For most people if they have pain they take an aspirin or two and walk it off. However, for millions of others that simply will not cut it.
Those who suffer from chronic pain will tell you that there is not much they would not, nor have not, tried to assuage the constant and debilitating pain they suffer. From doctors with prescription pads to modern medicine men with their snake-oil promises, chronic pain sufferers have run the gambit of possible, but often mostly ineffective, treatments.
On the horizon is a “new” treatment aimed at healing chronic pain rather than just treating it. New is actually a misnomer for this treatment comes in most part from a time before chronic pain was considered to exist. A ketogenic diet, also known as a low carb diet, has begun surging to popularity over the last few years as doctors and consumers realized its benefits for weight loss. Yet, this dietary lifestyle harkens back to our ancestors and the way they ate before people started worrying about how they ate.
So, what exactly is chronic pain and what makes it different from any other pain? Further, where does it come from and why is it so hard to treat?
What is a ketogenic diet and how is it different from what people eat now? Moreover, how does eating a ketogenic diet help relieve chronic pain?
What is Chronic Pain?
Chronic pain is defined by Merriam-Webster as prolonged physical pain that lasts for longer than the natural healing process should allow. Doctors often define it as a prolonged, enduring pain that continues for six months or more. Pain itself is broadly defined as being physical or mental discomfort.
This means that people who are suffering due to an injury or illness can often ease their discomfort by applying heat or cold to the site, taking an over the counter analgesic or anti-inflammatory medication such as aspirin or ibuprofen respectively, or even simply resting. Chronic pain, however, resists these simple treatments and continues despite them.
The World Health Organization (WHO) acknowledges that pain is an essential global public health concern. In 2007, they recognized “a need for improved, standardized management of chronic pain, both malignant and non-malignant, and acute pain.” More directly, the medical community as a whole has realized over the last decade or so that pain is not merely a symptom but a cause and the detrimental effect it has on a patient’s outlook impacts both their clinical outcomes and their general quality of life.
More and more, physicians are being advised to view chronic pain as a disease of its own. They are adjusting their point of view in an attempt to treat it as the multifaceted condition that it is. They are working to go beyond treating chronic pain by treating the condition that causes it but rather treating it as a condition that has additional causality.
What causes it?
Pain is generally caused by injuries, inflammation, or nerve disorders. That pain becomes chronic when traditional remedies fail and it continues past what is considered the normal time for healing. Often treating the underlying cause for that continuation can bring some relief of the pain as a symptom.
These medical conditions, and the chronic pain that accompanies them, can be extremely debilitating and often life altering. They can hinder somebody’s normal functioning and their ability to move with ease. They may also lead to anxiety, feelings of hopelessness, and depression.
The primary culprit for chronic pain is actually chronic inflammation. This natural effort of the body to defend itself against attackers like viruses or bacteria is designed to help your body heal by attracting white blood cells to damaged or infected areas. When this healing response continues for too long however, it becomes chronic and not only leads to chronic pain but also many long term diseases which in turn lead to more inflammation and more pain.
It is a vicious cycle that becomes virtually unbreakable. Maggie Phillips, author of Reversing Chronic Pain, writes: “Having a chronic pain condition is traumatizing in and of itself.” The causal relationship lines blur and it becomes nearly impossible to determine which is cause and which is effect. As a result, chronic pain and chronic inflammation are often impervious to the classic treatments which should help alleviate both.
How is it treated?
Traditionally, inflammation is treated with either steroidal therapy or non-steroidal treatments or a combination of both. These treatments have been used for decades despite their mediocre results.
The most common steroidal therapy is synthetic corticosteroid injections at or near the sight of the inflammation. There are a wide range of side effects associated with this semi-invasive type of treatment including headache, dizziness, and nausea on the common end and ranging from rapid weight gain to seizures and even death on the severe end. Often, a prolonged course of oral steroids is prescribed with a similar list of side effects as well as the added risks of addiction and abuse.
Non-steroidal treatments are usually medication based and thus carry another hefty list of side effects. The most common and recognizable of these medications are NSAIDS, non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen. Long term use of these medications is known to cause liver damage and even standard use of them wreaks havoc with your stomach.
When these treatments fail, doctors and nurse practitioners often turn to narcotics to ease their patients’ suffering. These opioid based drugs are highly addictive and carry severe side effects, even on the common list. The medical community of late has begun to realize the dangers of prescribing these drugs and groups have popped up to ease the problems caused by the medicine that was supposed to help.
When the information above is combined with the dismal results of such therapies to treat either chronic inflammation or chronic pain, it seems almost like more of a torture than a treatment. One has to wonder how this ketogenic diet is supposed to succeed when all these advances of modern science have failed.
What is a ketogenic diet?
To understand the ketogenic diet, you must first have a basic understanding of ketosis itself.
Ketosis is a normal metabolic process that occurs when the body does not have enough glucose. The body then burns fat stores for energy building up ketones in the body. These ketone bodies are produced in the liver in response to the low glucose caused by a fasting or carbohydrate purge.
Ketone bodies are defined as; any of three related compounds (acetone, beta hydroxybutyrate (BHB), and acetoacetic acid) which are produced during the metabolism of fats. Alone and unused, these chemicals would be toxic to a person but since they are burned up as energy they become beneficial.
For decades, the battle cry for eating healthy has been, “Fat is bad.” Every food item imaginable is now offered in a “Low fat” or “No fat” version … Or both! We have been told to eat smaller meals packed with carbs for energy and to snack in between to keep the energy going. This logical, yet somewhat misguided, dietary advice led to the nutritional disaster we have today.
The body needs fat. Without fat, and protein, the body would die. However, there is one thing that the body can live without just fine. That is carbohydrates.
As a matter of fact, the majority of the world lived just fine without them, for the most part, until the Industrial Revolution in the late 18th and early 19th centuries brought factories that could turn out processed goods just loaded with carbohydrates. These treated, processed, and packaged “foods” led the way to generation after generation of people who had strayed far from their dietary roots and were growing increasingly less and less healthy.
According to a report by the US Institute of Medicine’s Food and Nutrition Board, “The lower limit of dietary carbohydrates compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed.” It is important to note however, that a totally zero-carb diet is not recommended as this eliminates some truly healthy foods.
The life we live today does not resemble that of our not so distant ancestors in many ways, some good and some bad, but few worse than the unhealthy way we view food and the role it plays in our health. Our ancestors lived a simpler life filled with long periods of fasting, either due to scarcity of food or working in the fields.
After this they would gather for large filling meals made up of animal and plant products that they had gathered themselves … and the fattier the meat the better. As for between meal snacks, they consisted of fruit or greens gathered while working or even a grub they’d dug up if they felt really peckish.
While it is true that body needs the glucose which carbohydrates produce for the energy to function, it is not necessary to get that glucose from carbohydrates alone. Thanks to the process of gluconeogenesis, our bodies can turn protein into glucose. This exclusion or limiting of carbohydrates in your diet will lead to another dietary condition, ketosis.
The majority of metabolically healthy people shift into some amount of ketosis every day. For example, overnight as they sleep. People often wake up with “funky” slightly sweet smelling breath from the burning of the ketone body, acetone. This is a good sign as it is the hallmark of a healthy metabolism.
Ketogenic and low carb diets have been known for many years to promote weight loss and to help fight diabetes. Also, low carb & ketogenic diets lower glucose levels, which is associated with a higher seizure threshold and less neuronal excitability making them a major treatment avenue for seizure patients for the last 120 years.
A true ketogenic diet limits the intake of carbs to less than 50 grams a day whereas the Low carb version allows carbohydrates to vary between 25 and 150 grams per day. Also, the ketogenic diet often restricts the intake of protein. The classic ketogenic diet is a 4:1:1 dietary plan with the parts being fat to carbs to protein. The low carb diet however, does not usually restrict the protein intake of its users.
The main goal of the ketogenic diet is to increase the levels of ketones in the blood to be used as a replacement for glucose as an energy source for the body.
What does this mean for chronic pain?
According to the National Institute of Neurological Disorder and Stroke (NINDS), there is evidence emerging from multiple studies to put forward that a ketogenic diet can alleviate pain. Dr. Joe Tatta, doctor of physical therapy and certified clinical nutritionist, advances this contention as he notes that “healthy fats might also be the missing ingredient in diets to help alleviate chronic pain.”
A joint effort of the NINDS and the NIH (National Institute of Health) studied the effects of a ketogenic diet on inflammation. Inflammation, as was stated earlier, is cited as the leading cause of pain, chronic and otherwise. The central hypothesis of their study is that a ketogenic diet will alleviate pain. This is to include Intractable Pain syndrome or IP, which is defined as a relentless and severe pain that is incurable by any known means and which results a bed or house bound state and even premature death if not effectively handled.
Their conclusions are promising for chronic pain sufferers. They found that a ketogenic diet has a number of “biochemical consequences.” Ketogenic diets are found to decrease neural activity, reactive oxygen species in the blood, and free radicals produced by the process of consuming glucose for energy. Neural activity is linked to both seizure activity and chronic pain as they are both though to involve increased excitability of neurons. High levels of reactive oxygen species and free radicals in the blood have long been found to contribute to inflammation.
At the same time, ketogenic diets “increase the baseline pain thresholds while reducing both inflammatory and neuropathic pain.” While very technical, that all sounds promising for chronic pain relief.
Other studies have concluded that the fat burning activity of a ketogenic diet leads to weight loss. This weight loss has the added benefit of reducing the stress on the muscles and joints that often are the source of patient’s chronic pain.
In addition, sugar has been defined as inflammatory and the ketogenic diet is intended to be totally devoid of sugar. This lack of sugar shuts off insulin surges in the body that raise blood sugar and create inflammation. Less inflammation equals less pain.
All of the studies surveyed agreed that a ketogenic diet boost the natural chemical adenosine which acts as an analgesic within the body.
How is a ketogenic diet achieved?
Well, a ketogenic diet in the most classic sense is often considered distasteful and extremely difficult to follow. The best way to describe some of the staples of that diet is “vile.” Yet it is the surest way to put the body in a state of ketosis and to use the ketone bodies produced for fuel for the brain.
Still, the benefits of a ketogenic diet can be achieved to some degree by eating a low carb, ketogenic based diet. Not everything in a ketogenic diet needs to be unappetizing.
What to eat …
- Natural fats such as avocado and coconut oils, naturally based butter (grass fed), and whole pasteurized eggs.
- Raw nuts: macadamia, Brazil nuts, walnuts, pistachios, and almonds.
- Wild caught fatty fish heavy in omega 3s like mackerel, salmon, sardines, and shellfish.
- Cold pressed extra virgin, organic coconut, avocado, walnut, sesame, and olive oils.
- Berries of any kind.
- Seeds: hemp, chia, and pumpkin.
- Dark leafy greens: collards, spinach, chard, and kale; also cauliflower and broccoli
Maintaining a low carb version of the ketogenic diet still will not be easy. It involves completely changing how people look at healthy eating and ignoring all the modern dietary conveniences. There needs to be a high level of commitment to stick to the diet and forgo the banned items.
What not to eat …
- All processed foods. Get your food as close to the source as possible.
- Artificial sweeteners and sugar…yes, both of them. If you want sweet on a ketogenic diet you need to get it from low glycemic fruits…berries.
- Soy products as these are often heavily processed and carbohydrate laden.
- High glycemic fruits: bananas, mangos, grapes, apples, etc.
- Refined fats and oils. Again, get your food as close to the source as possible.
- Oils like Safflower, corn, soybean as these are heavy in omega 6, a pro-inflammatory oil.
- Grains … the leading source of carbohydrates.
- Alcohol. Many do not realize that this is a sugar often derived from a grain. Both of these are on the banned list and thus, so is alcohol.
Not every single carb needs to be avoided every single time. There is room to treat yourself in small amounts. Ideally, the macronutrient range of a ketogenic diet is 70 percent fats, 25 percent protein, and 5 percent carbohydrate.
Although there has been little direct research into the correlations between pain reduction and ketogenic diets the evidence from clinical research has “identified ketogenic diets as a platform deserving further optimization and exploration.” All evidence points to ketogenic diets as being beneficial in the battle against chronic pain. Better yet, it does not have any of the side effects involved in other less effective treatments such as corticosteroid therapy (both oral and intravenous), opioid based treatments, or NSAIDs.
Those who suffer from chronic pain would be hard pressed to find a reason not to try to live a more ketogenic lifestyle. There is no downside other than the effort required to change how healthy eating is defined in one’s mind.
Yes, it is necessary to give up sugar, alcohol, bread and many other foods that have become staples in the average person’s diet. Yes, you will have to shop more carefully and possibly spend more on organic foods. Yes, it is worth it.
If people who suffer from intense pain that continues for more than six months and is unresponsive to classic treatments can find relief, it is worth it.
If a diet rich in fat and lacking in glucose producing carbohydrates can ease their suffering, it is worth it. If inflammation and other pain causing factors can be eliminated or at least reduced, it is worth it.
Always discuss any drastic change such as this with your doctor to make sure that it is in your best interest and not counterproductive to your treatment. However, sans a doctor’s direction against it, switching to a lifestyle of ketogenic eating may relieve much of the chronic pain of those who suffer from it.