We Are What We Eat: The Role of Food in Chronic Pain
LAS VEGAS — Ensuring good nutrition is vital to overall health and well-being. It should therefore not be surprising to learn that nutrition can influence chronic pain.
This topic was addressed by Heather Tick, MD, Clinical Associate Professor in the Departments of Family Medicine and Anesthesiology and Pain Medicine at the University of Washington Medicine, in Seattle, at PAINWeek 2016.1
“Food is the first thing I talk about with most of my patients,” she states in the introduction to her presentation. “Why is that so important [to talk about food]?” she asks. “Basically, it is because every single time you eat, you change your body chemistry. And that is not an exaggeration; you either increase your inflammation, or you decrease your inflammation.”
She reported that this statement is often met with surprise in her patients, who do not always realize the influence nutrition has over their state of well-being, and it “can be something that affects them quite quickly,” she continues.
Dr Tick quizzed the audience to determine their knowledge on the microbiome, which “has a profound effect on the inflammation and immune systems and our mood, is not a drug, has 10 times as many cells as us, and 200 times as much DNA as us.” The microbiome is “the mass of microorganisms that inhabit us.” The gut contains 70% to 80% of our immune system and 80% of serotonin is produced in this organ.
“We are what we eat; to be more specific, we are what we ingest, digest, and absorb, and the microbiome has a key role to play in that,” adds Dr Tick.
She then detailed the benefits of the Mediterranean diet, the food pyramid, and how the average American diet has a calorie surplus and is highly glycemic with 85% to 90% of carbohydrates, yet is deficient in micronutrients.
Dr Tick emphasized that food choices can increase or decrease inflammation. Chronic inflammation has been determined to be the root cause of many chronic diseases, from automimmune disorders like lupus to rheumatoid arthritis and cancer.
Among foods that Dr Tick recommends are vinegar and cinnamon, both of which have been found to reduce increases in blood sugar by 20% to 30% and 6%, respectively. Patients are advised to avoid foods that include chemicals that damage the microbiome, foods high in sugar, processed foods, aspartame and sucralose, antibiotics, pesticides, carrageenan (made from seaweed and used as a food texturizer), and nonsteroidal anti-inflammatory drugs (NSAIDs).
Recommended as well as ill-advised foods are listed on Dr Tick's website, which also includes healthy and anti-inflammatory recipes.
“Let's talk about a few good things,” Dr Tick continues. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are the active omega-3 fats in fish oil; they are analgesic and improve mood as well.
Dr Tick further discussed the need to assess vitamin D levels in pain patients, as vitamin D is known to decrease levels of inflammation. The chronic pain population, including those with fibromyalgia, is generally deficient in vitamin D. Pain patients without adequate vitamin D levels tend to stay on opioids twice as long and take twice as much of the drug as patients with appropriate vitamin D levels.
Dr Tick also recommendeds magnesium to her patients with neuropathic pain as she has found it to be beneficial. Magnesium inhibits the release of acetylcholine from motor endplates, making it an effective muscle relaxant. Diabetes—which is highly prevalent in patients with chronic pain and a major cause of pain, decreased healing, and neuropathy—is improved by restoration of adequate magnesium levels. The electrolyte also improves inflammation, fibromyalgia, and myofascial pain.
Turmeric, one of Dr Tick's “favorite topics” and that she dubs an “absolute superfood,” has been studied for osteoarthritis and perioperative pain. Treating patients with turmeric prior to surgery has been shown to decrease the amount of opioids and NSAIDs required postoperatively and to improve long-term recovery. Turmeric contains 6 identified NSAIDs. “In that way, it is able to be more subtle in its effect on the inflammatory system,” she adds. "The problem with NSAIDs is that they work too well. They cut off too much of the inflammation, and the first step of healing is an inflammatory step, and turmeric seems to preserve that. They have been very fewer adverse effects with turmeric than with NSAIDs.”
At the conclusion of her presentation, Dr Tick engagedthe audience by asking, “If you had a drug [that] reduced diabetes by 93%, heart attacks by 81%, strokes by 50%, and all cancers by 36%, would you give it to all your patients?" Maintaining a body mass index below 30 kg/m2 and exercising moderately (for half an hour a day or 3.5 hours a week) [maintained] for 7.8 years provides this amount of improvement in health."
- Tick H. Nutrition for chronic pain. Presented at: Pain Week 2016. Las Vegas, NV; September 6-10, 2016.