Diet and Pain
Many people who suffer from chronic pain seek out alternative therapies to help manage their disease and diet is often one such therapy. The three most common diet interventions used for rheumatoid arthritis and associated pain are vegan/vegetarian diets, Mediterranean-style diets and elimination/elemental diets.
Although dietary manipulation is extremely appealing there is little evidence confirming the benefits of modified diets for patients with chronic pain due to the lack of controlled studies and clinical trials. Therefore, when using dietary intervention to manage pain it is important to understand the benefits and risks associated with diet restrictions.
Vegan/Vegetarian diets are composed predominantly of plant foods and may or may not include eggs and dairy products.
Benefits of vegan/vegetarian diets include:
- Increased intake of fruits and vegetables
- Reduced intake of saturated fats through avoidance of red meat/poultry
- Increased dietary fiber provided by whole grains, fruits/vegetables and legumes
An increased intake of fruits and vegetables provides higher amounts of anti-oxidants which may be a causal factor in reducing pain and stiffness.
Risks associated with vegan/vegetarian diets include:
- Protein deficiency
- Calcium deficiency
- Vitamin D deficiency
- Iron deficiency
- Zinc deficiency
- Vitamin B-12 deficiency
Nutrient deficiency can be avoided by including a wide variety of plant based proteins (legumes, nuts, whole grains, etc.) over the course of the day to provide essential amino acids.
Vegan/vegetarian diets should include a calcium rich milk alternative like soy or rice milk, and strict vegan diets need to supplement vitamin B-12.
Cretan Mediterranean diets are high in fruits and vegetables, cereals, legumes, fish and olive oils while low in red meats. This diet could have protective effects due to its high level of unsaturated fats and anti-oxidants. The Mediterranean diet is nutritionally adequate and covers all of the food groups.
An elimination diet removes one or more potentially offending foods while an elemental diet is a hypoallergenic formula-based diet providing essential amino acids, carbohydrates, fats, vitamins and minerals. There are multiple nutrient deficiencies associated with these extreme diets and therefore they are not generally advised.
In conclusion, there is a great deal of controversy regarding the role of diet in the treatment of RA and associated pain. The best diet therapy is to include a balanced diet with a variety of foods. Diets should be rich in fruits/vegetables, whole grains, legumes, nuts and lean meats. This diet will provide beneficial antioxidants, mono and poly-unsaturated fats, and does not pose any nutritional risks.
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