full article 2500 words
Do you seem to have more than your fair share of aches and pains? It’s probably not your imagination, and there are many possible explanations for it, but this article is about one of the most insidious and interesting. It’s most relevant to you if you’re struggling with your weight and/or severe chronic stress… or if you’re just getting older. So really quite a lot of people.
Everyone over 40 knows that it gets more uncomfortable to get out of beds and chairs as we age, and we’re plagued by ever more pains that come and go without much rhyme or reason. Most people chalk this all up to “arthritis,” but that’s rarely a significant factor until much later in life.1 Conditions like fibromyalgia and myofascial pain syndrome, as common as they are, can’t account for all of it. Some medications cause widespread sensitivity as a side effect,2 but that still doesn’t explain such a widespread problem either. So what’s going on?
A little bit of inflammation spread all over the place is one possible culprit. And I have to strongly emphasize that this is an unproven idea, and there is plenty of guessing in this article: well-informed and evidence-based guessing, but guessing.
Chronic low grade inflammation is increasingly seen as a part of other orthopaedic conditions such as osteoarthritis — once considered a ‘cold’ wear and tear problem (as opposed to the far more overt and ‘hot’ inflammation of rheumatoid arthritis).
Summer is coming — Frozen Shoulder, Cocks (Noijam.com)
Chronic low-grade inflammation might happen as a consequence of “metabolic syndrome,” [NIH] a set of biological dysfunctions strongly linked to poor fitness, obesity, and aging. We know that metabolic syndrome is associated with at least some common pain problems, like neck pain.3
Metabolic syndrome may also be linked to severe chronic stress.4 If true, it means that metabolic syndrome could affect millions of people who would not otherwise be likely victims. But this is quite speculative.
Much less speculative: aging itself seems to be inflammatory — no matter how fit, skinny, and calm you are. This is known as “inflammaging.”5
Another possibility, more speculative again, is that chronic low-grade inflammation could be a symptom of mild autoimmune disease — diseases where our immune systems attacks our own tissues, the “why are you hitting yourself?” diseases.6 This could also have something in common with metabolic syndrome and aging, but it’s unknown.
Finally, there’s now good evidence that inflammaging is probably related to the gradual weakening of the immune system, which slowly allows some common minor infections to “reactivate” after lying dormant in our cells for years or even decades.7
If you’re on the far side of middle age, or you’re younger but struggling with your weight and/or major long-term stress, chronic inflammation could be your issue.
Probably not easily, by definition, since the heart of the idea is that it’s a subtle problem. There are blood tests that are quite sensitive to inflammation, but — because biology is messy — they are not super reliable, and even people with serious inflammatory diseases do not always get a clear result. Nevertheless, it’s worth asking your doctor. Check your “CRP” (C-reactive protein). This is a common and easy test, and who knows: you might discover that you have not-so-low-grade inflammation.
The pain of fibromyalgia. [Mayo] is caused by an unexplained neurological dysfunction, and results in widespread oversensitivity to stimuli, among other things. It is stigmatized and overdiagnosed,8 and all too often it is used as a way to dismiss the complaints of people who have unexplained pain, with the insinuation that they are “sensitive” or “dramatic” and don’t really have anything “real” wrong with their tissues. Of course this is great disservice to patients who don’t really have fibromyalgia and those who actually do.You’re not paranoid if they’re really after you & you’re not “sensitive” if you’re actually inflamed.
But you’re not paranoid if they’re really after you, and you’re not “sensitive” if you’re actually inflamed. The pain of widespread inflammation is fundamentally different from the pain of fibromyalgia, yet the result is identical. Fibromyalgia is indeed a kind of sensitivity — the nervous system is over-reacting to stimuli. But inflammation constitutes an actual insult to tissues. Molecules produced by immune system activity, normally associated with infection and injury, are stimulating nerve endings (nociception). The information is sent to the spinal cord and brain for consideration, where the experience of pain may or may not be generated (but it probably will be).
Subjectively, it is effectively impossible to tell the difference between the pain of an oversensitive nervous system and the pain of a nervous system that is actually detecting inflammation all over.9
And then of course there is the ominous possibility that you could have both things going on. And even worse still: it is also possible that constant exposure to the irritation of chronic systemic inflammation could actually cause fibromyalgia.
No one really knows, of course, and quite possibly nothing. But here are some ideas…
Fitness: Undoubtedly critical! Regular moderate exercise really is the closest thing we have to a miracle drug or a fountain of youth.
Anti-inflammatory nutrition: It’s also possible to some extent to eat an “anti-inflammatory” diet — which isn’t as impressive as it sounds. It basically just means a healthy diet, particularly one that doesn’t give our system major blood sugar regulation challenges.
Ketogenic diets and fasting: Might be worth experimenting with. More below.
Reduce stress: Even though it’s not confirmed that there is a link between stress and inflammation, stress management has so many benefits that it is well pursuing regardless. You don’t have to meditate or do yoga (unless you want to). Often the best place to begin is troubleshooting major sources of chronic stress, like insomnia or anxiety.
Quitting bad habits: Consider finally ditching habits that are putting a strain on your biology, especially smoking (of course, smoking is a well known independent risk factor for pain), or drinking too much too regularly (anything more than a couple per day). Any kind of “hard living” is suspect. Coffee in reasonable doses, mercifully, is not an obvious suspect (it doesn’t dehydrate you, for instance10) — but if you’re drinking so much that it’s aggravating emotional stress with caffeine-powered agitation and anxiety, that’s another matter.
Diets that force you to mainly burn fat for energy, instead of carbohydrates — a “ketogenic” diet, like the infamous Atkins diet — may be anti-inflammatory and/or de-sensitizing.
Ketogenic diets are so low in carbohydrates (sugars) that they force the body to burn fat for fuel, a novel metabolic state, which is well-known to treat epilepsy in some children. We can infer from that success story that the biology of this treatment might also have an effect on some kinds of inflammation and pain (especially neuropathic pain, the pain of damaged nerves11). Although highly speculative, there are some reasons to think this might work, and some indirect (animal) evidence that it does.12 Like seizures, some kinds of pain may involve “overexcited” neurons, and can be treated with anticonvulsant drugs. Ketone metabolism “produces fewer reactive oxygen species,” a contributor to inflammation; and it produces adenosine signalling, which is a suspected pain-killer in other contexts (exercise, possibly acupuncture).
This is a completely experimental treatment. However, like an anti-inflammatory diet (AKA “healthy”), it has a non-crazy rationale, and it’s safe and inexpensive to dabble in. As long as you don’t get extreme, the worst case scenario is putting up with a fussy and unpleasant change in eating habits. Nevertheless, I am obliged to suggest that you run this by your physician and/or a nutritionist.
You should probably spend at least two to four weeks in a ketogenic state to be sure that you’ve given it an adequate chance. If you see a clear reduction in symptoms, that’s a strong sign that it’s working. In a spirit of moderation, I do not recommend trying to stay in a ketogenic state for any more more than a several weeks at a time, and you should probably take breaks — give your system a rest from ketogenesis once every week or two.
Actual fasting might work simply because it includes ketogenesis, but it’s also harder and not as safe — so I’m less inclined to recommend it. But if you are keen on the idea fasting for whatever reason (e.g. meditative, emotional, spiritual reasons) it’s another possibility to consider. Of course, the subject of fasting is rife with pseudoscience and big claims, but here are two good sources to start with: Martin Berkhan’s LeanGains.com (start with his myths of fasting), and Dr. Bojan Kostevski’s thesis paper, “The Effects of Intermittent Fasting on Human and Animal Health.”
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
— Added mobile summary, and a “perspective” sidebar warning against snake oily imposters.
— Added another plausible explanation for inflammaging: the reactivation or dormant common infections. Also added a citation link metabolic syndrome to neck pain.
— Many miscellaneous minor improvements.
BACK TO TEXT
Ketogenic diets are well established as a successful anticonvulsant therapy. Based on overlap between mechanisms postulated to underlie pain and inflammation, and mechanisms postulated to underlie therapeutic effects of ketogenic diets, recent studies have explored the ability for ketogenic diets to reduce pain. Here we review clinical and basic research thus far exploring the impact of a ketogenic diet on thermal pain, inflammation, and neuropathic pain.