“Let thy food be thy medicine, and thy medicine be thy food” – Hippocrates (400 BCE)
Introduction
Written by Hayley Therrien and Lizzy Boshears, PT, DPT
Edited by Megan Van Buren
The term “Western diet” is used to describe diet patterns that cater to fast-paced, on-the-go living that is common in Western societies. The United States' staples of the Western diet often feature fast food, sugary beverages, and mass produced singularly-packaged convenience snacks often with very little fiber, vitamins, or minerals. These food options, while convenient, can lead to issues over time; many people know that eating less healthy options lead to weight gain, but a less common known fact is that it can exacerbate pain!
Fast foods are not the only culprit though; common grocery store items with extra added ingredients (like sugar) can also be problematic! Understanding the better options that we can make for our diets can also help us manage our pain. An abundance of scientific literature outlines the connection between Western lifestyle habits (such as diet) and a range of chronic disease states from diabetes to heart disease as well as chronic pain (Bjørklund et al, 2019). That connection is inflammation.
What is inflammation?
It’s both a friend and an enemy – a frenemy. Think about what happens when you twist your ankle. When tissue is damaged, specific molecules circulate through the blood to help heal the injury. While the swelling and tenderness that is common in ankle injuries is painful and uncomfortable, this process of inflammation is natural and is beneficial as it allows for tissue to be repaired. But it’s a double-edged sword as those inflammatory molecules can damage healthy tissue on its own if it’s excessive or occurring when it should not be. And sometimes rather than being confined to a particular location (like a twisted ankle), inflammation is occurring throughout the body. This type of inflammation is called “systemic” inflammation.
Western diet staples that are consumed on a frequent basis cause higher risk for developing chronic inflammation. In addition to refined sugars, many of these food options are high in other ingredients, such as animal fats, salts, processed grains, and extensive use of preservatives and mass production processes. Along with high stress levels and air pollution, these interact with each other to produce a chronic state of low-grade systemic inflammation (Minihane et al, 2015). It’s as though the cells of your body are like embers smoldering after an extinguished fire. The long-term damage caused by that toxic brew later can express itself as aggravated pain, and ultimately lead to other serious systemic conditions, such as type 2 diabetes, cardiovascular disease, and non-alcoholic fatty liver disease (NAFLD).
Pro-inflammatory Properties of the Western Diet
Pain is one of the primary symptoms of inflammation. This is due to numerous inflammatory molecules circulating through our tissues which activate and sensitize special nerve cells that we perceive as pain; (learn more about what your pain means here). The Western diet is problematic in this regard because the carbohydrate, simple sugars, fat, protein, and preservative content of it induces systemic inflammation.
Glycemic index is something that is often used in discussions about sugar content of food (What is the glycemic index?). The glycemic index indicates how rapidly certain foods will cause the amount of sugar in our blood to increase. Foods are ranked 0 to 100 with lower numbers indicating a slow rate of increase and higher numbers indicating a faster increase. A study carried out in the Netherlands (Du et al, 2008) found that as the glycemic index of food consumed increased there was also a very large increase in inflammatory molecules in the participants’ blood. Similar pro-inflammatory effects have been described for dietary cholesterol and saturated fatty acids (Christ et al, 2019).
Adjusting one’s dietary choices to include foods without added sugars, more vegetables and plant-derived products, and more omega-3 fatty acids can have significant anti-inflammatory effects. Less inflammation means less chronic pain.
A helpful resource particularly for choosing low glycemic index foods is the University of Sydney which maintains a searchable database of foods ranked by glycemic index (http://www.glycemicindex.com/). Experiment with your food choices and see what might trigger your symptoms. The gold standard for this is to try an elimination diet. Eliminate the suspect foods for a minimum of two weeks (best for 3+) and pay attention to how you’re feeling; some might keep a food and symptom diary to record each day. At the end of the elimination phase, pick one food to reintroduce to your diet. If you feel fine and have no worsening symptoms at the end of the week of reintroduction, you can move on to the next food item. Repeat until all foods have been tested. A big mistake would be to reintroduce them all at the same time, as you will not know which is the most plausible culprit and it may increase inflammation!
Another way to combat increased sugar intake is by eliminating food options that have unnecessary added sugars.
Become a label reader! Scanning the food nutrition and ingredients labels can help you navigate the healthier options. Food companies often have a tendency to put additional ingredients into unsuspecting products to make them more palatable. For example, the most popular ketchup brands lists sugar, high fructose corn syrup, and glucose as main ingredients—all are just different types of sugar! This sneaky tactic can make it difficult to navigate toward the best choices. Label reading can help us make the best dietary choices to reduce inflammation and ultimately our pain.
We went to multiple grocery stores and our shelves to compare some common food products. Below we have listed ways to navigate around these different food labels, as well as some pictures of labels to show the disparity between products. There are also some suggestions for alternatives listed at the end.
Diced tomatoes (below): many cans had added salt even though it did not say so on the label and there were not always labeled options for “low or no sodium”
Generic Brand Ketchup (left below): Sugar is second ingredient! Of the 4g sugar labeled, 3g was added
Waldon Farms Ketchup (right below): good alternative as it doesn’t have sugar. It has sucralose listed as one of the last ingredients so while it is technically a sugar, it is a low amount
Juice: Look for 100% juice and no added sugars under the Nutrition Facts and ingredient list. Mott’s Natural has apple juice, water and apple juice concentrate as its only ingredients = better choice than some other brands.
Canned Fruit: “Fruit in water”, “fruit in juice” and “fruit in heavy syrup” are all options for canned fruit. Aim to have only “fruit in water” or “fruit in juice” where you can always add sugar if you want something sweet (allows you to control how much sugar is being added).
Canned fruit "in syrup" (left below) has 40 more calories per serving and 11g of added sugar compared to canned fruit "in juice" which has 0g of added sugar.
What to Look For on Your Labels
1. Ingredient Order
Food labels list ingredients in descending order—those that exist in the majority will be listed first. This can be useful when deciding between to products, the one that has something like sugar listed later in label is arguably the better choice. While it can take some practice understanding what certain things mean on labels, learning the language can help us make the best choices for our health.
2. Sugar Pseudonyms
The pre-mentioned ketchup brand with multiple sugars listed shows just a few of the many alternative names for sugar. Below are some other names for sugar food companies use in their products:
Granulated sugar, brown sugar, confectioner’s sugar, raw sugar, molasses, sucrose, maltose, dextrose, fructose, high-fructose corn syrup, coconut sugar, agave nectar, honey, brown rice syrup.
3. How its Marketed/Advertised
Be wary of products that list themselves as “low fat”, “sugar free”, etc. as these often try to make up in other ways to be tasty, such as adding more salt or other unnecessary additives. Often the self category that the food advertises itself as does not always hold to true. For example, one Keto based creamer was listed as “Unsweetened vanilla”, but upon further inspection, actually had 3g of added sugar listed on its label.
Beneficial Alternatives to the Western Diet
Label reading can make all the difference in one’s aspirations to make healthier dietary choice. If you’re hoping to shift even more away from typical Western Diet, consider using the model of “Mediterranean diet”. This diet has shown to be way of eating that leads to less inflammation that food choices in Western diet. The Mediterranean diet is because of its high vegetable, legume, and unsaturated fat content and low sugar content (Galland, 2010), virtually the opposite of the Western diet with its high sugar, high saturated fat, low fiber qualities. Olive oil is featured prominently in the Mediterranean diet as a source of unsaturated fats such as oleic acid and has been shown to have anti-inflammatory properties (Schwingschackl & Hoffman, 2014). Additionally, foods containing omega-3 fatty acids, vitamin B12, vitamin C, magnesium, turmeric, ginger, nightshade vegetables (e.g. tomatoes, eggplant, potatoes, peppers) are anti-inflammatory and useful for pain reduction (Tick, 2015).
Now, the old saying holds true “everything in moderation”. While a perfect diet with no added sugar is possible for a few people, it is not going to work for most of us, but we can make changes in our normal Western diet. Do your best to make healthy dietary choices as often as possible, but don’t be afraid to enjoy yourself occasionally. A good rule is 80-20; eat healthy 80% of the time and allow yourself 20% of freedom for choices. In this way, you can allow yourself wiggle room with social gatherings (when that becomes a thing again), virtual happy hour, birthdays and holidays! So go ahead, eat that cupcake, just make sure you have a salad that day too!
References
Bjørklund, G, Aaseth, J, Doşa, MD, Pivina, L, Dadar, M, Pen, JJ, and Chirumbolo, S. (2019). Does diet play a role in reducing nocicpetion related to inflammation and chronic pain? Nutrition, 66, 153-165.
Christ, A, Lauterbach, M, and Latz, E. (2019). Western Diet and the Immune System: An Inflammatory Connection. Immunity, 51, 794-811.
Du, H, van der A, DL, van Bakel, MME, van der Kallen, JH, Blaak, EE, van Greevenbroek, MJ, Jansen, EHJM, Nijpels, G, Stehouwer, CDA, Dekker, JM, and Feskens, EJM. (2008). Glycemic index and glycemic load in relation to food and nutrient intake and metabolic risk factors in a Dutch population. American Journal of Clinical Nutrition, 87, 655-661.
Galland, Leo. (2010). Diet and Inflammation. Nutrition in Clinical Practice, 25(6), 634-640.
Minihane, AM, Vinoy, S, Russell, WR, Baka, A, Roche, HM, Tuohy, KM, Teeling, JL, Blaak, EE, Fenech, M, Vauzour, D, McArdle, H, Kremer, BHA, Sterkman, L, Vafeiadou, K, Benedetti, M, Williams, CM, and Calder, PC. (2015). Low-grade inflammation, diet composition and health: current research evidence and its translation. British Journal of Nutrition, 114, 999-1012.
Schwingschackl, L, and Hoffman, G. (2014). Mediterranean dietary pattern, inflammation and endothelial function: A systematic review and meta-analysis of intervention trials. Nutrition, Metabolism, & Cardiovascular Diseases, 24, 929-939.
Tick, Heather. (2015). Nutrition and Pain. Physical Medicine and Rehabilitation Clinics of North America, 26, 309-320.
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