You know the feeling you get when you learn something new
about a health problem you’ve been trying to reverse?
Maybe high blood pressure, diabetes, or heart disease.
Well, there’s nothing I like better than bringing you the information
that will help you do just that.
Welcome to the Nutrition Facts Podcast.
I’m your host, Dr. Michael Greger.
Today we deal with pain: chronic, debilitating pain.
And we look at how anti- inflammatory diets can be effective
in alleviating chronic pain syndromes.
Fibromyalgia is a common disorder
whose cardinal manifestation is chronic, widespread pain.
Well, not so common, affecting 2 to 4% of the population
though probably more like 2%, and especially women.
For decades, some medical professionals dismissed fibromyalgia
as all in people’s heads, but this outdated view has been refuted
by more recent research characterizing it as a disorder
of pain regulation and sensitization.
Brain imaging studies have shown several perturbations of pain
processing and regulation that amplify pain
in people with the condition.
Twin studies have shown that about half of fibromyalgia is genetic,
but the other half we can do something about.
There are lots of drugs with lots of side effects to help
with some of the symptoms, but what about lifestyle approaches?
Engagement in regular physical activity is considered
imperative for effective management of ﬁbromyalgia.
A systematic review and meta-analysis
of randomized clinical trials on the
effectiveness of therapeutic exercise in fibromyalgia
found that both aerobic and resistance exercises
are effective ways of reducing pain
and improving global well-being in people with fibromyalgia.
Patients may worry and perceive that exercise
will worsen their pain and fatigue,
and so you have to start slow and work your way up as tolerated,
with the goal of eventually achieving 30 to 60 minutes
of moderate intensity aerobic exercise in addition to
muscle strengthening exercises (1 to 3 sets of 8–11 exercises,
8–10 repetitions with a load of about 7 pounds
or 45% of the max you can lift.
But what about dietary interventions in terms of
dialing down the pain sensitivity?
Well, what causes it in the first place? Inflammation.
During the inﬂammatory response, pain receptors are activated,
and chronic inflammation, can cause chronic activation,
which may cause chronic pain, due to this prolonged
hypersensitization of pain pathways.
No wonder, then, that a pro-inﬂammatory diet
was found to be associated with pain hypersensitivity
in patients with fibromyalgia syndrome.
Exactly which foods are pro-inflammatory
and which foods are anti-inflammatory?
Check out those twin videos, but broadly speaking
components of processed foods and animal products,
such as saturated fat, trans fat, and cholesterol,
were found to be pro-inflammatory,
while constituents of whole plant foods,
such as fiber and phytonutrients, were strongly anti-inflammatory.
The intake of dietary fiber, found concentrated in
only one place— whole plant foods—
is fundamental to reducing not only the risk of abdominal pain
but also muscle and joint pain,
we think because of these short chain fatty acids
that our good gut bugs produce when we eat fiber.
These short chain fatty acids are important mediators of pain,
fundamentally because they modulate inﬂammation.
So having a lot of fiber-feeding bugs in your colon is like
carrying around your own anti- inflammatory compound factory.
But to cultivate them you actually
have to eat the foods that feed them.
And in terms of phytonutrients, plant-derived polyphenols
are widely acknowledged to also act as anti-inﬂammatory substances.
Here’s some foods packed with anti-pain pathway nutrients:
berries, greens, citrus, nuts,
spices like turmeric and ginger, edamame, and green tea.
That’s why you can do randomized, double-blind crossover trials
showing that about three cups worth of strawberries a day
can significantly improve pain and inflammation.
If that’s what a single plant can do,
what about a diet chock full of plant foods?
Put people on a strictly plant-based diet rich in
fresh fruits and vegetables, whole grains and various legumes,
which are beans, split peas, chickpeas, and lentils,
as well as nuts and seeds, and you can drop
C-reactive protein levels 33% in 3 weeks,
which is a leading blood marker of systemic inflammation.
But does that translate into less pain?
And the answer is yes, when it comes to migraine headaches.
Yes when it comes to painful periods.
A signiﬁcant reduction in menstrual pain, duration of pain, intensity
in addition to premenstrual symptoms.
In fact even just a single plant, cinnamon,
about a third of a teaspoon three times a day during your period
can help, though it doesn’t work as well as ibuprofen.
Ginger powder, on the other hand—
ground ginger – has been found
to be comparable to ibuprofen in relieving pain
in women with painful cramps.
Whole-food plant-based diets also alleviate
the symptoms of osteoarthritis.
Several studies have shown improvements in rheumatoid arthritis
symptoms with diets excluding animal products,
though it may be just as much a function of
increasing the quantity of healthy plant foods.
But it’s not just because plant- based diets are so effective
in causing weight loss, even at the same weight
there’s an improvement in rheumatoid arthritis
from more plant-based diets.
And plant-based diets can also alleviate fibromyalgia symptoms.
This is the latest study, which enrolled anyone
with chronic musculoskeletal pain, fibromyalgia or not.
Yes, diets high in animal proteins and fats have been linked to
chronic pain and inﬂammation, while plant-based diets
produce anti-inﬂammatory responses.
So, did it actually work when put to the test for pain?
Yes.
Consumption of a plant-based diet produced
positive improvements in chronic pain and function.
How much?
Well, a minimally clinically important diﬀerence in
chronic musculoskeletal pain is 1 point on the
Numeric Pain Rating Scale, which is just a scale of 1 to 10,
on how much pain you’re feeling.
And on the plant-based diet
perceived pain decreased an average of
three points on a 10-point scale,
from an average of 5 or 6 out of 10 down to 2.
Now, unlike most of prior studies there was no control group,
but what’s the downside of giving healthier eating a try?
In fact, those with chronic pain are more likely to be overweight
and have nutrition-related maladies such as high blood pressure,
diabetes, and heart disease all of which can be prevented,
arrested, and in some cases even reversed
with a healthy-enough plant-based diet.
So, any pain benefit is just icing on the cake of health.
Uh...scratch that.
How about...
the dollop of guacamole on your bean burrito.
In our next story,
we look at how apple peels can help those with chronic joint pain.
Regular apple intake is associated
with all sorts of good things, like living longer,
particularly a lower risk of dying from cancer.
Here’s the survival curve of elderly women
who don’t eat an apple a day.
Ten years out, nearly a quarter died,
and 15 years out, nearly half were gone.
But, those who average like
a half an apple a day didn’t drop off as fast,
and those eating an apple a day—
more than 3 and a half ounces—
like a cup of apple slices,
stayed around even longer.
Yeah, but maybe people who eat apples
every day just happen to practice
other healthy behaviors
like exercising more, or not smoking,
and that’s really why they’re living longer.
Well, they controlled for most of that–
obesity, smoking status, poverty, diseases, exercise—
so as to compare apples to apples (so to speak).
But, what they didn’t control for
was an otherwise healthier diet.
Studies show that those who regularly
eat apples have higher intakes
of not just nutrients like fiber, found in the apples,
but they’re eating less added sugar,
less saturated fat—in other words,
they’re eating overall healthier diets;
and so, no wonder apple eaters live longer.
But is apple eating just a marker for healthy eating,
or is there something about
the apples themselves that’s beneficial?
You don’t know, until...
you put it to the test.
There are all sorts of fun studies
like this, where subjects were randomly
assigned in the morning to nothing,
a caffeinated energy drink, black coffee, or an apple,
given that athletes use a variety
of common strategies to stimulate
arousal, cognition, and performance
before their morning training.
Did the apple hold its weight?
Yes, appearing to work just as well
as the caffeinated beverages.
The problem with these kinds of studies though,
is they’re not blinded.
Those in the apple group knew
they were eating an apple,
and so, there may have been this expectation bias,
placebo effect, that made them unconsciously
give that extra bit of effort in the testing
and skew the results.
You just can’t stuff a whole apple into a pill.
That’s why researchers, instead,
test specific extracted apple components;
so, they can perform a double-blind placebo controlled study,
where half get the fruit elements,
half get the sugar pill,
and you don’t know until the end who got which.
The problem there, though, is that
you’re no longer dealing with a whole food,
removing the symphony of interactions
between the thousands of phytonutrients
in the whole apple.
Most of these special nutrients
are concentrated in the peel, though.
Instead of just dumping millions
of pounds of nutrition in the trash,
why couldn’t researchers just dry and powder the peels
into opaque capsules to disguise them
and then run blinded studies with that?
Even just a small amount could greatly
increase phytochemical content
and antioxidant activity.
The meat industry got the memo:
dried apple peel powder decreases microbial
expansion in meat and protects against
carcinogen production when you cook it.
And, one of the carcinogens formed
during the grilling of meat
is a beta carboline alkaloid, a neurotoxin,
which may be contributing to the
development of neurological diseases,
like Parkinson’s.
I did a video about it awhile ago. Uncooked meat doesn’t have any;
the neurotoxin is formed when you cook it,
but you can cut the levels in half
by first marinating the meat with dried apple peel powder.
And also cuts down on the amount of
fecal contamination bacteria in the meat.
Apple peels can also inhibit the formation
of genotoxic, DNA-damaging, heterocyclic amines,
cutting the levels of these cooked meat carcinogens
by up to more than half.
In view of the risks associated with consuming
these cancer causing compounds in meat,
there is a need to reduce exposure
by blocking HCA formation,
such as by adding apple powder
during the cooking of meats
to help prevent their production.
I mean, I can’t think of any other way to reduce exposure. (mocking)
What about consuming apple peels directly?
Dried apple peel powder was found
to exhibit powerful anti-inflammatory and antioxidant action,
but this was in mice.
Does it have anti-inflammatory properties in people?
You don’t know...
until you put it to the test.
A dozen folks with moderate loss of joint
range of motion and associated chronic pain
were given a spoonful of dried apple peels
a day for 12 weeks,
and pain scores dropped month after month,
and the range of motion improved
in their neck, shoulders, back, and hips.
Conclusion: consumption of dried apple peel powder
was associated with improved
joint function and pain reduction.
Why just “associated”?
Because there was no control group;
so, they might have all been
just getting better on their own,
or it could have been a placebo effect.
But hey, why not give apple peels a try,
by eating more apples.
We would love it if you could share with us your stories
about reinventing your health through evidence-based nutrition.
Go to nutritionfacts.org/testimonials.
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To see any graphs, charts, graphics, images, or studies mentioned here,
please go to the Nutrition Facts Podcast landing page.
There you’ll find all the detailed information you need –
plus, links to all of the sources we cite for each of these topics.
My last two books are “How to Survive a Pandemic”
and the “How Not to Diet Cookbook”.
Stay tuned for December 5, 2023
for the launch of my new one, How Not to Age.
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