Belly Fat and Chronic Pain: The Worst of Both Worlds

09/28/2022 | 6 min. read

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Obesity has strong associations with chronic pain, but most of us assumed this was caused by the excess weight putting added pressure on the joints and muscles. Belly fat—what doctors call “central adiposity”—is particularly closely associated with low back pain, a prevalent condition associated with functional deficits and disability.1

While all types of fat deposits anywhere on the body may be associated with pain, there is a definite link between belly fat and chronic pain throughout the body.2

Why Belly Fat Causes Pain

Advances in medicine have shown that fatty tissue is more than fat, it’s also an endocrine system that secretes various pro-inflammatory chemicals and hormones.

Belly fat is particularly notorious for driving what is known as “neuroinflammation” or chronic inflammation of the nervous system, including the brain. Neuroinflammation sends the body’s signaling system into red alert—sending pain signals—and has long been known as part of the chronic pain state.3

What is newer to scientists is that this signaling is a two-way street: the gut and the brain talk back and forth to each other.

It is this gut-brain telephone that contributes to something doctors call “central sensitization.” In ordinary terms, central sensitization means your brain overreacts and tells you you’re in pain, even when there is no reason for that. Chronic pain can just be bad communication and that communication is being encouraged by neuroinflammation.

Stopping Pain: The Food-Brain Connection

Despite the fact that belly fat contributes to chronic pain and food can contribute to belly fat, even researchers have not done much work in studying how food influences pain—but it does!

Diets high in junk food, highly processed food, sugar, artificial sweeteners, and saturated fat can contribute to pain. These “pain foods” set off more neuroinflammation. Remember that neuroinflammation is what keeps signaling the brain incorrectly that you’re in pain. “Pain foods” cause even more neuroinflammation. And, in the process, these “pain foods” can widen your waistline and give you more belly fat, causing even more pain.

What Should You Eat to Minimize Pain?

At first, the dietary link—what has been called nutritional neurobiology—was related mainly to weight loss. The idea was that excess weight caused pain, not the diet itself. In other words, obesity was solely a mechanical cause of chronic pain. While this is true, it is far from the whole story. Today, we are starting to recognize that there are very real “pain foods” that are going to both promote belly fat and worsen chronic pain.

By contrast, diets that emphasize fruits, vegetables, healthy oils, and fiber have a pronounced anti-inflammatory effect.5 Not only can foods that reduce pain and inflammation help you shed pounds, but these diets can also ramp up beneficial anti-inflammatory activity in the body and that can lessen pain.

Chronic pain has also been associated with high levels of serum glucose or blood sugar. Metformin, a common drug that controls blood sugar, decreases not only body weight, but the inflammatory response and central nervous system sensitization. 8 In other words, keeping blood sugar under control may lessen the pain as well. The connection between blood sugar and chronic pain is a new one—but very real.

Plus, of course, poor diets, overeating, and a sedentary lifestyle can lead to obesity, which both weakens the body, while at the same time putting undue strain on the musculoskeletal system. A high-sugar low-fiber diet can lead to belly fat, which, in turn, can exacerbate low back pain by creating a physical imbalance.11 Today, it appears more likely that belly fat works in two ways: both mechanically (extra stress) and by promoting neuroinflammation.

The good news is that if fat, especially belly fat, is a driver of chronic pain, losing weight can reduce inflammation, decrease pain intensity, improved wellbeing and energy, along with a trimmer and more youthful physical appearance.

What Should You Eat for Less Pain & Better Health?

While the ketogenic diet is sometimes proposed to reduce belly fat and pain, the Mediterranean diet is easier for patients to use and promotes excellent health benefits. Here are a few key pointers that you may already know:

  • Eat plenty of vegetables and fruits, especially fresh foods.
  • Eat whole grains and avoid “white food” like white bread, white rice, white pasta, and white sugar.
  • Avoid overeating; if it suits you, you can try intermittent fasting to help speed weight loss.
  • Get exercise every single day; 20 minutes of exercise a day is better than 3 hours of exercise once a week.
  • Use topical products such as Instaflex® Pain Relief Cream to treat aching joints and muscles and help you move as much as possible.
  • Drink lots of water and avoid “drinking calories” in sweetened beverages; stay away from artificially sweetened anything
  • Use moderate amounts of healthy oils such as olive oil; enjoy avocados in moderation.
  • Protein is good, but protein should come from lean meats, chicken, fish, and beans; minimize red meat consumption.
  • Get lots of sleep; sometimes we eat to power through fatigue.


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Dr. Joseph Pergolizzi

Meet Dr. Joseph Pergolizzi

Dr. Joseph Pergolizzi is an internationally recognized expert in pain medicine who has spent much of his career studying what pain is, why it occurs, and how best to treat it. That experience has led him to believe strongly that there are often ways to relieve or manage pain which are overlooked or discounted, and that the most effective treatment approaches are always multi-modal.

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