Can What You Eat Make Your Pain Better?

Food is medicine. Meaning that what you put in your body can affect you just like popping a pill can. However, how far can you take that analogy? For example, can eating the wrong stuff make your back pain better or worse? Let’s find out.

Chronic Inflammation and Diet

If you had to point to one killer and disabler of people as they age in a first-world context it would be chronic inflammation. That’s the low-level inflammation in your body that causes everything from heart disease to cancer to Alzheimer’s to arthritis. Hence, reducing that inflammation is a good thing for your health.

Believe it or not, there’s a standardized research tool that’s updated regularly that allows anybody to see if they’re eating foods we know cause chronic inflammation. This is called the The Dietary Inflammatory Index or DII (1). The choices of pro-inflammatory foods were initially based on studies showing that certain foods like trans-fatty acids (unsaturated fats) caused a spike in serum inflammatory markers in people.

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The DII and Back Pain

A recent study presentation at the virtual meeting of Academic Physiatrists by researchers at the University of Pittsburgh showed a connection between eating more inflammatory foods (DII) and back pain (2). After adjusting for many variables including age, sex, and demographics, the researcher found that individuals in the fifth DII quintile were found to have 42.4% higher odds of developing LBP compared with those in the lowest quintile. Now realize that for those in the middle, the differences were far less. Meaning this effect only showed up as sizable when the worst inflammatory eating group was compared to the best.

Is the DII Associated with Other Types of Chronic Pain?

Yes, for example, the DII was associated with knee arthritis pain intensity, meaning the higher the DII was in a knee arthritis patient, the higher their pain levels (3). Again, realize that for those eating in the middle, there was no significant difference in pain. For example, the significant pain differences were only found for the worst 20% eating group compared to the best 20%. So if we take a 0-100 DII score with 0 being the best and 100 being the worst, we see that people who had a 10 had more pain than those at a 90, but people who had a 30 were no different in knee pain intensity than those with a 70.

Also realize that if we use a different metric of low-carb diets, the same thing was observed (4). Meaning people who ate a low-carb diet also reported better knee pain. In addition, in this study, a low-fat diet didn’t have this same effect.

The DII vs. Low-Carb Battle

The DII would have you eat a certain way while a low-carb diet would have you eat another. For example, fruits and veggies are low DII foods. However, while an apple may be a good low glycemic (low-carb) food, you wouldn’t want to pig out on apples as that would eventually be too many carbs. A banana is also a fruit that has a low DII, but is generally considered a high-glycemic fruit. In addition, while eating cholesterol-laden foods is a no-no for DII, it would be encouraged in a low-carb diet.

Which Diet Should You Try to Decrease Your Pain?

I’ve always believed that the reason diets can be hit or miss is because of the vastly different ways we all respond to foods. For example, for my genetics, I would definitely stay away from unsaturated trans-fats like those found in fast food, but if I ate too many bananas, you can bet that my blood sugar would get whacked out and that would impact the parts of me that ache like an old man. For my wife, this would be totally different. She doesn’t have a blood sugar instability issue. So following the DII very strictly would likely be a greater benefit. In addition, the banana would have very little impact on her system. This may be why we’re only seeing the DII show it’s effects at the extremes of good and bad eating.

So what would I recommend as your doctor? If you have chronic pain, try your hand at a number of different dietary approaches. Try eating low DII foods and see how that impacts your pain. Try low-carb and see how that works. I would also consider trying a Fasting Mimicking Diet like Prolon to see how that works. All of these have been shown to reduce inflammation and I suspect some of these work better for some people than others.

The upshot? What you eat matters. Just find out which of these low inflammation diet approaches works best for your body. That may take some experimenting, but your back or knees will thank you!



(1) Hébert JR, Shivappa N, Wirth MD, Hussey JR, Hurley TG. Perspective: The Dietary Inflammatory Index (DII)-Lessons Learned, Improvements Made, and Future Directions. Adv Nutr. 2019;10(2):185-195. doi:10.1093/advances/nmy071

(2) Association of Academic Physiatrists. Pro-Inflammatory Diet Associated with Low Back Pain Prevalence in U.S. Adults. Accessed 5/5/21

(3) Toopchizadeh V, Dolatkhah N, Aghamohammadi D, Rasouli M, Hashemian M. Dietary inflammatory index is associated with pain intensity and some components of quality of life in patients with knee osteoarthritis. BMC Res Notes. 2020 Sep 21;13(1):448. doi: 10.1186/s13104-020-05277-x. PMID: 32958008; PMCID: PMC7507718.

(4) Strath LJ, Jones CD, Philip George A, Lukens SL, Morrison SA, Soleymani T, Locher JL, Gower BA, Sorge RE. The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis. Pain Med. 2020 Jan 1;21(1):150-160. doi: 10.1093/pm/pnz022. PMID: 30865775; PMCID: PMC7999621.

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