In this course, you will learn how the way you eat can affect pain. In every diet, there are healthy choices and not-so healthy choices. It’s important to understand how the food you put into your body can affect your pain so you can make an educated choice.

This course will cover some nutritional basics, as well as introduce you to different Ways of Eating (WOEs). We are not suggesting that you follow any of these WOEs, in particular. However, you will learn why these diets may impact pain levels, through the lens of nutrition. Then, you may understand how to choose more healthful foods for yourself.

What you eat stays with you

When you eat, you’re introducing several compounds into your body. By compounds, we mean nutrients, the building blocks of your food: carbohydrates, fats, proteins, vitamins, preservatives, water, salts, etc. Your body can use some of these in productive ways; they might even relieve some pain. However, some of these can be harmful to you and worsen pain.

Knowing which foods can help and which can hurt will assist you in better managing your pain.

Factors That Affect Pain That Can Be Controlled by Diet

Chronic Inflammation

Chronic pain is often the result of chronic inflammation. Inflammation helps the immune system tackle injury or infection; although, sometimes inflammation sticks around for much too long. This can lead to adverse health effects. For example, it can cause pain in the muscles, tissues, and joints, and/or damage cells and organs.

Inflammation is triggered by the immune system. So, we must consider this when trying to remedy the problem. The immune system can be thrown off by a poor diet. Processed foods, with low nutritional value, can trigger an immune response. Likewise, a lack of healthy nutrients can change how the immune system responds. Either can lead to more inflammation than normal.

Conversely, foods that are rich with antioxidants are anti-inflammatory. This means they calm inflammation. Eating more antioxidant-rich foods can prevent and improve pain flare-ups. Antioxidants are found in berries, nuts, dark leafy vegetables, legumes, and whole grains.

Additionally, Omega-3 Fatty Acids can also control inflammation. This healthy type of fat is found in olive and flaxseed oils, and fatty fish (e.g., salmon). Omega-3s reduce two proteins that are responsible for inflammation. They are called C-Reactive Protein (CRP) and interleukin-6.

In summary, eating processed foods and foods with low nutritional value can increase inflammation, while eating foods with antioxidants or omega-3 fatty acids can reduce inflammation.

**Note before beginning the following section: Your worth in this world is not tied to your body size. All body sizes are beautiful – each person is uniquely special. Additionally, health is not always associated with body weight. Further, we are not suggesting that you drop extreme amounts of weight. Before losing weight, you should talk with your doctor. They may have some additional resources or recommend against it based on your own personal health. Lastly, weight-loss should not be your primary goal. Focus on increasing your activity and eating healthier foods; then, weight loss will naturally follow. We do not condone or recommend unhealthy routes of weight loss.**

Obesity

Some chronic pain conditions are worsened by excess bodyweight. If you have pain in weight-bearing joints, such as the knees, spine, hips, or feet, this might apply to you.

Extra body weight increases pressure on the body’s frame. It may cause added wear and tear to your body. Studies suggest that dropping just one pound can reduce up to four pounds of pressure on the knees. Further, for those with arthritis, pain relief and daily functioning improves as more weight is lost. For fibromyalgia, migraines, and some bone or muscle disorders, weight loss has been shown to reduce pain and improve quality of life.

Being overweight can also reduce your ability to move or exercise easily. This can lead to further chronic pain issues, like loss of muscle mass and flexibility.

Unfortunately, it’s common for pain-relieving medications to cause weight gain. For example, taking opioids can cause sugar cravings. Eating large amounts of carbs (sugar and starch) can make your blood sugar levels unstable. This causes weight gain.

Controlling your carbohydrate and fat intake can help regulate your weight. This can improve your pain levels. Speaking to your doctor about weight loss is an essential step in this process. However, cutting out processed foods that are high in sugar is an easy place to start.

Nutrients and Pain Control

Food is made up of macronutrients and micronutrients. Your body needs macronutrients, like proteins, carbs, and fats, in large amounts to survive. Micronutrients are needed in smaller amounts. These are your vitamins and minerals.

Overall, your body needs each of these to survive. The proportion of each macro- and micronutrient in your diet can affect your pain. In the following sections, we’ll explore how.

Protein

Protein plays a vital role in how your body heals, grows, and functions. Your proteins are in your tissue structures, cell membranes, hormones, and metabolic enzymes. Without protein in your diet, you can’t support any of these biological necessities.

Protein is so important for people with chronic pain. Yet, many people with chronic pain have low protein-intake.

Many of the pain-relieving molecules in our body are made from protein. When we eat protein, it gets broken down into amino acids. These amino acids are then used to build molecules that are essential for pain relief (e.g., endorphins and dopamine).

Do you suffer from muscle weakness or stiffness? Many people with chronic pain do. Protein intake is necessary to maintain muscle mass. Your body needs certain amino acids that it cannot make itself. Without enough protein in your diet, you can’t maintain and build muscle. Also, your body requires a healthy protein-intake to maintain collagen, a major component in skin and cartilage.

Eating protein prevents low blood sugar (hypoglycemia). It stops cravings for carbs and sugar. Protein intake signals the pancreas to secrete glucagon. Glucagon is a hormone that opposes insulin and prevents the storage of extra glucose as fat.

Further, several high-protein foods have anti-inflammatory properties.

In summary, you need protein for pain relief, muscle strength, blood glucose stability, and inflammation control. These are all vital for people with chronic pain.

Some high-protein foods include:

• Meat
• Eggs
• Beans
• Nuts
• Seeds
• Whole grains
• Soy products
• Leafy green veggies

Carbohydrates

Carbohydrates (carbs) are your body’s quick source of energy. You use carbs as fuel during high-intensity exercise. Also, your brain uses glucose (a simple carb) as a primary energy source.

When you eat carbs, they are broken down into sugars, which are stored as fat if they aren’t used as energy. So, if you are more sedentary, you should eat less carbs. This is especially true for high-sugar food items (e.g., sweets, sodas, etc.).

Eating carbs triggers the release of insulin from your pancreas. This then triggers the body’s cells to absorb glucose from the blood.

Some carbs (e.g., high sugar foods) can cause an insulin-spike in response to the rise in blood sugar. This can lead to excess glucose storage and cause a blood sugar crash. Low blood sugar will make you tired and hungry for more carbs.

When carb-intake is high, it stops you from using your fat storage as energy, preventing weight loss. Further, your body might struggle to control your blood sugar levels if you’ve been eating a high-carb diet.

Hypoglycemia (low blood sugar) has been linked to pain flare-ups. Conversely, hyperglycemia (high blood sugar) can make it difficult for your body to heal. Each of these processes contribute to pain pathways. This is why it is important to maintain healthy blood sugar regulation.

The risk of having high or low blood sugar levels is higher when eating processed and refined carbs more often. Healthier carb sources are harder to break down; therefore, they don’t cause your blood sugar to spike as rapidly.

Some examples of carbohydrates are as follows:

Healthy Carbs (complex carbs): vegetables, fruits, beans, whole grains.

Carbs to avoid (refined carbs): white bread and pasta, sugary drinks, soda, candy.

Fats

We’ve been taught that fat is bad. This is so untrue. In fact, eating healthy fats can do wonders for pain.

You cannot survive without fat. Fat provides long-term energy, protects your organs, and regulates your temperature. Further, there are some vitamins (A, D, E, and K) that are fat-soluble. To be digested and used properly, these vitamins need fat.

Indeed, it’s best to avoid foods that are processed and high in saturated fats as these have high cholesterol. They can contribute to plaque build-up in your arteries. A diet high in saturated fats is a risk-factor for heart disease and stroke. However, eating healthy sources of fats can be lifesaving.

Here is a good trick for choosing healthier fats. Look at how solid the fat is in room temperature. Fats that are solid in room temperature (butter, margarine, lard) are saturated fats. These fats have high cholesterol and can contribute to heart disease. Conversely, fats that are liquids (oils) at room temperature are unsaturated. They are usually healthier.

The star of the show is omega-3 fats. In several studies, they were shown to work better than anti-inflammatory drugs, without the side effects. Eating foods with omega-3s can improve pain and inflammation. Also, they’re great for heart health and brain functioning.

You can get omega-3s from cold-water fatty fish like salmon, tuna, or mackerel. Flax, pumpkin, or chia seeds, avocados, walnuts, and pistachios are also great sources of omega-3s.

Important Vitamins and Minerals

Vitamins and minerals are micronutrients that perform hundreds of roles in your body. They support your body’s processes, like healing, building bones, and using energy.

Vitamins are organic molecules that can be broken down. There are two types of vitamins: water-soluble and fat-soluble. This refers to where the vitamins are stored in food.

Water-soluble vitamins can be absorbed directly into your blood as your food digests. They circulate easily and are regulated by your kidneys. In other words, if you have too much, you’ll pee it out.

Fat-soluble vitamins can be found in healthy fats and oils. They require a greater process to enter your bloodstream. This process involves several steps, different organs, and various protein-carriers. Then, your body stores these vitamins in your fat tissues and liver. When your body needs any fat-soluble vitamin, it will release them into your blood.

Minerals are inorganic and maintain their chemical form. They are vital for water-balance. Further, some are major components of healthy bones and protein structures.

**Disclaimer**

Vitamins and minerals are excellent in very specific amounts. However, you can damage your body if you have too little or too much of any vitamin or mineral. Also, they can counteract each other or certain medications. Make sure to consult your doctor if you decide to take any supplements. Getting vitamins and minerals from food-sources usually ensures that you are not overdoing it.

Vitamins and Minerals that are Important for Chronic Pain

Magnesium

This mineral plays a part in relaxing smooth muscles and blocking pain receptors. It is also vital in nerve conduction. Magnesium activates vitamin D. When it is low, numbness and muscle cramping occur. It can be found in spinach, beans, nuts, and whole grains.

Vitamin D

This fat-soluble vitamin helps you to absorb calcium. Without it, you cannot build strong bones. This is important if you take opioids to control your pain. Opioids can disrupt your ability to build bones. Vitamin D can be found in mushrooms, salmon, egg yolks, and fortified milk. Also, your skin makes vitamin D when you’re in the sun.

Calcium

This mineral is necessary for bone strength. It is also a major part of nerve transmission and muscle contraction. Similar to vitamin D, calcium is important if you are taking opioids. Low calcium can cause muscle cramping and fatigue. It can be found in milk products, leafy-green veggies, beans and nuts.

Vitamin E

This fat-soluble vitamin has several pain-relieving properties. It is an antioxidant, anti-inflammatory, and analgesic (pain reliever). It can be found in sunflower seeds, spinach, fish, mangos, avocados, and almonds.

Vitamin B Family

There are many vitamins in the B-family. They are water-soluble and are required for energy metabolism. They help protect your nerves and can reduce inflammation. Whole foods have various types of B-vitamins in them. This includes meat, fish, dairy, leafy-greens, nuts, beans, and eggs.

Reflect

Throughout this course, you will find guiding questions to reflect on what you’ve learned. These questions are an opportunity to apply your learning to your situation. You may find it helpful to write down your thoughts to discuss with a friend.

Did anything you learned in this lesson surprise you? What was it and why?

There are two quizzes associated with this lesson. To take the quizzes scroll past the references and select one from the list under “Lesson Content”, or from the side bar on the left (listed below the title of this lesson).

References

Buyken, A. E., Goletzke, J., Joslowski, G., Felbick, A., Cheng, G., Herder, C., & Brand-Miller, J. C. (2014). Association between carbohydrate quality and inflammatory markers: Systematic review of observational and interventional studies. The American Journal of Clinical Nutrition, 99(4), 813-833. doi:10.3945/ajcn.113.074252

Edmonds, S. E., Winyard, P. G., Guo, R., Kidd, B., Merry, P., Langrish-Smith, A., . . . Blake, D. R. (1997). Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double blind trial. Annals of the Rheumatic Diseases, 56(11), 649-655. doi:10.1136/ard.56.11.649

Fraser Health. (n.d.). Nutrition and Chronic Pain. https://www.fraserhealth.ca/health-topics-a-to-z/chronic-pain/manage-chronic-pain/nutrition-and-chronic-pain#.XxWv9JNKh_Q

Ghosh, R., Alajbegovic, A., & Gomes, A. V. (2015). NSAIDs and Cardiovascular Diseases: Role of Reactive Oxygen Species. Oxidative Medicine and Cellular Longevity, 2015, 1-25. doi:10.1155/2015/536962

Gruenwald, J., Petzold, E., Busch, R., Petzold, H., & Graubaum, H. (2009). Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in Therapy, 26(9), 858-871. doi:10.1007/s12325-009-0060-3

Haghiac, M., Yang, X., Presley, L., Smith, S., Dettelback, S., Minium, J., . . . Mouzon, S. H. (2015). Dietary Omega-3 Fatty Acid Supplementation Reduces Inflammation in Obese Pregnant Women: A Randomized Double-Blind Controlled Clinical Trial. Plos One, 10(9). doi:10.1371/journal.pone.0137309

Harvard Medical School. (2018, July). Can diet heal chronic pain? Harvard Health Publishing. https://www.health.harvard.edu/pain/can-diet-heal-chronic-pain

Harvard Medical School. (2020, April). Understanding acute and chronic inflammation. Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/understanding-acute-and-chronic-inflammation

Jonas, W. B., Rapoza, C. P., & Blair, W. F. (1996). The effect of niacinamide on osteoarthritis: A pilot study. Inflammation Research, 45(7), 330-334. doi:10.1007/bf02252945

Society for Endocrinology. (2018, March). Glucagon. You and Your Hormones. https://www.yourhormones.info/hormones/glucagon/#:~:text=The%20release%20of%20glucagon%20is,by%20cells%20in%20the%20pancreas

Tennant, F. (2012, December 21). A Diet for Patients With Chronic Pain. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/complementary/diet-patients-chronic-pain

Washington State University. (n.d.). Nutrition Basics. https://mynutrition.wsu.edu/nutrition-basics#:~:text=Nutrients%20can%20be%20divided%20into,body%20needs%20in%20smaller%20amounts