Diet and Nutrition


The best diet for most chronic pain conditions is the anti-inflammatory or
Mediterranean diet. It was named originally after the diet eaten by Greeks living
on the coast of Crete in the 1950’s and 1960’s. More recently, it typifies the
diet of many Greeks, southern Italians, and Spanish peoples. The Cretans ate
mostly fish caught daily from the Mediterranean Sea along with plenty of fresh
fruits, vegetables, legumes, nuts, whole grains, seeds, and olive oil in place of
butter. Red wine was taken in moderation with meals. Poultry, eggs, cheese,
and yogurt were eaten in moderation, while red meat and sweets were eaten
much less often. The diet is low in fats and carbohydrates compared to the
typical American diet. This diet is now recommended by the American Heart
Association to lower the risks for cardiovascular diseases.

The health of these people was significantly better than those in more modern
countries at the time where people ate more red meats, saturated fats found
in dairy products, and simple carbohydrates. They have had lower rates of
heart disease, strokes, Alzheimer’s disease, and cancer. Unfortunately, as the
Cretans developed a more modern culture, their diets became Westernized and
their health deteriorated. Now, those Greeks who eat the “typical American diet”
see their rates of these diseases of modernity catching up with the rest of the

The good news is that researchers have clearly identified the essential elements
of this healthy diet so we may all start to enjoy the health benefits that come with
it. One such benefit is the reduction of inflammation in the blood vessels and
connective tissues that might lead to heart attacks and strokes, and exacerbate
chronic pain and auto-immune diseases such as rheumatoid arthritis. In addition to the diet, regular exercise, maintaining a healthy
weight, having time to relax and enjoy life, and maintaining social networks of
friends and family all constitute a healthy lifestyle that reduces pain and suffering.
For more detail on the Mediterranean Diet, go to the Mayo Clinic website at

Certain foods are known to cause or aggravate pain or inflammation.
The “nightshade” family causes inflammation in genetically susceptible people.
These include potatoes, tomatoes, eggplants, bell peppers, and tobacco. Try
avoiding these for a month to see if there is improvement in pain or inflammation.

Gluten-containing foods can cause migraines and inflammation in genetically
susceptible people. Gluten, a protein, is found in wheat, rye, and barley.
Although it may be difficult to avoid glutens, doing so if you are intolerant to
it may lead to a substantial improvement in pain. A one-month trial of gluten
avoidance is worth the effort if you are intolerant.

Many people lack the enzymes to metabolize milk sugar. Many also have an
allergy to milk products. A trial elimination of all dairy products for a month may
reveal if you have a problem with dairy products. Some people see a substantial
reduction in pain, allergic symptoms, and fatigue when eliminating dairy.

Many people are allergic to one or many foods. A food allergy panel may reveal
what foods to avoid in order to reduce pain and inflammation. A food elimination
trial may also reveal foods to which you are sensitive.


There are several nutritional supplements that are helpful to reduce pain and
suffering. They may work by reducing inflammation, but may have additional
benefits such as being anti-oxidants, precursors to neurotransmitters, catalysts to
essential metabolic processes, and basic constituents of tissues.


Vitamin D: for chronic pain, fatigue. Low Vitamin D levels are endemic to the
Northwest due to low levels of sunlight exposure.
Dose: Vitamin D3 2000 IU /day

Vitamin C: for wound healing, impaired immunity.
Dose: 500 to 2000 mg/day. Some advocates recommend increasing dose until
diarrhea develops, then backing off dose to a “bowel tolerant” level.

Niacinamide: for osteoarthritis
Dose: 500 mg 3-6 X/day.
Contraindications: Hepatitis or other liver disease

Vitamin B6: for carpal tunnel syndrome, neuropathies in some cases
Dose: 50-150 mg/day


Magnesium: for fatigue, migraines, muscle spasm, high blood pressure, seizure
disorders (not to substitute for anti-seizure medications), fibromyalgia,
Dose: 200-600 mg/day available in oral tabs or transdermal strips (best for
avoidance of diarrhea) Take with calcium supplement.

Amino Acids:

L Tryptophan: for chronic pain, fibromyalgia, depression, migraines
Dose: 500-4000 mgs/day
Contraindications: Avoid if taking an SSRI antidepressant medication (Prozac,
Zoloft, Celexa, Lexapro or their generic forms)

SAMe: for osteoarthritis, depression, liver disease, fibromyalgia
Dose: 1200 to 1600 mg/day
Contraindications: Bipolar Affective Disorder

DL-Phenylalanine: for chronic pain, depression D-isomer is active form
Dose: 50 to 2500 mg/day split into three doses
Contraindications: Phenylketonuria

Fatty Acids:

Fish Oil: for chronic inflammation, rheumatoid arthritis, multiple sclerosis,
inflammatory bowel disease, other autoimmune diseases
Dose: 3-12 gm/day

Accessory Food Factors:

Coenzyme Q10: for migraine prevention, high blood pressure, chest pain,
congestive heart failure, use with statins (Lipitor, Crestor, simvastatin),
gemfibrozil, beta blockers, tricyclic antidepressants, phenothiazines
Dose: 30-200 mgs/day

Alpha-Lipoic Acid: for diabetic neuropathy
Dose: 600 mgs tid
Caution: Take with copper 2 mg and B complex to avoid potential toxicity

Specific Diseases:

Diabetic Neuropathy: Alpha-Lipoic Acid 600 mg 3X/day, capsaicin cream .075%
4X/day, Vitamin B6 50 mgs 3X/day

Crohn’s Dx: Diet: Eliminate sugar and refined carbs. Identify and avoid allergic
foods. Low disaccharide diet, fish oil 4.5 gms/day, folic acid 1-20 mg/day if
diarrhea is present and persistent, Boswellia 3.6 gm/day, supplementation with
high potency multi-vitamins/ minerals

Carpal Tunnel Syndrome: Vitamin B6 50-200mg/day. Use with Vitamin B

Fibromyalgia: Avoid allergic foods. MSG and aspartame may trigger flares.
Acetyl-L-carnitine 1500 mg/day, Magnesium 400 mg/day

Osteoarthritis: Diet…avoid Nightshades (white potatoes, tomatoes, bell peppers,
eggplants, tobacco). Avoid allergic foods. Treat insulin resistance with weight
loss, berberine (see herbs). Chondroprotective agents: Glucosamine sulfate 500
mg/day, chondroitin sulfate 800-1200 mg/day, niacinimide 500 mg 3-6 X/day,
SAMe 400 mg 3X/day, MSM 3000 mg/day

Rheumatoid Arthritis: Avoid allergic foods, Zinc 30 mg 2-3 X/day, Copper 2-4
mg/day, Borage oil 1400 mg/day, fish oil 10-12 gm/day, ginger 500-1000 mg/day

Menstrual Cramps: Magnesium 400 mg/day, Niacin 100 mg every 2 hours with
Vitamin C 500 mg plus flavonoids, Fish Oil 6000 mg/day, Vitamin E 400 IU daily
beginning 2 days before start of period through 3rd day.

Anxiety: Eliminate sugar, caffeine, alcohol. Avoid allergic foods. Kava
standardized extract providing 200-250 mg/day in 2-3 divided doses (avoid use in
alcoholism, liver disease), Inositol for panic disorder 12 gm/day, Passion Flower
extract 45 drops/day, L-Theonine 200-400 mg 3-4 X/day.

Depression: Eliminate sugar, caffeine, alcohol. Avoid allergic foods (dietary
changes work best with rapid mood swings), St John’s Wort 300 mg 3X/day if not
on BCP’s, L-Tryptophan 1000-1500 mg 2X/day if not on SSRI’s (Prozac, Zoloft, Celexa, Lexapro or their generic forms), Fish Oil up to 20 gm/day, SAMe up to
800 mg 2X/day, Testosterone supplementation in men with low levels.

Fatigue: Avoid refined sugar, other refined carbohydrates, caffeine, alcohol.
Avoid allergic foods. Potassium magnesium aspartate 2000mg/day X 2-4 weeks
then taper to a lower level.

Migraines: Eliminate refined sugar, other refined carbohydrates, aspartame,
caffeine, alcohol, tyramine-containing foods (red wine, beer, aged cheeses, fava
beans). Avoid allergic foods! Reduce salt intake, Magnesium 200-600 mg/day
(try transdermal patch to avoid diarrhea), Riboflavin 400 mg/day with breakfast,
Fish Oil 6-15 gm/day, Feverfew, CoQ10 150 mg/day, Butterbur extract 75 mg/