FOODS THAT FIGHT PAIN

Until recently, most people did not think that food had much to do with pain. Many physicians still do not see the connection, but little by little physicians are realizing that there is often a connection between pain and what we eat. We now know that certain foods and substances in foods can help to "heat up" or "cool down" inflammation. A good example is the link between high-protein diets and gouty arthritis.

The American diet is typically low in several nutrients. Deficiencies of many vitamins and minerals, including vitamins B6, BIZ, C, D, and E; folic acid; selenium; magnesium; and zinc have been associated with arthritis. Even if the nutritional shortfalls do not cause the problem, they certainly do not help and can make things worse.

The American diet is full of fat. When the very tiny blood vessels nourishing our joints fill with fat from our food, oxygen exchange is hampered, and the body has difficulty removing waste products. As a result, body tissue may weaken or break down. For example, saturated or hydrogenated fats can affect the regulation of hormonal substances called eicosanoids. Eicosanoids are important to pain patients because they help to control inflammation and pain—especially in the joints.

Certain foods may cause allergic reactions in some patients with rheumatoid arthritis, worsening their pain and other symptoms. Some forms of what we call rheumatoid arthritis may be what medical researchers call "allergic arthritis."

All of us react individually to foods, so it is impossible to issue blanket statements about which foods are good or bad. Milk and other dairy products commonly cause problems for pain patients. Excessive fat seems to increase the levels of inflammatory substances in the body. Meat is also filled with substances that can trigger allergies. Chemicals given to animals bred for consumption tend to concentrate in fatty tissue. Bacon, hot dogs, ham, bologna, cold cuts, and other cured meats have preservatives and other chemicals that can trigger allergic reactions.

Switching to a highly nutritious, low-fat, low-glycemic diet has helped many patients reduce or banish their pain, helping them to reduce or eliminate the need for their drugs as well. In general, pain patients should:

• Eat a wide variety of foods (the more variety, the better) because each food contains a unique formula of nutrients. Although there is no perfect food, a diet based on many fresh vegetables and fruits, plus a variety of whole grains, comes close to perfection.
• Think of the diet as a pyramid. The widest part of the pyramid, the foundation, is made up of fresh vegetables, fruits, and whole grains. On top of that, add small amounts of fish, low-fat dairy products, lean poultry, nuts, and seeds. At the top of the pyramid are snack foods and desserts. Eat only tiny amounts of them.
• Eat as much real food as possible. Take a look at your shopping cart as you roll it up to the checkout stand. Is it filled with boxes and cans or do you see mostly fresh foods? Fresh foods should predominate.
• Avoid food additives that are mostly found in packaged foods. When you do select packaged foods, compare labels carefully and look for those with the fewest additives.
• Keep sugar consumption low. Nature already has as much sugar as your body needs packed inside its foods. Everything else that is added is debris that our bodies must remove. A little added sugar will not harm most of us, but a lot will hurt many of us.
• Do not add salt to your food. Excess salt has a number of bad effects. Nature has already put plenty of salt in food. Extra salt, which is common in packaged foods, means extra work for your body.
• As much as possible, eat meals at home where you have control over food intake.
• Snack frequently on low-fat foods to blunt your appetite so that you will not overeat at the dinner table. Snacking also helps to keep your blood sugar reasonably stable throughout the day. Carry a plastic bag filled with raw or cooked vegetables and snack liberally on them.
• Avoid large meals within several hours of going to sleep. Eating a large meal close to bedtime is not healthy and more of the food eaten will be stored as fat.
• Eat slowly. Enjoy your food. Savor it. Give your appetite center enough time to tell you that you have had enough before you have eaten too much. Put down your fork or spoon while you are chewing. Do not overeat. Eat until you are comfortably full (but not stuffed) and then stop. If you are not hun­gry, do not eat. Let your stomach be your guide, not the clock.
• Drink plenty of water, at least six to eight 8-oz glasses of plain water a day.
• Keep fat consumption within healthful limits. Most vegetables, fruits, and whole grains are low in fat. It is only when you eat large amounts of processed and other high-fat foods that you overload your body with fat. Excessive consumption of fat has been associated with heart disease, cancer, and many other deadly and disabling diseases. Fatty foods certainly can be tasty, but you will be surprised how quickly you will lose your fat cravings once you eliminate eating fatty foods.

Fatty Acids as Pain Fighters

Interestingly, there are some types of fat that help to reduce pain. Just as protein is built from amino acids, fats in the body are composed of smaller substances called fatty acids. You may have heard of the omega-3 fatty acids that have generated a great deal of excitement in the scientific community. In the early 1970s, Danish scientists noted that Eskimos in Greenland ate a high-fat diet based on fatty fish, seal, and whale meat but had relatively little heart disease. The researchers quickly surmised that something in fatty fish warded off heart disease by thinning the Eskimos' blood, lowering blood fat (triglyceride) levels, and protecting against chronic inflammation. That magical something was a fat (oil) in the fish they ate. Specifically, it was a type of fat composed of omega-3 fatty acids. Since then, we have learned that the omega-3 fatty acids not only protect against heart disease, but also may help to fight off arthritis and other painful diseases. In a 1985 study, patients with rheumatoid arthritis experienced a definite decrease in joint stiffness and less tenderness of the joints after 3 months of treatment. Giving fish oil to laboratory mice as a dietary supplement also sup­pressed lupus, a potentially fatal autoimmune disease that most often attacks young women (Kelley et al. 1985).

Studies in humans have shown that enriching the diet with fish oil has an anti-inflammatory effect. Part of the effectiveness of omega-3 may come from its ability to act on the immune system, cutting by at least half the secretion of immune system substances (pro-inflammatory cytokines) which are involved in inflammation and pain.

Fatty acids found in fish and plant extracts have special value in fighting pain. GLA is an omega-6 fatty acid derived from evening primrose, borage, and black currant oils. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are omega-3 fatty acids derived from flax, perilla, and fish oils. These essential fatty acids are important in the manufacturing of pros­taglandin El and E3, which help to reduce inflammation and pain, while reducing pro-inflammatory prostaglan­din E2.

In a study reported in the Annals of Internal Medicine, patients underwent a double-blind, placebo- controlled protocol lasting 24 weeks. Neither the patients nor the doctors knew until the test was over who was receiving GLA and who was receiving a placebo. The study was designed this way to rule out the placebo effect, the well-known tendency of some peo­ple to feel better simply because they believe in their medicine. When the study was completed and the code was broken, revealing who had received the GLA, the researchers discovered that those who took GLA experienced a 36% reduction in tender joints and 41% fewer swollen joints. Those who had received the placebo reported no such benefit.

A later study reported in the British Journal of Rheumatology used oil taken from black currant seeds, which contain both GLA and alpha-linolenic acid. Rheumatoid arthritis patients in this double-blind, placebo-controlled study who received the black cur­rant oil experienced relief, but those receiving the pla­cebo did not. There were no side effects noted (Leventhal 1994).

An article in Seminars in Arthritis and Rheumatism looked at many studies on GLA and rheumatoid arthritis. The authors reported that GLA was proven effective in reducing the effects that autoimmune disease can have on joint linings (Ariza-Ariza et al. 1998). A second article appearing in the Journal of Clinical Epidemiology also looked at a number of pre­viously published studies on fish oil and reported that a 3-month course of treatment with fish oil led to a substantial improvement in joint tenderness and morning stiffness (Fortin et al. 1995).

Now take a brief look at some of the studies demonstrating the effectiveness of EPA and DHA against rheumatoid arthritis. Capsules containing either high or low doses of EPA and DHA or olive oil were given to 49 patients with rheumatoid arthritis. The high-dose group experienced signifi­cant reductions in the number of swollen joints by week 12 and in the number of tender joints by week 18. The number of tender joints also fell in the low- dose group by week 12, but it took 24 weeks for them to experience a drop in swollen joints. Over­all, those receiving the high or low doses of EPA and DHA did better than those who received olive oil.

In another study (a double-blind, crossover), 12 people who had rheumatoid arthritis were started on EPA and DHA daily. Midway through the study, patients receiving EPA and DHA were switched to placebo without their knowledge, while those who had been taking a placebo were given EPA and DHA. (The secret switch was made to be certain that the EPA/DHA pills actually worked.) The study showed that the EPA/ DHA combination led to a significant improvement in the clinical signs of the disease.

Either EPA and DHA or placebo was given to 33 rheumatoid arthritis patients. After 14 weeks, those receiving the EPA/DHA combination had fewer ten­der joints. The pain-killing effect lasted for more than 4 weeks once the EPA/DHA was discontinued. This was a double-blind, controlled, crossover study, which is the most scientifically rigorous and valid form.

In an interesting study mixing diet and EPA, 17 participants were asked to eat a diet low in saturated fat and high in polyunsaturated fat and to supplement with EPA. A control group of 20 was instructed to eat a typical American diet and take placebo capsules. After 12 weeks, participants on the special diet and EPA capsules reported significantly less morning stiffness; morning stiffness had become worse in those on a standard American diet. Unfortunately, when participants eating the special diet and taking EPA returned to their normal diet and gave up EPA, their pain and stiffness rapidly returned.

For optimal pain relief, the correct balance of omega-3 and omega-6 fatty acids should be obtained; take 1000 mg of DHA and 400 mg of EPA from the omega-3 family and 900 mg of GLA from the omega-6 family.

For additional information on pain-relieving therapies, refer to the specific protocol that discusses the underlying cause of your pain.

As discussed earlier in this protocol, dietary factors can influence how much arachidonic acid is produced in the body. An enzyme that is needed to convert dietary factors into arachidonic acid is phospholipase A2 (PLA2). Arthritic pain and inflammation are the end results of a pathway known as the arachidonic acid cascade.

SUGGESTIONS:

• We need the support of others who experience and understand chronic pain.

• Recognizing emotions helps us to understand ourselves.

• While our pain is certainly not all in our heads, atti­tudes and expectations do make a difference.

• Learning how to relax is essential. It helps prevent tension and redirects our attention on to things we have some control over.

• Staying active, within realistic limits, can help us remain flexible and strong and reduce our sense of suffering.

• It is important to set realistic goals and chart our progress toward them.

• Chronic pain not only involves the person with pain, but the family as well.

• Hearing others talk of similar feelings and experi­ences caused by pain reduces our isolation.

• There are no wrong feelings.

• Half the battle is won when you begin to help yourself.

SUMMARY