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I'm always asked by patients if they can change anything to help their
pain while theyre being treated at our clinic. Many patients who have
been diagnosed with Fibromyalgia Syndrome (FMS) have inflammatory type
symptoms in multiple joints (hands, shoulders, hips, knees, ankles, etc)
To help this type of pain, there is strong circumstantial evidence (as
well as our own anecdotal and clinical experience), that chronic
inflammation in many patients may be strongly linked to diet.
In order to understand this topic, some
background is needed. Its been known for several years that some people
are likely genetically predisposed to develop type II diabetes.[1-4] To
understand what happens to these people as they age, you need to
understand how the body handles sugars. One type of sugar, Glucose, is
critical to brain functioning and acts as the coal for the furnace of the
body. We need glucose to live. When we eat sugar or starches in our diet,
these are broken down to glucose. This glucose has to get into cells to be
used effectively as coal for the furnace. A hormone called insulin is
the key that unlocks the door for the glucose to enter all of your cells
and be used as energy. Some people produce too much insulin in response to
sugars in the diet. These patients develop what is now being called the
Metabolic Syndrome.[5-9] Over time, these massive amounts of secreted
insulin cause the cells to become less sensitive to insulin and these
patients develop insulin resistance.
This is the first step toward full blown type II
diabetes or as I like to call it, a diabetic in training. These patients
usually have normal or near normal fasting glucose levels, so they are
rarely diagnosed with anything at this point. These patients usually
become overweight in middle age and are noted to have high triglycerides
and blood lipids and over time will develop high blood pressure. They are
usually tired all the time, as their blood sugar levels drop substantially
after a high glycemic meal (lots of carbs and/or sugar).
What does all of this have to do with pain?
Its all about the inflammation. In last 5 years, hundreds s of
studies have been completed finding strong links between heart disease and
inflammation. One measure of total body levels of inflammation is
C-reactive protein or CRP. Patients with the Metabolic Syndrome or
diabetics in training have elevated CRP levels.[8, 10-13] While not much
study has been focused on how diet can impact osteoarthritis, elevated
inflammatory markers have been found in several studies of patients with
hip, knee, and erosive hand osteoarthritis.[14-17] It would seem logical
then that patients who have early insulin resistance may be able to
control both onset of diabetes and inflammation by dietary changes.
What does all of this mean? If you have rapidly
gained weight in middle age (like many of us) you may be rapidly
developing insulin resistance. You should consider yourself a diabetic in
training. If you change your diet, you will likely lose weight and stave
off the development of type II diabetes and this will definitely have a
great positive health impact. This may also reduce your pain or make it
more manageable (through weight loss and less mechanical overload as well
as through reducing inflammation in your body). How should you eat? The
first rule is simple: AVOID THE WHITE STUFF! Avoid white sugar and
white flour. The second rule is also simple; ITS ALL ABOUT YOUR BLOOD
SUGAR!
1. Avoid white flour. This also means that you significantly
limit bread intake to small amounts of true whole grain bread or some of
the low carb breads on the market. This is as little as 2-4 slices of
bread (or the equivalent) per day. This means no cakes, pastries, or other
concoctions made with white flour. Your intake of any of these types of
sweets (even if made with whole wheat flour) should be significantly
limited.
2.Avoid all candy.
3.The best sweetener to use is natural honey
(not
processed big company brands that add sugar, but old fashioned small farm
honey from real bees). Several studies have shown that small amount of
natural honey have a stabilizing effect on blood sugar.[18, 19] Depending
on how you feel about artificial sweeteners, you can also use small
amounts of Equal or Splenda (but these can also elevate blood sugar).
4. Caffeine will drop your blood sugar by
triggering massive insulin releases, avoid this as much as possible. That
means pretty much anything they sell at Starbucks is off limits. This also
means that teas and diet coals are also off limits. Green teas seem to be
a little easier on blood sugar levels, but not that much, so avoid
drinking significant quantities of these as well. In order to accomplish
this part of the diet in our busy world, you have to take care of yourself
and rest when you are tired. We've gotten into the habit of tanking up on
caffeine when were tired and not resting, this is bad for your pain,
blood sugar, and your health.
5. Avoid potatoes and other very high
carbohydrate fruits and vegetables (a lot of carrots, bananas), eats lots
of all other kinds of fruits and vegetables.
6. All pasta is off limits.
7. While saturated fat has been demonized by the
medical community, the research showing that it has negative health
effects is very weak. In fact, the largest funded dietary study (WHI or
Women's Health Initiative) failed to show any benefits to avoiding
saturated fats. Fats will help stabilize blood sugar, so dont avoid
natural fats.
8. In our parents day, if you baked a cake
or cookies, they went bad after a week. In the 1950s the food industry
fixed that by superheating the oils to create a new substance that had
never existed. It extended the shelf life of foods so that you could keep
crackers on the shelves for years without them going bad. However, it also
introduced a completely foreign substance into the food supply. For
general health, avoid trans fats like the plague! These are hydrogenated
or partially hydrogenated oils. They are found in most foods that have a
substantial shelf life, so read the labels! While this may not have much
to do with pain, these types of fats are a substantial heart health risk
among just about all studies. To get an idea of how to avoid these fats,
go into your cabinets and spend 10 minutes reading labels, you will be
surprised at how these fats are in almost everything.
9. If you feel tired after a meal or are
ravenously hungry before a meal or when you wake up, you have
exceeded your glycemic load. This means that you ate more starchy or
sugary carbs than your body can handle. Avoid these foods and/or cut back
severely on them. True hunger is a deep gnawing realization that you
should probably eat. An insulin overload from eating the wrong foods is
the realization that you would gladly knock over a convenience store if
you could just eat something now! You should study yourself after meals
and in the mornings to learn the difference between these two sensations.
10. Like everything you've heard, exercise will help you control weight and will also help you control blood sugar.
How do you exercise when you hurt all the time? Warm water pool therapy is
a great start for many patients.
For more information about how to eat this way,
see www.amazon.com and search in books under glycemic index. Many great
books will come up. Eating this way will help you lose weight, feel better
with less fatigue, and may just help your joint pain!
1. Fernandez-Real, J.M., Genetic predispositions
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3. Horikoshi, M., et al., A polymorphism in the
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14. Garnero, P., et al., Cross-sectional
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