It is evident that unhealthy diet is associated with various diseases such as cardiovascular and even certain cancers; but could poor diet be also associated with chronic musculoskeletal pain? Could positive changes to a diet help symptoms of fibromyalgia, osteoarthritis and chronic low back or neck pain?
The simple answer appears to be yes, as excess fat, sugar, caffeine and overall caloric consumption, have all been associated with chronic pain. There are now several animal and human studies to support this mostly ignored concept by many health care providers. For instance one study on mice showed that excessive fat consumption increased pain in mice who were induced with knee OA (cruel studies!), when compared to the mice fed a normal diet. Based on a survey study involving more than 1 million people, individuals with a high BMI were up to 2.5 times more likely to experience chronic pain and 4 times more likely to have symptomatic knee OA compared to those with a healthy BMI. One explanation is that adipose tissue can release pro-inflammatory cytokines which can contribute to low-level chronic inflammation.
In one paper (Rondanelli 2018), the authors suggest an anti-inflammatory food pyramid starting from the bottom to the top to include, water, fruits & vegetables, low-glycemic carbs such as whole bread or brown pasta & rice, extra-virgin olive oil, seeds & nuts, yogurt, red wine, curcumin and ginger. They also recommend the minimal consumption of refined sugar, red meat and processed meats. One explanation is that blood pH levels have been shown to decrease (increased acidity) with the greater consumption of meats (Deriemaeker 2010) and high intervertebral disc acidity has been associated with greater irritation of the nerve roots in those with chronic low back pain (LBP) (Liang 2013) where some have recommended alkaline supplements to help those with chronic LBP (Vormann 2001).
Although a recent review paper (Elma 2020) makes a pretty good case for the potential value of addressing diet in those with persistent musculoskeletal pain, there is still a lack of RCTs on this topic and I doubt that there will be one in the near future. The truth is that pain is complex and multi-factorial and diet is likely just ONE of the many factors contributing to the pain experience. Despite the lack of RCTs, I do not hesitate recommending some of my patients to consult a Registered Dietician!