Chronic joint or musculoskeletal pain is the leading cause of disability in the United States and worldwide. Current treatment options are limited in their ability to alter disease outcome. Recent studies are unequivocal about the inflammatory origins of musculoskeletal pain and prove that nutritional therapy can be a cost-effective option to improve patient outcomes in clinical care. This case study examines the effect of a nine-week nutritional intervention in a 47-year-old female with an eight-year chronic pain in her shoulders and knees. The nutritional program included a three-week Elimination Diet Food Plan, followed by a Detox Food Plan. Both diet plans followed guidelines offered by the Institute for Functional Medicine®. The client also had secondary complaints that included nausea, bloating, a foul taste in her mouth, and adult-onset acne. After nine weeks, the client achieved nearly full range of motion in her shoulders. Knee movements improved significantly, and the client was able pursue physical activities without pain. During this time, all digestive issues resolved and skin breakouts reduced, though skin lesions remained.
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References
1.
HootmanJ, HelmickC, BarbourK, et al.Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015–2040. Arthritis Rheumatol, 2016; 68:1582–1587.
2.
WoolfA, PflegerB. Burden of major musculoskeletal conditions. Bull World Health Organ, 2003; 81:646–656.
3.
JordanK, ClarkeA, SymmonsD, et al.Measuring disease prevalence: A comparison of musculoskeletal disease using four general practice consultation databases. Br J Gen Pract, 2007; 57:7–14.
4.
PeatG, GreigJ, WoodL, et al.Diagnostic discordance: We cannot agree when to call knee pain “osteoarthritis.”. Fam Pract, 2005; 22:96–102.
5.
JordanK, TanV, EdwardsJ, et al.Influences on the decision to use an osteoarthritis diagnosis in primary care: A cohort study with linked survey and electronic health record data. Osteoarthritis Cartilage, 2016; 24:786–793.
6.
LuimeJ, KoesB, HendriksenI, et al.Prevalence and incidence of shoulder pain in the general population: A systematic review. Scand J Rheumatol, 2004; 33:73–81.
7.
KiddB, LangfordR, WodehouseT. Arthritis and pain. Current approaches in the treatment of arthritic pain. Arthritis Res Ther, 2007; 9:21–4.
8.
LaineL.Gastrointestinal effects of NSAIDs and coxibs. J Pain Symptom Manage, 2003; 25:32–40.
9.
SokoloveJ, LepusC. Role of inflammation in the pathogenesis of osteoarthritis: Latest findings and interpretations. Ther Adv Musculoskelet Dis, 2013; 5:77–94.
10.
BerenbaumF.Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis Cartilage, 2013; 21:16–21.
11.
GallandL.Diet and inflammation. Nutr Clin Practi, 2010; 25:634–640.
12.
ChrysohoouC, PanagiotakosD, PitsavosC, et al.Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol, 2004; 44:152–158.
13.
HaslerC.Functional foods: Benefits, concerns and challenges—A position paper from the American Council on Science and Health. J Nutr, 2002; 132:3772–3781.
14.
SimopoulosA.Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr, 1991; 54:438–463.
15.
LippielloL, FienholdM, GrandjeanC. Metabolic and ultrastructural changes in articular cartilage of rats fed dietary supplements of omega-3 fatty acids. Arthritis Rheumatol, 1990; 33:1029–1036.
16.
StammersT, SibbaldB, FreelingP. Efficacy of cod liver oil as an adjunct to non-steroidal anti-inflammatory drug treatment in the management of osteoarthritis in general practice. Ann Rheum Dis, 1992; 51:128–129.
17.
GoldbergR, KatzJ. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain, 2007; 129:210–223.
18.
HenrotinY, SanchezC, DebergM, et al.Avocado/soybean unsaponifiables increase aggrecan synthesis and reduce catabolic and proinflammatory mediator production by human osteoarthritic chondrocytes. J Rheumatol, 2003; 30:1825–1834.
GiuglianoD, CerielloA, EspositoK. The effects of diet on inflammation. J Am Coll Cardiol, 2006; 48:677–685.
21.
21. The Institute for Functional Medicine. The Elimination Diet Comprehensive Guide, Version 6. Federal Way, WA: The Institute for Functional Medicine, 2015.
22.
EswaranS, GoelA, CheyW.What role does wheat play in the symptoms of irritable bowel syndrome?. Gastroenterol Hepatol, 2013; 9:85.
23.
Merras-SalmioL, KolhoK, PelkonenA, et al.Markers of gut mucosal inflammation and cow's milk specific immunoglobulins in non-IgE cow's milk allergy. Clin Transl Allergy, 2014; 4:8.
24.
ZopfY, HahnE, RaithelM, et al.The differential diagnosis of food intolerance. Dtsch Arztebl Int, 2009; 106:359–370.
25.
25. The Institute for Functional Medicine. Elimination Diet Food Plan. Federal Way, WA: The Institute for Functional Medicine, 2015.
26.
26. The Institute for Functional Medicine. Detox Food Plan Comprehensive Guide, Version 5. Federal Way, WA: The Institute for Functional Medicine, 2015.
27.
27. The Institute for Functional Medicine. Detox Food Plan. Federal Way, WA: The Institute for Functional Medicine, 2015.
28.
28. The Institute for Functional Medicine. Medical Symptoms Questionnaire, Version 2. Federal Way, WA: The Institute for Functional Medicine, 2015.
29.
HardinJ.Clinical methods: The history, physical, and laboratory examinations. In: Walker H, Hall W, Hurst J, eds. Arthralgia. 3rd ed. Boston, MA: Butterworths, 1990, ch. 160.
30.
30. The Institute for Functional Medicine. Functional Medicine Timeline, Version 5. Federal Way, WA: The Institute for Functional Medicine, 2015.
31.
MifflinM, St JeorS, HillL, et al.A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr, 1990; 51:241–247.
32.
SteenbruggenT, HoekstraS, Van der GaagE.Could a change in diet revitalize children who suffer from unresolved fatigue?. Nutrients, 2015; 7:1965–1977.
33.
ZhangJ, WuZ, CaiY, et al.L-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: A randomized controlled study. Nutr J, 2014; 13:11–0.
34.
SchubertM, IrwinC, SeayR, et al.Caffeine, coffee, and appetite control: A review. Int J Food Sci Nutr, 2017; 68:901–912.
35.
AhnfeltN, ForsH. Making early modern medicine: Reproducing Swedish bitters. Ambix, 2016; 63:162–183.
36.
ChildersN, MargolesM. An apparent relation of nightshades (Solanaceae) to arthritis. J Neurol Orthopaed Med Surg, 1993; 14:227–227.
37.
IorioR, Del DucaS, CalamelliE, et al.Citrus allergy from pollen to clinical symptoms. PloS One, 2013; 8:e5368–0.
RajendranN, KumarD. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol, 2010; 16:1442–1448.
40.
MacDermottR.Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis, 2007; 13:91–96.
41.
SarkerS, AhmedT, BrüssowH.Hunger and microbiology: Is a low gastric acid-induced bacterial overgrowth in the small intestine a contributor to malnutrition in developing countries?. Microbial Biotechnol, 2017; 5:1025–1030.
42.
KingC, LeibachJ, ToskesP. Clinically significant vitamin B 12 deficiency secondary to malabsorption of protein-bound vitamin B 12. Digest Dis Sci, 1979; 24:397–402.
43.
McMullenM, WhitehouseJ, TowellA. Bitters: Time for a new paradigm. Evid Based Complement Alternat Med, 2015; 2015:67050–4.
44.
FolwarcznaJ, ZychM, NowińskaB, et al.Pytlik, M. Unfavorable effect of trigonelline, an alkaloid present in coffee and fenugreek, on bone mechanical properties in estrogen-deficient rats. Mol Nutr Food Res, 2014; 58:1457–1464.
45.
KitawakiJ, KadoN, IshiharaH, et al.Endometriosis: The pathophysiology as an estrogen-dependent disease. J Steroid Biochem Mol Biol, 2002; 83:149–155.
46.
LuceroJ, HarlowB, BarbieriR, et al.Early follicular phase hormone levels in relation to patterns of alcohol, tobacco, and coffee use. Fertil Steril, 2001; 76:723–729.
47.
Hyun SookH, Hyun AhK. Chondrocyte apoptosis in the pathogenesis of osteoarthritis. Int J Mol Sci, 2015; 16:2603–5.
48.
ClarkK.Nutritional considerations in joint health. Clin Sports Med, 2007; 26:101–118.
49.
LopezH.Nutritional interventions to prevent and treat osteoarthritis. Part II: Focus on micronutrients and supportive nutraceuticals. PM R, 2012; 4:S155–S168.
KongJ, YooS, KimH, et al.Inhibition of synovial hyperplasia, rheumatoid T cell activation, and experimental arthritis in mice by sulforaphane, a naturally occurring isothiocyanate. Arthritis Rheumatol, 2010; 62:159–170.
55.
ZhangH, WangY, JiangZ, et al.Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: A prospective cohort study with propensity score matching. Nutrition, 2017; 37:53–59.
