Diet and Chronic Pain

Introduction

Numerous research studies have confirmed that diet and nutrition play a significant and important role in the management of pain. Success relies on a multidisciplinary and multidimensional approach, incorporating lifestyle & dietary changes to achieve optimum health and well being.

Nutritional therapy is using diet to treat and prevent illness, and restore the body to a natural healthy equilibrium. Some believe that deficiencies of minerals and vitamins are responsible for much disease and weakness in the body. Examples of conditions resulting from deficiencies include fatigue, lethargy and susceptibility to colds and viruses. 

The foods we eat are far less nutritious than they appear thanks to intensive farming methods, pesticides, additives and preservatives. We now know that food intolerance and allergies significantly contribute to various conditions such as asthma, eczema and rheumatoid arthritis. But on a more positive note, we also know that certain types of food can actually support and stimulate the body's ability to heal itself. A healthy diet is one in which the food you eat contains all the nutrients needed by the body for it to grow, heal and to function on a day-to-day basis. Diets that are low in fat and cholesterol, and high in whole grains, dietary fiber, fruits and vegetables, are healthier and provide more energy. 

As a general rule, supplements should be taken regularly over a period of months. Vitamin B3 and B6 and magnesium deficiencies are well recognized in fibromyalgia sufferers and therefore taking a good quality multivitamin and multi mineral supplement is the best way of ensuring you to get a balance of nutrients.

Eating the right kind of food can go a long way in helping your body's own healing forces. You need sulfur-containing foods to repair and maintain bone, cartilage and connective tissue. Foods high in sulfur are - asparagus, eggs, garlic and onions. Eat less saturated fat and more alkaline-forming foods like organic fruits and vegetables. Other good foods are green leafy vegetables, fresh vegetables, non-acidic fresh fruit (avoid oranges, plums and rhubarb), whole grains, oatmeal, brown rice and fish.

Certain foods may aggravate various musculoskeletal conditions and therefore should be avoided. They are dairy products, gluten (as found in wheat, oats, barley and rye), corn, sugar and members of the nightshade family - potatoes, tomatoes, eggplant, peppers and tobacco. Reduce your intake of acid-forming foods such as tea, coffee, alcohol and red meat. You may want to check for other food allergies as well (especially if you have Fibromyalgia / Chronic Fatigue). Coenzyme Q10, a vitamin-like substance, plays an important role in the enzymatic process of producing energy within cells and particularly muscles. Your doctor can perform a blood test to determine your CoQ10 levels, if low, supplements of 100mg per day may actually boost energy levels and help lift fatigue and lethargy.

Foods to Favor

Chlorophyll reduces inflammation and so enjoy a generous serving of leafy green vegetables with each meal. You may wish to supplement with the superior chlorophyll sources spirulina, dunaliella, chlorella and blue green algae. Sprouts and wheat-grass and barley grass juice are also excellent chlorophyll sources. However immature alfalfa sprouts (those that have not yet set forth their first two leaves) are to be avoided as they contain an amino acid, canavanine, which exacerbates arthritic conditions.

Both cherries and pineapple reduce inflammation. Pineapple contains the anti-inflammatory enzyme, bromelain. This impressive protein-digesting enzyme literally consumes foreign microbes and diseased cells in your system. So next time you're at market and smell a musky-sweet pineapple aroma…buy pineapple. Pass on green pineapples, they have no aroma (especially at their base) and will never ripen. At home, savor fresh pineapple in sorbet, salad and by the slice.

The spice, turmeric, increases ligament flexibility and so is especially useful in the case of stiffness. Additional foods and culinary herbs that reduce inflammation and support healing of muscles, ligaments and tendons include the onion family, flax oil, burdock, ginger, yam, winter squash, sweet rice, millet and chamomile.

In terms of your overall diet, favor easy to digest, whole foods that are freshly prepared. They have the necessary nutrients to cleanse, build and maintain your whole body. Then your body functions optimally plus has extra energy to repair the inflamed and damaged muscles and ligaments.

Try to keep your diet to 40% carbohydrate / 30% protein / 30% fat.

FOODS TO AVOID

A first step is to determine if you've any food sensitivities and, should you do so, then avoid those foods. A common group of foods that intensify pain, even in people who otherwise do not have food sensitivities, are the nightshade vegetables (tomatoes, potatoes, peppers and egg plant).

Avoid refined foods as they rob you of energy. These nutritionally impoverished foods are not fully metabolized and so create metabolic debris or toxins in your system. This compromises bodily functions and creates additional burdens that exacerbate existing problems and eventually may manifest as new health problems. Refined foods include all the foods that contain “white” flour, salt or sugar. Avoid all refined carbohydrates including cold breakfast cereals and puffed rice cakes.

Also avoid stimulants and chemicals in your food and water supply and in your environment.

Use only unrefined oils. Because saturated and hydrogenated fats are transformed into a hormone-like compound, prostaglandin, which promotes inflammation and pain you may need to reduce your meat consumption. But first and foremost, eliminate margarine, shortening and any food containing hydrogenated fat.

Rather than fleeing from our pain, let's address it with awareness and diet. True, a slice of pineapple, a cup of chamomile tea or a pinch of turmeric in your curried vegetables doesn't cure deep-seated damage. But it's lovely to prepare and then sit down to a tasty meal that fills our bellies deeply satisfies and subtly supports our healing. Light a candle, offer thanks and tuck in. Our featured recipe, sautéed collards, tastes great and helps reduce inflammation.

· Avoid all processed foods, especially white sugar (refined sugar); white flour products.

· Avoid packaged snack foods such as potato chips and candy bars.

· Avoid high-calorie, high-fat, low-food-value junk food.

· Avoid sugary snacks such as snack bars or cakes.

· Avoid coffee, strong tea (weak tea with milk and honey is okay).

· Avoid very acidic foods (tomatoes, citrus fruits and juices, vinegar).

· Avoid fried foods, charcoal‑broiled meat, chocolate, and MSG.

· Avoid hard liquor, use wine and beer with meals only.

· Avoid foods with yeast.

· Avoid foods high in saturated fats.

· Eliminate Chocolate

· Eliminate Alcohol

· Eliminate Carbonated beverages

· Eliminate Coffee

SUGGESTIONS

• Eat several (five or six) small meals attractively prepared.
• Thirty percent of each meal should contain a good protein source such as meat, fish, fowl, eggs, milk products (cottage cheese, cheeses, yogurt), nuts and seeds (unsalted and unroasted).
• Sixty‑five percent of each meal should contain complex carbohydrates such as whole grains (whole wheat, rye, brown rice, oats, barley, millet), potatoes, yams, buckwheat (kasha).
• Exercise and drink 8+ glasses of water a day.

MORE SUGGESTIONS

• Fruit eaten with meat or cheese makes it more easily assimilated. All fruits and vegetables must be FRESH ‑ not frozen or canned. Herb teas can be calming. Good ones for this purpose are chamomile or comfrey. Sprouts in salads add vitamin C and inositol.
• While some fiber in a diet is needed for proper bowel movements, very high fiber diets can interfere with absorption of vitamins and minerals, especially magnesium which is needed to relax muscles.
• Root vegetables generally are a good source of magnesium. They may also be a good source of hyaluronic acid, the connective tissue that has been found to be abnormal in people with fibromyalgia.

VITAMIN SUPPLEMENTS

With vitamins and minerals, there is a delicate balance between them that you need to maintain in a healthy body. For example, too much calcium can cause a a zinc deficiency. Too much zinc can cause a copper deficiency. Too much iron can cause a magnesium deficiency and so on.

Consider taking the following nutritional supplements:

· B complex tablet containing at least 50 mg of B1, B2, B3, B6, and pantothenic acid.

· An extra supplement of B12 (100‑500 mg)

· 5 grams of vitamin C daily in 1 gram doses (it is best to use calcium or potassium ascorbate. Do not use sodium ascorbate [too much sodium]. The acid form may irritate the stomach lining or cause diarrhea, so it should be approached with caution.)

· Vitamin A to repair epithelial tissues

· Vitamin E to protect polyunsaturated fats in the whole grains Zinc, which works with vitamin A. (Dose: 400 IU per day.)

· Treatment with coenzyme Q10 appears to be effective in preventing migraine. Coenzyme Q10 is an essential element of the mitochondrial electron transport chain. 150 mg of coenzyme Q10 a day. In a recent study, 61.3% of patients had a greater than 50% reduction in the number of days with migraine. The mean reduction at 1 month of treatment was 13.1%, and at 3 months of treatment it was 55.3%.

· 100,000 IU vitamin D3 (cholecalciferol) every four months. A resent study over a 5 year period showed a 22% lower rate for first fracture at any site and a 33% lower rate for a fracture occurring in the hip, wrist, forearm, or vertebrae.

· Long-term treatment with glucosamine sulfate may retard progression of knee osteoarthritis, according to the results of a three-year, randomized, placebo-controlled, double-blind study published in the Archives of Internal Medicine. Glucosamine sulfate is a pharmaceutical derivative of the naturally occurring aminomonosaccharide. 1,500-mg/d of glucosamine sulfate (single dose). The average joint space width at enrollment was slightly less than 4 mm. After three years, placebo patients experienced average joint space narrowing of 0.19 mm, while space narrowing among users of glucosamine sulfate was negligible (0.04 mm). Compared with patients in the placebo group, fewer patients treated with glucosamine sulfate experienced substantial joint space loss (14% and 5%, respectively). Also, patients in the placebo group experienced modestly improved symptoms, while those in the glucosamine sulfate group experienced as much as 20% to 25% improvement. Glucosamine sulfate and chondroitin sulfate are components of natural joint cartilage. They are thought to help slow the loss of cartilage -- called joint space narrowing -- seen with osteoarthritis by stimulating production of new cartilage. In addition, the supplements are reported to provide pain relief and greater joint flexibility. Both supplements significantly reduced symptoms such as pain, stiffness, physical functioning, and joint mobility from the two compounds. Symptom improvement began about two weeks after starting the supplements. Taking at least 1,500 mg of oral glucosamine sulfate for at least three years was most effective in slowing the degenerative process. While there were similar findings on chondroitin, those findings were not as clear-cut. Overall safety of glucosamine and chondroitin can be considered excellent. (Dose: Glucosamine 1500 mg + Chondritin 1200 mg / three times a day)

· Echinacea has been traditionally used to build connective tissue.

· Magnesium which is needed to relax muscles. Design the diet to increase magnesium intake and absorption. Magnesium is needed to relax muscles. Lack of magnesium may often be the single biggest factor in fibromyalgia. Be careful with multivitamin pills since they almost invariably contain a number of magnesium antagonists and very little, if any, magnesium. Formula to Calculate Magnesium Daily Requirement -  5 to 10 milligrams per day per kilo of ideal body weight or 2.5 to 4.5 milligrams per day per pound of ideal body weight. Try to keep all doses at not more than 300-400 mg. each. 100-200 mg at a time work more efficiently. Take the 100-200 mg 3 to 4 times a day, depending on your needs. Some patients have experienced sleep difficulties when taking magnesium late in the day. If this happens to you confine your supplementation to earlier hours. Magnesium should be taken with your other supplements and/or food. Split up your supplemental intake into 2 or more doses daily. Magnesium supplements should usually not be consumed late in the day.  Some magnesium supplements can be energizing and in some persons may have a negative impact on getting to sleep and staying asleep when taken near bedtime. If taken in the correct dose and early enough in the day magnesium often corrects insomnia. Taking  magnesium late in the day is not a problem if it does not adversely affect your sleep.

· Alpha Lipoic Acid, also known as alpha lipoic acid, is a powerful, natural antioxidant slowly becoming recognized as having some unique properties in the therapy and prevention of a broad range of diseases. In addition to being an antioxidant, lipoic acid helps the body use glucose, hence lipoic acid's potential role in improving blood sugar control. Lipoic acid is readily absorbed from the diet or as a supplement. Lipoic acid can regenerate vitamin C from its oxidized form, dehydroascorbic acid. Lipoic acid can also potentially regenerate other antioxidants. Lipoic acid increases the levels of glutathione, a very important antioxidant normally found in our cells and responsible for mopping up all types of toxins and free radicals. Glutathione supplements, however, are not helpful since glutathione does not have the ability to cross cell membranes. Fortunately, both laboratory and animal studies have shown that lipoic acid can stimulate the production of this antioxidant. This is particularly important during periods of excessive stress or exposure to radiation or toxic substances. Lipoic acid also acts as a powerful antioxidant in the brain and is likely to protect brain cells from toxins. The ideal dose of lipoic acid is not known at this time. As a daily maintenance, a dose of 20 to 50 mg seems reasonable. Higher doses may be required to treat or prevent diabetic complications or other medical conditions.

SUGGESTIONS FOR SLEEPING

At bedtime, a snack of something high in tryptophan plus a carbohydrate to release insulin will aid sleeping. Foods high in tryptophan include milk products, eggs, potatoes, sunflower seeds.

Interesting Information

• Research published in Clinical Pharmacology and Therapeutics (May, 1998) showed that aspartame (Equal, NutraSweet) worked about as well as aspirin to relieve pain and inflammation. Unlike traditional anti-inflammatory drugs, aspartame does not irritate the stomach. The dose that researchers used ranged from four to eight tablets daily (76 to 152 mg).
• Muscle pain and weakness are known complications of statins (cholesterol-lowering drugs). More recently, researchers in Denmark have reported (Neurology, May, 2002) nerve damage called “polyneuropathy.” Some patients on long-term statin therapy experienced pain, tingling and numbness in legs and feet.
• Bovine cartilage is typically recommended at 3 grams three times per day. Shark cartilage is typically taken in much higher amounts (e.g., 60–100 grams per day orally or by enema). These amounts are based on animal and anecdotal evidence, and their safety and efficacy have not been confirmed by controlled clinical trials. Not only is toxicity information on this amount of shark cartilage lacking, but the amount of calcium to be found in this amount of shark cartilage exceeds the 2–2.5 grams per day that is commonly considered to be the upper limit of safe intake. Reports have suggested that some people should not use a cartilage supplement—this concern is based only on theory, not clinical evidence. This would include those people with cardiovascular disease, women who are planning to be or are pregnant, nursing mothers, anyone having or having had surgery within thirty days, and athletes training intensely. None of these concerns have been proven in clinical trials, however. Because shark cartilage contains calcium, people who ingest large amounts of shark cartilage (60–100 grams per day) may be consuming excessive amounts of this mineral. However, no cases of calcium toxicity resulting from the ingestion of shark cartilage have been reported. At the time of writing, there were no well-known drug interactions with cartilage. Do not give cartilage to children, pregnant women, or anyone who has recently undergone surgery or survived a heart attack. Although there are no known cartilage/medication interactions, consult with a medical professional prior to taking this product. Include magnesium and potassium for mineral balance if taking large amounts of shark cartilage. Read labeling carefully to insure the product is 100% pure shark cartilage. The product should be white in color. If not, it is not pure and should not be ingested.
• Antioxidants: Intake of antioxidant nutrients—including L-methionine, beta-carotene, vitamin C, D, and E, lutein, lycopene, and organic selenium—has been found to be beneficial in people with osteoarthritis. One study found that people with osteoarthritis who consumed more antioxidant nutrients, especially vitamin C, slowed the progression of the disease, reduced the risk of cartilage loss, and reduced the risk of developing knee pain (McAlindon et al1996). These relationships were not seen with other nutrients. The results of the study may be explained by the effects of the antioxidant nutrients but also could be due to the fact that healthier people are more likely to eat diets that are rich in antioxidants. So far, there is no proof that increased consumption of antioxidants can reduce the risk of developing osteoarthritis in people who are free of the disease. It is also important to understand that antioxidant nutrients do not act independently from other nutrients and cannot replace eating plenty of fruits and vegetables. The high-antioxidant diet is rational in theory, but supplementing one's diet with artificial antioxidants in capsules or tablets has been shown to have problems, It is too simplistic to give antioxidants in supplement form. It is logical to take them in a diet full of fish and vegetables. But you cannot give it in a pill and expect it to solve free-radical diseases.
  
  

Nutrient	Reference Daily Intake (RDI)	Dietary Sources	Evidence
Vitamin C	60 mg	Citrus fruits, strawberries, tomatoes, cantaloupe, broccoli, asparagus, peppers, spinach, potatoes.	Consuming more than the RDI in supplement form has not been found to prevent heart disease or cancer.
Vitamin E	30 IU	Vegetable oils (soy, corn, olive, cottonseed, safflower, and sunflower), nuts, sunflower seeds, wheat germ.	Doses of 100-800 IU may lower heart disease risk by 30%-40%.
Beta-carotene	None available	Dark green, yellow, and orange vegetables including spinach, collard greens, broccoli, carrots, peppers, and sweet potatoes; yellow fruits such as apricots and peaches.	No association between beta-carotene supplementation and heart disease or cancer risk; some evidence that carotenoid-rich foods protect against heart disease and macular degeneration.
Selenium	None available; RDAs are 70 mcg for men and 55 mcg for women.	Egg yolks, tuna, seafood, chicken, liver, whole grains, and edible plants grown in selenium-rich soil. (Found west of the Mississippi).	Preliminary evidence suggest that 150-200 mcg may lower prostate cancer risk.

• A herbal supplement containing sea-algae extract reduces carpal tunnel pain, according to a report at the recent meeting of the American College of Nutrition. A companion study suggests the supplement, BioAstin, also helps reduce rheumatoid arthritis pain. BioAstin contains an algae extract called astaxanthin -- the same chemical that makes shrimp and salmon pink. Astaxanthin is a powerful antioxidant. This type of chemical soaks up destructive byproducts in the body. Taking antioxidants can also form these so-called free radicals. It's still not clear when, in what form, and in what amounts to take antioxidants.

Disclaimer: The above should be considered guidelines. For more accurate information please consult a certified medical nutritionist.