Nutrition’s Effect on Inflammation & Pain: PART II
Author: Kara M. Peters, MS, RD, LDN
Omega-3 & Omega-6 Polyunsaturated Essential Fatty Acids
Various foods, nutrients, and dietary patterns can reduce inflammatory markers along with objective and subjective measures of inflammation. Omega-3 and omega-6 essential fatty acids are two of those nutrients that can impact inflammation in the body. Omega-3 and omega-6 essential fatty acids are called “essential” because they must be obtained through the diet as the body cannot synthesize them. Both serve crucial functions throughout the body and work together to promote health. Omega-3 fats are involved in circulation, cognition, mood, behavioral function, heart health, and reducing inflammation. Omega-6 fats are essential for normal growth and development, reproductive system maintenance, and synthesis of bone, skin, and hair. Omega-6 also helps increase blood flow in acute inflammation for healing, but contributes to prolonging chronic inflammation that promotes continued degeneration and tissue damage. Therefore, maintaining the proper balance of omega-3 to omega-6 is a less inflammatory physiological state. Because they work together, their balance strongly affects function. Humans evolved on the omega-3 to omega-6 ratio of 1:1, but today the ratio is estimated to be between 1:10-1:20 due to agricultural businesses, western diets, and increased consumption of highly processed foods. The lack of omega-3 and excess of omega-6 in the US diet today is thought to be correlated to the increased prevalence of inflammatory and chronic diseases. In addition, the omega ratio can be corrected by reducing omega-6 consumption and increasing omega-3 consumption through whole foods. The Academy of Nutrition and Dietetics recommends adults consume one serving of fatty fish 2-4 times per week. The omega-3 RDA is 3.5 g/day for most healthy adults. This RDA can likely be decreased to one-tenth of this amount by eating fewer omega-6. Seafood sources of omega-3 are recommended over other sources because of its higher conversion rate into EPA and DHA. Those taking an anticoagulant, antihypertensive or have a clotting disorder should consult their doctor before taking an omega-3 or fish oil supplement.
Scientific evidence suggests that diets high in cholesterol increase inflammatory biomarkers. Those with high cholesterol levels who consumed a low cholesterol (<200 mg/day) and saturated fat (5% of dietary fat) diet for eight weeks had reduced inflammation shown by a 40% decrease in C-reactive protein (CRP) levels, which is a protein produced in the liver in response to inflammation.
Vitamin D deficiency is associated with inflammation, susceptibility to illness, and muscle and bone pain/weakness. In a recent study, scientists found that vitamin D supplementation of 400 IU at least once a week for over four years significantly reduced progression of worsening cartilage, meniscus, and bone marrow abnormalities. Worldwide, about 1 billion people are vitamin D deficient. In the United States, approximately 30% are vitamin D deficient and 42% have vitamin D insufficiency. More significant deficiencies are found among chronic pain populations. Additionally, deficiencies are more common among those who live in the northern hemisphere, the elderly, those with more skin pigmentation, and the obese. The RDA of vitamin D for those aged 1-70 years is 600 IU per day and 70 years and older is 800 IU per day. Vitamin D made in the skin from sun exposure lasts twice as long in the blood in comparison to dietary vitamin D. Dietary sources include fatty fish, egg yolk, organ meats, UV ray exposed mushrooms and fortified milk.
Vitamin C is famously known for being an antioxidant. It’s required for tissue repair, proper immune function, stress adaptation, regeneration of other antioxidants, iron absorption, and the production of neurotransmitters and some hormones. As a potent antioxidant, it prevents the damaging effects of free radicals in the body which are pro-inflammatory. Vitamin C is also involved in collagen production which is a main component of connective tissue and it plays a vital role in wound healing. Overall, higher vitamin C levels in the blood have been associated with lower inflammation levels. A randomized control trial among healthy nonsmokers discovered that vitamin C supplementation (1,000 mg/day) for two months decreased inflammation levels by 17% among participants with elevated inflammation levels. Inflammation levels increased by 9% in the group that did not receive the supplement. However, vitamin C did not impact those with inflammation levels lower than the 1.0 mg/L threshold. Many studies have indicated that vitamin C may help protect against gout and heart disease which both have inflammatory components.
Recent evidence has indicated an association between spinal pain, primarily neck, lower back, and arthritis/rheumatism with suboptimal vitamin C status. Vitamin C deficiency and scurvy (a disease resulting from lack of vitamin C), although generally rare in developed countries, occurs among elderly hospitalized patients, critically ill patients, and cancer patients. Surgery, trauma, and severe infections can significantly deplete vitamin C levels. Additionally, aspirin may interfere with vitamin C absorption among individuals with already low vitamin C consumption. The vitamin C deficiency disease, scurvy, can cause musculoskeletal pain, primarily as joint and/or muscle pain in the ankles, knees, and wrists. Vitamin C needs vary daily based on stress levels, injury, and/or illness, but males and females 19 years and older need 90 and 75 mg per day.8 Smokers require an additional 35 mg per day.
Magnesium is an essential mineral known for its roles in energy production and over 300 metabolic reactions. The potential positive effect of adequate magnesium intake on chronic disease may be partially explained by its ability to inhibit inflammation. Another function of magnesium is controlling the speed of nerve firing and muscle relaxation, making low magnesium intake a likely cause of muscle cramps, spasms, and myofascial tightness. Patients with fibromyalgia are often magnesium deficient. Low magnesium intakes have been associated with high inflammation levels, type 2 diabetes, metabolic syndrome, high blood pressure, heart disease, migraines, osteoporosis, colon cancer, and sudden cardiac death. About 75% of Americans consume a magnesium-deficient diet. Contributing factors include: dramatically declining magnesium content in food since 1950, magnesium removal during food processing, and increased use of pesticides and fertilizers which reduces the content of magnesium and other minerals. Males and females 19 years and older need 400-420 mg per day.
Turmeric & Ginger
Curcumin is the active part of the turmeric tuber and its extracts were shown to positively impact knee osteoarthritis, acting similarly to ibuprofen. Alternative and Complementary Therapies reviewed hundreds of studies and stated that curcumin use for numerous chronic debilitating diseases is superior to many pharmaceutical drugs with nearly no side effects. Curcumin is best absorbed with heat, in the presence of a small amount of black pepper and oil. A systematic review found that ginger is an effective anti-inflammatory plant useful in treating pain.
It’s unknown if cinnamon directly affects pain, but it’s being researched for an indirect mechanism that can affect pain by reducing inflammation.
Tart Cherry Juice
A study by the American College of Sports Medicine showed that tart cherry (TC) juice has many antioxidant and anti-inflammatory compounds.1Researchers found that TC reduces pain and accelerates strength recovery after exercise and decreases inflammatory and oxidative stress biomarkers in the blood. Dose and timing vary, but most research has found that 8-12 ounces of non-concentrate TC (1 ounce if in concentrate form) twice a day, 4-5 days before, day of, and 2 days after intense training and/or competition promotes recovery.
With all of this said, it may seem easy to simply consume supplements and call it a day. However, too much of a good thing can most certainly be dangerous. The usefulness of supplements depends on the individual, medical history, and current lifestyle. All vitamins and minerals rely on several other vitamins and minerals to be properly absorbed and utilized within the body. This is one of the many reasons why consuming a variety of whole, unprocessed, naturally colorful foods in a balanced manner each day will provide adequate nutrients the body needs to properly function and fight inflammation. In most cases, overall dietary and lifestyle habits are more important to consider rather than any single change. Of course, there are certain circumstances and individuals where supplementation is appropriate. However, concern exists regarding the sources of omega-3 supplements and fish oils because they can be contaminated with mercury and polychlorinated biphenyls (PCBs), toxins dangerous to humans. Supplements may cause harm if they contain inaccurate dosing information and take caution in that some supplements make unsubstantiated health claims. Please consult a registered dietitian and/or physician before taking nutritional supplements to ensure validity and safety.
About the Author: Kara obtained her bachelor's degree in Exercise and Health Science from UMass Boston in 2016 and Master of Science in Nutrition from UMass Amherst in 2018. She completed her ACEND accredited dietetic internship at the University of Saint Joseph in 2019 and became a certified Registered Dietitian in July 2019. During her educational career, Ms. Peters was a research assistant for the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. She has worked with, educated, and counseled collegiate and youth athletes since 2017 and has recently advised the United States Rowing National and Olympic Teams. She currently works as an Clinical Dietitian at Baystate Medical Center in Springfield, MA. Ms. Peters is continually fascinated by the intricate relationship between nutrition and exercise and is deeply invested in learning more about how these variables dictate both mental and physical performance and health.