Lifestyle changes is not probably a topic that most doctors discuss with their patients in pain. One of the great physicians of the early 1900s William Osler once said ”The good physician treats the disease; the great physician treats the patient who has the disease.” The best way to treat a disease in my opinion is to treat the whole patient with the biopsychosocial approach : see my previous post on slow medicine vs fast medicine. Most diseases occur because of the interaction between genes, lifestyle and environment.
Diet is an essential part of our lifestyles. Currently, the diet of most people in the US is contributing to many diseases. Below is a graph with the prevalence of diabetes in US:
People can argue which food increased the diabetes prevalence, but I think it is pretty clear that the diet is the cause. Definitely, this increase is not due to purely genetic factors. Our bodies are very efficient in using energy and our food is too high in calories. It is quite remarkable that nowadays we pay more for food with less calories in order to eat healthy. Our ancestors would be incredibly puzzled.
Interestingly enough many patients I see in my pain clinic do not make a connection between their lifestyle and their pain. Many of them blame osteoarthritis (inflammation) in their joints for their pain. Diet has a very important role for inflammation in our bodies and the standard american diet rich in processed food and sugar is one of the worst. Some diets shown to help with inflammation and prevention of disease are DASH and Mediteranean diet. A few institutions recommend antiinflammatory diets: Harvard link, Cleveland clinic link and University of Wisconsin pdf file. Besides inflammation there are studies showing that food rich in excitatory molecules aggravates chronic pain. One example is monosodium glutamate (MSG) with studies showing that MSG is not good for some fibromyalgia patients (an overview here). A review of the inflammation and chronic pain is on the pain science website.
In addition to the diet obesity creates a state of inflammation in the body that seems to induce diabetes, heart disease, cancer (one scientific paper) and probably pain too. This is a decent review of the relationship between obesity and chronic pain: practical pain management link. One indirect link between obesity and pain is diabetes which damages nerves and creates neuropathies. Obesity also creates mechanical stress and increases the risk of damage in the weight bearing joints. Everybody who is overweight/obese can try the following experiment: get a backpack, put 30 pounds of weight in it and walk around….this is how your 30 pound lighter body feels every day.
If you need motivation to change your diet you should watch a few lectures by Robert Lustig: http://www.robertlustig.com/. If you are interested in biochemistry, metabolism and general science Peter Attia might be a place to start: https://peterattiamd.com/. Serious research about lifestyle changes and various diseases was published in prestigious journals over many years by Dean Ornish who promotes healthy diet, stress reduction, social support and moderate exercise. Obviously diet and lifestyle changes cannot fix everything and that is why we have modern medicine to help. But if there is a choice between medications, surgeries and lifestyle changes I am not sure why somebody would choose the first two options.