I spend 50% of my clinical time treating chronic pain patients. A paleolithic diet which consists of pastured grass-fed meat, free range poultry and eggs, fresh seafood, fresh vegetables, fruits and nuts decreases inflammation by eliminating major sources of dietary induced inflammation.
Yesterday I saw a patient one month after he started a paleolithic lifestyle (paleo diet, 8 hours of sleep per night- cycling with the sun, regular exercise including a prescribed spine rehab program).
Within 30 days his pain has decreased by more than 50%, He feels more energetic. He stated “I have started to dream again and get a full night’s sleep”. He has lost 12 pounds in one month and his blood pressure is down. He is ready to return to work after not working for eight months (with some activity restrictions). He is not taking any opiate pain medication.
His MRI scan and X-rays of the spine will not demonstrate any improvement. He still has degenerative disc disease, one or more tears in a disc annulus (outer wall of the disc) and arthritis in the facet joints of his neck (cervical spine) and lower back (lumbar spine). But the lifestyle elements that have contributed to his chronic inflammation have been significantly reduced in just 30 days and he has benefited “tremendously” in his own words.
There are many mechanisms involved with chronic inflammation. Most patients with chronic pain have an inflammatory component. Many patients with chronic pain are overweight or obese. Excess visceral adiposity (fat around the internal organs) creates a state of chronic inflammation by constantly producing inflammatory chemicals called chemokines and cytokines. These inflammatory mediators are produced by the fat cells and by the white blood cells (macrophages) that reside alongside the fat cells. They contribute to a process called central sensitization where the brain and spinal cord nerves that mediate pain become sensitized and over-react to sensory input. Interleukin 6 is one of these mediators. Increased levels are associated with fatigue, depression and a state of hyperalgesia where painful stimuli are amplified. Tumor necrosis factor alpha is another important inflammatory mediator produced in excess when excess fat accumulates around the internal organs. Weight loss is essential to decease systemic inflammation, particularly in the setting of chronic pain when someone is overweight or obese.
Pro-inflammatory foods can also increase inflammation by altering intestinal flora and increasing intestinal permeability. These mechanisms have been discussed in previous posts and in the manifesto page of this website.
Few patients follow my dietary and lifestyle advice. Most seem to prefer taking pills, getting injections and other interventional pain procedures. In other words, they prefer to “be-fixed” rather than take lifestyle initiatives that are likely to not only decrease their pain but also improve their general health. As an interventional pain practitioner I encourage patients to take full advantage of the pharmacology and interventional procedures that are likely to help. But without significant changes in bad dietary habits, poor sleep hygiene and without adopting a rehabilitation exercise program the pills and injections/procedures are much less effective and the prognosis is poor.
Stress reduction is also essential for health in general and for pain reduction in particular. Yet despite repeated recommendations to utilize an inexpensive stress reduction workbook, few patients ever bother to take this important step to reduce pain, anxiety and suffering.
Our culture is one in which patients expect to “be fixed” rather than to be led down a path which leads to healing and functional improvement by actively participating in their own rehabilitation and healing. Our culture is also one in which major organizations provide bad dietary advice, particularly with respect to encouraging increased consumption of grains and legumes which have pro-inflammatory components and anti-nutrients. We evolved over a few million years without consuming grains, legumes, refined vegetable olis or dairy. Our evolutionary biology and physiology thrive when these foods, particularly processed foods are eliminated from the diet and we consume only those whole natural foods we have evolved to eat.
Modern medicine provides many remarkable drugs, surgeries and procedures that can be life saving and life altering. But application of this technology without addressing the fundamental determinants of health (proper nutrition, restorative sleep, judicious exercise, stress reduction, and restoration of circadian rhythm) yields much less benefit. Ultimately, unless we remove from our lives the destructive components of modern society and culture we cannot heal and instead continue to suffer from chronic degenerative diseases that cause pain, loss of intellect and loss of mobility.
No references tonight, just comments and reflection. References have been provided in previous posts.
Peace, health, and happiness.
I really enjoy your posts.
Thank you for sharing all of your research!
Hi Dr. Bob…Here is one chronic pain patient who is more than willing to be led, and tired of being “fixed”!
I have started into the paleo lifestyle, gradually, I will admit, but doing it. Last month, I stopped eating all processed food, and have given up all carbs, which I see now actually made up quite a bit of my diet…bread, cereal, pasta, potatoes ( love them spuds) and the like. Last week, I stopped eating ALL sugar. I have constant headaches since then, which, from my reading, I expected. I’ll be VERY happy when they level off. My body feels like I’ve been hit by a bus, but I am determined to make these changes if there is ANY chance of living a life not practically bedridden with pain. It has been a very long time…a VERY long time since I have held any hope of living SOME sort of life where joy and expectation overruled pain and despondency. I look forward, instead of backward. You did this for me, Dr. Hansen, and I thank you for it !
With respect, Rosemary
Ditto, Bob. All things in moderation, including reliance on the pills and procedures. No better health plan than prevention and good lifestyle!
Wow, Dr. Bob, I just read this post the second time and I understood so much better. I feel inspired and empowered. There is so much that I can actually do to improve my health and decrease or eliminate pain. This encourages me to keep going and to believe that my body was created to heal. Thank you for writing this blog. I believe more people are learning and growing and making changes to their lifestyles. The more stories you tell of success, the better. Keep it coming!
Thanks, Shari Merrill