Finally, a Diet That Doesn’t Hurt
Can surgery patients eat their way to less postoperative pain?
A recent study by French researchers suggests that a diet low in polyamines can reduce pain after spinal surgery, with few side effects.
“There have been some data to show that a polyamine-deficient diet decreased pain in rats,” said Jean-Pierre C. Estebe, MD, PhD, professor of anesthesiology at University Hospital of Rennes in Rennes, France, who led the latest work. “This effect is likely due to polyamine’s modulation of the N-methyl-D-aspartate (NMDA) receptors. But no data are available on the potential efficacy of a polyamine-deficient diet on perioperative pain, so we decided to undertake a prospective, randomized trial with chronic pain patients with high levels of pain.”
Dr. Estebe and his colleagues enrolled 64 spine surgery patients into the study. Patients were randomized to one of two diets. Those on the polyamine-deficient diet ate a low-polyamine breakfast supplemented with six 250-mL low-polyamine drinks per day.
“Just to drink that, they received around 10,000 kcal per day,” Dr. Estebe said. Controls had a partial polyamine-deficient diet comprising two of the drinks each day plus regular food. “The study group received less than 10 micromoles per day of polyamine, while controls received an average of more than 400 micromoles per day,” Dr. Estebe explained.
The diets were initiated seven days before spine surgery and continued until five days after the procedure. The primary end point was pain at rest and with motion. Researchers also monitored compliance, side effects and quality-of-life scores. Patients in both groups were demographically similar, and had comparable levels of preoperative pain.
As Dr. Estebe reported at the 2013 annual meeting of the American Society of Anesthesiologists (abstract 2067), patients in the study group demonstrated a trend of decreasing pain at rest in the seven days before surgery (P=0.144), which became significant thereafter (P=0.022). The French team found a trend toward decreased postoperative pain with motion in these patients, but it did not reach statistical significance (P=0.128).
The effect of the low-polyamine diet became significant when the investigators analyzed the subset of patients experiencing more severe pain at rest and with motion (P=0.0135 and 0.0093, respectively). No reduction in pain was observed in controls.
Quality-of-life scores were significantly improved in the low-polyamine diet patients immediately before surgery (P=0.046), and continued as a trend five days after surgery (P=0.0629). Hospital length of stay was similar for both groups of patients.
“In terms of compliance, it’s very interesting to note that 100% of the study group completed the diet for the seven days before surgery, compared with 83% thereafter,” Dr. Estebe said. “By comparison, 83% and 71% of controls consumed both drinks each day before and after surgery, respectively. The only side effect was minor gastrointestinal intolerance. So a low-polyamine diet could be useful for surgery because pain is decreased, compliance is high and adverse effects show no difference between the two groups.”
Eugene R. Viscusi, MD, professor of anesthesiology and director of acute pain management at Thomas Jefferson University, in Philadelphia, called the study “fascinating.”
“Some diets can promote inflammation, which might have a role in pain. Here, the authors identified another familiar pathway involving the NMDA receptor, which is well known to have a role in chronic pain, particularly in the presence of chronic opioid use. There is a resurgence of interest in ketamine—a potent NMDA receptor antagonist—in patients with opioid tolerance, and this drug is now commonly used in this setting. So it is entirely possible that modulation of diet in a way that modulates the NMDA receptor might have an effect on pain.”
Yet Dr. Viscusi raised several questions about the study. “The experimental group not only had polyamine restriction but also received what appears to be a markedly different caloric load during the study,” he said. “One has to question whether this alone, or perhaps the type of calories, made the difference.
“One thing is for sure: We generally do not pay close enough attention to the diets of our perioperative patients,” Dr. Viscusi added. “Perhaps careful preoperative and postoperative feeding may have a far greater impact than we ever imagined.”
Anti-Inflammatory Diet Tips for Rheumatoid Arthritis:
Do restaurant meals and snack attacks leave you with rheumatoid arthritis aches and pains? Certain foods – some of your favorites, like steak and cookies – may be causing flareups. Find out what you should stay away from and how to pick tasty substitutes for a healthy rheumatoid arthritis diet…
When you have rheumatoid arthritis (RA), a restaurant menu or open refrigerator can seem like a test: Can you find foods that satisfy your cravings without making joints swell, ache and stiffen?
Definitely. It’s easier than you think. Read on…
You can still eat meat – as long as you choose leaner cuts. Crave salty snacks? Eat nuts instead of chips.
The key is following an anti-inflammatory diet, which helps you avoid RA flares. And these smarter food choices aren’t necessarily boring ones.
Antioxidant-rich fruits and vegetables, high-fiber grains and healthy fats all constitute a rheumatoid arthritis diet that can help you reduce RA aches – in a matter of days.“I start my RA patients on a general anti-inflammatory diet, and they feel better within a week,” says internist Leo Galland, M.D., whose book The Fat Resistance Diet (Three Rivers Press) is based on anti-inflammatory foods.
“Their pain and stiffness is greatly reduced.”
We asked RA experts how to avoid flareups without sacrificing your favorite treats. Here’s what they said:
1. Red meat, pork, poultry, eggs, butter
Why they’re RA triggers: These animal products contain harmful saturated fat, which increases inflammation in the body.
“After a single meal high in saturated fat, blood cells produce more inflammatory signals for several hours,” Dr. Galland says.
“Continue eating like that, and blood cells stay in this inflammatory state,” he adds.
For RA sufferers, that means joint and muscle pain, heartburn, fatigue and even acne.
Anti-inflammatory diet alternative: Love omelets? Whip one up with egg whites (the saturated fat is in the yolk).Proud of your milk mustache? Switch to skim. Can’t give up meat? Choose leaner cuts like sirloin steak, chicken breasts and pork loin chops.
If it’s protein you crave, get it from salmon or mackerel, which are rich in healthful omega-3 fatty acids (you’ll learn more about their health-boosting benefits in the next section).
But “get more fats from plant sources than animal,” says David Rakel, M.D, director of Integrative Medicine at the University of Wisconsin School of Medicine.
“Fat isn’t bad, but we need more polyunsaturated and monounsaturated fats, such as those found in olive oil, nuts and avocados.”
2. Store-bought chips, margarine
Why they’re RA triggers: These snacks and spreads contain trans-fatty acids (TFAs), oils that are chemically processed to make them more solid and stable.
A diet high in TFAs increases C-reactive protein, a marker doctors use to indicate the amount of inflammation in the blood, according to a 2004 Harvard Medical School study published in the American Journal of Clinical Nutrition.
The study showed that TFA-rich foods had a profound effect on inflammatory markers, making them twice as dangerous as saturated fats.“Adding TFAs to the American diet was one of the worst things we could have done. The body requires a lot more energy to break down trans fats, which creates inflammation,” Dr. Rakel says.
TFAs show up in many packaged and processed foods, but they’re easily detected: Just look at the nutrition label.
Since 2008, the Food and Drug Administration (FDA) has required that all U.S. food manufacturers list trans fats.
But watch out: Even if a label proclaims zero trans fats, it’s not necessarily free of them.
Federal regulations allow products containing up to half a gram of trans fat per serving to be labeled as “trans-fat free.”
That means consumers can easily exceed the maximum daily recommended amount of trans fats (1.11 grams) with just three pieces of toast spread with “trans-fat-free” margarine.A safer bet: Stay away from products that include partially hydrogenated oils on the ingredient list; that’s code for trans-fat content.
Anti-inflammatory diet alternative: Nuts and seeds contain omega-3 fatty acids, a healthier fat that reduces levels of C-reactive protein, according to a 2009 study published in the European Journal of Clinical Nutrition.
“When you crave a crunchy snack, dump the chips and scoop up a handful of walnuts, a great source of omega-3,” says Joan Levinthal, a registered dietitian in Woodland Hills, Calif.
Replace margarine with trans-fat-free spreads, such as Smart Balance Omega-3 Buttery Spread, which contains omega-3-rich flaxseed and fish oil.
3. Cakes, cookies, white bread, potatoes and white rice
Why they’re RA triggers: These comfort foods rank high on the glycemic index (GI).
They quickly break down into sugar, making insulin levels rise, which can cause inflammation.In fact, each 10-point increase in a diet’s glycemic status is associated with a 29% rise in C-reactive protein, according to a 2008 Netherlands study published in the Journal of Clinical Nutrition.
“Sugar increases the inflammatory [process],” says nurse practitioner Marcelle Pick, R.N.C., OB-GYN N.P., author of The Core Balance Diet (Hay House) and co-founder of Women to Women, a holistic medical clinic in Maine.
“If you must have something sugary, eat it with some protein to slow its breakdown into glucose.”
Anti-inflammatory diet alternative: By replacing white bread, potatoes and rice with moderate servings of whole-grain bread, sweet potatoes and brown rice, you’re eating on the lower end of the GI index.
Plus, you’re adding more fiber to your diet, which fights inflammation, according to the Arthritis Foundation.
Bing cherries have been found to reduce inflammatory markers, according to a 2006 study in The Journal of Nutrition.Apples and pears are also low on the glycemic scale. Baked and flavored with cinnamon, they’ll taste like a decadent dessert.
“Cinnamon has been shown to help regulate blood sugar; plus, it has a sweet taste all its own,” says registered dietitian Angela Ginn, a spokesperson for the American Dietetic Association.
4. Milk and wheat products
Why they’re RA triggers: Some foods trigger food-intolerance reactions, such as bloating, irritable bowel syndrome (IBS) and headaches.
If you have food sensitivities, your immune system creates antibodies every time you eat them, causing an inflammation cycle, according to Pick.
To prevent this, eliminate foods that disturb your gastrointestinal tract.
Anti-inflammatory diet alternative: Because intolerances differ by person, find out your food allergies first, then pick healthier substitutes.
In month one, Pick’s patients follow a strict month-long elimination diet that excludes common food triggers: sugar, dairy, wheat, eggs, citrus, caffeine, soy. They also keep track of physical reactions in a food diary.In month two, they slowly reintroduce missing foods, one at a time. Any foods that produce a negative reaction are permanently removed from the plate.
“After changing diets, some patients are able to go back to their doctors and ask to be taken off their RA medications,” Pick says.
By Barbara Stanifer, Lifescript
What would you do if rheumatoid arthritis ended a thriving life as a star cake artist? Catherine Ruehle, a former contestant on “Food Network Challenge,” faced that situation. In this exclusive interview, she shares how her anti-inflammatory RA diet and lifestyle led to a new career…
Catherine Ruehle, 45, was known for creating one-of-a-kind cake masterpieces at her Sublime Bakery in Fort Worth, Texas.
So when the seasoned baker appeared on the reality show “Food Network Challenge” in 2010, her competitors were ready for a formidable opponent.
But Ruehle surprised everyone – including herself – when she had to withdraw from the show. The reason? Her hands stopped working as she was making a cake.
At first, she chalked up her symptoms to long hours in the bakery. But when her hand pain worsened, she saw a doctor. The diagnosis: rheumatoid arthritis (RA), a chronic autoimmune disease that causes joints to become inflamed and painful.
“I was shocked,” Ruehle tells Lifescript. “I was 41 at the time, and always believed RA was an elderly person’s disease.”
In fact, RA most commonly begins between ages 30 and 60 but can occur even earlier, according to the Arthritis Foundation. Its symptoms can build slowly or strike suddenly, as it did with Ruehle.
Still, she couldn’t just stop baking, so she “plodded along in denial,” she says.
“When I first started experiencing pain in my hands, it was Christmas – the busiest season at my bakery – and I couldn’t take time off,” Reuhle says. “It became hard to do everyday tasks, such as [screwing] the top off a water bottle or bending my elbows to brush my hair.”
Finally, she had to close her bakery in 2011. But Reuhle’s food career wasn’t over. She now has a business helping other people improve their health with diet and lifestyle changes.In this exclusive Lifescript interview, Ruehle reveals how she has learned to manage her condition through an anti-RA diet.
What symptoms led to your RA diagnosis?
I had pain and stiffness throughout my entire body – it started in my hands and spread to my elbows, ankles, legs and toes. The pain was so bad that I initially worried I might have bone cancer.
Is that what led you to see a doctor?
I procrastinated when it came to making a doctor’s appointment. It was the holiday season and I was swamped. I convinced myself that my body was just tired from spending long hours in the bakery.
What convinced you to see a doctor?
The [symptoms got worse, so] I went to see my doctor. I asked if there was a way to alleviate my pain so that I could enjoy Christmas with my family, and then return for testing.
He gave me a shot of prednisone [an anti-inflammatory steroid], which immediately eased my stiffness.
After the holidays, I went in for tests, which included blood work and a rheumatoid factor blood test. The tests indicated that I had RA.
[Editor’s note: No single test can confirm RA, so Ruehle’s doctor asked about her joint symptoms, how and when they started, how severe they were, and what, if anything, made them better or worse. She was also given a blood test that measured her inflammation levels and the rheumatoid factor blood test, which measures the antibody most common in RA. Although high levels of rheumatoid factor are associated with more severe rheumatoid disease, it can also be present in patients with other conditions such as lupus or hepatitus and in people who have family members with RA.]
What was your reaction to the RA diagnosis?
While I was glad I didn’t have bone cancer, I was shocked to learn I had RA. I lead an active lifestyle, and have always eaten healthfully – I felt as if my body was betraying me.
I also didn’t [know] how severely it would affect my life. I wondered if I would eventually have disfigured, arthritic hands.
I immediately began to read everything I could find out about RA so that I could weigh my treatment options.
What did you learn about the condition?
I was intrigued by evidence that RA is caused by an overactive immune system. I realized my immune system was angry and attacking my body.
I wanted to see if I could treat the cause with anti-RA diet and lifestyle changes. I discovered a functional medicine expert, Dr. Mark Hyman, and adopted his mantra as my own: “Treat the fire, not the smoke.”
How did your rheumatologist feel about this idea?
[He] told me diet had nothing to do with RA inflammation. But my gut told me that [what I ate] would have everything to do with my long-term health.
What dietary changes have you made?
I [now] describe my diet as a whole foods, mostly organic plan that’s also free of corn, gluten and dairy.
I discovered evidence that foods, such as vegetables and omega-3 [oils in] fish, can ease an overactive immune system. And I decided to load up on nutrient-dense plant foods and drink green juice daily.But I avoid nightshade vegetables (such as tomatoes, peppers and eggplants), because I found they set off my arthritis symptoms.
[Editor’s note: Some arthritis patients say these vegetables increase symptom flares; there’s little scientific proof that they cause inflammation].
While I enjoyed a couple glasses of wine for my recent birthday, I can’t drink it every night because it also exacerbates my condition.
With your anti-RA diet, was it hard to give up certain foods?
I’m a foodie, so it wasn’t easy. Rather than concentrate on foods I couldn’t have, I tried to focus on what I could eat.
What are some of your favorite healthy foods?
[In place of] cow’s milk, I now use coconut milk for cooking and in smoothies. It contains selenium, an important antioxidant that controls free radicals and has been shown to relieve the symptoms of arthritis.
[Editor’s note: Selenium-rich foods, which also include whole grains and shellfish, may be useful in preventing arthritis symptoms, according to the Arthritis Foundation.]
I also eat a lot of green, leafy vegetables. I had never eaten kale before [my diagnosis]; now I have it every day. I also eat hemp seeds, nuts such as walnuts and almonds, and cold-water fish including salmon and sardines – all inflammation-fighting foods.
What other lifestyle changes have you made?
I’ve started working to eliminate stress in my life, which has shown to be a cause of RA flare-ups.How do you combat stress?
I’ve become addicted to yoga and subscribe to an online service that streams yoga videos. I’ve found that practicing it daily not only strengthens the core and improves flexibility, it also helps me sleep better, feel more centered and clear-headed, and gives me more energy.
I went through a divorce this past year and lost my father, and I know doing yoga helped me cope better with the loss and stress.
Are you still working as a chef?
I closed my bakery shortly after my diagnosis, because [the business] involved long, unpredictable hours. I needed a schedule that was more manageable and less stressful.
How did your RA diagnosis lead to a career change?
In my quest to learn more about the effects of diet on health, I enrolled in a yearlong online study program through the Institute for Integrative Nutrition, where classes are taught by health experts, including Dr. Andrew Weil and Dr. Deepak Chopra.
I have a business, A Well-Nourished Life, where I create individualized wellness programs, including meal plans. My goal is to help [people with chronic illnesses] improve their symptoms and regain their health. I do custom meal planning and preparation for some clients.
And I just finished writing Gluten Free Cakes, a cookbook that will be published by Ten Speed Press [in September 2014].
Have you found any gadgets that make cooking easier?
One of my favorite tricks is using those nonstick squares that you place under rugs to open bottles. They make it so much easier! Oxo also makes a vegetable peeler with oversized rubber handles.
I also use a gel floor mat in the kitchen that can make it easier on your knees if you’re standing and cooking for long periods of time.
How’s your health today?
I’m doing great and continue to be primarily pain- and symptom-free – as long as I stick to my diet and exercise regimen.Here are three of Ruehle’s anti-RA recipes.
All recipes reprinted with permission from Catherine Ruehle’s A Well-Nourished Life.
Oven Roasted Beets & Brussels Over Kale with Raw Honey-Ginger Dressing
2 medium beets, washed, peeled and cubed
3 cups whole Brussels sprouts, washed & halved
1 tablespoon extra virgin olive oil
1 head kale, washed and coarsely chopped
Pinch pink Himalayan sea salt (optional)
2 tablespoons pine nuts (optional)
1 tablespoon fresh ginger root, grated
1 tablespoon raw honey
1 lemon, juice only
1-2 teaspoons organic oil, such as toasted sesame or extra virgin olive oil
Salt & pepper to taste
1. Preheat oven to 400 degrees.
2. Toss the beets and Brussels sprouts with the olive oil in a bowl to coat well. Spread out on a foil-lined baking sheet in a single layer.
3. Roast in the oven until tender and darkened at the edges, about 25 minutes, rotating the pan halfway through the cooking time.
4. While the veggies are roasting, combine the dressing ingredients in a small bowl and whisk together.
5. Toss the chopped kale with half the dressing and set aside while veggies roast.
6. Remove veggies from oven. Spread the kale on the serving plates. Place the hot veggies in the same bowl the kale was in and add the remaining dressing; toss to coat.
7. Layer the beets and Brussels sprouts over the kale on the serving plates. Top with the sea salt and pine nuts. Season with salt and pepper to taste.Zucchini & Herb Fritters with Mint-Yogurt Sauce
3 large zucchini, grated
1 teaspoon salt
1 shallot, diced
1 garlic clove, diced
1 tablespoon chopped fresh mint
1/2 cup crumbled feta cheese (optional)
1/4 cup gluten-free flour mix (I like Angel’s), or all-purpose flour if not gluten-free
Salt & pepper to taste
Olive oil for sautéing
For the Yogurt-Mint Sauce:
1 cup Greek yogurt (or nondairy yogurt like Amonde or So Delicious)
2 tablespoons chopped fresh mint
1 tablespoon chopped fresh dill
Juice of 1 lemon
Salt and pepper to taste
1. Place the grated zucchini in a colander and sprinkle with the salt. Allow to sit for about 15 minutes while you chop your shallot and garlic.
2. Squeeze the excess moisture out of the zucchini then place in a large bowl.
3. Add shallot, garlic, eggs, mint, feta and flour to the zucchini. Combine and season with salt and pepper.
4. Add enough olive oil to your saute pan to coat the bottom of the pan and heat over medium. While pan heats, use your hands, two spoons, or an ice cream scoop, to form balls of zucchini mixture.
5. Place 3-4 balls into your hot pan, and press down to flatten to about 1 inch tall. Make sure you keep at least 2 inches between each fritter so they will brown nicely and not “steam” each other.
6. Cook on each side for about 2-3 minutes until golden. Remove to a paper towel to drain.
7. Combine all ingredients for the Yogurt-Mint Sauce.
8. Serve fritters warm or room temperature with sauce on top or on the side.
Note: Fritters will keep in the refrigerator for 3 days or in the freezer for 1 month. Sauce keeps in refrigerator for 3 days. Vegan Chocolate Pudding
2 ripe avocados, peeled and pit removed
1 cup canned coconut milk, chilled overnight and liquid drained off
3/4 cup organic maple syrup
3/4 cup raw organic cacao powder
1 teaspoon pure vanilla extract
1 teaspoon ground cinnamon
Pinch fine sea salt
1. Add all ingredients to a blender or food processor and blend until smooth.
Note: you want to use only the thick coconut “cream,” reserve the liquidy coconut water for another use such as smoothie. Don’t skip the chilling step or you may not be able to separate the cream from the water, resulting in a thin pudding.