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Nutrition and Weight Management | Smoking | Physical Activity | Headache Management

Nutrition and Weight Management

Gordon Irving, M.D.

Good nutrition improves sleep, energy levels, mental focus and emotional health. Our food choices help fight germs, so if we aren't eating well we are more likely to become sick or feel poorly.

Poor nutrition and/or eating calories, particularly derived from processed foods and sugar may cause weight gain and obesity. A body mass index (BMI, which is your weight in pounds divided by your height in inches) of 30 or more indicates obesity. A BMI of more than 40 is called morbid obesity and carries significant risk of shortening your life. Obesity makes pain worse and increases stress on your knees, hips, and other joints. It is important to lose weight for your health and to control pain.

How does nutrition help pain?

  • Many pain sufferers have food sensitivities that they may or may not know about (see the elimination diet listed below).
  • Some foods cause inflammation in the body which can make pain worse. You may help your pain by eating foods that decrease inflammation. Search the internet for “anti-inflammatory foods” for more information.
  • Being overweight can cause pain all over the body pain as well as in the knees, hips, or back. Losing 10-15 pounds in weight can decrease your pain significantly.

Changing how you eat, drink, and exercise can be hard, but the results are rewarding in every part of your life. It can help you think clearly, improve memory, and better your moods. Eating healthily can also help you decrease your risk of heart disease, diabetes, and cancer.

If you are overweight:

  • Check your weight at least once a week.
  • Focus on losing one to two pounds every week. Cut out sodas and fried food as a first step.
  • Use measurement tools (cups, spoons, and food scales) and read nutrition labels. Patients who need to lose weight, especially those having trouble, may not realize how many calories they eat. These tools can help.
  • Lower your body mass index (BMI) (weight in pounds divided by height in inches) to less than 30. Weight loss lasts longer for people who are happy with their results so aim for realistic goals. This will help build your confidence so you may not need professional help.

Steps to Get There

Tips to improve your nutrition:

  • Choose a diet that follows basic rules. There is no single diet that will work well for everyone who needs to lose weight. The basic rule of any healthy diet is to limit foods that are high in unhealthy fat, get plenty of healthy protein such as skinless chicken, non-fatty meat portions, or fish, eat more vegetables (except potatoes which are high in carbohydrates) and fresh fruit (except bananas which are high in starch) and drink plenty of water. Avoid sodas, even diet sodas.
  • Eat only at meal times.
  • Choose foods that you enjoy. Finding healthy foods you love to eat helps!
  • Remove triggers for overeating:
    • Go to the grocery store after a meal to prevent impulse buys.
    • Keep unhealthy food out of sight.
    • Avoid buying unhealthy food.
  • Shopping: When you shop, use cash instead of your credit card; this may help you from buying "comfort food".
  • Have a reward system: Set weekly goals and reward yourself when you reach them, but not through food. Tell yourself 'I've been OK,' 'I'm doing great,' and 'I have the ability to lose weight and to have an active lifestyle'.
  • Figure out your emotional eating cues and replace them with other behaviors. Choose behaviors that are difficult to do when eating (e.g., writing, knitting, housekeeping, exercising, and taking a bath).
  • Vitamin supplements: Some vitamin supplements may help. Vitamin D may help with muscle pain. How much vitamin D you need depends on many factors like sun exposure; skin color; food choices and digestive health. If taking a multivitamin supplement most have only relatively small amounts of vitamin D. You may have to take a single vitamin D supplement to get to the 2000 to 4,000 IU (international units) per day that is frequently recommended.
  • Nutritionists and Naturopathic doctors (NDs): Registered dietitians and naturopathic doctors are great nutrition counselors. See a nutritionist or naturopath to get help with new healthy habits.
  • Elimination diets: If you think you may have food intolerances, trying an “elimination diet” may help you find out which foods you are sensitive to. First, stop eating all foods you may be sensitive to. Then reintroduce them one food at a time. Meeting with a dietitian or naturopathic doctor during an elimination diet may help.
    • Keep a food diary and write down what and how much you ate and any symptoms you notice. This can help you identify food allergies or intolerances.
    • Stop eating these foods for two weeks. If you cannot do this all at one time, choose a few and then try not eating the others during a second two-week trial. (Only do two trials.)
      1. Dairy products, including cheese. Instead, use soy milk and soy cheese, or rice milk, and rice-based ice cream.
      2. Egg and foods with egg.
      3. Foods with gluten, such as wheat and wheat-based products (pasta/noodles, barley, oats, or rye grains.) Instead, you can eat brown rice, nuts, buckwheat, spelt, millet, potatoes, or sweet potatoes.
      4. Citrus fruits.
      5. Corn and foods with corn.
      6. Plants from the nightshade family (tomatoes, potatoes, eggplant, peppers, and tobacco.)
      7. All processed foods, including caffeine. Suddenly stopping some foods (such as drinks with caffeine) may cause withdrawal symptoms (such as headaches) but this should only last a few days.
    • After two weeks, add back one food group to your diet every 3-5 days. Writing down what you are eating and how you are feeling during this time can help you to notice how a food may be affecting your mood, energy, and pain (using numbers to rank how you are feeling may be helpful).
    • Your pain may flare-up or you may feel more tired when you eat something that you are sensitive to. If you notice this, you may want to stop eating that food.



Gordon Irving, M.D.

Most people are surprised to learn that smoking makes pain worse. One of the best things you can do to help your pain is to quit smoking. Smoking changes how your brain and body feel pain. Most people think that smoking helps with stress. In fact, smoking causes stress on the body, and it is linked to more anxiety. Cigarette smoke keeps oxygen from going to your discs and the tight muscles affected by pain. By quitting smoking you will save money, improve your physical and emotional health AND you will improve your pain!

Why should I stop smoking?

  • Over time smoking makes your brain more anxious, stressed, and tensed. Like any highly addictive drug you then have to take another cigarette to avoid withdrawal and "feel better".
  • For an hour after smoking, oxygen cannot get to areas of your body, such as the discs of the spine or tight muscles. Smokers tend to have more back and muscle pain.
  • Smoking may make some pain medications not work as well.
  • In a study, people who had lung cancer and continued to smoke had more pain than those who stopped.

Steps to Get There

Tips to help you stop smoking.

  • Keep telling yourself your reasons for quitting and imagine yourself as you'd like to feel, enjoying your favorite activities without smoking.
  • Promise yourself something you enjoy, such as a movie or dinner out as a reward, for getting through the first week.
  • Get involved in activities that don't go with smoking, such as meditation or exercise.
  • For two days before you quit, every time you smoke, write down the feelings you had before smoking each cigarette:
    • Were you tired? Bored? Hungry? Restless?
    • Write down the positive feeling that came from smoking each cigarette. Did it help you relax? Did you feel less bored? Did it help you wake up? Did it help you go to asleep?
    • Study your list. You'll probably notice a pattern. Consider how you could substitute a more positive lifestyle to get that same feeling such as an activity like a brisk walk.
  • Make specific plans ahead of time for dealing with temptations. Find two or three coping strategies that work for you, such as taking a walk or calling a friend.
  • Set a quit date. If you smoke mostly at work, try quitting on a weekend. If you smoke mostly when relaxing or with friends, quit on a weekday.
  • Find things to distract you when you start feeling like smoking. If you smoke to relax, figure out how to relax without a cigarette. If you smoke to clear your mind, figure out how to do that without a cigarette.
  • Get help from family and friends. They can't quit for you, but they can help by not smoking around you, listening to your struggles and encouraging you, and leaving you alone when you need some space.
  • Make it clear to your smoking friends that you don't want them to give you a cigarette. When people relapse and smoke, they usually get their cigarettes from friends.

Helpful Hints

  • The average person quits up to nine times before they are able to stay smoke-free. If you return to smoking, it doesn't mean you can't quit. It just means you need to try again. Find out what caused you to slip up and change your plan for next time.
  • Ask your doctor about other options to help you quit. Try a support group, an individual counselor or other source of help if you have not been able to quit on your own.
  • You do not reduce your health risks by smoking low tar/nicotine. Smokeless tobacco, pipes and cigars are just as harmful.
  • A scientific trial of cytosine, sold over the counter as Tabex, showed similar results to nicotine replacement therapy with no serious side effects reported.


Physical Activity 

Gordon Irving, M.D.

Pain may get worse when you do too much or too little activity. If we are not active enough, our bodies age more quickly and our muscles get weak. Research shows that controlled exercise can help chronic pain better than any other treatment, including medication!

Exercise is also one of the best treatments for anxiety, stress, and depression. But if a person with chronic pain tries to do too much, their pain get worse and it may take days to feel better.

Beginning a gentle exercise program is one of the best things you can do to help your body and your pain, but go slowly. You can reduce the pressure on yourself by setting goals you can meet. Having pain means you can't do all things you used to do. Pushing yourself to do more than you are able may lead to more pain, both physical and emotional.

Steps to Get There

  • Pacing means starting slow and figuring out how much you can do without causing your pain to flare up. Start by walking to the mail box 2 to 3 times a day.
  • Frequency: Doing an activity more often during the day may allow the body to recover and strengthen.
  • Once you have done an activity 3 times, try increasing the distance or time. Before long, you will be doing more activity on a regular basis than you have done for a long time, and feeling the mental and physical benefits.
  • Exercising daily can help you move more easily and with less pain in as little as 3 weeks.
  • Remember even if you start slowly, pacing and consistency are the keys.
  • Exercise is not about overnight success, but if you are consistent and patient, you will likely meet your goal.
  • Work up to exercising for at least two and a half hours a week.
  • Record how much you exercise currently. Check how much you walk every day by using a pedometer. Work up to 10,000 steps every day.
  • Both aerobic exercise (like walking or running) and strength training (lifting weights) are important. Start off using smaller weights and higher repetitions (number of times you lift the weights).
  • You may want to try Tai Chi, which research has shown can help pain sufferers.

Helpful hints

  • Do exercises you enjoy. Walking is often the easiest because all you need is your legs. Swimming, biking, Tai Chi, yoga and dancing help chronic pain, too. Try different activities on different days to keep from getting bored.
  • Try to exercise with a partner or pet. Taking a dog for a walk is good for both of you.
  • Get a pedometer. Set weekly goals that involve increasing number of steps or length of time (e.g., walk 500 more steps every week)
  • Make exercise a priority. Set a schedule and stick to it.
  • Listen to your body. Set goals that work for you: No goal is too small.


Headache Management 

 Hubert A. Leonard, M.D., Ph.D.

Types of Headaches

  • Tension headaches are the most common type of headache. As many as 90% of adults have had or will have tension headaches. They are more common in women than men and are not as bad as migraines.
  • Migraine headaches are the second most common type of headache but the most common headache causing distress and disability. An estimated 30 million people in the United States, about 12% of the population, will experience migraine headaches. An estimated 6% of men and 18% of women will experience migraine headaches. Chronic migraine (more than 15 days of headache each month with at least 8 days of migraine) affects 1.5-2.5% of Americans and causes disability. Migraine is more than just headache; it involves nausea and/or vomiting or sensitivity to light and sound.

Stages of Migraine

Identifying Your Level of Disability

Migraine disability is different for everyone. Treatment depends on the level/stage of disability. In Managing Migraine (see Resources List), the authors talk about four stages of disability:

  • Stage 1: Migraines only happen once in a while. Between migraines, people feel normal and do not fear another one. Strong medications work well. Migraine is short-lived and not a disease.
  • Stage 2: Migraines happen many times every month and get in the way of daily life. People have 3 to 8 headache days a month with some disability. Medication may not always work. Migraine may get in the way of sleep and affect mood. Eating well, exercise, and daily medication may help.
  • Stage 3: People have 10 to 14 headache days a month for at least 3 months. Medications may help but pain may come back. They may have anxiety, bad moods, and trouble sleeping. They may miss work, school, or family events. They may overuse medications. Eating healthy, excising, and taking daily medication is needed. Often there are other medical or psychiatric issues that must be identified and treated.
  • Stage 4: Headaches happen on 15 or more days a month. Overuse of medication often becomes part of the problem. Most people have trouble sleeping, depression and other problems with their health. These people have chronic pain that can only be treated with big lifestyle changes, daily medication, and help from a pain psychologist and others.

Steps to Get There

Know Your Triggers

  • Some foods may cause migraine headaches but this is different for everybody. Also, these foods will not always bring on a migraine headache. Some common triggers include alcohol, monosodium glutamate (MSG), citrus fruit (lemons, lime, oranges or grapefruits), aspartame (one kind of artificial sweetener), caffeine and aged cheeses.
  • Caffeine – found in sodas, coffee, tea, chocolate, caffeine pills, some medicines, and painkillers like Anacin, Empirin, Midol, and Excedrin – is a major cause of headaches. The headache pain killers can cause a "rebound" effect: You take it to get rid of the headache, which goes away, but then comes back worse than ever. Try to remove all caffeine from your diet. Although you may have withdrawal symptoms for a few days, including headaches, it will be worth it.
  • Medical issues can cause headaches and migraines, including mental stress, drugs of all types, thyroid problems, diabetes, chronic pain, low magnesium, and brain diseases.
  • Alcohol can cause headaches or migraines by itself or by causing dehydration. To avoid dehydration, drink water while you are drinking alcohol and before bedtime.
  • Smoking can cause headaches because the nicotine and carbon monoxide in cigarette smoke affect the blood vessels. Secondhand smoke causes headaches in some people.
  • Stress is the most common cause of headaches. Know the common sources of stress at home and at work. If it is difficult to get rid of the stresses, get help from other family members or through a psychologist or counselor.

Treat the Symptoms without Medication

  • Rest in a cool, dark, and quiet place. Use cold compresses, an ice pack, or a bag of frozen vegetables. Some people find heat helps.
  • Changing behavior helps control headaches. Eat a healthy diet, get enough sleep, drink at least a liter of water a day, and find ways to manage stressful relationships and responsibilities. Learn how to say No.
  • Have someone massage your neck and lower back. Try a hot shower.
  • Acupressure is good for pain relief. Place one finger between your eyebrows and another finger on the top of your head. Push gently and hold for 2 minutes. Another pressure point is between your thumb and index finger. Push there for 2 minutes.
  • Relax! Tension is a major cause of headaches. Lie down where it is quiet and breathe in for 8 seconds; breathe out slowly. Do this many times until you feel yourself relaxing. Breathe deep into your belly.


  • Managing Migraine. A Patient's Guide to Successful Migraine Care by Roger Cady et al.
  • Heal Your Headache by David Buchholz, M.D.
  • National Headache Foundation,
  • American Headache Society,