Modified ketogenic diet and supplement based intervention for adults with chronic widespread pain and widespread co-morbid medical symptoms. A case series

Reference as:

Gibbons SGT (2019) Modified ketogenic diet and supplement based intervention for adults with chronic widespread pain and widespread co-morbid medical symptoms. A case series. Proceedings of: The 10^th Interdisciplinary World Congress on Low Back Pain. October 28-31, 2019; Antwerp, Brussels

Introduction:

Chronic low back pain (CLBP) is often associated with chronic widespread pain (CWP). There is growing evidence this presentation is part of a more complex health problem that includes multiple medical co-morbidities, multiple bodily systems and chronic low grade inflammation.  There is preliminary evidence to support the use of dietary and supplement interventions for certain inflammatory and musculoskeletal pain conditions. Sub-classification has been suggested as a strategy to manage CLBP. It was hypothesized that a subgroup of CLBP exists with more severe co-morbid medical symptoms (CMS), which would benefit from a dietary and supplement based intervention.

Purpose/Aim:

The purpose of this study was to assess if a subgroup of cases of CLBP with severe CMS symptoms would have a global improvement with a dietary and supplement based intervention.

Materials and Methods:

56 consecutive subjects (M= 18; F=38) were asked to participate. Inclusion criteria: between the ages of 18-65; CWP; CMS based on a score of 19/19 on the Neuro-Immune-Cardiometabolic-Endocrine symptoms Questionnaire (NICE-Q); unhealthy diet pattern based on a survey; normal medical screening. The main outcome measure was the Global Rating of Change (15 pt) (GROC). Secondary outcome measures included: Numerical Pain Rating Scale (NPRS);  Patient Specific Functional Scale (PSFS); quantitative sensory testing (QST); nociceptive flexion reflex (NFR).Subjects were interviewed and explained the study protocol to ensure compliance. Included subjects went through an orientation phase up to 3 weeks (healthy eating). Following this they took supplements q.d. in the morning (omega 3 fatty acids: 3.5g; curcumin: 1g; probiotics: 50B; Inulin: 10g; Vitamin D3: 10,000IU); followed a healthy ketogenic diet and eliminated foods containing gluten, dairy and soy for 6 weeks. Subjects attended twice a week during the first 3 weeks and once a week for six weeks. Blood ketones were measured with a blood ketone meter. Questionnaire outcome measures were taken at baseline, nine weeks, 6 months and 12 months. QST and NFR were assessed at baseline and 9 weeks. Descriptive statistics were used.

Results:

8 subjects did not want to participate due to the dietary changes. 3 subjects withdrew after 6 weeks due to difficulty maintaining the diet. 48 subjects (17M; 36F) completed the outcome measures at each stage. The mean change at 9 weeks was GROC: +4.8 (2.8-7.0); NPRS: -3.4; PSFS: +10.6. QST and NFR improved in all subjects and returned to within normal limits in 37 subjects (77%). All subjects noted clinically relevant changes within 2 weeks. At 12 months the GROC was +5.4 (3.2-7.0); NPRS -3.8; PSFS: +12.2.

Conclusion:

This study provides preliminary evidence that in a subgroup of subjects with CWP, CMS and normal medical screening, a ketogenic diet and supplement intervention may be beneficial for: global improvement, pain, function, and laboratory measures relating to sensory hypersensitivity in subjects with CWP, CLBP and severe CMS. Further research is needed in a larger sample, other subgroups and a clinical trial.

Keywords: Chronic widespread pain, ketogenic diet, sub-classification

Note: the reason I chose a ketogenic diet was because I could measure it to know if subjects were complying. A normal functional medicine approach would match the dietary and supplement needs to the specific person and address the cause(s) of the low grade inflammation.