about a health problem you've been trying to reverse?

Maybe high blood pressure, diabetes, or heart disease.

Well, there's nothing I like better than bringing you the information

that will help you do just that.

Welcome to the Nutrition Facts Podcast.

I'm your host, Dr. Michael Greger.

Today we deal with pain: chronic, debilitating pain.

And we look at how anti- inflammatory diets can be effective

in alleviating chronic pain syndromes.

Fibromyalgia is a common disorder

whose cardinal manifestation is chronic, widespread pain.

Well, not so common, affecting 2 to 4% of the population

though probably more like 2%, and especially women.

For decades, some medical professionals dismissed fibromyalgia

as all in people's heads, but this outdated view has been refuted

by more recent research characterizing it as a disorder

of pain regulation and sensitization.

Brain imaging studies have shown several perturbations of pain

processing and regulation that amplify pain

in people with the condition.

Twin studies have shown that about half of fibromyalgia is genetic,

but the other half we can do something about.

There are lots of drugs with lots of side effects to help

with some of the symptoms, but what about lifestyle approaches?

Engagement in regular physical activity is considered

imperative for effective management of fibromyalgia.

A systematic review and meta-analysis

of randomized clinical trials on the

effectiveness of therapeutic exercise in fibromyalgia

found that both aerobic and resistance exercises

are effective ways of reducing pain

and improving global well-being in people with fibromyalgia.

Patients may worry and perceive that exercise

will worsen their pain and fatigue,

and so you have to start slow and work your way up as tolerated,

with the goal of eventually achieving 30 to 60 minutes

of moderate intensity aerobic exercise in addition to

muscle strengthening exercises (1 to 3 sets of 8–11 exercises,

8–10 repetitions with a load of about 7 pounds

or 45% of the max you can lift.

But what about dietary interventions in terms of

dialing down the pain sensitivity?

Well, what causes it in the first place? Inflammation.

During the inflammatory response, pain receptors are activated,

and chronic inflammation, can cause chronic activation,

which may cause chronic pain, due to this prolonged

hypersensitization of pain pathways.

No wonder, then, that a pro-inflammatory diet

was found to be associated with pain hypersensitivity

in patients with fibromyalgia syndrome.

Exactly which foods are pro-inflammatory

and which foods are anti-inflammatory?

Check out those twin videos, but broadly speaking

components of processed foods and animal products,

such as saturated fat, trans fat, and cholesterol,

were found to be pro-inflammatory,

while constituents of whole plant foods,

such as fiber and phytonutrients, were strongly anti-inflammatory.

The intake of dietary fiber, found concentrated in

only one place— whole plant foods—

is fundamental to reducing not only the risk of abdominal pain

but also muscle and joint pain,

we think because of these short chain fatty acids

that our good gut bugs produce when we eat fiber.

These short chain fatty acids are important mediators of pain,

fundamentally because they modulate inflammation.

So having a lot of fiber-feeding bugs in your colon is like

carrying around your own anti- inflammatory compound factory.

But to cultivate them you actually

have to eat the foods that feed them.

And in terms of phytonutrients, plant-derived polyphenols

are widely acknowledged to also act as anti-inflammatory substances.

Here's some foods packed with anti-pain pathway nutrients:

berries, greens, citrus, nuts,

spices like turmeric and ginger, edamame, and green tea.

That's why you can do randomized, double-blind crossover trials

showing that about three cups worth of strawberries a day

can significantly improve pain and inflammation.

If that's what a single plant can do,

what about a diet chock full of plant foods?

Put people on a strictly plant-based diet rich in

fresh fruits and vegetables, whole grains and various legumes,

which are beans, split peas, chickpeas, and lentils,

as well as nuts and seeds, and you can drop

C-reactive protein levels 33% in 3 weeks,

which is a leading blood marker of systemic inflammation.

But does that translate into less pain?

And the answer is yes, when it comes to migraine headaches.

Yes when it comes to painful periods.

A significant reduction in menstrual pain, duration of pain, intensity

in addition to premenstrual symptoms.

In fact even just a single plant, cinnamon,

about a third of a teaspoon three times a day during your period

can help, though it doesn't work as well as ibuprofen.

Ginger powder, on the other hand—

ground ginger – has been found

to be comparable to ibuprofen in relieving pain

in women with painful cramps.

Whole-food plant-based diets also alleviate

the symptoms of osteoarthritis.

Several studies have shown improvements in rheumatoid arthritis

symptoms with diets excluding animal products,

though it may be just as much a function of

increasing the quantity of healthy plant foods.

But it's not just because plant- based diets are so effective

in causing weight loss, even at the same weight

there's an improvement in rheumatoid arthritis

from more plant-based diets.

And plant-based diets can also alleviate fibromyalgia symptoms.

This is the latest study, which enrolled anyone

with chronic musculoskeletal pain, fibromyalgia or not.

Yes, diets high in animal proteins and fats have been linked to

chronic pain and inflammation, while plant-based diets

produce anti-inflammatory responses.

So, did it actually work when put to the test for pain?

Yes.

Consumption of a plant-based diet produced

positive improvements in chronic pain and function.

How much?

Well, a minimally clinically important difference in

chronic musculoskeletal pain is 1 point on the

Numeric Pain Rating Scale, which is just a scale of 1 to 10,

on how much pain you're feeling.

And on the plant-based diet

perceived pain decreased an average of

three points on a 10-point scale,

from an average of 5 or 6 out of 10 down to 2.

Now, unlike most of prior studies there was no control group,

but what's the downside of giving healthier eating a try?

In fact, those with chronic pain are more likely to be overweight

and have nutrition-related maladies such as high blood pressure,

diabetes, and heart disease all of which can be prevented,

arrested, and in some cases even reversed

with a healthy-enough plant-based diet.

So, any pain benefit is just icing on the cake of health.

Uh...scratch that.

How about...

the dollop of guacamole on your bean burrito.

In our next story,

we look at how apple peels can help those with chronic joint pain.

Regular apple intake is associated

with all sorts of good things, like living longer,

particularly a lower risk of dying from cancer.

Here's the survival curve of elderly women

who don't eat an apple a day.

Ten years out, nearly a quarter died,

and 15 years out, nearly half were gone.

But, those who average like

a half an apple a day didn't drop off as fast,

and those eating an apple a day—

more than 3 and a half ounces—

like a cup of apple slices,

stayed around even longer.

Yeah, but maybe people who eat apples

every day just happen to practice

other healthy behaviors

like exercising more, or not smoking,

and that's really why they're living longer.

Well, they controlled for most of that–

obesity, smoking status, poverty, diseases, exercise—

so as to compare apples to apples (so to speak).

But, what they didn't control for

was an otherwise healthier diet.

Studies show that those who regularly

eat apples have higher intakes

of not just nutrients like fiber, found in the apples,

but they're eating less added sugar,

less saturated fat—in other words,

they're eating overall healthier diets;

and so, no wonder apple eaters live longer.

But is apple eating just a marker for healthy eating,

or is there something about

the apples themselves that's beneficial?

You don't know, until...

you put it to the test.

There are all sorts of fun studies

like this, where subjects were randomly

assigned in the morning to nothing,

a caffeinated energy drink, black coffee, or an apple,

given that athletes use a variety

of common strategies to stimulate

arousal, cognition, and performance

before their morning training.

Did the apple hold its weight?

Yes, appearing to work just as well

as the caffeinated beverages.

The problem with these kinds of studies though,

is they're not blinded.

Those in the apple group knew

they were eating an apple,

and so, there may have been this expectation bias,

placebo effect, that made them unconsciously

give that extra bit of effort in the testing

and skew the results.

You just can't stuff a whole apple into a pill.

That's why researchers, instead,

test specific extracted apple components;

so, they can perform a double-blind placebo controlled study,

where half get the fruit elements,

half get the sugar pill,

and you don't know until the end who got which.

The problem there, though, is that

you're no longer dealing with a whole food,

removing the symphony of interactions

between the thousands of phytonutrients

in the whole apple.

Most of these special nutrients

are concentrated in the peel, though.

Instead of just dumping millions

of pounds of nutrition in the trash,

why couldn't researchers just dry and powder the peels

into opaque capsules to disguise them

and then run blinded studies with that?

Even just a small amount could greatly

increase phytochemical content

and antioxidant activity.

The meat industry got the memo:

dried apple peel powder decreases microbial

expansion in meat and protects against

carcinogen production when you cook it.

And, one of the carcinogens formed

during the grilling of meat

is a beta carboline alkaloid, a neurotoxin,

which may be contributing to the

development of neurological diseases,

like Parkinson's.

I did a video about it awhile ago. Uncooked meat doesn't have any;

the neurotoxin is formed when you cook it,

but you can cut the levels in half

by first marinating the meat with dried apple peel powder.

And also cuts down on the amount of

fecal contamination bacteria in the meat.

Apple peels can also inhibit the formation

of genotoxic, DNA-damaging, heterocyclic amines,

cutting the levels of these cooked meat carcinogens

by up to more than half.

In view of the risks associated with consuming

these cancer causing compounds in meat,

there is a need to reduce exposure

by blocking HCA formation,

such as by adding apple powder

during the cooking of meats

to help prevent their production.

I mean, I can't think of any other way to reduce exposure. (mocking)

What about consuming apple peels directly?

Dried apple peel powder was found

to exhibit powerful anti-inflammatory and antioxidant action,

but this was in mice.

Does it have anti-inflammatory properties in people?

You don't know...