Dear Laura... Will an anti-inflammatory diet actually help my chronic pain? (Part two)

Welcome to ‘Dear Laura’ - a monthly column where I fashion myself as an agony aunt and answer the questions that readers submit. If you’d like to send in a question for me to answer next month - then you can submit it here.

I’m happy to answer Qs about anti-diet nutrition, developing a more peaceful relationship to food and weight-inclusive health, annoying diet trends and news stories, body image challenges, and, of course, challenges with feeding your kiddos. Please give as much detail as you’re comfortable with and let me know if you’d like me to include your name or keep it anon.

Please remember that these answers are for educational purposes only and are not a substitute for medical or nutritional advice; please speak to your GP or a qualified nutrition professional if you need further support.

As a reminder, this week is part two of answering a *ahem*, ‘reader’ question about whether anti-inflammatory diets can help attenuate some of the inflammation associated with chronic pain.

Here’s the question in full again:

I suffer from chronic pain in my hips and have done for around 12 years. During my pregnancy 4 years ago, I suffered from ‘pelvic girdle pain’ which didn’t go away after having my baby and has been gradually getting worse/more debilitating. I’ve seen various different (bad) physios and have been working with a good physio consistently for over a year doing clinical pilates and some manual therapy. I also recently had an MRI scan which showed significant inflammation in my hips and have recently had a steroid injection in one of them (which, hasn't helped so far).

The thing is, people keep asking me if I’ve tried an ‘anti-inflammatory diet’. My sense is that it’s probably bullshit, but I wanted to get your opinion since I’m in so much pain and feel like I’m running out of options. For background, I’m vegan (not that I count, but I definitely get 30 plants a week). I generally eat well, but I do eat plant-based products that would be considered ‘ultra-processed’ or higher in sugar. I don’t feel like giving up little pleasures like a vegan croissant or chocolate (or lets be honest, spooning Biscoff from the jar). I guess my question is, is the juice worth the squeeze? An anti-inflammatory diet sounds super restrictive and like it could mess with your head to always worry whether or not something is causing inflammation. Are there any other weight-inclusive recommendations you would make instead?

And follow-up: are people just low-key telling me to lose weight and using the ‘anti-inflammatory diet’ as a sort of socially acceptable way of doing that? I don’t weigh myself, but I know my BMI would be in the ‘ob*se’ range. I’m straight size, so I’m not getting the outright fatphobia I know other people deal with, but I guess it’s worth asking about the relationship between weight and inflammation too?

In part 1 we discussed:

• How inflammation is a normal physiological response to injury, infection, or metabolic stress
• How inflammation that doesn’t resolve can become chronic and either high-grade (as in some disease states) and low-grade (as with aging and high and low body weight - but even that is complicated)
• There are lots of factors that influence inflammation outside of diet, including: age, activity levels, genetics (sort of), the gut microbiota, smoking, alcohol, stress, stigma, and oppression, sleep, exposure to air pollution and other environmental exposures, and anti-fat bias
• As with a lot of wellness woo, there’s a grain of truth that some foods can be ‘anti-inflammatory’, but as with everything in nutrition: it depends.
• Gluten, sugar, and dairy have all been vilified as ‘inflammatory’, and while some people (especially with clinical conditions) may struggle with these foods, they are not universally ‘pro-inflammatory’ and for many people are part of an overall anti-inflammatory eating pattern
• This has prompted scientists to focus less on individual foods or even nutrients, and look more closely at dietary patterns, which is what we’ll look at today.

So we have established that claims made about dairy, gluten, and sugar ravaging your body with ‘hidden inflammation’ is probably a stretch. And at the same time, like all good wellness woo, there’s something here we need to pay attention to.