Diet and Pain

By Teresa Dews, MD

You wouldn’t treat high blood pressure, high cholesterol or obesity without also addressing a patient’s diet. The same should be true for chronic pain.

Patients’ dietary choices contribute to acute and chronic inflammation, a major underlying mechanism in many chronic diseases and pain syndromes.

You don’t need to be a nutrition expert

Diet optimization is fundamental to the success of pain management therapies. But you don’t need to be a nutrition expert to guide patients in healthier eating. Your role can be as simple as encouraging patients to:

• Follow the current Dietary Guidelines for Americans
• Eat mostly fresh seasonal food
• Limit convenience and processed foods
• Eat out less often

Those basics can help patients reduce pain levels naturally by avoiding:

1. Sugar

Added sugar is pervasive in manufactured food. It acts as a preservative and hides the unsavory chemical flavors that may result from processing. Sugar also triggers the desire for more sugar and can lead to overeating or addictive eating behavior.

Nearly 75 percent of processed food has added sugar — predominantly the sweeter, lower cost high-fructose corn syrup. People who eat processed food may be unknowingly overconsuming added sugar, which can lead to a host of pain-causing conditions, including chronic inflammation, diabetes and cardiovascular disease.

There are multiple factors that lead to the development of type 2 diabetes. However, excess sugar triggers an increase in insulin. High insulin levels over time can lead to insulin resistance in the liver and other tissues, and eventually type 2 diabetes when pancreas beta cells can no longer produce enough insulin to compensate. Diabetes can lead to organ damage and painful neuropathy.

High blood sugar also triggers pain by endogenous formation of advanced glycation end products (AGEs), which interfere with multiple cellular functions and increase inflammation. For example, a patient may have pathology associated with joint degeneration, but arthritic pain may be intermittent. Inflammation is one variable that makes arthritis symptomatic.

Thirdly, sugar can increase pain by increasing body weight. Sugar not needed in the bloodstream or in short-term glycogen stores is converted to fat. People who are overweight or obese suffer more with joint pain, fibromyalgia, back pain and other musculoskeletal conditions.

1. Processed carbohydrates

In order to be used by the body, all carbohydrates except fiber are converted to sugar.

Natural carbohydrates associated with plants are beneficial to the body because they provide energy and are associated with other nutrients in the fiber. It’s the carbohydrates manufactured into processed food that can be harmful.

For example, whole grains, the seeds of a plant, are natural. However, they don’t store well because they are prone to oxidation and rancidity. When the bran, wheat germ and wheat germ oil are removed from grain, we get shelf-stable flour. This refined grain is no longer a whole food. It’s low in fiber, low in naturally occurring oils, low in any other associated nutrients — and is metabolized in our bodies just like sugar. In fact, the glycemic index of grain, including wheat and whole-wheat products, can be similar to candy. The impact on pain conditions is the same as that outlined for sugar.

Unfortunately, the majority of food ingested in the United States is processed.

1. Damaged fats and oils

Fats can be beneficial, neutral or damaging. It’s their ability to oxidize that determines their harmfulness.

We all know trans fats are problematic. The reason trans fats have a high correlation to all-cause mortality is because they cause oxidative damage in blood vessel endothelium and other tissues.

Vegetable oils, which are highly processed from the seed of a vegetable using high heat or chemicals, are easily oxidized. Because they are molecularly fragile, a small percentage of the oil converts into trans fat during manufacturing.

Vegetable oils are highly concentrated in omega-6 fatty acids. Our bodies use omega-3 and -6 oils as part of the inflammation cascade, helping manage the inflammation needed for healing. But when the ratio is off, too much omega-6 can amplify inflammation. Instead of healing tissue, the inflammation can cause more damage and pain.

1. Toxins

Ingesting pesticides and herbicides can create illness and pain as the liver, kidneys, lymphatics, skin, gastrointestinal system and respiratory system work overtime to detoxify. Patients can minimize exposure to these toxins by sourcing their food wisely.

Organic foods are the cleanest options, although they may be more difficult to find and slightly more expensive. I tell my patients that if buying organic isn’t always feasible, compromise. At least buy organic for produce deemed the “Dirty Dozen” by the Environmental Working Group:

1. Strawberries
2. Spinach
3. Nectarines
4. Apples
5. Peaches
6. Pears
7. Cherries
8. Grapes
9. Celery
10. Tomatoes
11. Sweet bell peppers
12. Potatoes

Help your patients take action

When asking patients about lifestyle conditions, such as their exposure to tobacco or stress, also inquire about their access to healthy food. Encourage them to make more critical food choices and reinforce the connection between their nutrition, general health and pain.

Dr. Dews is Eastern Region Vice Chair of Pain Management at Cleveland Clinic, and Chair of Pain Management and Medical Director of the Pain Management Clinic at Cleveland Clinic Hillcrest Hospital.

References

Estadella D, da Penha Oller do Nascimento CM, Oyama LM, et al. Lipotoxicity: effects of dietary saturated and transfatty acids. Mediators Inflamm. 2013;2013:137579.

Hebebrand J, Albayrak Ö, Adan R, et al. “Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior. Neurosci Biobehav Rev. 2014 Nov;47:295-306.

MacLellan GA, Dunlevy C, O’Malley E, et al. Musculoskeletal pain profile of obese individuals attending a multidisciplinary weight management service. Pain. Published online: April 5, 2017 (doi: 10.1097/j.pain.0000000000000918).

Popkin BM, Hawkes C. Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. Lancet Diabetes & Endocrinol. Vol. 4(2):174-186.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th ed. 2015.