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How does nutrition affect pain?
Nutrition is a source of energy and provides us with all the necessary vitamins, minerals and trace elements. Nutrients that enter the body in this way influence countless processes - including pain. Scientific studies show that diet can influence chronic pain [3-7]:
- Eating behavior and pain
An optimal diet and nutrient intake is the basis for body health. Suboptimal nutrient intake and poor eating habits can affect the body's nutrient supply. This becomes visible in the blood count via altered serum nutrient levels. For example, increased serum glutamate and aspartate levels have been found in patients with fibromyalgia [8]. Low levels of nutrients such as vitamin D, omega-3 polyunsaturated fatty acids, vitamin B12, magnesium, zinc, ferritin, selenium and folic acid are also frequently found [9,10]. Although these studies do not provide a causal link between nutrition and pain, they do indicate a change in eating behavior before or during the development of pain [11].
- Nutrition and pain risk
Dietary habits influence pain risk. Studies show that a “southern” diet with a high proportion of processed meat, sweetened drinks and fried foods increases the relative risk of pain by 41%, while a plant-based diet reduces the risk of pain by 22%.
- Body weight and pain
Diet influences body weight. People who are underweight, overweight or obese are more likely to suffer from chronic pain than people of normal weight [13-15].
The mechanisms of action between diet and pain are complex. Food does not usually trigger pain directly, but influences bodily processes that subsequently affect pain indirectly.For example, diet influences
- Inflammation and oxidative stress [16,17]
- the gut-brain axis [18,19]
- the fat metabolism [20]
- Overweight and underweight [21]
which in turn can influence pain.
How does nutrition affect pain in Fibromyalgia?
Nutrition and pain are linked in a complex way. Accordingly, an adapted diet can have a positive effect on pain - even in the case of fibromyalgia. What insights have already been gained?
Overweight
Studies have shown that overweight patients suffer more pain, have greater functional limitations, suffer more frequently from depression and take more medication compared to patients of normal weight [22,23]. A healthy body weight in the normal range (BMI between 18.5 and 24.9) is therefore not only generally beneficial to health, but can also help to alleviate the everyday burden of fibromyalgia and improve quality of life.
If you are overweight, slow, healthy weight loss can help to reduce the strain on the muscles and fatigue, especially in fibromyalgia patients. According to various studies, weight loss leads to an improved quality of life and fewer pain-related limitations. Weight loss plans should be discussed with the person treating you.
Nutrient supply & malnutrition
Diet determines the body's nutrient supply, which can be measured in the blood, microbiome (stool) and other body fluids. One study found elevated serum glutamate and aspartate levels in patients with fibromyalgia [8]. Low levels of nutrients such as vitamin D, omega-3 polyunsaturated fatty acids, vitamin B12, magnesium, zinc, ferritin, selenium and folic acid are also frequently found [9,10].
Before changing your diet or taking supplements, it is advisable to check with your doctor whether there is a deficiency. If these values are too low, the following foods or behaviors are suitable:
Compensate for vitamin D deficiency
Vitamin D is essential for general health and well-being. It is a fat-soluble vitamin that is necessary for the immune system, bone health, maintaining calcium and phosphate levels in the blood, among other things. Vitamin D helps to reduce inflammation and influences cell growth regulation.Vitamin D can be obtained through diet or sun exposure:
- Vitamin D2 (ergocalciferol)
Obtained mainly from plant sources and mushrooms. Foods rich in vitamin D2 include mushrooms, chanterelles, shiitake mushrooms, portobello mushrooms and maitake mushrooms.
- Vitamin D3 (cholecalciferol)
Is synthesized in the skin by sunlight (UVB rays) and is found in animal products. Foods rich in vitamin D3 include cod liver oil, eel, herring and salmon. However, only about 10-20% of vitamin D is absorbed through the diet.
Vitamin D is synthesized through the skin if the UVB radiation is sufficiently high. As a rule of thumb, the sun must be so high that the shadow of your body is shorter than you are tall.
Compensate for omega-3 deficiencies
Omega-3 fatty acids are a group of polyunsaturated fatty acids. They affect heart health by helping to reduce inflammation, lower triglyceride levels, lower blood pressure and reduce the risk of heart attacks and strokes. The omega-3 fatty acid DHA is crucial for brain development and function. Omega-3 fatty acids are associated with a lower risk of cognitive impairment and can help treat depression and anxiety. Omega-3 fatty acids are important for eye health as they are an important component of the retina and can reduce inflammatory processes in the body.Omega-3 fatty acids are obtained exclusively from the diet:
- Alpha-linolenic acid (ALA)
This is found in vegetable oils such as linseed oil, hemp oil, walnut oil, walnuts and chia seeds.
- Eicosapentaenoic acid (EPA)
This is mainly found in oily fish such as salmon, tuna, herring, mackerel and sardines, trout as well as in certain microalgae (e.g. Ulkenia) and fish oil, algae oil and krill oil made from them
- Docosahexaenoic acid (DHA)
This is also found in fish and other seafood such as tuna, sprat, salmon, herring, mackerel, microalgae (Schizochytrium sp. and Ulkenia sp.).
Balancing vitamin B12
Vitamin B12, also known as cobalamin, is a water-soluble vitamin that is necessary for the production of red blood cells, the synthesis of DNA and the function of the nervous system, among other things. Vitamin B12 is unique because it is the only vitamin that contains a metal ion (cobalt), which gives it its name.
Vitamin B12 is not synthesized by the body itself, but is supplied exclusively through food.Foods rich in vitamin B12 are meat, fish, dairy products and eggs. Traces of vitamin B12 are also found in fermented cabbich (sauerkraut), fermented soy products, shiitake mushrooms and root and tuber vegetables.
Balancing magnesium
Magnesium is an essential mineral that is required in many processes in the human body. These include enzymatic reactions such as the synthesis of DNA, RNA and proteins, the control of muscle contraction and relaxation, the transmission of nerve impulses and energy metabolism. Magnesium contributes to the structure and strength of bones and supports cardiovascular health by helping to regulate heart rhythm, lowering blood pressure and improving vascular health.
As the human body cannot produce minerals itself, magnesium must also be supplied to the body through the diet.
Foods that are rich in magnesium are green leafy vegetables (e.g. spinach), nuts and seeds (e.g. almonds, sunflower seeds), wholegrain products (e.g. brown rice, oatmeal), pulses (e.g. beans, lentils), fish (e.g. mackerel), bananas and avocados.
Balance zinc
Zinc is an essential trace element that is required in various bodily processes. These include protein synthesis, DNA synthesis, cell division and wound healing. Due to its antioxidant effect, zinc also contributes to cell protection against oxidative stress by being part of the antioxidant enzyme superoxide dismutase. Zinc plays a central role in the immune system. It supports the function of T cells and other immune cells that are important for the defense against infections. Zinc is important for maintaining the sense of taste and smell. A zinc deficiency can lead to impairment of these senses.
Zinc is supplied to the human body exclusively through food.
Foods rich in zinc include meat (especially beef and pork), seafood (especially oysters), pulses (such as beans, lentils and chickpeas), nuts and seeds, wholegrain products and dairy products.
Balancing ferritin (iron)
Ferritin is a protein that stores and releases iron. It plays an important role in iron metabolism and serves as an indicator of the iron reserves in the body.
Iron is an essential trace element in the human body and plays a crucial role in various physiological processes. It is particularly important for the formation of haemoglobin in the red blood cells, which enables oxygen to be transported in the blood. In addition, iron is involved in energy storage and production processes, acts as a cofactor for various enzymes and is important for the normal functioning of the immune system.Iron is found in food in two forms:
- heme iron
In animal products such as meat, fish and poultry. It is absorbed more efficiently than non-haem iron.
- Non-haeme iron
In plant sources such as beans, lentils, spinach and fortified cereals. The absorption of non-haeme iron can be improved by vitamin C.
Balancing selenium
Selenium is an essential trace element that is needed in small amounts but is of great importance. As a component of antioxidant enzymes, selenium helps protect cells from oxidative stress and damage caused by free radicals. It supports the immune system, thyroid function, reproductive health and cardiovascular health.
Selenium is absorbed exclusively through the diet. Good food sources of selenium are Brazil nuts (very high selenium content), fish and seafood, meat (especially offal such as liver), eggs, wholegrain products and dairy products.
Balancing folic acid
Folic acid, also known as vitamin B9 or folate, is essential for the formation of DNA and RNA and is therefore essential for cell growth and cell division.
Folic acid is obtained from the diet, particularly from green leafy vegetables, legumes, liver and fortified foods such as breakfast cereals and supplements.
Anti-inflammatory diet
Although fibromyalgia is not an inflammation-based disease, some people with fibromyalgia have been found to have elevated levels of inflammation. Since inflammation is stressful for the body and can exacerbate pain, it can be helpful to avoid foods that further fuel inflammation. These include processed products, especially refined sugar and carbohydrates (e.g. white flour products) as well as fried products and alcohol.
In contrast, anti-inflammatory foods rich in antioxidants can prevent inflammation in the body. These include olive oil, green vegetables, nuts, oily fish, dark chocolate and dark berries.
Food intolerances
Food intolerances and allergies occur more frequently in people with fibromyalgia than in the average population [24]. Irritable bowel syndrome is also a common accompanying condition.
Finding out which foods the body reacts intolerantly to is important in order to exclude these foods and prevent additional symptoms. Food intolerances can be identified, for example, through exploratory exclusion diets or blood or microbiome tests of the stool.
