Diet and Pain

In this article Carr & McCall (2017) list evidence for vitamin C administration in the treatment of pain and propose a novel analgesic mechanism for vitamin C supported by studies showing a decrease in need for opioid analgesics in surgical and cancer patients administered with high dose vitamin C. While epidemiological evidence has associated suboptimal vitamin C status and spinal pain, there is also clinical evidence: for example a number of studies have demonstrated that vitamin C administration to patients with chronic regional pain syndrome reduces their symptoms; also acute herpetic and post-herpetic neuralgia (nerve pain following herpes) are also diminished after taking high dose vitamin C; in addition high dose vitamin C has been shown to decrease cancer-related pain and thereby improve patient quality of life. While a number of mechanisms have been proposed for its analgesic properties, Carr and McCall (2017) suggest vitamin C’s role as a cofactor for the biosynthesis of amidated opioid peptides. Even if the mechanism is not very clear yet, vitamin C appears to be a safe and effective adjunctive therapy for acute and chronic pain relief in specific patient groups.

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, 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 were 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.

Helde-Frankling and Björkhem-Bergman (2017) review the current evidence for the possible role of vitamin D in nociceptive and inflammatory pain. Observational studies have associated low levels of vitamin D with increased pain and higher opioid doses, while recent interventional studies have shown the promise of supplementation of this vitamin in cancer pain and muscular pain (when vitamin D levels are “insufficient” before intervention). The writers propose possible mechanisms for vitamin D in pain management including the anti-inflammatory effects mediated by cytokine and prostaglandin release. It is also suggested that patients with deficient levels (25-hydroxyvitamin D [25-OHD] levels < 30nmol/L) are most likely to benefit from supplementation while those with levels > 50nmol/L would likely gain little from this vitamin D boost. The conclusion is that vitamin D may constitute a safe, simple and potentially beneficial way to reduce pain among patients with vitamin D deficiency, but that more randomized and placebo-controlled studies are needed before any firm conclusions can be drawn.

Pusceddu and Gareau (2018) describe the neuroanatomical basis of signaling in visceral pain (complex and heterogeneous disorder involving pain ranging from mild discomfort of indigestion to the agonising pain of renal colic) and the existing evidence of its manipulation exerted by the gut microbiota. Recent findings had linked the microbiota to gastrointestinal disorders characterised by abdominal pain, implying microbes may be capable of modulating visceral hypersensitivity and nociception to pain. This review also explored potential therapeutic effects of dietary intervention such as probiotics and prebiotics in alleviating hypersensitivity to visceral pain stimuli. The conclusions drawn were that gut microbiota dramatically impacts normal visceral pain sensation, affects the mechanisms mediating visceral nociception, and also the use of probiotics and prebiotics may play a potential role in the regulation of visceral pain disorders.

This 2019 article by Rowin reviewed the available evidence to support the use of complementary and alternative treatments for commonly encountered conditions associated with neuropathy and neuropathic pain. Rowin (2019) believes that diet and lifestyle interventions are becoming important components in the management of neuropathy, as the association between metabolic syndrome and neuropathy is increasingly becoming recognised. There has been progress in the understanding of the gut-immune interaction, highlighting the role the gut microbiome and inflammation plays in the modulation of neuropathy and neuropathic pain, as well as promising evidence for nutritional interventions, exercise, supplements, acupuncture and mindfulness-based practices in the treatment of neuropathic pain.

Lim & Kim (2016) claim to have identified food-derived compounds that alleviate neuropathic pain and in this review they explored the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs (G-Protein Coupled Receptors) for neuropathic treatment. The authors state that available neuropathic pain medicines have undesired side effects (such as tolerance and physical dependence), do not alleviate the pain, that the mechanisms of neuropathic pain are still not fully understood, and that traditional plant treatments have been used worldwide for treating diseases. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2) acts as an important signaling mediator, which is why Lim & Kim (2016) discuss the potential benefits of CCR2 antagonists for treatment for neuropathic pain.

This 2017 review looks at the potential use of polyunsaturated fatty acids (some of which [n-3s] have anti-inflammatory and pro-resolving properties) in rheumatoid arthritis (RA), a chronic inflammatory arthritis in which many inflammatory pathways contribute to joint and systemic inflammation, disease activity, and structural damage. The reviewers reported that data from animal models suggests supplementation with n-3 polyunsaturated fatty acids (n-3 PUFAs), which is found to be low in Western diets, may be an interesting perspective in future research as much in prevention as in treating RA. Human studies have implicated a diet high in n-3 PUFAs with a protective role for incident RA in subjects at risk. Supplementation with n-3 PUFAs could represent a promising therapeutic option to better control many features of RA as it could improve pain symptoms, the tender joint count, duration of morning stiffness and frequency of NSAID assumption.

Haß, Herpich & Norman (2019) aimed to study the effects of anti-inflammatory nutrients, foods and diets on inflammatory markers and fatigue in various populations, as there has been a build up of data linking a pro-inflammatory status and occurrence of chronic disease-related fatigue. Analysing 21 human trials, the authors state the available research indicated the use of single nutrients possess anti-inflammatory and fatigue-reducing capability. There were also conflicting literature as some clinical studies demonstrate that a balanced diet with whole grains high in fibres, polyphenol-rich vegetables, and omega-3-fatty acid-rich foods may improve disease-related fatigue symptoms. Further research is required to substantiate the promising results from human trials on fatigue.

This 2016 review studied the scientific evidence linking headaches to those dietary triggers commonly reported by various headache sufferers (particularly those with migraines) such as chocolate, caffeine, dairy products namely aged cheese, alcohol (especially red wine and beer), food preservatives with nitrates and nitrites, monosodium glutamate (MSG), and artificial sweeteners such as aspartame. Prevalence of these triggers from prior-population-based studies will also be examined. Depending on study population and methodology, the presence of any specific dietary trigger in migraine patients varies from 10-64%. Some foods will trigger headaches within an hour while others develop within 12 hours of ingesting the trigger food. Zaeem, Zhou & DIlli (2016) summarised recent literature surrounding headache related to fasting and weight loss as well as eliminating diets based on serum food antibody testing in order to help physicians in their recommendations of low-risk, non-pharmacological adjunctive therapies for patients with debilitating headaches.

Minerbi et. al (2019) compared the microbiomes of 77 women with fibromyalgia (FM) which is a prevalent syndrome characterised by chronic widespread pain, fatigue, and impaired sleep - with that of 79 control participants. Significant differences in bacterial taxa were revealed. In addition to the variance in composition of the microbiomes, targeted serum metabolite analysis verified differences in the serum levels of butyrates and propionates in fibromyalgia patients. With the assistance of machine-learning algorithms, FM sufferers and controls could be identified by solely using the microbiome composition. Claimed to be perhaps one of the first to demonstrate gut microbiome alteration in non-visceral pain, this study may goad further research on the pathophysiology of fibromyalgia, for developing diagnostic aids and new treatment modalities.

This 2020 cross-sectional study examined 95 women diagnosed with fibromyalgia syndrome (FMS) and 98 menopause-status matched controls, to learn about the relationship between an anti-inflammatory diet profile and the pressure pain thresholds (PPTs) of tender point sites and other fibromyalgia-related symptoms in patients with FMS. The study evaluated disease severity, sleep, fatigue, anxiety, central sensitisation, Dietary Inflammatory Index (DII) and the PPTs of tender point sites and self-reported global pain levels (through algometry and visual analog scale). The DII score was associated with the PPTs of tender point sites including the occiput, trapezius, zygapophyseal joint, second rib, gluteus, greater trochanter, and knee using linear regression analysis (after variable adjustments) and using analyses of covariance (significant association between the PPTs of the above tender point sites with the DII score quartiles in patients with FMS). However, no significant differences were found for the cases or controls between the DII score and the remaining clinical symptoms or between the DII score quartiles with other symptoms in patients with FMS. The writers conclude that a pro-inflammatory diet was associated with pain hypersensitivity in patients with FMS.

This 2018 systematic review searched for random controlled trials (RCTs) and pilot studies of chronic fatigue syndrome (CFS) or fibromyalgia syndrome (FMS) published between 2006 and 2016, to analyse the current literature on the reported effect of probiotic treatments in patients diagnosed with FMS or CFS. Two studies (n=83) conducted on CFS patients considered to be “high range of quality score” (determined by the Jadad scale) were included in this review. Over the course of 8 weeks, the administration of Lactobacillus casei strain Shirota in CFS patients was found to reduce anxiety score and also change faecal composition after the 8 weeks. The other study showed evidence of Bifidobacterium infantis 35624 reducing inflammatory biomarkers in CFS patients over the same period of time (8 weeks). Although these studies demonstrate significant effects of probiotics on modulating anxiety and inflammatory processed in CFS, Roman et. al (2018) found evidence limited and call for more experimental research focusing mainly on the symptoms of FMS and CFS.

This 2016 review summarised the latest findings on the role of nutrition and nutraceuticals, microbiome, soy, obesity, omega-3 fatty acids, and curcumin supplementation as key elements in modulating the efficacy of analgesic treatments, including opioids. These main topics were addressed in the first edition of the Study In Multidisciplinary Pain Research workshop: “Feed Your Destiny: Fighting Pain” held in April 2016, which recommended the initiation of nutritional assessment and counseling in patients with chronic pain from the onset of treatment. Since some foods and supplements used in personalized treatment will likely improve clinical outcomes of analgesic therapy and result in considerable improvement of patient compliance and quality of life, De Gregori et. al (2016) believe in the “highly promising” benefit of including nutrition in personalising pain medicine.

Minerbi & Fitzcharles (2020) highlight the involvement of gut bacteria in the pathogenesis of various medical conditions in numerous medical fields such as gastroenterology, metabolic, rheumatologic, neurologic and psychiatric disorders, and states evidence is accumulating linking gut microbiome to chronic pain and specifically fibromyalgia (FM). The composition of the gut bacterial community is altered in individuals with FM, with an altered abundance of a small subset of bacterial species (some of which have metabolic activity potentially related to FM symptom expression). The appearance of short-chain fatty acids, bile acids, neurotransmitters and bacterial antigens in the circulation may allow these bacterial species to affect pain, fatigue, mood and other symptoms in the host. The writers anticipate better mechanical understanding of FM in the future, hopefully permitting the development of objective diagnostic aids new therapeutic modalities.

Rea and colleagues (2017) reviewed the involvement of the gastrointestinal microbiota in visceral pain, focusing on the anatomical and physiological nodes whereby microbiota may be mediating pain response and discussing the potential for manipulating gastrointestinal microbiota as a therapeutic target for visceral pain. The writers explained the consequences of changes to the microbial environment in the gut: drop in gut barrier integrity; altered gut motility; inflammatory mediator release; nociceptive and distension receptor sensitisation while hypothalamic pituitary adrenal (HPA) axis, neuroinflammatory events and neurotransmitter systems are concomitantly altered. The microbiota-gut-brain axis imbalance results in the alteration of the central and peripheral pathways, both of which are associated with pain manifestation and perception.

Holton (2016) presents the evidence for the important role of diet in contributing to symptoms of fibromyalgia (FM) and explains how it is thought specific dietary components may be leading to abnormal glutamatergic neurotransmission and thereby perpetuating the process of central sensitisation. Holton states good biological plausibility exists for how dietary excitotoxins may be leading to increased symptom occurrence in FM while low intake of omega-3 fatty acids, vitamin B6, magnesium, zinc and antioxidants may also play a supporting role in symptom occurrence. The author encourages research into modulating glutamatergic neurotransmission while measuring dietary intake and plasma levels of these micronutrients, and combined intervention approach studies which modulate intake of excitotoxins while concurrently increasing the consumption of these key nutrients to examine the potential for synergistic effects.

This 2020 systematic review conducted a search for published original research on the gastrointestinal microbiota and its biomarkers in adult fibromyalgia sufferers, and summarised its findings. From 4771 studies, 11 met the inclusion criteria and were separated into four main groups: papers reporting Helicobacter pylori; other gut bacterial markers; metabolomics and other biomarkers, which included intestinal permeability and small intestinal bacterial overgrowth. The results indicated the gut microbiota may play a role in fibromyalgia within the emerging field of the gut-musculoskeletal axis and suggested there is a limited amount of quality research in this area. Erdrich et. al (2020) call for more studies on the relationship between the gut microbiota, gut dysfunction and fibromyalgia.

This 2019 review discusses the many immunological, environmental and nutritional aspects investigated with regards to chronic fatigue syndrome (CFS), a multi-systemic and complex illness which induces fatigue and long-term disability in educational, occupational, social or personal activities. The focus is on nutritional interventions in CFS since some nutrient deficiencies such as vitamin C, sodium, magnesium, zinc and many more appear to affect the severity and exacerbation of CFS symptoms. This review highlights a far-driven analysis of mineral and vitamin deficiencies among CFS patients.

Since low FODMAP (fementable oligo-di-mono-saccarides and polyols) diet has been effective in controlling irritable bowel syndrome symptoms, Marum et. al (2017) investigated the effects of a low FODMAP diet on symptoms of fibromyalgia (comorbidy associated with IBS) and weight status (since being overweight is an aggravating factor for fibromyalgia). The 4-week longitudinal study had a sample size of 38 fibromyalgia patients, 37% of whom were overweight and 34% were obese. Following the FODMAP diet, weight, body mass index and waist circumference all decreased significantly (p < 0.01) but there was no significant effect on body composition. As for the fibromyalgia-related outcomes, symptoms significantly dropped as well as severity as shown by the fibromyalgia survey questionnaire. The “diet adherence” was reported to be 85% as reflected by the significant reduction in FODMAP intake. "Satisfaction with improvement of symptoms" (76%), showed correlating with "diet adherence" (r = 0.65; p < 0.01). Although the intake of essential nutrients (fiber, calcium, magnesium and vitamin D) showed no significant difference, the results were highly encouraging. The researchers found that a low fermentable oligo-di-mono-saccharides and polyols diets as a nutritionally balanced approach contributed to weight loss and reduced the severity of fibromyalgia symptoms.

This 2018 review examined the many effects of metals and vitamins in pain evaluation of fibromyalgia (FM) patients as some research have shown deficiencies in certain essential nutrients may result in dysfunction of pain inhibitory mechanisms and may predispose individuals to experience fatigue and other FM symptoms. Bjørklund and his team propose the need for dietary guidance to help FM patients correct a suboptimal or deficient diet limited in essential nutrients, especially since pain levels are lowered once optimal levels of nutrition are achieved. The writers also recommend supplementary research on FM and nutrition to disclose further possible relationships.

This 2019 experiment studied the effect of cannabidiol (CBD) - primary non-addictive component of cannabis associated with possessing analgesic and anxiolytic properties - on neuropathic pain using rats. Repeated treatment with CBD (5 mg/kg/day, subcutaneously [s.c.], for 7 days) was shown to increase serotonin (5-HT) neuronal firing through desensitisation of 5-HT1A receptors. Rats subjected to the spared nerve injury model for 24 days showed decreased 5-HT firing activity, mechanical allodynia (condition where pain is caused by a stimulus that does not normally elicit pain), and increased anxiety-like behavior but seven days of CBD treatment reduced mechanical allodynia, decreased anxiety-like behavior and normalised 5-HT activity. De Gregorio and colleagues (2019) discovered that repeated treatment with low-dose CBD induces analgesia predominantly through TRPV1 activation, reduces anxiety through 5-HT1A receptor activation, and rescues impaired 5-HT neurotransmission under neuropathic pain conditions.

As interest in medical use of cannabis is growing, and as the endocannabinoid system is known to control pain at peripheral, spinal and supraspinal levels, this 2020 review examined evidence for the THC:CBD blend formulated as a oromucosal spray (nabiximols) in the management of chronic pain conditions. Überall (2020) explains that the mainstay of chronic pain management is analgesia, although prolonged use of non-steroidal anti-inflammatory drugs or opioids to manage chronic pain is rarely sustainable. Further precise clinical trials are required to draw definitive conclusions but cumulative evidence from clinical trials and an exploratory analysis of the German Pain e-Registry suggests that add-on THC:CBD oromucosal spray (nabiximols) may have a role in managing chronic neuropathic pain.

Dreher, Kosz & Schwarting (2019) gathered data from randomised controlled trials (RCTs), non-RCT studies, reviews and recommendations from professional societies in order to investigate the assumed positive effects of physical activity, physical training, and diet adaptations on inflammatory rheumatic diseases and their potential comorbidities. The review found that nutritional medical approaches provide preventative and rehabilitative beneficial possibilities while physical activity and training have positive influences on rheumatic diseases and its comorbidities. It was also mentioned that the exercise and training recommendations of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) provide recommendations, which were adapted by the European League Against Rheumatism (EULAR) to control intensity, duration and training extent. Although the author believes implementation of increased physical activity, regular physical training and diet adaptation should be an additional component of the treatment of inflammatory rheumatic diseases, further research is required in individual sub-aspects.

This experimental study published in 2019 explored the analgesic effects of inhaled pharmaceutical-grade cannabis in 20 chronic pain patients with fibromyalgia by testing 3 different cannabis varieties (Bedrocan [22.4-mg THC, <1-mg CBD], Bedoil [13.4-mg THC, 17.8-mg CBD], Bedrolite [18.4-mg CBD, <1-mg THC]) and a placebo variety without any ∆9-tetrahydrocannabinol (THC) or cannabinoid (CBD). After the patients inhaled the vapour once, THC and CBD plasma concentrations, pressure and electrical pain thresholds, spontaneous pain scores, and drug high were measured for 3 hours. None of the treatments had an effect greater than placebo on spontaneous or electrical pain responses, although more subjects receiving Bediol displayed a 30% decrease in pain scores compared to placebo (90% vs 55% of patients, P = 0.01), with spontaneous pain scores correlating with the magnitude of drug high (p < 0.001). Cannabis varieties containing THC caused a significant increase in pressure pain threshold relative to placebo (p < 0.01) while CBD inhalation increased THC plasma concentrations but diminished THC-induced analgesic effects, proving the synergistic pharmacokinetic but antagonistic pharmacodynamic interactions of THC and CBD. While this randomised placebo-controlled 4-way crossover trial demonstrated the complex behavior of inhaled cannabinoids in chronic pain patients with just small analgesic responses after a single inhalation, supplementary research could determine long-term effects on spontaneous pain scores, THC-CBD interactions and the role of psychotropic symptoms on pain relief.

This 2020 article analyses the current literature on the beneficial and detrimental effects of medical cannabis in the treatment of pain, and discusses the problems and challenges facing the medical community in this domain and offers a practical approach to deal with these challenges. Vulfsons, Minerbi & Sahar (2020) attempt to answer questions such as “what is cannabis? An abusive substance or a medication? Should it be incorporated into current biomedical practice, and how should it be administered? Finally, what is the evidence for the beneficial and detrimental effects of cannabis?”.

This 2018 paper presents the evidence for the use of nutraceuticals, which are compounds or materials that can function as nutrition and exert a potentially therapeutic effect, in osteoarthritis pain management. Wang et. al (2018) focus on human clinical trials since they have shown the potential of nutraceuticals in relieving osteoarthritis (OA) pain. This review consists of discussions on the biologic and pharmacologic actions underlying the nutraceutical effects on pain relief based on the potential active ingredients identified from traditional nutraceuticals in OA pain management and their potential for drug development. What is required in future studies is elucidation of the mechanisms of action of nutraceuticals in OA and developing those that mitigate OA pathology as well as relieving pain.

Wu et. al (2018) reviewed published observational research on 25-hydroxyvitamin D (25(OH)D) concentration and pain-related conditions with the aim of finding an association between mean 25(OH)D concentration on the level of vitamin D deficiency and pain conditions. A meta-analysis was conducted on the eighty-one observational studies included in this review with a total of 50 834 participants. In comparison to the controls, mean 25(OH)D concentration was significantly lower in patients with arthritis (mean difference (MD): -12·34 nmol/l; P<0·001), muscle pain (MD: -8·97 nmol/l; P=0·003) and chronic widespread pain (MD: -7·77 nmol/l; P<0·001), but not in patients with headache or migraine (MD: -2·53 nmol/l; P=0·06). The odds of vitamin D deficiency were higher for arthritis, muscle pain and chronic widespread pain, but not for headache or migraine, compared with controls. Sensitivity analyses revealed similar results. The results of this review suggests that low 25(OH)D concentrations may be associated with pain conditions.

Since vitamin D has been proposed as an associated factor in chronic non-specific widespread pain (CWP)(characterized by widespread pain, reduced pain threshold, and multiple tender points on examination, causing disability and decreased quality of life), Yong et. al (2017) aimed to explore the benefit of vitamin D supplementation in the management of CWP by searching on several databases for randomized clinical trials evaluating the effects of vitamin D treatment in adult subjects with CWP or FMS. Data extracted from four randomised controlled trials totalling 287 participants revealed a significantly lower visual analog scale (VAS) of pain intensity in CWP patients who received vitamin D supplementation compared with those who received placebo, although no significant relationship was found in the meta-regression analysis between the changes of vitamin D and VAS. This meta-analysis has shown vitamin D supplementation can decrease pain scores and improve pain despite no significant change in VAS after increasing serum vitamin D levels but more studies are required to investigate the improvements in quality of life, functional status, and the pathophysiological aspects that improves chronic widespread pain.

Lim & Kim (2016) claim to have identified food-derived compounds that alleviate neuropathic pain and in this review they explored the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs (G-Protein Coupled Receptors) for neuropathic treatment. The authors state that available neuropathic pain medicines have undesired side effects (such as tolerance and physical dependence), do not alleviate the pain, that the mechanisms of neuropathic pain are still not fully understood, and that traditional plant treatments have been used worldwide for treating diseases. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2) acts as an important signaling mediator, which is why Lim & Kim (2016) discuss the potential benefits of CCR2 antagonists for treatment for neuropathic pain.

This 2019 review outlines the current understanding on the role of gut microbiota in pain regulation and discusses the possibility of targeting gut microbiota for the management of chronic pain. Numerous signalling molecules derived from gut microbiota, such as by-products of microbiota, metabolites, neurotransmitters, and neuromodulators, act on their receptors and remarkably regulate excitability of primary nociceptive neurons (modulating peripheral sensitisation) and causes induction and maintenance of central sensitisation, regulating the development of chronic pain. Guo and the others (2019) propose targeting gut microbiota by diet and pharmabiotic intervention as a new therapeutic strategy for the management of chronic pain.

Costa et. al (2019) investigated whether nutritional interventions focused on enhancing diet quality and healthy weight can promote improvement in clinical parameters of women with migraine. The study involved fifty-two women aged 44.0 ± 13.0 years receiving an individualised diet meal plan and nutritional orientation according to their nutritional diagnosis for 90 days. Anthropometric, clinical and nutritional data were measured once a month while diet energy content and macronutrients were checked using 24-hour dietary recall. Diet quality was assessed through the Brazilian Healthy Eating Index-Revised (BHEI-R), the Migraine Disability Assessment and Headache Impact Test version 6 were used to determine the severity of migraine, and the Beck Depression Inventory evaluated depressive symptoms. The result showed no changes in anthropometric characteristics, energy, macronutrients and fiber intake but the BHEI-R scores improved after 60 and 90 days of intervention, while the Beck Depression Inventory Scores and Headache Impact Test scores decreased after 60 and 90 days, respectively. The change in BHEI-R score was found to be negatively correlated to the migraine severity at the end of the intervention. In conclusion, Costa and the other researchers (2019) find the management of diet quality to be a good strategy for improving migraine severity regardless of nutritional status and weight change.

This is a 2020 article on fatigue, the mechanisms in which we may be able to mediate the degree of lethargy in old age, particularly looking at nutritional methods. Azzolino et. al (2020) believe fatigue is often underestimated by health professionals primarily because reduced stamina is seen as inevitable with age. But the incomplete knowledge of pathophysiological mechanisms of fatigue and the lack of a gold standard tool for its assessment contribute to its poor appreciation in clinical practice. Inadequate nutrition is invoked as one of the mechanisms underlying fatigue: dietary modifications and body composition changes seem to influence its perception.

Lehrskov et. al (2018) here investigated whether postprandial (post-meal) fatigue is regulated by the cytokine IL-1 (which seems to play a role in the pathogenesis of fatigue associated with some chronic diseases) by testing the effect of an IL-1 receptor antagonist in lean and obese subjects. In this double-blind crossover study, 16 male individuals (8 lean, 8 obese) were randomly assigned to receive either the placebo (saline) or the IL-1 receptor antagonist anakinra, and were given a high-fat, high-carbohydrate meal 30 minutes after the subjects ran. Fatigue was determined using the Stanford Sleepiness Scale and blood samples were drawn at baseline and after the intervention. The results showed a reduction in postprandial fatigue in the individuals who were given the IL-1 antagonist, with the effect more pronounced in the obese group than those lean participants. These researchers have concluded IL-1 is involved in the regulation of postprandial fatigue under physiological conditions in lean and obese individuals.

In this cross-sectional study, twenty undergraduate university students in Finland completed online surveys to assess diet behavior and health (by reporting health complaints and conditions). From the sample of 1189 students, 20 health complaints were logged, of which included psychological, pains/aches, and circulatory or breathing symptoms. Nutrition behavior, defined in the analyses as 2 composite food pattern scores (based on sweets, cakes, snacks, fruits and vegetables), was analysed along with a dietary guideline adherence index and the participants’ subjective importance of healthy eating. Results showed the majority of students who reported either excellent or very good health were scored high in vegetable (raw and cooked) and fruit consumption, dietary guidelines adherence index and subjective importance of healthy dieting, while those individuals with inverse scores were more likely to report high levels of psychological symptoms and poor/fair health. Reported pain and ache was associated with greater consumption of sweets, cookies and snacks and lower adherence to the guidelines. Those with healthier eating habits were consistently linked with better self-reported health and fewer complaints.

The aim of this 2019 study was to investigate the relationship between dietary inflammatory index (a measure of the inflammatory potential of the diet) and psychosomatic complaints (caused or aggravated by a mental factor such as internal conflict or stress). The sample group consisted of 2818 adults (aged 19 to 69 years) from the Isfahan province in Iran. Food frequency questionnaires were distributed, and the subjects were assessed for psychosomatic complaints using a validated Persian questionnaire. After controlling for potential confounders, the participants who ate the most inflammatory diet (in the top tertile of the dietary inflammatory index) were 44% more likely to have psychological complaints and had 22% higher risk of experiencing gastrointestinal complications. In addition, those in the highest tertile of DII scores were associated with more neuro-skeletal issues. However, pharyngeal-respiratory complaints did not significantly correlate with more inflammatory diets after adjusting the analysis model for stressful life events, medical condition, and anti-psychotropic medicine use. To conclude, a diet with anti-inflammatory potential may be recommended to reduce psychosomatic problems.

Nijs et al. (2020) provide us with an update on the current knowledge with regards to the impact of lifestyle factors in chronic pain on a long-term basis. The factors associated with chronic pain severity and sustenance include physical activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking. This applies to chronic pain across its lifespan. Despite this, there is limited research on the effect of lifestyle factors on chronic pain in children and older adults. The vast majority is based on studies conducted on adult populations. Moreover, the current treatment options do not or only to a small extent, take into account the lifestyle factors linked with chronic pain. This review promotes the consideration of all relevant lifestyle factors together when implementing treatment plans for chronic pain sufferers. Also, these interventions should be individually tailored to suit the needs of the patient. In this way, hopefully the psychological and socioeconomic burden of chronic pain can be greatly reduced.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.