Diet and Chronic Pain
The CNP Diet and Chronic Pain Research Category consolidates research exploring the interdependent relationship between dietary intake and pain. To view each original study on the open internet, click “Original.” To view the CNP-written abstract summary, click “CNP Summary.” While only some of the CNP-written abstract summaries are available below for free, all abstract summaries are available to CNP members through the CNP Library Membership.
FEATURED CNP RESEARCH SUMMARY
This 2020 systematic review screened 20,316 articles from three large online scientific databases to analyse the current literature on the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain. Twelve eligible studies were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Proteins, fat, and sugar intake were all found to be associated with pain intensity and threshold, and also, inadequate consumption of calcium, folate, zinc, magnesium, and vitamin B6 was seen in sufferers of pain from chronic rheumatoid arthritis, whilst patients with fibromyalgia showed a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Moreover, chronic pain severity was seen to be positively correlated to fat and sugar intake in osteoarthritis, and pain threshold was positively associated with protein intake in fibromyalgia. Elma et. al (2020) also believe plant-based diets might have pain-relieving effects on chronic musculoskeletal pain.
2021
Elevated dietary ω-6 polyunsaturated fatty acids induce reversible peripheral nerve dysfunction that exacerbates comorbid pain conditions
Coming Soon.
2022
High-fat diet causes mechanical allodynia in the absence of injury or diabetic pathology
Coming Soon.
2022
Mediterranean diet and changes in frequency, severity, and localization of pain in older adults: The Seniors-ENRICA Cohorts
Despite current evidence demonstrating the impact of the Mediterranean diet on reducing pain risk owing to the antioxidant and anti-inflammatory properties it possesses, there is a lack of population-based studies that explore the impact of Mediterranean diet fidelity on changes in experiencing pain over time. Ortolá et al. (2022) decided to remedy this lack of information by conducting their analysis using data on older adults from the Seniors-ENRICA-1 (n = 864) and Seniors-ENRICA-2 cohorts (n = 862), inclusive of their follow-up data (2.8 and 2.4 years). Mediterranean diet fidelity was evaluated using the MEDAS score, and a pain scale was computed using data on pain severity, frequency, and location, collected at baseline and at follow-up. Data analysis showed that study participants were 71.5 ± 5.1 years of age, that 36.8% were males, and that 78.3% suffered from chronic illnesses. Secondly, participants in the highest quartile of MEDAS scores (i.e., highest levels of Mediterranean diet fidelity) showed the highest benefit in terms of pain improvement, compared to participants in the lowest MEDAS score quartile. This benefit was reflected in two components on the computed pain scale, namely pain severity and a decrease in reported pain locations. Finally, the authors noted that the main supporters of these observed benefits were the high intake of vegetables and fruits and the lower intake of sugar-sweetened drinks. The authors conclude that a higher level of Mediterranean diet fidelity is linked to improvements in the experience of pain in older adults, which postulates the use of dietary quality as a method of reducing the negative impact of pain on overall health. [NPID: Chronic pain, cohort study, dietary patterns]
2022
Relationship between diet and relative risk of pain in a cross-sectional analysis of the REGARDS longitudinal study
In this study by Strath et al. (2022), the authors explored whether dietary patterns are related to the risk of experiencing pain. Using data from the REGARDS study (n = 16061 participants, 44.6% males, 65 ± 9 years of age, 32.3% Black), participants were divided into categories depending on their dietary habits and the prominent food categories constituting their diets: convenience, plant-based, alcohol/salads, sweets/fats and ‘Southern’ (rich in fats, processed meat, organ meat, fried food, and sweetened drinks). Analysis of the results revealed that increased fidelity to ‘Southern’ diets was linked to a 41% increase in the relative risk (RR) of experiencing pain, while fidelity to a plant-based diet led to a 22% reduction in the RR of pain. The authors conclude that dietary patterns of poor quality raise the RR of pain, while a plant-based diet can lower the RR of pain, and recommend including dietary patterns as a part of a patient’s medical history. [NPID: Dietary pattern, nutrition, pain, racial differences]
2022
Participants with chronic pain do not perceive diet as a contributing factor to their pain: a survey-based study
In this cross-sectional study by Field et al. (2020), the authors investigated the diet consumed by 50 individuals who report suffering from chronic pain and how these individuals look at the part diet plays in their chronic pain experience. The participants submitted nutrition and pain questionnaires in addition to anthropometric data. Analysis of the results revealed that despite the majority of participants accounting that their diets were good/excellent and helped enhance their well-being (76% and 62%, respectively), 74% of the participants’ BMI scores were above the normal range (average BMI score = 30) and suffered from several comorbid conditions. No links were found between reported pain and dietary fidelity and dietary knowledge. The authors conclude that despite participants reporting their diets as ‘good’ overall, this did not necessarily translate into their dietary habits, and that food does not play a significant role in modulating the experience of chronic pain. [NPID: Australia, Mediterranean diet, chronic pain, comorbidities, diet, nutrition, pain management]
2022
Does diet play a role in reducing nociception related to inflammation and chronic pain?
Food intake patterns play critical roles in the regulation of overall health and well-being, however, the use of nutritional panels could protect from acute and chronic pain. Several dietary components, such as anti-inflammatory compounds and antioxidants, possess these protective properties. In addition, flavonoids, curcuminoids, terumbone (ginger root), taurine, and ω-3 polyunsaturated fatty acids were found to have analgesic and antinociceptive properties. Moreover, the prudent dietary intake of minerals and trace elements helps ameliorate inflammation and associated pain. Bjørklund et al. (2019) discuss these dietary components in their review, aiming to propose new dietary supplementation criteria targeted towards pain prevention. [NPID: Diet, natural compounds, nutritional supplementation, pain]
2020
Effects of nutritional interventions in the control of musculoskeletal pain: An integrative review
Dietary intake is responsible for several beneficial impacts on our overall health, including diminishing musculoskeletal pain responses. However, our understanding of the use of certain food groups to treat pain remains insufficient. In this integrative review by Mendonça et al. (2020), the authors examined the available evidence regarding specific dietary nutritional interventions, the use of fatty acids and/or oils, and natural food elements in musculoskeletal pain disorders. Through searching several databases, including PubMed, Embase, LILACS, and Google Scholar (English, Portuguese and Spanish publications between 2000 - March 2020), a total of 17 studies met the inclusion criteria, where 14 of which reported a decrease in musculoskeletal pain with the use of dietary interventions like vegan and Mediterranean diets, dietary intake of food items like blueberries, passion fruit peel extract, strawberries, fish oil (omega-3), argan oil, olive oil, and supplements like vitamin D and undenatured type-II collagen. In addition, eight studies reported on inflammatory marker profiles, where two of which demonstrated a reduction in interleukin (IL), IL-6, and tumor necrosis factor (TNF)-α with dietary interventions. The authors comment that the use of nutritional modalities, including dietary regimens, fatty acids and/or oils, and foodstuffs in natura may play a role in reducing musculoskeletal pain, especially in osteoarthritis patients, in addition to the observed reductions in inflammatory markers with the intake of vitamin D capsules and strawberries. [NPID: Diet therapy, fatty acids, fruit, inflammatory markers, muscle, obesity, skeletal]
2018
Chronic musculoskeletal pain and function improve with a plant-based diet
Current research demonstrates how pervasive chronic musculoskeletal pain can be, impacting individuals of different ages, genders, and ethnicities, in addition to how a plant-based diet (rich in vegetables, fruits, and whole grains) could help improve the symptoms of chronic pain and overall quality of life. In this study by Towery et al. (2018), the authors investigated the impact of a plant-based diet on symptoms of chronic musculoskeletal pain and associated functional impairments in a population of 14 participants over a period of eight weeks. The participants’ anthropometric measures were evaluated at the start of the intervention, together with submitting a Short Form Health Survey (SF-36) and a Numeric Pain Rating Scale (NPRS). Aided by a registered dietician, the participants were educated on plant-based diets and were provided with a sample menu cycle, in addition to using a phone app to document dietary intake and receive dietary support. Upon study conclusion, the participants repeated baseline measurements and submitted a Patient Global Impression of Change Scale. After highlighting their small sample size to be considered when appreciating their results, the authors observed an overall decrease in reported pain and an enhancement in the quality of life of the study participants, who reported an 89% fidelity to the dietary intervention. Thus, the authors conclude that a plant-based diet enhances the quality of life and symptoms experienced by individuals suffering from chronic musculoskeletal pain and that collaborations involving registered dieticians, physical therapists, and healthcare professionals should be established to integrate dietary interventions into patients’ treatment strategies. [NPID: Chronic musculoskeletal pain, complementary therapies, global health status, pain management, plant-based diet]
2021
Poor diet quality is associated with self-reported knee pain in community-dwelling women aged 50 years and older
In this cross-sectional, population-based study by Shin et al. (2021), the authors investigated the links between knee pain and the quality of diet consumed by a population of women ≥ 50 years old (n = 3,881, Korea National Health and Nutrition Examination Survey). The study participants had their diet evaluated using the Diet Quality Index-International (DQI-I), while they reported on their osteoarthritis and knee pain personally (which was found to encompass 25.4% of the study population). After accounting for factors like body mass index, household income, age, education, occupation, marital status, smoking, physical activity, perilous alcohol intake, menopause, and chronic diseases (diabetes, hypertension, osteoarthritis, dyslipidemia, depression), the authors observed that women suffering from knee pain consumed less protein, total energy, and fat, but that these women had a higher intake of carbohydrates when compared to their peers. Women who did not suffer from knee pain were also noted to have higher DQI-I scores overall, and substantially higher scores in several adequacy components, compared to their peers who suffered from knee pain. The authors conclude that knee pain unrelated to osteoarthritis was linked to poorer dietary quality in community-dwelling women ≥ 50 years of age. [NPID: Knee pain, osteoarthritis, dietary quality, women]
2018
High-fat diet exacerbates postoperative pain and inflammation in a sex-dependent manner
Despite the links between obesity and experiencing elevated levels of pain, our understanding regarding the impact of obesity and diet on postoperative pain remains insufficient. In this study by Song et al. (2018), the authors investigated the impact of obesity and diet by using the paw incision model (designed to investigate postoperative pain) in a population of Long-Evans rats, fed either a high-fat or a low-fat diet for a period of six weeks prior to the start of the experiment. The authors observed an increase in pain response and in the duration of overall hypersensitivity to pain upon conducting paw incisions in male rats receiving a high-fat diet compared to controls, however, female rats did not show the same propensities. Secondly, the authors noted that eliminating the high-fat diet for a period of two weeks prior to the paw incision procedure ameliorated the dietary derangement of pain behaviors despite the persistence of the weight gained. Moreover, the exposure to a high-fat diet for a short period of one week prior to the paw incision procedure led to an increase in observed pain behaviors, an impact that was noted to be of lesser magnitude compared to the six-week experimental exposure. From a cellular level, the authors noted an increase in lumbar dorsal root ganglion macrophage population and increased sensitivity of peritoneal macrophages to lipopolysaccharide with the administration of the high-fat diet for six weeks in male rats compared to controls. Finally, high-fat diet rats were noted to have higher skin levels of the nerve regeneration marker growth-associated protein 43 (GAP43) and retarded wound healing, compared to controls. The authors conclude that a high-fat diet worsens postoperative pain, especially in male rats, and that this dietary impact is not entirely associated with the weight gained, as short-term dietary exposure led to deranged pain responses that were not associated with significant obesity. [NPID: Postoperative pain, high fat diet, obesity, rats, animal]
2021
Effect of anti-inflammatory diets on pain in rheumatoid arthritis: A systematic review and meta-analysis
A myriad of nutritional components has been suggested to elicit a therapeutic effect in rheumatoid arthritis, especially ω-3 fatty acids that may reduce eicosanoids. In this systematic review by Schönenberger et al. (2021), the authors examined the impact of anti-inflammatory diets (vegetarian, vegan, Mediterranean, and ketogenic) on pain, by investigating the pain visual analog scale, health assessment questionnaires, C-reactive protein levels (CRP), erythrocyte sedimentation rate (ESR), tender/swollen joints, disease activity score 28, weight and body mass index. Through conducting a search on a number of databases (Embase [Elsevier], MEDLINE [OVID], and CINAHL, inception to November 12th, 2021), 564 publications were identified, with 12 meeting the inclusion criteria for the systematic review and seven for the meta-analysis. The authors noted that all included studies were determined to be of a high risk of bias and had a very low rating in terms of evidence, however, the results demonstrated a substantial reduction in pain with the consumption of anti-inflammatory diets compared to ordinary diets. [NPID: Mediterranean diet, anti-inflammatory diet, arthralgia, ketogenic diet, pain, rheumatoid arthritis, vegan diet, vegetarian diet]
2021
Gluten-free diet reduces pain in women with myofascial pain in masticatory muscles: A preliminary randomized controlled trial
In this randomized controlled trial by Buosi et al. (2021), the authors investigated the impact of a gluten-free diet (GFD) on improving chronic masticatory myofascial pain in a population of 39 women, who were divided into three groups (“healthy”, n = 14, age = 34.57 ± 9.14, “control”, n = 12, age = 31.50 ± 7.38, and “experimental”, n = 13, age = 30.00 ± 7.64) using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The experimental group received a GFD for four weeks, and the treatment groups were evaluated at the start of the experiment and four weeks after its conclusion (save for the control group). Analysis of the results revealed a substantial decrease in pain intensity and a substantial increase in pressure pain thresholds of the anterior temporalis and masseter muscles with GFD intervention compared to controls. The authors comment on how GFD may be a beneficial adjunctive dietary intervention in women who suffer from TMD-associated chronic myofascial pain, and that more research is necessary to further our understanding of this relationship. [NPID: Chronic pain, mastication, myofascial, women, gluten free, dietary intervention]
2019
A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain
In this systematic review by Brain et al. (2019), the authors investigated the role of nutritional interventions in modulating the severity and intensity of pain experienced by participants suffering from chronic pain. The authors conducted a systematic search of eight databases for studies investigating adults with chronic pain, and the use of dietary interventions to ameliorate pain, yielding a total of 71 studies, of which, 23 underwent meta-analysis. The studies were divided into four groups based on their dietary intervention methods: group 1 (alterations to overall diet, n = 16) demonstrated a substantial reduction in participant reported pain in 12 out of 16 studies, group 2 (alteration of specific dietary nutrients, n = 5) demonstrated a substantial reduction in participant reported pain in two out of five studies, group 3 (supplement-based intervention, n = 46) demonstrated a substantial reduction in participant reported pain in 11 out of 46 studies, and group 4 (fasting, n = 4) demonstrated a substantial reduction in participant reported pain in one of the four studies. Meta-analysis of the studies revealed that nutrition interventions induced a substantial decrease in pain in studies that investigated overall dietary modification in addition to studies that reported the efficacy of a certain dietary nutrient over others. Thus, the authors conclude that their results demonstrate the beneficial effects of dietary interventions in managing individuals who suffer from chronic pain. [NPID: Chronic pain, dietary intake, supplements]
2022
Impact of diet on pain perception in women with endometriosis: A systematic review
Endometriosis is a chronic condition characterized by pain and inflammation originating from the presence of endometrial tissue outside of the uterine cavity. Scientific evidence points to the role of diet in ameliorating chronic inflammation, however, the evidence regarding the role diet plays in the perception of pain in endometriosis remains poorly understood. In this systematic review by Sverrisdóttir et al. (2022), the authors examine whether diet could influence pain perception in endometriosis patients. A comprehensive search was conducted on Medline and Embase to identify PRISMA and SWiM guidelines-adherent randomized controlled trials and observational studies, yielding six studies that fulfilled the inclusion criteria out of 2185 publications. The studies were assessed for bias using the Cochrane tool and the Newcastle-Ottawa scale and were found to be of low risk. Analysis of the studies revealed that a diet high in polyunsaturated fatty acids, a gluten-free diet, and a low nickel diet were associated with a substantial reduction in the perception of pain (five out of six studies, while all studies reported a positive improvement in pain perception). Meta-analysis was not possible due to significant heterogeneity between studies. The authors comment that, while all studies reported a positive influence of diet on pain perception in women suffering from endometriosis, the current evidence is mainly made up of non-randomized controlled trials with several areas of potential bias, which raises the demand for conducting more studies to fully understand the role diet may play in pain perception among women suffering from endometriosis. [NPID: Diet, dietary changes, dietary therapy, endometriosis, inflammation, inflammatory, pain, systematic review]
2020
Dietary patterns and interventions to alleviate chronic pain
Pain is the most commonly reported somatic complaint expressed by patients in modern society and medical practice. Chronic pain impacts our quality of life negatively and is linked to substantial degrees of functional disability and/or emotional stress. An in-depth biopsychosocial examination is required to understand chronic pain and necessitates a holistic biological, social and psychological approach to acquire useful data. In this study by Dragan et al. (2020), the authors outline the pertinent collective of articles in the PubMed database which investigate using dietary patterns to improve chronic pain, a search that returned 272 relevant studies conducted up to 10 years prior to the study's inception. In addition to classical and alternative chronic pain treatment methods, the authors note how literature points to different dietary patterns as potential interventions, owing to the antioxidant and anti-inflammatory properties of the included dietary components that can improve chronic pain and the overall quality of life. Furthermore, a total of 38 randomized controlled trials and clinical studies were analyzed in an endeavor to define current dietary behaviors and dietary interventions used to treat chronic pain. [NPID: Chronic pain, diet, gastrointestinal, inflammation, nutrition, pain, supplements]
2022
Chronic pain precedes disrupted eating behavior in low-back pain patients
The influence of chronic pain disorders is not limited to somatic symptoms, but extends to causing behavioral alterations, as seen with anhedonia (i.e., loss of ability to feel pleasure) and observed reductions in motivation occurring alongside chronic pain. These behavioral alterations are postulated to occur due to cerebral limbic system dysfunction (responsible for regulating survival functions like eating), which would explain the concurrent obesity seen in chronic pain patients. The mechanisms governing the relationship between behavioral alterations, limbic dysfunction, and chronic pain are not well known to date. Thus, Lin et al. (2022) sought to investigate whether eating behavior is altered through the transition from low-back pain to chronic pain in some patients compared to others who recover from low-back pain, and whether the changes seen in the hedonic approach to fat-rich foods (i.e., the action of seeking fatty food, motivated by pleasure or by escapism from pain) seen in chronic pain patients is related to derangement in the nucleus accumbens (which is the cerebral juncture between motivation and behavior). The authors’ working hypothesis is that the nucleus accumbens, a central part of the limbic system, is responsible for the hedonic drive towards fat-rich food in patients suffering from pain, due to its function in survival behaviors. Thus, the authors conducted behavioral assays and structural brain imaging to investigate sub-acute back pain (SBP) patients and healthy controls, at the beginning of the study and at one year during follow-up, and acquired further data from chronic low-back pain patients (CLBP). The authors discovered that SBP patients who recovered from pain at the time of follow-up (SBPr) and CLBP patients displayed deranged dietary habits, compared to SBP patients who still had persistent back pain at follow-up (SBPp), who were found to display intact dietary habits. Through neurological examination, SBPp and CLBP patients displayed significant links between hedonic insight of fatty food and the volume of the nucleus accumbens, denoting that the alteration in nucleus accumbens seen in SBPp patients outlined in published literature might provide a protective effect from hedonistic behavioral derangements during the preliminary trajectory of the disease process. The authors thus conclude that disruptions seen in the eating behaviors occur after the disease course becomes chronic and that these disruptions are linked to alterations in the nucleus accumben’s structure. [NPID: Sub-acute back pain, chronic back pain, eating behavior, limbic dysfunction, hedonic perception]
2020
Anti-inflammatory and anti-nociceptive effects of cocoa: A review on future perspectives in treatment of pain
A diverse volume of publications demonstrated the medicinal profile of cocoa, which holds several phytochemicals, particularly polyphenols that boast anti-inflammatory and antioxidant effects and help alleviate pain. There may be other potential components in cocoa that may alter pain perception through influencing biological processes, however, the evidence from human clinical trials regarding the painkilling properties of cocoa remains insufficient. De Feo et al. (2020) present in their review the need for more studies to further the understanding of the active ingredients in cocoa, the mechanisms behind their activity, and to exhibit their effectiveness in humans. [NPID: Anti-inflammatory effects, anti-nociceptive effects, cocoa, flavonoids, oxidative stress]
CNP Research Summary can be found in the CNP Library Membership
2021
Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study
This 2021 study analyzed whether the adoption of the Mediterranean diet can affect disease activity and cardiovascular risk in systemic lupus erythematosus patients. The sample included 280 patients with systemic lupus erythematosus (SLE), who completed a food questionnaire to assess their food intake habits and frequencies. The answers were then used to determine the subjects’ adherence to the Mediterranean diet, while their disease activity and damage accrual were also examined. The results revealed significant correlations between increased adherence to the Mediterranean diet with better anthropometric profiles, fewer cardiovascular disease risk factors, and lower disease activity and damage accrual scores. As the Mediterranean diet score rose, SLE disease activity dropped, along with damage accrual. The patients who scored higher Med Diet scores were also less likely to have active systemic lupus erythematosus or to show higher levels of damage. Less clinical activity and damage were associated with higher consumption of Mediterranean diet foods such as olive oil, fruits, vegetables, fish, and with avoiding red meat, meat products, sugars and pastries. In conclusion, greater adherence to the Mediterranean diet may reduce systemic lupus erythematosus disease activity and lower patients’ cardiovascular risk. [NPID: pain, inflammation, Mediterranean diet, cardiovascular risk, lupus, lupus erythematosus]
2021
Anti-inflammatory diet and inflammatory bowel disease: what clinicians and patients should know?
Shafiee et al. (2021) recognize that repeated use of anti-inflammatory agents, the current treatment for inflammatory bowel disease (IBD), can have adverse effects on the patient. The aim of this review was to outline the current literature regarding the anti-inflammatory diet’s effectiveness in IBD. Recently, diet-related strategies have been formulated to try to improve the clinical activity scores in IBD patients. A promising approach is the modification of microbiota living in the digestive tracts through dietary therapy, which has been reported to improve IBD outcomes. The anti-inflammatory diet has been recommended as it restricts the consumption of carbohydrates that contain modified fatty acids. This diet also contains probiotics and prebiotics that can promote balanced intestinal microbiota composition. However, the authors emphasize that there is not yet clear evidence that supports this type of diet for the maintenance of remission or for prevention of IBD relapse. [NPID: pain, inflammation, IBD, digestion]
CNP Research Summary can be found in the CNP Library Membership
2021
Inflammatory diseases and vitamin E-what do we know and where do we go?
This 2020 article inspects the pathogenesis of inflammatory diseases such as atherosclerosis and non‐alcoholic fatty liver disease (NAFLD), while examining the cellular signaling pathways involved in certain inflammatory processes. Nutrients’ influential role in inflammatory responses are being increasingly recognized. This suggests nutrition can greatly contribute to the treatment of inflammation-driven diseases and related comorbidities (obesity, fatty liver disease, and cardiovascular diseases). Vitamin E has been identified as the most important antioxidant in the human diet. In-vitro and in-vivo studies have suggested that vitamin E, in its many forms and its derivatives, have anti-inflammatory activity. Wallert et al. point out that recent publications have also been written about the therapeutic potential of vitamin E and its metabolites in inflammatory diseases. [NPID: pain, inflammation, atherosclerosis, fatty liver disease, obesity, cardiovascular disease, Vitamin E]
2021
The effects of antioxidant and anti-inflammatory capacity of diet on psoriasis and psoriatic arthritis phenotype: nutrition as therapeutic tool?
This 2021 review covers dietary nutrients that are capable of modifying glucose/lipid metabolism and insulin responses and aims to present the impacts of these nutrients on chronic inflammation and immunity. Katsimbri et al. also discuss how these nutritional regimens may act as potentially therapeutic tools for psoriasis and psoriatic arthritis. Dietary nutrients have been shown to activate the immune system, and their effects may result in the overproduction of proinflammatory cytokines. Psoriasis is a chronic, immune-mediated inflammatory disease that is more prevalent in obese individuals. It is said that weight loss interventions, supplementation, and various dietary regimens such as gluten-free and Mediterranean diet, may lead to improvements in psoriasis' natural course and response to therapy. Because of the low volume of research, further investigation into more sophisticated nutritional patterns, such as ketogenic, very low-carbohydrate or specific macro- and micro-nutrient substitution, are recommended. [NPID: pain, glucose, lipid metabolism, insulin, chronic inflammation, inflammation, immunity, psoriasis, psoriatic arthritis, proinflammatory cytokines, immune disease, gluten, Mediterranean diet, Med diet, keto, low-carb]
CNP Research Summary can be found in the CNP Library Membership
2021
Ideal food pyramid for patients with rheumatoid arthritis: A narrative review
Rondanelli et al. (2021) took a look at the current literature on the ideal dietary approach for rheumatoid arthritis management, aiming to construct a food pyramid for sufferers since many patients start following various dietary interventions even without taking the advice from physicians. Diet can affect inflammation, antigen presentation, antioxidant defense mechanisms and gut microbiota. According to the food pyramid, carbohydrates should be consumed every day (consisting of 3 portions of whole grains, preferably gluten free), as well as daily fruits and vegetables (five portions, with berries, citrus fruit, and green leafy vegetables the most recommended). In addition, the pyramid advocates the intake of 125ml of light yoghurt, 200ml of skimmed milk, extra virgin olive oil, and 1 glass of wine (125ml). Furthermore, 3 portions of fish, 2 portions of legumes, 2 servings of eggs, 2 portions of seasoned cheeses, and one meal consisting of red or processed meats should be eaten every week. At the top of the pyramid, there is personalized supplementation with vitamin D and omega 3, while at the same time, the importance of removing certain foods (salt and sugar) is also stressed. [NPID: pain, rheumatoid arthritis, inflammation, gut microbiota, antioxidant defense, food pyramid]
2021
A bioavailable form of curcumin, in combination with vitamin-D- and omega-3-enriched diet, modifies disease onset and outcomes in a murine model of collagen-induced arthritis
In this 2021 animal study, male DBA/1J mice were given a diet high in vitamin D3 (D3), and omega-3-fatty acids (O3FA) along with a highly bioavailable form of curcumin in a collagen-induced arthritis (CIA) murine model. The mice were challenged with bovine collagen II (CII) to induce arthritis. Joint thickness and standardized clinical score were checked regularly to determine the progress of disease in terms of severity. Hemshekhar et al. observed significantly drops in disease severity from curcumin administration alone (around 60%), while the mice eating the enriched diet plus curcumin supplements showed decreased disease severity by > 80% and maximally delayed disease onset and progression. It appeared that curcumin alone was responsible for mediating the suppression of anti-collagen antibodies and decreasing cellular infiltration and MMP abundance in the joints of the collagen-induced arthritis mice. But the daily curcumin supplementation in addition to the vitamin D3 and omega-3-fatty acids- enriched diet resulted in significantly more suppression of inflammatory biomarkers known to be associated with rheumatoid arthritis pathogenesis such as TNF, IFN-γ, and MCP-1. Since the combination of curcumin, vitamin D3 and omega-3-fatty acids have demonstrated their efficacy in delaying CIA severity and development in this animal model, it may be worthwhile assessing the use of these supplements in people at risk of developing rheumatoid arthritis in the future. [NPID: pain, vitamin D3, omega-3s, curcumin, animal, bovine collagen, joints, collagen, rheumatoid arthritis]
CNP Research Summary can be found in the CNP Library Membership
2021
A study protocol for a randomized controlled trial of an anti-inflammatory nutritional intervention in patients with fibromyalgia
The purpose of this 2021 study was to evaluate whether an anti-inflammatory nutritional intervention can affect inflammatory markers, disease assessment parameters, and quality of life of 100 female fibromyalgia (FM) patients. The sample was randomized into one of two groups: control group (to eat a diet based on general recommendations for healthy eating) or intervention group (adopting an anti-inflammatory diet absent of gluten, dairy, sugar, and ultra-processed foods). The intervention group had a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet in addition to the anti-inflammatory diet for the first month, before reintroducing all fruits and vegetables over a consecutive period of 2 months. Silva et al. assessed the subjects’ pain, fatigue, quality of sleep, quality of life, gastrointestinal symptoms, and inflammation over the course of the 3-month study. The results were expected to determine whether recommending nutritional modifications will help alleviate patients’ symptoms. [NPID: pain, inflammation, fibromyalgia, gluten, daily, sugar, processed food, FODMAPS,quality of sleep, quality of life, gastrointestinal symptoms]
2019
Nutritional intervention may improve migraine severity: a pilot study
Costa et al. (2019) state that while there are studies on the role of nutritional interventions on migraine, there is a lack of research on how diet quality is associated with migraines. In this present intervention study, fifty-two women were given individualized diet meal plans based on their nutritional diagnosis. Their clinical and nutritional data were taken once a month for 90 days. 24-hour dietary recalls allowed the reporting of energy content and macronutrients, while the Brazilian Healthy Eating Index-Revised was used to assess diet quality. In addition, the participants’ migraine severity and depressive symptoms were examined. While the intervention did not appear to affect anthropometric characteristics, energy, macronutrients and fiber intake, there was a rise in diet quality assessment scores after 60 and 90 days of intervention. Furthermore, the subjects’ depression scores dropped after 60 days, and their Headache Impact Test scores decreased also after 90 days. The increase in BHEI-R score (diet quality measure) correlated with the decrease in Headache Impact Test scores (migraine severity) at the end of the intervention. Costa et al. declared diet quality enhancement as a good strategy for improving migraine severity, regardless of the nutritional status and weight change. [NPID: pain, migraine, macronutrients, fiber, diet quality]
CNP Research Summary can be found in the CNP Library Membership
2020
Migraine and diet
This 2020 narrative review presents the author’s current view on diet and migraine and explores what is coming up in the future within this area of research. While the clinical manifestations of migraine are influenced by factors such as dietary behaviors, migraines are also thought to be triggered by certain food types. This has led to the development of diets such as elimination diets, ketogenic diets, and comprehensive diets, which may offer assistance in the prevention of migraines. Furthermore, some research supports the positive impact of dietary interventions on patients who experience migraines, although there is inconsistency in the evidence. There are several influential factors, namely sex, age, genetics, and other environmental factors. Scientists are also looking into the possibility that diet can alter diseases, interfering with the gut-brain axis or the migraine epigenetics (alterations caused by modification of gene expression rather than alteration of the genetic code itself). In the future, migraine patients can potentially be identified through their phenotypes, and then offered personalized treatment for the management of their migraine. [NPID: pain, migraine, elimination diet, keto, ketogenic diet, gut-brain axis, migraine epigenetics, gene expression, phenotype]
2020
The role of diet and nutrition in migraine triggers and treatment: A systematic literature review
This 2020 systematic review looks at the evidence linking dietary patterns, diet-related triggers, and dietary interventions with migraine. Dietary triggers are common causes of migraines, while specific diets have also been reported to reduce the frequency of migraine attacks. Hindiyeh et al. searched for randomized controlled trials and observational studies that assessed the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Of the 43 studies included in this analysis, 11 evaluated dietary patterns, 12 investigated dietary interventions, and 20 examined diet-related triggers of migraines. Since the majority of the studies on dietary patterns and triggers were either cross-sectional studies or patient surveys, the overall quality of the studies were deemed to be of low quality. The review identified alcohol and caffeine consumption as the most common diet-related predictors of more frequent migraine attacks. Whereas, a lot of the interventions including low-fat and elimination diets, were linked with decreases in frequency of migraine attacks. The authors conclude that there is a lack of high-quality randomized controlled trial data on dietary patterns and triggers, while the number of randomized controlled trials on dietary interventions’ efficacy in migraine prevention is also limited. There is a need for further high-quality research on diet’s impact on migraine sufferers. [NPID: pain, migraine, migraine triggers, alcohol, caffeine, elimination diet, low-fat, migraine prevention]
CNP Research Summary can be found in the CNP Library Membership
2021
A bidirectional view of Migraine and diet relationship
This 2021 targeted review describes diet’s effects on migraine features and the impact migraine has on dietary choices, through examples from the current literature. Guidelines for prevention of migraine have been developed by identifying the lifestyle factors that may trigger the migraine (e.g. stress, exercise, sleep and diet). Regarding the nutritional interventions developed thus far, the main focus has been to eliminate triggers and implement strategies for weight control. The ketogenic diet has been suggested as a so-called migraine diet, while epigenetic diets or functional food have been considered in studies designed to change some components of the migraine pathogenesis. Although these theories have not been thoroughly looked into, there is growing evidence suggesting that some mechanisms underlying migraine may alter dietary choices (type, amount, or patterns). Since a causative relationship between migraine and diet has not been confirmed yet, the concept of underlying mechanisms of migraine modifying dietary choices is possible, suggesting a potentially bidirectional interaction. There is a lack of epidemiological data available demonstrating individual dietary choices among patients with migraine compared with individuals without migraine. [NPID: pain, migraine, migraine prevention, ketogenic, keto, epigenetic]
2021
The effect of antioxidant and anti-inflammatory capacity of diet on psoriasis and psoriatic arthritis phenotype: Nutrition as therapeutic tool?
This 2021 review covers dietary nutrients that are capable of modifying glucose/lipid metabolism and insulin responses and aims to present the impacts of these nutrients on chronic inflammation and immunity. Katsimbri et al. also discuss how these nutritional regimens may act as potentially therapeutic tools for psoriasis and psoriatic arthritis. Dietary nutrients have been shown to activate the immune system, and their effects may result in the overproduction of proinflammatory cytokines. Psoriasis is a chronic, immune-mediated inflammatory disease that is more prevalent in obese individuals. It is said that weight loss interventions, supplementation, and various dietary regimens such as gluten-free and Mediterranean diet, may lead to improvements in psoriasis' natural course and response to therapy. Because of the low volume of research, further investigation into more sophisticated nutritional patterns, such as ketogenic, very low-carbohydrate or specific macro- and micro-nutrient substitution, are recommended. [NPID: pain, insulin, inflammation, immunity, psoriasis, psoriatic arthritis, immunity, immune system, psoriasis obesity, keto, low-carb]
CNP Research Summary can be found in the CNP Library Membership
2021
Dietary patterns and biomarkers of oxidative stress and inflammation: A systematic review of observational and intervention studies
This article is a systematic review from 2021 that inspected observational and intervention studies published in the last 5 years on the associations between dietary patterns and biomarkers of oxidative stress and inflammation. Out of the 3 large online research databases, 29 studies met the inclusion criteria (16 observational studies and 13 intervention studies). The plant-based diets such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets were negatively associated with oxidative stress and proinflammatory biomarkers. Whereas, observational studies indicated inverse correlations involving the vegetarian diet, paleolithic diet, and the USDA Healthy Eating Index (HEI) - based diet. On the other hand, the western and fast-food diets were linked with greater oxidative stress and proinflammatory biomarkers. The majority of dietary intervention studies (n = 12) were deemed to be of low to moderate quality. Aleksandrova et al. have discovered a link between plant-based dietary patterns and lower levels of oxidative stress and inflammation, which may prove helpful in the prevention of chronic disease. [NPID: pain, oxidative stress, inflammation, Mediterranean Diet, Med diet, hypertension, DASH, chronic disease]
2021
Lifestyle and Mediterranean diet adherence in a cohort of Southern Italian patients with Multiple Sclerosis
Since the Mediterranean diet has been promoted to possess positive effects on chronic diseases, Esposito et al. (2021) analyzed the lifestyle and dietary habits of Southern Italian patients with multiple sclerosis (MS), and examined the impact of the Mediterranean diet (MeDi) on multiple sclerosis clinical outcomes. The 435 participants had attended outpatient clinics for routine follow-up visits. During the experiment, the subjects were given a 29-item self-administered questionnaire on life and dietary habits. The results showed that 75.8% of the respondents were interested in nutrition, while 72.8% were non-smokers, 52.9% performed physical activity, and 45.6% used food supplements. People with multiple sclerosis and normal waist circumferences had higher Med Diet Scores (MDS), which is a measure of their adherence to the MeDi and also of their cardiovascular risk. Increased Med Diet Scores also correlated with lower MS Severity Score and Expanded Disability Status Scale. However, no relationship could be identified between the MDS and the total number of relapses. Metabolic comorbidities were associated with an increased 10-year cardiovascular risk. In conclusion, this data suggests that the Mediterranean diet has a positive impact on waist circumference, multiple sclerosis course and disability. Moreover, the MeDi appears to improve MS long-term disability outcomes. [NPID: pain, Mediterranean diet, Med diet, chronic disease, chronic pain, cardiovascular risk, multiple sclerosis]
CNP Research Summary can be found in the CNP Library Membership
2019
Nutrition interventions in Rheumatoid Arthritis: The potential use of plant-based diets
Since rheumatoid arthritis affects around 1% of the world’s population, Evers et al. (2021) explore how dietary factors such as the intake of plant-based diets can help manage or treat this autoimmune disease. It is unclear how rheumatoid arthritis (RA) develops, although genetic factors have been reported to contribute around 50-60% of the risk, and the remainder may involve modifiable factors including gut bacteria and nutrition. A compromised intestinal barrier may allow food components or microorganisms to enter the bloodstream, inciting inflammation. There are studies that have proven that rheumatoid arthritis symptoms improve after the consumption of diets excluding animal products. While other studies may recommend increased intake of dietary fiber since inflammation and joint pain were found to decrease as the fiber in the plant-based diets can enhance the composition of the gut bacteria and increase bacterial diversity in RA patients. Although many patients will have different trigger foods depending on the individual, many of these foods don’t appear to be in vegan diets, which may improve RA symptoms. Additional research is required to evaluate the effectiveness of plant-based diets on joint pain, inflammation, and quality of life in patients with rheumatoid arthritis. [NPID: pain, autoimmune disease, rheumatoid arthritis, arthritis, gut bacteria, gut-brain axis, fiber, animal products, inflammation, vegan]
2021
Adherence to dietary guidelines is associated with better physical and mental quality of life: results from a cross-sectional survey among 728 Dutch MS patients
Although a healthy diet has been associated with reducing symptoms of multiple sclerosis or slowing its progress, Evers et al. (2021) wanted to find out which diets specifically will lead to improvements in patients with multiple sclerosis (MS). The objective of this study was to analyze the relationship between diet quality, use of diets, and quality of life (QoL) in men and women with MS. Among the 623 women participants with MS, a correlation was discovered between diet quality with physical and mental quality of life (after adjusting for several confounders). There was a similar trend observed among the male sample (105 men). In addition, subjects who followed a specific diet had a higher diet quality and benefited from a higher quality of life, when compared with those who did not follow a particular diet. This study therefore found that people with MS, especially women, who adhered more to the Dutch dietary guidelines were more likely to have better outcomes such as physical and mental quality of life. Also, following an MS-specific diet may help to adhere to these guidelines. [NPID: pain, multiple sclerosis, MS, quality of life, QoL]
CNP Research Summary can be found in the CNP Library Membership
2019
Blueberries improve pain, gait performance, and inflammation in individuals with symptomatic knee osteoarthritis
Since the progress of osteoarthritis is strongly influenced by inflammation and dietary polyphenols possess anti-inflammatory properties and potentially induce anabolic effects on the cartilage cells, Du et al. (2019) believed that blueberry consumption may help improve the symptomatology of osteoarthritis. This trial investigated the effect of eating freeze-dried blueberries on pain, gait performance, and inflammation in patients with symptomatic knee osteoarthritis (OA). The adult participants with knee OA were randomly selected to either receive 40g of freeze-dried blueberry powder or placebo powder every day for 4 months. As well as drawing blood samples, the subjects were assessed on their pain and gait through questionnaires at baseline, and at the 2-month and 4-month marks. Those treated with blueberries felt less pain, stiffness, and difficulty performing daily tasks compared to baseline levels, while the placebo group did not report an easing of daily activity performance. In the blueberry treatment group, single support percentage for both limbs while walking at normal pace increased compared to baseline. Moreover, their double support percentage for both limbs decreased after blueberry treatment. Although there were no significant changes in plasma concentrations of inflammatory markers in either group, the level of IL-13 tended to rise and MCP-1 concentration appeared to drop in the blueberry group. To summarize the findings, incorporating whole blueberries into your daily diet may improve the quality of life of patients with symptomatic knee OA by reducing pain, stiffness, and difficulty to perform daily activities, as well as improving gait performance. [NPID: pain, inflammation, polyphenols, blueberries, osteoarthritis, gait performance]
2020
Chronic musculoskeletal pain and nutrition: Where are we and where are we heading?
This narrative review published in 2020 outlines the current knowledge on the interaction between nutrition and chronic musculoskeletal pain, focusing on different underlying mechanisms such as inflammation, obesity, homeostatic balance, and central sensitization. Elma et al. also informs us how nutritional behavior interventions and dietary assessments can be utilized in clinical practice for patients with chronic musculoskeletal pain. Poor diet can be an underlying factor in chronic musculoskeletal pain and can often predict this type of pain. The current literature suggests that diet quality and dietary behavior can affect pain conditions, although the direction of this effect has not been confirmed. We require supplementary human nutrition studies that analyze specific musculoskeletal pain conditions and the underlying pathologies. [NPID: pain, chronic musculoskeletal pain, chronic pain, inflammation, obesity, homeostatic balance]
CNP Research Summary can be found in the CNP Library Membership
2021
Role of diet in diarrhea-predominant Irritable Bowel Syndrome
This 2021 review outlines the current understanding on the role of dietary factors such as consuming gluten-free diet, low fermentable oligosaccharides, disaccharides, monosaccharides, polyols diets, and the malabsorption of carbohydrates in the pathophysiology and symptom management of diarrhea-predominant irritable bowel syndrome (IBS). IBS is a chronic condition characterized by abdominal pain connected with unpredictable bowel habits. The condition affects the sufferers’ quality of life, particularly in diarrhea-predominant IBS, since these patients often avoid food to lessen or prevent symptoms. Although physicians recommend dietary treatment to mitigate the symptoms, it is only in the last ten years that scientists started looking into dietary interventions such as a gluten-free diet, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diets. [NPID: pain, gluten, gluten-free, oligosaccharides, disaccharides, monosaccharides, polyols, carbs, IBS, chronic pain]
2018
Gut-brain Axis: Role of lipids in the regulation of inflammation, pain and CNS diseases
This 2018 review discusses the role of bioactive lipids in inflammation, acute and chronic pain, obesity and central nervous system diseases. These lipids are capable of modulating peripheral and central pathologic processes and have been linked with the gut microbiota through various mechanisms. A connection between the gut and the brain has been proposed (named the gut-brain axis) since microbial composition has been shown to influence behavior and cognition. Scientists have started investigating the relationship between this axis and health and disease, including stress-related (depression, anxiety and irritable bowel syndrome) and neurodevelopmental disorders (autism), and neurodegenerative diseases (Parkinson Disease, Alzheimer's Disease). Russo et al. mentions an animal study that discovered the reduction of abdominal pain in rats after systemic administration of bacteria. Other findings include PEA and butyrate, which reduced inflammatory markers in animal models with inflammatory bowel disease (IBD), and reduced inflammation as well as pain in irritable bowel syndrome and IBD, respectively. This review provides a summary of the relationship between inflammation, pain, microbiota and various lipids, focusing on N-acylethanolamines (NAEs) and short chain fatty acids (SCFAs) in the gut-brain axis and their functions in the central nervous system diseases. [NPID: pain, chronic pain, inflammation, obesity, gut-brain axis, IBS, anxiety, depression, neurodevelopmental disorders, autism, neurodegenerative diseases, Parkinson Disease, Alzheimer’s, animal, IBD]
CNP Research Summary can be found in the CNP Library Membership
2018
Are probiotic treatments useful on fibromyalgia syndrome or chronic fatigue syndrome patients? A systematic review
This 2018 systematic review evaluates the evidence behind the reported influence of probiotic treatments in patients with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). There have been suggestions that the gut microbiota have an important role in these syndromes. The reviewers looked for randomized controlled trials (RCTs) and pilot studies involving CFS or FMS patients that were published between 2006 and 2016. The two studies that met the inclusion criteria both investigated people with chronic fatigue syndrome and were considered as a 'High range of quality score'. The anxiety scores of the participants with CFS dropped following an 8-week course of Lactobacillus casei strain Shirota. Moreover, their faecal composition was altered after the 8-week treatment. CFS patients given Bifidobacterium infantis 35624 for the same time-period showed reduced levels of inflammatory biomarkers. These probiotic strains mentioned can significantly affect anxiety and inflammatory processes in individuals with chronic fatigue syndrome. Further experimental research taking a closer look at the symptoms of the pathologies would be useful. [NPID: pain, chronic pain, fibromyalgia, chronic fatigue, fatigue, anxiety, Lactobacillus, probiotics]
2020
Food in chronic pain: Friend or foe?
This 2020 review focuses on the current research being conducted regarding the dietary factors that influence multiple pain conditions. Fifi & Holton discuss the positive as well as the negative impact of diet. The study of dietary factors that affect glutamatergic neurotransmission may be considered by some since glutamate is an abundant neurotransmitter that mediates pain transmission. The authors reveal some positive findings for glutamate in cases of fibromyalgia and irritable bowel syndrome. Due to the rise of ketogenic diets being recommended for seizure control, this type of diet is thought to hold potential in pain perception too. Inflammatory pain conditions are also discussed here, including promising dietary strategies currently being investigated. Another section reports the link between body mass index (BMI) and prevalence of chronic pain. With regards to the evidence on diet’s positive influence on pain, various herbal remedies such as curcumin, peppermint oil constituents are mentioned, along with their reported mechanisms of action. The last section is dedicated to the role of micronutrients in promoting optimal neuronal functioning. These summaries can help inform people on how food can have both positive and detrimental effects. Understanding their impacts can benefit people, especially those living with chronic pain. [NPID: pain, chronic pain, glutamatergic neurotransmission, glutamate, pain transmission, fibromyalgia, IBS, keto, ketogenic, inflammation, curcumin, peppermint, neuronal functioning]
CNP Research Summary can be found in the CNP Library Membership
2020
Association of chronic spinal pain with diet quality
Since certain behaviors may contribute to increasing the risk of developing chronic spinal pain (which is very costly and disabling), Zick et al. (2020) examined the relationship between diet quality and odds of experiencing spinal pain. The researchers hypothesized that individuals who consume high quality diets and more macronutrients would be less likely to have spinal pain. Population-based data from the NHANES cycle 2009-2010 was used for analysis. Of the 4123 participants, chronic spinal pain was reported by 800 (19.4%). Although these sufferers had significantly poorer diets than those with no spinal pain, they ate similar amounts of calories. The subjects in the highest tertile for diet quality (based on Healthy Eating Index-2015) were 24% less likely to complain of spinal pain compared to those in the lowest tertile. Higher intakes of whole fruits, grains, and dairy were associated with 20% to 26% lower risks of having pain in the spinal area. On the other hand, added sugars were linked with increased odds of chronic spinal pain by 49%. While there is no evidence of causality, this study promotes further research into the function of diet quality in pain. [NPID: pain, chronic pain, spinal pain, fruit, grains, dairy, added sugar, sugar]
2020
Nutritional intervention in chronic pain: an innovative way of targeting central nervous system sensitization?
Since chronic pain treatment programs rarely consider dietary pattern or adipose status, this 2020 review explores the alternative treatments to the current standard. While neuroinflammation is known to play a role in chronic pain, it is believed that this is partly due to the increased central nervous system glial activation. Preclinical studies have pointed to the possibility that the relationship between nutrition and central sensitization may be mediated via the bidirectional gut-brain interactions. This seems to suggest that neuroinflammation is induced by diet, which is a modifiable factor in people with chronic pain. The expert’s opinion is that a dietary pattern consisting of low quantities of saturated fat and added sugars may have various consequences, and ultimately prevent glial activation as well as prevent the transmission of inflammatory signals to the brain. Furthermore, a diet that reduces polyamine generation in the gut microbiota may help lessen or prevent central nervous system sensitization since polyamines can potentially excite N-methyl-D-aspartate receptors (essential component of the central nervous system sensitization). [NPID: pain, adipose tissue, neuroinflammation, gut-brain, inflammation]