Optimal nutrition can be a complex and confusing discussion in 2020. 

Many of us will remember a simpler time when the Atkin’s diet and Weight watchers were seemingly the only well established and well marketed dietary plans in the health and wellness game.  Low carb and portion control were the main messages.  And sure, there was also the low fat 90’s era that permeated into all our favorite grocery store staples.  God forbid you didn’t buy the “healthy” low fat salad dressing option!  

But the times they are a changin’…correction Bob Dylan, they have changed and continue to change faster than most of us can keep up in the nutrition world.

If you are looking for a plan to follow, your list of options now is HUGE.  You’ve got keto, vegetarian, vegan, raw, low carb-high fat, paleo, modified paleo, atkins, modified atkins, whole30, dukan, mediterranean, pescatarian, eat right for your blood type, lectin free, gluten free, FODMAP and my personal favorite, setting an all time new level of ridiculousness: the carnivore diet.  And I’m sure if I scoured social media I could find a bunch more zealots trying to create new categories.

In our office pain management is a primary concern.  Does what we put in our mouth make a difference when it comes to musculoskeletal (bone, joint, soft tissue) pain?  And if so, what are the best diets or the most important nutritional considerations if we are trying to eat better to minimize our pain.

Does our diet matter?

A recent systematic review published in March of 2020 reviewed 9 studies looking at chronic pain in response to a specific diet.  7 out of 9 of these studies reported improvements in chronic pain severity: including a vegan diet for fibromyalgia and rheumatoid arthritis, weight loss diet for osteoarthritis, vegetarian diet for general musculoskeletal pain, FODMAP diet for fibromyalgia and a peptide diet for rheumatoid arthritis.  So while this systematic review is quite broad in nature, we can make one conclusion with certainty…what you eat absolutely matters for pain.

Chronic Inflammation

One of the most reported issues of chronic pain is the association with chronic inflammation.  Several studies in rheumatoid arthritis patients have demonstrated increased inflammatory mediators such as IL-1, IL-6, IL-8, TNF-alpha in patients with higher pain levels.  Chronic inflammation has been shown to be at the root cause for many health issues including heart disease, diabetes, cancer and auto-immunity disorders.  Many of these disorders have also shown an association between increased inflammatory markers and increased pain.  

The standard american diet (SAD) where less than 20% of the average caloric intake comes from whole grains, beans, fruits, vegetables and nuts is prone to systemic inflammation.

So what diet is anti-inflammatory? 

A recently developed Dietary Inflammatory Index and Dietary Inflammatory Score seeks to try and quantify how inflammatory our diets may be for research purposes.  Although the tool isn’t quite ready for clinical use the ratings for which foods are anti-inflammatory is worth noting. 

Apples and berries for example have a strong negative rating (powerful anti-inflammatory effect), followed by orange and yellow coloured fruits and vegetables and then leafy green and cruciferous vegetables.  

Legumes such as beans, peas and lentils have a marginally anti-inflammatory rating along with fish and poultry and nuts.  Red meat on the other hand is pro-inflammatory in nature.

The most highly inflammatory foods are processed meats, added sugars, refined grains (such as cereals, bread and pasta) and starchy vegetables (such as potatoes and sweet potatoes).  

Of note being overweight and obese is also highly pro inflammatory as adipose tissue synthesizes and releases pro inflammatory mediators.  Other highly inflammatory contributors that won’t surprise you are heavy alcohol use and smoking.    

 

What diet is best?

Many of the aforementioned trendy diets such as keto, paleo, whole30, medetteranean, pescatarian and vegetarian/vegan emphasize whole, unprocessed foods.  Simply eliminating these highly processed foods full of sugar, chemical additives and empty calories towards whole foods with an emphasis on colourful plant based foods will be anti-inflammatory.  We can obsess about the macronutrient proportions (proteins, carbs, fats) of each of these diets, but in reality they have more in common than they are different when compared to our Standard American Diet.  If we stick to a Pareto (80/20) principle analysis here any of them can work as a positive shift towards a more anti-inflammatory diet.    

 

Weight loss as a starting point

Besides being linked to chronic inflammation, being overweight and obese may be mechanically sensitizing your issue.  Knee pain, hip pain or back pain are well linked to carrying around excessive body weight.  A diet focused on reducing body fat composition will be a great place to start to ease the physiological burden of chronic inflammation and ease joint and soft tissue loading. 

Caloric intake is an important part of the weight loss formula.  Intermittent fasting can be a great adjunct to moderate your caloric intake over the course of time.  https://www.theproactiveathlete.ca/intermittent-fasting-research/

 

Our recommendation

Vegatarian/vegan, pescatarian and mediterranean diets in particular are all great options chalked full of plant based foods and low in pro-inflammatory animal fats, added sugars and processed junk.  These diets have also been linked to longevity (unlike the carnivore diet!!!) 

 More broadly than any specific diet we’ve always been drawn to Michael Pollan’s simple yet profound dietary advice: eat real (whole) food, not too much, mostly plants.