Why keto helps with pain management

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Being told xyz treatment is effective for pain management is one thing. Understanding why means we can make informed and empowered choices around our treatment plans. Having a sense of control of our own destinies when we can feel like pain has stolen that from us, is essential for a multitude of reasons.

There’s a growing body of research looking into inflammation and how diet impacts pain. By the time I saw my fourth pain specialist, I was long into my keto journey. Pain Specialist #4 was the first medical doctor that proactively spoke about diet having a positive impact on pain. In fact, Pain Specialist #3 was quite against keto. But was unable to provide me with anything to say why, other than outdated and disproven information about fat and animal protein.

Let’s get straight on what I mean by keto

There are a lot of weird and wonderful ideas about what keto is and what it is not. It’s gained popularity in the weight-loss world which frankly has been a double edged sword. You will hear “lion diet”, carnivore, clean keto, dirty keto, strict keto and honestly god knows what other keto… if you’re curious, I talk about that keto jargon here.

At its core keto is about eating food within certain macro ratios. It essentially flips the food pyramid as we know it, on its head.

In a standard ketogenic diet, the typical macronutrient breakdown is:

  • High Fat: Approximately 70-80% of total daily calories come from healthy fats. These include things like avocados, nuts and seeds, olive oil, coconut oil, butter, fatty fish, and high-fat dairy products like cheese and cream.
  • Moderate Protein: Around 20-25% of total daily calories come from protein. This moderate protein intake helps maintain muscle mass while still allowing the body to enter and stay in a state of ketosis. Good sources of protein on a ketogenic diet include meat, poultry, fish, eggs, tofu, and tempeh.
  • Very Low Carbohydrates: Carbohydrates are restricted to approximately 5-10% of total daily calories, typically amounting to fewer than 50 grams of net carbs per day. Non-starchy vegetables like leafy greens, broccoli, cauliflower, and zucchini are preferred sources of carbohydrates on a ketogenic diet due to their low net carb content.

A quick note on total carbs verses net carbs.

In Australia, net carbs are the total carbs on the nutrition label. We don’t need to faff around with other calculations.

If you’re in the Americas (and Australia imports American keto products, so it can be confusing) net carbs are calculated by subtracting fiber from total carbohydrates since fiber does not significantly impact blood sugar levels.

Can you sustain ketosis with more than 50 grams of carbs per day?

Ketosis simply means that your body is using ketones for fuel instead of glucose.

And maintaining ketosis at more than 50g per day is a very individual answer with a lot of caveats. Technically yes. IF you are extremely active and have a high BMR and high energy requirement, then yes. In fact you will need to slightly higher carb count.

When my partner does a cut, he will eat at the same macro percentages I do. His carb macro work out to be around 75g per day last time I calculated his ‘cut’ macros.

If I’m being strict because I’m testing a theory, I will eat 20g or under. I know how my body reacts when I am strict and clean which helps me work out what’s going on. Mostly I sit between 20-50g.

How to work our your macros?

Macros should be individually calculated. Sex, age and activity level impacts the amount of fuel your body needs to run effectively.

My partner and I generally eat around the same macro percentages. But what the looks like in grams and target calorie intake per day is quite different.

  • My maintenance keto macros work out to be Fat: 141g, 91g Protein; 45g carb. 1817kCal/7603kJ
  • His maintenance keto macros work out to be Fat: 285g, 183g Protein; 92g carb. 3669kCal/15362kJ

Calculate your macros here.

Why fat helps pain

I love to hate this particular conversation. Fat doesn’t make us fat. Fat as a generalised macro group, is not going to kill you with heart disease on its own. I will dive into more specific fats, which are preferred and which ones trigger inflammation in another post.

But as a snapshot, here’s why fat helps manage pain:

Anti-inflammatory properties

Certain types of dietary fats, such as omega-3 fatty acids found in fatty fish (e.g., salmon, mackerel, sardines), flaxseeds, and walnuts have potent anti-inflammatory effects. These fats can help reduce inflammation throughout the body, including in joints and tissues affected by pain conditions such as arthritis. By decreasing inflammation, omega-3 fatty acids may alleviate pain and improve overall comfort.

For someone like me, who is allergic to fish, I supplement with flaxseed supplements and eat keto-friendly foods like chia seed, hemp seeds and tofu which are high in alpha-linolenic acid (ALA), a type of omega-3 fatty acid.

While fats play a huge role in the anti-inflammatory aspects of keto, the fact that we steer clear of a lot of processed foods themselves helps significantly reduce food-induced inflammation.

Endocannabinoid system modulation

The endocannabinoid system (ECS) is a complex signaling system found throughout the body, consisting of cannabinoid receptors, endocannabinoids (cannabinoid-like compounds produced by the body), and enzymes that help make and break down endocannabinoids.

Endocannabinoids are lipid-based neurotransmitters that turn on cannabinoid receptors in the body. Dietary fats, especially those with omega-3 and omega-6 fatty acids, are needed to make them.

How we fuel our endocannabinoid system is very important for controlling many bodily functions, like mood, hunger, pain perception, immune system function, and the stress reaction.

Enhanced absorption of fat-soluble vitamins

Some vitamins with antioxidant properties, such as vitamins A, D, E, and K, are fat-soluble. This means they require dietary fat for absorption. These vitamins play important roles in immune function, tissue repair, and overall health. Adequate intake of dietary fat ensures the absorption of these vitamins, which can support the body’s natural healing processes and help manage pain associated with inflammation or tissue damage.

Support for nerve health

Fats that contain essential fatty acids like linoleic acid and alpha-linolenic acid, are critical for the health and function of nerve cells. Consuming sufficient dietary fat, especially sources rich in essential fatty acids, can support nerve health and potentially alleviate neuropathic pain symptoms.

Satiety and weight management

Consuming dietary fat, particularly healthy fats from foods like avocados, nuts, seeds, and olive oil, can help promote feelings of satiety and fullness. I tend to focus more on this than the weight loss aspect of it. By maintaining stable blood sugar levels and reducing cravings, dietary fat may indirectly support pain management by preventing overeating and excessive weight gain.

I’m not going to labour this point, because I know we cop it from doctors a lot. But excess body weight can exacerbate certain pain conditions. So maintaining a healthy weight can help alleviate pressure on joints and reduce pain intensity. I know that when I lost the 30kg of medication-induced weight gain, I found moving easier. Weight loss is a benefit of keto when you shift your macros for weight loss. It is not the only reason to try it. The pain management benefits for me have far outweighed the weight loss benefit. And I seriously did not mean a pun there!

Where to start

I dove in head first. But that won’t work for everyone and I think I made my life a lot harder for myself in hind sight.

  • Browse the meal plans and recipes. Get a feel for it. What is similar to what you’re currently eating?
  • Plan and prep. Even if you’re wanting to ease into keto by starting to cut out sugar or more refined carbs, make a plan. Work the plan. Refine the plan.
  • Swap out ingredients for more keto friendly foods. This may look like swapping marinades and sauces or swapping pasta for a keto friendly alternative. Reducing higher carb, higher processed foods will help with reducing inflammation, even if you’re not in ketosis.
  • Keep a food diary. Once you start swapping out foods for more keto friendly options, what are you noticing with your energy and pain? For me it wasn’t always amazingly obvious. My energy and brain fog was better. I was noticing my pain less and less until I ate something that would trigger me.

If you still want to know more (or enjoy a nerd out), I’ve added more of the emerging research below 🙂

Diving into the nitty gritty of the science

nerd, cartoon, geekIf you’ve dug around into the medical journals for more insights into CRPS, you will know it’s limited. Dig into nutritional science and pain management… it’s equally as limited.

At the risk of over simplifying things, chronic pain in many respects is chronic pain, despite its origins. I think we’re operating in a space where some information is worth exploring to understand if/how it has applications to help manage more specific conditions. CRPS specifically is one of those conditions.

There are some interesting developments since I first started digging around…


Mechanisms of Analgesia by a Ketogenic Diet

A more recent study from 2023 was studying “Mechanisms of Analgesia by a Ketogenic Diet“. Basically what impacts does keto have on pain. This was not a CRPS specific study, in fact the cohort was Type I Diabetics.

It found “ketone oxidation is critical to the proper development and function of peripheral somatosensory nerves. Additionally, we determined that ketone oxidation and activation of ATP-gated potassium channels are essential for analgesia provided by a ketogenic diet.”

In simple terms, the process of breaking down ketones (a type of fuel produced by the body when it burns fat) is really important for the healthy growth and function of the nerves in our body that help us feel things through touch, pain, and temperature (these are called peripheral somatosensory nerves). Breaking down ketones and making them useful for our body is crucial for reducing pain (analgesia) that comes from following a ketogenic diet. This diet is high in fat and low in carbohydrates, and it seems to work to reduce pain by both breaking down ketones and activating certain channels in nerve cells that are sensitive to energy (ATP-gated potassium channels). So, ketone breakdown and activating these specific channels are really important for the pain-relieving effects of a ketogenic diet.

Rat studies

In this case, I am talking literal clinical studies on rats. Not how some specialists choose to treat CRPS patients.

Over the last few years, there have been a few studies looking at how keto effects allodynia and ongoing pain. The studies are showing that there are positive impacts on reducing tactile allodynia and reducing spontaneous pain. The conclusions of the studies say that more study in warranted 🙂

Here’s some of the studies I’m currently following:



Disclaimer: No Spoons to Cook is based on our own experience and research, and what we know works best for us. It is not medical advice. Our recipes focus on low inflammatory ingredients, whole foods and are founded in ketogenic and low carb ways of eating. We encourage spoonies to stay curious, ask questions, do your own research, listen to your body and to work with a Registered Dietitian or Medical Professional when appropriate to tailor your nutritional needs to support your care plan and goals.

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