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The broad aim of this thesis is to investigate the effects of a low-carbohydrate ketogenic diet on chronic pain. The scene is set with a published survey of 50 people with chronic pain which demonstrates a mismatch between how participants rate the quality of the diet and their metabolic health, along with a low perceived role of their diet impacting on their pain outcomes. A published systematic review with meta-analysis summarises all the published evidence for whole-food diets that have been used in the context of chronic pain management. No single diet stood out as more effective leading to the conclusion that features common to all these diets (such as diet quality, improved nutrients, and weight loss) may all be involved in altering pain perception. Two published scoping reviews provide background for the ketogenic diet in relation to chronic pain. The first reports ways a ketogenic diet exerts influence on the nervous system from animal studies. The second follows with a review of the ketogenic diet in human populations that report clinical outcomes related to nervous system function and inflammatory biomarkers. A systematic review of the Food Standards Australia New Zealand Food Composition Database identified whole or minimally processed low-carbohydrate foods for each of the essential vitamins and minerals that can be used to formulate a nutrient replete low-carbohydrate ketogenic diet. This resource was then used as part of the clinical trial dietary information. The published randomised clinical trial protocol is followed by the published clinical trial manuscripts. These are the cornerstone chapters of the thesis reporting on the primary pain outcomes and secondary outcomes from the trial, and a second paper reporting on the experience of participants enrolled in the trial. The thesis concludes by providing recommendations for clinical application and future research. |
