Nov. 26, 2008 -- A few years ago, my mom woke me up in the middle of the night complaining of chest pains. As I frantically searched for my car keys, one scary thought kept racing through my mind: "She's having a heart attack. ... She's having a heart attack. ..."
I hurried her into my car, backed out of the driveway and took off for the hospital. About halfway there, she told me to pull the car over. She was feeling better, but I insisted on taking her to the hospital. After a quick exam, the doctor said she was fine and blamed the chest pains not on a heart attack but on acid reflux.
The culprit? Our traditional Sunday afternoon pasta and tomato sauce, eaten just a few hours before.
While an estimated 40 million Americans live with what they describe as chronic pain, many more suffer from acute bouts of pain, such as acid reflux and headaches. But be it chronic or acute, pain is something we'd all like to live without.
Dr. Neal Barnard, founder and president of the Physicians Committee for Responsible Medicine and president of the Cancer Project in Washington, D.C., believes that pain-free living could be a dietary change away.
"What we know is that when people eliminate certain foods from their diets, their symptoms are eliminated or reduced, so we know that there is a link here," says Barnard, who is an outspoken advocate of vegetarianism. The link could be a number of things, ranging from a reaction to certain proteins found in particular foods, to an increase in cholesterol, which can irritate the lining of our arteries, he says.
Since pain is something that we'd all like to live without, we've rounded up the worst pain-inducing offenders for headaches, acid reflux and arthritis.
But as Dr. Ali Askari, director of rheumatology at University Hospitals Case Medical Center in Cleveland, warns, results may vary.
"It's different for each person," he says. "For instance, John's arthritis may get worse when he eats tomatoes or carbonated beverages, but Mary's arthritis may get worse when she drinks coffee."
Both Askari and Barnard agree that the best approach is elimination.
We put them in chunks on our salads. We eat them ground up in our tomato sauce. And the chemical that makes them so red -- lycopene -- may lower our risk for certain cancers. But for the millions of Americans who suffer from heartburn and acid reflux, the tangy fruit is a chest pain waiting to happen.
"Tomatoes or tomato-based products can lead to or contribute to heartburn because they affect the lower esophageal sphincter," says Dr. Felice Sussman, a gastrointestinal specialist and director of research at Weill Cornell Medical College in New York.
When you ingest things like a tomato or spicy foods, the lower esophageal sphincter has an abnormal relaxation, and it allows the acid contents of the stomach to splash back up into the esophagus. This causes the discomfort known as heartburn, says Sussman.
And although everyone experiences small amounts of reflux every day, some people's acid reflux is so severe that the excessive amount of acid actually breaks down the lining of the esophagus, leading to extraordinary pain.
"The most classic symptom that people describe is heartburn, and what that typically means is that they have a burning sensation in their chest area," says Sussman. "They can also get bad breath. Some people will cough or get wheezy, and some people can feel pain that is similar to that of a heart attack."
Although there appears to be no great substitute for tomatoes, Sussman suggests not eating them near bedtime.
"There are many people who in the middle of the night are refluxing, and it's because of something that they ate for dinner," she says.
And since gravity is the one thing that helps with acid reflux, when someone lies down with a distended stomach, gravity isn't allowed to work. To help combat against this, Sussman tells her patients to prop themselves up in bed at a 15-degree angle.
If you are all too familiar with the fiery sensation in your lower chest that grabs hold of you after you eat something citrus-y, you have plenty of company. One in every 10 Americans suffers from acid reflux or heartburn on a weekly basis. Although the acid reflux-inducing citrus fruits can vary from person to person, the most common offenders are oranges, grapefruits and lemons.
As with tomatoes, it is the high acid content of these fruits that causes the pain, Sussman says. The aggravation is the same as well; eating citrus-y foods affects the lower esophageal sphincter in much the same way as tomatoes. These foods cause the lower esophageal sphincter to overly relax, allowing acid to squirt back up in to the esophagus, leading to heartburn. Excessive acid reflux can eat away the lining of the esophagus and if left untreated can cause difficulty in swallowing or even cancer of the esophagus.
For those who suffer from acid reflux, the first thing Sussman likes to do is talk about lifestyle modifications.
"Most people want to take a magic pill to cure reflux, but really, everything starts with the patients and the habits they have," she notes. One such lifestyle change she recommends is keeping a food diary to help identify reflux-inducing foods in your diet and then eliminating them.
Sussman does admit that despite lifestyle changes, many patients need to go on medication to help their acid reflux and some many even require surgery to help correct a weakened lower esophageal sphincter.
Although it may be a weekend ritual for many, Askari cautions that consuming high-fat meats such as bacon could be the cause of your arthritic pain, especially when the meats are deep fried. The average slice of bacon is made up of 71 percent fat, and about half of that fat is saturated fat -- and that's before it's cooked.
Eating high-fat meats such as bacon may form the internal substances that are responsible for inflammation, Askari says. And it's this inflammation that leads to increased arthritic pain.
"Saturated fatty acids lead to the formation of arachidonic acid, which in turn converts to inflammatory substances called prostaglandins and leukotrienes, which are pro-inflammatory agents," notes Askari.
And if the prostaglandins and leukotrienes don't get to you, the extra weight you'll put on by consuming fatty foods will, says Dr. Carol Warfield, a professor of anesthesiology at Harvard Medical School.
"In my experience, the greatest effect of diet on arthritis is weight control," Warfield says. "There is no question that being overweight makes osteoarthritis worse, especially that involving the knees and hips."
A great substitute for the traditional high-fat bacon is turkey bacon, which on average has half the calories as pork bacon and just five fat calories. For some brands of turkey bacon, none of this fat is saturated. And this reduction in saturated fat could reduce or eliminate your arthritic pain, Barnard says.
If you are thinking about ditching the bacon for more eggs, you many want to reconsider. Askari warns that eggs contain the same pro-inflammatory agents as bacon. Eggs contain arachidonic acid, and as this acid is broken down by the body, "in some, but not all individuals, this can lead to the formation of inflammatory prostaglandins," Askari says. These inflammatory prostaglandins can lead to increased swelling and joint pain.
Eggs also contain a fair amount of saturated fat, which many doctors believe has a direct link to increased inflammation and arthritic pain. An average large white egg is 63 percent fat, a third of which is saturated fat. These saturated fats could lead to the development of the pain-inducing prostaglandins and leukotrienes in much the same way as they could in bacon, says Askari.
Since most of the fat and cholesterol of an egg is found in the yolk, one way to have your egg and eat it too would be to eliminate the center. A large white egg with the yolk removed comprises only 3 percent fat and contains no saturated fat. And if separating the yolk from the egg is a bit too tricky for your culinary talent, egg substitutes are another great option. A one-quarter cup serving, which is the equivalent of two medium-size eggs, has zero fat calories and contains zero saturated fats.
Eliminating saturated fat-filled egg yolks from your diet could reduce your arthritic pain, but Askari does caution, "the results are not uniform, and reactions should be monitored individually."
"Cheese is arguably the most unhealthy food out there," says Barnard. When you look at the label and see what's in it, it's hard to argue.
Up to 70 percent of the calories found in cheese come from saturated fat, which is known to raise a person's cholesterol and could set the body up for inflammation.
In the early 1900s, says Barnard, the average American was consuming 4 pounds of cheese a year. That number jumped to 15 pounds in the 1970s and is even higher today.
"Thanks to call-out pizza services and all the restaurants that believe you can't have a sandwich without cheese all over it," notes Barnard, "we're now consuming 32 pounds of cheese annually."
Barnard says this excess cheese consumption can cause pain in several ways. While people used to believe that aged cheeses caused the most damage, many now agree that all cheeses are to blame. Besides being a major weight control deterrent, Barnard believes that the inflammation some people experience in response to eating cheese may in be a reaction to the protein found in the cheese -- very similar to an allergic reaction.
Barnard suggests switching to soy cheeses, although he does admit that "most of them taste like glue."
However, soy cheeses are naturally cholesterol-free, contain fewer calories and boast half the saturated fats of regular cheese. And since saturated fats, obesity and cholesterol could all contribute to the development of pro-inflammatory agents, Barnard says avoiding cheese may reduce your arthritic pain.
Some call it pop. Others call it tonic. But most of us just call it soda. Regardless of what name you give it, soft drinks are one of the most consumed beverages in the United States.
According to a 2005 American Beverage Association study, 28.3 percent of America's total beverage consumption consisted of soft drinks. And according to government data, this "liquid candy" is so ubiquitous that it contributes to about 10 percent of the calories consumed in the average American diet.
And Barnard says diets that are high in sugar have been associated with inflammation, since excess sugar consumption can lead to obesity, which is known to cause joint pain and swelling.
The average 12-ounce can of soda contains 136 empty calories and 33 grams of sugar -- the equivalent of 11 sugar packets or more in every can.
According to a report by Michael Jacobson of the Center for Science in the Public Interest, "carbonated drinks are the single biggest source of refined sugar in the American diet."
Eliminating soft drinks, as well as other sugary foods such as pastries, candy and sweetened cereal from your diet could help your pain, says Barnard. And he says it does not matter if it is table sugar or high fructose corn syrup; both need to be replaced. He suggests switching over to plain old water but understands this switch is not easy for everyone.
"Kids don't think it's very chic to have water; they'd rather have a Mountain Dew," says Barnard, adding in a faux French accent, "If you are looking for something chic, grab an Avon bottle."
It's been argued that, next to diamonds, chocolate is a girl's best friend. And although chocolate in moderation can actually help relieve the pain of headaches, consuming too much of it can bring on a migraine. As it turns out, chocolate contains the chemical phenylethylamine, and too much of it may affect concentration and can cause a nasty "chocolate hangover" for some.
Previously, migraine sufferers were told to avoid cheese, chocolate and red wine. But chocolate is really "up in the air" because it's not a trigger for everyone, says Dr. Carolyn Bernstein, attending neurologist and medical director of medical specialties at Cambridge Health Alliance in Boston.
"It really varies from person to person," she says. "Some people can eat a little bit, but for other people, they may be so sensitive that they can't eat it at all."
Bernstein believes that this sensitivity could be due to the amount of cocoa or caffeine found in chocolate.
"I don't think people realize how much caffeine is in chocolate," she says. "Especially the darker chocolate. There's a lot."
Dark chocolate, which contains 70 percent cocoa or more, is the worst caffeine offender, containing twice as much caffeine as regular milk chocolate. The average 1-ounce piece of dark chocolate contains about 20 milligrams of caffeine. That's the same amount of caffeine found in a 1-ounce shot of espresso.
And although Bernstein admits that there is "no substitute for chocolate," she does suggest carob, the Mediterranean edible seed pods, as a substitute for those who experience chocolate-induced migraines. However, she does warn that the taste is significantly different from chocolate.
Although it's true that drinking too much wine can cause just about anyone to get a headache, for some people drinking any amount of wine will bring on a vicious migraine, nausea and flushing. For some, these symptoms can develop as quickly as 15 minutes after their first sip of wine.
It was previously believed that red wine headaches were caused by sulfites in the wine, some of which are created naturally as the yeast breaks down sugars in the grape juice and turns them into alcohol and carbon dioxide. But most of the sulfites found in wine are added after the fermentation process and act as a preservative.
However, Bernstein argues, the sulfite-induced-headache theory has pretty much been debunked. The only people who have a reaction to the sulfites in red wine are people who already have sulfite allergies.
Instead, wine headaches may be blamed on the amino acid tyramine, which have been shown to induce migraines in many people, says Bernstein, although she does admit that "no one knows for sure."
Bernstein also believes that wine headaches could also be caused by the dehydrating effects of alcohol and recommends the "one-to-one" approach. "For every glass of alcohol or wine you consume, have a glass of water with it," she says.
She also suggests drinking your wine with food, since the food will absorb the alcohol and help you remain well hydrated.
For those who are really sensitive to wine, Bernstein recommends organic wines, which are, according to USDA guidelines, "a wine made from organically grown grapes without any added sulfites." They are also free of other chemicals that are introduced during the fermentation process and could serve as a great alternative to more processed red wines.
"With regard to processed foods, there's everything bad about them and nothing good," Barnard says. They're high in cholesterol and high in fat -- and in December 2007, researchers at the National Cancer Institute reported that a high consumption of processed meats could put you at an increased risk for a variety of cancers.
And if that's not enough to keep you away from a ballgame frank, Barnard says they could increase your arthritic pain as well.
Processed meats such as lunch meat, hot dogs and sausages contain chemicals such as nitrites that are associated with increased inflammation and chronic disease. This is partially due to the unhealthy fats used in preparing and processing these foods, especially the trans fats and saturated fats.
The average hot dog (plus the roll) has 315 calories, 52 percent of which comes from fat, including 7 grams of saturated fat. Barnard says it's these saturated fats that can cause you pain, since they can lead to swelling of the joints.
"The saturated fats tend to be pro-inflammatory, whereas the unsaturated fats tend not to be," says Barnard.
He suggests substituting your traditional hot dog for a veggie or soy one.
"If you go to the meat counter at your grocery store, sitting right next to the hot dog you can find a veggie hot dog, and right next to the hamburgers, you can find veggie burgers," he says.
A vegetarian hot dog has just 56 calories and no saturated fat, and a vegetarian burger has only 70 calories, a half gram of fat and no saturated fat.
Barnard does admit that "They're not culinary art, but they're much better than what you're replacing."
Junk Food/Potato Chips
Although Barnard agues that "everything we've been talking about so far qualifies as junk food," potato chips are one of the most common and ubiquitous junk foods out there.
Besides being loaded with saturated fat -- the average 1-ounce serving has a whopping 155 calories, 16 percent of which comes from saturated fat -- the potatoes from which they come are also part of the nightshade family. According to Warfield, consuming members of this family of plants has been associated in the past with increased inflammation and arthritic pain.
Barnard also believes that certain proteins in potatoes may just trigger a bad reaction in some people, quite similar to an allergic reaction. This reaction could cause painful migraines or arthritic flare-ups.
He suggests substituting sweet potatoes or yams for the white potatoes or potato chips. Although a 1-ounce serving of sweet potato chips carries about the same amount of calories as a regular potato chip, they only contain 5 percent saturated fat, which could help decrease arthritic inflammation.
However, since both chips contain about the same amount of calories and fat, just substituting a sweet potato for a white potato will not address the biggest problem with eating them -- weight gain. And Warfield says that in her experience, weight has the largest bearing on arthritis pain. So it might be better to just pass on the potato chips altogether.