Almost a fourth of the U.S. population lives with chronic pain, with treatment options including medication and physical therapy. But where does nutrition fit in? Is it possible to reduce chronic pain with food and weight management?
In this episode of On Nutrition, Healthnix app founder Maja Mazur and registered dietitian Chelsey Hoffmann talk about the gut-brain connection’s role in pain, which foods trigger inflammation, and how supplements may or may not help.
Listen to Can diet help with chronic pain?
Read the transcript:
Maja Mazur: We are in a banana lovers camp, aren’t we, Chelsey?
Chelsey Hoffmann, PA, RD: Yes.
Tara Schmidt, RDN, LD: This is “On Nutrition,” a podcast from Mayo Clinic where we dig into the latest nutrition trends and research to help you understand what’s health, and what’s hype.
I’m Tara Schmidt, a registered dietician with Mayo Clinic in Rochester, Minnesota.
This episode — Managing chronic pain.
Almost a fourth of the U.S. population lives with chronic pain — defined as pain lasting more than three months. There are plenty of treatment options available, including medication and physical therapy, but where does nutrition fit in?
Is it possible to reduce chronic pain with food and weight management? Here to help us parse out the health from the hype are Maja Mazur and Chelsey Hoffmann. Maja’s own experience with chronic pain led her to found Healthnix, a platform that works with patients and dieticians to find the best lifestyle plan for managing chronic pain symptoms. And Chelsey is a physician’s assistant and registered dietician in the Division of Pain Medicine at Mayo Clinic in Rochester, Minnesota.
Maja, can you share your experience with chronic pain and how it led to the founding of Healthnix?
Maja Mazur: The story began in my early twenties when I was working my first corporate job in London. And it was a very high stress, working environment. I was doing lots of sports, lots of gym, lots of hiking, and I developed really strong chronic hip pain. And initially I thought it was going to go away very quickly, but it never did.
I had great health insurance and, you know, we were throwing money at it. We were trying injections, physical therapy, medication. Nothing was really helping to the point where my worst flare-ups really left me barely able to walk. I couldn’t even sit in a car because the seats are inclined, which is something I never thought about before. I was really scared.
We put me on a shortlist for surgery and, thankfully, at that time I met someone who specialized in nutrition, who basically asked me whether I have tried doing anything about my nutrition to help with chronic pain. I was really skeptical. I’ll be very honest about it, you know, I thought I was eating well. I didn’t really think he could help me, but I had nothing to lose. And really working with that person completely transformed my health. I not only really learned what foods were triggering inflammation and gut health issues for me and my pain flare-ups, but I also got rid of other symptoms, like brain fog, fatigue. My sleep got better.
And, you know, once I’ve recovered and I was at the peak of that realization that it really worked. I was already working in tech so very naturally started thinking about how can I use that personal experience as a patient, but also my knowledge of technology to build something to really make clinical nutrition the standard of care for chronic pain management and not an afterthought.
Tara Schmidt, RDN, LD: I remember you telling me your story the first time we met a few years ago, so thank you for being willing to share. Chelsey, you have such a unique career path being a dietician and also an advanced practice provider.
Tell us about the counseling that you do for patients with chronic pain.
Chelsey Hoffmann, PA, RD: Here at Mayo Clinic we’re a highly interventional pain management practice. So I’m always looking at these things with an eye of, is there something non-pharmacologic that we could do to help a patient that would offset their need to take medications on a daily basis?
And I’m seeing more and more as we move into 2026 and beyond, there’s a heavier emphasis and interest in our patients that are coming in to see us on lifestyle medicine. So people are actually starting to come to me more and more with questions about, well, what about diet? What about supplements that I could take? And I think people are really just craving non-prescription medication options. They’re starting to take their health into their own hands. They’re doing their own research, but they really need a knowledgeable clinician to try to help guide them through what is evidence-based and what is something that they’re just seeing in some sort of social media platform that maybe doesn’t have a lot of evidence behind it.
Tara Schmidt, RDN, LD: You work with patients who have chronic pain. How do you define that? And I know that there’s musculoskeletal pain, there’s neuropathic pain. I think it can be a combination. How do we define those diagnoses?
Chelsey Hoffmann, PA, RD: It’s pretty well-defined or well described that any pain that has been present for 12 weeks or longer is, by definition, chronic pain.
Before that, depending upon which definition that you’re looking at, people might call pain acute or even subacute. But once we hit that 12-week mark and beyond, it’s chronic. And you’re right, we can also define pain based upon the mechanism or the nature of pain.
And so some people will discuss joint pain as being musculoskeletal in nature, or folks that have neuropathic or neuropathy type of pain, more the burning, the tingling, and some people have a combination of both. So we can classify pain either from the duration or based on the mechanism or nature of the pain.
Tara Schmidt, RDN, LD: Then, what are some conditions that are usually linked to the chronic pain or inflammation?
Chelsey Hoffmann, PA, RD: I would say pick your choice. When I think about the main reasons that individuals in our modern day society seek care from their primary care provider, the majority of those indications are sort of rooted in inflammation. And so we think about things like cardiovascular disease, including high blood pressure, high cholesterol, stroke, type 2 diabetes, endometriosis, chronic musculoskeletal pain, even rheumatologic conditions.
Those are all rooted in chronic inflammation.
Tara Schmidt, RDN, LD: And speaking of inflammation, a key driver of chronic pain, can we talk about whether there’s a connection between excess weight or obesity and chronic pain?
Chelsey Hoffmann, PA, RD: There’s absolutely a connection. There is a link between chronic pain, chronic musculoskeletal pain, and pre-obesity or obese conditions. We’ve seen in multiple research studies that chronic pain is more common in individuals who are pre-obese or obese. There’s some studies that show that as BMI rises in severity, that pain scores also accordingly rise in severity as well, but not always. There’s some research that has shown that that’s not the case, but without a doubt there’s a connection between the two and it’s a vicious cycle.
Tara Schmidt, RDN, LD: And you both are experts in this in your own ways, but I would love to hear about the cycle of chronic pain, obesity, inflammation and, of course, nutrition.
Maja Mazur: The way that we think about obesity — or actually patients who are underweight as well — and nutrition and inflammation and chronic pain is more through the lenses of what is the nutritional status? Do they get the fuel that their body needs in order to really function at its best?
And we really think about the four main mechanisms being, what is driving the inflammation in the body of that particular person? What might be affecting the metabolism? What might be affecting the nervous system — so making it more reactive rather than calmer? And then also that gut-brain axis. And when it comes to patients who are overweight, there is a whole body of research that points to certain inflammatory cytokines being produced as a result of the excess fat tissue in the body.
Tara Schmidt, RDN, LD: And those cytokines you mentioned are proteins that help control inflammation when you’re sick, but having too many of them can trigger inflammation and autoimmune diseases.
Maja Mazur: Yeah. But we know that that’s not all that there is to it. Patients with arthritis also can experience stronger chronic pain as a result of mechanical load.
We know that patients who show up with nutritional deficiencies, malnutrition can experience higher severity of pain and that is, you know, typically not linked to excess body weight. I think it really comes into play when we think about patients who think that being obese is the problem when it comes to chronic pain and it often like is not that simple.
So we really like to say that what we are chasing is not a change in the number on the scale, but it’s a change in what kind of fuel and nutrients are you giving to your body every single day and how that translates to your nervous system.
Tara Schmidt, RDN, LD: Let’s talk about this gut-brain pain relationship. Maja, you mentioned it quickly, can we talk a little bit more about how those two are connected?
Maja Mazur: Yeah, so we like to say nutrition will probably never substitute the medical treatment for chronic pain or mental health for that matter. But if you’re fueling your body with foods that really help you reduce inflammation and regulate metabolism, improve your gut microbiome, you are creating an environment that is more conducive to a less reactive nervous system.
And then we know that inflammatory foods, which create inflammatory cytokines, can actually disrupt your neurotransmitter pathways, which means that your body is not correctly producing serotonin or dopamine.
Tara Schmidt, RDN, LD: I see. So that has to translate into mental health as well.
Maja Mazur: Yes, exactly. And that translates to feeling more anxious, feeling more severe pain, flare-ups. And I know that I’ve really lived that as a patient because I recall when my flare-ups were getting so bad, I was in this forever vigilance mode when I would just really pay attention to the tiniest new flare-up.
I would sit on a new chair that was uncomfortable and it would just spike so much angst and, you know, inner panic in me. And I would think not only about how uncomfortable I was in the moment, but I would also think about, oh my God, like what will this look like in the future? And we do know that really taking care of your gut microbiome can help you calm this system down.
Tara Schmidt, RDN, LD: And Chelsey, can you talk to me more about mental health and how that can influence levels of pain, or I’m assuming vice versa? Opportunities for pain management, like you mentioned, we do such a nice job of these interdisciplinary teams at Mayo. I’m assuming that you have multiple mental health providers in your department as well.
Chelsey Hoffmann, PA, RD: Yeah, we do. Oftentimes when we see patients for a medical consultation, we’ll piggyback what we call a wellness consult, where my colleague can meet with them and talk about cognitive behavioral therapy for chronic pain management.
Because we know that our thoughts and our emotions and our behaviors are so intimately connected with our experience of chronic pain and, as a practice, we really strive to treat the whole person. I always tell folks that I would be doing them a disservice as a medical provider, not recognizing the toll that pain takes on the whole person.
It impacts their overall quality of life, their mood, their sleep, their emotions, their hobbies and leisure activities. And so offering them that mental health care, that cognitive behavioral therapy component can be so incredibly complimentary to all of the other things that we do. And I see people have a lot more success in terms of deescalating chronic pain, calming down their nervous system so that our treatments are more effective.
Tara Schmidt, RDN, LD: Yeah. Maja, I was hearing when you were telling your story about just the level of stress physical and mental that you were experiencing, did you have the opportunity to seek out cognitive behavioral therapy or something similar for your mental health?
Maja Mazur: I did. And it actually came at a much later stage because for me, what really triggered taking action was just feeling so bad every single day physically. When it came to pain, I couldn’t sleep, I was always tired, you know? It didn’t matter kind of how long I slept, I was always exhausted. And I had really strong brain fog where I would walk into a room and I wouldn’t, you know, remember why I walked into the room and it would keep happening.
And it was only after I fixed those initial pillars, if you will, and really started having more energy and feeling a little bit more in control that I then actually worked with a therapist who specializes in cognitive behavioral therapy, who really helped me put that next layer on top of what I was working through, and also who helped me think through the lifestyle and the nutrition changes that I was implementing in a way that was actually helpful and productive rather than a very kind of zero-sum game, which is what I initially did.
Tara Schmidt, RDN, LD: And Chelsey, we know that there’s kind of this hierarchy when it comes to pain management interventions. How important are our eating patterns to managing pain when we compare them to things like medications or supplements? How do we kind of find that balance?
Chelsey Hoffmann, PA, RD: So I review what I have sort of self dubbed a modified nutrition pyramid for chronic pain management. When I think about a pyramid, I envision that any pyramid’s going to need some good structural support. And so one side of the pyramid is going to be nutrition counseling from a qualified nutrition healthcare professional, ideally a registered dietician. And the foundation of that pyramid that I go through with patients is their overall dietary pattern.
The foods and drinks that they consume on a daily basis are of course going to be what matters the most. And then from there, the middle of the pyramid would be specific foods, macro or micronutrients. At the top would be things like supplements. So we won’t even talk about supplements for nutrition, inflammation, chronic pain until they have really optimized those two lower levels of the pyramid.
So I think you still need those things alongside this nutrition pyramid for chronic pain supporting it. It’s going to be multimodal, it’s going to be an individualized, personalized approach, but we need all the tools in our toolkit available.
Tara Schmidt, RDN, LD: Chronic pain is classified as anything lasting longer than 12 weeks, and it can show up in different ways, like musculoskeletal pain in the joints or muscles, neuropathic pain in the nerves, or even a mix of both.
Chronic pain also connects with inflammation, weight, and overall health, which is why treatment needs to be multilayered. Nutrition plays a bigger role than people think. What you eat can influence pain levels, your nervous system, and even your gut-brain connection.
The gut-brain connection and mental health piece are where things get really interesting. What you eat can affect your gut microbiome, which in turn messes with neurotransmitters like serotonin and dopamine, increasing your pain and anxiety. That’s why pain treatment plans may include cognitive behavioral therapy to help patients manage both the physical and emotional sides of pain.
Now, let’s get into which specific foods can actually help or exacerbate chronic pain.
Tara Schmidt, RDN, LD: I’d like to do some social media myth busting in a segment we like to call health or hype so we can rapid fire this. Shout out if you have an opinion. Some of these, I don’t even know where they came from —clearly, the internet — but let’s talk about whether or not the following foods cause inflammation.
Chelsey Hoffmann, PA, RD: OK.
Tara Schmidt, RDN, LD: Gluten.
Chelsey Hoffmann, PA, RD: I am going to say maybe. I think it depends if you are gluten intolerant, if you have celiac disease. If you have one of those conditions, then I think certainly it could set off your system for sure.
Tara Schmidt, RDN, LD: OK. Dairy? Definitely a common one that patients have asked me about.
Maja Mazur: I think, again, maybe. We find it really varies from one patient to the other. And also what kind of dairy are we talking about? It’s the same as with gluten, right? Like what was gluten sprayed with before it became the pasta that you’re eating or with dairy, for instance, are we talking about your reaction to dairy or are we talking about your reaction to some other substances that happen to be in that yogurt that you’re eating?
Tara Schmidt, RDN, LD: Or I was thinking like, is it lactose, right? Like there’s, we have to like break down, right, even further, some of these.
Bananas. I don’t know where these came from?
Maja Mazur: I think we are in a banana lovers camp, aren’t we, Chelsey?
Chelsey Hoffmann, PA, RD: Yes, we are. I have no issues with bananas and I thought about this before we came on. I guess the only thing I could think of as far as, and maybe someone will respond to this podcast and correct me, but when I think about bananas, the only thing I can think of is that it is perhaps one of the fruits that might spike blood sugar a little bit more readily.
And so when we talk about like the glycemic index perhaps of certain foods or items that we consume, I guess maybe if you wanted to come at it from that angle, but otherwise, I have no issues with bananas.
Tara Schmidt, RDN, LD: OK. Same. And anyone have issues with mangoes?
Maja Mazur: Oh, I hope not. I love mangoes.
Tara Schmidt, RDN, LD: I love mangoes.
Chelsey Hoffmann, PA, RD: I don’t think so.
Tara Schmidt, RDN, LD: Moving on. Carrots.
Chelsey Hoffmann, PA, RD: No.
Maja Mazur: No.
Chelsey Hoffmann, PA, RD: I have no issues with carrots.
Tara Schmidt, RDN, LD: Eat your bananas and your mangoes and your carrots, everyone. Excellent. OK. Now we’re getting somewhere. Alcohol.
Chelsey Hoffmann, PA, RD: Yes, inflammatory in the majority of the studies. Although I will say that it’s interesting, the Mediterranean diet, which is inherently an anti-inflammatory pattern of eating, does allow for mild to moderate alcohol consumption and in very specific forms. But I would say by and large, across the evidence base that’s out there, when we think about long-term ramifications from alcohol and the inflammation that can be associated with it, when it’s being used chronically, it’s going to be a no-go.
Tara Schmidt, RDN, LD: We’re even adapting some of our Mediterranean, like education materials, in clinic to remove the alcohol. Some of them say three ounces, and I’m like, just so you know, everyone, no one’s ever poured you three ounces of wine before. So your typical goblet of wine is not what we are referencing here.
Maja, what else did you want to add?
Maja Mazur: Yeah, I was always really surprised by that glass of wine being allowed in the Mediterranean diet, and I just think it’s because the Italians and the Greeks couldn’t let it go.
Tara Schmidt, RDN, LD: It was also with a meal in small amounts.
Maja Mazur: Exactly. But there is, I mean, there is an abundant body of research that really, really shows that alcohol is just not good for us.
Tara Schmidt, RDN, LD: I always simply say the risks outweigh the benefits. Period.
Fish. I’m usually encouraging fish. You guys, am I not supposed to do this anymore? Chelsey gave a thumbs up.
Chelsey Hoffmann, PA, RD: I gave a thumbs up because, again, we need to try to increase that omega-3.
Tara Schmidt, RDN, LD: OK. Any thoughts on ginger?
Maja Mazur: So ginger for me, I actually have a difficult relationship with ginger. I don’t think there’s any scientific basis for what I am about to say or at least not much. But personally I just find it’s not great for me. I love the taste. I really like using it, but I’ve noticed that it is just really not very beneficial.
It’s meant to be really anti-inflammatory. I think there is some research showing that it’s anti-inflammatory, but it’s also not great for some patients, and I seem to be one of them.
Tara Schmidt, RDN, LD: Well, and this is maybe an important point to bring up, is that even if we’re all laughing about how the fact that we love bananas and mangoes and carrots, if you can determine as an individual that that food for whatever reason does not agree with you, then that’s OK. But what I think all three of us don’t want happening is people taking blind advice and over-restricting their diet in saying: “I read to not eat these 50 foods, and now I’m restricting them even though I don’t have even anecdotal evidence or personal evidence to say that they need to be restricted.”
Maja Mazur: Yeah, absolutely.
Chelsey Hoffmann, PA, RD: Yeah, I would agree with that.
Tara Schmidt, RDN, LD: Cool. This one I’m interested in hearing some research, if you’ve got it. Red meat.
Maja Mazur: Oh, I kind of always say that what does a carnivore diet and a plant diet have in common? And both have been shown in some studies to have really great outcomes for patients with autoimmune or even certain cancers. What we don’t know is precisely what makes someone the phenotype that will benefit more from a plant-based diet versus a very carnivore keto.
So I think there’s an argument that can be made for both. What I feel very strongly about, and especially nowadays with all the kind of hype around red meat, is it’s about the quality of that red meat. When we talk about the super ultra-processed sausage that has really little of the beef or the pork in it, that is a very different thing to eat versus a grass-fed steak, for instance.
Now there is, of course, a really big budgetary difference between those two products, and that’s something that is, you know, has to be acknowledged. But yeah, we, you know, we take the approach very much like what we talked about with other foods. If it helps you feel better and if you can procure a high-quality red meat, it’s probably something to include in your diet, or at least not feel really bad about.
We wouldn’t recommend anyone to eat raw red meat or eat it every day as you can find on some social media channels. But, yes, in moderation and high quality.
Chelsey, what would you add to that?
Chelsey Hoffmann, PA, RD: Yeah, I think that was a great answer. I’m conflicted on this one as well. If we look at the Mediterranean diet and anti-inflammatory diet recommendations, they would say to minimize or eliminate red meat. But I think a lot of that is based on the premise that folks are selecting red meats that are very high in saturated fats and so very high-fat ground beef to make hamburgers, steaks that have a lot of marbling and things that we know that that’s not good for our heart health, it’s not good for our arteries, for inflammation, and then that cascade that goes along with it with metabolic dysregulation.
But you’re right. I think there are some health-conscious people out there who are purchasing higher quality, grass-fed, grass finished products. I think the masses are not purchasing those. And so I guess I would have to lean towards the minimize or reduce as much as possible, assuming that these individuals are the ones that are buying the higher saturated fat content products.
So it’s nuanced. I guess it depends.
Tara Schmidt, RDN, LD: As always. So are there foods we didn’t mention that are associated with inflammation?
Maja Mazur: Sugar.
Tara Schmidt, RDN, LD: Oh, we haven’t talked about sugar yet.
Chelsey Hoffmann, PA, RD: Yeah.
Tara Schmidt, RDN, LD: And can we, can we talk about whether this is white sugar, sugar in the raw, agave, honey? Because anytime I talk about added sugar, I have to clarify that added sugar is added sugar and I politely don’t really care if it’s honey or not. So, and maybe you do, but can we talk about sugar?
Chelsey Hoffmann, PA, RD: I would just say commercially available, processed packaged foods that are, you know, hyper palatable. We talk about them having a high salt, high added sugar content. That’s really the things that I would counsel against for patients that are suffering from chronic pain and inflammation, because those are going to be some of the quickest things to pull out of the diet and perhaps start feeling better.
Maja Mazur: So I feel very strongly about all the quote-unquote healthy protein bars, which are often really packed with an incredibly long list of artificial ingredients. And I see people, especially who want to increase protein intake or who suffer from chronic pain and, for instance, they heard red meat is bad, so they want to go more plant-based and they go and buy these products and then have horrible flare-ups because they are very, very processed. And typically when you do suffer from some GI or autoimmune or chronic pain issues, you are more sensitive to these substances.
So I always really urge everyone to pay special attention to these added protein, protein bars, plant-based substitutes that don’t quite explain what’s in there.
Tara Schmidt, RDN, LD: Yeah, we’re going back to ultra processed, whether it’s, you know, an ultra-processed meat or an ultra-processed snack, or an ultra-processed quote-unquote health food, right? They all are being formulated in similar ways, you could say.
Any foods that we haven’t talked about that can truly reduce inflammation or pain?
Chelsey Hoffmann, PA, RD: So when I’m counseling patients on foods, macro, micronutrients to focus on, I’m picking out specific food groups or items, again, based on a Mediterranean style diet of eating and anti-inflammatory eating patterns. So we’re talking about fresh fruits and vegetables, our whole grains. We talk about magnesium, we talk about vitamin D, we talk about our B vitamins and what foods that we can sort of put our money on in terms of getting the best bang for our buck.
Tara Schmidt, RDN, LD: I like that. And referencing money, Chelsey, like you just said, many people are concerned with the cost of food, especially if they need to stop eating a lot of these foods that we’ve been talking about, right? The ultra-processed foods that are contributing to inflammation, but those tend to be more affordable. So what do you guys advise for people who are on this journey and are also on a budget?
Chelsey Hoffmann, PA, RD: I just did a LinkedIn post like three days ago about this. And I pictured myself with a giant bag of spinach that I purchased. I think it was $2.49 for that giant bag of spinach, and it lasted us two weeks because we were putting it in things like a veggie egg bake in the morning. We were putting it in wraps, we were putting it in health bowls, whatever. But imagine how many meals we got out of that bag of spinach for $2.49 cents. And when I look at the average cost of a family size or multi-serving size bag of chips, it’s $5 or more currently in 2026. And so that debunks the myth right there.
You can pick healthier foods within your budget if you are savvy and thoughtful about what you’re selecting. Bananas are also something that’s incredibly cheap, and so you are choosing where you want to put your dollars. You can also, I’ve noticed, buy things in bulk. So, for example, like organic brown rice or quinoa or those grains you can buy in bulk, so it can be done.
People just need to think about what they’re picking and where they want to put their dollars.
Tara Schmidt, RDN, LD: I am just proud that your bag of spinach didn’t die in your crisper drawer because mine usually does. I use like half of it for whatever I got it for and I’m like: “Oh, gosh, darn it. Now all the spinach is brown.”
Maja, what do you have to add about this kind of cost debate?
Maja Mazur: I really, really believe that you can eat better, you know, to Chelsey’s point, at almost any budget. But I do think that once you really identify your own dietary pain triggers, the number of changes that you need to make in order to feel your best goes down. And with this, you actually get to control your budget more, because I think we often see patients really feel that they need to buy everything organic and they need to do one million things or it’s not going to work, and that’s just not true. It’s finding what is triggering you, whether that’s working with a dietician, journaling, using an app like Healthnix, whatever it is you do. Find what triggers you and don’t eat it, and don’t buy it, and you will find that that budget becomes more manageable.
Tara Schmidt, RDN, LD: Maja, how is the Healthnix app designed to help users really find an eating pattern that works for them?
Maja Mazur: We really focus on helping you track what you eat, and how you feel to really help you identify these unique foods that might be triggering your symptoms.
And kind of taking one step back, we really pay attention to all of this being very data-driven. Each patient that works with us starts with a blood test. We collect information on your medical history, but we also ask you about your lifestyle and what else really is happening for you and what are your preferences? And then as you start working with a dietician that is assigned to you, you record by taking a picture of what you eat and then you record your symptoms once every day. And then over the course of 12 weeks, actually, we really help you identify these patterns. We made some very intentional decisions around, for instance, only asking for a picture of the food rather than all the macros and all the, you know, calories and all of that. We don’t actually want that. We are only asking for measuring of the symptoms, you know, three to four times a week, give or take. But we always also say, look, at the end of the day, this is just a tool and you, as a patient, are the expert of what helps your body and what doesn’t. So we really emphasize using the Healthnix tool to learn to listen to your body rather than as a tool that tells you how your body is doing. You know that best.
Tara Schmidt, RDN, LD: So what foods cause inflammation? Well, it’s different for each body. Gluten and dairy aren’t automatically inflammatory, but they do cause issues for some people like those with intolerances or sensitivities. Now, there are more clear-cut triggers like alcohol, added sugar, and ultra-processed foods. That includes some healthy protein bars and plant-based products that can actually make symptoms worse for people.
When it comes to red meat, it’s best to reduce or eliminate intake of meats with high saturated fats, but there may be some wiggle room if you’re eating a small serving of leaner meat. Don’t fall into the trap of cutting out a huge list of foods just because the internet says so. Instead, pay attention to what actually works for you and focus on whole foods like fruits, veggies, and whole grains, many of which can be pretty affordable. Now we’ll talk about supplements and whether it’s possible to rid your chronic pain through diet alone.
Tara Schmidt, RDN, LD: Let’s talk supplements. So there’s a few, of course, that are all the rage on the internet right now. Chelsey, can you talk about how effective some of these are in managing chronic pain? So we’ve got fish oil, vitamin D, magnesium, CBD. How do you answer that question for your patient?
Chelsey Hoffmann, PA, RD: So I sort of categorize supplements according to the type of pain that a patient’s having. So I don’t just kind of throw things willy-nilly. I am paying attention to, are they telling me that they have that musculoskeletal pain that we talked about in the beginning versus neuropathic pain versus some sort of mixed pain?
When I think about things like musculoskeletal pain, probably the supplements that have the highest level of evidence would be things like collagen, glucosamine, chondroitin, omega-3s would be in there as well. When I think about neuropathic pain, acetyl-L-carnitine or alpha-lipoic acid and so that’s kind of how I would look at it.
Tara Schmidt, RDN, LD: What about more popular options like fish oil?
Chelsey Hoffmann, PA, RD: So if we take fish oil for a minute, again, that would be your omega-3s. Decent evidence for musculoskeletal pain, the thing we have to be careful about, is that it can be antiplatelet. And so anyone that is on anticoagulants or blood thinners, omega-3s don’t always play nice with those. And a lot of patients are on those, so we have to be careful about that.
Tara Schmidt, RDN, LD: And we know there’s a link between chronic pain and vitamin D deficiency. Would you recommend vitamin D supplements?
Chelsey Hoffmann, PA, RD: I’m all for vitamin D. We live in the north. A lot of us are indoor. We have, you know, the time change and everything that’s going on. We don’t get a lot of sunlight on our exposed skin, and so we’re not making our best available source of vitamin D. So depending upon where you are geographically, not a bad idea to have your vitamin D levels checked annually during a preventative exam and then supplement accordingly.
Tara Schmidt, RDN, LD: Got it. What about magnesium?
Chelsey Hoffmann, PA, RD: Magnesium I don’t necessarily just throw on when someone’s describing muscular pain or cramping, spasm type of pain.
There can be toxicity syndromes associated with some of these, and so I actually would prefer someone to have their magnesium levels checked before we add that in.
Tara Schmidt, RDN, LD: Totally agree. And then there’s CBD, which we can’t at Mayo outright endorse, but people do use for pain management.
Chelsey Hoffmann, PA, RD: I am probably pretty biased on this one. In our practice, we have certain clinicians who are certified to register patients for the statewide medical cannabis program, and we know that that is probably a more regulated way to get your CBD products. As with any of these supplements, we always have to worry about purity. What else is in there? And so that’s one that if you have a statewide medical cannabis program, at least in my mind, I’d prefer you to talk to someone that can certify you for that program and go in and meet with a pharmacist, talk about your specific type of pain, and get some sort of recommended product with a specified dose.
Tara Schmidt, RDN, LD: And walking into any store with supplements is incredibly overwhelming. Even for me. Maybe for you, maybe you’re like: “No, I’ve got this. I’m a pro.” Can you teach us how to identify high-quality supplement brands? Like if I pick up a bottle, what do I look for?
Chelsey Hoffmann, PA, RD: So I would say always look at the ingredient label, and we want to know or have some increased confidence that what we’re taking is what’s actually in the bottle.
These are not regulated by the Food and Drug Administration. So we need as consumers to take some steps to protect ourselves and protect where we’re spending our dollars. So always look at the ingredient list. If you see something on there that you know that you have an intolerance or allergy to them, put it back.
And so I would encourage people to try not to get mixed supplements as much as possible. Try to pick something that’s a single-agent or a single-ingredient supplement, and that doesn’t have a lot of additives mixed in with it. So that’s kind of step number one. And then step number two would be looking to see if your supplement brand or bottle has one of the seals of purity on it, meaning that they’ve been third-party tested for purity.
So some examples of independent third-party testing companies that you might see the logo or the seal of on that supplement bottle would be USP, which is United States Pharmacopoeia and ConsumerLab. Usually it’s CL and sometimes it’s got a little beaker around it. So ConsumerLab is another one. And then the National Sanitation Foundation or NSF.
The really good supplement companies out there will actually post on their website their most recent third-party purity testing results.
And so you can go ahead and go look at those and see did they test positive for heavy metal contaminants or other contaminants? Was the dosage close to what the reported dose was on the label? And those are all different ways that you can help identify a higher quality supplement.
Tara Schmidt, RDN, LD: Thank you. That was so, so helpful. And how does somebody evaluate whether a supplement is actually helping with their chronic pain or it’s time to wean off? How long should they give it?
Chelsey Hoffmann, PA, RD: Research that’s out there on supplements, in clinical trials or studies, is going to show that usually roughly around that 12-week mark if we’ve not experienced benefit by that point, we can go ahead and wean off or discontinue.
I also like people to pretend that they’re scientists. We’re not going to add a bunch of things into our experiment at the same time, because otherwise we don’t know what’s helping and what’s not.
And if you get side effects, I don’t know what they’re coming from. So if you’re going to try a supplement, we’re going try it independently without any other changes for up to 12 weeks, and if we’re not getting 30% relief or more — that’s our benchmark as well, 30% relief or more — then we’re going to go ahead and discontinue. And people might ask, well, why 30%?
That’s because in many pharmacologic studies, placebo, meaning a sugar pill, has been shown to offer 30% relief. So we’re comparing a supplement to placebo and asking ourselves, is this providing 30% improvement in my symptoms? Yes or no? If the answer is no, you’re wasting your time, energy, and money, and we’re going to get rid of it because body doesn’t need to metabolize all of that if it’s not helping.
Tara Schmidt, RDN, LD: Chelsey, where do you draw the line between being health conscious, positive, of course, and becoming a little bit too obsessive, if I can say that with your eating pattern or your care regimen.
Chelsey Hoffmann, PA, RD: I think with any other type of addiction or maladaptive coping, we are looking for people where these things have become almost like intrusive thoughts. We’re overly fixating on this. We’re spending too much time on this and sort of backing out of the rest of life.
We’re not enjoying life because we’re so focused on this. It’s intrusive, it’s interruptive. I want to be very clear about how I state this. I think it’s OK in the beginning to track your foods, to weigh and measure things. I think that gives you knowledge and that’s empowering. And now you know what a portion size looks like and you can carry that forward with you. But if we’re to the point where we’re weighing and measuring every single thing that we consume daily, if we’re recording our pain scores every single hour, and we’re bringing all this documentation into our provider appointment. Sometimes that’s a red flag a little bit because you’re not focusing on things outside of your pain, outside of your nutrition. I think back to one of the physicians that I work with, he really says it best.
He says that our goal is to help people live better, move better, feel better, and that’s what it’s all about. And so I don’t want people having to overly obsess about tracking. I want them to be living their best lives, and that means that we’re doing everything to support them towards that goal. And they’re not having to hyper focus on the details, if that makes sense.
Tara Schmidt, RDN, LD: I love that. Maja, do you feel like it’s possible to reverse chronic pain once and for all?
Maja Mazur: I do really believe in getting to a point where you really manage it instead of it managing you.
Tara Schmidt, RDN, LD: Oh, I love that.
Maja Mazur: Because I know I was really in this position where the pain was controlling me, whereas now the roles are reversed.
I still have occasional flare-ups or, you know, I have worse days, but they don’t affect me. It’s like the weather. I’m not happy that it’s raining, I’d rather for it to be sunny, but it’s an external circumstance, and I really believe that by taking this whole person care approach you can put yourself back in control of your nervous system, your physiology, your entire body, and just feel so much better and really manage your chronic pain, but also everything else that comes with it.
Tara Schmidt, RDN, LD: And it sounds like you’re also not living in that constant state of kind of fight, flight, or freeze anymore either, which is a huge quality of life indicator I think.
Maja Mazur: Yes, exactly.
Tara Schmidt, RDN, LD: Do you have any success stories from Healthnix that you want to share with us?
Maja Mazur: We’ve had this one lady who was in her late seventies, and she came to us and was kind of skeptical but, you know, open to give it a go. And she’s really experienced this complete transformation, both when it comes to getting the GI and pain symptoms, but also just the energy, and the optimism. She just really turned into this, such a happy lady. She got four of her neighbors to sign up.
Tara Schmidt, RDN, LD: Oh, that’s so cute.
Maja Mazur: We were all doing it together. They were calling us. They did a webinar.
Tara Schmidt, RDN, LD: They made like a book club out of Healthnix.
Maja Mazur: I just absolutely love them, and the reason why it really matters to me so much is because one, you know, people often say for older adults that it’s too late to learn new habits or to get healthier, and they just completely showed that that is just not true.
Tara Schmidt, RDN, LD: Or that you have to live with the pain, right? It’s just part of being old, but that’s not true.
Maja Mazur: Exactly.
Tara Schmidt, RDN, LD: Maya and Chelsey, thank you so, so much for your time, bringing your personal expertise and experiences as well as your professional so thanks so much for being on “On Nutrition.”
Chelsey Hoffmann, PA, RD: Excellent. Thank you so much for having me. It was an honor to be here and I really enjoyed this conversation today.
Maja Mazur: Thank you so much.
Tara Schmidt, RDN, LD: Supplements for pain aren’t one size fits all. You have to match them to the type of pain you’re experiencing. For muscle and joint pain, things like collagen, glucosamine chondroitin, and omega-3s tend to have the best evidence behind them.Magnesium may be helpful too — if you check your levels with your provider first. For nerve-related pain, options include acetyl-L-carnitine, alpha-lipoic acid, or vitamin D.
Remember, supplements aren’t tightly regulated, so you have to do your homework. Look for single-ingredient products when possible. Check labels for anything you might react to. And try to find brands that have third-party testing, like USP, NSF, or ConsumerLab seals. And when you try something, treat it like a mini experiment.
Give the supplement about 12 weeks to see if it works. If you’re not getting at least 30% improvement in your chronic pain, it’s probably not worth continuing. Understanding chronic pain is great, but if you’re constantly measuring, logging, and stressing, it can take over your life. As much as weight loss, nutrition and supplements can help, they’re just tools to get to a place where you’re managing the pain, not the other way around.
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Thanks for listening! And until next time, eat well, and be well.
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