A better quality diet may protect against pain, but patient’s food aversions and restrictions may make it a difficult switch.
A spoonful of sugar may help the medicine go down, but a gutful of highly processed sugar and fats won’t help with abdominal pain.
Pro-inflammatory diets have been associated with increased pain in migraine and rheumatoid arthritis, while anti-inflammatory diets – like the Mediterranean, ketogenic or FODMAP – have been associated with reduced pain in osteoarthritis and rheumatoid arthritis. But, to date it is not clear whether a pro-inflammatory diet is linked to abdominal pain.
Now, the results of new Chinese research, published in Pain Medicine, suggests an extremely pro-inflammatory diet is associated with increased risk, severity and frequency of abdominal pain.
Dr Katherine Brain (PhD), senior dietitian from the Hunter Integrated Pain Service at John Hunter Hospital, told The Medical Republic while she was excited to see more research into the association between nutrition and chronic pain, she was not surprised by the findings.
“The key messages that keep coming up [in the literature] are that having a higher quality and variety of core foods – fruits, vegetables, whole grains, good quality protein, water and dairy – is associated with better pain experiences, and having a lower quality diet, which can also be described interchangeably as a pro-inflammatory diet – is associated with worse pain outcomes.”
Using data from the UK Biobank and the US National Health and Nutrition Examination Survey, researchers found people whose diet was in the highest quintile for being pro-inflammatory were 12% more likely to report experiencing abdominal pain for at least three months compared to people whose diet was in the lowest quintile. The result held true even after adjusting for factors such as age, gender, race, smoking status, BMI, exercise habits, alcohol consumption and other comorbidities (e.g., hypertension, thyroid issues and mental health problems).
Similarly, NHANES participants in the highest quintile were 46% more likely to report experiencing abdominal pain in the past 12 months.
Dr Brain said there were multiple reasons why a proinflammatory diet could contribute to chronic abdominal pain.
“The evidence [suggests] there’s a hypersensitivity of the nervous system in chronic pain, and a hypersensitivity of the gut in abdominal pain. We believe there is some link between [the two] through the gut-brain axis [where] if you’re hypersensitive in one, you might be hypersensitive in the other. [For example,] there’s quite a big overlap between people with fibromyalgia and irritable bowel syndrome,” she told TMR.
Dr Brain said there were often challenges in helping patients manage chronic abdominal pain, and recommended starting with small, simple steps.
“A lot of people with abdominal pain [might] have a lot of food restrictions or aversions, [meaning] they could be eating a restricted diet or might not be eating much food at all. So saying, ‘okay, instead if eating your two-minute noodles, go and have five servings of vegetables and a piece of salmon’ [is] just not going to happen.
“I suggest going back to basics and following the RAVES framework, where the first step is encouraging regular meals throughout the day. Once you’ve established regular eating, then you can look at nutrition adequacy and the quantity and quality of food [before] building from there.”
Dr Brain highlighted the find a dietitian tool on the Dietitians Australia website as a useful resource for patients and GPs.
