Inflammatory Food and Pain

One of the most significant deficiencies in medical education is nutrition and the effect of food choices on inflammatory pain.¹² Dietary ingredients have been increasingly recognized to play a role in the balance of oxidative stress, inflammation, and resultant pain. Rondanelli et al. looked at 172 studies and proposed a food pyramid for subjects with chronic pain.¹³ Recommendations take into account providing better raw materials for the body to utilize and limiting inflammatory triggers. There are recommendations to limit high-glycemic foods and also to ingest some nutritional supplements.

Clinical experience during the past 25 years has continued to demonstrate a list of foods and ingredients that aggravate chronic pain from all causes in most patients. While there are exceptions, they are rarer than ever suspected. Expectations for real improvement through experimentation of dietary elimination can really only come with total black and white adherence to avoidance of the particular substance.

These include:

• • Wheat
• • Most sugar
• • Potato
• • Fruit juice
• • Fake fat and hydrogenated oil
• • Artificial sweeteners

Each of these inflammatory and toxic instigators should be discussed with pain patients. Learning what each does and its effect on pain can provide powerful motivation for change. A big help for the practitioner working with skeptical patients are two widely sold books that motivate change and are relatively easy for many people to understand. These are Wheat Belly by William Davis and Grain Brain by David Perlmutter. Each provides an independent source of information with a consistent and important message for people in pain.

One common factor among the foods on this list is the induction of insulin and increase in visceral fat. Another is the increase in zonulin proteins that regulate intestinal permeability. This has been linked to inflammation, autoimmunity, and cancer.¹⁴

Wheat, especially that grown in the U.S., and bread flour have a unique and perhaps multifactorial influence on chronic pain. Clinically we consistently observe lower back pain, joint stiffness, and pain related to barometric change to be often dramatically increased by even a very small amount of flour. This effect seems independent of celiac disease.

Sucrose has been linked to many chronic illnesses. It also affects the intestinal microbiome. These changes may have far-reaching consequences in how people function and behave. Mice fed a simulated Western diet showed reduced cognitive flexibility.¹⁵ Changing how patients respond and even think about pain and healing may be negatively influenced by their choices of food.

Sugar also increases the likelihood of intestinal overgrowth of yeast. One of the easiest to spot physical signs of yeast overgrowth is a coating on the tongue. In general, the thicker the coating, the worse the problem. The pictures in Figure 21.1 are the same man, before and 3 months after taking sugar out of his diet.

Sugar has also been shown to significantly augment the nociceptive properties of morphine in the rat.¹⁶ Rats given sucrose exhibited augmented antinociceptive effects of morphine to the hot-plate test when heated to 51 and 53°C. This may help explain some of the observed clinical response to opiates. Where sugar potentiates opiate pain relief, the effect wears off in a couple of hours, perhaps leaving the person with only their opioid medicine “on board.” To that effect, we hear our patients report that their pain medication only lasts 2 or 3 hours.

Sugar-sweetened beverages are known to have adverse effects on glucose and lipid metabolism, especially if consumed in high quantities and by overweight people. A study published in 2011

FIGURE 21.1 Tongue on left with white coating and brown stains: same tongue on right, 3 months after sugar-free diet.

studied the effect of these drinks on normal-weight subjects. The data showed elevated cardiac risk markers and hs-CRP after low to moderate consumption within just 3 weeks.¹⁷

Whether the mechanism relates to nociceptive properties or the induction of inflammation, our clinical experience is that opiates provide longer and more consistent relief when sugar and insulinraising, or inflammatory foods are totally avoided.

The power of this in practice is that an office visit changes from negotiating for more opiate medication to a patient needing to learn what to do or not to do so that the medication you are willing to prescribe can work more to their satisfaction. To pull this off, it is best that the practitioner set an example, and is firm in their belief that this inflammatory food avoidance will be helpful.

Stevia is not an artificial sweetener and does not seem to instigate an insulin or inflammatory response and resultant or consequential pain. While it may prove to be one of the best alternatives for sweet taste, safety may be overestimated.

Potato

Many of my patients have noted that white, red, and blue potatoes cause exacerbation of lower back pain starting the next day and lasting 2-4 days. There are glycoalkaloids in potato that increase intestinal permeability and aggravate inflammatory bowel disease.¹⁸¹⁹ Moreover, frying concentrates these glycoalkaloids and makes them even more dangerous.²⁰ The prevalence of irritable bowel disease is highest in countries where fried potato consumption is highest.¹¹ It is perhaps this relationship that helps define the origin of increased lower back pain with even a teaspoon of white potato.

Conversely, it is interesting to note that, when an ethanolic extract from potato tubers is administered orally to mice, there is evidence of decreased inflammation and pain.²¹