We often see pain patients in our clinic who are obese. Many of them did not start their pain journey this way, and there is emerging evidence that pain, in addition to changing activity, can also change dietary patterns. In addition, the stress of chronic pain combined with these factors may make chronic pain patients more like to go on to metabolic syndrome.1 To add to this difficult scenario, there is evidence that many of the surgical and nonsurgical treatments commonly utilized for pain in general may have less robust benefit in an obese population.2
What to offer these patients in need? The Mediterranean diet. We already know from PREDIMED and other trials that this diet is cardioprotective and can aid in reversal of the metabolic syndrome, central obesity, and high levels of fasting glucose.3
A recent trial from Ohio State University attempted to go one step further and examine the diet’s association with pain. In the study, 98 men and women (aged 20–78 years) provided information regarding their pain and eating patterns using the Healthy Eating Index during a 3-hour interview. The researchers controlled for factors including age, mental health, education, and use of pain medications
The analysis demonstrated that those eating a diet with more significant reliance on staples of the Mediterranean diet, including fish, fruits, vegetables, nuts, and beans, had significantly lower levels of pain. The researchers used three different measure of obesity (BMI, waist circumference, and body fat) and in all cases found evidence that dietary intake of Mediterranean diet foods with anti-inflammatory effects mediated the relationship of obesity with body pain. The authors concluded that this may be due to several reasons, including the ability of these dietary components to reduce silent inflammation as well as aiding in weight loss. Although this was a retrospective look and did not include biomarkers, the dietary evaluation was extensive and completed at the participants’ homes where, conceptually, dietary recall and evaluation would be more accurate than in the clinic.
Bottom line: When working with our obese patients dealing with pain, it would be appropriate to bring up the Mediterranean eating pattern as an approach not only to reduce cardiovascular risk but also to reduce pain. Some of the resources below can help with the conversation.
Babio N, Toledo E, Estruch R, et al. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014;186(17):E649-E657. http://www.cmaj.ca/content/186/17/E649
We often see pain patients in our clinic who are obese. Many of them did not start their pain journey this way, and there is emerging evidence that pain, in addition to changing activity, can also change dietary patterns. In addition, the stress of chronic pain combined with these factors may make chronic pain patients more like to go on to metabolic syndrome.1 To add to this difficult scenario, there is evidence that many of the surgical and nonsurgical treatments commonly utilized for pain in general may have less robust benefit in an obese population.2
What to offer these patients in need? The Mediterranean diet. We already know from PREDIMED and other trials that this diet is cardioprotective and can aid in reversal of the metabolic syndrome, central obesity, and high levels of fasting glucose.3
A recent trial from Ohio State University attempted to go one step further and examine the diet’s association with pain. In the study, 98 men and women (aged 20–78 years) provided information regarding their pain and eating patterns using the Healthy Eating Index during a 3-hour interview. The researchers controlled for factors including age, mental health, education, and use of pain medications
The analysis demonstrated that those eating a diet with more significant reliance on staples of the Mediterranean diet, including fish, fruits, vegetables, nuts, and beans, had significantly lower levels of pain. The researchers used three different measure of obesity (BMI, waist circumference, and body fat) and in all cases found evidence that dietary intake of Mediterranean diet foods with anti-inflammatory effects mediated the relationship of obesity with body pain. The authors concluded that this may be due to several reasons, including the ability of these dietary components to reduce silent inflammation as well as aiding in weight loss. Although this was a retrospective look and did not include biomarkers, the dietary evaluation was extensive and completed at the participants’ homes where, conceptually, dietary recall and evaluation would be more accurate than in the clinic.
Bottom line: When working with our obese patients dealing with pain, it would be appropriate to bring up the Mediterranean eating pattern as an approach not only to reduce cardiovascular risk but also to reduce pain. Some of the resources below can help with the conversation.
Mediterranean Diet Resources
American Heart Association: (http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Mediterranean-Diet_UCM_306004_Article.jsp#.WN1-SI61tM9)
Mediterranean Diet | Getting Started with the Mediterranean Diet: 8 Steps: https://oldwayspt.org/traditional-diets/mediterranean-diet
References
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