Did you know that dieticians can help improve the lives of people with chronic pain? The 20-26th of March is Dieticians Week and we’re lucky to have Dr Katherine Brain (PhD), a passionate and knowledgeable accredited practising dietician, on our Chronic Australia Board to talk about an often undervalued aspect of pain management.
Contrary to popular belief, Katherine, like many other dietitians, eats cake, and she probably won’t ask you to stop eating it either. She finds that people often come to her with quite a few misconceptions about what dietitians actually do. So in honour of Dietitians Week, we had Katherine shed some light on the work dietitians do and how they can be part of a multidisciplinary approach to managing chronic pain.
What dietitians do
Dietitians are people who have completed at least four years of university training to be able to provide medical nutrition therapy to patients. This involves translating scientific nutrition information into practical, tailored and meaningful nutrition-related advice. Recognising that the dietitian is the expert in nutrition and the patient is the expert in themselves.
Katherine said that it’s important to recognise the difference between a dietitian and a nutritionist. Nutritionists are not regulated as a profession and generally have more limited qualifications. While dietitians are required to have four years of training, it is not necessary for nutritionists to have completed study at the tertiary level. Therefore, it’s better to seek out a dietitian for those who are looking for a more comprehensive approach to managing chronic pain through diet.
What dietitians do NOT do: Debunking common misconceptions about dietitians
There are many misconceptions around what dietitians do, so clearing these up can provide a deeper understanding of their work. There is one thing in particular that Katherine likes to make clear to her patients:
“I am not the food police. People will often come in thinking I’m going to make them stop eating all the foods they normally eat and only eat salad for the rest of their life, but that’s just not what dietitians do,” Katherine said.
Dietitians help people avoid restrictive eating patterns. Katherine said it’s generally fine for people to still enjoy a glass of wine, chocolate, etc. as long as they are mindful of the quantity and frequency of consuming these things.
Rather than simply interrogating and scrutinising what people eat, Katherine said she spends more time talking with patients about things they can do to build a healthy relationship with food. This is particularly important for people with chronic pain when it comes to how food is used in social settings.
“Food is there to enjoy and we use it to connect with people. A lot of times catching up with friends involves food, like going out for lunch. For people with chronic pain, it’s a big issue when they become isolated and withdraw from these things,” Katherine said.
One way Katherine encourages people to develop more positive feelings towards food is to look at food related hobbies, like starting a veggie garden. She also works with patients to address food-related issues such as emotional eating.
Another common misconception Katherine likes to debunk is that dietitians are all about weight loss. “It’s more important to improve what you’re eating rather than trying to focus on a number on the scale,” Katherine said.
How dietitians fit in the ecosystem of allied health professionals in pain management
Katherine works as a dietitian at a public pain service and a private practice, both of which are multidisciplinary settings that aim to provide holistic care. These kinds of settings recognise that the work of a dietitian is part of a whole person approach to pain management that includes nutrition, physical activity, the mindbody relationship, social connection, and biomedical factors.
“Nutrition has been traditionally underrepresented in pain management, but it really does play a role in all aspects of health related to chronic pain and is part of the multidisciplinary approach that is supported by science,” Katherine said.
From a biomedical perspective, diet can be used to reduce inflammation and oxidative stress, which are mechanisms in the body related to pain. Reducing levels of these things helps lessen pain experiences.
Nutrition also plays a role in other comorbidities that are often associated with pain, such as mental health. According to Katherine, many of the same nutritional strategies used to reduce pain would also have a positive impact on someone’s mental health if they have anxiety or depression.
How dietitians use nutrition to improve the lives of people with chronic pain
Helping patients understand the connection between nutrition and pain is one way dietitians help people manage their chronic pain. Katherine looks at how a patient’s current diet may impact their pain and identifies ways to improve what they’re eating. She has found four things are particularly important in managing pain through diet: eating a variety of fruits and veggies, incorporating healthy fats, reducing ultra-processed foods, and cultivating a healthy and diverse gut microbiome.
“I always suggest consuming a rainbow of fruits and veggies so people can get a variety of antioxidants. Red, purple and blue fruits and veggies in particular have an antioxidant called polyphenols, and there’s some research to suggest that it can reduce pain in a similar way that anti-inflammatory medication like ibuprofen does,” Dr Brain said.
Reducing inflammation is key when it comes to pain management, and eating healthy fats such as oily fish, nuts, seeds, olive oil, and avocado can help there. Katherine says eating these kinds of foods is especially important because they contain omega-3 fatty acids, a healthy fat people tend to be deficient in. Other things that can help reduce inflammation include cutting back on ultra-processed foods and added sugars e.g. soft drinks.
Katherine has a good tip for spotting if a product is overly processed:
“I often give an example of an apple versus a commercially made apple pie; there’s not much apple left in that commercially made apple pie. In general, if the ingredients list looks like a science experiment, then it’s probably an ultra-processed food and something to avoid,” Katherine said.
Additionally, Katherine recommends that people with chronic pain eat foods to support a healthy gut microbiome in order to improve their overall health. She recommends regularly consuming a variety of fibre, through wholegrains, fruit and vegetables, aiming for at least 30g per day, and fermented foods, such as yoghurt, kimchi or, sauerkraut, to nurture good gut bugs.
Probiotic supplements have become a popular for improving gut health, and Katherine says they can be helpful in certain circumstances, but shouldn’t necessarily replace foods that support a healthy gut.
“I would suggest taking probiotics to reintroduce good gut bugs if you’ve had a course of antibiotics, since the antibiotics generally just wipe out your gut. But to get the benefit of probiotics you have to take them every day and they only contain a limited amount of bacteria. So in most cases, it’s better to nurture the gut bugs you already have through food,” Katherine said.
More ways dietitians can improve the lives of people with chronic pain
While nutrition may be the most obvious way dietitians help people manage pain, it’s not their only method of assisting patients to achieve a better quality of life. Katherine acknowledges that food is related to pain on multiple levels, including food insecurity.
According to the National Pain Survey in 2022, nearly 70% of respondents and their households had to reduce the amount of food they purchased to be able to afford medicine and healthcare for chronic pain management. Knowing this reality, Katherine provides her patients with tips on food items that are high in nutrition but low in cost, like tinned beans.
She also helps patients with chronic pain find more accessible and practical ways to incorporate nutritious foods into their diet. For example, she recommends swapping fresh produce with frozen or tinned fruits and veggies to save people with chronic pain from having to stand and chop ingredients.
“It is possible to make preparing nutritious food quick and easy. For instance, you can buy a wholemeal pizza base and chuck a whole bunch of frozen veggies on it with some cheese and maybe some barbecue sauce. This is just one of those four ingredient recipes that you can do really quickly,” Katherine.
Importantly, Katherine says frozen vegetables are just as nutritious, perhaps even more nutritious, than fresh versions because they’re snap frozen straight away. There is no opportunity for their nutritional quality to decrease over time.
What to expect at a consultation with a dietitian
Katherine talked us through what a typical one-on-one session at a private practice might look like:
As part of the first consultation, Katherine takes some time to explain who she is, what she does and, if relevant, why she has interest in this space. She has chronic pain herself, and was driven to become a dietitian because of her interest in food and her desire to help people.
“I did my degree in dietetics around the same time that I had the most significant issues with my chronic pain. I found that understanding the science behind pain really helped with my own symptoms,” Katherine said.
Just as she found knowledge to be empowering in her own pain experience, Katherine ensures her patients are equipped with accurate information and realistic expectations about how diet can reduce pain.
“I don’t want to come across as preaching that nutrition is going to fix everything. It’s not the only thing that will help manage pain, but in combination with other things it certainly will,” Katherine said.
She then asks her patient a series of questions to learn a bit more about them, including what their background is, their medical history, what they do for work, what their family situation is like, and who does the shopping and cooking at home. From there, she takes some time to collect information about what they typically eat.
After gathering all this information, Katherine discusses personal goals with the patient. She ensures that they lead the discussion so the goals are relevant, meaningful, and well-suited to their lifestyle. She then talks through what achieving those goals might look like and ends the session by providing them with resources and information.
How to find a dietitian
Katherine recommends finding a dietitian through the Dietitians Australia website. Just enter your postcode and/or health condition to pull up a list of Accredited Practising Dietitians.
Katherine’s top tips for managing chronic pain through diet
- It’s not just what you eat, it’s also how you eat. Go for nutritious yet practical food items that are suited to your lifestyle, such as frozen and tinned fruits and veggies. It will save you the time and effort of chopping while still providing you with the ability to eat the whole rainbow of produce.
- Incorporate some of these healthy swaps for a more nutritious diet:
- Swap cooking oil to olive oil
- Swap white bread to whole grain
- Swap processed meats to lean meats
- Increase your healthy fats by having a handful of nuts per day
Words by Arianna Camille Menzies