The Effectiveness of Intermittent Fasting, Time Restricted Feeding, Caloric Restriction, a Ketogenic Diet and the Mediterranean Diet as Part of the Treatment Plan to Improve Health and Chronic Musculoskeletal Pain: A Systematic Review

Abstract

Food strategies are currently used to improve inflammation and oxidative stress conditions in chronic pain which contributes to a better quality of life for patients. The main purpose of this systematic review is to analyze the effectiveness of different dietary strategies as part of the treatment plan for patients suffering from chronic pain and decreased health. PubMed, Web of Science, ProQuest, Scopus, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Cambridge Core, and Oxford Academy databases were used to review and to appraise the literature. Randomized clinical trials (RCT), observational studies, and systematic reviews published within the last 6 years were included. The Physiotherapy Evidence Database (PEDro) scale, the PEDro Internal Validity (PVI), the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a variety of fields (QUALSYT), and the Quality Assessment Tool of Systematic Reviews scale were used to evaluate the risk of bias of the included studies. A total of 16 articles were included, of which 11 were RCTs and 5 were observational studies. Six of them showed an improvement in pain assessment, while two studies showed the opposite. Inflammation was shown to be decreased in four studies, while one did not show a decrease. The quality of life was shown to have improved in five studies. All of the selected studies obtained good methodological quality in their assessment scales. In the PVI, one RCT showed good internal validity, five RCTs showed moderate internal quality, while five of them were limited. Current research shows that consensus on the effects of an IF diet on pain improvement, in either the short or the long term, is lacking. A caloric restriction diet may be a good long term treatment option for people suffering from pain. Time restricted food and ketogenic diets may improve the quality of life in chronic conditions. However, more studies analyzing the effects of different nutritional strategies, not only in isolation but in combination with other therapies in the short and the long term, are needed.

Effect of obesity and sociodemographic factors on chronic pain: a cohort study in general practice

“…Ряд модифицируемых факторов -курение, соблюдение диет, проживание -вносят неоднозначный вклад в течение болевых синдромов и на сегодняшний день являются поводом для дискуссий [12][13][14]. В нашем исследовании продемонстрирована связь курения с болью в шее и спине, а проживание за городом -с болью в области живота, но на характеристики ХБС данные факторы не влияли.…”

Mitochondria: It is all about energy

“…CR can induce an activation of the autophagic/mitophagic machinery. As we explain above, fasting induces an ANTI-Warburg effect ( Bianchi et al, 2015 ; Choi et al, 2016 ; Mattson et al, 2017 ; de Cabo and Mattson, 2019 ; Kornberg, 2020 ; Locati et al, 2020 ; Cuevas-Cervera et al, 2022 ) and prevents pathological accumulation or altered proteostasis that are part of the pathophysiology pathways leading to neurological and metabolic pathologies. Protein and biomass accumulation is treatable, improving autophagia, for example, with fasting ( Gherardi et al, 2019 ; Hu et al, 2021 ; Lechado Terradas et al, 2021 ; Lizama and Chu, 2021 ; Roberts and Markby, 2021 ).…”

“…Lifestyle interventions, such as avoiding sedentarism, improving social connection, avoiding mitochondrial toxins/drugs (if possible), and lowering glucose intake, combined with fasting targets, could serve as an antidote against mTOR aging effects and glycolytic reprogramming. Intermittent fasting alone already induces an anti-Warburg effect ( Bianchi et al, 2015 ; Choi et al, 2016 ; Mattson et al, 2017 ; de Cabo and Mattson, 2019 ; Kornberg, 2020 ; Locati et al, 2020 ; Cuevas-Cervera et al, 2022 ) (elaborated in PART III).…”

“…Multiple dietary phytochemicals are useful in regulating NRF and the subsequent activation of cytoprotective effects (Cuadrado et al, 2019). Some useful phytochemicals investigated are naringenin in citrus fruits and tomatoes (Lim et al, 2013).…”

“…Research shows an increased expression of mitochondrial fusion-related proteins, MFN 1 and MFN 2. In an experimental model that studied the influence of CR on mitochondrial morphology and dynamics in muscle cells, it was reported that CR reduced fission ( Cuevas-Cervera et al, 2022 ; Xu et al, 2022 ). CR can induce an activation of the autophagic/mitophagic machinery.…”