SIB# 458- Treating Pain With Diet

The Study: Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial

Key Points: 

·         The authors sought to determine whether dietary interventions to increase intake of Omega 3 fatty acids (EPA and DHA) both with and without reduction in Omega 6 fatty acid (Linoleic Acid) could alter circulating lipid mediators implicated in headaches and/or decrease migraine headaches in a group of adult subjects.

 ·         This study builds on previous work demonstrating proof of concept that food based increases in Omega 3 fatty acids in conjunction with reduction of Omega 6 can be effective for headache.

 ·         This paper looked at 182 participants (88% women, mean age 38 years) who were experiencing migraines 5-20 days per month. 

·         The study compared the effect two diets to a control diet which provided Omega 3 and 6 in ratios representative of the average American diet (i.e. EPA/DHA ≤ 150 mg and Linoleic Acid 7.2% of total caloric intake).  

·         Intervention #1- (H3 Diet) provided 1500 mg of Omega 3 (EPA and DHA) only. 

·         Intervention #2- (H3-L6 Diet) also provided 1500 mg of Omega 3 (EPA/DHA) while also reducing the intake of Omega 6 (Linoleic Acid) to less than 1.8% of total caloric intake. 

·         All dietary modifications consisted of food only and did NOT involve any supplements. 

·         Primary endpoints measured were a six item headache impact test (HIT-6) to measure clinical impact as well as blood testing to measure levels of 17-HDHA and other antinociceptive (pain relieving) factors previously shown to be related to headache frequency and severity. 

·         At study entry, participants were averaging 16.3 headache days per month and 5.4 headache hours per day. 

·         67% of participants were considered chronic migraine patients and more than half (56%) also met the criteria for acute overuse of pain medications. 

Results:  

·         On a biochemical level, both the H3 and the H3-L6 diets produced 46-95% increases in EPA/DHA levels in red blood cells and immune cells. 

·         Likewise, the H3-L6 diet also decreased levels of pro inflammatory Omega 6 (Linoleic Acid) in both red blood cells and immune cells compared to the H3 diet. 

·         Compared with the control group, both the H3 and the H3-L6 groups significantly reduced the number of total headache hours per day as well as the number of headache days per month. 

·         The H3-L6 (High Omega3/Low Omega 6) diet produced twice the reduction in headache days as the H3 diet (High Omega 3 only). 

·         As further evidence of reduced pain levels, participants in the H3-L6 Group significantly decreased their use of NSAIDs over the course of the intervention.

Author’s Conclusions: “the study provides a biologically plausible demonstration that pain can be treated through targeted dietary alterations in humans” and opens “the door to new approaches for managing chronic pain in humans.” (emphasis ours)

Reviewer's Comments: Interesting paper with potential application far beyond just migraines. Also makes a good case that individuals interested in increasing their Omega 3 intake would be well served to also limit their intake of Omega 6 fats commonly found in grain seed oils and processed foods.

 Reviewer:  Mark R. Payne DC 

Reference:  Ramsden CE, Zamora D, Keturah FR, MacIntosh B et al.  Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. British Medical Journal. June 30, 2021 

Link to Full Text: https://www.bmj.com/content/374/bmj.n1448