This week, we’ll be focusing on a study by a group of researchers from Australia. The title of their paper is Effects of a low-carbohydrate ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain: A pilot randomised clinical trial. It was published in Pain Medicine in February 2022.
The aim of this research was to determine changes in reported pain, metabolic biomarkers, inflammation, and quality of life in patients with chronic pain on a well-formulated whole-food ketogenic diet (WFKD) compared to a whole-food diet (WFD).
Time to go over some of the notable points of this paper.
Who were the participants in this study?
27 participants were enrolled in this study with an average age of 53 years and ranging from 37 to 74 years. Of the 27 participants, 23 were female and 4 were male. Their average BMI is 29. The most common pain they experienced was spinal pain. 6 of the participants were diagnosed with fibromyalgia.
Participants were included in this study if they were 18 years or older, had experienced chronic musculoskeletal pain for over three months, were currently eating a standard Western diet, and had a baseline pain score of over 30 on a scale of 0-100, with 100 most severe. Alternatively, applicants were ineligible to participate in the study if they took insulin or oral hypoglycemic medications, had a history of eating disorders, had bariatric surgery, and/or had recent weight loss.
What were the methods used?
All participants used a whole foods diet (no ultra-processed foods) for three weeks prior to starting the study. They were then randomized into two groups for the 9-week intervention. One group continued with a whole-food diet (n=9) and the other group began using a well-formulated whole-food ketogenic diet (n=15). The main difference between the two diet groups was that the ketogenic diet group consumed much fewer carbohydrates.
By having all participants use a whole-food diet, this effectively removed a potential confounding variable. If the ketogenic group was the only group that didn’t have processed foods, outcomes could have been related to that rather than a reduced carbohydrate intake. The participants were then assessed again at a 3-month post-intervention follow-up.
It should be noted that the groups were of different sizes (9 in the whole food group and 15 in the ketogenic diet group) because three of the participants were in a family group, so they had to be randomized as a single unit.
Now let’s take a look at the measurements/assessments this study used.
Measurements/Assessments
Because the study aimed to determine changes in reported pain, metabolic biomarkers, inflammation, and quality of life in patients with chronic pain, the researchers needed to observe the following:
Adherence to diet – Adherence was assessed using blood ketones levels (higher levels indicated adherence in the ketogenic diet group). Participants were also asked to report what they ate in the last 24 hours. This was then assessed for adherence to their particular diet.
Blood labs – C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fasting glucose and insulin (with HOMA-IR for insulin resistance calculated), lipid panel
Pain – Brief Pain Index (BPI), which rates pain severity (worst, lowest, average, and current level using a scale of 0-100) and pain interference (general activity, mood, walking ability, normal work, relationships with others, sleep, and enjoyment of life scale of 0-100) in the previous 24 hours. A Daily online diary was also used to rate the worst, least, and average pain for the day; any change in medication use; and a rating of current mood, sleep, and adherence to their diet.
What were the results?
In terms of pain, both groups had reduced reported pain, but the ketogenic group did significantly better. There was also a significant correlation between diet adherence and pain relief in the ketogenic group, but interestingly enough, no such correlation existed in the whole foods diet group.
As for blood values, both groups showed a reduced CRP, but the ketogenic group reduced more. There were no other significant changes in blood values for either group.
In the area of quality of life, both groups improved, but the ketogenic group did much better. For instance, the average rating for anxiety, depression, and mood improved significantly for the ketogenic group, but not for the whole foods group.
The ketogenic group lost significantly more weight than the whole foods group (3.9 kg/8.6 lbs. versus 1.2 kg/2.6 lbs.). Both groups reduced their caloric intake, but the ketogenic group reduced much more (802 kcal vs. 399 kcal) while still reporting satiation.
The ketogenic group also significantly reduced their carbohydrate intake, while the whole foods group did not. Neither group had a significant change in protein or fat intake.
At the 3-month follow-up, both groups maintained their respective reductions in pain severity and pain interference in both the daily visual analog scale and the Brief Pain Inventory. But the ketogenic group had already outperformed the whole foods group at the end of the intervention period.
On the daily pain scale, the ketogenic group had an almost 18-point reduction in pain while the whole foods group maintained an 11.4-point reduction. The results from the Brief Pain Inventory also showed that the ketogenic group did significantly better (16-point vs. 4-point improvements).
It’s important to note that the ketogenic group continued to have a greater overall reduction in carb intake than the whole foods group.
Takeaways
Removing ultra-processed foods had a beneficial impact on pain for both groups. Still, it looks like restricting carbohydrates even further by using a ketogenic diet may have even greater impacts on pain, weight, and mood. The main difference between the two diets was carbohydrate intake, as both diets were based on whole foods. Having everyone start on a whole food diet not only removed a potentially confounding variable, but it might have also made it easier for the ketogenic group to adhere to the diet as the change was not so drastic from their standard Western diet. This study demonstrates that eating a whole foods diet may be good for many disorders, including lipedema, but a ketogenic diet is prescription-strength and gives much better results.
This study is important for women with lipedema because it demonstrates that carbohydrate restriction to ketogenic levels (20 grams or less of carbohydrates per day) can be a powerful tool for chronic pain, a symptom that many individuals with lipedema suffer from. Overall, this study shows the favorable impacts of a ketogenic diet on several symptoms seen in the lipedema population besides pain, including weight gain and mood disorders such as depression and anxiety. This study demonstrates that we are on the right track with using keto for lipedema symptoms.
For more updates on the latest research regarding lipedema, check out Lipedema Simplified’s Flash Briefings. It’s our daily mini-podcast where we share tips, tools, and research pertaining to Lipedema.
~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project