Online Health Chat with William Welches, DO, PhD and Carla Vanpelt, PCC

Monday July 13, 2015

Description

A large number of people live with chronic pain. For many, neural (nerve) blocks aren't the answer, and treatment with medications may have undesired side effects. Following an anti-inflammatory diet is powerful therapy for pain control with many beneficial side effects. The anti-inflammatory diet is considered an integrative approach to pain management, along with exercise, stress management, osteopathic manipulation therapy and acupuncture.

Inflammation is a natural process in the body that provides a defense against disease. Chronic inflammation can lead to heart disease and strokes, diabetes, Alzheimer’s disease and even depression. Exercise, stress management and a proper diet are lifestyle approaches for managing the problems associated with inflammation and chronic pain.

The anti-inflammatory diet, and lifestyle management in general, provides an important method of reducing the levels of pain. Importantly, this approach to pain management is without any negative side effects. Unpleasant side effects of some medications, including fogginess, memory loss and sleepiness, are no longer a problem.

Nutrition that supports a diet rich in anti-inflammatory foods is another approach to chronic pain management. The anti-inflammatory diet is a lynchpin of such an integrative approach. Although there are no magic foods, putting the right combination of foods into your diet can produce remarkable results.

About the Speaker:

William Welches, DO, PhD is an osteopathic physician with board certification in family practice medicine who has specialized expertise in osteopathic manipulation. Dr. Welches holds a PhD in biochemistry and was a research scientist for a number of years before returning to medical school.

His area of specialty is pain management. In his practice, Dr. Welches uses osteopathic manipulation, along with several programs, including diet therapy and counseling, to help patients with their pain. His techniques and programs are integrated with those of other pain management specialists to provide patients with comprehensive treatment.


Let’s Chat About the Anti-inflammatory Diet and Chronic Pain

Moderator: Welcome to our chat about the Anti-inflammatory Diet: A Way to Manage Chronic Pain with Cleveland Clinic pain management specialist William Welches, DO, PhD, and Carla Vanpelt, PCC.

Dr. Welches and Ms. Vanpelt, thank you for taking the time to be with us and share your expertise regarding chronic pain and the anti-inflammatory diet.

Let’s get started with our questions.


Diet Specifics

Sandy123: I'm interested in what the anti-inflammatory diet IS.

William_Welches,_DO,_PhD: I get this question a lot. There are several different formats of increasing severity. If you are in constant, excruciating pain, I recommend the severest form: no simple carbs like sugar or flour, no dairy, no red meat, nine servings of vegetables (two to three may be fruit), fish (skinless chicken sometimes). Notice for the average American, it is about what we shouldn't eat.

acho7: What is the diet?

William_Welches,_DO,_PhD: Everything you like is off the diet. Everything you might have a problem with is on the diet. Basically, vegetables, some fruit and a little bit of fish. Simple carbohydrates, red meat and dairy are right off. If you are a trim, athletic individual with no pain issues, you can cheat a bit.

internetkat01: Can you give some tips to help stay on the diet. I've been doing the diet for months and it is successful, but I find it difficult to always follow the diet. For me, giving up dairy has been especially helpful in keeping inflammation down, but staying away from the carbs I find difficult.

William_Welches,_DO,_PhD: I have no special insights on what to do to stay on the diet. I am on the diet myself, and it is a constant challenge. However, I can make some suggestions. Keep the wrong kinds of foods out of the home. Stay away from any fast food places. Get on the diet in stages; for example start by eating more fish, then cut back on carbohydrates and eat more vegetables. (My typical breakfast now is raw vegetables.) Acknowledge to coworkers that you want the doughnut, but state that it is bad for you. Remember a time in your life when eating wasn't that important. (I was 10, at the swimming pool and forgot to eat lunch.)

COalmostNative: Do you recommend eating foods in raw form or are there some foods that benefit from cooking?

William_Welches,_DO,_PhD: The argument goes on. Some contend that cooking destroys many of the beneficial components that we want from food; others state that cooking releases those things. I do both. I eat raw vegetables for breakfast and salad four to five times a week. Steamed vegetables or in soups seems fine to me.

bholeve: What are the diet basics? Which foods?

Carla_Vanpelt,_PCC: For the basics I would recommend you go to www.drweil.com. The diet itself is: seven to nine servings of fruits and vegetables, minimal red meat and dairy, complex carbohydrates, and no processed sugar or foods.

zman949: Are all anti-inflammatory diets the same or is there one particular one that you think is the better than the others?

Carla_Vanpelt,_PCC: I like this question. I have read numerous articles regarding this diet, and each one is different. I think the easiest to follow is Dr. Andrew Weil's. He even sneaks some things into his recipes that I thought to be taboo, but it seem to work. Go to www.drweil.com. I would suggest whichever author you choose to follow, you stick with just one.

Xomue: Where can I find information on the complete details of the diet. For instance, you say nine veggies a day, does a white or sweet potato count as a "veggie" in this diet? What are the best vegetables for anti-inflammation diets? No simple sugars? How about complex whole-grain foods?

William_Welches,_DO,_PhD: You ask just the right questions. No. Potatoes are more starch than anything else. Corn is predominantly sugar, and a sweet potato OMG, starch and sugar. Complex carbohydrates in whole grain are nearly complex enough. Think of food on a linear anti-inflammatory scale. The best is the cruciferous vegetables, fruit not as good but at the better end of the scale. Sugar and flour are at the worst end. Whole grain is a little bit better than sugar and flour, but it is not broccoli. Everything more or less lines up along this scale.

MC: Due to cardiac issues I'm on warfarin and need to stay away from many green vegetables. How does this affect my ability to take advantage of this diet?

William_Welches,_DO,_PhD: The biggest effect will be to make your diet more restrictive. You should be able to get a very good effect even avoiding the problematic vegetables.

SusQ: If one adopts the diet and adheres to it religiously, how quickly might one be able to assess its benefits to their particular inflammatory status?

William_Welches,_DO,_PhD: For the patients who adhere, it has been two to three weeks before major effects. The literature states six to 12 weeks to adequately test the diet.

Sandy123: I read something about a "Fast-Mimicking Diet" (FMD) that consists entirely of a vegetable soup with a certain percentage of protein, fat and carbs, with the fat component a fairly high part. I made up my own recipe that fits the percentages. It has olive oil and brown rice, the rest vegetables AND a small amount of peanut butter (homemade - just roasted peanuts). It seems to me that just eating this soup for breakfast lunch and dinner would go a long way toward being anti-inflammatory. Have you heard of the FMD?

William_Welches,_DO,_PhD: No, but there are many diets out there. There is considerable scientific evidence supporting the anti-inflammatory diet. For all others, Caveat Emptor.

outlyarr: I consume a lot of aspartame, probably 15 cans of diet soda per day. I know this is a lot, but the FDA says that aspartame is normal dietary amino acids. What are your thoughts?

William_Welches,_DO,_PhD: Aspartame is a methyl ester of a dipeptide made up of aspartate and phenylalanine. Snake, mushroom, spiders etc. inject simple peptide structures into our bloodstream as part of the venom package. Marketing departments are masters of partial information. Moreover, aspartame is not the only thing in diet sodas. As with many things, moderation is the key.


Fast Facts About Foods

Suzi: Thank you for taking my question. Is it true that grass-fed red meat is allowable for an anti-inflammatory diet? There are those who believe that grain-fed red meat is the cause for the inflammatory response. Also, with the newest research regarding the effects of diet and our neurochemistry, what foods are optimal for blocking chronic pain? I understand that sugar in the diet is a inflammation firestorm in our bodies. Is that all sugars or only refined/processed sugars? Thank you.

William_Welches,_DO,_PhD: Think of anti-inflammatory food as a line and not two separate categories. At the anti-inflammatory end are the vegetables, especially the cruciferous. Fruit is a little back toward inflammatory but still close to the anti-inflammatory end. At the other end is flour and sugar, right next to it are red meats. Grass-fed (low-fat) beef is slightly better, and skinless chicken is even a bit better. There are no good sugars. I have been asked about honey as a positive choice; nope, sugar water (I like bees and we should support them but not their honey). Remember what your father told you about a free lunch. He knew what was up.

ArleneG: Does this diet eliminate all sugar? Is there an allowable amount?

William_Welches,_DO,_PhD: Yes.

  • A cinnabun on Christmas
  • A piece of birthday cake on your birthday

Trina: I consume coconut oil, water and milk. There are many pros and cons about the fat. I've read that it's a good fat.

William_Welches,_DO,_PhD: All fats are good in the proper amount. Americans, as a matter of course, get too much fat. Beware of nutritional one liners. For a good idea of what fats we need and those we get in overabundance, talk to a nutritionist or other professional.

Want2Lrn: What about artificial sweeteners? Can you recommend any?

Carla_Vanpelt,_PCC: Some of the articles I have read allow Stevia.

kasper: Fruit has sugar; should I eliminate all fruit. Thank You.

Carla_Vanpelt,_PCC: No, natural sugars are OK.

Sandy123: What about whole grains, like brown rice, quinoa, oatmeal?

Carla_Vanpelt,_PCC: These are perfect; all complex carbohydrates. Steel-cut oatmeal is better than the regular.

Sandy123: Are sweet potatoes or yams allowed?

Carla_Vanpelt,_PCC: Absolutely. No brown sugar, though.

Dillard: How much fruit (fructose) is allowed? And does ripened fruit contain more sugar then fruit that isn't too ripe?

William_Welches,_DO,_PhD: I don't know the answer to the question of ripened versus. unripened; I will have to look that up. The strict diet would only have two to three servings of fruit out of a total of nine vegetables and fruit servings. I might go as high as four. If it is a question of an apple or a candy bar, always go with the apple.

ccligal: I just make switch from Splenda (originally developed as pesticide, yikes) to Stevia, but there is controversy there too. Which brand is best?

Carla_Vanpelt,_PCC: In speaking from the anti-inflammatory diet perspective, strict adherence to the diet would mean no artificial sweeteners. Suggested sweeteners would be honey or agave nectar, or fruit (not fruit juice) to sweeten. However, in some of the literature, Stevia is allowed.


Assorted Disorders

tbawtinhei: What success, if any, does the anti-inflammatory diet have on sarcoidosis?

William_Welches,_DO,_PhD: I haven't found any scientific studies on this interesting topic. However, I would expect the anti-inflammatory diet to be effective in treating this condition. Moreover, there is a great deal of anecdotal data to support the diet. The cause of sarcoidosis is unknown, but it expresses itself as inflammation in many different tissues. The diet robs inflammation of one of its three necessary components, i.e., fuel.

Xomue: I have an autoimmune disease. I have been advised to avoid dairy products because dairy is known to create congestion (a sign of inflammation). Does the diet you are discussing today eliminate dairy for that reason? I have osteoporosis, too, and it is difficult to get enough calcium without eating dairy products. Calcium supplements are known to create problems of another kind. What is your "take" on dairy?

William_Welches,_DO,_PhD: Dairy is problematic for inflammation in general, so yes, dairy is eliminated to lower the inflammatory content. Most of us are not calcium limited. We may have a problem with low Vitamin D levels (get checked), but mainly we are weight bearing exercise limited. There are good Vitamin D and Ca++ supplements. Walk, walk, walk.

Murray: Hi, Murray from Australia here. I was recently diagnosed with sarcoidosis. I was wondering what your thoughts are on gluten in an anti-inflammatory diet for someone without (or simply not known) gluten intolerance. Can one go off gluten for a month or two then start bringing it back into the diet?

William_Welches,_DO,_PhD: Gluten sensitivity or intolerance is a theory with a ton of anecdotal data. I recommend you do a gluten-free anti-inflammatory diet. This is a difficult diet, but it will answer some questions. To fully test the diet, you need to go for 12 weeks. But in my experience, you may have some strong indications within two to three weeks. You can put gluten back in if you have gone three months and see what happens.

Barney07: I am currently on a gluten- and dairy-free diet for inflammation due to several autoimmune diseases. What other recommendations do you have for my diet?

William_Welches,_DO,_PhD: No simple carbohydrates; nine servings of vegetables a day (two to three servings may be fruit); avoid red meat; one serving of fish a week if you are under 50; two to three servings per week if you are over 50.

PeggyB: Has the anti-inflammatory diet shown to be effective for helping with primary pulmonary arterial hypertension? Arthritis?

William_Welches,_DO,_PhD: There are a number of high-quality studies that demonstrate the importance of the anti-inflammatory diet in controlling arthritic pain. There are no specific studies on the anti-inflammatory diet and pulmonary arterial hypertension that I am aware of. However, we do have studies on all of the parameters important to this disease, specifically blood pressure and lowering the concentration of pro-inflammatory metabolites.

kayhl43: Most anti-inflammatory diets utilize foods that a Crohn’s patient has difficulty consuming. Can you address this issue if possible.

William_Welches,_DO,_PhD: I cannot address the problem easily. If the question is consistency: soups and smoothies may provide some relief. If the question is type of food, unfortunately there isn't always a substitute. Three things to consider are getting down to your ideal weight (weight loss is anti-inflammatory all by itself), getting daily exercise in the form of a walk and managing stress.

icwife: Are there any foods that would be beneficial if added to the diet of an interstitial cystitis sufferer?

William_Welches,_DO,_PhD: It is the diet, not individual foods that control inflammation. For a chronic pain patient who is suffering, I recommend the extreme form of the diet, that is no red meat, no flour or sugar or simple carbohydrate and no dairy. Exercise is a good adjunctive therapy. If there is any extra weight, you will need to lose it. There may be structural considerations, and realignment may be a good idea, but the diet and exercise would be the first steps.

HealthCoach: Is there any evidence supporting an anti-inflammatory diet for fibromyalgia pain?

William_Welches,_DO,_PhD: Oddly, not that many studies. I know this because I am reviewing the literature right now. There are several random clinical trials that showed promising results, but they were not as carefully done as I would like. Part of the problem is there is no firm agreement on what fibromyalgia is. My intuition tells me that the anti-inflammatory diet along with an elimination diet is the best starting place. Exercise has been shown to be effective in multiple careful studies. As always, take a look at your stress levels.

bbofran: What is the best pain medicine for someone with kidney disease?

William_Welches,_DO,_PhD: Kidney disease is a problem. I would recommend looking at topical agents like the lidocaine patch or lotion. Consistent with our chat today, consider changing your diet, increasing your exercise (mainly walking) and taking a look at your stress levels.

TrevaM: How do we utilize the eating plan to deal with pain from fibromyalgia and osteoarthritis AND manage Type 1 diabetes? When the pain is too significant to exercise, how much help will the eating plan alone be in reducing pain until I am able to move again?

Carla_Vanpelt,_PCC: The anti-inflammatory diet is geared to address diseases like the ones you mention, including diabetes. Utilizing the eating plan as the only form of treatment can help with pain, but this must be a lifestyle change. Therefore, if you are going to utilize only the diet for pain control, strict adherence would be necessary. Usually the diet is used as one form of pain control along with exercise and perhaps medication.


Injury Improvement

SteveH: I injured my knee on June 4, 2015, and the x-rays indicated nothing broken. I took 440 mg naproxen sodium, which was totally ineffective. A PA at Cleveland Clinic injected cortisone on July 1. It was effective for two days and then the pain returned. What should be my next step.

William_Welches,_DO,_PhD: These are the steps in order:

  1. Go on the anti-inflammatory diet.
  2. Start physical therapy and find someone to look at you structurally (i.e., an osteopath).
  3. Take a look at your stress levels and begin to work out a plan for management.
  4. Consider walking and Yoga/Tai Chi for long-range management.

MarL: I fractured L12 while shoveling snow last November. I now have a 30 percent deformity. If I were a patient of yours, what would be your opinion? I am female and 57 years old. I was told I had a compressed fracture. I am still having pain that wraps around my ribs. I have been doing physical therapy off and on depending on funds. Thank you for your time.

William_Welches,_DO,_PhD: At the risk of sounding like a broken record, start the anti-inflammatory diet. I practice osteopathic manipulation therapy, and I would want to make sure you have optimal alignment. I am also a certified acupuncturist, and I believe that acupuncture could be very useful in a case like this, but check this with your insurance policy. Most of my patients have to pay out-of-pocket (approximate cost: $60 to $80/session). If the pain is not well controlled, a thoracic epidural might be indicated.


Fare Fight

attagirl!: I've been diagnosed with arthritis, but I don't think all my pain is arthritis. Mainly because it comes and goes and feels like it corresponds to what I ingest, but I can't figure out what to avoid/focus on eating to prove this. I already know I have a pretty serious gluten intolerance and have been off gluten for about one and a half years. I don't say "Oh wow, I feel so much better being off gluten," but I know I feel much worse when I DO eat something that is not gluten-free, and it manifests as arthritic-type pain. I'm wondering if I'm right that I need to figure out what foods aggravate the situation and if this is a correct assumption. Thanks.

William_Welches,_DO,_PhD: You are probably correct. Make sure that you are getting enough exercise and that you have a handle on your stress. Try additional diet components. Dairy can be a big problem for some people.

Nobel: 1) Is there any scientific evidence to support the anti-inflammatory diet (AID)? 2) Does the AID agree with the food allergy theory named ALCAT that states taking the same foods daily may create food allergy from these foods? 3) Does food allergy cause inflammation in the body tissues ? If yes, that means we must apply a combination of both ALCAT and AID simultaneously by ensuring rotation of various food types. What is your opinion? 4) For people who have food intolerance/allergy from Soya products, what is the proposed replacement by AID? 5) The AID recommends eating salmon fish. What about the rising concern of mercury poisoning that is contained in large fish?

William_Welches,_DO,_PhD: 1) Yes. I am doing a reference review of that literature right now, and the number of good, random clinical trials with determination of physical parameters is overwhelming. 2) The short answer is yes. The anti-inflammatory diet arose out of the Mediterranean diet, and the concept of food allergies and food sensitivities was not part of it. But they don't include any contradictions. I am not convinced that eating the same foods every day cause a food allergy by itself. It is plausible that such a diet could create problems for someone who has the necessary genetic predilection. 3) Yes. A true allergy creates inflammation in the tissue. Don't confuse allergy with sensitivity. I believe that food sensitivity is a growing problem. There is reason to think that the mechanisms are similar to food allergy. We don't really understand food sensitivities. They are best treated with an elimination diet. 4) There is no specific replacement for Soya products. I would recommend something else from the legume family; my favorite is lentils. 5) It isn't just salmon. The rule of thumb is: if you are under 50, consume fish one time per week, and if you are over 50, consume fish two to three times a week. Additionally, join a good environmental group and let your representatives know how important the environment is to you. By the way, farmed salmon contain three times the amount of omega 3 than wild salmon. It also contains more mercury.


Supplement Sense

pan: I would like to ask if taking a tablespoon of non-organic turmeric with some black pepper and olive helps to control inflammation and if it is safe for daily use. Thanks in advanced.

William_Welches,_DO,_PhD: I am not a big fan of using supplements to control inflammation outside the boundaries of a diet. I would encourage the use of pepper and turmeric in cooking meals consistent with an anti-inflammatory diet. If there is concern about the need for supplements, I would recommend going to a specialist who can also perform the necessary blood testing.

circusman: Is turmeric a good supplement to manage pain? If so, what dose and what product should I shop for? Since supplements like this are unregulated, it's hard to know what to buy or where to shop.

William_Welches,_DO,_PhD: This follows on an earlier question regarding turmeric. I don't typically recommend supplements as such, unless a true deficiency has been demonstrated, e.g., Vitamin D. Supplements are effective because they are active. Turmeric may increase the risk of bleeding and can interact with other medications. In small doses, turmeric is fine; but like everything else, moderation is the key. When thinking about herbs, spices and other natural supplements, think diet. Soups and teas are good traditional way to introduce these items into our diet.

tinar2764: Is fish oil actually a validated anti-inflammatory and, if so, how much should be taken daily?

William_Welches,_DO,_PhD: There have been a number of good studies that indicate fish oil is a good anti-inflammatory. Think diet. Eat fish, especially salmon, tuna, herring, char; the caveat: those under 50, maybe once a week, those over 50, two to three times a week. The bad guy is environmental mercury. The over 50 risk is less than the benefit. If you take fish oil capsules outside of a good integrative medical program, no more than 1000 mg a day.


About Inflammation

Xomue: Gluten: Does it cause inflammation?

William_Welches,_DO,_PhD: We are not sure. The anecdotal evidence suggests that it does in gluten-sensitive people. Does it cause inflammation in non-gluten-sensitive people? We have no evidence of that.

Want2Lrn: What blood tests are available to determine if you suffer from inflammation?

William_Welches,_DO,_PhD: There are a large number of blood metabolites that have been identified as inflammation markers. The most common is CRP. Your insurance will probably not pay for the testing and it is expensive.

Xomue: Do meat and animal products, eggs, etc., cause inflammation?

William_Welches,_DO,_PhD: Inflammation is caused by a biochemical reaction initiated by the immune system or wound healing coagulation system. Specific food can promote or shut down the inflammatory cycle. For example, simple carbohydrates promote; vegetables shut down.

Xomue: What is the worst inflammatory food?

William_Welches,_DO,_PhD: Sugar and flour.

Cathyb1955: Can following this type of diet help with neuroinflammation?

William_Welches,_DO,_PhD: This diet can help with any type of inflammation. It does require a great deal of discipline.

TrevaM: This may sound silly, but is alcohol inflammatory? I rarely drink it, but every time I have a glass of wine or beer, my pain seems to increase.

William_Welches,_DO,_PhD: One glass of wine a day may be beneficial. There is quite a bit of data that supports the moderate use of alcohol.


Pain Particulars

outlyarr: I have pain, both muscular and arthritic. It is better after I have been moving . It limits my ability to exercise. I cannot take NSAIDS or ASA due to cardiac conditions. I have no headaches. I am 62 years old. My BMI is 24. I have an ICD for Vtach. (My meds are carvedilol, amiodarone, rosuvastatin 20 and an ACE.) Intercostal chondritis causes a lot of unilateral pain on my left side on my sternum (non-cardiac, movement in the joint). When I awaken at night, I feel sore and have flu-like aches, afebrile. I am currently battling bursitis,(legs and arms, no pain). I can ride a stationary bike for 40 minutes easily pain free, but it is difficult to walk. Do you believe this diet could reduce the pain significantly?

William_Welches,_DO,_PhD: I believe this diet would lead to less pain and better control of your arthritis. You are starting off with a number of advantages. You have a desirable BMI and you are already exercising, although I would recommend walking in addition to the bike. Biking is done sitting and walking is upright. If the evolutionary scientists are right, we have been upright for 6 million and sitting for the last 100 years. We need to be up and walking around every day.

kasper: If you have arthritis in your joints, will a special diet help ease pain without medication.? Thank You.

William_Welches,_DO,_PhD: In my experience, the diet can have miraculous effects if followed vigorously. However, its effects may not be total if there are comorbid conditions. The version of the FDA food pyramid places exercise as the lowest tier. If the patient cannot exercise for whatever reason, this can influence the results. Furthermore, stress can mitigate some of the benefit of the diet, although the diet does help with stress management. The first goal is to increase your function, then lower your medication and finally come off of pain medications totally.

HAPPY231: I am 23-year-old male suffering from left side lower back pain around mostly the top of my hip for the last two years. MRI is negative, but I am on medication, an anti-inflammatory drug and a muscle relaxant, on and off. No relief in sight. Please advise what more I can do for pain reduction. The pain gets worse while sitting and lying, and improves while walking. Also, the pain is continuous, 24-hour pain.

William_Welches,_DO,_PhD: At this point, I would recommend structural treatment. I will presume that you have already been through physical therapy. Osteopathic manipulation therapy is a good place to start. On your own, take a look at Yoga (traditional, not extreme) or Tai Chi. I recommend a minimum of 30 minutes of low-impact walking every day. After the low-impact walking, you can increase the effort. Finally, try to get a handle on your stress. It may not be the cause of your pain, but it is turning up the volume knob.

willes: Would an anti-inflammatory diet help severe neck pain?

William_Welches,_DO,_PhD: The simple answer is yes. The more complete answer: get your neck looked at. If you already have done the round of x-ray and MRI, neurologist, epidurals, etc., have a competent manual medicine person look at it. My bias is for a DO.

JPMUR: After a good workout, I know that I am going to be sore that night and into the next day. Should I take some Advil to repress/eliminate the upcoming soreness or is that counter-productive to why we exercise. I have been told that inflammation after a workout is good, as it means your muscles got a good workout, but if I take ibuprofen, that is defeating the purpose of working out. Which is correct?

William_Welches,_DO,_PhD: Avoid taking any NSAID like Advil prophylactically. These are not benign drugs. Sore is OK, usually. Take a look at whether you are overtraining. If the soreness is bad enough, don’t take two Advil and see a competent manual medicine person (i.e., a DO).

outlyarr: I have generalized pain, worse in the am, not in extremities. I have been diagnosed with arthritis. I cannot take NSAIDS due to cardiac issues. I am a 62-year-old male with a BMI of 24. I ride a bike for 40 min. four days per week. Fibromyalgia drugs have caused side effects. Is this diet a significant choice for me? My pain is definitely arthritic, but it seems muscular, too.

Carla_Vanpelt,_PCC: I say why not give it a try. You have nothing to lose but a lot to gain.

ArleneG: Does apple cider vinegar have any benefit for reducing arthritis pain? What about wine?

William_Welches,_DO,_PhD: I have never heard of the apple cider vinegar-arthritis connection. I can't think of a reason not to try, depending on your GI track. There is no particular benefit of wine to arthritis.


Learning More

SusQ: Can you provide some basic reference materials for investigation and implementation of this diet?

Carla_Vanpelt,_PCC: Cleveland Clinic has a wellness site that is helpful. I have found the best site to be www.drweil.com. This site has a food pyramid, recipes etc.

tbawtinhei: Silly question. I thought you were just speaking in general about anti-inflammatory foods, but it sounds like there is an actual documented diet. Is that correct? What is it called and where would I find it?

Carla_Vanpelt,_PCC: I have found that Dr. Weil seems the easiest to follow. His website is very helpful: www.drweil.com. Check it out!

MC: Does Cleveland Clinic publish or is there a comprehensive guide available for this diet?

William_Welches,_DO,_PhD: Both the Department of Pain Management and the Department of Integrative Medicine have diet plans with guides (nearly identical). You can make an appointment, but tell the operator what you want.

ccligal: Can you suggest alternative to NSAIDs? I tried Tylenol but nothing works as well as Advil Gel Caps for arthritis or osteoarthritis. I can't take NSAIDs due to proteinuria. Please provide a link to the anti-inflammatory diet. I've never heard of it until now.

William_Welches,_DO,_PhD: I don't recommend substitutes for NSAIDs or Tylenol. There is no medication that is safe and totally without side effects. Before considering medication, consider diet, exercise/walking and stress management. Alternative therapies for pain include osteopathic manipulation therapy, acupuncture, meditation, Reiki and many more. Using "anti-inflammatory diet" on a search program you will get a ton of information; much of it good. The Integrative Medicine Department and The Pain Management Department at Cleveland Clinic both have anti-inflammatory diet programs (nearly identical), and you can make an appointment for these.

llong: Where do you find the instructions for an anti-inflammatory diet?

Carla_Vanpelt,_PCC: www.drweil.com.

attagirl!: Can you please tell me where to find the diet? Thanks.

Carla_Vanpelt,_PCC: You can Google "anti-inflammatory diet" or you can go to www.drweil.com.

dayglowst: Is Dr. Weil's anti-inflammatory diet book a good reference?

Carla_Vanpelt,_PCC: I have not checked out his book, so I really cannot say. I would suggest that you stick with one book, be it Dr. Weil's or another as you begin the program. As you learn, you can probably incorporate other information from other references.

llong: We do not live close to your facility so making an appointment to get the diet plan with guides as you suggested is not practical. How else can we get it (not Dr. Weil site).

William_Welches,_DO,_PhD: The internet is the answer to all questions. I have no favorite sites, but you will get a great deal of information. Remember that there is no single best diet. You can be more liberal if you are at your ideal weight, athletically active and your blood values for glucose, cholesterol and others are normal. If you have a lot of chronic disease and are in chronic pain with morbid obesity, you need to get serious.


Closing

Moderator: That is all the time we have for questions today. Thank you, Dr. Welches and Ms. Vanpelt, for taking time to discuss the anti-inflammatory diet and chronic pain.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.

William_Welches,_DO,_PhD: I have had a good time chatting with all of you. Take a look at the anti-inflammatory diet and see if you can't begin to practice, if not all, a substantial part of it. Remember to exercise/walk and develop a plan to handle your stress. If you have a serious problem with pain, find a good holistic program.

Carla_Vanpelt,_PCC: I hope this was helpful. I enjoyed all the questions and am sorry we could not get to them all. There is a lot of information on the internet regarding the anti-inflammatory diet. Check it out!


For Appointments

To make an appointment with Dr. Welches or another pain management specialist, call 216.444.PAIN or visit clevelandclinic.org/painmanagement to request an appointment online.

For More Information

Cleveland Clinic Health Information

Learn more about chronic pain and diet.

For additional information about clinical trials: clinicaltrials.gov (must use Chrome or Firefox as browser to link).

Managing Your Health

MyChart® is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org.

An online second opinion from a Cleveland Clinic specialist is available as a service for patients who have received a diagnosis and are unable to travel to Cleveland, OH. For more information, please visit my.clevelandclinic.org/online-services/myconsult.


Contact Information

For general information, you may visit our Appointments and Questions page to schedule appointments, ask questions, view frequently asked questions and access important phone numbers.

If you need health information, call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272, ext. 43771, to speak with a Health Educator. You may also email healthl@ccf.org to correspond by email.

And finally, to suggest topics, ask questions or make comments about upcoming web chat topics, please email healthchats@ccf.org.

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2015. The Cleveland Clinic Foundation. All rights reserved.