Nutrition In Rheumatic Diseases: Pain And Nutrition

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The Relationship Between Pain And Nutrition

Hippocrates: “Let food be your medicine, and medicine be your food.”

Especially many patients with inflammatory rheumatic diseases ask me the question “What should I eat?” The importance of this question is becoming more and more understood every day. I am also trying to inform my patients who do not ask me about this.

Because I have personally experienced how important this issue is with the well-being I gained by changing my own diet.

We are all our own doctors first. We can notice the reactions of our own body. For example, like people with allergies who notice which foods cause allergies, we can track the effects of the foods we eat on our bodies.

What are the questions/thoughts that come to mind about this?

Is it important for me to have an opinion on this issue?

Why is it important?

What can it add to me?

I don’t want to go on a diet! I’m happy with my life and I love to eat.

In recent years, the importance of taking a broader look at chronic musculoskeletal pain has been understood. Psychological, cognitive and social factors are also included among the factors affecting chronic musculoskeletal pain.

How we live our lives is also becoming increasingly important in the treatment of chronic pain. How is our sleep quality? Do you smoke? Is our nutrition unhealthy? Are you overweight? Insidious chronic pain varies greatly from person to person and the factors affecting pain are individual.

The World Health Organization also points out that nutrition is a modifiable determinant in chronic diseases. Our eating habits and the foods we eat can be effective in the development, continuation and perception of chronic musculoskeletal pain.

What Is Our Goal In Nutrition, What Should It Be?

While very little but quality food is enough to sustain our lives, we eat to have eaten rather than to be full in the stress and intensity of daily life, and while eating, we eat without paying much attention to what we eat in order to reduce our stress.

In nutrition, which is important in protecting our health, our goal may be to lose weight, maintain our weight, or gain weight, as well as to stay healthy, treat our autoimmune disease, get rid of allergies, protect and treat from neurological diseases, and find a cure for our pain and fatigue.

Questions I ask about this?

What should I eat?
What should I avoid?
How should I eat?
How much should I eat?
How often should I eat?

Is Nutrition Important In Chronic Pain?

Pain lasting longer than three months is termed “chronic pain” by the European Pain Federation (EFIC). It is divided into two groups as primary and secondary:

  • Primary chronic pain:
    • Fibromyalgia
    • Nonspecific low back pain
  • Secondary chronic pain:
    • Chronic cancer-related pain
    • Neuropathic pain
    • Chronic visceral pain
    • Chronic posttraumatic and post-surgical pain
    • Chronic headache and orofacial pain
  • Chronic musculoskeletal pain

Chronic pain is a major problem in most rheumatic diseases. Inflammation and oxidative stress are the underlying factors in chronic pain. Factors that negatively affect the treatment of chronic pain include unhealthy diet, obesity, smoking, and stress.

Chronic pain is generally caused by a persistent inflammatory condition. Reduced consumption of pro-inflammatory foods and increased consumption of unsaturated fatty acids, vegetables, and fruits have been shown to reduce chronic pain.

These dietary models have included unprocessed grains, fish, fruits, green vegetables, and olive oil, as well as anti-inflammatory and antioxidant-rich diets (polyphenols).

There are six main food sources: carbohydrates, fats, proteins, minerals, vitamins, and fiber.


Western-style diet refers to the consumption of processed meat, sugary foods, processed grains, and low consumption of vegetables and fruits. Diet therapies include specific foods, antioxidants, and prebiotics.

Inadequate intake of micronutrients through the diet has also been associated with chronic neuropathic and inflammatory pain.

When the diet is enriched with these nutrients, a reduction in chronic pain has been reported (back pain, rheumatoid arthritis, joint pain secondary to inflammatory bowel disease, migraine, chronic non-cancer pain, pain in chronic liver patients, joint pain associated with aromatase inhibitor in breast cancer, etc.).

Gut microbiota is important in the digestion and absorption of food, and contributes to normal immune function. Dysbiosis is associated with irritable bowel syndrome and chronic abdominal pain. Prebiotics and probiotics are promising in the treatment of this condition.

In fibromyalgia syndrome and widespread chronic musculoskeletal pain:

  • Plant-based diets, vegan diets, and low FODMAP diets have been shown to reduce pain, functional deficit, and inflammatory biomarkers.
  • A gluten-free diet has been found to be effective in fibromyalgia and irritable bowel syndrome, while stiffness in the neck and shoulders responds to probiotics.
  • In fibromyalgia syndrome, the imbalance of nutrients (deficiency of magnesium and selenium minerals, deficiency of B and D vitamins, heavy metals (cadmium, mercury, lead)) affects pain inhibition mechanisms and develops fatigue and pain symptoms.
  • When microbiota is restored to normal levels, a significant reduction in pain has been shown.

In low back pain and knee osteoarthritis, the course of the disease has changed with low-calorie diet and weight loss.

In migraine, short-term ketogenic diet (1 month ketogenic, 5 months low-calorie diet) has been reported to be effective. Omega-3 supplements have beneficial effects in inflammatory and autoimmune diseases and shorten the duration of migraine attacks.

In studies:

  • Food additives directly act as inflammatory mediators.
  • Food antigens, gluten: cause inflammation.
  • Body mass index has been found to be associated with pain.
  • Certain foods have been reported to have analgesic effects.

Studies on this issue are increasing. However, new studies are still needed in this area.

What Can You Do For Yourself?

In the end, it is important that you experience the renewal and comfort you will experience with healthy eating by changing your own diet. It is necessary to start on the way by targeting the change of eating habits.

In order to make it easier to change habits, you need to prepare yourself mentally first. It is the easiest thing you can do to stay away from ready-made packaged foods, foods made with unhealthy oils, and sugary foods, to reduce pastries as much as possible, and to add your favorite vegetables to your diet.

It has been reported that the time required for recovery after the removal of foods that touch you from the diet is between 3 months and 1 year. So, you should do this for at least three months to be able to say “I changed my diet, but nothing happened”.

It may be necessary to look at the levels of vitamins and minerals with blood tests performed to determine if there are any deficiencies in your body. It is important to correctly interpret the tests performed and to use the necessary supports for a sufficient period of time. Many of my patients neglect to use their vitamins until they reach a sufficient level, even though they have deficiencies in their blood tests.

It may be necessary to re-test to check if the deficiencies have reached a sufficient level after the use of supports.

Remember that widespread complaints such as body pain, swelling, fatigue, neck back pain, and numbness occur, especially in anemia, iron deficiency, D, B vitamins, diabetes, and thyroid hormone deficiency. Detailed evaluation and examination of patients with pain will lead to correct diagnosis and treatment.

Non Celiac Gluten Sensitivity  you can take a look at our article.

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