly broken down before they can be safely absorbed.) Intestinal leakage can result from an inflammatory bowel disease, certain microbes, repeated exposure to foods we’re sensitive to, and some drugs. The leaked substances may cause inflammation throughout the body, including our joints and heart. Many naturally-oriented medical practitioners can prescribe a course of treatment to restore gut integrity, although the removal of any offending agents is key.

People with chronic pain, especially joint pain, often report an improvement from cutting out vegetables in the nightshade family (potatoes, tomatoes, peppers, eggplant, wolfberries [“goji” berries], gooseberries, tomatillos, paprika). It isn’t clear why these plants should provoke joint pain, and there aren’t any great human clinical studies to support this. Some have theorized that it’s the solanine (and/or a related compound called chaonine), a poisonous constituent of (mostly the green parts) of some of these plants, that contributes to pain, (although solanine poisoning usually begins with nausea and gastric upset). It has been suggested that solanine can interfere with calcium in the body, causing its loss from bone and its deposition in muscle. Others believe the problem with nightshades is the content of minuscule amounts of nicotine, also a poison, that may inhibit tissue healing. In any case, I believe it’s worth avoiding these foods for a month just to see if there is any benefit.

Although I think it’s most important to remove any foods that are insulting your body, it is also worthwhile to add foods that help mend your body. Anti-inflammatory foods include:

– Monounsaturated fats such as olive oil and macadamia nut oil (don’t cook with olive oil though – it’s best unheated); omega-3 fat sources, like ground flax seed and flax seed oil, walnuts, oily fish like salmon, sardines, and halibut; and other good fats, such as avocado, coconut, hemp seed, chia seed, and pumpkin seed. Fish oil, in particular, is a powerful anti-inflammatory agent that benefits many kinds of pain.

– Green tea. Several cups of green tea a day (or an encapsulated extract) may be a worthwhile and pleasant routine to adopt. Besides its antioxidant benefits, green tea appears to have some preventive value for joint pain, including rheumatoid arthritis.

– Brightly colored and deep green fruits and vegetables are rich in pigments and nutrients that have a host of beneficial properties, including promoting cell repair and alleviating inflammation. One worth trying, especially if you never have, is nettles. You can find nettles in most parts of the country. They’re covered with stinging hairs, and should be picked with gloves on, but the sting goes away after they’re cooked (steaming is my preferred method). A German study found that nettle leaf extract inhibits certain inflammation-provoking compounds that play a role in rheumatoid arthritis. For best health, vegetables should comprise the largest portion of your diet.

– Spices. Early spice traders treated these plants like gold for good reason. Many of them, such as turmeric, rosemary, ginger, basil, cloves, cilantro, and oregano, are not just delicious, they also have anti-inflammatory properties. Turmeric and ginger are especially powerful in this regard. Turmeric is a strong anti-inflammatory – a property that seems concentrated in a constituent called curcumin. Studies show it improves joint pain and stiffness. Ginger inhibits the COX-2 enzyme that is instrumental in inflammation – several new pain drugs target this same enzyme.

Besides pain, inflammation has been shown to play a critical role in numerous other health problems, including cardiovascular disease, Alzheimer’s disease, and depression. So, it’s safe to say, even if your pain disappears, it’s always worthwhile to do whatever you can to reduce inflammation by eating well.

I discuss this topic in greater detail, along with a test to determine your approximate inflammatory load, and a million ways to reduce your pain in my online course, Live Pain Free. Check it out!