Olives and Olive Oil
Rich in monounsaturated fats (MUFA), polyphenols (including lignans) and secoiridoids (including oleocanthal), olive oil has anti-inflammatory, antimicrobial, and antioxidant characteristics that may positively impact health, as reported by several in vitro and animal studies (1). Oleocanthal can reduce pain in a similar way to ibuprofen, i.e., inhibiting the activity of COX-1 and COX2 (2), and could protect against several diseases.
A randomized, double-blind study reports an improvement in pain [mean Japanese Orthopedic Association score and visual analog scale (VAS) score for mean pain for sleeping in bed at night] in 25 patients with gonarthrosis following treatment with hydroxytyrosol, an olive leaf extract (3). Although further clinical studies are needed, the use of olive oil in the treatment of chronic pain has interesting therapeutic potential.
Nuts and Their Oils
Among other things, nuts have attracted attention for their high content of a-linolenic acid (ALA), omega-3, polyunsaturated fatty acids (PUFAs), magnesium, arginine, and antioxidants (1). These components allow them to play an important role in the inflammatory process, which impacts chronic pain (see our previous article). Compared to a conventional Mediterranean diet, pistachio supplementation in healthy young adults resulted in a decrease in IL-6 and some oxidation markers, although no difference was noted for other inflammatory markers (4). Supplementation (30g/day) of flaxseed for two weeks decreased C-reactive protein (CRP), serum amyloid A protein, and fibronectin in a group of morbidly obese individuals (5). In mice, an extract of grape seed polyphenols reduces peripheral and central sensitization (6) and improves osteoarthritis-related pain (7).
Pumpkin-seed-oil supplementation also improved certain parameters that had been altered by the presence of arthritis in rats (8). Thus, nuts have interesting potential in managing chronic pain. However, several studies investigated the inflammatory state rather than the pain per se, and in a different population than that which may suffer from chronic pain. Also, several studies have been performed in mice, limiting the interpretation in humans.
Legumes and Soy
According to 135 patients with osteoarthritis who answered the McGill Pain Questionnaire, a 40g soy protein supplement resulted in decreased pain, decreased use of painkillers, and decreased serum concentration of human cartilage glycoprotein 39 (YKL-40), a marker of cartilage degradation, compared to a milk protein supplement (9). Improvement in several quality of life factors and increased knee range of motion were also reported (9). These associations are primarily present in men, as no significant differences with milk protein supplementation for several of these parameters were noted in women (9). In a randomized controlled trial, replacing two servings of meat with two servings of legumes three days a week for eight weeks resulted in a reduction in inflammatory markers (CRP, TNF-ɑ, and IL-6) in overweight individuals (10). Although additional studies are needed, incorporating legumes and soybeans into the diets of people with chronic pain seems a promising avenue.
Fruits and Vegetables
Fruits and vegetables are of particular interest, considering their antioxidant, fibre, and micronutrient content. Several studies have shown a decrease in several inflammatory markers (including CRP) with increased fruit and vegetable consumption (1). In an elderly population suffering from chronic pain, a Mediterranean-like diet is associated with decreased pain; fruit and vegetable consumption was a factor most associated with this improvement (11). Other studies in humans and mice also showed pain reduction with fruit supplementation (see previous article). Although more specific studies in chronic pain populations are needed, enough studies are available to demonstrate the importance of fruit and vegetable consumption in reducing inflammation, which may play an important role in pain management.
Fresh Cheese and Yogurt
The impact of dairy products on inflammation is controversial; although several studies report a decrease in inflammatory markers with increased consumption of dairy products, the high saturated fat content in these products suggests they may increase inflammation (12). A systematic review of 78 studies showed a lowered inflammatory score associated with the consumption of dairy products, both in a healthy population and a population suffering from chronic diseases (12). This association was observed with both low- and high-fat dairy products (12). Although the authors conceded that the association was weak and that the volume of evidence was low, dairy products still seemed to lower inflammation rather than increase it (12). Fermented dairy products, including yogurt, also appeared to reduce inflammation (12).
Through its pre- and pro-biotic benefits, yogurt may decrease chronic inflammation by improving innate and adaptive immune response and intestinal barrier function (13). Again, although additional studies with chronic pain sufferers are needed, the positive impact of dairy products on inflammation is an interesting finding.
Consumption of red wine (one ‘standard’ glass per day for women and two standard glasses for men) is known to prevent inflammatory disease (14), particularly due to its high concentration of flavonoids (see previous article for the impact of flavonoids on chronic pain) and resveratrol. This stilbene activates sirtuin 1 (SIRT1), a protein known for its impact on oxidative stress, the inflammatory process, and apoptosis (14). This protein could therefore play a role in preventing several inflammatory and chronic diseases (15). Despite its potentially interesting role in treating pain, these mainly mechanistic studies in vitro or in animal models limit the interpretation of results in humans.
It is important to mention that alcohol consumption is contraindicated for patients undergoing opioid and benzodiazepine treatment and that consumption of more than one or two standard drinks is contraindicated due to the risk of abuse or dependence (1).
Despite the limitations of the current literature, studies do show the great potential of nutrition in treating chronic pain. Do you have clients who might benefit from a follow-up for management of chronic pain? If so, please contact us to learn more about our services!
Rondanelli, M., Faliva, M.A., Miccono, A., et al. (2018). Food pyramid for subjects with chronic pain: foods and dietary constituents as anti-inflammatory and antioxidant agents. Nutr Res Rev; 31(1): 131–151.
Beauchamp, G.K., Keast, R.S.J., Morel, D., et al. (2005). Ibuprofen-like activity in extra-virgin olive oil. Nature; 437(7055): 45–46.
Takeda, R., Koike, T., Taniguchi, I et Tanaka, K. (2013). Double-blind placebo-controlled trial of hydroxytyrosol of Olea europaea on pain in gonarthrosis. Phytomedicine; 20(10): 861–864.
Sari, I., Baltaci, Y., Bagci C, et al. (2010). Effect of pistachio diet on lipid parameters, endothelial function, inflammation, and oxidative status: a prospective study. Nutrition; 26(4): 399–404.
Faintuch, J., Horie, L.M., Barbeiro, H.V., Barbeiro, D.F., Soriano, G., Ishida, R.K. and Cecconello, I. (2007). Systemic inflammation in morbidly obese subjects: response to oral supplementation with α-linolenic acid. Obes Surg; 17(3): 341–347.
Cady, R.J., Hirst, J.J. and Durham, P.L. (2010). Dietary grape seed polyphenols repress neuron and glia activation in trigeminal ganglion and trigeminal nucleus caudalis. Mol Pain: 6, 91.
Woo, Y.J., Joo, Y.B., Jung, Y.O. et al. (2011). Grape seed proanthocyanidin extract ameliorates monosodium iodoacetate-induced osteoarthritis. Exp Mol Med.; 43(10): 561–570.
Fahim, A.T., Abd-el Fattah, A.A., Agha, A.M. and Gad, M.Z. (1995). Effect of pumpkin-seed oil on the level of free radical scavengers induced during adjuvant-arthritis in rats. Pharmacol Res.; 31(1): 73–79.
Arjmandi, B.H., Khalil, D.A., Lucas, E.A., et al. (2004). Soya protein may alleviate osteoarthritis symptoms. Phytomedicine; 11(7–8): 567–575.
Hosseinpour-Niazi, S., Mirmiran, P., Fallah-Ghohroudi, A. and Azizi, Fl. (2015). Non-soya legume-based therapeutic lifestyle change diet reduces inflammatory status in diabetic patients: a randomised cross-over clinical trial. Br J Nutr; 114(2): 213–219.
Ortolà, R., Garcia-Esquinas, E., Sotos-Prieto, M. et al. (2022). Mediterranean Diet and Changes in Frequency, Severity, and Localization of Pain in Older Adults: The Seniors-ENRICA Cohorts. J Gerontol A Biol Sci Med Sci; 77(1): 122–130.
Bordoni, A., Danesi, F., Dardevet, D., Dupont, D. et al. (2017). Dairy products and inflammation: A review of the clinical evidence. Crit Rev Food Sci Nutr; 57(12): 2497–2525.
Pei, R., Martin, D.A., DiMarco, D.M .and Boilling, B.W. (2017). Evidence for the effects of yogurt on gut health and obesity. Crit Rev Food Sci Nutr; 57(8): 1569–1583.
Giacosa, A., Barale, R., Bavaresco, L., Faliva, M.A. et al. (2016). Mediterranean Way of Drinking and Longevity. Crit Rev Food Sci Nutr; 56(4): 635–640.
Giacosa, A., Adam-Blondon, A.F., Baer-Sinnott, S., Barale, R. et al. (2012). Alcohol and wine in relation to cancer and other diseases. Eur J Cancer Prev; 21(1): 103–108.