Living a Healthy Life with Chronic Pain (33 page)

The good news is that most people already eat more than enough protein. Unless you have a special medical condition, there is no need to be concerned about not getting enough from your normal diet. Unfortunately, many people get most of their protein from meat, which tends to be high in the bad fats. The best way to get protein is mainly from plant foods, along with small amounts of lean meat, poultry, or fish.

Vitamins help regulate the body’s inner workings. Minerals are part of many cells and cause important reactions to happen in the body. All vitamins and minerals are essential for survival and good health. Most of us can get the vitamins and minerals we need from healthy eating. But the minerals sodium, potassium, and calcium stand out because many of us eat either too much or too little of these nutrients.

For some people, too much sodium (salt) can raise blood pressure. This can lead to heart disease, stroke, and kidney failure. Cutting back on sodium may help lower blood pressure and help prevent high blood pressure.

It is easy to get enough sodium to meet your bodies’ needs. In fact, most of us get way too much. We need only about 500 mg a day (in terms of table salt, this is less than a fifth of a teaspoon, or 1 mL). Yet the majority of people eat 8 to 12 times that much. Adults should limit sodium intake to 2,300 mg a day, which is about the amount in 1 teaspoon (5 mL) of table salt. People who have high blood pressure, kidney disease, or diabetes, are African American, or who are middle-aged or older should not consume more than 1,500 mg of sodium a day.

There is sodium in most foods we eat—from trace amounts in some plant foods to higher amounts in some animal foods. But the real culprits are processed foods, which typically contain a lot of added sodium.

Eating less sodium takes some getting used to, but over time you will learn to enjoy the natural flavors of food. The following are some tips to help you keep your sodium intake in check:

• Always taste your food before salting it. Many times, it is good as is.
  

• Don’t add salt to food when cooking. Season with spices, herbs, pepper, garlic, onion, or lemon.
  

• Use fresh or frozen, minimally processed poultry, fish, and lean meat instead of canned, breaded, or prepared packaged food.
  

• Choose foods labeled “low sodium” or those with 140 mg or less per serving. (Check out the Nutrition Facts label for this information.)
  

• Save high-sodium food for special occasions. Serve bacon, deli meats, frozen dinners, packaged mixes, salted nuts, salad dressings, and high-sodium canned soups as part of celebrations, not as everyday fare.
  

• In restaurants, ask that your food not be salted during preparation.
  

Potassium is a mineral that helps your heart beat regularly, helps maintain normal blood pressure, and allows your muscles and nerves to work together. It may also reduce your risk of kidney
stones and bone loss as you age. Most people do not get enough potassium. But when you follow the MyPlate Map for Healthy Eating (see
Figure 13.1
), it’s easy to get enough of this important mineral. Lots of healthy foods are good sources. These include tomatoes, potatoes, sweet potatoes, and winter squash; fruits, including oranges, cantaloupe, bananas, kiwifruit, prunes, and apricots; and nuts. Dairy products like milk, buttermilk, and yogurt also contain some potassium.

You probably know that calcium helps build bones, but did you know it is also needed for blood clotting and helps with blood pressure? It may also help protect against colon cancer, kidney stones, and breast cancer.

Unfortunately, most people, especially women and young children, do not get enough calcium. Most women under 60 should get the amount of calcium found in 3 cups (750 mL) of milk every day. Other good sources of calcium are yogurt and kefir (a beverage similar to yogurt); calcium-fortified soy, rice, and almond milks and calcium-fortified orange juice; and seaweed. It is also found in smaller amounts in such leafy greens as kale, Brussels sprouts, broccoli, kohlrabi, collards, and bok choy. Most fruits are low in calcium, except for dried figs (there’s not much in fig cookies, though) and the tropical cherimoya (custard apple).

Water is your most important nutrient. Like the air you breathe, you cannot live without it. More than half of your body is made up of water, and each of your cells is bathed in it. Water helps keep your kidneys working, helps prevent constipation, and helps you eat less by making you feel full. It also helps prevent some medication side effects.

Although people can survive for weeks without food, you cannot typically live longer than a week or so without water. Most adults lose about 10 cups (2500 mL) of water a day. Fortunately, people usually have no problem getting the six to eight glasses each day many experts recommend. This is especially true because you get water from the food you eat as well as from what you drink. Most foods, even the driest cracker, contain some water.

To see if you are drinking enough, check your urine. If it is light-colored, you are fine. When you feel thirsty, you need more water. Milk, juice, and many fruits and vegetables are good sources of water. Beware, though: coffee, tea, and other drinks with caffeine or alcohol, can cause you to lose water. Do not depend on these drinks for your water.

If you take certain kinds of medication or have other health conditions such as kidney disease or congestive heart failure, your needs for water may be different. Talk to a registered dietitian or your health care provider.

The relationship between nutrition and pain is at a relatively early stage of research. However, everyone agrees that the best eating plan for someone with chronic pain is a balanced and varied diet. It should include lots of fruits and vegetables; legumes and nuts; protein sources like
fish, poultry, or alternative plant sources; and whole grains. It’s also important to get adequate amounts of liquids in order to stay hydrated. Such a diet appears to reduce inflammation, decrease stress, and improve mood and depression. If you are living with chronic pain, follow the healthy diets in the USDA MyPlate and Eating Well with Canada’s Food Guide programs. Remember to eat regularly and not to skip meals.

Self-management of your food choices does not end with eating a healthy diet. Some substances in foods may be helpful or harmful for chronic pain. Here are some of them.

• Omega-3 fatty acids are “good fats” that need to be in balance with other fats in our diet. Increasing the intake of foods rich in omega-3 may improve pain due to headaches, migraines, rheumatoid arthritis, and other types of inflammatory pain such as fibromyalgia. Foods that are high in omega-3s include fatty fish (such as salmon, mackerel, sardines, arctic char, anchovies, and trout), flaxseeds and flaxseed oil, canola oil, soybean oil, soy products like tofu, and walnuts. To increase the amount of omega-3 in your diet, try the following: eat fish twice a week; use canola or soybean oil for cooking and in recipes; use flaxseed oil for making salad dressings or uncooked dips; use 1/4 cup (60 mL) of walnuts or tofu in salads; and replace regular eggs with omega-3 eggs. (The websites listed under Other Resources at the end of the chapter contain more information on omega-3 food sources.) There is no need to purchase supplements. In fact, it is much better if you get your omega-3s from food sources.
  

• Vitamin D is thought to be a factor in pain regulation. It is estimated that as many as 50 percent of people with chronic pain have low levels of vitamin D. Scientists do not know for certain if vitamin D helps people with chronic pain but they think it might. There are other reasons to increase vitamin D. It can help you absorb calcium for your bones and teeth, and it may help prevent diabetes, multiple sclerosis, and some cancers. Vitamin D can be obtained from sunlight; therefore it is important to get outdoors every day when possible. It can also be obtained through some foods, including milk; fortified yogurt, orange juice, and soy beverages; margarine; fish (many of the same varieties high in omega-3s); and cod liver oil. It can also be taken as a supplement. Health Canada suggests that Canadians over the age of 50 take at least 400 IU a day. (Low levels of vitamin D are a common problem for people who live in more northern countries.) Safe tolerable levels are up to 4000 IU a day. Talk to your doctor about whether you should take vitamin D supplements and at what dose.
  

• Magnesium may reduce migraine headache, fibromyalgia, and some neuropathic pain. Magnesium-rich foods include flaxseed, sesame seeds, pumpkin seeds, Brazil nuts, almonds, pine nuts, fatty fish (salmon, halibut, mackerel), beans (black, lima, navy), black-eyed peas, green vegetables (cooked spinach and swiss chard), and wheat germ. Consult your doctor before you take a magnesium supplement, as too much may cause diarrhea.
  

• Caffeine should be limited to about 400 mg, which is the equivalent of two to three 8-ounce cups of coffee a day. Caffeine isn’t only found in coffee; it is also in tea, colas, cocoa, and some energy drinks. Cold remedies and some mild analgesics that you might take for pain may contain caffeine. Always read the label. Excess amounts of caffeine can increase feelings of anxiety, restlessness, irritability, chest palpitations, and stomach complaints and can interfere with sleep. These symptoms can further intensify your pain.
  

If you consume a lot of caffeine, it’s important to gradually reduce your caffeine intake over two to three weeks. You may develop symptoms of withdrawal if you reduce it too quickly. These symptoms include headache, fatigue, irritability, and mood swings. If you reduce gradually, you should have no ill effects. Try to decrease your intake by substituting decaffeinated coffee, teas, and caffeine-free drinks. Brewed decaf coffee, for example, has 2 mg of caffeine per 6-ounce cup compared to 103 mg of caffeine in regular brewed coffee.

In addition to eating healthy foods, you can make other choices that may help you self-manage your chronic pain such as the following:

• Stay hydrated. There may be a link between chronic dehydration and muscle soreness. (See p. 217 for more details on the recommended amount of liquid to consume.)
  

• People with chronic migraines often report that certain foods may trigger their headaches. Some of these common triggers include alcohol, sulphites (found in dried fruits and some alcohol), tannins (wine, strong tea), various cheeses (especially aged or fermented), food additives like nitrates and nitrites found in processed meats, monosodium glutamate (MSG, a flavor enhancer in Asian and processed foods), aspartame and other artificial sweeteners, and fatty foods. Other reported triggers include fasting or missing a meal and becoming dehydrated. The exact cause of migraines is still not known, so it may be useful to experiment by avoiding foods you might suspect are triggers for you. As long as entire food groups are not eliminated, avoiding certain foods won’t harm you.
  

Other kinds of chronic pain, not just migraine, can be triggered by certain foods. To determine if you have sensitivities to certain foods, keep a food journal. (See, for example, the Lifestyle Tracking Diary in the next chapter.) Write down all the foods and beverages you consume in two weeks. Also, note if you have missed a meal. Then note whether your symptoms—your pain, mood, and emotions—are worse, better, or not affected. Then look for patterns to see if certain foods make your symptoms better or worse. You may not have realized that some common foods may be causing you problems. If you suspect some foods are a problem, eliminate them one at a time to test your idea. Again, it is important not to eliminate entire food groups. Always eat a balanced diet of fruits, vegetables, grains, proteins, and healthy dairy choices. And don’t forget to hydrate!