The Impact of Food Dyes on Inflammation, Pain, and Orthopedic Surgery Recovery

Orthopedic injuries and ailments, whether they involve physical therapy, injections, surgeries, or other interventions, can be challenging experiences. Optimal recovery rests on a multimodal approach to reduce pain and restore function. While recovery often focuses on movement and medications, nutrition is an overlooked factor. What we eat significantly influences how well we heal, and evidence suggests that processed foods and the artificial dyes commonly found in them such as Red Lake 40 (FD&C Red No. 40) impact inflammation and pain.

Understanding Food Dyes

What Is Red Lake 40?

Red Lake 40, also known as Allura Red AC, is a synthetic dye used to give foods, beverages, and cosmetics a red hue. Chemically, it is derived from petroleum, specifically coal tar, which is refined into a colorant. Red Lake 40 is commonly found in products such as soft drinks, candy, and packaged snacks. Manufacturers use synthetic dyes like Red Lake 40 because they provide vibrant, long-lasting color at a low cost, making them a popular choice for mass-produced food items.

Other Common Food Dyes:

Red Lake 40 is not the only artificial food dye in use. Other widely used synthetic dyes include:

• Yellow 5 (Tartrazine): A yellow dye found in candies, cereals, and soft drinks.
• Blue 1: Used in ice cream, baked goods, and beverages.
• Red 3: Often used in candy, processed meats, and previously, medications.

In January 2025, the Food and Drug Administration (FDA) revoked authorization for the use of Red 3 because of studies showing cancer in animals exposed to high amounts. At the state level, Arizona and New York are the most recent states to propose bills banning these types of food dyes in school meals. While synthetic dyes are cheaper and more stable than natural alternatives like beet juice or spinach powder, they come with a growing concern about their potential health effects, particularly in sensitive individuals.

The Link Between Food Dyes and Inflammation

How Do Food Dyes Affect Inflammation?

Recent studies have raised concerns about the inflammatory effects of artificial food dyes. Some research suggests that these dyes can trigger immune responses, leading to an increased production of excess pro-inflammatory molecules. This process, known as increased systemic inflammation, drives nearly all health conditions to some degree, including diabetes, heart disease, autoimmune conditions, asthma, mental health conditions, and even skin reactions like rashes or hives.

For example, a recent study published in Toxicology Reports found that food dyes like Red Lake 40 disrupt the gut microbiome and increased inflammation. Synthetic food dyes may not only cause local irritation but may also impact systemic inflammation throughout the body.

Connection to Inflammation After Surgery

In the context of orthopedic surgery, inflammation is a double-edged sword. While inflammation is a natural part of the healing process, excessive or prolonged inflammation can delay recovery. For patients recovering from joint replacements or spinal surgery, increased systemic inflammation can hinder wound healing, increase pain perception, and cause prolonged swelling.

A poor diet full of processed foods and artificial ingredients contributes to increased systemic inflammation and can further complicate the recovery process. For people looking to improve their recovery and overall health, minimizing pro-inflammatory processed foods, ingesting adequate protein, and correcting any nutritional deficiencies in the pre-operative and post-operative periods helps support better healing and pain management. Guidelines for perioperative nutritional support such as the Enhanced Recovery After Surgery protocol have been developed due to the profound impact of nutritional status on surgical outcomes.

How Food Dyes Impact Pain and Orthopedic Surgery Recovery

The Healing Process and Inflammation

The body’s healing process after surgery involves several stages, with inflammation playing a critical role in tissue repair. However, when inflammation becomes chronic or excessive—whether due to external factors like pro-inflammatory foods, or internal factors like infections—it can interfere with the healing process. This may lead to increased pain, slower recovery, and even complications like excessive scar tissue formation.

Potential Impact of Food Additives

Research suggests that food additives may contribute to widespread inflammatory processes. A study published in Toxicology indicated that food additives alter the gut microbiota and can have effects on the brain including in cognition, memory, and behavior. Disrupted gut health impacts normal food processing and brain processing. This can impact pain control and healing. A healthy gut microbiome, based on whole foods with minimized processed foods, supports not only gut health but whole-body health.

By reducing inflammation and managing pain more effectively, patients may be able to recover better and experience improved surgical outcomes.

Overall Impact on Surgery Outcomes

Uncontrolled inflammation after orthopedic surgery can lead to chronic pain, increased risk of infection, and decreased mobility. Reducing inflammation—whether through medical treatments, dietary changes, or other lifestyle modifications—can improve surgical outcomes significantly. In fact, the American Academy of Orthopaedic Surgeons considers nutrition optimization a key part of reducing surgical risks. Controlling inflammatory conditions and avoiding ultra-processed foods loaded with food additives such as artificial dyes are simple yet effective steps to help reduce unnecessary complications.

Recommendations for Patients Recovering from Orthopedic Surgery

Limit Ultra-Processed Foods

One of the easiest ways for patients recovering from orthopedic surgeries to minimize inflammation is by focusing on whole foods with five ingredients or less, and limiting processed foods that are high in unhealthy fats and low in nutritional value. Ultra-processed foods often contain food additives such as dyes, including:

• Soda and sweetened beverages
• Candy and sweets
• Packaged snacks
• Processed baked goods

Instead of reaching for these products, patients can opt for whole foods, homemade meals, and natural colorings from fruits and vegetables. These items do not have to be time-consuming and may include snacks like carrots and hummus, guacamole on sourdough bread, or Greek yogurt with berries.

Anti-inflammatory Diet for Recovery

In addition to limiting processed foods, an anti-inflammatory diet can support healing and improve recovery outcomes. Some key dietary recommendations include:

• Omega-3 fatty acids: Found in fatty fish (like salmon and mackerel) and plant-based sources like flaxseeds and walnuts. Omega-3s are known for their anti-inflammatory properties.
• Antioxidants: Foods rich in antioxidants, such as berries, dark leafy greens, and colorful vegetables, help reduce oxidative stress and inflammation.
• Fiber: Whole grains, legumes, and vegetables support gut health, which in turn can influence inflammation levels throughout the body.

Additionally, foods rich in calcium, vitamin D, and magnesium can support bone and tissue repair, making them especially important for orthopedic recovery.

Practical Tips

• Read food labels: Look for terms like “Red Lake” or “Allura Red AC” and similar names to identify products containing synthetic dyes and avoid these items.
• Discuss a plan with your physician: Ask your physician for more information on the connection between nutrition and optimal healing.
• Check trusted sources for nutrition information: MyPlate.gov has a wealth of practical, nutrition information.
• Read Guides for Managing Orthopaedic Inflammation & Pain: For a step-by-step plan consider the book, The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain without Medication.
• Consult with the Orthopaedic Integrative Health Center: Meet with a double-board certified physician specializing in pre- and post-surgical care to create your own anti-inflammatory, recovery plan.

Conclusion

Reducing inflammation is key to optimizing recovery after orthopedic injuries, procedures, and surgeries, and minimizing processed foods is one simple, yet effective, strategy. By making mindful dietary choices, patients can improve their healing time, reduce pain, and enhance overall surgical outcomes. Small dietary changes—like limiting food additives and embracing anti-inflammatory foods—can make a significant difference in recovery.

It is important for you to discuss any dietary adjustments with your physician. With a dedicated approach, even seemingly minor dietary changes can help improve your recovery and support better long-term outcomes. To meet with Dr. Sharma or one of the many specialists at Rothman, make an appointment today. 

References

1. U.S Food and Drug Administration. FDA to Revoke Authorization for the Use of Red No. 3 in Food and Ingested Drugs. Constituent Update. January 15, 2025. Accessed January 31, 2025. https://www.fda.gov/food/hfp-constituent-updates/fda-revoke-authorization-use-red-no-3-food-and-ingested-drugs
2. Hofseth, Lorne J et al. “Allura Red AC is a xenobiotic. Is it also a carcinogen?.” Carcinogenesis vol. 45,10 (2024): 711-720. doi:10.1093/carcin/bgae057
3. Zhang, Qi, et al. "The synthetic food dye, Red 40, causes DNA damage, causes colonic inflammation, and impacts the microbiome in mice." Toxicology Reports 11 (2023): 221-232.
4. Martínez-Ortega, Antonio Jesús et al. “Perioperative Nutritional Support: A Review of Current Literature.” Nutrients vol. 14,8 1601. 12 Apr. 2022, doi:10.3390/nu14081601
5. Abiega-Franyutti, Pilar, and Veronica Freyre-Fonseca. "Chronic consumption of food-additives lead to changes via microbiota gut-brain axis." Toxicology 464 (2021): 153001.
6. American Academy of Orthopaedic Surgeons. AAOS Toolkits. Preoperative Risk Factors, Nutrition. Surgical Toolkit. https://www.aaos.org/quality/quality-programs/quality-toolkits/nutrition/
7. U.S. Department of Agriculture. MyPlate. https://www.myplate.gov/