What diet should you follow for chronic pain: Episode 2

In the first episode, we saw that our diet can have an impact on pain. In this sense, a diet low in glutamate and aspartate may be beneficial for chronic pain conditions such as fibromyalgia, migraine, and irritable bowel syndrome.

In addition, several nutrients that are essential for the functioning of our body play a key role in optimizing the functioning of our nervous system. Certain nutrients have the ability to modulate glutamatergic neurotransmission and are therefore closely linked to pain syndromes.

Zinc and magnesium: two essential minerals

Magnesium

This is the fourth most abundant mineral in the body. Our bodies contain 20 to 30 g of magnesium, 60% of which is found in the bones, 28% in the muscles and the rest mainly in the nervous system. Magnesium is involved in more than 400 biochemical reactions and is necessary for energy production. It also plays a key role in muscle contraction, heart rate regulation, and nerve impulse transmission.

In chronic pain, magnesium plays a key role in regulating the glutamate receptor NMDA by blocking it and thus preventing the transmission of pain signals. [1, 2]

Foods rich in magnesium:

-Cocoa powder

-Oilseeds (walnuts, hazelnuts, almonds)

-Dark chocolate (min. 85% cocoa)

-Swiss chard

-Whole grains (whole wheat bread, buckwheat, brown rice)

-Dried fruit

-Dried vegetables (lentils, split peas, dried beans)

-Bananas

Zinc

Zinc is a trace element, meaning that it is present in very small quantities, around 2 to 4 g in total, in the human body. It is mainly found in muscles (60 to 65%), bones (20%), the liver, and the skin.

It is a structural component of many proteins and is involved in multiple cellular functions. Zinc is a powerful antioxidant and immune modulator that plays a role in reproductive and neurological functions. In chronic pain, zinc, released at the same time as glutamate, downregulates pain signal transmission. [3, 4, 5]

Foods rich in zinc

Zinc must be supplied to the body daily because it cannot be stored.

The main sources of zinc are:

-Oysters

-Shellfish

-Cheese

-Meat

-Offal and liver

-Eggs

-Dried vegetables

It is therefore easy to understand that if our body is deficient in magnesium and zinc, this promotes excitotoxicity (CTA episode 2) and could therefore contribute to an amplification of pain signals. Another nutrient that plays an important role in glutamate neurotransmission is vitamin B6.

Vitamin B6: the soothing nutrient

Vitamin B6, or pyridoxine, is a water-soluble vitamin that provides energy to the body, helps build new proteins, supports our immune system, and produces chemical messengers in the brain. In the context of chronic pain, this vitamin acts as an important cofactor for an enzyme that converts glutamate (the exciter) into GABA (the inhibitor, the soothing agent).

Foods rich in B6

Like zinc, vitamin B6 must be supplied to the body daily because it cannot synthesize or store it.

The main sources of vitamin B6 are:

-Sunflower seeds

-Tuna

-Dried lentils

-Offal

-Meat

-Dried red beans

-Bananas (1 banana = 25% of daily requirements)

A vitamin B6 deficiency can lead to higher levels of glutamate and reduced levels of GABA, which promotes excitotoxicity in the central nervous system and therefore pain signals.

Finally, other elements such as vitamins, polyunsaturated fatty acids, and antioxidants are also being studied and have shown positive results on chronic pain, such as vitamin D, vitamin B12, and omega-3. [6, 7, 8, 9 ]

Daily consumption of specific nutrients such as zinc, magnesium, and vitamin B6 offers further avenues for the treatment of chronic pain. However, such a dietary protocol is implemented in a very specific context of chronic pain, in addition to other treatments such as movement and exercise.



SOURCES

[1] Savic Vujovic, K. R., et al. “A Synergistic Interaction between Magnesium Sulphate and Ketamine on the Inhibition of Acute Nociception in Rats.” European Review for Medical and Pharmacological Sciences, vol. 19, no. 13, July 2015, pp. 2503–09.

https://www.researchgate.net/profile/Katarina-Vujovic/publication/280498143_A_synergistic_interaction_between_magnesium_sulphate_and_ketamine_on_the_inhibition_of_acute_nociception_in_rats/links/5c0e31bc92851c39ebe1ee1c/A-synergistic-interaction-between-magnesium-sulphate-and-ketamine-on-the-inhibition-of-acute-nociception-in-rats.pdf

[2] Kreutzwiser, Denise, and Qutaiba A. Tawfic. “Expanding Role of NMDA Receptor Antagonists in the Management of Pain.” CNS Drugs, vol. 33, no. 4, Apr. 2019, pp. 347–74, https://doi.org/10.1007/s40263-019-00618-2.

[3] Anderson, Charles T., et al. “Modulation of Extrasynaptic NMDA Receptors by Synaptic and Tonic Zinc.” Proceedings of the National Academy of Sciences, vol. 112, no. 20, May 2015, pp. E2705–14, https://doi.org/10.1073/pnas.1503348112.

[4]Takeda, Atsushi, et al. “Release of Glutamate and GABA in the Hippocampus under Zinc Deficiency.” Journal of Neuroscience Research, vol. 72, no. 4, 2003, pp. 537–42, https://doi.org/10.1002/jnr.10600.

[5] Tamano, Haruna, and Atsushi Takeda. “Dynamic Action of Neurometals at the Synapse†.” Metallomics, vol. 3, no. 7, July 2011, pp. 656–61, https://doi.org/10.1039/c1mt00008j.

[6] Schreuder, Ferdinand, et al. “Vitamin D Supplementation for Nonspecific Musculoskeletal Pain in Non-Western Immigrants: A Randomized Controlled Trial.” Annals of Family Medicine, vol. 10, no. 6, Nov. 2012, pp. 547–55, https://doi.org/10.1370/afm.1402.

[7] Mendonça, Carolina Rodrigues, et al. “Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review.” Nutrients, vol. 12, no. 10, Oct. 2020, p. 3075, https://doi.org/10.3390/nu12103075.

[8] Zhang, Ming, et al. “Methylcobalamin: A Potential Vitamin of Pain Killer.” Neural Plasticity, vol. 2013, 2013, p. 424651, https://doi.org/10.1155/2013/424651.

[9] Elma, Ömer, et al. “Chronic Musculoskeletal Pain and Nutrition: Where Are We and Where Are We Heading?” PM&R, vol. 12, no. 12, 2020, pp. 1268–78, https://doi.org/10.1002/pmrj.12346.

Fifi, Amanda C., and Kathleen F. Holton. “Food in Chronic Pain: Friend or Foe?” Nutrients, vol. 12, no. 8, Aug. 2020, p. 2473, https://doi.org/10.3390/nu12082473.