PainRelief.com Interview with:
B.App.Sc (phty) M.Physio. APAM
PhD research candidate Sydney University
STEPP (solutions tools and education for persistent pain)
PainRelief.com: What is the background for this study?
Response: Chronic pain is a difficult problem to treat because it is multifactorial, driven by the brain continuing to arrive at the conclusion that protection is required. Turning up the sensitivity in the nervous system results in ongoing pain as a protector even though there is no new tissue damage. Other protection mechanisms such as increased inflammation, and increased sympathetic ‘fight or flight’ also occur.
Chronic pain becomes part of a whole system protective response, so looking at other treatment options that alter the system (such as diet) are useful additions to pain management. A ketogenic diet restricts carbohydrate to below 50g/day producing ketones for energy from fat. It has been used to treat epilepsy over the last two centuries and successfully reduces nervous system excitability. Many of the drugs used for chronic pain (such as Lyrica) are also anti-epileptic medications, suggesting common pathways. As well as these impacts on the nervous system, pre-clinical research has also shown ketones to be signalling molecules that reduce inflammation.
Combined with the clinical reports that pain reduction occurred when people were on ketogenic diets, it seemed reasonable to test the diet specifically in a chronic pain population.
PainRelief.com: What are the main findings?
Response: We compared a whole-food ketogenic diet to a whole-food non-ketogenic diet (both groups removed ultra-processed foods from their diet). Both groups had significant pain reductions and improvements in quality of life.
The ketogenic group had additional benefits with weight loss, reduced depression and anxiety and reduced inflammation.
PainRelief.com: What should readers take away from your report?
Response: Removing ultra-processed foods and returning to cooking from whole foods is the starting point for any dietary approach to reduce chronic pain. We know that doing this will get some improvement. However, reducing the carbohydrate intake is another strategy that is likely to get further benefits.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: This was a small pilot study (24 people) so a larger trial is needed. We also included all types of musculoskeletal chronic pain, so narrowing the focus to particular pain presentations may also identify populations where the diet gets the best results.
Rowena Field, Fereshteh Pourkazemi, Kieron Rooney,
Effects of a low-carbohydrate ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain: A pilot randomised clinical trial rationale, study design and protocol,
European Journal of Integrative Medicine,
Volume 45, 2021, 101346,
Rowena Field, M. Physio, Fereshteh Pourkazemi, PhD, Kieron Rooney, PhD, Effects of a low-carbohydrate ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain: A pilot randomised clinical trial, Pain Medicine, 2021;, pnab278, https://doi.org/10.1093/pm/pnab278
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