The Food, Inflammation & Pain Connection

Food may not be the first thing that comes to your mind when you think about orthopedic pain and dysfunction, but it is an important factor. Food programs your body for greater health or greater disease. Unfortunately, the standard American diet (SAD) makes us sicker. It sets us up for the standard American health conditions such as chronic pain, arthritis pain, heart disease, diabetes, obesity, stroke, and dementia. These inflammatory conditions reduce healthspan and lifespan. The SAD feeds them with processed foods high in added sugar, added salt and saturated fats; as well as lacking in nutrients, vegetables, fruits, and legumes. The antidote?

An eating plan that is just the opposite: rich in vegetables, fruits, and legumes, and low in processed foods, excess sugars, saturated fats, and extra salt. Our fuel matters and the science behind it is fascinating. Let’s take a deep dive into specialized pro-resolving mediators, the ibuprofen-like benefits of fruit, and the gut microbiome. 

Specialized pro-resolving mediators (SPM) in Omega-3-Rich Foods 

Alpha-linolenic acid is one type of omega-3 fatty acid. It is found in flaxseed, leafy green vegetables, and other omega-3-rich plant foods. In the body, alpha-linolenic acid is converted to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which produce powerful anti-inflammatory agents, including prostaglandins, leukotrienes, and specialized pro-resolving mediators (SPMs). SPMs resolve imbalances in the body. They include resolvins (which resolve inflammation), protectins (which protect the body), maresins, and lipoxins. Research has shown that SPMs reduce inflammation, reduce pain, and promote tissue healing while preventing chronic inflammation. They help heal and restore homeostasis. The Specialised Pro-resolving Mediators of Inflammation in Inflammatory Arthritis study of patients with knee joint effusions found that the presence of SPMs in the knee joint fluid corresponded to less pain and lower inflammatory markers. SPMs are considered by many to be the therapy of the future to prevent chronic pain and inflammation. 

Consider adding some Omega-3 rich foods:

• fatty fish, seafood 
• chia seeds, ground flaxseeds, walnuts, tofu, tempeh, edamame, miso 
• olive oil, butter, coconut oil, ghee 
• green leafy vegetables (spinach, kale) 
• brassicas (brussels sprouts, broccoli, cauliflower) 
• avocados 
• algae, seaweed 
• hemp oil, krill oil 

These foods can help with inflammation and promote better healing. 
 

The Anti-inflammatory Benefits of Fruits

A 2022 article in the journal, Nutrients, reviewed the health and anti-inflammatory benefits of fruits. The active compounds in fruits include flavonols, flavones, flavanones, chalkone, anthocyanins, flavan-3-ols, stilbenes, lignans, vitamins, and minerals. These act as anti-inflammatory agents in the body by reducing inflammation along the arachidonic acid pathway (just like ibuprofen, naprosyn etc.), having antioxidant activity, and modulating the immune system. Berries are especially powerful and jam packed with phytonutrients. Remember it is better to focus on whole fruits and not juice which is devoid of the fruit’s natural fiber and other constituents. For an easy start, try eating a fruit of a different color each day for the next five days (different colors often provide different phytonutrients and support gut health). Fresh fruits are best but frozen fruit (without any added sugar) work too. 

The Gut Microbiome 

An optimal microbiome helps us digest food, absorb vitamins, fight infections, and lower painful inflammation. An unbalanced gut microbiome creates chaos, dysfunction, and pain. Poor diet, infections, stress, surgery, and certain medications can wipe out some beneficial gut organisms and enable the growth of harmful ones. Studies have found that an unbalanced gut microbiome correlates with chronic musculoskeletal pain. The SAD directly affects the “gut-joint axis” and leads to more swelling, more inflammation, more pain, and more dysfunction. To support good gut health, we must consider prebiotic and probiotic foods. Prebiotics are foods that support a healthy microbiome and feed the beneficial bacteria. Examples of these include onions, apples, asparagus, artichokes, cabbage, almonds, leeks, flaxseeds, seaweed, and leafy greens. Probiotics are foods that contain beneficial bacteria. Examples of these are cultured and fermented foods such as plain, unsweetened yogurt, kimchi, sauerkraut, pickles, miso, and tempeh. 

Maintaining a Healthy Gut Microbiome 

• Keep hydrated. 
• Eat high-fiber foods. 
• Eat fermented foods. 
• Avoid foods with added sugar and artificial ingredients. 
• Limit stress. 
• Avoid long-term use of NSAIDs. 
• Stay physically active. 

The bottom line is to focus on vegetables, high-fiber fruits, unprocessed foods, and fermented foods for a balanced microbiome. 

Dr. Sharma is a physical medicine and rehabilitation specialist and the Director of the Orthopaedic Integrative Health Center at Rothman Orthopaedics. For a customized anti-inflammatory living approach, check out more articles and consider a consultation at the Orthopaedic Integrative Health Center. 

References
1. Sharma, Saloni. The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain Without Medication. New World Library, 2022.
2. Chávez-Castillo M, Ortega Á, Cudris-Torres L, et al. Specialized Pro-Resolving Lipid Mediators: The Future of Chronic Pain Therapy?. Int J Mol Sci. 2021;22(19):10370.
3. Serhan CN, Levy BD. Resolvins in inflammation: emergence of the pro-resolving superfamily of mediators. J Clin Invest. 2018;128(7):2657-2669.
4. Barden AE, Moghaddami M, Mas E, Phillips M, Cleland LG, Mori TA. Specialised pro-resolving mediators of inflammation in inflammatory arthritis. Prostaglandins Leukot Essent Fatty Acids. 2016;107:24-29
5. Majdan M, Bobrowska-Korczak B. Active Compounds in Fruits and Inflammation in the Body. Nutrients. 2022;14(12):2496. 
6. Szychlinska MA, Di Rosa M, Castorina A, Mobasheri A, Musumeci G. A correlation between intestinal microbiota dysbiosis and osteoarthritis. Heliyon. 2019;5(1):e01134.