Chronic Pain Relief

You know the feeling you get – when you learn something new about a health problem you’ve been trying to reverse – maybe high blood pressure, diabetes, or heart disease. Well – there’s nothing I like better than bringing you the information that will help you do just that. Welcome to the NutritionFacts podcast. I’m your host – Dr. Michael Greger.

Today – we deal with pain: chronic, debilitating pain. And, we look at how anti-inflammatory diets can be effective in alleviating chronic pain syndromes.

Fibromyalgia is a common disorder whose cardinal manifestation is chronic, widespread pain. Well, not so common, affecting 2 to 4 percent of the population, though probably more like 2 percent, and especially women. For decades, some medical professionals dismissed fibromyalgia as all in people’s heads, but this outdated view has been refuted by more recent research characterizing it as a disorder of pain regulation and sensitization. Brain imaging studies have shown several perturbations of pain processing and regulation that amplify pain in people with the condition.

Twin studies have shown that about half of fibromyalgia is genetic, but the other half we can do something about. There are lots of drugs with lots of side effects to help with some of the symptoms, but what about lifestyle approaches? Engagement in regular physical activity is considered imperative for effective management of fibromyalgia.

A systematic review and meta-analysis of randomized clinical trials on the effectiveness of therapeutic exercise in fibromyalgia found that both aerobic and resistance exercises are effective ways of reducing pain and improving global well-being in people with fibromyalgia. Patients may worry, and perceive that exercise will worsen their pain and fatigue, and so you have to start slow and work your way up as tolerated, with the goal of eventually achieving daily 30 to 60 minutes of moderate intensity aerobic exercise in addition to muscle-strengthening exercises (1 to 3 sets of 8–11 exercises; 8–10 repetitions with a load of about 7 pounds, or 45 percent of the max you can lift). But what about dietary interventions in terms of dialing down the pain sensitivity?

Well, what causes it in the first place? Inflammation. During the inflammatory response, pain receptors are activated. And chronic inflammation can cause chronic activation, which may cause chronic pain due to this prolonged hypersensitization of pain pathways.

No wonder, then, that a pro-inflammatory diet was found to be associated with pain hypersensitivity in patients with fibromyalgia syndrome. Exactly which foods are pro-inflammatory and which foods are anti-inflammatory? Broadly speaking, components of processed foods and animal products, such as saturated fat, trans fat, and cholesterol, were found to be pro-inflammatory, while constituents of whole plant foods, such as fiber and phytonutrients, were strongly anti-inflammatory.

The intake of dietary fiber found concentrated in only one place—whole plant foods—is fundamental to reducing not only the risk of abdominal pain, but also muscle and joint pain. We think it’s because of these short-chain fatty acids that our good gut bugs produce when we eat fiber. These short-chain fatty acids are important mediators of pain, fundamentally because they modulate inflammation. So, having lots of fiber-feeding bugs in your colon is like carrying around your own anti-inflammatory compound factory. But to cultivate them, you actually have to eat the foods that feed them.

In terms of phytonutrients, plant-derived polyphenols are widely acknowledged to also act as anti-inflammatory substances. Here are some foods packed with anti-pain pathway nutrients: berries, greens, citrus, nuts, spices like turmeric and ginger, edamame, and green tea. That’s why you can do a randomized, double-blind crossover trial showing that about three cups worth of strawberries a day can significantly improve pain and inflammation. If that’s what a single plant can do, what about a diet chock full of plant foods?

Put people on a strictly plant-based diet rich in fresh fruits and vegetables, whole grains, and various legumes, which are beans, split peas, chickpeas, and lentils, as well as nuts and seeds, and you can drop C-reactive protein levels (a leading blood marker of systemic inflammation) 33 percent in three weeks. But does that translate into less pain?

The answer is yes, when it comes to migraine headaches. Yes, when it comes to painful periods. A significant reduction in menstrual pain duration and pain intensity, in addition to premenstrual symptoms. In fact, even just a single plant, cinnamon, about a third of a teaspoon three times a day during your period can help, though it doesn’t work as well as ibuprofen. Ginger powder—ground ginger—on the other hand, has been found to be comparable to ibuprofen in relieving pain in women with painful cramps.

Whole food plant-based diets also alleviate the symptoms of osteoarthritis. Several studies have shown improvements in rheumatoid arthritis symptoms with diets excluding animal products, though it may be just as much a function of increasing the quantity of healthy plant foods. But it’s not just because plant-based diets are so effective in causing weight loss. Even at the same weight, there’s an improvement in rheumatoid arthritis from more plant-based diets. And plant-based diets can also alleviate fibromyalgia symptoms.

The latest study enrolled anyone with chronic musculoskeletal pain, fibromyalgia or not. Yes, diets high in animal proteins and fats have been linked to chronic pain and inflammation, while plant-based diets produce anti-inflammatory responses. Did it actually work when put to the test for pain? Yes. Consumption of a plant-based diet produced positive improvements in chronic pain and function. How much? A minimally clinically important difference in chronic musculoskeletal pain is 1 point on the Numeric Pain Rating Scale, which is just a scale from 1 to 10 on how much pain you’re feeling. On the plant-based diet, perceived pain decreased an average of 3 points on a 10-point scale, from an average of 5 or 6 out of 10 down to 2. Now, unlike most of the prior studies, there was no control group. But what’s the downside of giving healthier eating a try? In fact, those with chronic pain are more likely to be overweight, and have nutrition-related maladies such as high blood pressure, diabetes, and heart disease––all of which can be prevented, arrested, and in some cases even reversed with a healthy enough plant-based diet. So, any pain benefit is just icing on the cake of health.

Uh, scratch that. How about the dollop of guacamole on your bean burrito?

In our next story, we look at how apple peels – may help those with chronic joint pain.

Regular apple intake is associated with all sorts of good things, like living longer—particularly a lower risk of dying from cancer. Here’s the survival curve of elderly women who don’t eat an apple a day. Ten years out, nearly a quarter had died, and 15 years out, nearly half were gone. But, those who average like a half an apple a day didn’t drop off as fast, and those eating an apple a day—more than three and a half ounces of apples a day—like a cup of apple slices—stayed around even longer. Yeah, but maybe people who eat apples every day just happen to practice other healthy behaviors, like exercising more, or not smoking, and that’s really why they’re living longer. Well, they controlled for most of that—obesity, smoking status, poverty, diseases, exercise—so as to compare apples to apples (so to speak!).

But, what they didn’t control for was an otherwise healthier diet. Studies show that those who regularly eat apples have higher intakes of not just nutrients like fiber, found in the apples, but they’re eating less added sugar, less saturated fat—in other words, they’re eating overall healthier diets. So, no wonder apple eaters live longer, but is apple eating just a marker for healthy eating, or is there something about the apples themselves that’s beneficial? You don’t know, until you put it to the test.

There are all sorts of fun studies where subjects were randomly assigned in the morning to nothing, a caffeinated energy drink, black coffee, or an apple—given that athletes use a variety of common strategies to stimulate arousal, cognition, and performance before their morning training. Did the apple hold its weight? Yes, appearing to work just as well as the caffeinated beverages. The problem with these kinds of studies, though, is that they’re not blinded. Those in the apple group knew they were eating an apple. So, there may have been an expectation bias, placebo effect, that made them unconsciously give that extra bit of effort in the testing, and skew the results. You just can’t stuff a whole apple into a pill.

That’s why researchers, instead, test specific extracted apple components. So, they can perform a double-blind, placebo-controlled study, where half get the fruit elements, half get a sugar pill, and you don’t know until the end who got which. The problem there, though, is that you’re no longer dealing with a whole food—removing the symphony of interactions between the thousands of phytonutrients in the whole apple.

Most of those special nutrients are concentrated in the peel, though. Instead of just dumping millions of pounds of nutrition in the trash, why couldn’t researchers just dry and powder the peels into opaque capsules to disguise them, and then run blinded studies with that? Even just “[a] small amount could greatly increase…phytochemical content and antioxidant activity…”

The meat industry got the memo: “Dried apple peel powder decreases microbial expansion in [meat] and protects against carcinogen production…” when you cook it. And, “[o]ne of the carcinogens formed during [the] grilling of meat is [a] beta-carboline” alkaloid, a neurotoxin, which may be contributing to the development of neurological diseases like Parkinson’s. Uncooked meat doesn’t have any; the neurotoxin is formed when you cook it. But, you can cut the levels in half by first marinating the meat with dried apple peel powder.

And, it also cuts down on the amount of fecal contamination bacteria in the meat. Apple peels can also inhibit the formation of genotoxic, DNA-damaging, heterocyclic amines, cutting the levels of these cooked meat carcinogens by up to more than half. “In view of the risks associated with consuming [these cancer-causing compounds in meat], there is a need to reduce exposure by blocking HCA formation such as by adding [apple peel powder] during the cooking of meats to [help] prevent their production.” I can’t think of any other way to reduce exposure.

What about consuming apple peels directly? Dried apple peel powder was found to exhibit “powerful anti-inflammatory and antioxidant action.” But, this was in mice. Does it have anti-inflammatory properties in people? You don’t know, until you put it to the test.

A dozen folks “with moderate loss of joint [range of motion] and associated chronic pain” were given a spoonful of dried apple peels a day for 12 weeks, and pain scores dropped month after month, and the range of motion improved in their neck, shoulders, back, and hips. Conclusion: “Consumption of dried apple peel powder was associated with improved joint function and…pain reduction.” Why just “associated”? Because there was no control group; so, they might have all been just getting better on their own, or it could have been a placebo effect. But hey, why not give apple peels a try by eating more apples?

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My last two books are “How to Survive a Pandemic” and the “How Not to Diet Cookbook.” Stay tuned for Dec 5, 2023 for the launch of my one “How Not to Age.” And – of course – all the proceeds I receive from the sales of all my books go to charity. 

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