We are realizing more and more – we are what we eat. That seems to be true for our health as well. There are several studies that strongly suggest that how and what we eat can also effect our pain. Following certain diets may provide new ways to impact pain levels. Ketogenic diets are well established as a successful anticonvulsant therapy. Based on the believed overlap between the mechanisms thought to cause seizures and the underling causes thought to impact pain, ketogenic diets may benefit those suffering from chronic pain. This is because many types of pain and painful or progressive conditions involve chronic inflammation. There are several hypothesis why a ketogenic diet will reduce this inflammation too.
- Like seizures, chronic pain is thought to involve increased excitability of neurons; for pain, this can involve peripheral and/or central neurons. Thus, there is some similarity of the underlying biology.
- Anticonvulsant drugs are often prescribed for neuropathic pain, (such as gabapentin, lyrica) which is poorly responsive to typical analgesic drugs (see below). Logically, then, if there is any commonality in the actions of anticonvulsant drugs and the ketogenic diet, the latter should have some effect on neuropathic pain.
- Reducing glycolytic metabolism appears to be anticonvulsant, whether it is accomplished by fasting, caloric restriction, high fat plus carbohydrate restriction (the ketogenic diet, the modified Atkins diet), or specifically blocking glycolysis with 2-deoxyglucose- or medications. In a parallel fashion, fasting and 2-deoxyglucose are both analgesic, so the ketogenic diet is also likely to be.
- The neuromodulator adenosine can be analgesic and is involved in acupuncture’s effects; evidence has been accumulating that metabolic changes such as fasting, the ketogenic diet, and 2-deoxyglucose all boost adenosine in the body. Recent evidence suggests that exercise can treat neuropathic pain via an adenosine-based mechanism as well.
The ketogenic diet is similar to the Paleo diet, which emphasizes whole foods and the elimination of sugar, grains, and processed foods. But the ketogenic diet is extremely low-carb, moderate in protein, and high in fat. It produces a state of ketosis (starvation mode) in which the body’s fat stores are used for energy.
The primary benefit of ketogenic diets for chronic pain is that they’re low in the refined sugars and simple carbs that cause inflammation. Some people can go into ketogenesis with a low-fat, low-sugar diet, while some need to lay on the fats. But it’s not necessary to be in ketosis to see the health benefits of cutting back on simple starches and sugars. It’s essentially a low glycemic index–type diet that helps, because that has the biggest correlation with reducing inflammation. More information about the glycemic index is available from the Glycemic Index Foundation.
How it works: While there is no single anti-inflammatory diet, the general approach is a balanced diet full of fresh, wholesome foods. The diet calls for lots of colorful fruits and vegetables, whole grains, fish, tea (instead of coffee).
What it promises: Eating whole, unprocessed, largely plant-based foods is thought to fight chronic inflammation and help counteract stress and environmental toxins. In turn, this may lower your risk of heart disease, cancer and Alzheimer’s. Following a diet that contains fruits, vegetables, whole grains, and healthy omega-3 fats provides nutrients, antioxidants, and proteins in addition to the other benefits.
The downsides: Learning to prepare fresh, plant-based foods can be more time-consuming than relying on pre-packaged or fast food.
Verdict: Just like the Mediterranean diet, this approach to eating is nutritionally sound and not overly restrictive like some other diet trends, so it’s easy to maintain.
Whether you’re considering trying a ketogenic diet, another type of low-carb diet, or any nutritional approach that’s different from what you now eat, always consult your healthcare provider before making the switch. A healthy weight is essential, since excess weight can contribute to pain, poor sleep, sleep apnea, and wear and tear on joints. Clearly, eating a healthy, whole, plant based diet can’t hurt! And it doesn’t have to be the restrictive and potentially dangerous “keto” diet. Study after study has shown cutting out carbohydrates, processed foods, and refined sugar benefits those of us suffering from chronic pain by decreasing inflammation. A great by-product? You’ll lose weight too.