We all know that what we eat can affect our health. New research, however, shows that there may be a specific link between diet and pain. Pain specialist Dr Rae Bell tells us more, and outlines steps you can take to improve your diet as part of your pain management regime.
It’s very important for people with chronic pain to maintain a healthy, balanced diet. There are several reasons for this. Firstly, the nervous system has the capacity to dampen pain. Most people have heard of the body’s own morphine-like substances called endorphins. In order to be able to function optimally, the nervous system requires specific nutrients such as essential amino acids. One example is tryptophan, which is very important in the body’s own pain-dampening systems. Tryptophan is found in chicken, seafood, turkey, avocado and bananas. On the very basic level, the nervous system needs nutrients. Certain vitamin deficiencies can cause pain problems. For example, vitamin B12 deficiency can cause very unpleasant peripheral polyneuropathy, which is nerve pain in the feet and also possibly in the hands. Vitamin D deficiency can cause diffuse musculoskeletal pain.
OMEGA-3 AND OMEGA-6
The World Health Organisation published a report in 2003 which described how there’s been a huge global shift in diet, moving from predominantly plant-based foods to more high energy foods. They were especially focusing on the balance between intake of omega-3 fatty acids and omega-6 fatty acids. The ideal ratio between these fatty acids is four to one, four times the amount of omega-6 compared to omega- 3. But in, for example, the average American diet today, the amount of omega 6 is around 15 to 25 times the amount of omega 3 intake. Some examples of foods containing relatively high levels of omega-3 are fatty and oily fish, flax seed oil, flax seed and walnuts, while omega-6 is found in red meat, dairy products and soya oil. Soya oil is used to make a lot of fast food and snacks, and I think this widespread use has particularly contributed to high levels of omega-6.Omega-6 has been linked to inflammation, which we need a certain amount of in order to aid healing in our body. But if we get too much, that can create its own problems. Omega-3 has an anti-inflammatory effect. So one thing for pain patients to pay attention to with regards to diet is to ensure they have sufficient levels of omega-3, and that one reduces the amount of omega-6.
There are actually a number of foodstuffs that have been demonstrated to have anti-inflammatory effects, just like nonsteroidal anti-inflammatory drugs. In virgin olive oil, there’s a substance called oleocanthol, and it’s been shown to have a similar effect to ibuprofen. This is really interesting because non-steroidal anti-inflammatory drugs can have a lot of adverse side effects. So if we can achieve some of the same effects through our diet, that would be ideal.
Anti-oxidants are found in many foodstuffs, and many antioxidants have anti-inflammatory effects. For example, resveretrol is an anti-oxidant which is formed in certain plants when they’re under attack by bacteria or insects. It’s found in the skin of red grapes, and in red wine, and it has a powerful anti-inflammatory effect. Other anti-oxidants are found in reddish-blue pigments, for example in blueberry skins and cherries. The problem is that there’s a lot of hype in the media and advertisements on television telling you to buy anti-oxidant products. You actually don’t need a huge intake, and the best way to get anti-oxidants is through your diet, not through pills. I think most people know whether their diet is healthy or not. If we’re busy and we just have a little snack here and there, it’s not good enough. We need to be getting vitamins, we need to be eating more fish, less red meat, and lots of fresh vegetables, especially green leafy and brightly coloured vegetables. It’s the colour pigments which contain the antioxidants, so if you think of a colourful, Mediterranean kind of diet then you’re on the right track.
FOODS TO LIMIT
Specific foodstuffs can increase pain. I have some colleagues who are doing interesting scientific research on an area called polyamines. Polyamines regulate a receptor in the nervous system which is involved in increasing pain. Oranges and orange juice contain very high levels of polyamines. That doesn’t mean you should stop drinking orange juice, it just means you should think twice before drinking many glasses a day or huge numbers of oranges. Peanuts also have quite high levels of polyamines. Then there’s the whole question of coffee. Everyone knows that coffee can disturb sleep, and if you have chronic pain and you can’t sleep, then you will feel the pain more strongly. If coffee is consumed on a regular basis, it can increase risk of developing a chronic daily headache.
Some pain-relieving medication contains caffeine because it interacts with analgesic drugs and increases the effect of paracetamol and aspirin. But caffeine has other attributes that are not beneficial, but actually harmful. High levels of caffeine are linked to osteoporosis, so if you drink more than six cups of coffee a day your risk of developing osteoporosis increases. This is also the same for cola. Cola contains phosphoric acid, caffeine and sugar. The taste might be nice, but there is nothing else positive about it. And it can cause osteoporosis in the same way as drinking large amounts of coffee because it has such high caffeine levels.
WHAT TO EAT
When myself and my colleagues at the pain clinic began to ask our patients what they ate, we discovered that many had poor diets. Many of our patients are depressed, they don’t feel like making food, and they don’t earn a lot of money so they can’t buy everything they want to eat. But it’s especially important that chronic pain patients have a good, healthy, balanced diet.
• Pain patients should be increasing the amount of omega-3 they eat and reducing the amount of omega-6. Think about eating a colourful meal with fresh fruit and vegetables, cutting out cola and reducing the amount of coffee. Don’t drink coffee with caffeine after midday if you have sleep problem.
• If you feel you need to lose weight, ask your GP for a consultation with a dietician. They will probably suggest you cut down on fats, oils and snack foods, and eat more vegetables and cereals.
• A study examined seven thousand 45-year-old men and women, and found that women with the lowest levels of Vitamin D, less than 25 mmol/litre, had the highest rate of pain. The findings did not apply to men, implying that hormones may be a factor. We get Vitamin D from sunlight, and from foods such as eggs and oily fish.
• Research seems to suggest that a deficiency of Vitamin C may be a significant factor in the pain experienced by people with post-herpetic neuralgia. Therefore, if you have post-herpetic neuralgia, maintaining good levels of Vitamin C in your diet could help you with your pain. Vitamin C is found in fruit and vegetables such as broccoli, strawberries, red peppers and oranges.
HEALTHY MEAL TO TRY
Roasted Sea Bass with Grilled Veg
• One whole Sea Bass, one whole lemon, fresh parsley.
• A mix of: red onion, fennel, courgette, garlic,
tomatoes on the vine and peppers.
• Stuff whole Sea Bass with lemon wedges, fresh parsley and season well with olive oil, salt & pepper. Wrap in tinfoil or greaseproof paper and place into a hot over at 220º for 30-35 mins.
• Roughly chop and place all veg into a roasting tray, cover generously with olive oil and place in to roast at same time as the Sea Bass.
• Serve with fresh bread (try using low fat or low cholesterol spread) and a glass of red wine.