The Pain-Reducing Diet This Doctor Prescribes To Patients Could Help Solve The Opioid Epidemic
Opioid use and abuse have reached epidemic proportions in this country. According to the CDC, 91 Americans die every day from opioid overdose, and over 1,000 people are treated in the emergency room each day for misuse of opioid medications. There is a lot of discussion and finger pointing around how we got here. As a spine surgeon, every single patient who comes to see me has pain. They are also all hopeful their pain can be improved. I am very cautious with the use of opioid medications. In fact, opioids work poorly for nerve-related pain (for example from a disc herniation pushing on a nerve) and have limited use in acute and chronic neck and back pain.
As health care providers, it is important to find strategies that decrease pain without the need for opioids. I just returned from the North American Spine Society’s (NASS) annual meeting, and the room discussing these issues and strategies was standing room only. Missing from that discussion was the role of diet.
The science behind how diet can reduce pain.
In my practice, I have found that dietary strategies can be incredibly powerful for decreasing both acute and chronic pain. Diet can also be a contributing factor to pain. When blood sugar levels are higher than desired, advanced glycation end products (AGEs) are formed. These molecules lead to brittleness of tissues (like spinal discs, nerves, and tendons) and activation of inflammation, which can all lead to pain. At the NASS meeting this week, a group presented new research demonstrating that this can happen even without diabetes or obesity being contributors. So keeping blood sugar from getting too high after a meal is important for everyone.
Obesity is also a factor in spine-related pain for both mechanical reasons and also inflammatory ones. Losing weight takes time and can be a challenging thought for someone who has pain. I rarely start the discussion with patients about losing weight but rather talk about inflammation. Dietary changes can help reduce inflammation. A ketogenic diet can be particularly powerful. A ketogenic diet is high-fat, moderate in protein, and low-carbohydrate. Because carbs are low on a keto diet, AGEs (those sticky molecules that cause problems) are decreased. When the body transitions from burning predominantly sugars to burning fats, as in a ketogenic diet or a fasting state, ketones are produced. Betahydroxybutryate (BHB) is one of those ketones. BHB decreases inflammation in several different ways. It activates the AMPK pathway, which decreases pain and inflammation. It inhibits the NLRP3 inflammasome, the pathway involved in starting inflammation. BHB also inhibits the COX-2 enzyme, similar to medications like ibuprofen. Keto diets have been shown in several animal models to decrease pain. There are additional benefits when ketogenic diets have ample omega-3 and limit omega-6. Algae and fish oil are useful sources of these anti-inflammatory omega-3s.
The pain-reducing diet I prescribe to patients.
I frequently put patients on a ketogenic diet that is rich in both nonstarchy vegetables (for the phytonutrients) and omega-3s. I have seen a dramatic improvement in patients’ pain and a decreased use of medications for pain. It can even help avoid the need for surgery. Just recently I had a patient who was scheduled for a complex surgery to fuse the spine from the front and the back because of severe nerve pain. The patient started the ketogenic, plant-rich, high-omega-3 diet that I put her on, and she improved so much from six weeks of the diet, we ended up canceling her surgery. Surgery is still sometimes necessary for my patients, but with the use of keto diets, I have seen patients use much less pain medication after surgery and also have low rates of surgical complications. In addition, patients also frequently report improvement in other pain with the diet, such as from arthritis of their hips, knees, or shoulders.
The opioid epidemic is a national crisis. Pain has a significant impact on people’s lives. We will never address these issues by simply denying opioid medication. A keto diet can be a consideration in safely improving pain by decreasing AGE formation and tissue damage and decreasing inflammation. It also frequently results in weight loss, and this is a positive side effect a lot of my patients appreciate, especially compared to the negative side effects of medications.